At The Swiss Cheese
I'd planned on calling the hospital of our current assignment the Cheese. Having arrived, I've decided to amend the name to the Swiss Cheese. That is because while this hospital has less than 500 beds (half the number of beds at either the Big D or the Y), the facility itself is enormous and very spread out. In fact, it's been called a honeycomb design during orientation, so given the cheesy nature of Wisconsin, I think Swiss is appropriate.
Currently I am sitting in a computer class for the computer charting system for the hospital. Naturally, it is fascinating, and I can barely tear myself away from it to write this entry. The thing about changing hospitals on a frequent basis is that you get to learn a whole new computer system nearly every time. Yea! Most systems seem like they seek to be counter-intuitive, as though they want to encourage the computer-illiterate nurses over the age of 45 to retire early. Here at the Swiss Cheese, technology is top priority. Everything is cutting edge here, from the monitors and pumps to little handheld scanners for meds. Seems like it could be handy, but on the other hand, sometimes simpler is better; replacing a single check on a paper with a complicated handheld device isn't necessarily the best thing to do.
This is actually my fourth and final day of orientation. Monday and Tuesday were hospital orientation, an experience that never fails to be painful and generally useless. Eight hours of sitting through non-applicable policies and boasting about the facility are eight hours that can never be redeemed nor retrieved. Yesterday was my single orientation shift on the unit, which I will talk about in a minute. Today, of course, is the computer training day, eight hours of following the tourist bike tour policy--that is, everyone goes the speed of the slowest user. There are plenty of older nurses in here who struggle each and every time they try to check their email. We won't be getting out early today.
Yesterday was an quite the day. It seems that each time a traveler starts on a new unit, the experience is different than the previous time. When I started at the Y, I only had an eight hour shift to get oriented to the unit. It turned out ok: I was shown all of the areas, given all the codes, given a general tour of the unit so that I could find my way around and could find supplies. That was pretty much what I expected from my orientation here. Tsk, tsk, perhaps not.
So, I was paired with a nurse who was taking a 1:1 assignment. The patient was a young man who was wheelchair bound. He had been crossing the street and was hit by a car, and ended up with all sorts of contusions and fractures. The assignment was supposed to settle out within an hour or so and then I would get the needed tours and information. By 9 am, it was apparent that there was not going to be any settling out with this patient. From his fractures, he developed a wicked case of ARDS (complete lung failure and multiple complications), with massive pulmonary edema. To make matters worse, he had internal bleeding from his pelvis fractures, requiring nearly continuous blood product infusion. We simply could not oxygenate the man; we had him on 100% O2, and his PEEP up to 20 (for those who don't know what that means, think of a bike tire that you keep inflating far beyond the safe recommendations--his lungs were the bike tire). I'm pretty sure that a PEEP of 20 is far out of the protocols, and in the end, we popped both of his lungs and had to emergently place bilateral chest tubes. There were several points during the shift that he came very close to death (e.g. when his O2 sats dropped to 40%, or when his PaO2 came back at 28 on 100% FiO2 or when he starting erupting pink froth from his endotracheal tube). We managed to pull him back from the brink, although it seems likely he suffered an anoxic brain injury from the long episodes of oxygen deprivation.
Needless to say, I didn't get a tour. At some point, during a lull in chaos, I was shown where they keep their supplies, where the meds are kept, and the men's locker--the important things. It wasn't very detailed, for sure, and there were vast parts of the introduction that I didn't get. For example, I have no idea what the unit's MAR (the medication administration record, one of the absolute essentials of nursing daily life) looks like, or how to do routine chores like order blood products. On the other hand, I did get to know my room very well, as in where all the various machinery and supplies can be found. I also got to see how they did certain procedures in this unit, such as place triple lumen IVs and chest tubes. We even put a Swan-Ganz catheter in this poor man, and practiced a little taking measurements.
I even got to play around with their technology a bit. Each room has a computer inside which has a screen that can be removed and carried around, and controlled by a touch screen. Labs and meds can be viewed this way. They have a setup to continuously watch cardiac output using the arterial line, which I hadn't seen before. All in all, it made the Big D look pretty old-fashioned, and the Y looks straight-up archaic in comparison. I think that when some hospitals like the Swiss Cheese upgrade to new equipment, they put their old equipment in storage for 5-10 years, then send it to the Y. Or ship the equipment off to Afghanistan for a couple of years before bringing it back to give to the Y.
At any rate, I won't know how effective my "orientation" to the unit was or how much more I need until my next shift. I have the weekend off, so I won't know until Monday. I don't think it will be a big issue; the staff on the unit is very friendly and open, and they are far too concerned for patient safety and well-being to let a nurse drown out of spite or disregard. That bodes well for me. I've been around nurses before who'd rather let the patient die than help you out. I didn't see any of those types yet at the Swiss Cheese. It's all about being willing to look a little dumb and have to ask questions whenever needed. That, and have a computer nearby to Google anything you don't know and don't feel comfortable asking. Which is a frequent thing, at least for me. Thank God for Google, if He didn't inspire it, he certainly owns stock in the company.
Finally, a strange event. As I stood waiting in the conference room for morning report to begin, I turned to find a familiar face looking at me. I didn't know if I was yet awake (I'm working all AM shifts), it was a bit surprising, but there before me was a nurse I worked with until late 2006 at the Big D. She has been traveling around the States, and actually is settling down after her assignment here at the Swiss Cheese. It was pretty remarkable meeting her, at this hospital of all places. We've also met travelers who know and have worked with traveler friends of mine in Colorado. A small world indeed.
Until next time, be safe.
