Rest in Peace, Little Angel

As I expected, my life back in N5 is stressful yet fun. I don't miss the fast paced life in N5 but I did miss my workmates who crack jokes and "make fun" of each other every now and then. .

So anyway, I survived my first day as a charge nurse. I had 23 patients which means I had 23 patient's charts to read and review in 8 hours. As a night shift charge nurse, it is your task to review all the doctors' orders in the past 24 hours just to check if anything was missed. Unfortunately,  I wasn't able to finish everything. Bear with me, I am still adjusting.  On my second day as a charge nurse, I think I got the right technique. Thanks to one of my seniors Ma'am Aloha who taught me the faster way. :)

Last Wednesday, we admitted a young looking lady who seems like giving up anytime. I took her initial blood pressure and I got 70/40. I got curious about her case so I waited for the medical intern to finish taking the patient's medical history. To my surprise, the patient is only 16 years old and has ovarian cancer. Another thing that surprised me is that she already lost her ovaries at a very, very young age. Through my whole shift, I always obtain low blood pressure. The medical resident on duty already talked to the mom (I assume)and asked her if they want to be "aggressive". I heard things like, "So i-tutubo siya? Hindi ba mahihirapan yun bata nun?", "Anong mangyayari kung di kame pumayag?", etc.

For five days, the patient fought for her life until this morning, I learned that she already succumbed to cancer. My heart sank upon hearing the bad news. She's too young to die. I know that if she was given a chance to live longer, she would probably grow up to a very, very nice and sweet lady. 

To be honest, she's my favorite patient among those who were admitted in that wing (N5 ward is divided into two wings). She never complained anything except for the back pain when I raised her legs during her hypotension episodes. Other than that, she was quiet and very cooperative. Sadly, this young girl isn't aware of her illness despite the procedures and medical treatment she has gone through. 

I've had a number of "deaths" during my first year in the hospital but this death made a big impact to my life. First, I don't like seeing young people suffer from illness. We can go back to our memories during our childhood but we can never turn back the time and be a kid again. Having diagnosed of cancer deprives these kids to enjoy the normal childhood life. It breaks my heart to see a kid watching other kids playing outside through the window. And second, being diagnosed with endometriosis, I feel like I am not as lucky as any other woman who doesn't have any problems in getting pregnant. When I was diagnosed and have undergone two major operations in two consecutive years, I was warned about my future that I might not get pregnant. Through this innocent stranger, I realized that I am still blessed. At least, I still have my ovaries and that I can still get pregnant through fertility work ups. I thank God for that.

The best thing about being a nurse is that everyday you meet new people whom you never thought would touch your life and give you a life changing experience instead of you touching their hearts.

Thank you, little angel. May you rest in peace.

Nursecissism

Finally renewed my domain, Nursecissism (too selfish to give it away!) which is actually inactive. Months before, I planned to make it a “full time” Nursing blog. Like a Nursing interactive blog… but I don’t have some people to work with me and also little time to work on the site.

While we were on our seminar this morning, I realized that I really have to make that happen. That interactive blog will consist of the following:

• featured case studies


• drug study


• true hospital stories


• research and new trends in Nursing


• forum for nurses

If you plan to be part of the Nursecissism team, please contact me at xyladevera@gmail.com. Send me your resume and an article (tagalog or english).

I need nurse bloggers and nurse webmasters/designers.

I accept nursing students and registered nurses, working or non working.

Thanks!

 

This is how I spent the Vday

This is an unforgettable Valentine's day for me. Not because my boyfriend surprised me with beautiful bouquet of flowers (he didn't actually. Haha!), but because I was one hell of a busy nurse on this very special day for couples.

At 12:00 am, I texted my boyfriend who was already sleeping at that time. I had the time to text him because I was INITIALLY not busy. I even had the time to cut paper hearts and posted on our bulletin board.

One of my patients though who was hooked to a mechanical ventilator through an endotracheal tube was febrile and hypertensive. Her blood pressure yielded 160/100 and her temperature was 40.3. I immediately referred it to our charge nurse.

