Processing events

The last four days I've worked have been rough.  My shift ended on Friday with a guy arriving to the ED in cardiac arrest. Saturday was a double shooting that kept me late. Sunday overall wasn't too bad other than working with a slowpoke in triage (I would triage 2-3 people to her one) but she did triage all the screaming pediatric patients.

Today things finally got to me (to an extent). Though I helped care for more, I only had three official patients over eight hours. 

First patient was a stroke and due to administering TPA that patient was 1:1 for almost two hours. I was able to sneak a lunch break in after I got her to the ICU (her symptoms had resolved within the first 15 minutes of TPA).

After finishing my lunch break I get paged for an unresponsive patient. He was dropped off by his "girlfriend" and was told his name was Gary. After a little Vitamin Narcan he became responsive and we discovered his name was Larry (close enough, right?). He was discharged.

Here's where it got rough. Triage was backed up and one of their nurses went to lunch. I went out to help, the other RN out front said it was my call.  I felt I should stick around and triage a few people.

While out there a woman asked for help getting her husband out of the car, he was having a heart attack (we hear this frequently so they can be seen quicker). Rolling my eyes I grabbed gloves and a wheelchair to help the man out of the car. He reported palpitations and being sweaty earlier. 

Checked him in and took him to the back for triage. Before I could start the official triage he started posturing and became unresponsive.

Fuck. I thought he was just trying to get back sooner.  Called a code blue, got him on a stretcher and to our trauma bay.  After 45 minutes we decided to call it, he was not coming back.

Talking with the other triage nurse we both came to the realization that if I had not felt inclined to help, this person would have literally died in the lobby in front of everybody because the other triage nurse was already tied up and didn't get back to the triage bay until after he had coded.

I'm grateful I was able to follow my impression today. I'm thankful for a good team that worked well during the 45 minute code. Even though communication wasn't 100% the extra hands were great and everything was completed as it should have been done. 

IV frustrations

Less than a year ago I was trained for the first time how to start ultrasound guided IVs for the department.  The superiors are trying to have more IV "experts"  so we don't become so dependent on a few people.

This was by far my favorite training.  I wasn't given a lot of details on how to do it properly, just showed the differences between a vein and an artery.

Veins and Arteries appear like black circles on the screen, when you push on it arteries pulse and veins collapse

I wasn't given a lot of information other than that. I was great at finding veins, it's not that difficult.  I didn't know how to access the vein, that information was briefly discussed but that's it.

After the training I would find the vein, set down the device and stab blindly for the vein I had just found.  Any seasoned nurse can tell you that going in blindly for a vein is horrible.  You end up digging and chances are you're just hurting the patient.  I was so bad at the ultrasound IVs I hated when people asked for my assistance with the ultrasound IVs.

Right before Christmas I was called and asked to do additional training after the holidays.  I jumped on the opportunity because, as described, I was horrible.  I needed additional training, I'm sure everyone knew.

The trainer taught me to find a vein, no problem here.  He then showed me, using the ultrasound guided device, what the needle looked like when inserted into the skin.  He then showed me what the vein looked like when the needle was inserted.  

The bright thing in the middle of the vein is the IV needle. When you see this image you're in and just need to advance the catheter.

He explained a couple of more things, and something clicked in my brain.  I don't miss frequently anymore.  I know I'm not the best but I can get an US guided IV quickly, with blood work, in less than 15 minutes (sometimes longer, depends on how much extra skin they have).  The most difficult part for me is finding the needle after it's inserted (again, sometimes takes a while but I'm pretty good at it). 

The other day I started an IV on a patient, it worked perfectly.  Several hours later I found out the IV had infiltrated and nobody was able to get another IV.  Even the doctor entered the room and wasn't able to get the IV.  He contemplated starting an IO on the patient.

Later that evening, before I learned of the first IV infiltration, I had been called in to start another IV.  The patient was extremely sick and required 2 IVs.  I got them without a problem, both of them were started quickly and without difficulty. Both in the antecubital just like before.  This patient, right after I let go of his arm, bent the arm to keep himself warm.  

I learned about 2 hours later that all the IVs had infiltrated on both patients.

