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Had a mixed day today, with half of the day spent doing visits and half in the classroom.  We started off early this morning (7am, new preceptor) with 12 flights of steps to go up.  Yikes-I was half dead by the 10th floor. Rock climbing is not so good for cardiac endurance.  Next time should be easier.  The second and third patient weren’t too remarkable–a hickman blood draw and a general nursing visit.

The afternoon started off a bit slower, with someone reading  us slides on SBAR reporting, then a chat regarding the private pay aide service we run.  After that we moved into the diabetes education, which I was thinking would be dull–3 hours on a topic I feel I know pretty well.  However, once we got into it I found myself quite interested.  The CDE was very knowledgable, and though I knew about half of what we talked about, the other half was new to me.  Example: alcohol is a hypoglycemic agent, because when the body runs out of sugar, usually the liver will take over and push some glucose out.  However, when you’re drinking, the liver is processing the alcohol, and apparently it can only do one thing at a time(single minded liver).  So, hypoglycemia!  Also learned how to use an insulin pen, which I’ve always wanted to do.

After the talk on diabetes, I went out with the CDE to a patient’s house where she had scheduled some diabetic teaching to do.  There, we met with an older gentleman who, though fairly knowledgable about his diabetes, was still having some new troubles with high blood sugars and a skin infection that wasn’t clearing up.  Chatted with him for about an hour, left the house with a new plan of care and some numbers–I now know who to call for education, that’s for sure.

10 hour day today–100 miles put on between two cars, and I only saw 4 patients! Hopefully a shorted day tomorrow.  Classroom training all day.

Every day, the visits get easier and easier to do.  See, I have a fair amount of social anxiety, to put it mildly, and sitting down and chatting with my patients can be really hard for me.  The technical nursing stuff?  No problem.  Answering questions they ask me–piece of cake.  Small talk about the weather: oh god, kill me now.  As I posted previously, my first visit was incredibly ackward.   However, things are getting smoother.  Today I ran two visits, and both went quite well–I got everything covered with a minimum of long silences.

And then, after my two visits, the drama started.  First, we saw a patient who had an absolutely warring family–his child said that the patient’s wife was abusive, hysterical, and controlling.  The patient’s wife said their son was abusive, hysterical, and controlling.  The wife says he has a month left to live.  The son says the wife is cancelling appointments.  And on, and on, and on.  The planned 30-minute visit took us two hours to sort everything out.

Taking two hours at that house made us late to our next patient, a hospice patient with horrible pain on a CADD pump.  This patient is a medical provider, and has thrice called in his own prescriptions–including one for Ativan.  Trying to tell him, “No, X, you can’t do that,” has gotten us nowhere.  All we can do is call his attending whenever he does it and update that doctor, but it’s starting to get a little frustrating.

Drama, drama, drama.  Tomorrow I see three patients, including one whom I remember from the ICU.  Should be interesting…

I added the blogroll today–I think I have everyone categorized right, but let me know if I screwed something up.

Also, add Road Nurse to your blog links!

So, the first patient I saw yesterday, who I went out to see this morning?  He died overnight.

I think I have a black cloud.  2 days and already someone’s died.

:/

I need the advice of any home care nurses out there regarding my bag.  I feel like I’m missing some important things and that I have too many unimportant things.  So, here’s my list of what I’m currently carrying.  Keep in mind, I’m in palliative care.  Cancer, mostly, with wounds, IVs, ostomies, etc

First pocket:

• Laptop
• Stethoscope
• BP cuff
• Thermometer
• gloves
• notebook

Second pocket

• tape measure(paper and plastic)
• tapex2 kinds
• lancets (not sure why, maybe these should go in the blood box?)
• 2×2s, 4×4s
• cotton balls (again, why?)
• Alcohol wipes
• Pill envelopes (I think?)
• Bandage scissors
• sharps box
• Squirty saline
• Paper towels
• Reference book: Mosby’s HH Nursing Pocket Consultant

Third pocket:

• Sterile gloves x2
• tongue depressors
• Qtips
• Aprons
• syringes c needles
• suture removal kit
• masks
• bottle of saline
• KY

Outer pockets

• gloves
• CPR mask
• pens
• Purell
• soap
• barrier

Trunk:

• Scale
• blood box
• cooler with ice pack
• stethoscope(I tend to forget mine)
• isolation garb

What am I missing?  What do I have that I don’t need?

