I placed two IVs successfully today. Holy crap. That will probably rule out any successful IV's through the first quarter of 2008. I must not get my hopes or expectations too high.
I have obsessed a lot on work recently. Today I would like to write about quilting.
I spent a good portion of my Thanksgiving holiday working on a quilt I am making for my niece. I am reasonably pleased with how it is turning out. It is a large twin size quilt made by a pattern called "Baby Steps" from the book "P.S. I Love You 3." This book is one of my favorites - so many pretty designs.
The piecing consists of squares and rectangles arranged in a straight set. The positioning of the partial-blocks and blocks give the top a random look, although on closer look, it is not really random. I used similar colors to those used in the book: fuschia, aqua, purple, green, and yellow. I used tonal fabrics. The fuschia and yellow have patterns, while the other colors have a mottled, "marbled" texture.
The fabric choices turned out alright - it is sufficiently bright to enchant a 6 year old girl. You never know for sure how it's going to look in the end, when you are picking out the fabrics. Most of the colors are of similar values - medium-dark - but the yellow is quite bright. It really stands out. I would choose a little more contrast in the values of the colors if I were to do it again so that the yellow pieces don't jump out so much.
This weekend I finished quilting the interior of the quilt. It took about 20 hours. I quilted a lines with a floral pattern evenly spaced across the top (but not associated with the piecing). Then I filled in the background with a swirled pattern inspried by the pattern in the fuschia fabric. This was my first major piece of quilting doing free motion machine quilting. I am fairly pleased with how it turned out. While my stitches are not very consistent in size, the patterns are generally smooth and attractive. I used variagated thread, and I'm not sure I'll do that again. I don't really like the effect; some places the light thread screams out against a dark background, while other places it blends in. As I said, it should be sufficient to delight a little girl and withstand being jumped on, wrapped up, thown on the floor, and washed repeatedly. Maybe, if I'm really lucky, it will become a beloved blankie.
The quilt feels just wonderful. To me, the most captivating aspect of quilting is how the fabric takes on texture and substance when quilted. Sometimes there's a pattern you can see, sometimes it's all in the feel. The completed center is heavy and pliable with a body-hugging drape. You wouldn't think something made of flat, smooth cotton can be so cuddly, but quilting does it. After it's quilted, I brush my hand lightly over the lumpy surface and coo in hushed tones
I have to finish quilting the border this weekend. I want to show it at my quilt guild on Tuesday before I give it to my niece for Christmas.
Free motion quilting takes practice. It is possible to achieve awesome results on a home machine; I have seen some amazing things done on a small machine, not a long-arm quilter. Practice is the key. I can see improvement in my skills from the start to the finish of my work on this piece. I want to be good at it, so I keep on trying.
And now, my philosophical finale: When you live long enough, you have time for different lives. I am 42 and I have been a musician, a country-western dancer, a bowler, a registered nurse, a weight-lifter, a sewer, a singer, a computer programmer, a researcher, a salesperson, a Christian, a pastry "chef," a vegetarian, a patient, an environmentalist. (Oh, not all of these were professional!!!) I can speak a little French, Spanish, German, and even a little Japanese. I know how to finger-spell and I know a little sign language.
I look back over the years, and some of these things seem so foreign, so long ago. Like I was a different person. But no. that was, in fact, me. Very curious. Who am I to strive to be a master quilter? Is not a musician, bowler, researcher enough??
No.
Wednesday, November 28, 2007
Tuesday, November 27, 2007
Success
I actually placed an IV successfully yesterday on the job. I was elated!
Realistically, this probably means I won't hit another IV until 2008. There is always hope.
Realistically, this probably means I won't hit another IV until 2008. There is always hope.
Sunday, November 25, 2007
The workday, part 5: Editorial
Overall, I really like my job. The previous posts may suggest otherwise, and accordingly I am starting with the good aspects of my work.
Most of the issues I have with my job is the milieu of being a nurse. They are not specific to my unit - in fact, most hospital nursing has similar problems.
I have been dying to confess this, but I am afraid of the repercussions if I talk about it too much. The issue is this: I am not good at placing IVs. I have tried and tried. I have gotten feedback. I have spent one of my days off following the hospital's IV team to learn pointers. I cannot do it. I can hit the vein, but for one reason or another, I can't thread the catheter in the vein. I have been struggling with this for over a year. When I ask for feedback and have people watch me, sure enough, they can't find an obvious reason for my lack of success.
This is a big deal because we start IVs on all of our preps. I am confronted by it every single day.
It is wearing on my psyche. Several times, I have wept at work (briefly, in private) when I fail. I am frustrated and I hate hurting the patient with no gain in the end. It is beginning to wear me down...in fact, if we weren't short staffed on my unit, I might fear for my job. This is one reason why I don't seek more help at work.
In my defense, many, many of our patients are hard sticks (that is, difficult to place IV's in). They're dehydrated little old ladies with no veins - I'm generalizing, of course.
I don't know what God is trying to teach me with this challange. There has never been anything that I haven't been able to conquer (or at least, improve), with hard work, education, and practice. This seems not to be the case! I can only assume that God is trying to teach me something and I stubbornly won't learn it. Too bad I don't know what that something is....and because I believe God asked me to be a nurse, this is particularly troubling.
I fear that this challenge could be what does me in, in this job...that is, it will wear on me too much, and I'll move on to something that doesn't humiliate me every day.
Another challenge is the situation of a predominantly female work environment. Weird things happen when it's women only - cattiness, lack of understanding, too much food. I used to work in a male-dominated field, and it was so different. Not really better, just different....and since I grew up in that environment, I find the female world a little foreign.
These are my thoughts on work for now. I expect I'll have more in the future. On to other things in my next posts.
Why my Job is Great
- I work 3 days a week.
- I get to help people and I get to interact with my patients and their families.
- My patients are generally nice people who are in the hospital to fix a problem, not put there by bad luck or circumstance.
- My coworkers are good to work with. I like them and I even socialize with a few of them outside of work.
- I have a good manager. My charge nurses are also excellent.
- I work only part of a Saturday every 6 weeks or so, and never on Sundays.
- I know what I'm doing.
- About once every two weeks, I get to come home early
- There are downtimes. I actually have time to pee and to eat lunch (most days).
- I get to know the doctors and their teams. I generally like all of them, too.
- There's a little bit of excitement every now and then.
- Every once in a while I really help someone.
- My employer offers good benefits.
- My pay is decent.I could definitely live on it.
Challenges of my Job
Most of the issues I have with my job is the milieu of being a nurse. They are not specific to my unit - in fact, most hospital nursing has similar problems.
- Work flow is unpredictable. I would like to partition my work out more evenly through the day, but experience has shown that this is very risky.
- Despite our greatest effots, things all seem to happen at the same time and everything needs to be done right now.
- Nurses are frequently caught in the middle between patient safety and demads of the job. Of course patient safety comes first, but in these situations, the cost is usually the nurse.
- Sometimes people think you're not too bright if you're a nurse.
- Nursing wants to be respected as a profession, but it continually is treated like (and acts like) a trade. This is partially the fault of the structure in which nurses work and partially the fault of nurses themselves. I don't know what the right solution is.
- Nurses are expected to know everything and be good at everything.
- Nurses are expected to read doctors' minds.....correctly.
- Nurses are the front line of defense against mistakes. If the pharmacy makes a mistake, the nurse is supposed to catch it. If the doctor makes a mistake, the nurse is supposed to catch it. If the nurse doesn't catch it, the mistake is her fault.
My Personal Challenges
I have been dying to confess this, but I am afraid of the repercussions if I talk about it too much. The issue is this: I am not good at placing IVs. I have tried and tried. I have gotten feedback. I have spent one of my days off following the hospital's IV team to learn pointers. I cannot do it. I can hit the vein, but for one reason or another, I can't thread the catheter in the vein. I have been struggling with this for over a year. When I ask for feedback and have people watch me, sure enough, they can't find an obvious reason for my lack of success.
This is a big deal because we start IVs on all of our preps. I am confronted by it every single day.
It is wearing on my psyche. Several times, I have wept at work (briefly, in private) when I fail. I am frustrated and I hate hurting the patient with no gain in the end. It is beginning to wear me down...in fact, if we weren't short staffed on my unit, I might fear for my job. This is one reason why I don't seek more help at work.
In my defense, many, many of our patients are hard sticks (that is, difficult to place IV's in). They're dehydrated little old ladies with no veins - I'm generalizing, of course.
I don't know what God is trying to teach me with this challange. There has never been anything that I haven't been able to conquer (or at least, improve), with hard work, education, and practice. This seems not to be the case! I can only assume that God is trying to teach me something and I stubbornly won't learn it. Too bad I don't know what that something is....and because I believe God asked me to be a nurse, this is particularly troubling.
I fear that this challenge could be what does me in, in this job...that is, it will wear on me too much, and I'll move on to something that doesn't humiliate me every day.
Another challenge is the situation of a predominantly female work environment. Weird things happen when it's women only - cattiness, lack of understanding, too much food. I used to work in a male-dominated field, and it was so different. Not really better, just different....and since I grew up in that environment, I find the female world a little foreign.
These are my thoughts on work for now. I expect I'll have more in the future. On to other things in my next posts.
Thursday, November 22, 2007
The workday, part 4: Afternoon, Shift Change, and Home
The afternoon can go in two different directions. The majority of time it's boring. Patients ride out their 6 hours of bedrest and we monitor them. After the first 2 hours, we are only doing vital signs every hour. Patients are sitting up 30 degrees, and they've eaten. If they were going to have a complication, they've mostly had it already. Now they get bored. Now the shenanigans can being.
The patient is on bedrest. The theme is to keep the groin area immobile and straight, and don't increase interabdominal pressure (that is, don't pull up with the abdominal muscles). Once there was a resident who told the patient to lean forward so she can listen to the patient's lungs. The patient thought that she shouldn't do it, but naturally, she obeyed the resident. Surely the resident knew what she was doing, right?
Ak! No!
Fortunately for this patient, she did not rebleed. Stupid resident.
I've seen people decide they need to roll over on their sides and curl up for a nap. No.
I've seen people in tobacco and alcohol withdrawal who can't lie still. Earlier in the day they swear it's not a problem, and they won't need a nicotine patch. Yeah.
No one likes to use a urinal or bedpan, but there's no getting up to the bathroom while on bedrest. I've seen a few patients rebleed after trying to use the urinal (men). They don't ask for help, and then raise up their heads to see what their doing, and pop! Hey, nurse? There's blood on my hands. (yeh, and everywhere else.)
The women aren't so bad, but they can't attempt to use the bedpan by themselves. We place them on the bedpan. Sometimes they pee all over the bed. This doesn't really bother me, though, because using a bedpan is hard and sometimes it's not positioned well, and women have lots of flesh in the way.
