Sunday, September 25, 2011

Expecting To Fail

First week at the fellowship was orientation, skills checkoff, EHR training, and probably failing a test.

One whole day was devoted to a "Performance Based Development System" assessment. It's a computer based test that's supposed to see how good I am at thinking like a nurse. It gave various patient situations, either by text, image, or video. In every case I'm supposed to figure out what is wrong, and write down every single thing I'll do in response. In the right order. After only one viewing. In a very tight time limit.

We are not expected to pass.

Since we're all new grads, no one expects us to have the full nursing skill set yet. The fellowship leaders say it takes about one full year of real-life hospital nursing to get there. The point of this assessment is to note what skills we have already, and where we most need practice and assistance.

Me, I'm great at recognizing situations and calling up facts. If you show me a post-op ortho patient with sudden chest pain and shortness of breath with hemoptysis, I'll correctly say "suspected pulmonary embolism" and tell you that I need to immediately put her on O2 (to start with). But where I'm weak is on policy and prioritization. I know PE is an urgent situation, but how urgent exactly? Is this a situation where I go page the physician, or do I stay in the room and call for the rapid response team? It depends largely on the patient's status and vital signs-- which the video helpfully avoids giving me-- so there is no rote, textbook answer for me to call up.

For this exam I tried to err on the side of caution, so I probably wrote to call the RRT when I should have been paging the doctor, and paged the doc when I could have handled the situation with independent nursing actions. We'll see what they tell me about that. The tests have to be read and graded by live humans, so I won't find out how I did until next week.

Monday, September 19, 2011

Suddenly, Lungs!

Started my new job at the hospital today. This week is all orientation and some redundant computer training, but clinical work should start next week.

It turns out I didn't get the ED slot I tried for. My initial placement is instead going to be on pulmonary med/surg.

If I'd had a choice, I would probably have put pulmonary at the very bottom of my preferences list, just because I know there will be lots of patients with tracheostomies. Out of everything I did in clinicals, trach care was the only thing that ever grossed me out. (It's something about the suctioning.)

I expect I will shift around and look at fellowship openings on other floors. But who knows? I might find out I like the lung unit. In any case I'm sure I'll learn a lot, because the patients are high acuity and have lots of varied problems. If I stay there long I'll be awesome at airway management.

Thursday, September 15, 2011

Irene Day 15: Out

Albany HQ is closing. The need for ARC services in this region has reached a level the local chapters can handle. Many of the national volunteers from here are relocating to Binghamton, where the urgent and immediate needs are still great.

When I got here the control center was always jammed with people, and so loud you had to walk outside to take a phone call. Right now I count six people in the room. The quiet is almost spooky. By tomorrow, they will have moved out the computers and rearranged the tables, and the war room will have transformed back into the chapter's CPR classroom.

My day was slow. I had only two followup calls to go out on. We also had a meeting with some local nurses and ARC personnel who will be taking over Health Services duties here. I spent the rest of my day inventorying the shelter health kits (which are enormous wheeled duffels with the unfortunate nickname "body bags") and finishing my outprocessing paperwork.

I fly out in the morning.

Tuesday, September 13, 2011

Irene Day 13: Ramping Down

HQ has been getting a lot quieter this week. That's all part of the plan. 

The role of the Red Cross is to help with the most important and emergent needs, immediately after the disaster. As those needs are met, as people and communities move into the long-term recovery phase, ARC services give way to FEMA and local institutions.

People have been getting outprocessed and redeployed pretty steadily. When I got here we had thirteen people on the Health Services team. As of tomorrow I'll be one of three, and the only RN. 

If we keep getting enough referrals from Client Services caseworkers to stay busy, I'll be here until Friday. But with nearly all the referrals done, and nearly all the caseworkers redeployed to places like Binghamton or Harrisburg, I may be going home even earlier. 

That would be just fine with me. Two weeks is a long time to be away. 

Sunday, September 11, 2011

Irene Day 11: Wait, eleven? Really?

Days are flying past. I last posted here a week ago and it feels like no time at all.

I can't say that the minutes always go as fast. Sometimes I have to wait for paperwork, or for an assignment, or for a client to show up. But every day has been full enough that I've gone to my bed early and eagerly.

Part of the effort is just all the driving. My regional sub-HQ is covering many counties in northern New York State, to the tune of seven thousand square miles. That's an awful lot of space for a dozen nurses to cover. The damaged towns are mostly in pockets and concentrated areas-- e.g., along certain flooded creeks-- so we can see many clients on any one trip. But still I've put over 1300 miles on my rental car since I got here.

Tired as I am, the accomplishments are completely worth it. Today I helped more people who lost medical supplies and could not afford to replace them. Phone calls to the pharmacy, the doctor, the insurance company, back to the pharmacy. Often a supplier will waive fees for victims of disaster. Sometimes we negotiate a discount. If all else fails we issue monetary assistance. One way or another our clients will get their medications, or oxygen, or dentures, or whatever it is they need.

Perhaps no lives dramatically saved today. But maybe tomorrow, or next week, because people have their nitro or coumadin or insulin. If not saved, then someone's life improved, because he now has glasses and can start fixing his house. So glad I got the chance to come and do this.

It seems like every blog today has posted some kind of 9/11 observance. Me, I don't have much to say about those horrible events. My response instead is this: I'm trying my best to make the world a better place.

Monday, September 5, 2011

Irene Day 5: What Holiday?

