What Do You Do With a Day Off?

What do I do on my day off?  Well, since I live at 1927 House, my day off is spent working on something.  If you visit me, you'll get an hour of being fussed over, the dog will kiss you as long as you'll tolerate it, and there will be tea in the good china at the dining room table...but if you stay longer than that, the dog will go back to sleep and you'll be put to work.  You can start anywhere, and do anything you like; this place is a handyman's dream. Like to drywall or plaster?  How do you feel about tile?  Come by next week and I'll have plumbing for the Inner Plumber in you.  I promise, the sound of a sawzall does not disturb the dog at all, so have at it!

After ridding ourselves of the Great Striped Wasp Migration of 2010, (highly recommend the Rigid contractor's vac) we went to Homely Despot and loaded the van with materials to finish our countertops.  We're covering them in Weathered Stone ("The World's First Bendable Stone" www.weathered-stone.com.) The malleable plaster and vinyl "stone" is perfect for jobs like ours because I can wrap a bullnose counter edge and I don't have to spend a month cutting tile to fit.  We'll grout, coat the whole thing with clear epoxy floor finish, and it's a wrap.  My husband, Mr. Geometry, is laying the product out on-point.  Weathered Stone is made in Fairhope AL, and is the brainchild of Sean Howard, a former paperhanger who is a friend of ours. We like to give him a plug when we can.

As I'm standing at the wall taping drywall joints, I am thinking of my favorite squirrelly patients.  Hospitals spin off their own sort of humor, the best of which is the recent "There is a fracture" cartoon.   Patients tell me all sorts of things, mostly because I haven't yet learned to flee when they start to speak.  A 90-yr-old struggled to speak after a long convalescence; I wondered about his LOC and orientation when he said tenuously, "I know the man who invented the hospital gown..."  I stopped what I was doing and looked at him.  "His name was Seymour Butts."   I blinked; then laughed.  He got me on that one!  One could also never forget the garrulous patient with lower leg cellulitis who nevertheless stumped out to the station to ask, "What is it that the more you take away from it, the bigger it gets?"  Hmmm.  You got me there, pal; what is it?  "A hole.  Gotcha!" he chortled with glee.  So glad I could make his day. 

After the patient humor, I just couldn't let a good giggle opportunity pass, so I went to the internet.
Q: How many nurses does  it take to change a light bulb?
A: Twelve: One to do it. One to chart it. Ten to write the policy and procedure. http://www.jokes.com/funny/health/doctors--nurses--lightbulbs

Vintage Nurse out.

Time On Your Hands

First of all, after several months of utter mayhem q shift, it was an unexpected surprise to find two nights in a row where I was not hideously busy.  I was busy, mind you, but not ridiculously so.  In other words, I was able to think ahead rather than react to a series of crises.  This was nice.

I even had time to do the sorts of things I do to occupy myself when things are slow, like restocking syringes and changing IV tubing.  Sure, restocking is done once a week by Central Supply, but that's small comfort if you've ever been ultra-busy and needed a saline flush STAT only to find the box empty and had to hunt for backup supply.  Restocking is a good way to get to know where supplies are, before you need them in a hurry.  I like to tidy things up, because having the med room in a shambles is to me like visual "noise" which I find very distracting.  And I contemplate pressing philosophical questions such as, why do two med rooms have a full supply of Day-of-the-Week tags, but the 3rd never does?  Night Shift Nurse remains baffled.

At about 0200 the floor went quiet; not an infusion pump beeped, no bed alarm split the silence.  Aaaah.  There is something to be said for any job that takes you away from the clamor to be endured on days and 3-11.  I made a bed check just to be sure the patients weren't getting away from me.  They were all snug in their beds; Lung Lady, the Moaner,  Mrs.NPO, BatLady, and Smiley; all snoring, the IV's infusing beautifully.  "IVF, O2, and patient safety maintained." You have to be careful with moments like these; they make you  think you've become Wonder Nurse and created the present serenity, when in fact it's pure dumb luck.