I try really hard not to embarrass people about this issue. It *IS* embarrassing, and we force these folks to be in a situation where they cannot take care of themselves. I just wish people would ask for assistance rather than try, if they aren't sure. I don't want to force myself on them, either.
It does bother me a little when a patient has to poop during bedrest.
On an easy afternoon, I can finish up my paper work. If that's all done, then I can goof off some, like check my home email, surf the net, do ancillary tasks like chart audits, peer reviews, restock supplies, etc. I cannot count on this time being available though; as a result, more often than not, I don't have any paperwork to do - I rushed through it earlier! I really wish I could partition my work out throughout the day so that I can do a quality job and not feel so hurried. It's unwise to do so, - getting the paperwork done, even if it's hurried and sloppy is better than not getting it done at all.
The late afternoon is when the early cases get off bedrest. Some people go home. In this case we complete their discharge paperwork, discharge teaching, and send them on their way.
Wait. Did you reach the logical conclusion? Some people come in and leave in the same day. We've done an entire admission and discharge on these people. This is why I use the term "shitload" for the amount of paperwork. I have created an entire chart full of paper for them. Some people come and go in as short as 3-4 hours!!!!!! That's one reason why you can't put off your paperwork. By the time you realize the patient is going done, you should have had it all done already.
The other reason you can't put off paperwork is that an easy afternoon can turn into a difficult afternoon without any notice.
An afternoon is difficult when the labs are working late into the afternoon and/or everyone, it seems, gets complications. Other factors include: lots of patients, high-maintenance patients or family members, and a number of patients getting changed to inpatient status and moved off the unit.
We also have fewer staff in the afternoon - several nurses and cardio techs do not work the 12 hour shifts and leave at 1630. Sometimes we get stuck waiting on only one cardio tech who remains through the end of shift to do sheath pulls because they pile up and back up. It sucks for the cardio tech because they go from holding pressure for 20 minutes straight to another, to another. It's physically difficult.
Sometimes management pressures us to get patients off the unit before shift change - usually it's a staffing issue. A patient has been changed to inpatient status, and we need to move them to an inpatient unit, because we don't have enough nurses on night shift to allow that patient to stay in our unit.
When I am this rushed, I am most vulnerable to errors. Thanks to my guardian angel, I have not made many errors, and those I have made have not been dangerous for the patients. I have just pissed off my team members.
On one recent afternoon, I was trying to get a patient's sheath pulled and moved upstairs before night shift. The patient had an ACT of 186 when he returned, and 2 hours had passed waiting for a cardiotech to do the sheath pull. It looks like the stars were aligning to have this all happen; the cardiotech became available, and if we starte right away, I'd be able to do the sheath pull, give 1 hour recovery, then get him upstairs. Bam, we started the line pull. I had not rechecked the ACT before we pulled because on average, a patient goes down 50 seconds every hour after the stop of the blood thinner. This means that even if the patient had terrible kidney function (which he did not) he should have been within range.
So when the 20 minutes of pressure was done, the patient was still bleeding!!!! Why? This made no sense???!!!
Well, it turns out, the patient's ACT was over 300 upon return to the unit. I was given an erroneous report. Due to other stuff that happened that afternoon, I had received report second hand, and somewhere between the cath lab nurse and the nurse that took report and me, the number had changed.
The patient was not harmed, but we had to hold about 30 minutes of pressure. It slowed everyone down. I felt bad...usually I'm very conservative with having numbers to back up my clinical decisions.
Indeed, I was rushing. I learned from this experience.
At shift change we give report to the night nurse. Hopefully all of the paperwork has been done for the patient staying over night. In most cases it is. I hate leaving a "mess" for the night nurse.
Mostly our team is pretty good about messes. They usually know that if the paperwork isn't completely done, then there is a good reason for it (because in the vast majority of instances, the paperwork is done to completion!). Every once in a while someone has an attitude about it. I hate that, but I get the hell over it.
Our night shift nurses are good. They come in on time, get report, and take right over. No one has called me after shift to ask questions. (That happened once on my previous job - that stressed me out all night.)
When I have given all of my reports, I pick up my stuff from my work station (if any) and log off the computer. I take off my Vocera, check for medications in my pockets, and leave the unit. First I go to the breakroom to pick up my lunch bag, sections of the paper I would like to keep, or any other things I'd stashed in my mailbox cubby. I clock out, then go in the locker room to un-gear for the the day. I empty my pockets. I hope I don't find any medications in my pockets becuase then I have to go back on the unit and return them. Don't want to be walking off the unit with a pocket full of Valium or Morphine! That's a quick way to get fired.
I bundle up if it's cold out (like yesterday - sheesh, 32 degrees!!!) and walk to the car. It takes about 7 minutes. Then drive home. I listen to NPR on the ride home. Usually I'm hear the last half of "The World." That's fun - I get to hear the "Geo-Quiz." Mostly I'm driving home between 1920-2000. Sometimes earlier, sometimes later.
When I come home, I want to be cared for. I want my dinner ready (or in the works) and I want to sit. I usually don't get this luxury. Sometimes I do, and I love it when it happens.
I go upstairs and change clothes. If I was mindful at work and drank my water, I usually have to pee (this is important, because I just don't drink when I'm working and that's not healthy). If I'm motivated, I'll wash my face for bed and take off my eye makeup before coming back downstairs. Then I eat. On the days I work, my husband is responsible for making meals, and about 90% of the time a meal is in the near future. My husband is not the most inspired cook. On a good day, I get hamburger helper, chicken helper, or a Zatarains mix. On an average day, I get spaghetti with sauce, sometimes with a can of mushrooms mixed in or some ground burger (fake beef) mixed in. Sometimes it's leftovers. I almost never get vegetables or sides with these dishes (such things are unnecessary, I suppose).
I don't complain about the food. After 10 years of marriage I have learned that this kind of griping is pointless.
However, I still hope. It feels so nice to come home to a fresh meal. Occasionally I am surprised! Occasionally there is the thrill of fresh take-out!
We eat dinner sitting at either end of the sofa watching Tivo of all the shows he likes. I enjoy them too, but I can live without them. Apparently, my sitting next to him quietly is very nurturing to him. If I want to talk, or if I want to sit at the kitchen table, he seems out of sorts.
We watch Jeopardy, The Daily Show (up until the writers strike), Grey's Anatomy, Pushing Daisies, Private Practice, Heroes (ooh, we actually watch THAT one live...), Reaper, Torchwood, or Graham Norton.
I ask him how his day is, and he says, "Not bad," or "I had a day." What did you do today? "Work." Anything interesting? "No." Oh.
He may ask how my day was. I'll say "Excellent." This is because if I say anything negative about my day, in his mind, I don't like my job and I'll be looking for another soon. This is not true: in fact, I like my job very much (see more about this in the next post). But, like many men, situations are either black or white. So, I'll whitewash to avoid accusations. I try not to talk too much about my day, either. Most of my issues are either mundane or disgusting. There are HIPAA issues to be considered. Or I get sucked into complaining about something....danger, danger!
...now you know why I am writing this series.
I tend to eat too much when I get off work. I am hungry, since I don't get a dinner break at work (I get a lunch break most days). But I crave the comforting feelings I get from food after a hard day. Since dinner isn't ready when I get home, I eat something that is easily grabbable and keep on eating until dinner. This is not good.
I try to do a few chores before bed, and often I'll work a few rows on a knitting project. I give attention to the pets. If I'm lucky, I'll remember to empty out my lunch bag from the workday (to get it ready for tomorrow), and I'll remember to plug in my cell phone. Sometimes, if the day was really busy, I curl up on the couch and doze off.
At 2130, I'm off to bed.
Coming next time: The workday: An Editorial.
Things I've seen
The patient is on bedrest. The theme is to keep the groin area immobile and straight, and don't increase interabdominal pressure (that is, don't pull up with the abdominal muscles). Once there was a resident who told the patient to lean forward so she can listen to the patient's lungs. The patient thought that she shouldn't do it, but naturally, she obeyed the resident. Surely the resident knew what she was doing, right?
Ak! No!
Fortunately for this patient, she did not rebleed. Stupid resident.
I've seen people decide they need to roll over on their sides and curl up for a nap. No.
I've seen people in tobacco and alcohol withdrawal who can't lie still. Earlier in the day they swear it's not a problem, and they won't need a nicotine patch. Yeah.
No one likes to use a urinal or bedpan, but there's no getting up to the bathroom while on bedrest. I've seen a few patients rebleed after trying to use the urinal (men). They don't ask for help, and then raise up their heads to see what their doing, and pop! Hey, nurse? There's blood on my hands. (yeh, and everywhere else.)
The women aren't so bad, but they can't attempt to use the bedpan by themselves. We place them on the bedpan. Sometimes they pee all over the bed. This doesn't really bother me, though, because using a bedpan is hard and sometimes it's not positioned well, and women have lots of flesh in the way.
I try really hard not to embarrass people about this issue. It *IS* embarrassing, and we force these folks to be in a situation where they cannot take care of themselves. I just wish people would ask for assistance rather than try, if they aren't sure. I don't want to force myself on them, either.
It does bother me a little when a patient has to poop during bedrest.
The Easy Afternoon
On an easy afternoon, I can finish up my paper work. If that's all done, then I can goof off some, like check my home email, surf the net, do ancillary tasks like chart audits, peer reviews, restock supplies, etc. I cannot count on this time being available though; as a result, more often than not, I don't have any paperwork to do - I rushed through it earlier! I really wish I could partition my work out throughout the day so that I can do a quality job and not feel so hurried. It's unwise to do so, - getting the paperwork done, even if it's hurried and sloppy is better than not getting it done at all.
The late afternoon is when the early cases get off bedrest. Some people go home. In this case we complete their discharge paperwork, discharge teaching, and send them on their way.
Wait. Did you reach the logical conclusion? Some people come in and leave in the same day. We've done an entire admission and discharge on these people. This is why I use the term "shitload" for the amount of paperwork. I have created an entire chart full of paper for them. Some people come and go in as short as 3-4 hours!!!!!! That's one reason why you can't put off your paperwork. By the time you realize the patient is going done, you should have had it all done already.
The other reason you can't put off paperwork is that an easy afternoon can turn into a difficult afternoon without any notice.
The Difficult Afternoon
An afternoon is difficult when the labs are working late into the afternoon and/or everyone, it seems, gets complications. Other factors include: lots of patients, high-maintenance patients or family members, and a number of patients getting changed to inpatient status and moved off the unit.