I've had a lot of IVs lately infiltrate after I leave the room.  It's becoming frustrating to me because it appears as though I'm incompetent with my IVs.  I've done research as to why the IVs would infiltrate after the fact and it basically boils down to the patients are moving too much causing the catheter to dislodge from where I secured it.

Or they are bending their elbows too much causing the catheter to kink.  Those are the only two explanations I can come up with.

I think ultimately I need to start trying for other locations for the IVs.  I think that's my only solution.  Talking with other nurses they aren't blaming me.  Personally I don't know, but I got to try something else.  I'll try again tomorrow.

My Dilemma

Several years ago I worked with a tech in the ED.  I'll call her Molly.  Molly was lazy, only liked working with certain people, and if she was asked to do anything she needed company.

At one point she was the tech working in my section.  I asked her to start a Foley Catheter in a room while I took care of an ambulance in another room.  Molly immediately turned around and asked her friend, the RN, to help her. This RN was already mad at me for starting an IV for me (she just wanted to sit in her section and literally do nothing).

The combination of Molly and this RN was enough to tarnish my name.  The RN stepped out of the room and started yelling that I was lazy and I needed to get off my ass and stop eating tacos so I could do my own job (at this point this RN had only started an IV and helped Molly do her job, literally nothing else).  The Charge nurse that night for the next several months harassed me about me doing my own work. Never allowed me to speak, etc, etc.

I lost all respect for Molly (and that RN, but that's another story).

Fast forward, Molly was terminated from my department for attendance problems (considering her work ethic, this was no loss in my mind).

Fast forward again to yesterday. It was a horribly busy day, we got slammed by multiple sick patients within a few minutes of each other (including a cardiac arrest).  This backed up the rest of the ED for several hours.  Molly checked in as a patient where people were waiting up to 3 hours just to get into a room.  

15 people ahead of Molly, she was the only one who came up to me and asked how much longer until she was seen.  Once again, not exactly the best thing to do when there are no rooms and the triage nurse has little respect for you as a person.

Molly was eventually seen and discharged.

Over the last several weeks the schools in the area have been sending us nursing students.  Guess who was sent our way today?  That's right, Molly.

She spent the first 4 hours of her shift with someone else.  I'm stewing in my section, avoiding her as much as possible but still keeping it professional (that's what I do). I vent to some people about the person, the situation and my complete lack of respect for her as a professional.

After those first 4 hours she is then transferred to me to I so I can precept her.  I'm not thrilled about the situation. 

I'm glad I could keep it cordial but she was no different at with my interactions tonight than she was when she tarnished my reputation several years ago. She was still the entitled, lazy tech who is now in nursing school. 

I still have no respect for her as a person. I hope she never works at my facility because I guarantee I will have no respect for her as a nurse.  

Is this a bad thing?

Why?

So I feel like I'm using this blog as a venting ground but whatever.  If I don't I'm going to snap at someone and put myself at risk of losing my career.

My day starts off with my supervisor asking me to come in early.  Apparently one guy is targeting me and a handful of others and tattling that we have cell phones out in the department. He is also claiming my documentation isn't "up to par" and they have a lot of things to do when my shift is over and I've left.  He's targeting me so much that I'm one step away from being written up and put on probation.  He hasn't confronted me, he is spineless and would rather stab you in the back.  I'm pretty close to telling him off (I'm probably never going to do it, I don't do well with confrontation).

I clock in and start my shift, already disheartened from the situation above.  I get an ambulance in one of my rooms and this person is really ill.  He has a pneumothorax (a collapsed lung) in addition to pneumonia and a shitty medical history.  I've taken care of him before and he is really sick.  He gets intubated because he can't tolerate Bipap (a breathing machine, puts positive pressure on the lungs, not a good idea for the pneumothorax) and he isn't doing well on his normal nasal cannula.

Long story short (too late) as the doctor is inserting the chest tube (he has received rocuronium and etomidate for the intubation process) he goes into PEA (pulseless electrical activity, the machine picks up on the heart rhythm but there is no heart beat).  Start chest compressions and ACLS protocol.  He goes into V-tach (ventricular tachycardia, not a good rhythm, needs to be shocked ASAP) and finally after 30 minutes of working him we get him back.

This person is 1:1, I need to be in there and I can't leave him alone.  He gets an A-line (inserted into the artery to give us accurate blood pressures and instant changes), central line (IV access inserted by the doctor that goes deep into the larger veins), peripheral line, and intraosseous line (IV into the bone) by the time we're done.  I end up working with this patient for almost 4 hours before I can do anything else.

