Renew

It's been a while. A friend, this week, told me that she "blogstocks" me and it had been a while since I wrote anything. She's right. So, I have a thousand stories, some funny, some sad, some just downright gnarly that all 3 of you who read this don't want to hear about. Here goes---and here is hoping to being a little more on top of blogging about this crazy nursing journey.

RENEW. Webster defines it as to make like new, to restore to freshness, vigor, or perfection; to do again. This word came along twice in the last couple of weeks, one as I received a notice to RENEW my nursing license. It's crazy that it has been a year and a half since the California Board of Registered Nursing found me capable and worthy of caring for others. Although I never know what the day will hold, what a privilege. Those that know me, know that I still struggle at work (with the shear load of patients, the pressure of caring for others while giving them medications that could kill them, with expectations that I have set for myself) and I do my share of venting (some call in complaining :). To those friends who let me talk about my feelings, both good and bad, many mahalos. I will probably do that for the rest of my career, and still never fully have a grip on this thing call nursing. I paid my fees and they let me have my license for another 2 years. Wow.

A couple Fridays ago, the term RENEW took on a different meaning and it will be a moment that I never forget. At 1730 (5:30 pm), I received report for a new admission from the ED. You see, I was hoping to put off getting report because if they come to the floor after 1800 (6:00 pm), all I have to do is take their vital signs and pass the admission paperwork to the night shift. Well, that didn't go as planned, and the patient came up. She had all kinds of things going on---infected wounds, high blood pressure, dialysis, altered level of consciousness, a feeding tube--you name it, this lady had it. In report, I was told she was a DNR---do not resuscitate. Although the ED nurse wasn't clear on the details, I knew this patient was super sick. I entered the room, with several family members there. I did my nursey tasks, and the patient, although sleepy, could tell me she was in pain. I asked her about the DNR order and she nodded yes and no to what she did and didn't want. Her family was on board, but the physician pushed them to wait one more day before making a decision. I asked if they would like to see a Pastor or a Priest, and the patient's daughter said, "Sure. That would be great. My mom is a Christian." Without thinking, I said, "I am too. Can I pray for you guys?" The family eagerly took me up on my offer, we layed hands on the patient, and in that moment, she opened her eyes and said "thank you." After leaving that room, a little misty-eyed and forever changed, I knew that soon, this patient would be RENEWED. She would be restored to freshness and perfection. It may not have been on my shift, but soon she would be with Jesus, without pain and perfect. RENEWED.

How freaking awesome is that? Amidst feeling like an imposter in scrubs and Nikes, God lets me be part of His plan for His people. He has allowed me to serve those that don't have a voice, those that cannot speak for themselves, (or can but no one is listening).

Jesus--RENEW me.

Code Blue

Code Blue. It is a term I never enjoy hearing over the loud speaker at my hospital. I have only heard it twice before, but this time, it was on my unit. As I was passing my morning medications, I heard “Code Blue, 3^rd floor, Room 18.” I am still thanking God that it wasn’t my patient and I didn’t have to call it. Code Blue, you see, is a cardiac arrest. A patient isn’t breathing, his heart may not be pumping, something is definitely very wrong. It’s the worst of all announcements that can be heard, and Friday the 13th, Code Blue became very real to me.

I’ve heard the code called before, but it was always a different floor, a different unit. I’ve told myself that if I could, I would go to the codes, to experience it so that if…no wait…when it happens to my patient, I will be as prepared as I can be (if you can even prepare for that). As I heard the 2^nd announcement, I forced myself to stop what I was doing and head to room 18. 10 people were already in the room, doing chest compressions and forcing air into his lungs. The crash cart was opened, pads were on his chest, and no pulse could be found. I weaved through the crowd of people and found my charge nurse, who was recording (all the medications, shocks, pretty much anything done to the patient). I helped her keep track of time, what we’d given, how long it had been since the last dose of epinephrine or atropine. The ER doc arrived and attempted to intubate the patient, respiratory therapy was giving him air, an ICU nurse was drawing up medications, the CNA was doing compressions, the House Supervisor was keeping an eye on the heart rhythm.

After 22 minutes, 5 rounds of Epinephrine, 3 of Atropine, 5 shocks, 200 mg of Amiodorone, the patient didn’t make it. No one was sure at the time, but he was admitted for sepsis and everyone was thinking he threw a blood clot in his lung. I stood there, not really sure what to think. I gave the patient’s nurse a hug, and asked him if I could do anything for him. The strangest part of the whole experience was that the staff didn’t seem all that affected by the event, like they were just doing their jobs and now would go back to what they were doing before. Now, that could be a defense mechanism or they may see this all the time, but I hope that I never get that way; that each Code Blue upsets me, and I don’t leave that room the same. I can imagine it gets easier to deal with death, but all I could think about was where is that man now? Is he pain free, hanging with Jesus or not? All I could do was pray for him and his family.

