New Experiences As A Traveler
This also applies to the clinical aspect of travel nursing. Obviously, all facilities have their own way of doing things. The most mundane chore can be done a thousand different ways. Last night, a thoroughly exciting and enjoyable night, only highlighted that aspect of this lifestyle for me.
I've been caring for the same woman for the past three nights. She has a lot of cardiac history on top of being generally unhealthy for a 51-year old woman. Turns out that they find (by way of a cardiac catheterization ) that she has a large lesion in one of her major coronary arteries. Essentially, she needs cardiac surgery, a CABG, big time stuff. But literally during the four hours that included the cardiac cath, she became severely septic. So, in the days that I've been taking care of her, she's become progressively more ill, which I hope isn't an indication of my nursing care (it's not--she was already intubated and very sick, more so than anyone knew at the time). Two nights ago, I had a busy night with her, she was very sick and required constant care; I basically walked into the unit to find her on the verge of coding, and it didn't let up until about 2 am. I was happy to have been involved, I am getting tired of the baby-sitting assignments I've been getting, so it was nice to use my brain. I didn't expect to get her last night, though, as she needs a balloon pump and should be heading off to the cardiac ICU for management of her heart failure.
To my great surprise, I walked through the door to find her still in the MICU, as my assignment. Even more interesting, although certainly not surprising, was that the team had placed a Swan-Ganz catheter. For non-medical folks, this is a big deal nowadays, where few MICU patients get them; you have to delve into the cardiac realm to find them. Of course, it's been about a year since I've managed one, so it was great to get this one, so that I could get refreshed in all the measurements and implications involved. I spent the better part of the first half of the shift getting familiarized with the catheter; it all came back quickly enough. It was surprising, however, to get this type of a patient as a traveler. It is an opportunity units usually reserve for their staff so that they will get the valuable experience. I think the only reason I ended up with this patient last night was because I'd taken care of her for a couple of nights prior.
That was interesting enough, but my learning experience wasn't over. She was severely malnourished, and they had started TPN (IV nutrition). However, they really wanted to feed her via the GI system, so they needed to put in a nasojejunal tube (a feeding tube from the nose that bypasses the stomach and empties directly into the intestines, to prevent reflux of fluids into the lungs from the stomach). At the Big D, they'd send these patients down to the radiology department to have it guided in. Not at the Y, it's the nurses job here. The day nurse had placed one, but it was coiled in the stomach and needed to be replaced, so I got the honor of trying it out. It seemed rather basic, even though I'd never done it before, and have used up all my asking tokens with the Swan, I had to rough it with just some literature. Needless to say, I didn't get it after a couple of tries, but not because I was doing it wrong, she was just a hard person to sink a NJ into. Others tried and failed.
She also had some interesting cardiac issues all night. The breathing tube was irritating her throat, making her cough whenever she was awake (I didn't allow that much--for the first time since I got up here, I've had the orders to give proper sedation, as they don't believe in sedating their intubated patients). The problem with her coughing was that she had a vagal response each time and dropped her heartrate from the 90s to the 30s. There was little I could do about that except send her into Happyland where coughing wasn't allowed, but she also had an occasional irregular heartrate slightly resembling atrial fibrillation, so the doctor wanted an EKG.
Again, at the Big D, there are techs who do the EKGs. Not at the Y, it's up to the nurses. So, there I was, by this point completely unwilling to ask another question, I'd even used up next week's tokens as well. This is fairly rudimentary, not exactly rocket science, so it didn't take long to figure out. But hey, if you've never done something, it is still a new experience when you do it.
Anyhow, it was a pretty good night. I handled myself well, I think. I had to ask questions, but then several people crammed in the room when we were learning about the Swan measurements, because no one knew how to do them, so I didn't feel too bad. It was a good night.
Even better, I'm off for the next two nights, then I work one night. After that, I have five days off, most of which will be spent in the Boston area. So, I'm even having a good day. I didn't sleep after work, it's a beautiful day outside and I didn't trust myself to wake up at noon after working four shifts in a row. Then again, I'm spending the beautiful day sitting in a Bruegger's Bagel shop writing this. Hmm...
Referring to the upcoming seven out of eight days off, I was reading the Facebook page of someone who just started travel nursing at the beginning of June (as if I'm an old hand at this). He was saying how this gig is turning out to be more like a long vacaction than work.
Indeed.
Until next time, be safe.