While working with this patient someone else takes care of my other 3 patients.  She discharges 2 of them.  The charge nurse puts a sick person in one room and at 3pm she leaves.  She never told me about my new patient. She never asked anyone to watch that patient. The person who cared for and discharged the other patients left at 3pm also.  I have no clue what's going on outside of my 1:1.  The next charge nurse puts another really sick patient in my other empty room.  In my opinion those rooms either should have been closed or they should have received a different nurse to take care of them while I was with my sick patient.  Nope.

Backtrack a little.  I have a patient being admitted because she is having difficulty breathing.  The patient is in no acute respiratory distress, she is actually able to complete sentences without struggling to breathe and she is stable.  She is in room 32.  While I'm literally doing chest compressions Someone asks me to answer the phone because the hospitalist needs to talk to me about room 32 and how she needs me to put orders to change her room assignment.  I ask the messenger to tell the hospitalist to do her own fucking job (I'm not sure it was relayed in that manner).  I continued to get requests from the hospitalist regarding room 32 like why didn't you change the bed request or can you administer meds or can you put in orders for me.  Each time I had to explain I was in the middle of taking care of someone else and she would either have to do it herself or wait (guess what she did, if you guessed she did her job YOU'RE WRONG!).  At one point I finally got some orders in for this lazy, incompetent POS hospitalist and I ask the lab to draw her blood because of everything going on.  They come over and inform me the patient has a port and they can't access blood from a port.  OK, well I didn't ask her to access the port so I assume the lab tech drew blood because she moved on.  There are other ways to draw blood, just because a patient has a port doesn't mean you can't find a way.  I guess that's my fault for assuming.  She had walked off without drawing her blood, leaving me to do it for her.

While I'm still dealing with the aftermath of my sick (almost dead) patient they continue to give me ambulances and expect me to care for them as well.

Even though I'd never walk away from a job (I don't ever want to put my license at risk), I was about to snap.  My usual mostly composed responses to frustrating questions were a little testy and snide (like room 32 asking for dinner even though her blood sugar was 700, my response to the messenger was "tell the fat fucker to stop eating like a pig so her sugar is more easily controlled and maybe I can give her a trough", hopefully room 32 didn't hear that).

This makes me wonder why it's OK for nurses to fix hospitalists problems.  Why is it OK for them to fuck up and expect us not only to catch their mistake but correct it both in the computer and before it touches the patient?  I don't get paid to do their job and they won't give me money to do so.  So why do I have to put up with their incompetence while they expect us to fix their shit?

I need a mental day. Glad I don't return until Saturday for my next shift.  Until then my job can just fuck off.

Uh, Hell No!

I feel violated.

I received a female patient today from the local jail who was vomiting and a heart rate in the 40s (should be at least 60, maybe 50s for someone who exercises regularly and I think the only exercise this patient did was taking a spoon to her mouth).  Officers are in the room telling her to be patient while we do our job.

I can tell this patient is going to be time consuming because as she was going to vomit she would purposely vomit on the floor.  How do I know this you ask?  She was given two different emesis basins and instead of using them she leaned over the bed on vomited on the floor (classy).

Considering the circumstances I needed to start an IV to help her get fluids, etc.  I get my other patients situated so I can spend time in her room knowing it will be time consuming.  By the time I return the guards are gone and she informs me she can leave whenever because she is no longer in the custody of the police.

She claimed she wasn't interested in leaving and she wanted treatment.  I proceed to tie a tourniquet and stretch her arm out to look for a vein.

Here's where the violation starts.  The picture below is how to search for a vein (if you have a table to assist in keeping the arm straight).  In the ED this is seldom available so we use our bodies (at least I do) to help keep the arm outstretched while searching.

Veins are spongy and will bounce back to normal, arteries have pulses, that's how you differentiate.

The way she is positioned she is able to use her fingertips to touch the inside of my arm (gentle brushing, obviously flirting type), then reached up and touched my chest.  I tell her to stop and to act appropriate during the process if she wanted me to continue.

