Thursday, May 28, 2009

Ready For Some Time Off

Don't know why, but it seems like I have been working ALOT lately! And the sad thing is...I really haven't been! I haven't done the 6 or 7 IAR thing for a long time, just my 3's with 2 off in the middle. But this is my last set of 3 before my "long stretch" and maybe that's why I'm tired. This week kinda messed me up too with the holiday. I didn't get to work my Sun/Mon/Tues, instead it was Mon/Tues/ I've been behind a day all week!

After my rough week last week I've been a little over anxious/nervous every time I come to work too. I didn't get my first baby 'till Wed, and that was a C/S that wasn't supposed to happen but baby only tolerated the cervidil for about 5 hrs before it got grouchy. I've done cervidils the rest of the week, I guess I had a recovery one night too, but no babies. :( Sadness for me!

I'm super glad that I get a few days off now, I need some time to sleep and exercise some, that's fallen by the wayside too many times the last few weeks. My bike wreck injuries are slowly healing and I'm not grossing my patients out anymore :) Horray!

Friday, May 22, 2009

So Much Better

So much better night at work last night...I had no nightmares today while I was sleeping! I must say, I love the nurses that I worked with. I guess I was more shaken up about the whole run-in with the doc and the crappy strip from Wednesday night, plus the 30wk SROM from Tuesday night than I thought. I had at least 3 nurses come up to me last night and tell me that I was a great nurse, that it just takes time to get the docs to trust you, and that the particular doctor didn't have a nurse there who hadn't had a run-in with her at least once. The couple nurses that had looked at my strip said they wouldn't have done anything different than I did, and that I did all the right things. That almost made me cry all over again! When I'd left Thursday morning I really felt like the worst nurse ever and that I had totally missed something super important and that I put my patient into real danger. But after all these nurses who have 10+ years of experience were saying the same thing...I didn't feel so bad!

I had a couple cervidils last night, dealt with a little drama/out-of-control pain issues...then finally gave some stadol which must have been pretty strong 'cuz Mom went from moaning and screaming with her contractions to sleeping for 6 hrs. Stadol must be a miracle drug! (or maybe once she didn't think about her contractions any more she just slept). Either babies, but no doctors mad at me either :) Off for a few days now, going to enjoy the graduation weekend at my brother's school and I'm back Monday. Happy long-weekend to everyone1

Thursday, May 21, 2009

Another Night...Another Lesson Tuesday night I learned that I should stand up to doctors when I want something or think something should be done for my patient. Last night I learned that it's probably better to call the doctors TOO often than not enough...and to go with my gut feeling instead of listening to what other people are "suggesting" even if they may have tons more experience and their opinions make you feel better about the situation at the time.

My strip turned to @(#^ last night, and after one run-in with the doc earlier in the evening I wasn't too excited about calling her back and asking for her to come back in to assess it. I had one nurse saying "ya...maybe you should call" and another nurse who has worked there WAY longer than any of the rest of us saying " doesn't look that bad. If it was bad you'd be doing something about it not just sitting here watching it." I didn't call 'till the patient was almost complete, then the doc came in and I got the very "subtle" feeling that she wasn't too happy with me, and we ended up in the OR.

The baby came out fine, Mom was great, but I get the feeling that I'm just going down the list of doctors and one by one losing their trust...not that I ever really had it in the first place. It's so hard being new and trying to figure out all the doctors. It's worse than a soap opera because everyone likes things done just a little different...and you know you're gonna do it wrong. I think the one thing that I want most as a nurse is to have the doctors hear your name or hear your voice on the phone and have the credibility for them to listen to what you're saying. For the first thing that flashes through their minds NOT to be : "why is she taking care of my patient? I hope she doesn't totally screw it up" or "can I really believe what she's saying?" or to have them worried about their patient because they know I'm the nurse. I've never once had a doctor tell me "hey, that was a good call" or "thank you for calling me when you did" or "you made the right decision" instead it's "why didn't you call sooner" or "why are you calling me now?" or "why hasn't this been already done?" or "why did you do that?"

On our way back to the OR this morning, and hearing the doctor talking to the other doctor assisting her saying "did you see the strip? why didn't she call? this never should have happened." I totally, 100% understood why one of the new nurses to OB just quit. I totally understood...

Babies today: 1m
Babies total: 46M/48F = 94
Vag:34M/38F = 72
C/S: 12M10F = 22
Babies 'caught' = 1f1/2m

Wednesday, May 20, 2009

Breaking Patients

So after getting sent home @ 0200 on Monday night, I got the dreaded 'you're on call" phone call @ 1745 last night. I was seriously on my way out to my car...bother. So I sat around after having slept all day, kept texting one of the nurses at work who assured me that everything was nice and quiet and under control. So finally about 0115 I sent one more text saying I was going to bed. My phone rang exactly 10 minutes later "we need you!" I come.

