Is it Possible?

How is it possible to want something so bad and yet I find I'm constantly pushing any possibility of having it away? I can have it all and yet I'm blatantly pushing it all away. There must be something wrong with me.




But I do want it. I think. I just don't make any sense. I've literally spent some long moments off in space just trying to figure myself out. Like, having conversations with my alter ego's in my head, going back and forth trying to figure out why the heck I am so ridiculous all the time and I literally can't come up with anything. Nothing. So I just leave it at the fact that I'm just weird complicated and want what I can't have and don't want what I can? Eeeeeeebiejeebies.


There are so many times where if I described myself in one sentence, right now, I don't like what I hear. Sometimes I think I'm becoming I used to look down upon. I'm a good person in a lot of ways, also, I know that. Who knows. I try to be a good person.


I just don't even know what I want right now.


Sorry for the sad, vague, depressing, intuitive(?) post.....i'll be back to happy outgoing self soon. Ish. :-)


~WNB



.

Well, I do all the other holidays...

So I might as well write about this one! First of all, thanksgiving has always been my favorite holiday. For me it's always been a holiday spent with family from afar, and obviously lots of good food. The family I'm with every year from childhood is everything I could ask for. From just a child I've transformed in this big family from sitting at the kids table with them to progressing to the adult table.

Now as an equal, or at least seen as more of an equal adult nowadays, I've learned a lot about what true family Is, what it means, and how thankful we are for family.

For me, thanksgiving is about family.

This year in particular, however, I am thankful for:

- first and foremost, being 99% healthier than I ever have been.
- having a full time job that pays decent in the degree I went to college for
- having a wonderful, generous, understanding family that always supports me
- my brand new car (it's kind of amazing)
- my new found time to write, and draw (my sanity)
- my best friend (s)
- this blog (what would I ever do without it??)

So I hope you all can think of at least a handful of things you are thankful for this season, no matter how bad you think things are. Things could always be worse! Just don't tempt the fates ;)

With love,

~WNB

Drowning Alive

So these past couple nights I had a pretty interesting round of patients. My one though, was probably my first patient who scared me. She has chronic COPD and emphysema. Now, we learned about these two evils in class...In clinincals and as an RN I've had patients with "a history" of COPD/EMP and occaisonally they ask for an inhaler...And I guess in my mind thats all I thought it was. I guess I knew it got worse but so far I had never encountered it. Until last night.

She was extremely nice. Elderly woman. But the simple act of going to the commode which was right next to the bedside, was the equivalent of you or me running two miles with no break. Audible wheezing, gasping for air. On top of all this, she was admitted with extreme back pain and was going for surgery the next day, which was giving her extreme anxiety on top of it all.

So, luckily she slept through the night for me. I checked on her every hour (theres that hourly rounding for ya) and was thankful to see her breathing normally with no problems and she didnt appear to be in any pain.

But then comes time to wake up. First what happened was she needed to take her pills, but I had to have her sit up so she wouldn't choke. So she leaned forward in the bed, and she's now the color purple, and shaking violently. However she manages to get down the pills and falls back into bed but she's in excrutiating pain. Now, ( in comparision to the twenty something I had the shift prior who was making up reasons why she needed Dilaudid), this lady was truly in 10/10 pain. This was the first time I was actually watching the clock waiting to see when the next time I could give her Dilaudid. She even told me she hates painkillers, but the pain is so severe that she needed to take them. I believed every word.

So after I got her less purple and breathing a little better (just from the simple act of leaning forward in bed), she got a breathing treatment. After that, she wanted to seize the golden window to get on the commode. Nursing is the art of timing everything just so, so that maybe, if you're lucky, you can avoid emergencies and your patient ending up blue on the floor. So me and her timed it right so that she would get up to use the commode right after her breathing treatments and I would time it so that she would get her pain medicine about 30 minutes before we made the move.


Even so, its always an epic adventure/risk but a needed one. I always try and time it so that I can spend *at least* 30-45 minutes with her on one of these trips to the bathroom (oh the beauty of having time on nightshift!). She told me, "you know you have a loss of dignity when you can't even have a normal trip to the bathroom and peeing all over the floor." It broke my heart, to feel for what it must be like in her shoes. For those of you that don't have asthma, COPD, or emphysema, imagine when you've had a bad cold in your life, that tight feeling you get in your chest that you just aren't breathing right.  You just can't seem to take a full breath. You get short of breath faster. The simple act of brushing your teeth makes you exhausted and gasping for air. Now imagine that feeling being 10X worse. Now imagine suffering through this for 20 years, until your death. You are on your death bed, gasping for air, feeling like you are slowly drowning alive. In her case, add on 10/10 excrutiating nerve back pain and you've got yourself hell.


After I got her back into bed and *somewhat* comfortable, I had some time to really sit with her and talk to her. I knew she was having extreme anxiety about the surgery and that certainly wasn't helping her breathing. So I stayed with her for an hour, sitting at her bedside, even holding her hand. I let her talk and talk because thats what she truly needed. I listened. She needed someone to listen. We all do.