She stops, I move to look for a vein in the other arm.  Since I am now on her left arm I need to stretch out her arm and lay it in my lap (I start IVs with my right arm, searching for veins with the left).  At this point she took complete advantage of the situation.  She started feeling up my leg working her way up my leg.  Fortunately for me my wallet was in the pocket; she got distracted and tried to remove take the wallet instead.  

As quickly as possible I removed the tourniquet and stand up.  As I was standing up she reached up to my chest again and grabbed the trauma shears out of my pocket, asking if she could keep it.  I yank it out of her hands, remove all sharp objects from her reach and tell her that she is not welcome in the ED if she won't act appropriately.  I reminded her she was no longer in police custody so she could walk out whenever and left the room.

My coworkers (being the great friends they are) immediately pointed out she was in jail and just wanted to touch a man again.  Thanks guys.  She had only been incarcerated less than 36 hours by this point.  I've gone longer than that without seeing my wife (though she will probably claim I do the same thing if I've gone that long without seeing her).

This patient ended up walking out of the room and shat herself in the lobby in front of everyone, then demanded a change of clothes before she would leave.  Paper scrubs were happily provided to get rid of her.

Again, I feel so violated. 

On a side note, I told my coworkers this story and they got confused with the word shat.  It is the past tense of shit, in case you didn't know.  My patient shat on the floor because he was drunk and missed the bedside commode (yes, this was also my patient while dealing with the one above, fun night).

Family Oriented

In the ER we take care of people from every profession (obviously, we can't turn anyone away).  Most professions are typical (factory worker, truck driver, teller, food service, etc).  Occasionally we get the more "exotic" professionals.

Tonight was one of those nights.

Making conversation I asked where she worked.  She then divulged a lot of information that was rather interesting.  She used to work at "Gentlemen's Club A" before they lost their liquor license (selling alcoholic drinks to minors).  She then got a job at "Gentlemen's Club B".

Gentlemen's Club A is going to be reopening soon (at least that's what their sign says, I drive past it regularly) so I asked if she was going to return to Club A.  She informed me she would not because Club B was more family oriented.

So, that's not the reason I would ever expect out of an exotic dancer describing her place of employment.  "Hi Son, for your 12th birthday lets go to this family joint I heard about. You'll love it!"  Not exactly what I have in mind.

Her explanation isn't much better.  Club A is more cutthroat there between the workers.  They are likely to kick you while you're down (I pointed out the obvious, all the employees are competing for money).  Apparently Club B is more like a family (wrong choice of words, for all we know this area they could be family) and they are more friendly.

Interesting.  Anyone up for a family outing to Club B?

I don't think so

I have a 15 year old female patient who claims she can't see after getting hit in the face with a cell phone.  She obviously has a swollen black eye to one side but no trauma to the other side.  She refuses to even try to open her eye (unless she thinks you're not looking where she'll not only open both eyes but she is able to text from her phone without any problem until you walk in the room where she'll then pretend she can't read/write anymore on her phone).

At one point she needed to walk to the bathroom, once again "walking blindly" with her younger sister helping her out.  She calls my name and grabs my elbow (how could she see where that was?) so I can help "guide" her to the bathroom (where she then proceeds to take care of everything herself, presumably, because no way in hell I'm hanging out in there).

By the end of the night it's time to determine whether or not her eye will need stitches.  Because of all the dried blood near the site of injury (because when you're bleeding you just let it run down your face, no need to try and control it) we have to soak (damp cloth) and scrub (gauze and elbow grease). Because of the pain she is in (honestly I believe she hurt, just milked it for everything) she said she needed to hold my hand.  At this point she reaches out and grabs my hand (miraculously able to see exactly where my hand was even though her eyes were still "swollen shut").  Keep in mind her girlfriend (whose perfume smelled a lot like wacky tobacky), mother and sister are in the room with her cousin cleaning the room next door (who also couldn't figure out how to unlock a push lock door, that's something special).

Seriously, she just needed to push the handle down to unlock it and she couldn't figure it out.  Please don't breed...

I don't think so.  I literally pulled my hand away from her and pointed out her family and friends who could hold her hand during this "traumatizing moment" (ok, I didn't actually say traumatizing moment, just told her about her family in the room who could hold her hand).

Several co-workers said I should have just let her hold my hand so she could get a contact buzz from the situation (I think there was enough buzz in that room just going second hand. Here's hoping I don't get drug tested any time soon).

