Avoiding HIPPA
I had big visions about the blog and I haven’t made the time to shape it the way I had envisioned it. I think that I have been hesitant to post my experiences more is due to not knowing mug about HIPPA. I know the basics: don’t name names, list places and or specific identifying facts that may lead a person to know who or the specific situation I maybe talking about. Even though I understand that, there’s still a huge fear because anyone can read this and any blog like mine and say, “that’s me!” and then starts drama. But who knows if that will happen. It has happened though to other people though. I did a presentation on social networking in relation to HIPPA and I found articles discussing people that purposely and or inadvertenly violated HIPPA in blogs and sites like Facebook. Even when HIPPA was not violated, the posting was brought to light. I could write a posting more about my presentation later and reference articles.
So bare with my absence! Just trying to figure this all out.
=o)
Fine lines between MD & RN
Working in a teaching hospital.
IMO, There’s a fine line between MD & RN when working in a teaching hospital. In my head, I’ve come to terms with knowing that, “I’m the nurse. You’re the doctor. Now give me orders!” I try to draw a pretty bold line in the sand so that no MD can come back and say, “well, it was the nurses fault…. she told me to!” I had a doctor call me back on the phone for a Ty order. Here’s how the convo went.
:::Ring:::
Me: This is (Me)
MD: Yeah……..
Me: Uhhh, my pt won’t po Ty (for a reason which I won’t get into to much detail here.. basically the pt had such a fit, he stopped breathing….’nough said) He’s in obvious pain and I know you don’t want to give MS for this sleep apnea. Can we give PR instead?
MD: Uh…..Yeah….
Me: (long pause) Ok so how much do you want to give?
MD: Whatever his Ty/codeine order was before, is the dosage the same for PR?
Me: I don’t think so.
MD: Well what’s the dosage range for Tyelnol PR?
Me: Sorry, I couldn’t tell you off the top of my head.
MD: Well just put the previous dosage range.
Me: Well, it says 1mg/kg/dose… I don’t think that’s right. If I have an issue fullfiling the order can I call you back?
MD: Well, I’d rather get this settled now.
(Mind you, I’m like feeding this MD information which I shouldn’t be doing.)
So basically he wanted me to find out what the dosage range for his order!!!!! Are you kidding me? I hate playing doctor/pharmacist/nurse/patient advocate at the same time.
It’s like dude, PLEASE. I’m like you’re supposed to look that up! So I said you know what this doctor doesn’t know what he wants, so I’ll just help him a little. If I hadn’t I wouldn’t have gotten what I wanted and that’s the thing about teaching hospitals…
If you don’t tell the MD what you want for the pt, you’re mostly likely not going to get it because 9 times out of 10, they’re not thinking about the obvious. That’s why as a nurse my job is a lot harder because I have to be one step above the Resident. Being a resident MD I know has major challenges.. don’t get me wrong. But sometimes I’m like, I should be MD if this is the way it’s going to be.
There were worst situations at work but it’s too detailed to get into so maybe another post =o)
But do you see my frustration? Trying to find what my role is as a nurse…but more so in a teaching hospital.
Life after orientation
I’m going on the third month of being off orientation. The last month has been HELL. I mean I was in such a dark place. I started distancing myself from work and my coworkers. People were noticing that I just wasn’t myself. I was so overwhelmed. I was BURNT OUT. I started looking at home health and hospice agencies to work at because I couldn’t handle the acuity of my patients. I might as well work in an ICU where patients turn for the worse all the time. At least I’d expect that. I started to change so much. I got written up in the process for something I didn’t know I could get written up for. That wasn’t the straw that broke the camel’s back though. When that happened, it was like …ehh.. what else? I was already so numb to everything.
I ended up talking to a few I guess, “important” people and some others and I decided that I should just stay put. I decided that instead of running away from my hurdles, I should jump over them and continue the race.
I’m now getting more and more confident at work now that I’ve learned to cope better. I’m learning how to ask for help more and to not feel like I have to do this all on my own.
I’m continuing to grow and things are leveling out better. Oh yeah, I’ll still have those horrible nights. But I’ll push through them. I will.
Is it really this hard?
Last week, I came back to work with 4 days off. It’s always said that you’re first night back is always the hardest. I knew that. I always pray before I step out of my car to to go to work. But for some reason, I prayed even harder that night. My prayer lasted more than the few seconds.
My night couldn’t have been anymore worse. I don’t want to get into too much detail, but it kind of elevated when I gave Tylenol for a temp of 99.4. At my hospital, you don’t do that.. it’s considered a normal temp. We don’t start treating until 100.4. Well, I knew that and had I justified why I did it to the Attending (at the time I thought she was a resident), then she would have understood. Well, let me have that chance now.
He had been spiking temps all day. When I took my pt’s temp, it was 99.4 and he was starting to get warm, from what I felt and what the relative thought. So I thought, ok, let’s get this temp under control now. By the time I got the Tylenol, it was about 15 min later and I came in and he was burning up! I wish I had taken the temp again but I knew it was in the hundreds.