Down the hall, the staff were beguiling the time in conversation.  "Do you all follow nurse blogs?" I asked.  They looked at me blankly.  "Noooo..." they responded, after a moment to figure out what I meant by Nurse Blogs.  I wanted to tell them about Head Nurse's surgery, and how proud we all are of Crazed Nurse, and the latest ER story from Storyteller Doc, but I didn't think they'd get it.  Instead, I heard gardening and canning tips, we discussed the whereabouts of the last 3 heavy-work patients who had left, and Blondie told us an amusing story of an elderly woman so reticent that she could never bring herself to speak of her genitalia as anything but "my kittycat."  (I'm not a native; it was a new one on me.)

We looked at one another.  Our hardworking CNA heaved a sigh.  "Well, who wants to help me turn patients?"  Several of us volunteered and wandered off to the next Code Brown.  The rest returned to charting.  And so it goes...

Commodores - Nightshift

Night Shift

I'll have to tell the story on myself:

Now I find, after all the aversion I experienced over the prospect of work on the 11-7 shift, I actually like it.  Really.  For many years I dreaded working the Night Shift, but it's far from an  unworkable situation now.  I have no trouble staying awake, little difficulty sleeping during the daytime, and I enjoy being the quiet voice of reassurance in the dark hours of the night.  Of course, I no longer have little ones depending on me for three squares and program direction.  My Darling Dog sleeps when I do, regardless; although she is puzzled about my going out late at night to work.   It's just as well that Dog Daddy sleeps nights and consoles her with biscuits.



What happened to the Night Shift Effect I recall?  The post-shift feeling of being among the walking dead, the days misspent lying in bed, and still feeling foggy with fatigue on arising?  What happened to the feeling of missing everything that was important in life?  I never could see how others did it.  For decades I swore I'd sooner be hanged than work the Night Shift. 


I promised myself the one thing I will NEVER, EVER do is work the Night Shift, yet here I am.  I offer you the next 10 minutes to laugh--gloat if you must--over my former silliness ( I really had worked myself into a froth over this) but your privileges expire in...9.6 minutes.  I'm counting.



County General is a well-run tertiary care hospital.  Our medical unit is a magnet for high-acuity patients who also have concomitent physical, psychological, and social challenges.  We see more than our share of non-compliant diabetics and COPD'ers, plenty of elders with UTI's and altered mental status, more people with clostridium difficile and MRSA than I ever thought existed, and the odd rara avis.  More on the Bird of the Day later.



The true beauty of the Night Shift at County General is not rank or privilege, but teamwork.  At the moment, we manage to work together through the most difficult nights, without calamity or expecting fanfare.  A sense of humor is indispensable.  For example:


At the start of shift, our census had been low; we knew it was too good to last.  At 0300 our capable CNA stopped me in the hall to chat; "Do you believe this," she asked me, looking not at all incredulous. "This is the--what?--fourth admit tonight?" Here she smiled ruefully. I had been wondering myself how many more new admissions the supervisor was going to send us.  My hands were full already with high-acuity patients when ER called to announce the impending arrival of yet another new patient. The one that would cost me two hours of work and more.



"Do you work tomorrow?" she asked solicitously.

"No, I'm off one day and then I'm back Tuesday night. Are you on Tuesday, too?" She nodded, continuing, "It seems like I never get time off.  I'm here all the time." 

I replied, "Well, after Tuesday I'm off for a week...but (noting her shocked expression) remember I only work part-time."

She blinked. "I'm not speaking to you," she said firmly. "A whole week off!  I'm not talking to you," and she strode off in the direction of our latest admit shaking her head, but smiling.

"I'm going to spend my day off hanging wallpaper, if it makes you feel any better," I called after her, still laughing.

Return to Nursing 1988

I left nursing to become a full-time mother, and by 1988 I had three children, a son age 9, and two daughters, ages 7 and 3. I loved motherhood; we spent long hours at the park and library, and made ceremony of bedtimes and snowy days. The children caught insects and had the usual lineup of pets; rats, toads, & an ill-tempered box turtle named Mort. I was a big fan of finding new things for the children to try, especially during the interminable summer breaks. This year was radically different, though; my then-husband had been laid off for several months and after a month or two of dithering I decided I'd better take the nurse refresher course in case I might need to work as a nurse until he found another job.