So, what would you do in this scenario?

Witch Hunt

Our hospital "upgraded" our specimen collection system to something called Beaker.  Now instead of the lab collecting the specimens sent to them in the computer the nurses and techs do that.  It was a big readjustment for all of us, including myself.

Over the last several weeks they have received unlabeled specimens from our emergency department more frequently.  It's becoming aggravating to my boss to have to deal with the lab and something that should easily be taken care of from our end, just an extra minute of documentation on the computer before leaving the room and you're good.

Because of the number of calls the boss is getting on unlabeled specimens (specimens are usually blood and urine though can include many other things) it feels as though he is on a witch hunt now.

Earlier this week he sent me an email informing me not to send unlabeled specimens to the lab.  He included the patient ID for me to look into the chart.

My response was simple.  If the specimen was unlabeled, how does he know which patient it came from? Or even how did he know it came from me?

As you can see (I think) I also pointed out that the patient in question had results from the urine that was supposedly unlabeled and sent to them along with a collection from myself.

Being the boss man of course I'm going to make it sound a little more professional than that.  His response, it was recollected.

I'm not the only one he has done this to.  Two other people in my department got emails from Big Boss Man with similar accusations.  Their response was similar to mine.  How does he know which patient the unlabeled specimen came from and how does he know which person to blame for sending it to the lab without the proper label?

It honestly sounds like he wants to correct the problem (rightfully so) but it also sounds like a giant witch hunt to me.  Maybe he thinks if he sends enough of these accusations out the problem will correct itself.  Regardless of how he handles it I'm in the clear as far as I can tell.

What's going on?

Over the last couple of years I've had more than a few coworkers get fired.  Most of them deserved it (in my opinion), they would take a lunch break lasting an hour when it should only be 30 minutes or disappear for long periods of time.  One of them was so verbally abusive to any female "subordinate" he would make them cry.

One trend that is surprisingly shocking (to me) is the amount of my coworkers that have been fired for drug use/mismanagement.

As nurses we have to document when we take narcotics out of the Omnicell.  If the patients refuse the medication or the doctor orders a partial dose we have a second nurse sign off showing the narcotic was disposed of appropriately.

In the last 2.5 years there have been 5 nurses terminated for drug problems.  The first one I got called at home and asked if I had seen her dispose of the narcotic.  Turns out one of the patients noticed she was getting tylenol instead of percocet and reported the problem to the provider.  That led to the first nurse being terminated.

The next 2 took place about a year later.  One of them was spastic and would disappear for long periods of time.  Technically she resigned from her position and was going to work somewhere else in the hospital but she was so bad at abandoning her patients she was told not to worry about finishing her 2 weeks and she could leave then.  She was pulled over a few weeks later and admitted to the police she had been using drugs (LSD, PCP and Mary Jane).

Shortly after her the second never showed up to his shift.  There was a huge snowstorm coming in (we ended up getting 4 feet of snow in a 24 hour period).  We ended up calling the police near where he lived.  They reported he was safely in jail.  Confused we asked what was going on.  Apparently he was arrested for possession of drugs with the intent to sell to minors (he was in a school zone or something like that).  That one caught us all by surprise.

Another was busted under the influence while at work during this time frame as well.

Most recently two of my friends were dismissed for the same thing.  They were withdrawing narcotics with "verbal orders" on patients that they weren't even taking care of.  These two were more shocking to me because they were both friends of mine (the rest were like those annoying coworkers who you deal with because you need to make it through your shift without harming anyone).

WTF were they thinking?  Not only did they lose their jobs but they may have even lost their nursing license.  I worked my ass off for my license, why would I risk losing my livelihood and potentially my entire family over something so stupid and easily remedied?  Obviously their situations at home were different than mine but still.  Of all these people only one that I know of has bounced back but she is still not sure if the boss that fired her is going to press charges.  If so she will be in the same boat as the other 4.

I pray for them that they may be able to overcome whatever problem they have at home.  I wish them all the best in their ventures.  As for me, no way I'm going to throw my nursing license away for something so mundane.

Chuckles

Another after work post.  Not tired enough to fall asleep but not awake enough to do much so why not recall a story?

