Nurse Sean (dot) com

Mr. Smith was a 60 year-old gentleman whom I met on a Thursday nightshift, seven hours following his admission to our unit. During the day, he had undergone a simple surgical procedure to insert an artificial urinary sphincter. This device is used in patients suffering from urinary incontinence. A small cuff surrounds the urethra, closing the lumen and stopping the flow of urine. There is a button that lies in the scrotum (or labia in women) that when pressed, allows water to be transferred from the cuff to a bulb, opening the urethra and allowing the passage of urine.

The entire shift was quiet and uneventful. Mr. Smith slept for nearly the entire night, only waking when I needed to perform my duties. His vital signs were taken twice throughout the night, once at the beginning of my shift, and once at 6:00am. Both sets of vital signs were completely normal. A full head-to-toe assessment was performed at the start of my shift, which showed absolutely no abnormalities. He had a dressing on his right groin where they inserted the artificial sphincter. At one point, I noticed there was a small amount of fresh blood. It certainly was not serious, or out of the ordinary for a surgical wound, but I decided to remove the dressing and replaced it with two 2X2 gauze pads. Other than the dressing change, there were no interventions needed by Mr. Smith. His pain was well controlled, he felt well, and he was excited to be going home in the morning. At 07:00 I talked to Mr. Smith one last time. He denied experiencing any pain and he did not wish to get up to the bathroom. I said goodbye and wished him good luck.

I arrived on the unit at 23:00 the following night for my next shift. I was immediately told that Mr. Smith had passed away early in the morning. At approximately 8:00am, his nurse helped him get out of bed to go to the washroom. In the washroom, he began having chest pains and experienced difficulty breathing. They called a “code 66” and began helping him back into bed. Before the code 66 team arrived, he stopped breathing. They quickly changed the code 66 to a code blue. Unfortunately, they were never able to revive him. He had died of a massive pulmonary embolism.

As we were discussing the events, one nurse pointed to a young couple and whispered, “That’s his son and daughter-in-law.” They had driven in from Saskatchewan, and were holding two hospital bags and a suitcase full of their father’s items. A nurse was helping them fill out paper work and finalize what needed to be organized. I was asked to help them find a map to their father’s apartment on the Internet so they could drive there and start on the enormous task of tying up the loose ends of his life. I was amazed at how friendly they were, and how they were able to make jokes and talk about their drive from Saskatchewan. They seemed sad, but not destroyed. I was especially distraught to learn that less than a year earlier, their mother (Mr. Smith’s wife), had died on the operating table during a surgical procedure. I could not believe the amount of pain this family must be feeling.

I printed off the map and handed it to Mr. Smith’s son, and watched as my preceptor escorted them down to the morgue where she would have to prepare Mr. Smith’s body for a viewing. I could not help but feel sad that I had said goodbye to Mr. Smith and had a cheerful conversation with him only an hour before he was pronounced dead.

My mind turned to the current night shift. I did not have time to dwell on Mr. Smith’s death. I had five new patients that I needed to prepare to care for. I sat down with my clipboard and pen and began to write down information about my current patients. I could not move forward though. Even though I tried to focus, my mind kept wandering to Mr. Smith’s death and the events surrounding his pulmonary embolism. I would find myself going for twenty minutes without writing a word on my board. At one point, I looked at the clock, it was nearly midnight, and I was not ready to start my first set of rounds with my patients.

I could not help but run through the events of the previous evening and desperately try to grasp onto something that I could have done differently. What if I had made him turn more, would he have still developed an embolism? But I had to remember that he was easily repositioning himself frequently. What if I had made him go for walks throughout the night? I reminded myself that this was not a normal practice on our unit. Could he have died because I changed his dressing? I reminded myself that there was absolutely nothing abnormal about his dressing or wound. Besides, one of the nurses had told me that the blood clot was probably forming before he came to the hospital, so there was probably nothing we could have done.

I hated that I kept ruminating on what I had charted regarding his care, knowing that what I charted “covered my ass” sufficiently. I ran through my assessments, reminding myself that there was no chest pain, leg pain, or breathing issues during my shift and I had charted the same. I felt guilty for the selfishness of these thoughts. More than anything, I hated that I kept thanking my luck that he did not want to go to the washroom at 07:00 when I asked. Perhaps, if he had, he would have died on my shift. I felt overcome with guilt, which seemed to be flying at me from every direction.