Today, reassigned to go out with a pair of social workers. That's the first time I've done any nursing job without another RN anywhere on site. Didn't even realize it until just now.

Spent most of the day in an extremely hard hit town. It's at the bottom of two mountains and the water came through in a flash flood, like an inland tsunami. Some buildings were flattened entirely, and many more were shoved off their foundations and will have to be demolished. The ones still standing have had all their contents completely destroyed; the high water mark for most of the town is well over ten feet. Even the rafters were underwater.

You've all seen photos of the aftermath of Katrina. This is like that.

Our plan there was to canvass the town and go door to door, finding individual people needing help. But before I could even cross the first street I got flagged down by a man with a nasty gash on his arm who needed help with it. I cleaned and dressed the wound, and before I was done a younger guy with a bad bruise was asking me to have a look at it.

The rest of the team fanned out across the town as planned but I set up shop outside at the big church on Main street. The shiny Red Cross vest makes me visible from a mile away, and I hung my stethoscope around my neck to advertise my job. Together that was as good as setting out a neon sign and using a bullhorn.

I spent the whole afternoon on first aid. People doing cleanup work get lots of scrapes and cuts, and those are always full of the mud that covers everything in the town. Then there are the bruises and sprains, not to mention the assorted skin rashes from spending too long wading in contaminated floodwaters. Nothing was too serious, but everyone really appreciated my being there for them.

I even got to be logistical assistance in a bigger way. Long story, that part, but I happened to learn that the supplies of some things were getting critically low. (Gloves, cleanup kits, proper filter masks, others.) That's technically not my department, but I decided I could make it my department, because lack of masks is a health concern. I collected lists and contact info, and called HQ to try and pressure the folks in Bulk Distribution. Long story short: the people here are going to get all of what they need, by tomorrow.

All in all I'm totally happy with what we accomplished today. Compared to the vast total need out here it is just a drop in the bucket, and that's intimidating. But in terms of the work doable by one human in a single day, I think every one of us should be proud.

Sunday, September 4, 2011

Irene Day 4: Nursing In The Field

Yesterday I got my first work assignment. I was teamed up with another RN to do what the Red Cross calls community outreach. That just means instead of stationing at an established shelter or other fixed location, we go out and actively search for people who need our services. When anyone has a health need caused by the disaster-- whether a cut finger or a lost walker or contaminated medications, or anything-- our job is to help fix it.

We spent a big chunk of yesterday with large groups. For instance we talked to the command staff for several local fire departments. They're doing great things, feeding dozens or hundreds of people per day and providing supplies and tools for people trying to clean up. They know their residents and neighbors and they were able to direct us where we might be needed. We made a few nursing contacts, and also put the chiefs in touch our Mass Care and Bulk Distribution people.

One of the FD commanders pointed us down a route that had been blocked by a huge landslide until that morning. A single lane is now mostly open. The National Guard was posted at the entrance, turning most people away, but we showed our Red Cross ID and they let us right through.

The town on the other side was in great shape considering they'd been mostly cut off for a week. Their local FD and EMS crews had been keeping them supplied by making runs across the flooded creeks with boats and ATVs. And when we were led to the command post we found it included an impressive outdoor kitchen, completely staffed with volunteers, that was feeding practically all the people in town. Not many residents there needed assistance at all.

But they told us about yet another, smaller area that is still cut off. Every single bridge in has collapsed, except for one that was severely damaged. No vehicle traffic can pass. The only ways in are by small boat or on foot.

800 people are stuck on the wrong side of that bridge. Anyone who is elderly or infirm cannot leave town to see a doctor, or even refill a prescription. They have already needed one helicopter evacuation. That sounded to us like an area with some health needs. So my partner and I packed portable kits and walked ourselves in.

We arranged to meet a knowledgeable resident on the other side of the bridge, and spent the day going door to door.

Friday, September 2, 2011

Irene Day 2: Short Update

It's been a busy couple of days. However it's been all travel and logistics, which don't make for riveting stories.

Getting everyone on site has been a headache for the transport people. Air schedules are still so disrupted that a few nurse teams had to fly into DC or Baltimore, and come the rest of the way by car. I was blessed by the travel gods and scored a flight to LGA, and I beat rush hour traffic out of the city on my way to HQ in White Plains.

After that plus in-processing and orientation, it was already too late in the day for me to get a shelter assigment. I finished the afternoon helping to find and assemble supplies. I made runs to the local ARC chapter house and the one in Greenwich to pick up nursing bags from very friendly, unbelievably busy people.

Spent last night in an employee bunkhouse. This one happens to be in cabins donated by a wilderness camp in Carmel. It's up in the woods of the Catskills, a really gorgeous area on a small lake, far enough into the country that I could see the Milky Way in the night sky. The scenery made up for having to share a cabin with a dozen other people. I'm bummed that it was too dark for my phone camera to get any pictures.

This morning, I was one of several nurses tasked with work in the Albany area. So we made the necessary requisitions, piled into vehicles and travelled up here. Now we've got actual assignments, and that's really exciting. Unless something changes overnight, tomorrow I'll go on duty at a shelter and do real work as a disaster nurse. (Actually a lot will definitely change overnight. The situation is fluid. But it's more than likely that this one shelter will still need me.)

Staying the night nearer Albany. Not as pretty, this place, but there are fewer roommates. Somebody in here probably still snores though.