Fails of the week

[whitewriter]

Monday
1. my boss tells me she got feedback from when I was in CICU 2-3 weeks ago
Apparently I was receiving a TAVI patient, and was too busy attending to the MRSA and VRE swabs that I didn't connect the pt up to the monitoring. The doctors were not pleased with this and commented to the NUM of CICU.

I honestly, do not remember receiving any Tavi pt but I do remember receiving a young boy 21 yrs old who had a genetic condition-- and now had myocarditis and they were trying to figure out how he got that -- I don't remember him being on norad or anything. but he'd come from ED or was it Cath lab ... anyways. In my memory my only defence was, I thought I had everything attached, and functioning, but when I turned around I realised I hadn't.
There was an issue with a cable I think and that had to be sourced, hence the delay.
But yes I was swabbing like no tomorrow between connecting and then realising that actually, something wasn't working.

But to be honest I have zero defence because I completely don't remember the pt... nor the TAVI. I just thanked my Boss for passing on the feedback, agreed monitoring was important and more essential than swabs. She made sure to mention she hadn't heard of any complaints before and was surprised by the mention. I wish I knew which doc complained cause there's one particular doctor that is very very quick to complain about nursing staff and I wondered if it was her (she's not a consultant but the way she talks to us sounds like she thinks we're slaves. This I know because, the senior Sheena passed on a complaint to me from her whilst I was in makeshift ICU - they were trying to do the AM ward round and I was trying to go on morning tea. The complaint was I was "hard to catch" and barely at the bedside (yeah cause I'm trying to leave) but I stuck around anyways whilst trying to leave... anyways. Sheena was being nice and warning me. I'm like sure. No problem Sheena, I'll ensure I'm clearly either there. or not there. and not half there just to make things extra clear for them.

We need to know these feedbacks early and where they come from so we can watch our backs.

Tuesday


2. The arterial line that was "hard to get in".
The junior is putting in an arterial line and there's no flow from the line, very sluggish if any. Arterial lines spurt like mad if you get them in a nice spot so they're usually easy to spot. I thought I had the whole set up ready to go, monitoring connected etc, so when we connected it, the thing didn't show a trace at all, just a flat flaccid line. The doc put it down to atherosclerosis of the artery she was targeting. And got the senior for help (the complainer, of course for my luck).

They wrangle an art line into an artery of the R) foot and are super certain its in.

I hook up the arterial line to the same, flaccid trace. But they're so sure they got it in 'cause of the spurt - I check furiously, perhaps the connector isn't in the right connection (its a 3 way port, with port 1,2,3-- and I could see I had connected the line to port 3 but the monitor was reading the art trace off port 1. My mistake entirely. I pulled the wrong port out and shoved it in the right one. Just as the complaining doctor was freaking out and going to call the incharge to help me, I changed the monitor to optimum trace and she was like "oh maybe that's why it didn't work last time, cause it wasn't on optimum trace for that value" - nvm the incharge, (who is a super nice one that day) just went well it's working now. And I'm like yeah. It's working. When I knew it was just the wrong damn port (entirely my fault) that being said, there was very little if any flow from the "atherosclerosed arm" so that arterial line would have been terrible for doing bloods anyway.

So. Did she need a foot arterial line? Maybe. It'll make for an easier nightshift considering how much the pt waves her hands around (covid pneumonitis in a 40 something with 4 kids who usually has a job in freight administration and now has been in ICU for a month + off Ecmo and now trachyvent and ++++ anxious). She was nice. Overall we had a good day.

There was one moment when the 3 nurses in our little area were discussing bed 27 (some old lady who was presumed 70 but turned out to be an 80 yr old run over *multiple times* by a car -- just like that poor boy in pain, except, she's 80- she is listed as unknown xyz because they literally had no idea who she was when they scooped her up and brought her into hospital. Until eventually the police figured it out) whilst the doc's (complainer and the junior) are trying to wire in a line and she literally barks at us "excuse me can you get us ****" and the three of us scattered like rabbits in the headlights.

Mind you none of us had a proper afternoon tea break (me, a fresh young senior and a super junior- the super junior was about to handover to go home when the porter came to scan her pt and off she went. So she didn't end up handing over until ... 20:00 whilst I was at the desk finishing notes I should have written at 09:00).

I ate dinner, walking up the hill from the side entrance to the street entrance and then just took the bus cause, who wants to walk home through dark streets at 20:30 ?

