First patient death and the straight cath

This is an email I sent to my former nursing instructor when I was still on orientation. But I think it accurately shows how the beginning of a nursing career looks...I was still on day shift at the time. Thank goodness I work 7pm to 7am now.

When people say "there's a special place in hell for..." I truly believe I glimpsed that special place for nurses last week. I worked three days. Had three different preceptors. Worked three different units. With three different sets of patients. By report Friday morning, I was nearly in tears. Half of my patients were psyche and nearly all were on contact/droplet/or some other horrible communicable disease precautions. I was gloved and gowned and masked and ungloved and ungowned and unmasked enough times that I am certain there must be a Guinness record in there somewhere. Monday greeted me with the night shift vampires telling us to hurry up with report because they had such a busy night they HAD to get out of there. The horizon looked bleak. Call bells and bed alarms permeated the air with the tell tale stench of C. Diff. It only got worse from there. Wednesday was a gem. Started upstairs but then the moved me downstairs. I was on about an hour and a half and was doing meds post report, post chart checks, post answering call bells despite my desperate attempts to finish assessments when I finally managed to get back into the room with a DNR patient. The night nurse told me she'd gotten a priest to say last rites but the other nurses told me this woman had been predicted to get a visit from the Grim Reaper all week. Therefore, I was not tremendously concerned. But as I was talking to her, I saw a change in breathing pattern. Ah, yes, from somewhat labored to agonal. Then to apnea. Then to...? Okay, time to call in the big dogs. Sarah, the preceptor of the day, came in and we watched the patient take her last breath. After hours of going back and forth with Kidney One, it was decided no organs could be harvested, including her eyes which were large, round, and very much open. By then, thepatient was stiff, mottled, and smelled.Unfortunately for me, I was sent in to do post mortem care with Barbara, a patient care tech who was absolutely creeped out by our contracted, glaring body. I was okay except her tongue was kind of sticking out of her mouth. I had a cat that died once. Her tongue lolled out, too. Attempted to open her jaw to see if I could slip it back in, but rigor mortis had begun to set in. (The patient, not the cat). So I had to wash the patient while Barbara stood by and kept reminding me how much the patient's staring at us creeped her out. I was able to close her eyes with a washcloth. Did I mention we were gloved, gowned, and masked? The room had begun to smell. All of it made us giddy. The rolling of the stiff curled up body back and forth as we wrestled the thin plastic shroud under her. We were laughing so hard I was crying. However, we weren't too disrespectful. I opened the window to let her spirit out, in case it got the idea to attach to oneof us and haunt us. Fly, be free. Just get away from me, I said to myself. I didn't say it out loud to Barbara. She was already threatening to puddle the floor. So us two ninnies wrangled the body into the shroud, and used the ridiculously thin shoelace ties to bind the arms, waist, and feet. I had a terrible time with keeping her head covered. I could not get the wrap to look like the diagram on the bag. So I used critical thinking. Medical tape works wonders. Hey, I'm not being graded anymore. So we finally completed our creepy duty. Or so I thought. I asked Barb if she tied the toe tag on tight enough. "Toe tag?" she said. So our masterpiece was unwrapped and we managed to get the toes apart long enough to slip the tag on. I was sweating. I was tired. And I really didn't want to see any more dead bodies. By this point, I asked her if I could call Transport to take the body to the morgue. I told her we could call down there, "Uh,yes, this is Shannon on 2 West. We need a transport. Could you please send up a stretcher....uh, no, we don't need any oxygen." It could have been so easy.As we laughed our way out of the room, we smacked straight into the nurse manager. Surely, she was not as amused as we were. I said, "it was either we laughed or cried. I still have eight hours here so take your pick." Friday was the "let's ring the call bell simultaneously" day. All four patients on the call bell. Constantly. Three required morphine q hour. I'm new. I'm slow. Ten minutes for each patient to sign it out, draw it up, and log it into the computer before I give it. Three of the four were also bedpan divas. Ten minutes to put them on/take them off/clean them up. I'm sure you can do the math. Not a whole lot of time to look at new orders, give meds on time, and do wound care for 326 who had four areas of staples, two open stomach wounds, two groin puncture wounds, and a fasciotomy on her left calf. And, to boot, a nurse friend of the patient who has terminal cancer decided to ambulate my patient without my knowledge or consent. That call bell was to inform me that my patient had fallen. With a platelet count of 54k. And whom the doctor had just cleared for discharge. Now, the week is funny. But having to do three straigh caths and one foley in one day wasn't funny. Giving an enema to a patient who was fighting me tooth and nail while his mother kept saying "just get it in there and give it!" was not fun. I swear he had the furriest butt I have ever seen. 18 years old, CP, and ornery as heck. Ducolax to another patient who, after I was done, asked me to reglove and try to get it up further in her. My fingers can't get any longer but I tried just to make her feel better.If my family had any idea where my hands have been this past week, they'd never eat dinner again.

New nurse hits the floors...the journey begins

I graduated from nursing school in December, began orientation at the local hospital in January, and encountered my first deceased patient in March. This isn't my mother's nursing anymore. When she began nursing, the nurses wore sparkling white dresses with squeaky shoes and little dixie cups perched on their heads. I wear printed pajamas, really. I am still wearing the college's required squeaky white shoes. Hideous things they are. What I need are sporty yet functional sneaks. Ones that can allow me to sprint down the hallway to answer a code or that 85 year old senile man who keeps leaping out of bed as he attempts to yank out his foley cath. And I need shoes that resist stains; no more stopping off at the grocery store after work with urine, feces, blood, or vomit dripping off the soles. Yeah, I need a new pair of shoes. Super-snazzy-stain-resistant Sauconys.

It's amazing, really. In just one NCLEX, I went from being the lowly student nurse to "they actually pay me for this?" new nurse. (I'm still in the honeymoon phase). Years of studying until my brain threatened to hemorrhage lead to years ahead of learning the ropes as a new nurse. Oh how many nights I fell asleep on Lewis' "Medical-Surgical Nursing" only now to be startled awake with medical-surgical "Oh my gosh, did I remember to..." thoughts. There's one difference between being a student nurse and being a "real" nurse: as a student, you want to take the test and forget everything. As a nurse, you want to forget nothing.

This blog is a means for me to document the journey from being a new nurse to somewhere in the very distant future when I retire. Or when I feel like I kind of know what's going on while on the med-surg floor, whichever comes first. New nurse to Nurse Ratched if they keep short-staffing us.

The stories are true, yet wildly exaggerated, of course. My days of writing starched, dry, and medically sound papers are over. Okay, not over, I begin my RN to BSN journey in the fall. But at any rate, feel free to post up your own stories as we could all use a good laugh...and learn some nursing tips in the meantime. The truth is, I love what I do. Nursing is what I expected and more fun to experience the things I could have never suspected. But it's stressful just the same...trying so very hard to keep all six patients still breathing at the end of each shift. It probably wouldn't be a good thing reputation-wise to pass along a corpse to the day shift. Laughing is the gift that allows me to dress a stage 4 wound and still smile when I get home.