We also have fewer staff in the afternoon - several nurses and cardio techs do not work the 12 hour shifts and leave at 1630. Sometimes we get stuck waiting on only one cardio tech who remains through the end of shift to do sheath pulls because they pile up and back up. It sucks for the cardio tech because they go from holding pressure for 20 minutes straight to another, to another. It's physically difficult.
Sometimes management pressures us to get patients off the unit before shift change - usually it's a staffing issue. A patient has been changed to inpatient status, and we need to move them to an inpatient unit, because we don't have enough nurses on night shift to allow that patient to stay in our unit.
When I am this rushed, I am most vulnerable to errors. Thanks to my guardian angel, I have not made many errors, and those I have made have not been dangerous for the patients. I have just pissed off my team members.
Example
On one recent afternoon, I was trying to get a patient's sheath pulled and moved upstairs before night shift. The patient had an ACT of 186 when he returned, and 2 hours had passed waiting for a cardiotech to do the sheath pull. It looks like the stars were aligning to have this all happen; the cardiotech became available, and if we starte right away, I'd be able to do the sheath pull, give 1 hour recovery, then get him upstairs. Bam, we started the line pull. I had not rechecked the ACT before we pulled because on average, a patient goes down 50 seconds every hour after the stop of the blood thinner. This means that even if the patient had terrible kidney function (which he did not) he should have been within range.
So when the 20 minutes of pressure was done, the patient was still bleeding!!!! Why? This made no sense???!!!
Well, it turns out, the patient's ACT was over 300 upon return to the unit. I was given an erroneous report. Due to other stuff that happened that afternoon, I had received report second hand, and somewhere between the cath lab nurse and the nurse that took report and me, the number had changed.
The patient was not harmed, but we had to hold about 30 minutes of pressure. It slowed everyone down. I felt bad...usually I'm very conservative with having numbers to back up my clinical decisions.
Indeed, I was rushing. I learned from this experience.
Shift Change
At shift change we give report to the night nurse. Hopefully all of the paperwork has been done for the patient staying over night. In most cases it is. I hate leaving a "mess" for the night nurse.
Mostly our team is pretty good about messes. They usually know that if the paperwork isn't completely done, then there is a good reason for it (because in the vast majority of instances, the paperwork is done to completion!). Every once in a while someone has an attitude about it. I hate that, but I get the hell over it.
Our night shift nurses are good. They come in on time, get report, and take right over. No one has called me after shift to ask questions. (That happened once on my previous job - that stressed me out all night.)
Going Home
When I have given all of my reports, I pick up my stuff from my work station (if any) and log off the computer. I take off my Vocera, check for medications in my pockets, and leave the unit. First I go to the breakroom to pick up my lunch bag, sections of the paper I would like to keep, or any other things I'd stashed in my mailbox cubby. I clock out, then go in the locker room to un-gear for the the day. I empty my pockets. I hope I don't find any medications in my pockets becuase then I have to go back on the unit and return them. Don't want to be walking off the unit with a pocket full of Valium or Morphine! That's a quick way to get fired.
I bundle up if it's cold out (like yesterday - sheesh, 32 degrees!!!) and walk to the car. It takes about 7 minutes. Then drive home. I listen to NPR on the ride home. Usually I'm hear the last half of "The World." That's fun - I get to hear the "Geo-Quiz." Mostly I'm driving home between 1920-2000. Sometimes earlier, sometimes later.
At Home
When I come home, I want to be cared for. I want my dinner ready (or in the works) and I want to sit. I usually don't get this luxury. Sometimes I do, and I love it when it happens.
I go upstairs and change clothes. If I was mindful at work and drank my water, I usually have to pee (this is important, because I just don't drink when I'm working and that's not healthy). If I'm motivated, I'll wash my face for bed and take off my eye makeup before coming back downstairs. Then I eat. On the days I work, my husband is responsible for making meals, and about 90% of the time a meal is in the near future. My husband is not the most inspired cook. On a good day, I get hamburger helper, chicken helper, or a Zatarains mix. On an average day, I get spaghetti with sauce, sometimes with a can of mushrooms mixed in or some ground burger (fake beef) mixed in. Sometimes it's leftovers. I almost never get vegetables or sides with these dishes (such things are unnecessary, I suppose).
I don't complain about the food. After 10 years of marriage I have learned that this kind of griping is pointless.
However, I still hope. It feels so nice to come home to a fresh meal. Occasionally I am surprised! Occasionally there is the thrill of fresh take-out!
Dinner and After
We eat dinner sitting at either end of the sofa watching Tivo of all the shows he likes. I enjoy them too, but I can live without them. Apparently, my sitting next to him quietly is very nurturing to him. If I want to talk, or if I want to sit at the kitchen table, he seems out of sorts.
We watch Jeopardy, The Daily Show (up until the writers strike), Grey's Anatomy, Pushing Daisies, Private Practice, Heroes (ooh, we actually watch THAT one live...), Reaper, Torchwood, or Graham Norton.
I ask him how his day is, and he says, "Not bad," or "I had a day." What did you do today? "Work." Anything interesting? "No." Oh.
He may ask how my day was. I'll say "Excellent." This is because if I say anything negative about my day, in his mind, I don't like my job and I'll be looking for another soon. This is not true: in fact, I like my job very much (see more about this in the next post). But, like many men, situations are either black or white. So, I'll whitewash to avoid accusations. I try not to talk too much about my day, either. Most of my issues are either mundane or disgusting. There are HIPAA issues to be considered. Or I get sucked into complaining about something....danger, danger!
...now you know why I am writing this series.
I tend to eat too much when I get off work. I am hungry, since I don't get a dinner break at work (I get a lunch break most days). But I crave the comforting feelings I get from food after a hard day. Since dinner isn't ready when I get home, I eat something that is easily grabbable and keep on eating until dinner. This is not good.
I try to do a few chores before bed, and often I'll work a few rows on a knitting project. I give attention to the pets. If I'm lucky, I'll remember to empty out my lunch bag from the workday (to get it ready for tomorrow), and I'll remember to plug in my cell phone. Sometimes, if the day was really busy, I curl up on the couch and doze off.
At 2130, I'm off to bed.
Coming next time: The workday: An Editorial.
Monday, November 19, 2007
The workday, part 3: The Sheath Pull
One of the most common procedures we do on a patient is a "sheath pull." Sheath pull is our slang term for the process of removing the tubing device (sheath or "line") from a femoral artery or vein and holding manual pressure on the puncture site until it stops bleeding. Many patients come back to the unit with the tubing still in place - sometimes several lines. There is usually only one arterial line. Patients who have cardiac catheterizations, ablations, or occasionally pacemaker implants may come back with one or more sheaths.
The criteria for a sheath pull is whether the patient's blood can hold a clot sufficiently. This is determined by a brief lab test called the ACT, or Activated Clotting Time. If the ACT is 170 seconds or less, it is safe to remove a sheath. Anything greater, the patient's blood is too thin. During the procedure the doctor may infuse a blood thinner, such as Heparin. This medication thins the blood and raises the ACT. Therefore, if the patient comes back and has received heparin, we must test the blood for its ACT. We have a device that does this test. It's helpful we can do this test ourselves.
An alternative to heparin which the doctor may choose is Angiomax. This is a glycoprotein III inhibitor (a.k.a. blood thinner of a different kind) and the body processes it at a much more predictable rate. We wait 2 hours after the Angiomax infusion was discontinued, then it is safe to pull the sheath.
Sometimes the doctor uses no blood thinners, and we can remove the sheath immediately. Sometimes the doctor uses a closure device such as Angioseal or Starclose. Rarely a patient goes directly to surgery or has complication that sends him/her to the ICU. Even more rare, the patient dies. Since I've been working on the unit, this has happened only once.
It's interesting. The patients and their families expect us to know exactly how the day will go for the patient, like when they can eat, go to the bathroom, or go home. Honestly, we don't know a whole lot until the patient comes back from procedure and we know what medications the doctor used and whether a stent was placed. They understand once we explain it.
Obviously, we only remove a sheath when the patient has one - this procedure is not done for Angioseal and Starclose patients. We love when they use a closure device.
Removing a sheath is a two-person task. One is the cardiotech, who is specifically trained in sheath removal. The other is the nurse who monitors the patient during the process. The cardiotech removes the tubing and holds pressure. The nurse is there because once the sheath is removed the cardiotech MUST NOT UNDER ANY CIRCUMSTANCES let up on the pressure. Otherwise the patient will bleed to death.
So, the nurse is there to record vital signs (which are taken every 5 minutes), administer medications, or address any complications. The medications we typically use are morphine for pain and diazepam (valium) for anxiety. Sometimes we use fentanyl if a patient is allergic to morphine.
We watch for a few types of complications. The most common is a "vagal" which means the process of holding pressure on the groin stimulates the vagal nerve, which in turn lowers the blood pressure and heart rate. The patient may feel nauseous and throw up. The patient may break out in a cold sweat and feel light headed. We have specific protocols for how to address these things. Rarely a patient will pass out.
Because of the possibility of throwing up, the patient is not allowed to eat up until after the manual pressure procedure is completed. Patients hate that, but really, it's better than inhaling your barf and suffocating.
I have observed that if you give a patient both the Morphine and the Diazepam, they tend to vagal more frequently. These meds are depressants, anyway. I am very conservative in my administration of these medications for this reason. We have some flexibility in how much we can administer, so I always start slowly then increase. I can't un-administer!
Other complications include pain and internal bleeding.
For the entire sheath removal process, the nurse must be in the room with the patient. This means I can't care for my other patients. Most often, we help each other care for their other patients while someone's doing a sheath pull; sometimes, a nurse will do the sheath pull for another nurse. But the way things most frequently work out, you are doing a sheath pull when another of your patient arrives on the unit (a prep!), goes to procedure (give report to the lab nurse?), returns from procedure (get report from the lab nurse?), or crashes in one way or another.
You just gotta lean on the team, there's no getting around it. You also are expected to step in when another nurse is so occupied.
The tubing is removed and the pressure begins. Initially, it takes a pretty good amount of pressure and it's uncomfortable. For some people it's quite painful. I think it has to do with the patient's tolerance for pain, the location of the puncture and the patient's anatomy - how close the nerves are to the puncture, etc. Who knows this, though?
The pressure goes on for at least 20 minutes for an arterial line, at least 10 minutes for a venous line. If all goes well (as in most cases), the bleeding is stopped and the countdown begins for when the patient can eat and get up. Sometimes it takes longer for the bleeding to stop. If the ACT is too high, the bleeding won't stop any time soon...hence the reason we check ACT.
Holding pressure is a physically demanding task. It is a skill, if it is to be done well. We usually have 2 cardio techs on the unit for this task and they alternate doing the sheath pulls. However, frequently we have a bunch of sheath pulls all at the same time.
