I actually wore this outfit out into the community where people could see me.  I’m dressed by two Asian mothers: Soojung’s mom gave her the plaid purple pants which she then gave to me and I wear them all the time to the gym and my mom gave me the striped sweatshirt.  I had to stop by the hospital today to do some administrivia and I thought I could sneak in/out wearing these pants, but I now know too many people at the hospital and even though I was tunneling through the basement belly of the hospital, somehow the hospitalist who, yesterday, I was just getting to know in a professional-type manner was walking straight down the hall towards me, spied me in my plaid leggings and kind of smiled in a wow-those-are-some-pants kind of way and said hello to me.  I cringed a bit.


Speaking of yesterday’s shift, I started my first IV on a real-live patient.  I’m writing this only so I can remember it later on:  I had a nursing student with me (they show up on random days and get randomly assigned to various nurses – the last time I had one assigned to me, I was on my 2nd shift on my own and I implored the instructor to please take the student away from me because I was anxious enough on my own).  This time, I was like – what the hell, we’ll just go for it. I understand it’s part of the gig, I was a nursing student who tagged along another nurse, I need to do the same to pay it forward.  This particular nursing student was an asset because she added calmness to me instead of anxiety and I was happy to have her around.  I had a very friendly, very appreciative patient whose IV was infiltrated and needed to be replaced. I pulled the student aside in the medication room and told her that I was going to start my first IV and asked if she would she help me out.  It’s, of course, possible to start an IV on one’s own, but it’s also very nice to have someone handing you supplies as you need them.  She immediately said yes and then told me that she was hiding from her clinical instructor because she did not want to give any injections today.  I said, OK, I’m like 6 weeks ahead of you in that feeling.  We walked into the patient’s room with twice as many supplies as is technically necessary and it did take me three jabs to get it right, I was going to stop after two which is the general rule of thumb on our unit, but my patient was like – no, it’s fine, just keep going.  And then there it was: I got the flash of blood in the cartridge, I advanced the catheter, I got the blood return, I didn’t let the blood spill out like I did with me own self-IV, the student handed me all the supplies one by one as I needed it, the hep-lock, the saline flush, the transparent tegaderm dressing.  Beautiful.  And then I hung that damn bag of IV antibiotics.

I read with great interest Atul Gawande’s article in the New Yorker about electronic health records.  I have so many of the same feelings as the providers cited in the article.  I always, always feel defeated at the end of every shift by the documentation system that I’m required to use.  I feel like I’m a smart person, generally above average when it comes to computer systems, but it just kills me every day.  Each day, I make handwritten grid where the room numbers are across the top and the fields I need to document go down the side and I swear, the list is like 18 lines long now.  Each line doesn’t just mean one block like a block on Excel, each line is a complete section that might require 10-25 entries.  Some days I have 7 patients, so that is 18×7 things I’m suppose to remember to document.  The computer system gives me no indication which patients I’ve completed charting or which sections are done, so the handwritten grid is to prevent me from going back to each chart to remember what exactly I have filled out because I have to fit charting into the five minutes chunks of time I have between tasks and interruptions.  The charge nurse saw me write my handwritten list to-chart-list at 6:55 am and said, you know, you don’t have to handwrite it every time, you can xerox it and use it over and over again, but I told her, it changes every shift, I find out more things I’m supposed to chart each shift. I feel like I can do all the work I’m tasked to do, I can keep my patients safe, I can notify the docs on critical things, but I feel like I can absolutely document none of it in a timely manner.  I’m suppose to document each time I go into a patient’s room.  I’m suppose to note what they are doing, what I did, what they asked for, if I asked that they are pooping/peeing/eating.  I’m suppose to document that I taught them all about each of their medications, the scheduling of the meds, the mode of action, the side-effects.  I’m suppose to document every conversation I had with the doctors.  I’m suppose to document what their pain is now, what they would like their pain to be, if we have come up with a pain management system.  I’m suppose to fill out four screening questionnaires for each patient every shift: fall risk, bed sore risk, are they ready to learn, sepsis screen.  I had to use an interpreter (via phone) 4-5 times on Friday to explain a complicated all day hydration plan.  I had to document each phone conversation with the ID number of the interpreter.  While I’m documenting all this, I find it incredibly difficult to find out like why are we sending this patient to X-ray?  No one told me anything, I can’t find it in the doctor’s notes, the patient seems surprised.  It’s a mystery.  Even with all the documentation, I feel like it doesn’t pull together the feeling I have about the patient from the 12 hours I spent with them.  It doesn’t highlight the biggest issues. 

Jeremy bought more reflective gear.


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