A nurse refresher course was readily available through my old college nursing department, and with very little ceremony I found myself sitting among 24 peers, listening to day-long lectures on body systems. I did surprisingly well on the tests. I had not wanted to go beyond nursing school in college; this experience made clear that I could do the work. After a month of study, we were required to do 2 weeks of clinical experience, which I also passed, and then I had to do the thing I least wanted to do in life; leave my children and go out to work. Because I was sure I would not stay at any job for long, I didn't apply at a hospital, but chose to work for two agencies. They sent me out to do whatever was available; staff relief, nursing homes, private duty, and home care.

The paycheck was about the only good part of the experience. Despite taking any work offered to me, I didn't make enough to pay all our bills, a fact my husband reminded of every time a bill came in. Rotating shifts was bad enough, but leaving the children in the hands of their father who might--or might not--maintain their daily routine was very difficult. I would call home and ask, what are the kids doing? "I don't know; they're outside." "Where outside, what are they doing?" I don't know," he'd say, "I'm working on the porch."

The children hated the whole idea of me working, and their natural energy demanded a response I couldn't give. It seemed to me that they were all lined up with their hands out; one wanting to play, or tell me a story, or show me a picture, or ask me when is payday. I remember coming home from work one night so tired and depressed all I wanted to do was have a shot of whiskey (make that several shots) and go to bed, to find we had drunk all but the last three drops. There was no money to buy more. I broke down and cried.

I worked 3-11 so I could spend part of the day with the children, but found it hard to get up in the mornings with any enthusiasm. I worked 11-7 when it was all I could get, and even did a few 12's, which I found utterly draining. Oddly, I didn't have the energy then that I have now. I also worked staff relief in a hospital gynecology/oncology unit, which was the first place I ever used an automatic BP cuff and O2 saturation monitor. The patients tended to be frequent fliers, and many of them had perfectly horrific fistulas, obstructions, and non-healing infections.

I recall one of my favorite patients returning with a possible bowel obstruction. I got the order to put in an NG tube. I laid out the equipment, explained things to the patient, handed her an emesis basin, and began to pass the tube--whereupon she hosed us both with about 500ml of stomach contents! I managed to get her a wash basin for the second round of emesis, and between heaves the patient apologized profusely. "No apology needed," I said, managing a smile, "Looks like you really needed that tube!"

I also worked the general surgical floor, which was a nightmare of heavy patient assignments. One end of the floor held oncology patients who were admitted for chemotherapy, which was administered with much cautious preparation by a harrowed RN named Stella. Many of her patients had nausea and were generally miserable, which kept Stella running. I did a number of shifts in orthopedics, which I liked. It took no more than a few overwhelming evenings on the GU floor to understand why they had a chronic staffing problem; the patient load was heavy and the patients' conditions subject to rapid change. Oddly, it was there that I met my first Cystic Fibrosis patient. On most units where I floated the staff was happy to see me arrive because I was filling in, but no unit seemed like a place where I would spend one shift longer than necessary.

Home care was a bit better. I found my natural empathy went a long way toward calming patients and most of them liked me. I remember heart patients and chronic kidney patients, and a bowel-obstructed oncology patient whom I connected to TPN every night. I once arrived to start an IV infusion for a troubled young woman and I needed to take vitals first. Damn; that day I had left my nurse bag containing the BP cuff etc., at home. I knew I was in trouble when I phoned then-husband and asked him to bring me my nurse bag, and got the truculent reply, "What do you need it for?" I was on the patient's phone--which was in her room--trying to maintain a calm, professional, demeanor while I wrangled with him and the minutes ticked by. Finally convinced of the importance of having my equipment, he consented to bring me the bag. As always, his attitude was that his work, whatever that was, was "important" but whatever I was doing was not.

In home care I met Luke, my first AIDS patient, who was being cared for at home. Luke had a Hickman catheter, and I recall spoiling more than one Tegaderm trying to stick it to Luke's chest and not itself. After awhile, we became something like friends, as much as could be expected considering neither of us was where he wanted to be. I often thought I did more for his family than for the patient, for I was able to provide them emotional support during that difficult time. I had cared for Luke for several months when I stuck my finger trying to close a sharps box in his room. I went to the bathroom, poured bleach over the finger, and forced it to bleed. I forced myself to breathe slowly, remembering a prayer someone once prayed in extreme circumstances; I prayed, "Jesus."