At 1:00 am, her blood pressure and temperature was still the same. I also suctioned her regularly.

At 2:00 am, her blood pressure dropped to 120/80. It is already normal but I kinda got worried because my patient the other day died. His blood pressure dropped from 200/80 to 70/40. I didn't want another patient to die during my shift.

At 2:30 am, my patient's daughter requested to suction her mother. When I went inside the room, I noticed that my patient's lips were cyanotic (bluish in color). I checked her BP immediately as soon as I finished suctioning. I can't hear anything anymore. I can't even feel a pulse. I immediately ran to the nursing station to ask help from Sir Renz who also couldn't find a pulse.

From 2:30 am to 5:00, we were busy. We hooked dopamine and epinephrine drip as per doctor's order to save the patient. While we carried out the doctor's orders, the medical residents talked to the husband and daughter about the patient's situation. They asked them if they are aggressive with saving the life of their loved one. They contemplated about the pros and cons but there was definitely no assurance that the patient will survive since she now relies from the drugs we induced to stimulate her heart. They then decided not to go for a cardiopulmonary resuscitation in case the patient will arrest. I was teary eyed while I heard the husband talked to his wife. "Lumaban ka. Kumapit ka. Kelangan ka ng mga anak at apo mo. Kumapit ka. Mahal na mahal ka namin." Just typing those words I heard from the husband makes me teary-eyed again. I don't like being put in a situation like this. I easily get emotional.

Fortunately, my patient didn't die during my shift. She was still holding on when we endorsed it to the next shift. I don't know what happened next. I am not sure if she's still alive.

At 8:00, our station had a meeting about the new policies in the hospital. I actually do not like the new program for nurses because I already had enough with the oral revalida and return demonstration during my college days. Now, we have to do it again to evaluate the knowledge and skills of the staff nurses. Ugh.

Our meeting ended at 12:00 pm. We, the night shift nurses, were already groggy. I was in a hurry to go home and to sleep. On my way home, I fell asleep on the train and on the jeepney. I walked like a drunk person that the security guard in the LRT station even checked me if I was okay. Haha!

At 1:00 pm, I was home at last. After taking the shower, I called TJ to greet him Happy Valentine's then took Tylenol with diphenhydramine for my muscle pain. Then after 15 to 30 minutes, I already felt the effect of diphenhydramine.

At 8:00 pm, my father woke me up to eat dinner. He apparently bought cake, ice cream and pancit canton for mama. How sweet.

So this is how spent my Valentine's Day. No flowers, chocolates nor an extravagant date. I'm kinda envious of other couples who went out but... sleep is my priority. Hahaha!

This shouldn't have happened...

Something happened during my shift. I cried at the station because I felt humiliated and pressured at the same time. Here's the explanation letter that our senior nurse asked me to write.

February 10, 2011

To whom it may concern:

I am writing this letter to explain my side of the story of what happened this morning at N5 station.

At around 3 to 4 am, Kuya Hector delivered the medicines that I charged from the pharmacy to our station. While dispensing the medicines, I discovered that I charged the medicines of patient N505 to patient N504. So I immediately filled out the return slip and checked the “Incorrect entry of patient’s name” assuming that that option is for incidents when a nurse has tagged a medicine or any item to a wrong patient. Under the remarks, I indicated to change the charging of items from N504 to N505. As a new staff, I didn’t know that I was doing the wrong thing. I admit that I am still learning new tasks that I have not performed during my volunteer nurse days.

When Kuya Hector arrived, he asked me to put a reason on the slip. I explained to him that I have already written it under the remarks. I elaborated that I have tagged the medicines to the wrong patient. I thought he clearly understood what I have said.

