In the spring of 2022, I will reach a milestone in my nursing career, the 20 year mark. If you have gotten this far in reading my memoirs, may God have mercy on your soul. I am sure you are wondering how I made it this far. I am wondering the same thing myself. When I went into nursing, my first instructor made a very all important statement. One I remember to this day. She said that nursing is all about flexibility. You never know where your career or life will take you. Medicine is certainly about flexibility because if you are inflexible or set in your ways, you will never survive in this very demanding field. Take my case for instance, you would think that with almost 20 years under my belt, that my career path would be secure and set. Well, you would be wrong. I am finding myself making some career altering changes even now. If you stop and think about this for a moment, you will understand why. Your nursing career can span your entire adult life. What you were able to do when you started in the field you may find out that you no longer have the endurance to do any more. You may also find that you are getting burned out in one particular area. Many nurses as they progress in their careers go into management or even education.
But I digress, this chapter is supposed to be about my early years, there is plenty of time to discuss my “golden years” of nursing in later chapters. As you already know, I started my nursing career in Florida. While I only worked there a short while, my time there was very eventful. Apparently my primary Charge Nurse thought fairly high of me, because she made the statement to my wife who was the charge nurse on my off nights that I had not been challenged enough during my orientation time as not only a new hire but a new grad as well. Yes, I know you should not work on the same floor as your spouse. She being one of my immediate supervisors was not able to work on the same nights as I did. So I always got to work with her opposite. Due to our schedule we only got to have one night off together a week. Some people may say that this was a good thing. We were still a fairly new couple so it was not that great for us. But we managed to get through it, and besides this arrangement as it turned out only lasted four months.
It turns out that my nurse “Ratched” had the same name as my first wife, Tammy. While she was not a cruel person, she rode me like the witch in the Wizard of Oz rode her bike. I always got the hardest assignment and I was the first to get floated , even though I was a new nurse. I guess because I never let myself get stressed out, she thought this meant I wasn’t working hard enough. It wasn’t all bad because the unit I was working on was full of very experienced and friendly nurses who were always available with a helping hand. So needless to say, I was very busy. Our charting was a combination of paper and computer charting. The only part that was on the computer were the medications, labs, test results and order entries . The actual charting for the doctors and nurses was all handwritten. You may think that this hybrid system was inefficient, and you would be right. Each nurse was responsible for checking the paper charting to make sure that all of the orders written by the doctor were entered in the computer correctly for their 12 hours. The charge nurse was responsible for checking that the orders were correct for the whole 24 hours of that day. You may ask who was actually doing the work of entering this critical information into the computer, well that would be the least trained individual on the team, the ward secretary. Makes sense, right? That is why we had to spend so much time checking their work. Life is a lot easier now, because in most hospitals the doctors put their own orders in the computer. I say most, because nurses still have to enter telephone orders in as well as any verbal orders given by sneaky doctors who are either too lazy or too busy to do so themselves.
The reason that I seemed to function well is that I am by nature a highly organized and systematic individual. I did my assessments, charted and passed meds all at the same time. The certified nursing assistants (CNA) provided for the patients personal needs like bathroom breaks and clean ups. We only had to help when the assistant became overwhelmed. The CNA is one reason why I worked in the medical/telemetry floors for so many years. You don’t have CNAs in critical care, so you have to provide all the care that the patient needs. Our charting was by exception with flow sheets, so it was extremely quick. We only had to provide a patient note for anything out of the ordinary. In the medical floors this usually only involved one organ system, so even that was pretty quick.
One thing that I noticed in Florida was that the doctors in this state were very organized. Many had standing orders that covered all of the patients’ needs, so you did not have to call them for very many additional orders. Some of the surgeon’s standing orders were several pages long. This was a great thing since I always work nights and it is quite onerous waking up doctors at night for things like Tylenol or a sleeping pill. However, there were that occasional doctor who liked to practice medicine through the phone. This would happen for new admits that came in after the doctor went home. So he would quiz the hell out of you and give you a bunch of orders that would cover their care until the morning. It was a pain in the keister, but I guess it was understandable and besides in the surgical units, the admitting doctor has 12 hours to see his newly admitted patient while in the ICU they only have four hours. Which is why nurse practitioners and physician assistants are in vogue now.