Nurses are not trained to do a sheath pull on our unit. Legally, we can be, and I would like to be so trained. I think we don't get the training for managerial reasons; that is, we are more valuable to the unit in our other role. I agree, but it would be nice to have a few back up people trained for those crazy days when we have a bazillion sheaths and only one cardiotech. When that happens, the patients must wait to get their sheaths out, and waiting is a real drag. It lengthens their bedrest period and delays everything from moving along.
If the patient tolerates the procedure well, I usually use the time to catch up on paperwork - generating the shitload of documentation I have mentioned in a previous post. It's a good time to complete the patient profile.
Hemostatis is the official term for "the patient has stopped bleeding." This is the moment when we start the countdown for sitting up, eating, and getting off bedrest. The patient must remain straight with legs immobile for the next hour. Even though the puncture is not bleeding, it is delicate. If the patient moves too much or the fragile clot lets go, the patient will bleed internally. They will usually feel it ("Hey, this puncture kind of hurts..., oh, now it really hurts") and a big bulge appears at the puncture (a hematoma). I haven't had one squirt all over the room, but that's possible too.
In this case, we hold more pressure (and it really hurts this time) for another 20 minutes or more, try to work out the blood of the hematoma, and start the countdown all over again.
After one hour post hemostatis, the patient may have the bed raised up 30 degrees and may eat. Bedrest continues and the leg(s) with the punctures must remain still for 5 hours (arterial line) or 3 hours (venous line).
This is the hardest part of the day. Most patients feel fine and want to get up to pee, or whatever. They get bored, especially after they've had some food and there's 4 hours left with nothing to do but watch daytime TV. It is too risky to get up - if they bleed again, then we start the countdown all over again.
After hemostatis, we monitor vital signs every 15 minutes for the first hour, then every 30 minutes for 1 hours, then every hour for 4 hours, then every 2 hours for 4 hours, then back to our unit standard of every 4 hours. We also assess the patient's pulses in the foot of the leg with the puncture, and we check the incision for bleeding. We look at lots of groins and palpate lots of feet.
As I've said before, I think the doctors don't emphasize the duration and physical demands on the patient during the post-procedure time. It can be a long time before the patient can eat - for example, if the patient's ACT does not get into the safe zone for a few hours, no eating. Patients must lie flat on their backs for a long time.
Looking back over the last year of many sheath pulls, I have the following observations:
Coming soon: The workday, part 4: Afternoon and the end of the Day.
I have to work tomorrow and the next day, so it's unlikely I'll post until Thursday.
The criteria for a sheath pull is whether the patient's blood can hold a clot sufficiently. This is determined by a brief lab test called the ACT, or Activated Clotting Time. If the ACT is 170 seconds or less, it is safe to remove a sheath. Anything greater, the patient's blood is too thin. During the procedure the doctor may infuse a blood thinner, such as Heparin. This medication thins the blood and raises the ACT. Therefore, if the patient comes back and has received heparin, we must test the blood for its ACT. We have a device that does this test. It's helpful we can do this test ourselves.
An alternative to heparin which the doctor may choose is Angiomax. This is a glycoprotein III inhibitor (a.k.a. blood thinner of a different kind) and the body processes it at a much more predictable rate. We wait 2 hours after the Angiomax infusion was discontinued, then it is safe to pull the sheath.
Sometimes the doctor uses no blood thinners, and we can remove the sheath immediately. Sometimes the doctor uses a closure device such as Angioseal or Starclose. Rarely a patient goes directly to surgery or has complication that sends him/her to the ICU. Even more rare, the patient dies. Since I've been working on the unit, this has happened only once.
It's interesting. The patients and their families expect us to know exactly how the day will go for the patient, like when they can eat, go to the bathroom, or go home. Honestly, we don't know a whole lot until the patient comes back from procedure and we know what medications the doctor used and whether a stent was placed. They understand once we explain it.
The Removal Process
Obviously, we only remove a sheath when the patient has one - this procedure is not done for Angioseal and Starclose patients. We love when they use a closure device.
Removing a sheath is a two-person task. One is the cardiotech, who is specifically trained in sheath removal. The other is the nurse who monitors the patient during the process. The cardiotech removes the tubing and holds pressure. The nurse is there because once the sheath is removed the cardiotech MUST NOT UNDER ANY CIRCUMSTANCES let up on the pressure. Otherwise the patient will bleed to death.
The Nurse's Role
So, the nurse is there to record vital signs (which are taken every 5 minutes), administer medications, or address any complications. The medications we typically use are morphine for pain and diazepam (valium) for anxiety. Sometimes we use fentanyl if a patient is allergic to morphine.
We watch for a few types of complications. The most common is a "vagal" which means the process of holding pressure on the groin stimulates the vagal nerve, which in turn lowers the blood pressure and heart rate. The patient may feel nauseous and throw up. The patient may break out in a cold sweat and feel light headed. We have specific protocols for how to address these things. Rarely a patient will pass out.
Because of the possibility of throwing up, the patient is not allowed to eat up until after the manual pressure procedure is completed. Patients hate that, but really, it's better than inhaling your barf and suffocating.
I have observed that if you give a patient both the Morphine and the Diazepam, they tend to vagal more frequently. These meds are depressants, anyway. I am very conservative in my administration of these medications for this reason. We have some flexibility in how much we can administer, so I always start slowly then increase. I can't un-administer!
Other complications include pain and internal bleeding.
For the entire sheath removal process, the nurse must be in the room with the patient. This means I can't care for my other patients. Most often, we help each other care for their other patients while someone's doing a sheath pull; sometimes, a nurse will do the sheath pull for another nurse. But the way things most frequently work out, you are doing a sheath pull when another of your patient arrives on the unit (a prep!), goes to procedure (give report to the lab nurse?), returns from procedure (get report from the lab nurse?), or crashes in one way or another.
You just gotta lean on the team, there's no getting around it. You also are expected to step in when another nurse is so occupied.
Holding Pressure
The tubing is removed and the pressure begins. Initially, it takes a pretty good amount of pressure and it's uncomfortable. For some people it's quite painful. I think it has to do with the patient's tolerance for pain, the location of the puncture and the patient's anatomy - how close the nerves are to the puncture, etc. Who knows this, though?
The pressure goes on for at least 20 minutes for an arterial line, at least 10 minutes for a venous line. If all goes well (as in most cases), the bleeding is stopped and the countdown begins for when the patient can eat and get up. Sometimes it takes longer for the bleeding to stop. If the ACT is too high, the bleeding won't stop any time soon...hence the reason we check ACT.
Holding pressure is a physically demanding task. It is a skill, if it is to be done well. We usually have 2 cardio techs on the unit for this task and they alternate doing the sheath pulls. However, frequently we have a bunch of sheath pulls all at the same time.
Nurses are not trained to do a sheath pull on our unit. Legally, we can be, and I would like to be so trained. I think we don't get the training for managerial reasons; that is, we are more valuable to the unit in our other role. I agree, but it would be nice to have a few back up people trained for those crazy days when we have a bazillion sheaths and only one cardiotech. When that happens, the patients must wait to get their sheaths out, and waiting is a real drag. It lengthens their bedrest period and delays everything from moving along.
If the patient tolerates the procedure well, I usually use the time to catch up on paperwork - generating the shitload of documentation I have mentioned in a previous post. It's a good time to complete the patient profile.
After Hemostatis
Hemostatis is the official term for "the patient has stopped bleeding." This is the moment when we start the countdown for sitting up, eating, and getting off bedrest. The patient must remain straight with legs immobile for the next hour. Even though the puncture is not bleeding, it is delicate. If the patient moves too much or the fragile clot lets go, the patient will bleed internally. They will usually feel it ("Hey, this puncture kind of hurts..., oh, now it really hurts") and a big bulge appears at the puncture (a hematoma). I haven't had one squirt all over the room, but that's possible too.
In this case, we hold more pressure (and it really hurts this time) for another 20 minutes or more, try to work out the blood of the hematoma, and start the countdown all over again.
After one hour post hemostatis, the patient may have the bed raised up 30 degrees and may eat. Bedrest continues and the leg(s) with the punctures must remain still for 5 hours (arterial line) or 3 hours (venous line).
This is the hardest part of the day. Most patients feel fine and want to get up to pee, or whatever. They get bored, especially after they've had some food and there's 4 hours left with nothing to do but watch daytime TV. It is too risky to get up - if they bleed again, then we start the countdown all over again.
Vital signs and Assessment
After hemostatis, we monitor vital signs every 15 minutes for the first hour, then every 30 minutes for 1 hours, then every hour for 4 hours, then every 2 hours for 4 hours, then back to our unit standard of every 4 hours. We also assess the patient's pulses in the foot of the leg with the puncture, and we check the incision for bleeding. We look at lots of groins and palpate lots of feet.
Thoughts on the Sheath Pull
As I've said before, I think the doctors don't emphasize the duration and physical demands on the patient during the post-procedure time. It can be a long time before the patient can eat - for example, if the patient's ACT does not get into the safe zone for a few hours, no eating. Patients must lie flat on their backs for a long time.
Looking back over the last year of many sheath pulls, I have the following observations:
- Skinny little old people seem to have the most difficulty with the pressure (e.g. vagals) and rebleeds. I've had several little old ladies sit up after six hours of bedrest and have their incisions open up internally. Here we go again with the pressure and bedrest. You get a nasty looking bruise if you rebleed.
- Young men are the biggest whiners for pain.
- Some old men are terrible whiners, too.
- Most people do just fine with the process and complying with the instructions.
- Some people are so fat, the nurse must raise the "apron" of fat out of the way so the cardiotech can get his or her hands in the proper position to hold pressure.
- Most people, especially old people, have lousy looking feet. Cracked skin, fungal toenails, stinky. Oh, for heaven's sake, take care of your feet, people!!
Coming soon: The workday, part 4: Afternoon and the end of the Day.
I have to work tomorrow and the next day, so it's unlikely I'll post until Thursday.
Saturday, November 17, 2007
The workday, part 2: late morning
The schedule of when I get patients on the unit is highly variable. I could have new admissions all day long. Sometimes I get patients who are admitted to the hospital already.
We do a shitload of documentation on each patient. Our manager has concluded that for safety reasons, we need to do an entire hospital admission process for everyone who comes in. The outpatients, that is - inpatients should already have that done. For every patient we need to:
In addition to this, I am supposed to validate the medication administration record against the doctor's orders (and against what the patient tells me), I need to run EKG analyses, at least 2 per shift (pre and post procedure), develop a plan for the day, and evaluate the plan of care for the patient.
Then there is the "normal" nursing documentation that is done every shift (or more) on all patients: assessment, nursing note, record intake, output, pain, etc.