My last patient today was a high school senior who dislocated his shoulder, I'm calling him Chuckles.  All things considered he was handling it well, making jokes and laughing with us in our attempts to help him feel better.

It just looks painful, I need something just looking at this....

Doc comes in and we tell him we're going to administer some meds to help him relax and sleep a little while we pop it back in (shoulder reduction for those requiring medical terminology).  Doc administers Etomidate so we can perform the reduction.

Etomidate is a short acting anesthetic we administer to perform the procedure.  The process is called conscious sedation (they aren't fully under sedation but gone enough that they don't care and won't remember).

Chuckles passes out mid sentence shortly after administering the medication.  Shoulder is reduced without any problems, less than 10 minutes later the Chuckles is almost back to his baseline.  

When he wakes up he is stoned.  He laughs at everything, asks his mom to record him so they can remember, etc.  He calls his girlfriend, all the while laughing at everything (that's why the nickname).

Trying to see how oriented he is I ask him to give me his birthday.  His response, "I'm 18, you do the math."  I explain to him that I am not being quizzed, he is and needs to give his birth year.  So he starts counting backwards until he gets to his birth year.  

For being as stoned as he is he does a good job problem solving.

I point out to him that he is stoned.  He yells out, "I'm not stoned, I never do drugs!"

I responded, "Dude, I gave you the meds.  You're stoned because of me."

He replies, "Oh.  Man that's some good stuff, you should think about selling it.  You'd make a fortune."

Chuckles is funny.  Eventually he is discharged and asks to be taken to the vending machines.  The next time I see Chuckles he is still in the wheelchair (too dizzy to stand up by himself) inching himself around using his legs and trying to keep all the honey buns from falling to the floor (and failing miserably).

Honey Buns, snack of choice for a post shoulder reduction

I must say, Chuckles made my night.

Uhhhh....

I get an ambulance (my last patient of the day), a young female with abdominal pain.  She is obviously in pain, screaming in a shrill high pitched voice "aren't you going to help me?".

Shift change for the doctor's is only 10 minutes away, I know the doctor that is getting ready to leave won't see her so I order a few ATPs (advance triage protocol, the doctors in our ER have agreed on certain tests that can be run if they present with certain symptoms such as abdominal pain).

After putting in the orders I go in to assess the patient so I know a little better what is going on and where.  When assessing the abdomen it is protocol to listen for bowel sounds with your stethoscope before palpating (follow the link to hear bowel sounds).  If you palpate (examine by touch) before listening you can agitate the bowels and hear bowel sounds that may not have been there.

Because of the continuous shrill screams from the patient I knew I wasn't going to be able to hear anything through the stethoscope so I skipped this step and went to the palpation to determine where the pain was located.

I wish all patients had a flat belly like this...

The abdomen is divided into 4 quadrants.  As long as you listen and palpate all the sections it doesn't matter where you start.  I usually start away from where they claim their pain is located.

Tonight my patient had pain in the left upper quadrant (LUQ) so I started palpating on the right side.

She wasn't too patient with my assessment and decided to grab my hand and show me where her pain was located.

Unfortunately (for me) she placed my hand right on top of her naked, sagging breast.  Being the professional I am I moved the breast aside and palpated the belly underneath.  My brain, on the other hand, was screaming.  This is in no way ideal.  Nasty.....

Clint Eastwood's face sums up how I felt after "palpating" her mammary...

Rhetorical Questions

I was accused of not taking care of my own patients tonight. I asked her to start an IV for me on one patient (me and another nurse tried and failed) and I asked the tech to start a Foley catheter who in turn asked her for help with it.

I then hear her scream "Well fuck, why am I taking care of his fucking patients?  The only thing I haven't done for him is his assessment."

We've been working together tonight in the same section by this point for 2.5 hours and that's all I've asked her to do. Start an IV we had already missed. The tech asked for help doing her job. I didn't ask her to do it.

Anyway, I can tell she's fuming so I watch my patients remotely from the other end of the ED and I can hear her say to the charge nurse "If he would stop eating his fucking tacos maybe he could take care of his fucking patients and I wouldn't have to."

A little while later I go to the charge nurse to explain what had happened from my point of view.  He cuts me off and asks me if my patients are taken care of, if I'm caught up. I say yes and try again to explain and he cuts me off and says make sure my shit is done.  I explain again I'm caught up minus some documentation.