I know the day will come that I am put in that situation. I will be the nurse that has to call for help because her patient is crashing. When that day comes, I will be more prepared for having this experience but I can imagine it will be like it’s the first time again.

Confidence

One of my all time favorite movies is The Sound of Music. I know…many people laugh when they hear that but it’s totally true. I watch it at least once a year. I love that the lowly nun-in-training ends up with the powerful Captain. I love that she has no idea what she’s doing when she’s called to serve these children that are NOT ideal. In the movie, Maria is skipping down the road to the Captain’s home, guitar in hand, belting out one of her favorite tunes. As she approaches the house, she says, “I have confidence, in confidence alone…oh help” and then continues into the house. At that moment, she sees what she’s gotten herself into, and for a moment, doubts herself.

I headed to work a couple weeks ago, positive attitude, and ready to conquer the world. After report, I was already defeated. I immediately went down the road of “this day is going to be horrible” but told myself to take it one step at a time. I was J.F.’s nurse the day before. She’d had a stroke, affecting the right side of her body. She could follow commands but wasn’t able to move the right side, nor was she able to speak. But J.F. was there; she was very responsive. I could see it in her eyes, and I could feel it when I’d hold her hand.

0700--So, that morning, in report, I was told that NO consent was signed for the placement of her feeding tube (which is usually a night shift responsibility) and the pre-op checklist wasn’t even started (yet again, another night shift duty).

0740--After getting report on my other 3 patients, I sat for a moment, composed myself, took some deep breaths and decided to start with J.F. I called the GI lab, and they told me that if everything wasn’t ready at 0845, the doctor wouldn’t place the G-tube. Ahhhh. Okay, everything just got a little more intense. All I could think was, “how am I going to get consent signed (her husband wouldn’t call us back) and get her ready—oh, and assess all my other patients?” She’s needs this procedure!

0745--Back to concentrating on J.F. I finally get a hold of her husband, and he’s on his way. My other patients are okay. I check her chart, make sure the labs are printed, EKG is filed, and chest x-ray is included. Check her labs. Shoot. Her WBCs are 28K. Dang it.

0805—Another patient is in pain. Assess his pain, check his chart, draw up his medication, take his vital signs, and give the medication. I let him know I will come to check on his pain shortly.

0815--I head to J.F.’s room only to find that she’s pulled out her IV. Seems as though the restraint wasn’t tied. Sweet. Lesson learned: check the restraints during bedside report because sometimes they aren’t tied (even though the nurse tells you they are). I have NO confidence when it comes to starting an IV. Could this day get any worse (yeah, it could probably get way worse actually!)? Clean up the bloody linens and head to the medication room to get my supplies.

0830--I head in to start her IV, knowing that there was no way I would get it. Apply tourniquet, explain procedure to the patient, shop for veins, and find a fat one. Lo and behold, I nailed it! Okay. One thing down.

0840--Get the checklist done and the consent signed, assess my patient, and get her prepped for surgery.

0845—Called transport and got the patient downstairs for her procedure.

Too many times, I enter the hospital thinking there is no way I am going to make it through the day. I have all the confidence in the world when it comes to being with patients and families, but when it comes to the so called “skills” of nursing, I doubt myself every time. I defeat myself before I even try. I tell myself there is no way you can get everything done in time, your medications are going to be late, you don’t know what you’re doing, what have you gotten yourself into? I have Joshua 1:9 written on a note card in my car and read it every morning before work. “Have I not commanded you? Be strong and courageous. Do not be afraid, do not be discouraged, for the Lord your God will be with you wherever you go.” I should probably tattoo it on my forearm!

God has called me to His service and that happens to be in the hospital. As I doubt myself, I in turn doubt God too. If He’s called me to this discipline called nursing, then by His strength, I will succeed (maybe not by the world’s standards). As a new nurse, confidence is always a struggle. Do I know what I’m doing, am I worthy to be called nurse, do I know enough to care for these patients? As I channel my “inner Maria,” I sing,

“Oh, I must stop these doubts, all these worries

If I don't I just know I'll turn back

I must dream of the things I am seeking

I am seeking the courage I lack

The courage to serve them with reliance

Face my mistakes without defiance

Show them I'm worthy

And while I show them

I'll show me.”

Spoiled!