It is true, I have most of the day to do all of this for each patient. I try to get it all done as quickly as possible, because who knows what the day holds? I could get really busy with critical patients and not have time to do all of this.
After a patient comes back from procedure, we assess again, settle the patient back into the room and begin frequent monitoring. Most patients require vital signs every 15 mintues for the first hour, then every 30 minutes, then every hour for 4 hours. This is fun when you have more than one patient on 15 minute vitals. It is even more fun when several patients return from the lab at the same time.
I receive report from the procedural nurse, and follow the protocol as ordered by the doctor for the patient, based on what happened during the procedure.
A cardiac cath is when thin wires are threaded through the femoral artery or vein up to the heart. They are looking for blockages in the arteries of the heart (mostly..there are a few other things one can do with a cardiac cath). A peripheral cath is when these wires are directed down the legs to look for arterial blockages. If warranted, the doctor can "fix" these blockages with a stent, which is a wire mesh tube used to prop open an artery.
Our most frequent procedure is the cardiac cath. Patients usually come back with tubing (a "sheath") in one or more groin punctures. That is, there's tubing sticking out of their femorial artery. If blood thinners were used during the procedure, we have to wait to remove the tubing until their blood thickens up enough to hold a good clot. The patient has to lie flat on their back until that time, although we can tilt the bed so his head is higher than his feet. They can't eat until we get the tubing out.
Some patients have a pacemaker placed or the battery on a pacemaker replaced. Occasionally we have an explant or entire replacement of device. These patients come back with an incision in their chest, usually the left side just under the clavicle. They can eat when they're awake, they can sit up in bed, just not move the arm on the affected side.
Another procedure we do pretty frequently is an ablation. This procedure uses thin wires to go up to the heart and zap (e.g. burn, electrically) portions of the interior of the right atrium of the heart. Occasionally the left atrium needs to be zapped. These patients come back with multiple sheaths in their groins in the femoral veins, usually bilaterally, and sometimes they have a catheter in their internal jugular on the right side. These patients often have had blood thinners as well, so they must wait flat on their backs as well.
Devices are available that seal up the puncture. We use two types: starclose and angioseal. The former is like a little staple. The latter is a plug of collagen that closes up the hole and eventually gets absorbed by the body.
Sometimes pacemaker patients will have a groin sheath as well. During the procedure, if the doctor cannot place the pacemaker leads properly from the incision (via the mammary vein), she will thread catheter wires up through the femoral vein to assist.
Some of the variations for cardiac caths are to measure blood pressures in the hear as it's functioning, measure pressure of blood in the lungs, and assess the functionality of the left ventricle.
Patients are on bedrest post procedure while we are monitoring them frequently. Many patients are still somewhat sedated so they are pretty cooperative. Most of them don't have a lot of pain, again because of the sedation and the local anaesthetic. They come back to us cold, frequently. The cath lab and the EP labs are kept in the lower 60s.
Patients don't like bedrest. Many patients have back problems and it is painful to lie on their backs for hours. Most patients, particularly the younger ones, will repeatedly let me know their backs hurt and that nothing I can do for them helps. No one likes to use a bedpan. At least the men can use a urinal.
Now, we have the annoying variation of the older man with enlarged prostate. Mostly they are embarrassed about it, so they don't say anything until they can't pee and their bladder is extended to the point of pain. Then it's panic time because they are so uncomfortable. But no, they couldn't have said something earlier and we could have placed a catheter. When their bladders are distended with urine, it displaces everything internally, which makes it that much more difficult to place a foley catheter. If I can't do it (and failing at placing a urinary cath hurts!!! Succeeding at it isn't much fun, either.) I have to call the urology doctors and wait for them to come. More pain while we wait.
As you can tell, this process bugs me. Men, get over yourself and let me know, so I can help you. Don't let it come to panic time!!
It's kind of amusing how some people will try to negotiate to get off bedrest early. What am I supposed to do...let them? NO! What if they bleed? People don't realize how high-pressure a femoral artery is and that in a matter of minutes they'd bleed to death if it opens up. I shake my head in disbelief. I guess because they feel OK, they don't realize how vulnerable they are.
They also want to eat. I can give them clear liquids, but nothing else until that sheath is out. The reason for this is that when we do the sheath pull, the vagal nerve may get stimulated, which can cause them to throw up. And if they aspirate the food, then they stop breathing. Not good.
In the end, almost everyone complies. As the bedside nurse, I get to hear about how awful it is. A lot. I wish the doctors would impress upon the patient how long they typically must stay in bed. Patients seem so surprised when I tell them 6 hours of bedrest is required. I think the doctors gloss over it, mutter it under their breath, and patients don't think about what it will be like.
Caring for people is emotionally and physically demanding. Fortunately, we have good teamwork where I work and we help each other out. I try to get my morning "snack" break around 1030 - that's when I usually start feeling kind of light headed and hungry. I like to have a cheese stick, some crackers, a cup of coffee. I like to take lunch around 1330. Of course my self care is variable based on my patient-care demands. Some days I don't get much of a break.
It is so very tempting to eat too much. Like many people, women in particular, I get an emotional lift from having a treat. There is they physical hunger and the emotional need to be cared for given the demands of the job. There isn't much time for anything else, really (a back rub? Leave the unit and breathe fresh air outside? Oh, come on, seriously...)
My little indulgence is to read the newspaper which I bring in from home. I also keep the water at my workstation so I can keep hydrated. I have a terrible habit of not drinking enough. I have gone entire shifts without having to pee. That is not good.
Honestly, though, my unit is not really that bad for self-care. We help each other out, and there are lulls in the chaos when you can get a bite or go pee. When I used to work on a regular inpatient unit, I frequently had to make the choice between getting behind in my work or eating lunch/using the bathroom. I mean, when a patient is in pain or crashing, nobody gives a damn if the nurse is going to crap her pants because she hasn't gone to the bathroom in 6 hours. She should have done that earlier...and no one gives a damn if there wasn't time to do that earlier.
The nurse must assert her own self care in a safe and judicious way.
Coming next: The workday, part 3: The sheath pull.
Documentation
We do a shitload of documentation on each patient. Our manager has concluded that for safety reasons, we need to do an entire hospital admission process for everyone who comes in. The outpatients, that is - inpatients should already have that done. For every patient we need to:
- Do the admission process in the computer system which includes:
- Review of all medications they are taking.
Do you have any idea how many people have no clue what medications they take and when???. Horrifying - Validate all of their medication sensitivities and allergies.
- Get information on their legal status regarding durable power of attourney, living will, etc. If they have one, I need to find it and get it on the chart if possible.
- Investigate their living situation, and see if there are any dependents
- Get contact information for family and/or friends
- Screen for domestic violence
- Find out if they are in any medical research study and if so, get the contact information
- Assess their ability for self care, such as independent grooming, toileting, etc.
- Investigate their use of tobacco, alcohol, and illegal drugs
- Are there stairs in the house to the essential rooms (bed/bath/laundry/entrance)?
- Evaluate if the patient is at nutritional risk
- Ask the patient if s/he has experienced any major life changes in the last 6 months.
- Finally, get the patient's stated goal for his/her hospital stay.
This, I think is stupid. Most people say "to get out." Well, duh. Management has decided that this is important, so we do it.
In addition to this, I am supposed to validate the medication administration record against the doctor's orders (and against what the patient tells me), I need to run EKG analyses, at least 2 per shift (pre and post procedure), develop a plan for the day, and evaluate the plan of care for the patient.
Then there is the "normal" nursing documentation that is done every shift (or more) on all patients: assessment, nursing note, record intake, output, pain, etc.
It is true, I have most of the day to do all of this for each patient. I try to get it all done as quickly as possible, because who knows what the day holds? I could get really busy with critical patients and not have time to do all of this.
Post Procedure
After a patient comes back from procedure, we assess again, settle the patient back into the room and begin frequent monitoring. Most patients require vital signs every 15 mintues for the first hour, then every 30 minutes, then every hour for 4 hours. This is fun when you have more than one patient on 15 minute vitals. It is even more fun when several patients return from the lab at the same time.
I receive report from the procedural nurse, and follow the protocol as ordered by the doctor for the patient, based on what happened during the procedure.
Cardiac or Peripheral catheterization
A cardiac cath is when thin wires are threaded through the femoral artery or vein up to the heart. They are looking for blockages in the arteries of the heart (mostly..there are a few other things one can do with a cardiac cath). A peripheral cath is when these wires are directed down the legs to look for arterial blockages. If warranted, the doctor can "fix" these blockages with a stent, which is a wire mesh tube used to prop open an artery.
Our most frequent procedure is the cardiac cath. Patients usually come back with tubing (a "sheath") in one or more groin punctures. That is, there's tubing sticking out of their femorial artery. If blood thinners were used during the procedure, we have to wait to remove the tubing until their blood thickens up enough to hold a good clot. The patient has to lie flat on their back until that time, although we can tilt the bed so his head is higher than his feet. They can't eat until we get the tubing out.
Pacemakers
Some patients have a pacemaker placed or the battery on a pacemaker replaced. Occasionally we have an explant or entire replacement of device. These patients come back with an incision in their chest, usually the left side just under the clavicle. They can eat when they're awake, they can sit up in bed, just not move the arm on the affected side.
Ablations
Another procedure we do pretty frequently is an ablation. This procedure uses thin wires to go up to the heart and zap (e.g. burn, electrically) portions of the interior of the right atrium of the heart. Occasionally the left atrium needs to be zapped. These patients come back with multiple sheaths in their groins in the femoral veins, usually bilaterally, and sometimes they have a catheter in their internal jugular on the right side. These patients often have had blood thinners as well, so they must wait flat on their backs as well.
Other variations
Devices are available that seal up the puncture. We use two types: starclose and angioseal. The former is like a little staple. The latter is a plug of collagen that closes up the hole and eventually gets absorbed by the body.
Sometimes pacemaker patients will have a groin sheath as well. During the procedure, if the doctor cannot place the pacemaker leads properly from the incision (via the mammary vein), she will thread catheter wires up through the femoral vein to assist.
Some of the variations for cardiac caths are to measure blood pressures in the hear as it's functioning, measure pressure of blood in the lungs, and assess the functionality of the left ventricle.
Bedrest
Patients are on bedrest post procedure while we are monitoring them frequently. Many patients are still somewhat sedated so they are pretty cooperative. Most of them don't have a lot of pain, again because of the sedation and the local anaesthetic. They come back to us cold, frequently. The cath lab and the EP labs are kept in the lower 60s.
Patients don't like bedrest. Many patients have back problems and it is painful to lie on their backs for hours. Most patients, particularly the younger ones, will repeatedly let me know their backs hurt and that nothing I can do for them helps. No one likes to use a bedpan. At least the men can use a urinal.