The needle had been on a saline flush syringe, which greatly reduced the chances of me coming in contact with an HIV virus. I couldn't go back to Luke's after that. Everything was a haze of HIV testing and months of gut-wrenching worry. Luke's family was devastated. That was when the irritable bowel syndrome began in earnest. "All I wanted was to earn enough to feed my children; I can't believe I could die for it!" I said to myself, although it never came to that.

Catastrophe always goes in threes. At the same time I thought I might be pregnant, and not long after, our Aspen wagon caught fire in the parking garage. Fortunately, a security guard saw it and called the fire department. The catalytic converter had burned itself out which only happens once, so don't worry, our auto mechanic said cheerfully. Two weeks later, in the same parking garage, the Aspen caught fire again and this time it burned out the entire auto interior; no one noticed.

There was a steady stream of chronically ill home care patients, including two children under the age of 3. Both had been born prematurely; one was expected to live, and I spent long nights caring for her. The family living room was overflowing with the baby's crib and equipment which included apnea monitor, continuous humidified O2 to her tracheostomy, and G-tube feedings. She was an irritable child who would not suck or feed or do much else except grasp occasionally and stare at tv; she never smiled and had an eerie noiseless cry when displeased, which was often. Some nights I looked at her and wondered whether the parents, who had gone so far to save her life, had not saved her for a life of abject misery.

My other patient had obvious developmental deficits incompatible with living to school age. Obvious, that is, to everyone except his mother, who had given up everything including her marriage to "save" her baby. I stood in this child's room where he was surrounded with soft colors and beautiful plush animals, listening to Mom explain his care. Her unresponsive son was an edematous respirator baby, about the size and consistency of an oversized doll. His world revolved not around his furry menagerie but the tubes forcing air into his unwilling lungs. Despite Mom's chipper narrative and affectionate attentions, his response never advanced beyond blank, open eyes. Through experiences like these, I came to understand that medical science has a long way to go and while it knows how to prevent death with devices that can perfuse the body's tissues almost indefinitely, that is not at all the same thing as living.

The year 1988 ground on as I redeveloped nursing senses & saw all sorts of patients. It was my personal opinion that I still lacked some element of knowledge or attitude that would have made me a good-enough nurse. Add to that the fact things were going no better at home, I was chronically exhausted, and I was just holding on until my then-husband got a new job so I could go back to motherhood. Over the few next years, I enjoyed some aspects of nursing, but had an abiding animus against nursing as a career; it took me a very long time to understand that nursing was not really the problem.

"Camp Nursie Here"

If each area a nurse works leaves its mark on the nurse identity, then I have amassed a dozen identities over the years; my favorite was Camp Nurse. You haven't lived until you've managed health care for 125 Girl Scouts and a score of adult staff for a full week. I agreed to my first week of camp nursing because I could bring my girls for free, and I was promised the only cabin in camp with air conditioning. (I’m a real wuss when it comes to camping out.) What a week it was! Homesick campers, asthmatics, international staffers with allergies, hyperventilating adolescents, dehydration, and Camper's Complaint (constipation-induced stomach ache) filled my camp nurse days with drama.

As I recall, this is an outline of camp nurse duty: the week begins with Sunday afternoon intake, an event that fills my Infirmary wall-to-wall with excited campers and nervous parents. I and a helper wade among them, taking temps, checking medical forms, and examining for head lice. I organize camper medications and write out MAR’s before supper and prepare for the week's routine. Medicine call begins with before breakfast ac meds (which the sensible nurse administers clad in bathrobe and slippers) and ends after evening meds at bed time...if the campers show up on time. Be aware that the camper with the heaviest hs meds always signs up for Night Owl Stargazing.

A camp nurse learns to say things and make them stick. "No, you can't have a nurse excuse to avoid diving practice." Not even if you pretend to have the following: the 45-minute flu, excruciating pain related to a microscopic cut, unnatural dread of horseflies/menstrual cramps/garter snakes, or you think you might have poison ivy. Homesick campers are gently but firmly denied a tearful phone call home to be picked up . The remedy for most homesickness is getting involved in activities; campers are encouraged to pair with a counselor "buddy" for moral support, write distraught notes to the camp mascot if they like, and check in with the nurse twice a day. The goal is to stick it out for three days, after which the director will phone home, but by Wednesday it seldom comes to that.

