Nurse Jobs London

I came back to what passes for home, and the assignments that were coming up were just not what I wanted. I got one call from a place I hadn’t even said yes to (as a matter of fact, I’d distinctly told my recruiter NO but apparently she submitted me anyway). I might have considered it some other time, but it’s just not where I want to be right now. Then I got a call from another hospital in a city I’d been to before, but the package I was offered and the circumstances of the job were most definitely not to my liking, so I told that manager no. Meanwhile I’d started talking to my very first recruiter again.she’s never stopped calling to see how things are going, and I like her.

BUT.in the meantime, a friend of mine who lives in a University Town in a nearby state told me about a job opening in a quite different field–permanent, and not something I’d done, exactly, but close enough that I felt comfortable applying. So I did. I went up there and had a 2 hour interview with the person who would be my immediate boss. She seemed to like me; it was one of the best interviews I’ve ever had. I went home and did all the online stuff they require (why in hell did I have to do advanced math problems?????) and waited. The following week I got a call from the HR director asking me if I could come up again and meet with the Clinical Director and the Director of Nursing Services. He told me I was their “leading candidate.” Well, of course I could. At their expense? Wow! I must be pretty close to in. So I drove back up there, and the next day I had my interview. Except it wasn’t that easy. I got lost trying to find the office. I called as soon as I realized I was lost, but I ended up being about a half hour late. The interview seemed to go okay, though I thought the nursing services person was a bit uptight. At the end of the interview, one of them said the person I’d met with initially would be calling me in “a couple of days.” So I waited. And waited. Finally, on the advice of a friend who’s been through this, and whose advice I’ve come to depend on, I e-mailed her last Friday, a very tactful e-mail asking if I had perhaps missed some communication since I’d been traveling. Well.FINALLY.today I got an answer:

“Thanks for getting back in touch with me. I appreciate you coming up here for the second interview and I apologize for the hotel mixup. I have interviewed several candidates for this liasion position and again, appreciate you coming here but I’m afraid that after much thought it’s just not a good fit for us. Good luck in your ventures in the future and all my best.”

Okay, fine, I can appreciate that. But just why in HELL did you keep me dangling for two whole weeks? That is not only unprofessional, it’s downright RUDE. I’m not so much upset as I am just angry and hurt.

So I’m back with my recruiter Lizzie.my first one. She has me submitted already to a hospital Up the Road, a teaching hospital (love those!) on a telemetry unit, start ASAP. I told her I could start in about 10 days. Meanwhile, since her agency has changed hands, I’m having to do all the paperwork I did initially, all over again. I guess if I go there it’ll be okay, it’s close to here so I can run home over Christmas and be done with my contract when my daughter has her baby in February. But sheesh, it really hurts when the job you’re the “leading candidate” for turns to dust and ashes, and they don’t even bother to tell you.

The unit is okay, pretty much. It’s not a hard job; I think I said earlier that it was actually boring a lot of nights. The people I work with are nice, although a lot of them are refugees from units that are not happy places, and some are real burnout cases. The bitching from the regulars can be pretty wearing. Nights are long, much of the time spent just sitting around. And (shhhhhhhh!) sometimes we are painfully overstaffed, which is not the case in the rest of the hospital. I have read more books and spent more time online at work here than anywhere I’ve ever been.

Last night I got a look at the next schedule, and that REALLY pissed me off. My understanding when I signed on was that I’d be working weekends, and hopefully not ALL the holidays. I don’t work Thanksgiving (oh yippee) but I’m down for both Christmas Eve and New Year’s Day night. Not only that, but Christmas Eve is the fourth night in a row for me, and I don’t DO four in a row. Nor does one of the other travelers, who is down for four in a row the following weekend, and she’s pregnant. On top of that, everyone is working one or both of the holidays except for one traveler who for some reason is not scheduled for ANY! Fair? I don’t think so.

And then there’s the living situation. My apartment is actually quite nice, if small. It’s easy to keep clean and there’s plenty of room for me. I hate the driveway and the parking, but I can live with it. However.and it’s a BIG however.there is the matter of my upstairs neighbor. I have never seen her (I assume it’s a her, most of the residents here are travel nurses and female) but I have to HEAR her, and she walks *very* heavily. On top of that, she has a dog. Now, it can’t be that big a dog, because it barks in soprano, but when it runs through the house it sounds like a damn Clydesdale! And when she goes out and comes back, it does that for at least five minutes. Then it sits down and scratches and thumps on the floor for another five minutes. To make matters worse, it desperately needs its nails cut.just imagine a Clydesdale with jingle taps on its shoes. This morning I saw my neighbor come home just ahead of me (at least I assume it was her, looking at where the car parked). Oh goody, I thought, maybe she’ll go to bed! Ah, but it was not to be. Just as I started thinking about crawling between the sheets, she decided to VACUUM HER APARTMENT.the entire place.and the damn dog ran around in circles the whole time. If I ever have to live in another lower unit I will shoot myself.