I loved my patient that I had, she was 30+1 weeks and had just SROM'd. Absolutely nothing was done for her when I got there other than a sterile spec by the laborist to confirm rupture and that she was closed. IV, antibiotics, one dose of beta, tuck her in. She was "cramping" every 5-10 minutes she said but didn't say they were any more intense than a menstrual cramp. I finally called the doc about 0430 just to let him know that she was still contracting every 5" or so and if he wanted me to do anything about it. He said "no, just watch her and call her primary OB @ 0645 with an update." Ok, wrote those orders and watched.

Her baby looked amazing, and the patient even got a little sleep. Then about 0630 I went in to check on her and she said the last few contractions had gotten worse, she puked on me (that's way too many patients that have puked on me in the last few shifts!) and said she felt some pressure. So I checked her...she was 4/100/-1. So the primary OB got called a little earlier than 0645 and he wasn't too happy that she hadn't been mag'd already. So we got the mag bolus in, I gave report to day shift and she delivered while I was walking out the front door. The doctor got there, and last I heard baby was doing good. My heart was pounding most of the morning though. That was a little intense for the end of shift! The patient was AMAZING and handled everything perfectly.

I can't help but wonder if there was something I should have done differently though, if I should have pushed the Mag issue with the on-call doctor and laborist a little harder or what. All the nurses at work said I did everything I was supposed to do and that it was more between the docs than me. But my heart goes out to the patient who all of a sudden has a 30wk baby she wasn't expecting. Sigh...drama, drama, drama.

Tuesday, May 19, 2009

Birthday Twin!

So Monday was my birthday, and I wasn't originally supposed to work. But then I switched a shift with another nurse so she could do something with her I ended up working. I know nobody likes to work on their birthday, but I thought it was kinda fun! I had put in the request book that I did want a labor patient, because if I was gonna work my birthday, then I didn't want antes or postpartum!

The worst part of the deal was that I only got one night off (Sunday night) between my 2 sets of 3 IAR, so that was kind a bummer. But tonight was good!

I did get my birthday twin, a nice couple, a good delivery. She delivered right around 2100 and had a little girl! Yay! It's kinda weird to think that not-all-that-many years ago that was my mom and dad looking at their first baby and not sure exactly what hit them...then here that baby is helping another mom and dad do the same thing! That's pretty cool :)

It turned out that we had 3 back-to-back-to-back deliveries all within about an hour of each I really got about 3 birthday twins! We all moved our patients over and went from 6 nurses down to 4, then when there were 3 of us sitting around with no patients someone else had to leave. It was my turn by dates and for once nobody else wanted to leave. Most of the time people are jumping at the chance to go home early, but not tonight I guess! So I had to leave about 0215. I didn't really want to go, 'cuz I'm back the next two nights and if I was already there for 7+ hours there was no point in leaving. Bother...

My very cool family brought up treats to the floor about 2200, I was way surprised! It's my brother's finals week at school so he and mom are pretty tied up, and I knew I had to work so took a nap today so it wasn't really any different than any other day, even though it was my birthday. But then I got a fun surprise at work with the food, so I was excited. I'm pretty lucky (and so are all the nurses who work with me!) to have such cool parents!! Maybe I'll make working my birthday a habit!

Babies today: 1f
Babies total: 45M/48F = 93
Vag:34M/38F = 72
C/S: 11M10F = 21
Babies 'caught' = 1f1/2m

Sunday, May 17, 2009

Done With The Weekend

This weekend has been CRAZY. Not "no end of patients" crazy, just steady and "nobody goes home" weekend! After the 33wkr came in with no heart tones on Friday night, things just snowballed.

I feel like I've gotten SUPER lucky though. I've had AMAZING patients and AMAZING delivereis EVERY NIGHT!! Makes up for that week of all antes and NO babies! Anyway...I'm pooped!

Friday night I got a totally cool patient, she's a nurse at one of the children's hospitals in town. I feel an extra bond when the patient is a nurse too, even if they don't know the first thing about labor. I think there is something to be said for having the common ground of just working in a hopsital. They know what it's like to get tied up with doctors, they know what it's like when things have to change or don't go EXACTLY as planned, they've learned what it's like to go with the flow. Even if you're not a nurse, you still understand the environment and how things work. She had a beautiful delivery, she was 6+ feet tall, dad was like 6'6", baby was big too, but looking at mom you would never know! Baby had a nuchal X2 and her poor little face was SO bruised! Worst bruising I've seen in a very long time. After baby got weighed, Mom realized that she weighed the same, was the same length and also had a nuchal when she was born. Talk about "like mother like daughter". They were so greatful for a baby that they'd been trying hard for, and were happy with how everything went. Yay!