At around 6 to 7 am, our station got a call from Ma’am Helen from the nursing supervisor’s office. It was Ma’am Lorraine who answered the phone. She asked me if I returned any items to the pharmacy. I already had an idea that it was the return slip for N504 that she was talking about. I explained to Ma’am Lorraine about what I did. She then explained to me the process of returning items when tagged to a wrong patient so I filled out a new return slip again to correct the wrong thing I have done. She asked Ma’am Helen why they did the call instead of the pharmacist. She was informed that Kuya Hector headed to the supervisor’s office to ask or tell about what I did. Ma’am Lorraine informed Sir Kenji about what happened because he was already at the station when the supervisor called. What occurred to us is that why did Kuya Hector go to the supervisor’s office first before going back to our station to clarify things.

After the call, Kuya Hector appeared in our station and Sir Kenji confronted him about what happened. He told Kuya Hector to talk to me so I explained to him that he should have approached me first before going to the supervisor’s office. All of a sudden, during the endorsement of night shift to AM shift, Kuya Hector fell on the floor and had a seizure-like attack. I was worried because I did not intend this to happen. I admit that I was shocked and scared of what happened to Kuya Hector.

I know I have done nothing wrong except for filling out the return slip wrongly. I actually feel sorry for what happened to Kuya Hector. I did not want that to happen to him. On the other hand, I also felt upset because I really think that this shouldn’t have reached the nursing supervisor’s office because I believe that we can settle this in a proper manner.

Today, I have learned a lesson from a very simple mistake I have done. As a new staff nurse, I admit that I am still learning and in case I commit mistakes, I correct it immediately. I started working here with a goal of doing my job effectively. What happened earlier was beyond my expectation. If I have unintentionally disappointed anyone, I truly apologize for that matter. But again, I want to clarify and firmly justify that I have no intentions of doing harm nor cause any misunderstanding with people I am working with.

Thank you.



Sincerely,



Xyla De Vera

Like what my letter says, I don't intend to hurt anyone. I was filled with mixed emotions this morning: disappointment, anger, humiliation, sadness, etc.

Sigh. I never thought that my shift would end like this. :(

P.S.

Kuya Hector was diagnosed with MALINGERING. In short, umarte-arte lang. Sir Kenji told me that he did that a lot of times to different staff nurses to put the blame on them. Sigh. Why me...

My first week as Staff Nurse

It's been a week since I started my work as staff nurse. I wanted to blog every single detail of my day but I always get home really tired. Thank God, it's my off today. I finally have the time to blog. Now let me post it in bullets.

• My patient died on my last day as a volunteer nurse. Another patient died on my first day as staff nurse. Now, the staff nurses call me RIP girl. They think I have a jinx. After my duty on my first day, I headed to church to pray and ask for guidance. I also asked God to stop the jinx just in case I have one.


• I realized the importance of volunteer and student nurses. They somehow helped me lessen my tasks in terms of taking the vital signs especially that during my shift (3 pm to 11 pm), we regularly do not have  a nursing aide.


• I have a new uniform. It's quite bigger than my size. I think I need to eat a lot. Haha!


• Since I am a staff nurse now, my meals are sometimes skipped. I eat dinner at a later time. I always bring cookies and biscuits with me so just in case I don't have time to eat dinner yet, I can munch while working.


• I now double check all the things I do and sign on the chart. It's all my responsibility now.


• I made a few mistakes but I'm learning.


• One mistake I did is that I charged (c/o pharmacy) a lot of IV antibiotics to my patients. The desired dose is 750 mg. I charged 1.5 grams. I was worried how I will be able to solve that problem since the pharmacist reprimanded our senior nurse about the number of medicines I charged. Thank God, I was able to think of a solution right away.


• I need to lengthen my patience more. People are just so demanding these past few days. I understand that they want the best for the patient but I really think it would be better if they calm down their voice.


• Some of the staff nurses call me "admitera". Whenever I am on duty, we admit 2 or more patients. The last time I was there, I admitted 5 patients. Wow. That was quite confusing actually.


• I go home at around 12 am. I need to plan more strategies how to accomplish all the tasks in 8 hours. Again, I am learning everyday.


• The only problem that I have now is my thesis. I have lesser time to work on it now. I can't concentrate when I am tired. Help me God.