We had telemetry monitors right on the floor so we could frequently check the cardiac condition of our patients. However, it was the responsibility of specialty trained individual in telemetry monitoring that kept a much closer eye on all the patient’s heart rhythms. As part of our tasks, we had to write three notes for telemetry discussing the patients cardiac condition. However, not all of our patients required such close cardiac monitoring. Medication passes are usually ordered every 4 hours or in some cases as needed, like for pain management and nausea. So, as you can see even at night we were kept quite busy. So this is where I digress a little to discuss the unfair treatment nursing gets from the entertainment industry. First of all, we run the hospital and doctors would be totally lost without us being present to do all of the close monitoring that the patient requires. Doctors only spend a few minutes with each patient when they round each day. They only get a very brief snapshot of their condition. So they rely quite heavily on us. Besides who is going to provide the vast majority of the treatments that they prescribe for their patients? While it is true, the doctor has more specialized training, we are also highly trained and hard working individuals. We do not put mattresses and sleeping bags in the nursing station to take breaks during slow times. Most hospitals require a minimum of rounding every 2 hours and critical care requires rounding every hour at the bare minimum. We are also not busy in the closets playing grab ass with the doctors and surgeons.
Every hospital has different routines and schedules based on their clientele and the severity of the cases that they treat. In the four hospitals that I have worked in, there has been a marked variation in the systems used and even the software utilized for charting and ordering. This is one of the reasons that nurses have to be flexible. However, as the nurse ages this flexibility becomes less attainable. By nature, we become more set in our ways as we age.
So, now that I have bored the reader immeasurably, lets discuss a few of the anecdotal cases that every experienced nurse has. Patients are admitted to the hospital for all types of reasons. We as healthy individuals take our basic body functions for granted, that is until they are not working any longer or in some cases, are working too well like diarrhea. Who would think that diarrhea could be life threatening but it can be. If you are loosing fluid too quickly to replace it, your electrolytes can become out of balance. Besides in many cases diarrhea is also accompanied by nausea and vomiting, so you can get in trouble quite quickly. If your magnesium and potassium levels get out of balance your ability for your muscular system to work properly is brought into question. Don’t forget that your heart is just a specialized muscular pump. Now the opposite can also become a problem, though it takes the critical stages longer to manifest itself.
My hospital had 3 patient rooms… semi private and private rooms. It just so happened that I had two little old ladies in the same room with the same problem. Constipation for one week. A week is starting to get to the critical level. Especially when they have been taking stool softeners all along. One of the less dangerous codes you can have is the good old code “brown”. Well, I have always been fortunate at getting patients that like to defecate frequently. Before I became a nurse, I never knew people could store as much poop as they do. These two little old ladies could not have weighed more than a hundred pound each had to have pooped half their body weight that night. My CNA and I were in virtual tears. They went back and forth between the two, going in tandem as it were. When the flood gates released they pooped from head to toe. We ran out of clean linen twice that night just because of those two little old ladies.
Another simple body function that we take for granted is urinating. Though any elderly man with an over-active prostate gland will tell you that it is no fun. However, many things besides enlarged prostates can cause a reduction in urine output or stop it entirely. Let me be clear, here I am not talking about reduced production of urine due to renal problems, I am talking about people that are still producing normal amounts of urine but simply can’t eliminate it. This can become a critical problem quickly. Bladder infections can cause a blockage due to increased sediment caused by dead bacteria, usually a foley catheter or straight catheter will take care of this problem. But if the patient’s bladder is actively bleeding and creating blood clots , this requires a different intervention known as continuous bladder irrigation or (CBI). This is can be a real pain in the ass. It can be quite painful for the patient and is certainly a lot of work for the nursing staff, since we still have the rest of our patients to take care of. The earliest stages are the worst because the irrigation is by necessity done by hand and can be quite messy. You need to wear a gown and a face shield because there is that much of an issue with flying body fluids. Once you get rid of all the clots, you can just hang large bags of sterile fluid and keeps the bladder irrigated until it can heal by itself or a urologist can repair the occasionally recalcitrant bladder. By the way, urology is just not a popular specialty, so you may have to do this for quite a while. As it turns out insurance companies just don’t think that urinating is very important because they don’t compensate the doctors very well ( this is from the urologists themselves). Needless to say, this job is not one of a nurse’s favorite things to do. It is as I already mentioned very time consuming for. But this is my patient so you have to know that there is a twist coming. Well, my patient was a biker dude, so his bladder problem most likely had another origin. Remember how I said that nobody liked to do bladder irrigations, well this was not the case with my patient. Drum roll, please. Come on you can do better than that….He had a tattoo of a spider web and a spider on the head of his penis…. I kid you not. I could have sold tickets, I had nurses lined up down the hallway to help with the bladder irrigation. I actually had to set up time limits so that everybody had a whack at his penis, no pun intended. Only me. Needless to say that this was not my last penis-involved care that I came across in my career. There has been so many that I have simply lost count. I will discuss two of the more interesting cases I came across in my following chapters.