Well he had also had an issue with low bp. We only take bp once unless otherwise ordered. I just randomly decided to take his bp again at the midnight vitals and it was 76/44…down from 80s. His hgb was already 7 point something and the docs didn’t want to transfuse him. So I found the number for the on call hem onc resident (had sickle cell) and when gave a report to the doc, she was like, “You gave Tylenol for a temp of 99.4? Why did you do that? That’s normal temp!” and she kind of cut me off and I couldn’t justify why I did it. I could have but that night I have had 4 peds pt’s with TPN and GT feeds and antibiotics galore and I was just at the end of my rope. I couldn’t just say, “you know by the time gave him the Tylenol he was already burning up. ” In my head I didn’t think it was a good enough reason. I thought I needed numbers. Had I taken the temp again….
But you know, he ended up having a another temp of 101 towards shift change anyway.
Huhm.
So that day I’m like is this really this difficult? And I’m not basing it off of this one incident. Overall I think I’ve had a great experience so far in acute peds but at the same time I don’t think I can handle it for that very long. I’m starting to get burnt out. I hear from my educators that other nurses are saying that I’m not afraid to kind of just jump in there and take care of things and thank God I have some wonderful nurses that have my back. I think I’m getting harder pt’s because maybe they think I can handle it? Maybe so? And yesterday I had a crazy night too and I thought our team leader/resource nurse said “You know this is a test.” and she kind of said it in passing. and I’m like, “did she say that?”
But yes, lately, I’ve been thinking of going back to home health. Slower pace. When I was an LVN, I was a home health nurse as a new grad, so early on I learned how to be independent and figure things out on my own so I not scared to go back as an RN. I think it’s just a matter of time.
The next episode
It’s hard to remain hopeful after someone has completely disregarded your friendship as umm…. unecessary. Those words weren’t said but that’s how I see it. How do you remain hopeful after realizing that? Here I am trying to rationalize “well maybe he doesn’t see our friendship as that serious. Maybe it’s me that needs to not care so much.” I never thought I’d see the day where I should care less for someone. That’s opposite of what I believe. As a Christian, it’s my duty to love everyone regardless of what they do. But I hardly think God means to just let people walk all over you and be taken advantage of. “Be as harmless as a dove and as wise as a serpent.” uh, I’m so over it! I’m moving on and up in my life.
Speaking of, I’m moving on up! I’m moving out reallly reallly reallly soon. I mean, I’m counting the hours. I never thought I’d get emotional over this. I should my mom and dad the towels I bought and I had to jet to the next room cause i was getting a little teary-eyed. That was close. But it’s seriously coming down to the wire. You should never say “oh my life will begin at this point: when get married, when I move out, when I finish school or get a job.” But let me tell you this couldn’t be a better time to say this. My life is literally going to start. Being under my parents rule, lol, I couldn’t do much. I dared not stay out pass 8pm if I had been out all day. I remember days where I just thought, “what if I just said I’m gonna get an apt?” my parents would have laughed me into heaven. I know what it’s like to feel like you’re so behind as far as experiencing life “out there”. I mean just being about to go places without hesitation is one thing I have yet to experience. No more, “oh I can’t be out that late.” In the beginning I used to hate my parents for it. But more so now, i always say, “it’s out of the respect of my parents and since I still live underneath their roof, even at 24, it doesn’t give me the liberty to cause them heartache when I’m out at all hours of the night. So until I’m out, I’ll live by their rules.” and after I say something like that, people usually understand where I’m coming from and back off.
It’s so exciting and so scary at the same time. So happy I’ll be moving out with my sister. Makes it a little more bareable. I’ll have the mind to focus on bettering my mind body and soul.
This will certainly help me grow in my relationship with God. I’ll need Him more than ever in this transition! I’ll turn to Him to give me wisdom and discernment to meet and associate with the right people. I hope to get more involved in church. I’m so glad I have parents to taught me the power of prayer and no never go without it. I’ll always have that with me. Even when I stayed in the dorms my first yr of college, my dad told me to never forget to pray every night and anytime. I’ve got a great foundation to battle the next chapter.
=o)
“When are you going to get boyfriend?”
In the past year, I’ve gotten this question a whole lot… more than ever. I really don’t know why but lately people have been interested in my life in terms of relationships. And it’s like, “uhh, really?” My response a year ago would have been, “I don’t know I’m just a lonely girl in a lonely world. :::sad face::::. Starting my career, buying a new house, and a new car has just totally changed my persepctive on what’s important in life. Now, I’m not saying new cars and new houses are important.. but you know shelter is. It speaks a lot to me that I’m just sort of moving up in life and I thank God everyday for his blessings. I used to be so caught up in having a boyfriend. Now, it’s become less of a priority. And it’s mostly because I realize that I am great single. Of course, what girl wouldn’t want a boyfriend? I don’t want to be single forever, but for the first time in my life, I feel like it’s ok to be single. It’s not a sentence on my life. I have realized that I am happy with just being me. I’ve sort of grown up a little. And because I’ve never been in love doesn’t make me any less able to love someone. Someone told me, “Don’t tell anyone you haven’t been in a relationship. They’ll think you don’t know what you’re talking about. Or a guy may think you’re immature.” Immature at what? Common sense?