Last night, another early delivery in the shift, less than an hour of pushing, another >8# baby, amazing family, funny as everything. I love patients who make me laugh and will say anything they're thinking. Dad kept asking when he was going to get to put on the gown and mask and hat (gotta love those 80's birthing class videos...updates anyone?!). So I finally gave him one of C/S hats and masks. He decided that after he put the hat on he looked more like a food service worker than a doctor, so he didn't wear them for delivery. It was so cute. He wanted to cut the cord so bad, and when the doctor started to clamp it Dad yelled "I'm supposed to do that!!" We laughed and said that the doctor had to clamp the cord first, then handed him the scissors and let him cut the cord. He apologized for getting so excited and I said I was glad that he said something instead of missing out on the opportunity he wanted...but it was pretty funny.

After delivery/recovery I did one triage that I sent home, and then got a 26wkr with pyelo that I bolused, gave some antibiotics and tucked into bed. Then about 0400 the "bus" rolled in and I got a labor patient who was dying with uc's, sat down in bed, started a contraction and promptly said "I'm going to puke." I grabbed a bucket and ALMOST got it to her, which she missed and all over my hand it went. Remind me to ALWAYS wear gloves when I'm anywhere near a patient because who knows when they're going to spew. It was gross. I'm patting her back and telling her she's doing great all the while gagging with every heave. I don't do puke.

Her 6y/o step son had come to the hospital with them and was sitting on the couch wrapped up in his pj's and a Thomas the Train blanket and I figured we'd have either tears or another pile of puke in the corner but after she was done and I was dumping the contents of the bucket he was like "Dad, is that throw up?!" Leave it to a 6 year old.

After I threw in an IV and got some zofran on board I promptly walked back to the OR and told the doc that I had a patient of hers who needed a block. I felt bad later, I don't even think I asked, I said "she's been here 15 minutes, she's 3/100/-2, she's puked on me and I'm waiting on labs for a block." She kinda said..."uh...ok, go ahead." I guess I'm more assertive than I thought!

She did change her cervix and was 5 with a bulging bag and was laughing watching her contractions on her monitor and not feeling a thing. I totally was wishing that she'd come in at like 2000 instead of 0400 so I could have done her delivery. Oh well...

I can only hope I get 3 more deliveries this week too! I switched a shift with someone so I'm working on my birthday and I requested a labor patient. If I'm gonna work my birthday then I at least want a birthday twin!

Babies today: 1f1m
Babies total: 45M/47F = 92
Vag:34M/37F = 71
C/S: 11M10F = 21
Babies 'caught' = 1f1/2m

Saturday, May 16, 2009

Hard To Go Back

So after my little "bike accident" on Monday...I've turned down more extra shifts at work than I EVER have. Mark this one down for the record books...I didn't even step foot inside the hospital since I left last Wednesday morning 'till I went back for some simulation drills this Wednesday night! That's over 7 whole days...gotta be a record for me!!! I'm sad about all that extra that I missed :(

I felt super guilty and stayed for 2 hrs after the sim drills to do a C/S recovery Wednesday night and counted it my extra shift for my week off. And then did a full 12hr shift Thursday night. Things haven't slowed down...that's for sure!

I did have a nice delivery, first one in a while after having antes all week last week. I went in early for a nurse so she could leave @'s amazing how just an extra hour or two at work can make the shift seem never ending. After the delivery I took a cervidil, then another cervidil, then handed them off, then took one back, then did a triage that I sent home. Ah...the staffing matrix...

I'm still sore after my date with the pavement this week, and all the docs are mad at me for not going and getting the "full workup" after it happened...but one wrote me an RX for some stuff to keep the scabs soft so they look nasty, but at least they're not cracking and splitting open when I sit down or bend my arm. The bruises are turning nice colors :)

I got a Facebook message from a friend telling me that one of their relatives was a cervidil that night, and would I please take care of her. What a compliment! She took right off the cervidil too, I got her blocked and she delivered pretty early after I left. Yay for her!!

Babies today: 1m
Babies total: 44M/46F = 90
Vag:33M/36F = 69
C/S: 11M10F = 21
Babies 'caught' = 1f1/2m

Monday, May 11, 2009

Bike Crash more story from my "non-work related life."

Beautiful day today, so I decided to go for a bike ride instead of the running I was planning to do. There's a great trail just down the road that's about 24-miles round trip from end to end, so I thought it would be a great day to ride it. Set out, it's beautiful! About 5 miles into the ride there's a small hill on the trail that got wiped out in a flood a few years ago and they've never totally finished it, it's still gravel and torn up trail pieces. It's normally no big deal, but today my tire caught on it "just so."