However, the biggest thought that crossed my mind was that Mr. Smith had died because he simply wanted to fix his incontinence and improve the quality of his life. I could not help but wonder if this was a worthwhile reason to risk your life. In Mr. Smith’s case, it certainly was not.

I finally managed to quell my thoughts long enough to prepare for my shift and begin my rounds. However, I was noticeably distracted throughout my shift. This was especially true when I was taking care of a patient who had been admitted to Mr. Smith’s bed only hours after he had passed away. I hated being in that room because a wave of emotion would flood me with sadness each time I stepped through the doorway. I do not feel that I did an adequate job during my shift that night. My mind and heart were not focused on the task at hand. I felt distracted and depressed. I feel that my care was “sloppy” and incomplete.

I wondered how other nurses pushed through these emotions and continued on with their duties. I especially wondered how (or if) the nurse who was caring for him when he suddenly died was able to change gears and continue on with medication administration and assessments. How do nurses experience such pain and sadness, and then continue on their day with seemingly no lasting emotional damage?

I had no answer for this question. For myself, I had to sit down after my shift (on the bus ride home) and have a long talk with myself. I had to remind myself that there are side effects to every surgery, and that deaths such as Mr. Smith’s will occur throughout my career as a nurse. I realized that when such events occur, it is incredibly easy for the nurses that cared for the patient to carry the weight of the situation on their shoulders. It is so easy for these nurses to look at their own practice and wonder if something they should/could have done would have saved the patient.

Nurses need to remember that every difficult situation is a learning experience, even if this is not the easiest (or happiest) way to learn. I know that Mr. Smith will be with me for the rest of my career. He will stand behind me every time I talk with post-surgical patients. He will whisper in my ear, telling me, “Don’t forget to remind the patient to ambulate frequently, and make sure the compression stockings are on, and tell them to reposition themselves a lot.” It is voices like these that nurses carry around with them, informing their practice. As they gain experience, more and more voices join the crowd. It is these voices that remind them that the worst can and will happen, and that it is impossible to know when. It is these voices that protect patients from potential harm. It is these voices that save lives.

People think I am wierd, but I adore rainy, cloudy, dreary days. Here’s a picture from a Victoria, BC webcam I watch daily.

I love the fog that is rolling over the inner harbor. I want to go for a long walk and feel the mist against my face. This picture really gives Victoria justice as the most haunted city in North America!

There’s nothing like spending huge amounts of energy creating something, only to destroy it all in one fell swoop. What better example is there of the pure forces of chaos!

But…life goes on…what’s done is done.

I had a lot of plans to work on school projects today, but I’m finding myself in bed, coddling my laptop, drinking tea, and wishing for sleep to come. I have three clinical reflections to complete, a case study to write, a professional portfolio to work on. Plus, I wanted to finally dive into the urology section of my med/surg and pathophysiology text books.

But in reality, I really just want to stare at the television and forget the world….but that’s not an option.

I am stressed out, and it is really starting to chip away at my sanity. It washes over my body in buzzing waves. There is no respite or days off from my stress. It is ever present and tenacious.

Top Five Reasons for my stress:

5. Crazy sleep schedule.

I love changing shifts. One of the reasons I was attracted to nursing was the ability to work at all different times of day. This would help relieve the boredom of working the same hours all the time. However, there are limits to my ability to handle rapid shifts in my sleeping patterns. I worked a day shift on Friday, a night shift Saturday, followed by an early morning class Monday, and now back to night shifts. My body feels beaten up and exhausted through and through.

4. Looming move to Victoria

I made a promise to myself that I would not attempt any plans to move to Victoria until December 9th when I am finished school. However, I can’t stop the back of my mind from ruminating on it at a thousand miles per hour. Where will I work? Where will I live? How will I get my belongings there? Will Richard get a job right away? This move will be a hell of a lot of work, and I just can’t push it out of my mind.

3. Graduation

It is not necessarily the graduation that is stressing me out, but what I will be doing the day following graduation. Yesterday I was offered five jobs in my Health Region, all of which are very attractive.

However, aside from choosing a placement, the biggest stress is whether or not I should apply for the prestigious internship in the ICU. It is a six-month program that would give me the skills, experience, and theoretical knowledge to work in an ICU. It is the opportunity of a lifetime. Unfortunately, Richard was saddened by my desire to apply because it would delay our move to Victoria. However, this is an opportunity to take a career direction I have been dreaming of for years, so he says he would support my decision if I wanted to apply.