Whatever.  I only asked her to do one thing. Heaven forbid she get off her high horse and help.

Here's what I got out of tonight: Don't ever ask her for help, heaven forbid I set her off on a racist tirade attacking me personally, and don't ask this tech for help cause she'll throw me under the bus.

Neither one of them can look me in the eye after this, both avoid me (and I them).  So why is this still bothering me?  Chances of me being written up are nonexistent.  It's over with, I'm at home and don't go back to work until Tuesday.  Why am I still up?  Why am I frustrated over this situation?

I should pull an Elsa and let it go.

A day in our shoes

These thoughts came from a friend.  I'm not always able to articulate my sentiments as well as this, especially when it comes to this subject.  I agree 100% though (edited some grammar).

If patients' families walked a day in the life of a nurse, doctor, or anyone in healthcare they may be a little more understanding at what we do. 

Just because we walk by your room and are laughing or smiling does not mean we're not doing our job or we must not be busy.  

Are we not allowed to laugh or smile? We experience more than you may realize and sometimes laughing or smiling is our only way of coping with certain situations.  

We are overworked, underpaid, and short staffed most of the time. We strive to give our best to your family members. We are sometimes the only ones there for our patients, laughing with them, crying with them, or simply there just to listen. 

We see patients take their first breath and their last. We try and make the most/best out of every situation. So please before judging us for laughing at a time which may be stressful to you, stop and think what we may have just experienced. Just one day in our shoes would change your mind forever.

Venting session

Tonight was a slow night in the ER considering it's a Sunday night.  Usually we are busting at the seams with wait times up to 1.5 hours to get a room and 2 hours to be seen.  There were several occasions where There was nobody in the waiting room.  All night we had empty rooms, which is good.  I was able to enjoy watching a few football games which made for nice.

My shift is from 11am to 11pm.  The person in charge closes 4 rooms by 11pm because lack of nursing staff to keep them open.  Depending on the doctor and patient flow they start closing these rooms between 9 and 9:30.

My assignment tonight was the section that gets closed off early.  I discharged my last patient at 9:30.  We have 15 open beds in the ER, 11 if you claim my four rooms closed.  With my shift ending, I assumed I would be sent home because you can't justify the staffing (we had 2 float nurses after 7pm).  The coworkers next to me had a total of 3 patients to 2 nurses.

I wait around for 15 minutes for the "you can go home" from the charge nurse.  I finally decide to walk around to see if anybody needed help (nobody did, we had 2 other nurses helping out).

After another few minutes I'm told I will be getting an ambulance.  I know I look dumbfounded.  As I said above, my section should have been closed by this point, even with a fast doctor.  Because I am who I am instead of asking why not send that ambulance to one of the other nurses and send me home, I say OK and go wait for them.

By the time the ambulance arrives I had zero patients for more than half an hour.  Every nurse in the ER had only 2 patients to care for.  I do my job, take care of the patient, and less than 10 minutes later we are just waiting on CT results.  I'm done documenting on this patient by 1015, 45 minutes until the end of my shift.

Still waiting to get sent home.  Nothing.  I go kill time elsewhere.  By 1030pm I'm completely pissed off.  There are no ambulances out, no patients in the lobby, and every nurse has 2 patients to care for (except me, remember, I have one patient and 3 closed rooms at this time).

I decide to make myself scarce so the charge nurse doesn't find me.  Why bother going home?  My shift is over in less than 30 minutes and I'm not allowed to refuse being sent home early (that I know of).

By the time 11pm rolls around I'm beyond frustrated.  I could have gone home early and spent some time with my wife before she fell asleep, even if it was just watching TV.  That's better than not seeing her until she gets home from work tomorrow (we work opposite schedules, I sometimes go for several days without seeing her).

I give report on my patient to the nurse relieving me and I make my way to the break room.  I am very passive aggressive.  I would rather avoid confrontation and not make a scene.  The only thing I can do to be spiteful is get paid to sit.

We work 12 hour shifts.  If you take a 30 minute lunch break you need to stay until 30 minutes after your shift is over in order to get a paid lunch break.  For me I have to clock out at 11:30 to get that paid lunch.  Most of the time I would rather clock out and head home.  I'm too awake and pissed off to want to go home.