Tomorrow is my 8th day. I still have more than 500 days of work to attend to to be able to start working as a clinical instructor. I can't wait.

STOP Nurse No More

People say that when you lose something, a bigger opportunity knocks at your door. I do believe in that. Winning at least a single category in the recent Philippine Blog Awards was really important to me. Even though I know I have a small chance of winning knowing  that my opponents are big time bloggers with huge fan base, I still tried to get my luck. Well, if it is not really for you, then you will really never get it.

The day after the awards night, I woke up early for my AM shift. I was almost late for work. On my way to the elevator, I saw our head nurse. I greeted her with a smile and she replied, "Oh Xyla. Ma-iin ka na sa January 16. Asikasuhin mo na lahat ng mga papers mo."

Yes! Finally! After 4 years of waiting... I will finally tell myself and the whole world that I am not a STOP nurse anymore. After 4 years, I will now be called as a STAFF nurse. No more volunteering. My life as a struggling volunteer nurse ends on January 14. Thank you, God!

December 13 was a day filled with surreality. Every staff nurse and employee in our station greeted me with a smile. All of them congratulated me. Other staff nurses were already giving me lectures about their techniques and strategies in managing their tasks in a very limited time. I wanted to text my parents and my boyfriend right then and there. I was so excited to tell them the good news but I preferred telling them in person.

Blessed are those who wait as they say. I may be 4 years behind my other batch mates but I am really happy that my efforts and waiting will finally be paid off. I was actually planning to apply as a clinical instructor next year but I guess God wants me to serve patients first before I start teaching students.

Behind my overwhelming happiness, I also feel pressured and anxious. This time, it will all be my responsibility. Whatever happens to my patients, I will be liable of it together with the other medical professionals assigned to them.  I am risking my license in every task I do so I really have to be extra careful with all my nursing care. And not only that... my patients are human beings. I don't think I want to be responsible of my patient's death because of my negligence or medication errors.

Another thing, I only have a month to finish everything for my thesis. Honestly, I haven't accomplished anything yet due to my tight schedule. Sigh, help me God. I hope I can do all of these in less than a month.

I started my count down two days ago and with that, I went to Divisoria to buy a 12 1/2 yard-white cloth for my new uniform. Haha! I need a new uniform not because I will be a staff nurse next year but because our head nurse kept on reprimanding me about my uniform. She says it's too small and too sexy for me. Haha!

New year, new uniform, new work! Thank You, Lord, for this bigger and wonderful opportunity. :)

Gifts from Strangers

"Auntie, oh. Sa inyo na ito..."

My cousin, a nurse who worked in the hospital where I am currently in, used to say these words to my mom almost every day. When she was still living with us, she always had these goodies from random people. So when I was a kid, I always thought that being a nurse gives you the opportunity to bring home some random gifts/food. Well, kids do love gifts.

When I became a nurse, I realized that those gifts my cousin received from her patients were more than just a material thing. It's more of an appreciation from people whom you've helped. It's gratitude from people whom you're not related to but you still cared for. It's not the material thing... it's the feeling of being appreciated.

Lately, I've been getting food and fruits from one particular patient. She's very kind! I want her to be my grandmother! She's entertaining, generous and cute. Haha! But one thing that I like the most about her is that even though she's kind of rich, she didn't let me feel that I'm a low kind of person. Some rich people think that nurses are slaves. There's this one daughter of a patient who called for some help yesterday. I didn't get what she asked me and she just shouted "I know, I know! My gosh!!!" I felt humiliated at what she did. She shouldn't have said those words. She shouldn't have treated me like that. I may be a nurse who "makes punas punas the pwet of the patients" but I definitely do not deserve to be treated that way. You, patients and your relatives, owe the nurses a lot but we don't say that to you right in front of your faces because it is wrong. It is definitely wrong. Whatever we do FOR you is because it's part of our job, it is our task to save lives.

