The One with Lots of Updates All At Once

So many, many things have happened in the past couple months, and of course I have done absolutely nothing to keep family and friends updated.

For instance, baseball. I am a Baseball Wife, am I not?

Baseball started in January and goes until the end of April or early May. Coach has been gone pretty much every night during the week, keeping him blissfully happy and coming home smelling like dirt and grass.

The team is 7-7 for the season so far. The hard thing to keep track of is that unlike in Missouri and Mississippi, Varsity and JV do not play on the same night - therefore the reason Coach isn't home four to five nights of the week, and I cannot for the life of me keep track of which team plays which night. 

Spring break just kicked off for Matt this week though, and I think his plans include sleeping, going to the beach, sleeping, sitting by the pool and sleeping. Oh. And sleeping. 

I, on the other hand, have been keeping myself occupied by turning in my resignation at the hospital and going to visit my sister in Georgia.

We never do anything by little steps and measures around here. It's all or nothing, folks.

First: my job. I really, really love working with cardiac patients. I love that I have the knowledge and skill in how to bring down someone's sky-high blood pressure, relieve their pain and teach them how to move while protecting their chest after open heart surgery, and how to administer and monitor critical drips and medications. I love that chest tubes - while they still make me nervous - don't scare the bejeezus out of me anymore.

I love the girls that I worked with. Our floor was so insanely busy and crazy day after day, it was great to work with a team that would pull together and help each other out - some days it was all about survival for us.

However, you all know that I'm a Funeral Home Girl at heart. Growing up in the environment that I did - with the dinner table conversations that I had with my family - I was destined to have a career dealing with end-of-life issues.

Enter: Hospice.

Hospice and oncology is one of the main reasons I went back to school for nursing. I'll be helping someone stay comfortable and live their life to the fullest that they possibly can, while managing their end-stage disease symptoms. Hard, challenging, and one of those career moves that you just know is right. I couldn't pass it up when I was offered the job.

Everyone I'll be working with is so compassionate and caring, with such positive, encouraging attitudes. I'm learning more and more about Hospice and what it does - it's not just giving pain meds and watching someone slip away. I'll be going to patient's homes and doing complete assessments, wound care, medication administration, lab draws, and my big passion - education. Teaching families and their patients about what to expect as the disease enters it's final stages. What happens when the body starts shutting down. How to keep their loved one comfortable and to not hesitate to page the crisis team. You're not only be dealing with the physical, but the emotional and spiritual needs of the patient as well. The Hospice physicians are amazingly kind and helpful, the chaplains and social workers are fabulous resources that work hand-in-hand with the RN.

I'll be working out of the Fort Pierce location, but the Hospice House in Stuart, FL is where I spent the past week in orientation. Policies, procedures, OSHA, HIPAA, etc. My brain was gone as of 2pm Friday. The grounds are beautiful though - lots of landscaping, walkways, paths, fountains...all dedicated in remembrance of patients of TCH.

Ok. Sorry for the RN rambling. Now on to non-job stuff.

My sister!

I spent four days in Georgia visiting Erin, Cole, and Addie.

(Say cheese!!)

Addie got a nurses' kit from Auntie Addie - gotta teach em' young!

She kept going around the house (for hours...days...bedtime...bathtime) saying "Checkup! Checkup!"

She also refers to one of the bearded pirates on her Pirates of the Caribbean placemat as "Jesus," so I'm not really holding out hopes that she'll be a Nurse Practitioner in the next two years or anything.

Erin and Cole are looking forward to the arrival of Liddie in the next couple months - especially since every time I would turn around I would accidentally run into Erin's pregnant tummy. Ooops. My bad. It got to be hilarious after awhile...for me, anyway.

Fun Florida things we've done lately:

Universal Studios, particularly Harry Potter World. We're Potteraholics.

Braves vs. Mets spring training game. We live about 20 minutes from Tradition Field, spring home of the Mets (boooooooo!!!!). Since I'm married to a Braves fan, I humored him and drug myself to a game. Since he's a baseball coach who somehow gets incredible hookups from people he knows, the tickets were front-row and free. I can't really complain.

