I'm a night shift girl living in a day shift world

I get soooo bored at night when I am not at work. I end up staying awake all night and there is nothing on TV to watch. It doesn't help that I can't find the dish remote and the channel is stuck on the cartoon network tonight. I am going to share some of my work sayings;

I don't do skin care on my patients I "Butter their buns".

My patients don't have stool smears they have "Farts gone wild".

My patients don't die they go on "Field trips" they are not allowed to go on the field trip without a signed permission slip (DNR).

When I get a walkie talkie admitted to my ICU my question to them is "What's a healthy guy/gal like you doing in a place like this".

My patients don't get discharged with discharge instructions they get paroled with parole papers. I don't do much discharging on the night shift.

I am known as the "psych whisperer" because I seem to calm the anxious and confused (often without haldol or ativan for them or for me) I explain that "It takes one to understand one"

I often hear from my colleagues (lovingly) "You ain't right" my response "But I'm rarely wrong"

I believe you hurt the one you love so I know that at 2:00 AM there are a few doctors who absolutely adore me.

Drs don't like you to be too perky at 2:00 AM so be sure to use your 1-900 voice until they are fully awake.

All men need an extra large external catheter the different colors on the package just indicate where they were manufactured.

We call our external catheters Texas Caths I once had a patient tell me he didn't need a Texas he needed a Rhode Island. I loved him, he kept me in stitches during his stay.

While wearing bright lipstick I kiss my patients on the forehead before they go to surgery so that everyone knows they belong to me and will treat them extra special. (after all I have set high standards).

I want to know if my patient brought me back a T-shirt from radiology, you know the one that reads "My patient went to radiology and all I got was this lousy T-shirt"

When I do an EKG at the bedside I make sure to tell my patient to smile for the camera.
I also try to increase sales by asking them if they would like a 5x7 or wallets to share with family and friends.

The transfer center nurses know that if my patient is admitted on an odd hour they go into an odd numbered room even hour admissions go into even numbered rooms. If only even or odd rooms are available then the ED must hold the patient until the appropriate hour. (ha, ha not even in my wildest fantasy).

When my patient is in trouble or really sick don't mess with me, I will tell you exactly what I want you to do. I am not Bi-polar, depressed, angry or unhappy I am just extremely focused. I am a DGN (Damn Good Nurse) and know when it is time to get serious putting fun and games aside because this is MY patient. The patients that are entrusted into my care get the best that I have to offer.

I work tomorrow night I hope I get some good blog material while I am there.

permission slips and field trips

My patients don't die, they go on field trips. I don't let them go on the field trip without a signed permission slip (DNR). At least that is the way it is supposed to be.

The most draining, exhausting, burnout inducing cases are the ones in which the patient has had their permission slip signed yet the family refuses to let them go. A 90+ patient is admitted with ischemic bowel, there they lie in their bed intubated, TPN, Levo, Vassopressin, bicarb infusing into the central line, a-line pressure indicates a MAP barely above 60mmHg, CVP 4 urine output looks like over seeped tea and a DNR bracelet on their arm. Or the 80+ patient that signed a DDNR but the witness signature in not legible the family insisted that the EMTs do something when they were called to the home and now there the pt. lies in an ICU with the family refusing to accept the grim prognosis.

What keeps me going when I want to walk away and never look back? I'm not sure, I whisper in their ear that it will get better...one way or another it gets better. Scenario 1: The family will come to terms with the wishes of the patient and give them permission to go to the other side. Scenario 2: No matter how much or how many hormones, pressors, and fluids we pump into their system their heart no longer conducts the electrical impulses to keep it beating and life on this earth ceases for them. They are finally able to board their plane, train, car, boat, helicopter, UFO, wings of angels or what ever mode of transportation that is provided to the other side. Scenario 3: They may get well enough to leave our unit or hospital; but at what cost? None of them has ever come back and told me "thanks for keeping me alive"...then again none of them has ever come back and told me "thanks for staying with me till the end" either.

Since I have been a nurse (5 years) I have only had 2 of my OWN patients code (one lived on life support for a few days the other we were never able to revive). I do not know if it is luck, skill or because I let them know right up front that field trips are not allowed without a signed permission slip and their families permission; they are not to board the bus, train or plane. So far this has been an effective strategy for me along with a whole lot of prayer and diligence to keep them here until the next shift. Try it sometime and see how it works for you.

One is never prepared when a patient decides they are going on the field trip without your or anyone elses permission it can be devastating to one's confidence and moral. I personally still wonder if there is anything that I could have done better, diffrently, or faster to improve the outcomes for my patients.

Someday I will be on the other side and I will know the answer, but for today I have to have faith and courage to do what I do to the best of my ability.