As my first week flying solo (meaning I have left the comfort of having a preceptor to guide my decisions), I feel extremely unconfident. As I teach my COPDer breathing exercises to calm her down, am I even doing any good? Should I be doing more? When she says, "I can't breathe", do I freak out? If it were any patient, she'd be a CAT call or possibily even a code. But this is her baseline. So I have to think around the problem. The best we can do is breathing treatments, repositioning, inhalers and breathing exercises. But with me being so new and her being so sick, I was so nervous I wasn't doing enough. I prayed that she'd just make it through my shift, just keep breathing, please.

However I am beginning to really see whats important and whats not in nursing. I'm slowly beginning to see the bigger picture. Even though she is admitted for back pain, has baseline horrible COPD, a big big problem was beggining to be her bowels. On my second shift, she hadn't gone in over 6 days. I offered her prune juice and her prescribed laxatives but she kept refusing. Eventually I got it out of her that she is afraid to take any laxatives because she's afraid of having to rush to the bathroom and not being able to breathe. So I'm beginning to recognize that as almost an equally significant problem as both of her admitting diagnoses.

Apparently I did a good enough job, because when I got her settled in the morning, I gave report to the day nurse and we both went in to meet her. After that I finished some charting, and by 8am I walked by one more time and stopped by to say goodbye. She confided in me and told me she was really going to miss having me as her nurse. She then began to beat around the bush and was indirectly trying to ask about the day shift nurse. Eventually I had to ask, "What is your question?"  to see what she actually wanted to know, because I didn't want to give the wrong answer. She then said, "is the day nurse going to be as good as you? Is she going to.....you know, know how to take me to the bathroom like you have been?"

I was........astounded. She felt that comfortable with me? Me? A three day old solo nurse? (of course she didnt know that, but still). After I got over the initial shock, I reassured her that her day nurse was one of our best and is the nurse that even trained me. That helped her anxiety some. But I was truly astounded. After three nights of literally just *praying* she would make it.



I keep waiting for the day I can complete a 12 hour shift and feel like I *truly* did a great job. I knew how to do everything, I made all the right decisions.....but will that ever even come? probably not. At least not for a long time....



Well, goodbye for now folks, thanks for reading through!



~A Writer in a Nurses Body

Call Me if You Need Me

Hey Everyone! Its been a pretty insane week, I just pulled through 3 twelve hour's, one night off (last night) and have three more to go starting tonight. Yay! And I just started the inevitable daunting night shift this week, as well... So, I'm tired. But anyway, my hospital is starting a new approach to patient satisfaction, hourly rounding and reducing number of call bells. As many nurses do and all nurses should be doing anyway, hourly rounding is supposedly the key to making patients and nurses happy. As nurses, we naturally are in the room almost hourly anyway, but our new approach is to make it obvious with our wording, and say "Hi, I am doing my hourly rounding, Can I get you anything? I have some time." I think this is great. It does make the patients happier and they don't feel like they are bothering you if they do ask for something, especially with the "I have some time" thrown in there at the end.

At the end of our interaction at hourly rounding, we are supposed to say, "I will be back in a couple of hours to round on you again." We are not supposed to say "Call me if you need me", even if we tack it on to the above said phrase. Supposedly if we say this, it invites patients to call if they need something in the middle of the rounding cycle, and therefore there are more callbells to be answered. Whereas if we don't say it, Patients are more likely to group all their requests together and wait until we come back for rounding to have all their requests completed and questions answered. This is supposed to give nurses more time for attending to more complicated patients, emergencies, charting, etc.

Now, I have been trying really really hard to adapt to these phrases our hospital wants us to use. I try to work them into my interactions with patients without sounding like an automated nurse robot. However, I cannot seem to not say "Call me if you need me." I try, i do try to not say it, but somehow to me It just feels so wrong. Although yes I see the benefits for the nurse, I feel like my patient would feel like they cannot call me, and they must wait for hourly rounds to get something from me. I want patients to feel comfortable and call me if they need anything at all. I think hourly rounding is highly beneficial as well, and I don't want to ONLY say "call me if you need me" because then that dips the patient on the other side of the spectrum and they feel like they are alone and will never see you if they don't call for something. Then they call for every tiny request because they are subconsciously checking to make sure you are even still on the floor with them, especially overnight when not as many people are walking through the halls continuously. No one wants to feel alone while in the hospital.

So basically, I am happy saying to patients, "I will be checking in with you hourly throughout my shift but feel free to call me if you need anything in the meantime". It may not be fitting with my hospital policy, but it is fitting to my personal morals. I feel like the above said phrase lets patients know that I will be checking in hourly, and that they are not alone, but also gives them comfort that I am only a call button away.

There is a high possibility that I am wrong about this. I am a brand new nurse and still have a LOT to learn, not just skill but in communication. Maybe in even just five years I will look back on this post and think, hourly rounding is better without throwing in the "call if you need me part". Maybe I will see the true time saving benefits of doing so. Who knows. Fellow nurses out there, what are your hospital policies for rounding or key phrases? Do you agree or disagree with not saying "Call if you need me?". I just can't seem to not say it!  :-\



Sincerely, a Writer in a Nurses Body


.