The only Braves person I cheered for was their first base coach, former St. Louis Cardinals third-baseman Terry Pendleton. I watched him play with Ozzie Smith under Whitey Herzog in the 80's. Actually, I mostly remember Fredbird and eating ice cream out of plastic Cardinals helmets because I was only 10 years old, but still. I remember my parents getting really, really excited about all those good old STL guys and Ozzie's handsprings at shortstop.

So...the best part is...

WE WENT TO A CARDINALS GAME!!

A good friend of ours from our days in Licking came down from Missouri, and we spent the day at Roger Dean Stadium in Jupiter, watching our boys.

I felt so giddy and homesick and wanted to hug every single one of them and say "I know you!! I follow all of you on Twitter!!"

But I decided that that's fairly stalker-ish, so I stayed in my seat and took pictures of the best side of Yadier Molina.

Not ashamed. Not ashamed at all.

Matt just rolled his eyes and pretended he hated being at a Cardinals game. I knew he secretly wanted to cheer for them. You can't run from the red.

And the best part...I got to revive my childhood.

Ice cream helmets! And sunburns!

Great day, despite the loss by one run. I still love you, Redbirds!!

Coming up: I officially joined CrossFit last week. Not sure what it is? Google it. I have no words on how to explain it other than it hurts you and empowers you and makes you want to laugh and cry and scream all at the same time. Fundamentals Day One included roughly five bazillion squats with weights, which meant I couldn't walk upstairs to our bedroom or sit down to use the bathroom for about four days.

Anyway, my sadistic trainer Kristi told me to get all my fun out this weekend, because CF starts for real tomorrow. Meaning clean eating, meaning the complete opposite of the Dixie Cream doughnuts we just had to get for our Missouri guest this morning. (Seriously. Dixie Cream makes Krispy Kreme taste like nastiness. Come to Vero and we'll show you what's what.)

So tomorrow - WOD for real and Paleo/clean eating for real. Matt doesn't think I can stick with it so you know. Now I have to to prove him wrong.

It's on.

Observing Patients, Eleven at a Time

I keep having family and friends ask me what unit I work on at the hospital and what we do. As a brand-new, career-changing nurse, it's been a little hard to explain, even to myself. Now that I'm officially out of orientation and some (just some) of my naivety is gone, I figured I better know where I am and what I'm doing.

I didn't have the slightest clue as to what a hospital observation unit was when FGH hired me. I was just grateful for a job offer in a city that has one major university and several community colleges, all whom had just graduated their own gazillion nursing students who were looking for jobs in the Hattiesburg area at the same time I was. That, and I could finally move out of my parent's guest room and join my husband who had moved down to our new digs several weeks earlier.

No offense to mom and dad. It was a great time having mommy do my laundry again, but this 30-year-old was ready to move out of the proverbial basement and get on with her life.

Honestly, I was so proud of my title as "RN-Medical Oncology" back in Missouri. Caring for cancer patients? Totally worthy occupation. Outpatient Observation? It sounded weak at first, like I would be putting band-aids on boo-boos and sending my patients home with a lollipop.

Some days, I wish that's all I did.

I didn't really know what an observation unit was. I was like, do I just watch the patients and make sure they don't get worse? What are we observing for? Am I going to be bored to tears?

Today's Hospitalist explains observation units like this: "As Emergency Departments are increasingly stretched by capacity constraints and lack of specialist support, hospitals are turning to observation units, also known as clinical decision units, to fill those gaps without taking up inpatient beds. Patients admitted to observation units are expected to be evaluated and treated and rapidly improve within 24 hours."

“The setting is geared toward patients who require more management or attention than can be given in the traditional ED, but do not need the length or level of services provided in the inpatient setting,” says Russell Holman, M.D., senior vice president of Cogent Healthcare, a national hospitalist firm based in Irvine, Calif.

“Placing one patient in the observation unit frees up about three beds in the ED,” says Sandra Sieck, R.N., president of Sieck HealthCare Consulting, Mobile, Ala. "Observation units can help avoid unnecessary and costly inpatient admissions by aggressively diagnosing and treating patients’ symptoms, allowing them to go home in a timely manner."