Campers at risk of dehydration and heat prostration must be taken seriously. "You may spend 60 minutes in the air-conditioned nurse's office; I want you to drink a glass of Gatorade and then plain water, and sit quietly. After that, you'll (almost always) return to your unit," (not lie here in a bunk and quiz the nurse.) “Counselor, while it's this hot, make sure you have extra fluids for campers to drink, and watch everybody drink a glassful every 2 hours.”

The change to a new diet is enough to throw some campers’ digestive tracts off. Remember root dietary causes when dealing with "homesick stomachache" which is constipation that manifests as generalized stomachache and homesick feeling. During assessment the nurse should ask, "Did you poop today? Yesterday? Not sure?” and after ruling out something more serious, “Eat this apple and drink a glass of water. Counselor, remind her to eat fruit at lunch and drink fluid every time it's offered. Feeling a bit better? No, lying in the nurse's office will not help, but exercise will. Come tell me how you're feeling at lunch. Bye!"

There are serious issues in camp, as I learned when an intractably homesick camper was picked up by her (at least verbally) abusive father. In the absence of abuse evidence we had to let her go with him and her totally cowed mother, but I regretted having to do it. I watched racial conflict play out before my eyes, between a white camp staffer and the family of a black camper who had acted out and was going to be sent home. As camp nurse it was my job to second the director in cases of campers or staff who needed to be disciplined; many discussions took place with me as observer. I was the second line of emotional support for staff as well. One quiet afternoon I was working at the Infirmary, Rimsky-Korsakov's "Scheherezade" on the stereo when the director came in, shut the door, and blurted, "Take my blood pressure; and turn down that music, it sounds way too much like my life right now."

Then there are the things you will learn nowhere else. Camp nurses learn to announce at the weekly dance, "Campers who insist on head-banging to 'Bohemian Rhapsody' will NOT receive Tylenol for headache after the dance!" then make a show of watching the campers dance for awhile. This should be continued at least until the first emergency sprain draws you away. In anticipation of minor emergencies, I found that a military surplus medic's pack makes a fine nurse kit, if stocked with band-aids, thermometer, adhesive tape, ace wrap, bandage scissors, and so on. I also figured out how to sweet-talk the grounds keeper into handing out replacement shower curtains, a thing he was inexplicably reluctant to do.

The camp nurse is relied on for advice on all things medical. Utter annoyance compelled me to tell staff at a week's end meeting not to hover over the girls so much. The campers in question, aged 11-13, had been doing glass art all week and a few of them had suffered minor cuts. Staff was concerned that the activity was too risky; should staff handle the glass for campers to prevent future lacerations? Having observed activity in the craft house, it seemed a controlled risk to me and I said so. "When DO we let the girls take risks, if not here under supervision? Let's empower them to get cut occasionally, if that's what it takes to help them explore new things."

Bear in mind that camp life is not quite real compared with everyday standards and those who survive it get a sense of proportion and humor right quick. I didn't have a sense of humor when I started out, but I began to develop one after my friend Maureen insisted I participate in Costume Night. She fixed me up with an over-sized, deflated, mylar fish balloon (in shocking pink) which she affixed to dangle from my bandaged forearm...and called me a shark bite victim.

Camp life can also be a grind—long stretches of wet weather or heat bring on health problems and snappish tempers. Even in good weather, mental health among campers and staff can go awry, and since our reason for being there is all about girls under the age of 18, staffers need a firm grip on themselves. Everyday camp survival for me involved carrying a travel mug, learning the hours at which dining hall coffee would be fresh, and cultivating what I considered a MASH-casual look. T-shirt, shorts, stethoscope, and a pink name badge. Regardless of the badge, someone jestingly called me "Nursie" and it stuck like super glue. In the end I resigned myself to being called Nursie and gamely answered the phone in my cabin, "Infirmary, Nursie here." Whatever you’re doing at camp, you just can’t be too careful; one morning I entered the bathroom to find gigantic cockroaches climbing the mirror. They were no less horrific for being plastic! Another morning I was arrested by the Fashion Police and cited for passing meds in my unfashionable bedroom slippers. So much for the dignity of the adult.