So anyway, let me go back to my story. I told a-ma (grandmother in Chinese) not to give me food anymore, but she insisted. Then she told me, "I really like the nurses in AM shift because they're kind and very caring to my husband." I felt flattered because she appreciates what I do, what we, nurses, do. She understands that I cannot be there for her husband all the time because I have other patients to attend to. Being appreciated inspires me to do my best and to work effectively and efficiently. But don't get me wrong, even if a patient or his/her relative doesn't appreciate what I do, I still make sure that I render the nursing care he/she deserves. Again, it is our task to save lives without discrimination, without favoring a patient more than the other.

This Christmas season, I want to thank those people who appreciate the nurses. It's not only about the gifts that you give... It's how you make us feel that somehow in our 8-hour shift, you value what we do for you without us, nurses, expecting in return.

Real World vs Ideal Setting

Three weeks ago, student nurses started their RLE in our area. Their presence has advantages and disadvantages. One of the disadvantages is that some of your tasks are delayed because you have to assist and teach them about some nursing skills they haven't tried before. Sometimes, they actually cause confusion. I was once at loss when students approached me asking this and that. I then realized that when I was a student nurse, the staff nurses where our RLE was held probably felt the same thing. The advantage of it is that they lessen our tasks especially the vital signs taking which sometimes take most of our time especially that we handle 12-20 patients at a time.  When I was a student nurse, I complained about it. I didn't know I was actually helping a very busy ward nurse.

When I was a student nurse, I blogged about how staff nurses do not follow the ideal nursing care for a patient. I always see the bad side of their work. I didn't know that sometimes you can't avoid that to happen especially that we're working here in the Philippine setting where most of the wards are understaffed.

Yesterday, when I assisted a student nurse in feeding a patient through a nasogastric tube, I told her to push the blended (osterized) food through the asepto syringe's bulb. I asked her to do that because we still have a lot of patients to feed and medications to give.  I reminded her though that what I asked her to do is not the ideal thing (because the ideal method is to let the gravity do its work, you know what I mean) but when you're in the real setting, sometimes you have to think of strategies to finish all the nursing tasks in your 8-hour shift WITHOUT causing any harm nor jeopardizing a patient's safety. I always tell the student nurses I have assisted that when you care for a patient, treat him/her like a family member. Nurses save lives, not take away lives. And lastly, when you perform a nursing care, the ideal method will always be your priority... your own technique or strategy will just be your last resort.

This entry is to open the minds of student nurses reading this blog because when I was a student nurse, no one ever told me what happens in a real nursing world until we were exposed to public hospitals.

Back to Normal

For one month, I was assigned to only one patient almost every day. It started last October 13 when a patient was transferred to our ward who was first admitted in the Coronary Care Unit. Because her daughter who is apparently the secretary of our hospital's president isn't used to leaving her mom alone, she asked the nursing office if they could give her a nurse per shift inside their room. VIP much. I was the first nurse assigned to that patient as a "private duty nurse". As days went by, other volunteer nurses were also assigned to her but the daughter kept on requesting me to exchange with the nurse originally assigned for that day (she doesn't like how they do their nursing care for her mother).  The staff nurses in our ward teased me that I am the favorite nurse of 503 (the patient's room). It's flattering actually. I have nothing against them because the patient and her daughter treated me like a family member.

After 2 weeks of being a PDN, I suddenly felt bored inside the room as my nursing tasks were lessened. The patient recovers from her illness so I really have nothing to do but to stay inside the room, turn the patient every two hours or even less than that, call a nursing aide to change the diaper and apply lotion to her dry feet. It's not that I am complaining, it's just that I am the type of person who doesn't want a monotonous job. I love challenges. I prefer toxic areas. Yes, I'm weird.

Last Monday, I was happy to learn that they were already discharged from the hospital. One thing that makes me happy is that "mommy" (I call my old female patients mommy) survived from a very critical stage. As a nurse, I still wish my patients well. And of course, another thing is that I am back to the "outside" world where I have 17 patients to handle and medicate in 8 hours.

My medication tray and medex.