On the other hand, for once we had interesting times last night. I came in to two patients and one on the way. My partner was one of the regulars, an LPN who’s almost finished with his BSN. We decided he’d take the one coming and I could have the two who were already there. My two didn’t look awfully complicated, as most of our patients don’t, but of course there had to be a curve ball somewhere, and danged if one of them didn’t come up with some lab work that indicated *maybe* she might have a blood clot in her lungs, so off she went for a CT scan. The other had come in with a potassium of 2.4, which is sort of incompatible with life, but she was getting IV and oral potassium and seemed to be doing better. The first one came back from her CT scan, and before too long I got the word that it was negative for blood clots. My partner’s patient came up from ER and he got her settled in. We were notified of another patient to come from an outlying hospital, but an hour later we heard that he’d decided he wasn’t going anywhere but home and had left there AMA (against medical advice). We kicked back for a peaceful night.

So I’m sitting there, minding my own business and doing a job search online, when the monitor starts alarming. I look and it’s my partner’s patient, and she’s alarming bradycardia (slow heart rate) in the 40s. Then her rate goes back up to the 50s.then down again.and keeps going down, 35, 32.I grab the crash cart and he goes tearing in the room and tries to wake her.heart rate is in the 20s but she responds, sort of. “How about some atropine?” He runs to get the drug. Patient is pale and clammy, but she’s responding after a fashion. Heart rate at the lowest I saw on the monitor was 18. Since I’m the RN I get to push the atropine, half a dose at first with no effect, then what the hell, give her the whole thing. And the heart rate starts going up.40s.50s.oh boy, finally a nice happy 74! We breathe a sigh of relief, wrap up the observation, and he goes to chart. Later he told me that the patient and her family had described episodes at home where she got pale and clammy and “felt real weak.” “Wanna bet she buys herself a pacemaker?” he said. Yeah, I bet she does. But I won’t find out, because they just called and put me “on call” for tonight; there’s one patient in the unit and two other nurses on the schedule. I could get called in for another floor, though I hope not. I’m nervous about staffing levels everywhere else.

I REALLY don’t like it here. I’m starting to think about a permanent job somewhere. Maybe not bedside, although I might think about that if the position were just right. Well, we’ll see. I have until the end of January to think about it.

As most critical care folks know, baths are primarily a night shift thing. I don’t necessarily agree with that, at least not in the case of folks who are alert and oriented and can do at least some things for themselves, and especially not if they want to SLEEP! But if they are wakeful, as many older folks are along about 4 or 5 in the morning, sometimes it’s a good time for a wash-up and a bed change. There’s something about the process of doing all this that invites conversation and recollection. I’ve always been one who likes to listen to stories, so maybe I’ll ask the patient a few questions, and often the stories just pour out. Maybe they’re tales often told but now to a new audience, or maybe the patient hasn’t had anyone to listen to them in some time. In recent months I’ve heard stories from a World War II bomber pilot, mostly about the base in England where he was stationed rather than about his missions.most veterans don’t want to talk about those in specifics.and from a man who was a medic in the Korean War. I’ve learned what it was like to be a very young bride just after WWII. I’ve delighted in the stories of a woman who was one of eight girls in a family of eleven children, and laughed with her about what it was like to line up to get your hair braided in the morning.(”You’d better have the knots combed out before you got to mama, and the bigger ones combed out the little ones’ hair.”) Everyone has a story, and I find myself making little notes of things I might want to remember if I ever stop doing other things long enough to sit down and write seriously. But I have to admit that I don’t like being *expected* to give those baths whether the patient wants it or not.

Last night my partner and I had a couple of very “busy” patients. Hers was far busier than mine and far more sad, a woman dying of ovarian cancer, a retired nurse, sister of one of our docs, scared, in pain, disoriented because of some of her medications. I think she would like to let go but thinks maybe her family isn’t ready. She’s DNI–do not intubate–but not yet DNR. My thinking is that she might be ready for hospice, but I am not so sure about her family. Last night I sat with her for a few minutes while her nurse went to get something for her, and we talked about grandchildren, which seemed to divert her fears at least for a little. Stories.

About my patient, I don’t know whether to be sad or very, very angry. He came from a nursing home, and the story is that he was essentially “dumped” in our ER from a handicapped van, emaciated, with a leaking, corroded, non-working feeding tube. (Those don’t get that way overnight, folks!) The feeding tube was replaced and the area cleaned up and he was sent up to us. Okay, so he has a history of alcoholism and smoking and respiratory failure and lung cancer (chemo and radiation), and he has a trach so he can’t make himself heard.but how did he get to his current state just since April? He told me he used to weigh 198 lbs; when he came to us he weighed 100. He looks like a damn concentration camp survivor! To me the damning evidence is the condition of the feeding tube when he was admitted. I know nursing homes are understaffed, and that so many of the workers are undertrained and overworked, and many are burned out, but surely *someone* should have noticed and referred him to the doctor. Did he just not get attention because he’s quieter than some of the other patients? He’s perfectly alert and oriented and can make himself understood if you just take the time to pay some attention. Did they keep pouring tube feeding formula into the tube and letting it go who knows where, or did they stop just feeding him because the tube wasn’t working? Who let it get this bad? It’s a pretty damning indictment of this particular nursing home, at least in my not-so-humble opinion. I don’t know what family he has, a sister I think but no one immediately available, so it seems there is no one to advocate for him. For now I just have to do what I can, manage his meds and his feedings, keep him turned and dry and clean, and hope to hell someone picks up the ball that got dropped. I need to remind myself to hunt up a clipboard for him tonight so he’ll have a surface he can write on when he wants to tell us something.