I decided not apply. It was a very difficult decision, but I want to move to Victoria as much as Richard does. Bigger than that was the thought that I would be moving anyway after the six months of training. This is not fair to the people that would be investing hundreds of hours and tens of thousands of dollars training me. I just wouldn’t be able to deal with the guilt of up and leaving. The opportunity should go to someone who wants to stay here.

On a side note, this does not mean that I can’t go to the ICU later on in my career. I believe it will be good to have some med/surg nursing under my belt before jumping into the most advanced form of acute nursing.

So, I am still left with the stressful decision of where I will go following graduation. I believe I am going to choose my undergraduate unit, which I hated, but will offer me priceless experience. Bear with me while I traumatize myself by submitting myself to this unit.

2. Too Much To Do, Too Little Time

This one is self-explanatory. I have papers, clinicals, case studies, readings, presentations, and more. All the work is piling up and I can’t seem to fathom how I will finish everything.

1. Intangible

Perhaps it is just a combination of all of the above, but it feels as though my immediate future is uncertain, confusing, and full of uncertain change. I am probably facing a year of mental, emotional, financial, and career instability. I am typically the type of person that enjoys chaos and change. But I, like everyone, has a limit.

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On an exciting note, I received my papers today to apply for my temporary RN license and Canadian Registered Nurse Exam. It was the oddest feeling to be looking at those papers, realizing that my student nurse career is ending. There were times that I really didn’t think I would make it!

I guess there’s still the possibility of not making it! ACK! I better go back to writing dozens of entries in my annotated bibliography!

Not much is happening in my world at this time. I am busy beyond belief, but time is passing, and I sink into autumn with pure joy and comfort. Nothing in this world makes my heart sing more than the cool air and beautiful panoramas.

This is the minivan we picked up yesterday. A black 2006 Dodge Caravan. You may be wondering how the hell two gay men end up with a minivan. When it comes down to it, that’s just how it worked out financially. R.’s last car had been in a large accident and was worth almost nothing, but he still owed a LOT of money on it. Because of rebates and special offers, the caravan was the only vehicle we could find that was even close to affordable. We’re paying too much for it, but it has relieved R. of his upsidedown debt on the Sebring.

However, it works perfectly for us. We wanted a vehicle that offered a lot of space for moving to Victoria and the subsequent travelling and camping we plan to do. Plus, it will make the perfect carpool vehicle! I told R. that we need to make a lot of friends in Victoria so that we’d have people to drive around. We need to make use of those five extra seats!

It feels really nice to drive. Nice and big, looks sleek (for a minivan), and is extremely comfortable! I can’t wait to show it off to everyone. Who needs a ride soon? LOL

As for school, I’m so incredibly busy. This week we’re working on a case study project. I’m quite pissed off because I wrote up what I thought was an awesome case study. The story met all the necessary criteria. However, the group decided (in my absence of course) that they wouldn’t use it. So, now we’re left to come up with a new idea. Nobody has any ideas, and I just keep saying, “so, yah, what about the one that’s already created and written?” We’d be done our project by now, but they’re too stubborn, shooting down every idea that is thought of by the group. I can’t wait until I’m done school and won’t have to do tacky group projects.

We also had to create professional resumes. It seems like a fairly juvenile project; however, it has been quite useful. They brought in professional resume councellors to teach us all the “dos” and “don’ts” of writing a resume. Better yet, the lecture was focused on how to write a professional resume from a student nurse perspective. Meaning, showing us how to include clinical rotations, undergraduate positions etc. Even though I will most likely have two job offers without even applying for them, when I move to Victoria I will need a proper resume.

The thing that was great about this project was that when I compared the resume I already had, to what was expected, there wasn’t too many differences. Apparently I’m already good at resume writing! I just needed to “tweak.”

Finally, I have declared the song “Starlight” by Muse to be the best song of the year. This decision wasn’t made lightly, but it has been done. This is only the second year in a row that I’ve chosen this award. Perhaps, sometime soon, I will share last years. Unfortunately, I think almost everyone would disagree with last year’s choice! Anyway! Here’s this year’s top pick.

I just wanted to drag in any stragglers to Change of Shift. I actually have a post featured there! YAY! Lots of good nurse stuff.

