Same Shi(f)t, Different Day

So Jamie Goes To Work, Part I, went off smashingly well (snarf).

Stupid me, I get to work early to witness my post op CABG patient has gone from a perfect NSR to rapid afib overnight, and 10 mg of IVP Cardizem two hours ago at 0500 did nothing, and meanwhile, another patient is hanging out in the 40s and has a slew of cardiac meds due in the a.m.

Both patients were asymptomatic but it was one of those times you wish you could take tachy guy's HR and brady guy's HR and split the difference between the two, rather than have to get orders to do anything about it.

Be that as it may, it's mighty yucky to watch a post op CABG patient tach up to the 140's-150s sustained.

So Jamie bugged the PAs during their report (probably earning me the moniker "that stupid new nurse") and got to push Cardizem and start a Cardizem drip.

Funny thing is, I didn't think twice about pushing the Cardizem, and it was only two admissions that I realized, 'Hey! My scope of practice just doubled!"

Nurses on my old unit never got to push Cardizem, Lopressor, etc. Only unit nurses could, I think. Now it's just expected we do it, just like everyone on our floor has done an insulin gtt so many times they've got the protocol memorized by heart. Which is kind of cool, because who wants to wait for the PA or HO to come up and do it, but it's also kind of scary, because dude you're pushing some powerful fucking medication there.

This is going to sound lame, but I like my new floor (I'm so much funnier when I'm bitching, actually.) The nurses are wonderful and very supportive and helpful, just like on my old floor (which is a mixed blessing, because it also makes me miss my old floor). My manager actually praised me today for doing some stupid pneumococcal vaccine assessment. I thought I was having some kind of psychotic break, and instantly went into Paranoid Mode thinking: "Wait a minute! Why would she say I did something right? Why is she praising me?! Is she trying to trick me into working night shift or something?" Then I realized what a fucking freak I was being, as my nurse manager actually admitted to us during a staff meeting yesterday that she believes happy staff nurses make happy patients, and was totally into the whole concept of implementing change to make us happier.

Meanwhile, I feel, to quote Dennis Leary's song "I'm an asshole", because today I felt like, well... an asshole. The basic assessment skills of nursing always stay with you (thank God), but paperwork and charting--not to mention finding vented spike tubing that doesn't look a thing like the vented spike tubing you used on your old floor in a supply room that is nothing like the omnicell you had on your old floor--is completely disorienting. Even the med retrieval system is different, and it takes me hours to do a med pass.

At eleven o'clock I was still trying to pass my ten o'clock meds, and I didn't even have my two admissions up yet. (Back at Old Hospital, I would probably just be finishing up my first round of charting for the day). That was before I got s/p cath with 80% occlusion of his left main artery patient (read: pre-CABG patient) with orders to start Integrilin (which the cath lab nurse missed and forgot to mention in report) and day one post op CABG patient on an insulin drip, with chest tubes and pacer wires still intact.

By four o'clock this afternoon I was so tired I was ready to fake charting my meds and assessments (nota bene: I would never.)

Having experienced an inuslin gtt on my own today, I can see now why my old floor doesn't take them. Accuchecks q half an hour = pain in the ass. Accuchecks q half an hour with demented patients roaming the hall = completely unsafe.

Oh well. One day, when I learn what our phone extension is on the unit, and quit wandering around in aimless circles trying to find my patient's rooms, it'll all flow easily. And that day will probably be two days before I leave the unit for good, but hey, I can't complain.

For once.