Really, do you feel sad for me? People seriously feel like I am doomed to failure because I’m not in a relationship and I don’t think it’s right. I’m like, “is it really that serious?” Like you have something much more than I do. I’m not knocking relationships. It’s the most crazy/beautiful experience manifested between two people. Mind you, I used to be, “OMG I most fall in love with the next person that looks my direction or blinks, walks, talks and/or breathes. Now, there’s no more pressure because I realize all I need is God/family by my side to accomplish my goals.
I got the car. The house. The career. Hm, what’s next?
…..WORLD DOMINATION!!!!!
Just kidding =p
All in all, I hope someone can see where I am coming from. ”Boyfriend” is just not at the top of my list… and it should never be. But I would love God to bless me with a man that is just everything that I need. And He has (speaking things as if they were! it’s called faith).
I just have to wait and see.
“Maybe it was an earthquake.”
I fell asleep watching I Love Lucy on my iPod Touch last night. In the middle of the night, I felt like I had been picked up and tossed back in bed. I thought, “Maybe it was an earthquake.” So I looked on my ABC7 app on my ipod and saw nothing about a recent earthquake. Waited maybe 20 minutes, and still nothing on Facebook. Then I thought, then who shoved me back in bed? It was as if someone had grabbed me by the shoulders, sat me up and was pulling me into darkness.
I was dreaming that I was driving in a car at night. Street lights are on. I was making a turn on an off-ramp towards the right. When I was making the turn to get off this road, it got extremely dark. I saw greenery in front of me, then just darkness. Pitch black. And as I was turning into this “darkness”, I had no control. Someone was pulling me into it. Then I woke up as something pulled me back onto my bed. It was like I had been floating.
I’m not sure if this was anything spiritual but that was pretty out of this world. And it felt like someone pulled me back. There were like 2 opposite forces.
Something about sleeping at night just scares me. I never really liked it. Thank God I work nights. But when I go to sleep at night, it’s a weird creepy feeling.
I just pray to God that is was just a dream and nothing more. I mean they say your mind can’t tell the difference btwn a dream and reality.
All I know is that… uh….God protect me!
Transitional phase
Phases of transition. At least this is one I can see. I’m at a point in my life where I have started my career, closing on a new home, and growing closer to God. I’m in a phase of transition. Things are changing in me and it feels great. My thinking is changing and I’m loving the new direction I’m headed in. God has blessed me so much in the recent months. But you, I’m lacking in one area (well, one of many! I’m just sayin’ …. Lol I’m not perfect! And HE knows that.) And that area is drumroll please.. Dadadadadadadadada…
My weight. Yes! My weight. I’ve been struggling with probably since I entered college 6 yrs ago. In highschool it wasn’t a big deal to me. I remember every year I’m like “imma loose weight!” and it just never happened. There’s no more excuse of school in the way. Now it’s just work and I think I’ve got that one under control. Now, I feel optimistic about loosing weight. It’s exciting to see a change.
I’m not one to be a skinny mini. I love the fact of having meat on the bones.. Get the drift? (old saying I know) lol. Even though I have now learned to embrace my body shape as I am, I can’t wait to embrace even more at a size er 12? Yes! 12! Right now I’m at about a size 18/20 ( lol sometimes a 20/22 depending on the style of clothes). I’ve got about 98 pounds to get to that size which is around 160-170 from what I’ve researched. I think for my size, that’s a lot!! Many a time people have told me that I don’t look that heavy when I tell them my weight. Do I wear it that well? I think well before I reach the 100 pound loss mark, I’ll reach my size 12/14 goal.
Since I’ve switched to night shift, I’ve lost weight! Kind backwards from what everyone has told me about night shift. I don’t eat that much at 3 am and in the day time I sleep… So in a 24 hr period, I only eat twice. That cuts a lot of calories.
I’ve not been working out so that’s what I’m doing now.
Can’t wait to reach my goal =p
*I typed this on my ipod. i’ll just leave it with it’s imperfections =p*
Day 2/100
Two days I’ve been off of orientation. The first day on my own was just completely weird and awkward. I had no one to answer to. It was practically me. I mean, I could always ask questions, but all decisions kind of rest on me. But overall, I think I did well. I had 4 patients last night and a lot of meds happened at the last hour of the night which sucks because that’s the time when you’re supposed to kind of settle and get ready for the day shift. yeah so I stayed about 20 minutes after which wasn’t the greatest feeling =o( but you know it’s ok…. cause this week I’m getting paid my regular pay now.. FINALLY!…after such delay.