Somehow, I enjoyed the unpredictable quirkiness of camp nursing. Girls who started out as strangers and argued over caper duties all week became the closest of friends by the end of Friday night campfire. Over time I watched girls grow into young ladies; I was amused at their squabbles, and touched by the way they'd come to the Infirmary in a noisy, untidy flock, bringing an injured or ailing friend and watch over my shoulder with terrible concern as I went about the examination. I wasn't so much treating a camper as treating the lot of them and educating them as I went. We had many daft-but-serious talks at evening meds and treatment time. Life is never so glorious or so crisis-filled as it is for teen aged girls who feel they are among friends. For obvious reasons, camp nursing is not for the faint of heart, but in many ways it’s the opportunity of a lifetime.

Encore Nurse - September 2009

Trust me, you don't want to know how long ago I left nursing, or how little I have missed it since then...

I had grown to despise the shifts and rotation, the post night-shift dead feeling, and never knowing whether my relief would come in at the end of my shift.  I was not unhappy to bid acute care nursing farewell and enter home health care, and then toss the whole thing over when the children came along. 


Mostly the problem was about me; I had a lively family of three children and an overgrown toddler at home, a husband who was also frequently out of town on short notice, and no reliable babysitter.  On going back to nursing at the height of the AIDS epidemic in 1988, I found things changed but essentially the same; more IVACs, higher patient acuities, more responsibility, and little support for nursing.  I had plenty of that back at home!  My then-husband *loved* the idea of a two-income family and made a case for me staying in nursing.  However, he did not make himself useful in family management, so his grand vision for me, in practice, meant I’d have two full-time jobs: nursing and family management.  This was often reflected in his attitudes about work; his work was Serious Business and nothing took priority over it; my job was Just A Little Pin Money and was something to be disparaged when my shift fell at an inconvenient time.  Seeing all this, I was determined to work for awhile and then get out again, and I did. 

Some things are worth waiting for, I guess.  I was surprised to find I have interests and experience that are of value in the world of nursing after all this time.  Of course I'm going on the word of a BSN and an MSN, but I'm taking their opinions as authoritative. 

At the center where regional nurses go for continuing education, their interview centered around my past experience as an RN and my current computer savvy, which I had thought pretty marginal until I told them about my experience.  No, I'm not afraid of computers, I can do email, have a Facebook account, and in general can run the Microsoft Office suite.  How did I learn this?  Try running a small business without them!  I completed a course on Computers for Educators as part of my Education degree.  Did I mention having lived in a house where we had 1.2 computers per person?  Computer literacy, check.

I've always considered my lack of BSN a liability; I never especially wanted to study for one, but I did want to explore areas of practice beyond patient care in a hospital or nursing home, and back in the day nurses needed a BSN to do that.  I explored motherhood instead, then small business, then college; the next thing I knew I'd been out of nursing school for 30 years and in my absence they'd moved all the furniture.  Today I see things like holistic approaches to nursing, healing touch, magnet hospitals, a “culture of safety,” and spiritual dimensions of care, that remind me of why I went into nursing to begin with.  Maybe there's a place for me here after all, I mused.

The re-entry process for RN's is not simple.  We are required to study and pass exams on 24 modules of material involving all aspects of nursing.  Then we have a choice of independent study or classes on physical assessment, IV therapy, central venous lines, and delegating patient care.  In addition, we need a physical exam, criminal background check,  updated immunizations, and malpractice insurance, all before we can begin 160 hours of clinical practice.  A person couldn't do all that in a hurry if she wanted to; so I've entered the process.  I'm going to let it flow and go with it to its end.
 

Five years ago I was afraid I was too old to re-enter nursing, but now I'm returning to a workforce composed of a significant number of "gray-hairs", the experienced people like me with gray hair.  The average age among RN's in my state is 46.4 years, which means returning to work ought to be like a nursing school reunion.  I remember it all, right down to the glass IV bottles and metal bedpans; when discharge planning meant calling a cab to take the patient home with extra dressings, 10 days post-cholecystectomy; and our "gray-hairs" then could tell you how (and why!) to administer a turpentine stupe.  I hope this leg of the journey proves as interesting.