So I saw my first patient today, and it was…ackward.  Not with the physical nursing tasks; my nursing skills aren’t the question.  But the communication was, well, ackward.  I don’t know how to ask questions off of a form without seeming like I’m reading a form.  My preceptor can work it all into a conversation, but I don’t really have that yet.  It will come, I’m sure.

One problem was that I didn’t really get a good chance to prepare: I had time for a brief look-through just before we went in, but that’s it.  Luckily, I know the names of my patients for tomorrow (one is a person we saw today, one is new) so I can look them up.  I also am having problems–well, not problems, I’m just slow–with the computer program, the electronic charting, so I practiced that some more tonight.  Knowing what J, my preceptor, wants me to chart on helps.  In classroom orientation, we were doing the entire 25 page assessment–apparently it’s a little redundant and the forms we actually fill out(electronically) are much shorter.  So that helps.

I’m scheduled to see one patient tomorrow, but I’ll probably ask to do two, since I’ve got the advance info on them both.  Hopefully it goes a little smoother tomorrow.

…And I thought they overloaded me with stuff the first day!

Yesterday, I left work with my new nursing bag, a giant backpack to transfer all the nursing stuff into, a large rubbermaid trunk box full of supplies, the laptop, and my personal things: lunchbag, purse, coat.  I managed to get it all to the car in one load…barely.

I’ve been in McKesson training (electronic charting) for the past two days, and that’s overwhelming on it’s own.  Tomorrow I see my first patients with my preceptor–yikes!    Unfortunately, I have no idea who we’re seeing, so I can’t do any reading about the patients ahead of time.  I’m nervous about it, but hoping it will go well.  Wish me luck!

Orientation started today for me, and is totally overwhelming.  First off, I started a week late–this orientation cycle started last Monday, the day I was hired, and I had to do the physical, etc before I could start.  So I was behind to start with, and then they gave me:

• a laptop + accessories
• a cell phone + accessories
• a four inch thick 3 ring binder full of papers
• a benefits packet, all of which must be completed today
• a folder full of random orientation paperwork
• a folder with my orientation pathway
• and homework! (HIPAA stuff, blah…such dry reading)

So I wound up tottering out to the car after work, just a little bit overloaded.

And oh, how dull it was.  “Here’s how you change this password…and this password…and this password.  Here’s how you plug your laptop in,” etc.  I love IT guys–hell, I’m married to one–but teaching and leading a classroom is not their strong suit.

But overall, it wasn’t so bad.  A little overwhelming and dry. but managable, and I think the next few days will go better as we get into the software we use(McKesson/Horizen Home) and then get out to see patients!  I do my first visits as early as Thursday, yikes!

Now, if I could only figure out where the lunchroom is–the building is so confusing, and I’m totally lost!

So, I burned myself out of the ICU.

And then I tried floor nursing–a stepdown unit, and lord, I don’t know how you floor nurses do it.  Four patients, 12 hour rotating shifts, no help from anyone…I lasted a month.

And then I tried other things.  Interviewed and shadowed in a GI suite, an OB clinic. Sent resumes to the PICU, the Burn/Trauma unit.  Considered going back to the ICU.  Nothing–not one of those things caught my interest.

So now, for something completely different.  Visiting Nurse Service–home health care–road nursing.  Call it what you want; from now on, I’m trying out something new and hoping for the best.  And hopefully, blogging my way through it.

Into the Unit won’t be up for much longer–the domain expires in a few weeks, and I don’t plan on keeping it up.  But as ItU ends, Road Nurse starts–orientation starts Monday, and I’m looking forward to it.  Here’s to new starts!