Now, we have the annoying variation of the older man with enlarged prostate. Mostly they are embarrassed about it, so they don't say anything until they can't pee and their bladder is extended to the point of pain. Then it's panic time because they are so uncomfortable. But no, they couldn't have said something earlier and we could have placed a catheter. When their bladders are distended with urine, it displaces everything internally, which makes it that much more difficult to place a foley catheter. If I can't do it (and failing at placing a urinary cath hurts!!! Succeeding at it isn't much fun, either.) I have to call the urology doctors and wait for them to come. More pain while we wait.
As you can tell, this process bugs me. Men, get over yourself and let me know, so I can help you. Don't let it come to panic time!!
It's kind of amusing how some people will try to negotiate to get off bedrest early. What am I supposed to do...let them? NO! What if they bleed? People don't realize how high-pressure a femoral artery is and that in a matter of minutes they'd bleed to death if it opens up. I shake my head in disbelief. I guess because they feel OK, they don't realize how vulnerable they are.
They also want to eat. I can give them clear liquids, but nothing else until that sheath is out. The reason for this is that when we do the sheath pull, the vagal nerve may get stimulated, which can cause them to throw up. And if they aspirate the food, then they stop breathing. Not good.
In the end, almost everyone complies. As the bedside nurse, I get to hear about how awful it is. A lot. I wish the doctors would impress upon the patient how long they typically must stay in bed. Patients seem so surprised when I tell them 6 hours of bedrest is required. I think the doctors gloss over it, mutter it under their breath, and patients don't think about what it will be like.
My self care during the Workday
Caring for people is emotionally and physically demanding. Fortunately, we have good teamwork where I work and we help each other out. I try to get my morning "snack" break around 1030 - that's when I usually start feeling kind of light headed and hungry. I like to have a cheese stick, some crackers, a cup of coffee. I like to take lunch around 1330. Of course my self care is variable based on my patient-care demands. Some days I don't get much of a break.
It is so very tempting to eat too much. Like many people, women in particular, I get an emotional lift from having a treat. There is they physical hunger and the emotional need to be cared for given the demands of the job. There isn't much time for anything else, really (a back rub? Leave the unit and breathe fresh air outside? Oh, come on, seriously...)
My little indulgence is to read the newspaper which I bring in from home. I also keep the water at my workstation so I can keep hydrated. I have a terrible habit of not drinking enough. I have gone entire shifts without having to pee. That is not good.
Honestly, though, my unit is not really that bad for self-care. We help each other out, and there are lulls in the chaos when you can get a bite or go pee. When I used to work on a regular inpatient unit, I frequently had to make the choice between getting behind in my work or eating lunch/using the bathroom. I mean, when a patient is in pain or crashing, nobody gives a damn if the nurse is going to crap her pants because she hasn't gone to the bathroom in 6 hours. She should have done that earlier...and no one gives a damn if there wasn't time to do that earlier.
The nurse must assert her own self care in a safe and judicious way.
Coming next: The workday, part 3: The sheath pull.
Friday, November 16, 2007
The workday, part 1: Early morning.
I had high hopes of writing to my blog every day, but when I work, I am exhausted at the end of the day. I also feel the need to be with my husband after work to give him some companionship.
I am a nurse. I work at a large hospital in Kansas City. I became a nurse in 2006 after returning to school to earn another degree. I needed the degree in order to work as a nurse. I really didn't want to go to school again....
Wait. Strike that. Let's be honest. I loved going to school again. If I had my druthers I'd be in college forever. I enjoy learning, I enjoy working on projects. I like the camraderie of fellow students. I like having well-defined goals. I like research. It's just not a sustainable way of life. I thrill at the rush of "living poor" successfully - finding bargains at the thrift store, clipping coupons, living without cable TV, staying home and listening to the radio for entertainment, taking advantage of student discounts.
OK, I've confessed. That's out of the way, I will continue on my topic of the day. My typical work day. I intended to do the whole day in this post, originally, but it got too big. Here is part one: early morning.
I get up at about 0500, shower, dress, pack lunch and snacks, and go to work. It is a 25 minute drive - about 35 minutes door-to-clock-in. I always wear a cross necklace to work; this is because I need God's protection and guidance in my work, and because God called me to to become a nurse. I wear scrubs, support knee-hi hose, athletic socks, and comfortable shoes. I wear athletic shoes, mainly walking-style shoes.
I also need my watch. I have el-cheapo watch from walmart - digital, water resistant, lighted. It displays in Military time, which is how we chart. Then, I don't have to think about what time to write on my charting - look at watch, copy. It would be nice to have a good watch, but there are some places at work I might drop my watch from which I would not want to retrieve it.
I try to get to work about 10 minutes early so that I can do some of the set-up things I like to do before I need to start working with my patients. I also try to help the night nurses get out of work on time, by taking over care of my patients promptly. They do the same at the end of my shift. Boy, do I appreciate that!
After I clock in, I prepare my body for the day. I have a locker in which I place my valuables and stash my supplies. Here is how I get ready.
Then, I can get report from the night nurses and start the day. The race is on.
I work in a unit that supports the cath lab and the electrophysiology lab. Our patients are mostly heart patients. Most of our patients come in early in the morning and go home either that afternoon or the next morning. We do the prep and recovery for these patients. Our goals are to keep the patients safe and to supply these labs with a steady stream of patients. An idle doctor is not earning money for the hospital! Oh yeah, and the better we do our job, the more patients will get the interventions they need sooner. That, too.
Given these goals, a patient prep is our first priority. To get a patient ready, we have health related questions to ask them, consent forms to be signed, IVs to start, and we have to fill in any gaps in the preparation process that the doctor or the patient may have missed. We have to shave their hair in various areas of their bodies. We have to get a patient weight and a full set of vital signs. Sometimes we have to give pills (Aspirin, Plavix, Valium for the nervous patient). Often we have to get finger-stick blood sugar reading, draw labs and get them down to the lab ASAP. The patient can't go to procedure until the labs are reviewed. We start IV drips, sometimes more than one. I also have to assess the patient and mark their pulses on their feet. We monitor that later in the day.
In theory, we have to have this all done in 30 minutes or less. After a year at this job, I am still not that good; however, in my own defense, there are a lot of factors over which I have no control that impact my speed in a patient prep.
Unfortunately, as the nurse, I am still responsible for these things. That's one of the frustrating things about my job.
If a patient has stayed overnight, it is most often the case that they will leave early in the morning. We are usually urged to get them out as fast as possible. My personal goal is 1000, but the unit goal is 0900. Between 0700 and 0900, somehow I need to do all of the following:
That's a hell of a lot! Then after they go, I have to complete their chart and give it to the secretary for break-down. Indeed I have assistance, but our Nursing Assistants, like us, have priorities to prep the new people coming in. I usually do most of the above things myself.
Now, you must realize that I usually have 3 patients. It will typically be either 1 new patient and 2 discharges, or 2 new patients and 1 discharge. It's loads of fun when the new patients are scheduled to arrive at the same time and the discharge patient and his family are whining to be discharged.
In my comprehensive list above, I have not accounted for some of the variations of these tasks, such as new orders on a discharge patient (e.g., his serum potassium is low, please give him extra potassium), or a medication is missing (call pharmacy!), the unit coordinator is breathing down my neck to discharge patients because we need the beds. Something is suspicious on the patient that needs to be reported to the doctor (which the patient didn't say anything about when the doctor was in the room). Special patient requests like a cup of coffee. The patient failed to mention s/he needs a new prescription for a medication. I have to finish any paperwork the previous shift did not complete.
Mornings go by very quickly on my unit. This is when the doctors are doing most of their procedures so patients are coming and going all of the time.
Coming next time: The workday, part 2: late morning and afternoon.
I am a nurse. I work at a large hospital in Kansas City. I became a nurse in 2006 after returning to school to earn another degree. I needed the degree in order to work as a nurse. I really didn't want to go to school again....
Wait. Strike that. Let's be honest. I loved going to school again. If I had my druthers I'd be in college forever. I enjoy learning, I enjoy working on projects. I like the camraderie of fellow students. I like having well-defined goals. I like research. It's just not a sustainable way of life. I thrill at the rush of "living poor" successfully - finding bargains at the thrift store, clipping coupons, living without cable TV, staying home and listening to the radio for entertainment, taking advantage of student discounts.
OK, I've confessed. That's out of the way, I will continue on my topic of the day. My typical work day. I intended to do the whole day in this post, originally, but it got too big. Here is part one: early morning.
Early morning
Getting to work
I get up at about 0500, shower, dress, pack lunch and snacks, and go to work. It is a 25 minute drive - about 35 minutes door-to-clock-in. I always wear a cross necklace to work; this is because I need God's protection and guidance in my work, and because God called me to to become a nurse. I wear scrubs, support knee-hi hose, athletic socks, and comfortable shoes. I wear athletic shoes, mainly walking-style shoes.
I also need my watch. I have el-cheapo watch from walmart - digital, water resistant, lighted. It displays in Military time, which is how we chart. Then, I don't have to think about what time to write on my charting - look at watch, copy. It would be nice to have a good watch, but there are some places at work I might drop my watch from which I would not want to retrieve it.
I try to get to work about 10 minutes early so that I can do some of the set-up things I like to do before I need to start working with my patients. I also try to help the night nurses get out of work on time, by taking over care of my patients promptly. They do the same at the end of my shift. Boy, do I appreciate that!
Getting ready for the day
After I clock in, I prepare my body for the day. I have a locker in which I place my valuables and stash my supplies. Here is how I get ready.
- Gear up for the day - On my person, I have a stethoscope, locator badge, sharpie pen, black ball-point pens, alcohol pads, carpuject (a device for dispensing certain kinds of IV medicines), and bandage scissors. I usually take a jacket with me in case I get cold. I have a bottle of water. Finally, it is essential that I have a tube of lip balm in a pocket. My lips get dry.
- Go on the unit.
- Find out my patient assignments and from whom I need to get report, if any
- Stake out a claim on a computer station that will be mine during the day. Put my non-pocket stuff at this station and log in to the computer. My stuff include a 1-Liter bottle of water and a jacket.Everything else I mentioned above stays in a pocket, around my neck, or clipped on my clothing.
- Sometimes, I have time to check email before the race begins,
- Until recently I printed out specific sheets of paper that help me through the day. One is called the "brain" on which I take notes about the patients. These include name, age, room, diagnosis, medical history, parameters that a nurse needs to know, upcoming things for the day (i.e. tests, discharge, etc.) and significant lab results from last night. The other paper is a cheat sheet for a patient profile, a questionnaire for new patients.
- I don't do these things now because just this week, we switched to a computer charting system. I'm striving to live without paper!