Our unit works closely with the ER doctors - but when emergency department orders run out after eight hours, care is usually handed over to one of the on-call Hospitalists...which means a whole new set of orders to implement. In the meantime, the physicians and case managers are trying to determine - in less than 23 hours - whether the patient needs to be converted to inpatient status.

So it's very true we move at a rapid pace.

Yesterday alone, between transfers, discharges and admissions, I had 11 patients.

To give you a bigger picture, our unit is only 14 beds. I take seven, the other nurse on shift takes seven.

Seven beds. 11 patients.

Lots of coffee. And aspirin. And charting.

Our floor sees everything from sickle-cell crisis to cellulitis, COPD exacerbations to dehydration. Patients come from outside clinics for blood transfusions. We see a lot of patients with renal failure - I've gotten to know our nephrologists really well. We get a lot of funky wounds, and we also serve as a recovery floor for patients coming out of surgery.

PACU delivers us lap-chole patients, (seems like everyone and their second cousin has had their gallbladder removed lately) hernia repairs, thyroidectomies...just about any same-day surgery where the patient just needs to stay the night and be discharged in the morning. I call those my "eat solid food and drink with out throwing up, pee, walk the halls without passing out and be cleared to go home" patients. We've also had a run of PEG placements lately, and I feel like I can do tube feedings with my eyes closed.

(Which I once said to a co-worker, who told me she would hope I wouldn't. Southern people still don't get that when I say things like that, it's called sarcasm.)

A typical 12-hour patient rotation can look like this: a patient is admitted to the floor from post-surgery around noon, only to be discharged four hours later...who's room was rapidly cleaned and assigned to a new patient who arrives no less than 20 minutes after the previous patient was wheeled out the door.

Or a patient gets to the floor from the ER, and ten minutes later surgery is calling for them (no joke...this happened to me this week). To get a patient to surgery, you have to complete a whole checklist of items, have surgery consents signed - which you can't have the patient sign if they've taken narcotics (morphine, dilauded), which of course the ER gave them just ten minutes earlier - draw labs, make sure the patient has removed dentures/jewelry/glasses/clothes off/gown on, plus call surgery to give report on the patient you're sending them.

Giving report on a patient you've seen for a total of five seconds to the same-day surgery nurse who's been around the block a time or two is nuts. You better have your stuff together. Or at least make it sound like you have your stuff together.

And speaking of drawing labs, PCRMC spoiled me. We had phlebotomists who would come and do a simple stick for an H&H. Not so here. We grab our trays and tubes and trot off down the hall to play vampire.

PS: I love central lines and chest ports. The end.

It can get exhausting. Halfway through orientation I decided I didn't like the floor, it was too fast-paced and that I just couldn't get my day organized with all of the admission orders, discharge orders and general care orders going on in between. One patient coming in while another is going out...I seriously felt I was drowning trying to keep on top of everything. People wanting to be discharged want to go home NOW, not in 30 minutes...at the exact same time the PACU nurses are calling you into the room of the patient they just brought up because they need to hand off the chart and have lifting help from the stretcher to the bed. And then that new patient wants something to drink and their family is hovering and their IV is beeping and....

And people wonder why I'm still broken out in stress-related hives.

(Sarcasm again, my southern friends. But not really.)

Now that I've been on my own for two weeks, I'm realizing that I'm not as incapable as I first felt. I can do this.Yes, it's incredibly stressful. Yes, it's rapid work. But I feel like I know this floor now, I know where things are, and I know who to ask if I don't know something. I'm getting to know the doctors - most of whom are fairly approachable and easy to talk to.

I really like my co-workers and feel that we all work well together. They bring cake to celebrate birthdays, and I like cake.

This floor is growing on me. Once in awhile I still miss my cancer patients and the five-patient, steady, unchanging workload in Missouri, but honestly, this is now starting to feel like home. I don't want to bail ship and leave this unit anymore.

I get it now. I get the point and purpose of observation, and I'm proud to be an RN in the middle of it.

Oh, and my scrubs are cute too.