Others that are less embarrassing:
- forgot to apply for study leave for the 2 day wound care course I'm attending for the next 2 days on my day off.
Honestly, I thought the courses would get cancelled due to covid and then it turns out, everything's better now and everything's back to normal, which means - course is on. via zoom of course, not everything is entirely back to normal.
Course that means I didn't apply for study days which means, I'll be attending these unpaid. mybad. Ah well. It's just two days. And I've been waiting to do these courses since March. If I don't do it now I won't get to do them until 2023. And it's not like I have to pay to attend. So they'll be like 16 hrs of CPD in one hit.
I'll get to sit at home, actually test my BGLs on time, maybe even write a post or two whilst the course is running. Do a load of laundry... Maybe I can iron my uniforms even. Won't be half bad.


Meangirls at work
I don't know what is going on, but this is an ongoing issue. There are 2 seniors (youngish 30s) at work who are very unapproachable. If your in their incrowd or their friendship group - all is super chatty and lots of laughs and all that. But I just can't bring myself to say more then a Good morning to them. Seriously. So on Monday it was ultra hard because both girls were on at the same time, one was incharge and the other, had a pt. So that wasn't particularly fun.

Both them only ever talk to me if they have to give an instruction related to work "Rita your swapping with" "can you support xyz newbie" "so and so will watch your dialysis whilst you go on break because so and so is a junior" etc. and nothing else.

It kills the mood when I'm in small ICU. It makes me wish of my old unit, neuro when the only moody person was Hinton, and that wasn't really moody that was just entertaining mostly. In general everyone in neuro got along and you could always have a nice catchup chat with anyone on. There was no avoidance or fear factor.

Something felt even worse on Monday. Not sure what it was. Both girls had dark clouds over their heads. I talked about it to my old mentee Courtney today. I told her - I don't know how to break the barrier. And I used to go out to eat with one of them when they were a junior. And now I can't even say hi or how's your shift going? Just due to their highly unapproachable air that hangs about her head?

It's not pleasant. Sometimes I think it's because I come from neuro and they have this bug about me not "deserving to work in small ICU".

Both of them ran through the tea room as I was packing to go home and neither said a word. No see ya later or ... anything.

And to be fair, I'm a massive avoider of conflict so. That probably doesn't help things.

Today people were hugging one of the girls, which made me think, what happened did someone die?! But neither one's fb acct showed any such possibility.


TCC fails

1. I read the roster wrong and ran out of maternity uniform shirts today (I prepared 3 shirts when I had 4 shifts in a row). Luckily. I had only recently packed away my old uniform : and found a newer model one actually still fits! It's of the material that is so hard to unwrinkle but it fits and that's matters at this stage. There's no way any of my old pants fit. So lucky I didn't run out of those, otherwise I'd just have to wear a dirty one today.

2. No one has done a DV screen or EPDS (edinburgh perinatal depression scale) screen on me yet and I'm 25 weeks.
I realised this when I was doing the mandatory training for midwifery in perinatal mental health and the online course was going on about the EPDS and I was thinking if someone had don an EDPS on me at 18 weeks I would have had a rather high score (I was very upset about GDM insulin for a good week) I cried frequently actually.
I'm over it now the EDPS would be super low now despite the (mildly?) uncontrolled BGLs.

I'm the patient it's not up to me to remind them how to do their job. I know my EDS is technically fine and that although it was slightly high a few weeks back I definitely scored 0 for question 10 (which is about suicidal thoughts) so it wasn't a big deal. But imagine if I was some other woman, who got missed.

3. Forgetting to do my BGLs 1 hr after meals.
I am a naughty diabetic. I have a timer that I bought too, and need to get into the habit of setting everytime I start eating.
We get 30 mins for lunch, so when I get back I often get stuck into whatever task I'm intending to do, and before I know it 2+ hours have passed and I've missed the boat.

Then I get high readings...

I got so hungry today not having a proper afternoon tea, I had a bunch of snacks
- a nut bar
- a small 8g carb yoghurt
and what I think ruined me : a small fruit puree apple and strawberry cup which tasted sour but they must have added sugar.
cause when I finally got to my properly proportioned lentil pasta dinner my 1 hr postprandial reading (which I did at the correct time) was 8.0 (much too high).

Comments

[wendelah1]

I'm the patient it's not up to me to remind them how to do their job.

Yes. Absolutely not. And yet, if there was something being missed that I thought was going to negatively affect myself or a loved one, I have spoken up. Furthermore, knowing what you know, it undermines trust in their decisions. And what if you miss something, as well, and only realize it later on.

The double binds of being a healthcare professional are never ending.

[whitewriter]

This is true. Don't want a reversible mistake to be made on myself.

I have heard of some doozies down at MSH lately. I was talking about this to another midwife buddy who still works there - she said she feels like the staff don't seem happy, and keen to come to work. Like morale is low. I feel that to an extent in MICH also, but probably mostly in relation to us being dumped all those new graduates - and hearing some of their mistakes (that they've already made in their first 2 weeks on the floor) which are spine chilling (one of them put tap water down a central line...).