I skidded to a stop on my elbows and knees and the first thought I had was "it's gonna be a sore ride home from here." I've whipped out numerous times before (running, rollerblading, etc.) and I usually pick myself up and head back, 'cuz how else am I supposed to get there? Anyway, as soon as I got up everything hurt, especially my L elbow. My first hope is "I really hope my elbow's not broken...I gotta go back to work on Thursday!" A very nice older couple about 50ft ahead of me had heard me crash and they turned around to make sure I was OK. I told them "I'm fine!" at the same time thinking "Ok, maybe I'll just have my dad come and get me..." I whipped my phone out of my shirt (I had no other pockets...where else was I supposed to put it?!), walked my bike over to the edge of the trail and called my dad.

I got out "Dad, can you come pick me up at X access point on the trail..." and that was about all I clearly remember. I remember bits and pieces...the couple helping me sit down; my dad saying "where are you again?"; feeling really dizzy; not being able to focus; feeling my head go side to side; thinking "Come on BirthdayNurse, just open your eyes and focus!"; thinking my knees really hurt and hearing my phone ring again but not knowing how to answer it; the woman asking me my Dad's phone number and having to think really, really hard about what it was, and then not even being sure that I said it out loud.

The couple called 9-1-1, even though I kept saying I didn't need it. About 5-7minutes (from what they told me) I finally snapped back into it and was OK. About that time my dad and sister got there...along with 2 cop cars, a fire truck, an ambulance and the park rangers. They checked me out, cleaned up my road rash, had me sign a HIPPA form (first time I've been the signee of one of those...) found out I was a nurse, asked me if I wanted to go to the ER (I said absolutely not) and said thank goodness I was wearing a helmet!

Next time I'm gonna do it up good and deserve an ambulance ride! Good thing I don't have to go to work 'till Thursday, I'm best friends with the Advil bottle at this point. I had forgotten how many nerves are effected scraping off that top layer of skin!!

Top "owie" on my L knee

L elbow/forearm
(this is the one that's obnoxious!)

R wrist

Both arms

Thursday, May 7, 2009

Week's Worth of Work

Things I realized this week:

1) I hadn't had antes in a long time
2) I had antes twice this week and that was enough for a long time
3) Antes are all just little time bombs ready to explode...and I'm always afraid that they're going to explode on my shift!
4) If they don't explode...antes are boring after the first couple hours
5) I went all week with no babies...that made me sad and only slightly grouchy on my last night
6) I actually am going a WHOLE WEEK without working extra (because I was out of town the nights I wasn't working...)
7) I have GREAT job security...

Sunday, May 3, 2009

And Another Night...

12hrs Monday night, 12 hrs Tuesday night, 13.5hrs Wednesday night, got a call and went in @ 0430 on Friday morning, then got another call last night and went in from 2300 to 0400. Part of 5 shifts in 1 week! I took tonight off before I start my 3 IAR tomorrow.

When I got there last night they re-evaluated the board and kinda figured that they hadn't needed me as desperately as they thought they did, several of the patients ended up going home, and they did some re-assignments. If we get called in, we get paid for at least 2 hrs, so I figured I'd sit for 2 hrs and then go home. I helped move a patient or two, did some random stuff and was just about to leave when one of the doctors came down from the lounge and said he had a patient coming in who thought her water broke. He said that her own doctor was coming on call at 0700, so to just tuck her in and wait for the morning. So I said I'd hang out, get her started, then leave.

Story short, she delivered an hour and a half after walking in. 3rd baby, SROM'd, unblocked (delivered all 3 kids without one!), it was great! She came in 5-6cm which was what she'd been for the last week or so and said her contractions started after her water broke. Funny how labor happens when it's supposed to!! I think I finally got her admission paperwork done about 45minutes after she delivered.

I felt bad for her after the delivery. The delivery was flawless, she pushed maybe 3 full times, no tearing. The on-call doctor made some off-handed jokes, and then said "maybe next time you should try an epidural...just for the heck of it! Haha..." and he left. She asked me later, "did I do something wrong? Was I a bad pusher? Was it a bad delivery? Why should I have gotten an epidural?" No, no, no! She was a rockstar! She did everything perfect! I was so ticked at the doctor for what he said! Why would you tell anyone who just pushed out a baby without any meds (she didn't even want nausea meds!) that they should try a block "just for the heck of it"? Come on, now! Made me mad...

Came home and tucked myself into bed at about a quarter to 5 this morning and slept great! Enjoying my one night off...and starting all over tomorrow!

Babies today: 1f
Babies total: 43M/46F = 89
Vag:32M/36F = 68
C/S: 11M10F = 21
Babies 'caught' = 1f1/2m