And here’s a little Change of Shift reading music. “Breath” by erasure. Hit play and head off to read all those great blogs.

A big hearty “hello” to everyone visiting from emergiblog! I wish I had posted this yesterday, I have missed out on welcoming a bunch of people…

Don’t you hate when something works out, but the process just wasn’t comfortable? Today I had my third successful IV start ever (YAY for me!), but it was the ugliest, sloppiest start. My hand was shaking, the catheter was upside down (only noticed after the insert), I removed the needle to soon etc. etc. etc. However, in the end the tip was in, the return was great, and the IV meds flowed happily. I just wish the process was deserving of the outcome. Three more starts to go until I am certified to start IVs, and lord only knows how many until I am a pro.

Things are getting better with my precepter. We’re starting to feel a little more comfortable with each other. We’re much more comfortable working together, and she’s less “cold.” I am also starting to bond with the other nurses on the unit, all of whom (actually most) I really like. They’re all so relaxed and calm on this unit. Granted, their patient loads are much easier, but they’re just plain easier to get along with. Also, I am the only male on the unit…which is fun. I stand out. I am unique.

I really am torn as to which unit I would like to work for after finishing. The unit I like better and could see myself making a career on, or the one that I dispise but will challenge me and make me an better nurse. The latter unit is closer to my house and would lend itself to making a critical care nurse out of me. It’s looking like I will take on the challenge of the dispised unit, even though the idea makes me cringe. However, no matter where I work, it will only be for three months since I am moving to Victoria. I suppose that would be an even better reason to take the harder job. I could solidify my skills before moving on. OK, it’s settled…for now.

I have the next three days off, and while the majority of the time will be focused on school, it will nice that it will be on my terms. No alarm clock allowed!

P.S. I need to stop watching shows like Jericho, I’m having dreams of nuclear attacks and alien invasions (that started after seeing War of the Worlds) again. I hate waking up scared…I’m such a baby!

After reading this I must tell people that I think it’s day shifts that are horrible, not night shifts! Day shifts are rough on my body, which strongly believes that getting up at 4:30am is WRONG. Somebody mentioned that working night shifts makes them feel like they have the flu. Yes, day shifts do that to me for sure! It takes me many days to get over the pure exhaustion of working day shifts.

More than anything, I feel that when working the day shift, nurses are expected to work at inhuman rates. On night shifts, the workload feels manageable. There’s less chaos and disorganization. On night shifts, I don’t feel like I’m “just trying to keep them alive until the next shift.” Instead, I feel like I am being a nurse and working with my patients.

Oh yes, and not having to set my alarm clock is priceless!

In my city they pay a shift differential to evenings and night shifts. I seriously believe that day shifts deserved that extra $2 and hour. Afterall, they work twice as hard! I guess I’m just realizing now that I don’t value a fast-paced environment as much as I thought I would. Oops!

So! This week has been pretty bleh (for lack of a better word). Monday we had our senior seminar in the morning. I am really starting to love this class. It is an open environment in which we (eight of us plus our instructor) have the opportunity to discuss nursing on a high theoretical level. Conversation isn’t fully structured and is instead allowed to ebb and flow in whichever way it needs. Monday afternoons is our leadership course. We had to sit through three hours of resume writing and interviewing skills. While this is actually important, it certainly didn’t lend itself to being very interesting.

After all these classes I had to meet with my leadership project group to advance are project ever so slightly. I created an annotated bibliography, while others created a group evaluation tool etc. Now, we need to invent a case study. Sometimes, I feel like these projects are valuable, while at other times it just seems like busy work until we graduate (66 days!).

Today was clinical. It was a good day, but my patients weren’t following the expected (read: easy) paths. A post-op that was too dizzy to stand, others who’s pain wasn’t well controlled, and another who was (and this is my favorite term) “pleasantly confused.” It was a typical day shift–busy busy busy. My precpter was so busy with other projects and emergencies on the unit that she didn’t really have time to watch me closely. I suppose the fact that she trusts me to take care of the patients and go off and do other “stuff” is a positive sign. She doesn’t feel as though she needs to watch me closely. Hurray! Fortunately, whenever I DID have a question, she was more than welcoming–which was quite the feat! I don’t think a single moment went by in which she was doing less than four things at once.

Tomorrow I am there again. Wash, rinse, and repeat!