- Pick up and log into Vocera
Vocera is a little voice-recognition walkie-talkie device worn around the neck.
Then, I can get report from the night nurses and start the day. The race is on.
The Unit
I work in a unit that supports the cath lab and the electrophysiology lab. Our patients are mostly heart patients. Most of our patients come in early in the morning and go home either that afternoon or the next morning. We do the prep and recovery for these patients. Our goals are to keep the patients safe and to supply these labs with a steady stream of patients. An idle doctor is not earning money for the hospital! Oh yeah, and the better we do our job, the more patients will get the interventions they need sooner. That, too.
The Patient Prep
Given these goals, a patient prep is our first priority. To get a patient ready, we have health related questions to ask them, consent forms to be signed, IVs to start, and we have to fill in any gaps in the preparation process that the doctor or the patient may have missed. We have to shave their hair in various areas of their bodies. We have to get a patient weight and a full set of vital signs. Sometimes we have to give pills (Aspirin, Plavix, Valium for the nervous patient). Often we have to get finger-stick blood sugar reading, draw labs and get them down to the lab ASAP. The patient can't go to procedure until the labs are reviewed. We start IV drips, sometimes more than one. I also have to assess the patient and mark their pulses on their feet. We monitor that later in the day.
In theory, we have to have this all done in 30 minutes or less. After a year at this job, I am still not that good; however, in my own defense, there are a lot of factors over which I have no control that impact my speed in a patient prep.
Unfortunately, as the nurse, I am still responsible for these things. That's one of the frustrating things about my job.
The Overnight Patient
If a patient has stayed overnight, it is most often the case that they will leave early in the morning. We are usually urged to get them out as fast as possible. My personal goal is 1000, but the unit goal is 0900. Between 0700 and 0900, somehow I need to do all of the following:
- Do a safety check - make sure the patient is who the chart says they are, she isn't going to trip on anything in the room, etc.
- Assess my patient (listen to heart, lungs, belly, assess incisions from yesterday's procedure, monitor pulses and assess pain).
- Gather vital signs.
- More often than not, get a finger-stick blood sugar. Everyone is diabetic these days.
- Run an EKG strip from the monitor and analyze it.
- Fix any equipment problems, such as adjusting heart monitor leads.
- Make sure they order breakfast.
- Administer the morning meds. Safely and accurately, of course.
- Get them to any tests/consults before they go home. For patients who get a pacemaker, they usually have to go downstairs to get a chest xray to verify the placement of the leads.
- Make sure the doctor or nurse practitioner comes by to assess the patient
- Watch for the official release from the MD or NP
- Discontinue the IV or IVs, remove heart monitor
- Complete the discharge paperwork in the computer
- Go over the discharge instructions with the patient, give them their copies of the instructions, and get a signature. Make sure the patient has any other items from their procedure (identification cards, portable monitors, etc.)
- Give the patient their prescriptions
- Take them downstairs in a wheelchair to meet their ride.
That's a hell of a lot! Then after they go, I have to complete their chart and give it to the secretary for break-down. Indeed I have assistance, but our Nursing Assistants, like us, have priorities to prep the new people coming in. I usually do most of the above things myself.
Now, you must realize that I usually have 3 patients. It will typically be either 1 new patient and 2 discharges, or 2 new patients and 1 discharge. It's loads of fun when the new patients are scheduled to arrive at the same time and the discharge patient and his family are whining to be discharged.
In my comprehensive list above, I have not accounted for some of the variations of these tasks, such as new orders on a discharge patient (e.g., his serum potassium is low, please give him extra potassium), or a medication is missing (call pharmacy!), the unit coordinator is breathing down my neck to discharge patients because we need the beds. Something is suspicious on the patient that needs to be reported to the doctor (which the patient didn't say anything about when the doctor was in the room). Special patient requests like a cup of coffee. The patient failed to mention s/he needs a new prescription for a medication. I have to finish any paperwork the previous shift did not complete.
Mornings go by very quickly on my unit. This is when the doctors are doing most of their procedures so patients are coming and going all of the time.
Coming next time: The workday, part 2: late morning and afternoon.
Monday, November 12, 2007
Fall color and impending doom
This morning, I took some pictures of a pretty maple tree we have in our front yard. These pictures are kind of artsy, in that I took close up shots of the interior of the tree, so that all you see are brances and firey red. The leaves on this tree have turned a uniform orangey-red and it's just beautiful. It has done this in previous years, and it has been this color for a few days now. Yet, it still catches my eye as I walk by the window. It's so vivid!
I appreciate fall, but I do not like fall. I enjoy the cooler temperatures, the drier air, the dramatic swashes of color in the foliage. Autumn is the harbinger of winter, and I cannot ignore this point. I dislike the cold and the dark.
I get depressed with the lack of light. I chill very easily and I don't like being cold. This is why I hate winter.
I have tried to make peace with winter. When I lived in upstate New York, I figured I had to, as a matter of survival. I ice skated (which I actually know how to do, thanks to phys ed class in college), and I took Cross Country ski lessons. I bought the most expensive coats and gloves I could afford. To no avail. Even with my heart pounding in physical exercise, my fingers and toes can be numb with cold. Yes, they are wrapped up in several layers of gloves, socks, mittens, and boots.
My solution to this hatred was to move south. For nearly 15 years I lived in North Carolina, where I enjoyed balmy temperatures throughout the year. OK, I'm exaggerating - it did get cold for about 6-8 weeks, and then it was over with. And when it did snow or ice, everyone shut everything down. No work, no school, nothing. I consider this very civilized (I do concede that this is impractical for more northern parts of the country).
Woe to me when my husband decided to take a permanent position with a company in Kansas. Once again, I am finding myself having to make peace with winter. This time, I am finding ways to be happy while being inside. Winter is a productive time for quilting and sewing. Maybe my utilization of Netflix will improve.
If my blogging has a tone of gloom and doom for the next 5-6 months, the weather may have something to do with it.
I appreciate fall, but I do not like fall. I enjoy the cooler temperatures, the drier air, the dramatic swashes of color in the foliage. Autumn is the harbinger of winter, and I cannot ignore this point. I dislike the cold and the dark.
I get depressed with the lack of light. I chill very easily and I don't like being cold. This is why I hate winter.
I have tried to make peace with winter. When I lived in upstate New York, I figured I had to, as a matter of survival. I ice skated (which I actually know how to do, thanks to phys ed class in college), and I took Cross Country ski lessons. I bought the most expensive coats and gloves I could afford. To no avail. Even with my heart pounding in physical exercise, my fingers and toes can be numb with cold. Yes, they are wrapped up in several layers of gloves, socks, mittens, and boots.
My solution to this hatred was to move south. For nearly 15 years I lived in North Carolina, where I enjoyed balmy temperatures throughout the year. OK, I'm exaggerating - it did get cold for about 6-8 weeks, and then it was over with. And when it did snow or ice, everyone shut everything down. No work, no school, nothing. I consider this very civilized (I do concede that this is impractical for more northern parts of the country).
Woe to me when my husband decided to take a permanent position with a company in Kansas. Once again, I am finding myself having to make peace with winter. This time, I am finding ways to be happy while being inside. Winter is a productive time for quilting and sewing. Maybe my utilization of Netflix will improve.
If my blogging has a tone of gloom and doom for the next 5-6 months, the weather may have something to do with it.
Saturday, November 10, 2007
A Birthday and an Achievement
Thursday was my birthday. I am now 42. I have come to dislike birthdays, although I still enjoy treating myself with presents and getting attention from friends and family.
My achievement was that I found out yesterday that one of the patents that I had applied for in my previous life had been awarded. I am an inventor of an original software process. Technically, I am a co-inventor - I don't want to minimize that. Two of us developed the process and implementation. Both women, interestingly enough.
I am pleased this patent was granted. This one I actually invented and I do believe it is original. There was another one I co-invented with 4 other people. My role was much smaller, and I don't think the process is exceedingly original. But, there was a patent frenzy back in the late 90s and early 00s, and my corporation got caught up in it. I do put both of these things on my resume. It impresses people.
It also earned me about $1000 in bonus money. Nice, but long gone!!
I am torn whether to mention this award to my boss at my current job. On the one hand, it's pretty cool, and unique. On the other hand, it is some degree of shameless self promotion. This particular patent has nothing to do with my current job. As a result, I kinda feel like I'd be saying, "look at me, I was little miss sunshine when I was 5 years old!' (I wasn't, by the way). Still, it's an accomplishment and I'd like to share with a few people.
I struggle with my ego. Deep down, I think I'm very egotistical. I think I'm great, beautiful, talented, smart, and funny. Logically, though, I conclude I'm about as common as they come (except for the no-kids thing). Everyone is great, beautiful, talents, smart, or funny, all of these things, and many more. I am conflicted between real values and the world's values - am I great because of my achievements (world value)? am I great because I am one of God's beloved children (real value)? Am I nothing because I'm a common person living in the USA (world value)?
Another example of where I've been conflicted was when I found a writing contest in the newspaper. They were looking for several writers for a column about people's faith journeys. In some ways, I think my journey has been unique. I thought it was something I should share. Maybe it would inspire or comfort someone. I sat down and wrote one of the essays for the contest. But the more I thought about it, I wondered if my motivation was really self-aggrandization. I wanted to be published and have my picture in the paper. Maybe I really just wanted the admiration of others over what a superb Christian I was.
So I never sent in my essay.
I seem to have the urge to tell my story, since I'm writing here. However, I've told no one about my blog. Yet.
PS. I need to write about my faith journey here.
My achievement was that I found out yesterday that one of the patents that I had applied for in my previous life had been awarded. I am an inventor of an original software process. Technically, I am a co-inventor - I don't want to minimize that. Two of us developed the process and implementation. Both women, interestingly enough.
I am pleased this patent was granted. This one I actually invented and I do believe it is original. There was another one I co-invented with 4 other people. My role was much smaller, and I don't think the process is exceedingly original. But, there was a patent frenzy back in the late 90s and early 00s, and my corporation got caught up in it. I do put both of these things on my resume. It impresses people.
It also earned me about $1000 in bonus money. Nice, but long gone!!
I am torn whether to mention this award to my boss at my current job. On the one hand, it's pretty cool, and unique. On the other hand, it is some degree of shameless self promotion. This particular patent has nothing to do with my current job. As a result, I kinda feel like I'd be saying, "look at me, I was little miss sunshine when I was 5 years old!' (I wasn't, by the way). Still, it's an accomplishment and I'd like to share with a few people.
I struggle with my ego. Deep down, I think I'm very egotistical. I think I'm great, beautiful, talented, smart, and funny. Logically, though, I conclude I'm about as common as they come (except for the no-kids thing). Everyone is great, beautiful, talents, smart, or funny, all of these things, and many more. I am conflicted between real values and the world's values - am I great because of my achievements (world value)? am I great because I am one of God's beloved children (real value)? Am I nothing because I'm a common person living in the USA (world value)?