I am sure by now you realize that I don’t pull any punches, I say it is like it is. So I hope that my stories are eye openers. Insurance companies including Medicare and Medicaid have way too much say in the running of hospitals along with that tyrannical commission known as The Joint Commission on Accreditation of Healthcare Organizations, or JCAHO. It seems that Medicare and Medicaid take a great deal of enjoyment in finding reasons on not to pay the hospitals for the services they provide. It is bad enough that insurance companies can take an entire year to pay the doctors and hospitals. JCAHO seem to take the greatest deal of delight in finding the most miniscule of infractions, just to justify their existence. Unfortunately we have to take them very seriously, because without their accreditation, we receive no Federal assistance or compensation. I guess, they are trying to bankrupt the hospitals? I just don’t understand.
Can I have a leg up?
The hospital I worked at had an individual who worked at placing patients throughout the hospital. He was quite a funny guy. Because he placed two male amputees in one semi private room. One patient was missing the right leg and the other missing the left leg. Well, the damned funniest thing was that they both took the same shoe size. They also had similar backgrounds and became fast friends. They even as it turns out went shopping for shoes together after they were discharged. So they only had to buy one pair of shoes. So it turns out that our prankster who liked to mess with the nursing staff, actually did a good thing.
Our hospital was small, so we only had one ER doctor working at night, so occasionally we would get two codes at the same time, so the nursing staff had to run the second code. So this prompted the administration to push for all telemetry nurses on up to critical care to become ACLS certified. I thought this was quite progressive. It certainly increased our skill set. Florida also allows specially trained Respiratory Therapists to intubate patients. So we had the whole code covered. The only thing we had to do is to run the code until a doctor could pronounce a patient that could not be revived.
Boy do I have a story to tell you
One of our jobs as nurses is to collect admission information on new admits. Well, in nursing school we had been introduced with the term “confabulation” which is the creation of false memories in the absence of deception. They actually don’t even know that they are doing it. I should have picked up on the subtle hints given by my fellow nurses when I was taking this patient’s history. Just when I was finished taking all of his data and the patient had went into his room, everybody started laughing. Apparently, he was a frequent flyer and had burned several nurses before me. So that entire history of his was wrong. I had been so proud of myself that I had done such a great job. It is kind of funny now but it was a bit of a pain back then.
Anybody want a shower?
One thing that male nurses have to watch out is taking care of female patients. It is always a good idea to have a female co-worker in the room when you are providing their personal care, especially if you suspect that she has some issues. This was true of this rather obese lady who wanted me to bathe her in the shower. I told her that my CNA would be happy to assist her. As a way of getting revenge, she then went and told the charge nurse that I was having sex with the female patient in the bed next to her. Well, it certainly was news to her roommate. Of course, it never went anywhere but you can never be too careful.
Can I have a Float?
Well, let’s wrap up this chapter with my first float experience. I had just finished receiving report on my eight patients and the day nurses had all left, when I was told that I was going to have to go to the IMC. So I had to report back to new nurses for patients I had not even seen. I then had to put in a short patient note for all eight patients. I then went to the IMC where I took care of five patients. I had just finished up giving my meds and doing my charting when I was told that I was going to have to float to the orthopedic floor where I was going to take care of 13 different patients. So now I had to give report to even more nurses so that I could move to another floor. When I finally got to the ortho floor most of the nurses caring for my new patients had already left. What I walked into were written reports on the vast number of patients because the day nurses were not allowed to get overtime. So now I had to assess all 13 patients and give their morning meds to them. Thank god that the meds were few but I did have to give all the pain meds for the patients who had just had surgery in the previous day. What a night! When I went back to my floor in the morning and told Tammy, my charge nurse what had happened she didn’t say a word. She showed no remorse what so ever. No nurse should have been put in that position. Let alone a new nurse with less than one month of experience. Needless to say, the nurse manager in charge of my unit was not very happy.
Well at least my wife and I got a nice send off when we left for Las Vegas.