This new nurse is SPOILED! My hospital, for some reason or another, had changed its policy. Typically, for a unit that hits capacity at 23 beds, we've had the privilege of having 2 CNA (Certified Nursing Assistants) on the floor. I have grown accustomed to what our roles are---Recently, the new policy states that there will be 1 CNA per 25 patients. My unit only has 23 beds; therefore, we will never have 2 CNAs again. Ugh! Okay, I can deal with this. Yes, it makes my job harder because I cannot rely on the CNAs to be there to help my patients when I am charting, or busy with something else. I get to answer each call light, assist patients to the bathroom, change beds, and give bed baths. I've been trained to do that, but have HAD to do it for quite some time. Yes, this new nurse is spoiled. 

Today, there were a total of 14 patients on my unit. This, unbeknownst to me, meant we were not going to have any CNAs on the floor. It didn't help that we had 3 patients who needed a "sitter" in their room, as they were a danger to themselves or others. So, today, I had to take my own vital signs (I know..for all you "experienced" nurses you're laughing right now), perform all my own morning care, assess each patient, pass their medications, chart my assessment, pass more medications, perform wound care, help patients to the bathroom, get water for them (like 50 times!), pass their food trays, give pain medication, turn them because they weren't able to turn themselves, change their linens, give a massage (she was so sweet and so appreciative of my massage skills), collect the I&Os, assess the telemetry, get a new admission at 5:45 pm, call doctors for orders, find IV pumps, get the oxygen to work for my new patient, and so on. As I went from task to task, I kept reminding myself to treat each patient like they were the only one I had while I was with them. When I entered the room, head straight to them, make eye contact, and see how I can help, as if I had all the time in the world. It helped me get through a tough day.

The lesson learned, though, is how dang important my community is! God has commanded that we live in community with others, and at this point in my life (aside from my forever friends at CBU and my family) I am learning to live in a new community. This new community is foreign, and I think I assimilated to it quite well, but it's uncomfortable at times. I never know where supplies are, I have to ask questions all day long, and I just feel inadequate at times. What helps, though (other than the fact that I love my patients and I know that God is using me), is the community that I've found works together to maintain safety and comfort of our patients. It was so clear today, that although I can survive without the CNAs help, I am so much better at my job when we work together. God's placed me in this community, at this specific time, for His perfect purpose---and tonight, I will rest in that promise.

"Use your call light when you need help."

So, here is my first attempt at blogging. This transition from working full time to nursing school and then back to the work force (in a job that I feel completely inadequate in and like a failure most days). Being a nurse is the hardest thing I’ve ever done. As rewarding as it is, some days, I just feel like giving up. God has placed me in this profession for a reason. He has called me to serve---and serve I did today.

Ms. Confused was my patient for 2 days. She came to the hospital because of a low blood count and congestive heart failure. So, when I did my morning assessment, she was alert, oriented, knew her name, the year, where she was. I thought, this won’t be so hard. Then, as the day progressed, she became more and more confused. She kept trying to get out of bed but was not steady on her feet. I reminded her, every 15 minutes for the first hour, "use your call light when you need help." 1^st mistake…not asking enough questions to assess her mental status. 2^nd mistake, thinking she would remember to call the next time she tried to get up. Oh, the mistakes a new nurse makes---a lot. My patient fell as she was returning from the bathroom. She was okay, but to make matters worse, she pooped all over the floor. Oh, the joys of being a nurse. I guess all the moms and caregivers of aging parents or grandparents can relate. It was quite the day. I ended up having to restrain her, to help her remember to call when she couldn’t get out of bed alone. As many times as I reminded her, she still tried to get up alone.

It was so interesting that I was assigned this patient. Maybe not interesting but God telling me, reminding me over and over again, that he’s placed me exactly where he wants me and I need to ask for help from Him daily. I tend to question him, and I find myself trying to do it all by myself, just like Ms. Confused did. Proverbs 3:5 says,  “Trust in the Lord with all your heart, and lean not on your own understanding; in all your ways acknowledge Him, and He shall direct your paths.” It doesn’t always work the way I want it to. Ms. Confused wanted to get up alone, but she didn’t have the strength. It has become quite apparent, that this career is not one that I will “do” alone. Looks like my patients aren't the only ones that need to use their call lights.

The life of a nurse is NOT glamorous. It is physically demanding, and for me, emotionally draining. I haven’t cried these many tears since…since…I started nursing school! I pray each morning that I will be a blessing to my patients, to my co-workers. And, yes, I came home today was someone else’s poop on my pants---and I’ll probably do it again tomorrow.