Another example of where I've been conflicted was when I found a writing contest in the newspaper. They were looking for several writers for a column about people's faith journeys. In some ways, I think my journey has been unique. I thought it was something I should share. Maybe it would inspire or comfort someone. I sat down and wrote one of the essays for the contest. But the more I thought about it, I wondered if my motivation was really self-aggrandization. I wanted to be published and have my picture in the paper. Maybe I really just wanted the admiration of others over what a superb Christian I was.
So I never sent in my essay.
I seem to have the urge to tell my story, since I'm writing here. However, I've told no one about my blog. Yet.
PS. I need to write about my faith journey here.
Tuesday, November 6, 2007
Quilt Guild
Today I went to my quilt guild meeting. I am the newsletter person, as I mentioned in a previous post. Now, I think I'm going to be the "Bee Keeper." I want to be in a quilting bee. So, I'm organizing bees for the guild. Twenty two people signed up! Much more than I expected!
In the guild, I am more involved in the administrative side of things. I am not as good a quilter as many of the people in the guild. But I do alright. I quilt for love only - and that means I quilt for my own enjoyment, to make gifts for family members and friends, and to make things for myself. I have only shown two quilts in show and tell and it took me over a year to get up the courage to show.
My current major quilt project is a quilt for my niece Adia. It was supposed to be for her birthday, but it looks like Christmas will be a better bet. It is coming along well, actually - I'm working on the machine quilting now. Maybe close to half done with that. It is very colorful - a pattern of squares and rectangle patches. I am quilting an overall pattern on it - flowers, leaves and swirls.
When I figure out how to post pictures, I'll post one of this completed project.
In the guild, I am more involved in the administrative side of things. I am not as good a quilter as many of the people in the guild. But I do alright. I quilt for love only - and that means I quilt for my own enjoyment, to make gifts for family members and friends, and to make things for myself. I have only shown two quilts in show and tell and it took me over a year to get up the courage to show.
My current major quilt project is a quilt for my niece Adia. It was supposed to be for her birthday, but it looks like Christmas will be a better bet. It is coming along well, actually - I'm working on the machine quilting now. Maybe close to half done with that. It is very colorful - a pattern of squares and rectangle patches. I am quilting an overall pattern on it - flowers, leaves and swirls.
When I figure out how to post pictures, I'll post one of this completed project.
Monday, November 5, 2007
Be careful what you wish for
I am off work today. I feel a little sheepish after yesterday's post. I did call in early this morning.
During band rehearsal yesterday I had a short bout of indigestion (a.k.a heartburn). It happens from time to time; I wouldn't classify it as GERD, since it happens maybe once every 6 months. When I got home, I took Zantac and some Tums. I was OK when I went to bed, but it didn't last long. It kept me up til about 1:30. I can't work a 12 hour shift on only 3 hours of sleep!! And my gut hurt.
I finally did get to sleep, woke up in the morning and most symptoms were gone.
So here I am at home, feeling tired and embarrassed.
It's interesting that I feel compelled to write about it in this blog. I feel I must justify my decision. Other people don't have such guilty feelings when they call in sick. Other people call in sick all the time. Me, I need to be just short of unconscious before I consider it worthy of missing work. As a result, I have gone to work on days that I really shouldn't have.
Even though I'm an adult, one who has gone through much therapy, I think the reason I behave this way is that I was criticized and judged everywhere, while I grew up. I was not credible. I didn't know how I felt - or at least that's the message I received. So I don't innately trust how I feel.
Bit by bit, I get over this and learn to trust myself. I should be well actualized by the time I'm in my 70s.
It is nice to have a day off though.
During band rehearsal yesterday I had a short bout of indigestion (a.k.a heartburn). It happens from time to time; I wouldn't classify it as GERD, since it happens maybe once every 6 months. When I got home, I took Zantac and some Tums. I was OK when I went to bed, but it didn't last long. It kept me up til about 1:30. I can't work a 12 hour shift on only 3 hours of sleep!! And my gut hurt.
I finally did get to sleep, woke up in the morning and most symptoms were gone.
So here I am at home, feeling tired and embarrassed.
It's interesting that I feel compelled to write about it in this blog. I feel I must justify my decision. Other people don't have such guilty feelings when they call in sick. Other people call in sick all the time. Me, I need to be just short of unconscious before I consider it worthy of missing work. As a result, I have gone to work on days that I really shouldn't have.
Even though I'm an adult, one who has gone through much therapy, I think the reason I behave this way is that I was criticized and judged everywhere, while I grew up. I was not credible. I didn't know how I felt - or at least that's the message I received. So I don't innately trust how I feel.
Bit by bit, I get over this and learn to trust myself. I should be well actualized by the time I'm in my 70s.
It is nice to have a day off though.
Sunday, November 4, 2007
Day 2
I do not want to go to work tomorrow. This is not unusual for many people. Mostly, I like my job, but sometimes I am just tired.
I am a very healthy person...at least right now, I am. I don't get sick very often; in fact, I've never been hospitalized, and at most, I think I've only missed 2 or 3 days of work in a row due to illness. Therefore, I don't get many days off sick. That's a good thing, really. I am truly blessed.
As a result, my days off are planned. At least at this job, all of my time off is one category - PTO (personal time off). This is advantageous to me, since I don't need sick days (often) or sick child days.
I am really glad about this PTO policy. In my previous jobs, people who were ill or had family care responsiblities got extra days off. Not that they were "fun" days exactly. But I got no advantage for not taking those extra days. And, it's politically incorrect to criticize those who had to take those days. One could infer that it's politically incorrect also to give advantage to those who don't take such days off, because then you're denying those unfortunate people the opportunity to gain as well.
It's weird. There is no incentive in this society to do the right thing. To be healthy. To be independent. Other than the fact that these things are advantages in themselves.
I wish I had the courage to take a "mental health" day, though. It would be nice to have a day for a little self care for no particular reason other than the fact that it's good for me. But I just can't do it. If I'm able to get out of bed, then I'm well enough to go to work. And guilt. Oy, guilt. You see, they need me at work. Recently, we've lost a few nurses and we're short staffed for the moment.
To be needed. That is music to my ears.
I am a very healthy person...at least right now, I am. I don't get sick very often; in fact, I've never been hospitalized, and at most, I think I've only missed 2 or 3 days of work in a row due to illness. Therefore, I don't get many days off sick. That's a good thing, really. I am truly blessed.
As a result, my days off are planned. At least at this job, all of my time off is one category - PTO (personal time off). This is advantageous to me, since I don't need sick days (often) or sick child days.
I am really glad about this PTO policy. In my previous jobs, people who were ill or had family care responsiblities got extra days off. Not that they were "fun" days exactly. But I got no advantage for not taking those extra days. And, it's politically incorrect to criticize those who had to take those days. One could infer that it's politically incorrect also to give advantage to those who don't take such days off, because then you're denying those unfortunate people the opportunity to gain as well.
It's weird. There is no incentive in this society to do the right thing. To be healthy. To be independent. Other than the fact that these things are advantages in themselves.
I wish I had the courage to take a "mental health" day, though. It would be nice to have a day for a little self care for no particular reason other than the fact that it's good for me. But I just can't do it. If I'm able to get out of bed, then I'm well enough to go to work. And guilt. Oy, guilt. You see, they need me at work. Recently, we've lost a few nurses and we're short staffed for the moment.
To be needed. That is music to my ears.
Saturday, November 3, 2007
Initial Post
This is my first blog entry.
I have been on the web almost since its inception. I started writing raw HTML in 1993. It has come a long way baby. You'd think I'd have been an early blogger, but I have not. I have been extremely sensitive to privacy issues. Early on in the world of the web, it was so open, anyone could steal anything from you and your site. Since I knew exactly how the web worked, I was cautious about putting personal information online.
Technology has changed, I have changed. I need a way to express myself. I am giving it a try.
I am egotistical enough to think I have something to say and that maybe, someone would like to read it. Maybe someone will learn from it. Maybe it will entertain someone. I don't have any fiction in me, but I do have a life and sometimes I really think my life is remarkable. Other times, I think my life is as ordinary as it comes. History will be the judge of this. In fact, I suspect I will be forgotten to history, like most people.
Nevertheless, I have an urge to find significance. To leave a mark. To have made a difference. Therefore, I write.
I tried to come up with a pithy title for the blog. Heh. all the good ones are taken. I chose "Thoughtful Quilter" because:
It's only a partial description of me. I like to do these other things, too:
Oh, I'm sure there's more.
Did you notice I didn't mention kids?? I'm almost 42 and I don't have any. I'm married, but no kids. That's kind of unusual for someone my age and health and social status. I'll probably blog on that topic sometime. Soon, because it's on my mind lately.
I have lots to blog on. I hope that I keep this going for a while.
I have been on the web almost since its inception. I started writing raw HTML in 1993. It has come a long way baby. You'd think I'd have been an early blogger, but I have not. I have been extremely sensitive to privacy issues. Early on in the world of the web, it was so open, anyone could steal anything from you and your site. Since I knew exactly how the web worked, I was cautious about putting personal information online.
Technology has changed, I have changed. I need a way to express myself. I am giving it a try.
I am egotistical enough to think I have something to say and that maybe, someone would like to read it. Maybe someone will learn from it. Maybe it will entertain someone. I don't have any fiction in me, but I do have a life and sometimes I really think my life is remarkable. Other times, I think my life is as ordinary as it comes. History will be the judge of this. In fact, I suspect I will be forgotten to history, like most people.
Nevertheless, I have an urge to find significance. To leave a mark. To have made a difference. Therefore, I write.
I tried to come up with a pithy title for the blog. Heh. all the good ones are taken. I chose "Thoughtful Quilter" because:
- It was available
- I am incredibly introspective
- I like to quilt.
It's only a partial description of me. I like to do these other things, too:
- Play music and sing
- Play Texas Hold 'em
- Work at my job as a nurse in a hospital
- Make pretty documents
I produce a newsletter for my quilt guild - Keep a nice house
- Play with my dogs and walk my dogs
- Cook good food
- Make a pretty yard and garden
- Enjoy my family and friends
- Go to church
- Knit
- Sew clothing
- Go to shows downtown
- Travel
Oh, I'm sure there's more.
Did you notice I didn't mention kids?? I'm almost 42 and I don't have any. I'm married, but no kids. That's kind of unusual for someone my age and health and social status. I'll probably blog on that topic sometime. Soon, because it's on my mind lately.
I have lots to blog on. I hope that I keep this going for a while.
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