My passive aggressive self sat for 30 minutes in our break room so I could get a paid lunch break.  All in the name of spite.  No it didn't make me feel any better but at least I got paid to play on my phone for 30 minutes.

Speaking of taking a break, the overnight crew works from 7p-7a.  Typical in our line of work.  They regularly have potluck dinners because that's what they do.  They have recently started waiting to bring out their potluck food until after 11pm, when all the day shift people are gone.  No big deal, I'm leaving anyway.

During my spiteful sitting tonight one of the night shifters comes into the break room and notices all the food in the crockpot is gone.  This is just barely after 11pm.  She commented "See, this is why we don't bring the food out until after day shift is gone, they eat all the food."

Talk about rubbing me the wrong way after already being in a pissy mood.  I was the only "day" shift staff in the ER at this point.  The others left at 7pm and the one who came in at 11am with me went home sick.  The night shift had eaten all the food.  I hadn't been in the break room for more than 5 minutes when this was said and most of the food was already gone before I even came in.

All I wanted to say was "Fuck you, your overnight people ate all the food."  But what good would that do?  I decided to keep my mouth shut and stare at the phone.  Only 15 minutes until I could leave with my passive aggressive boycott for not getting sent home early.

I survived the night without saying too much.  It took a lot out of me.

Smoke Breaks

I consider myself a team player.  I'll jump in and help you if I see you're drowning as long as I am available.  I don't expect you to reciprocate, especially if I'm already familiar with your work ethic (most of my coworkers become extremely frustrated if I ask for help, even if all they have to do is discharge a patient and send them home).

There are some things that are beyond frustrating that have happened lately while trying to help.  The one that pushed me over the edge was a smoke break.

Here's the situation.  I'm working the the "urgent care" section of the ED (Rapid Medical Evaluation in my hospital, sometimes known as Minor Care).  One of my coworkers in the acute side of the ED receives an ambulance (respiratory distress) and has 2 other patients, one of whom they are trying to determine if he has a heart attack.

The Charge Nurse asks me to leave my area and help my coworker.  I get there and she is taking care of the respiratory distress. I'm asked to watch her other two patients. The rule out heart attack needs a second IV started along with a heparin drip (blood thinner) and a nitro drip (vasodilator, makes blood flow easier).  No problem.  I get that going in less than 10 minutes (including all the documentation and explanations to the patient).

Because I am who I am, I take over the care of her other patient as well.  I make sure they are situated, comfortable, and I explain what is going on with their care.  Time passes (about 30 minutes from when I get there) and she steps out of the room she has been frantically working in.  I give her updates on her other patients.  They are settled, just waiting for admission orders (heart attack) and discharge orders (the other patient).  I'm told to stick around for a while until the respiratory distress is more stable. No problem.

More time passes, the doctors involved with the heart attack patient continue to ask me for updates and I continue to help.  I discharge the other patient.  The next time I see her she is grabbing her cigarettes and leaving on a smoke break.  I ask her who is going to watch her patients (remember, this is not my assignment, I'm supposed in the "minor care", just keeping her afloat so she doesn't come back to a nightmare of orders).  She rambles off that someone else is going to watch her people and runs off.

Seriously?  I've been watching her people for 45 minutes at this point and she suddenly have enough time for a smoke break? I still haven't given her report on her other patients so she can officially resume care of them.  I am still answering questions from the doctors for her cardiac patient yet she has enough time for a "breathing treatment"? Unbelievable.

The worst part of this situation is reporting this incident.  It's beyond ridiculous that she did this. Unfortunately the charge nurse is in no position to help because he was a substitute.  Even so, our current boss doesn't know how to confront people (instead of writing people up for playing Pokemon in the ER he sent yet another reminder we aren't supposed to have cell phones, easily narrowed to 2 people on the overnight shift).

So what about confronting the person who went to smoke? Can't bring it up to her because in her mind her people were covered so she did nothing wrong.

Honestly by the time I'm writing this I'm mostly over the situation.  Obviously it still bothers me a bit but for the most part I'm over it.  There's nothing I can do and at this point it's far from everyone else's mind.

Life goes on.

They asked me to stay late that night to help relieve lunches.  I agreed to remain long enough to transport the patients that were admitted but did not want to do any lunches, especially my smoking friend.

The other night

I like to think myself a happy person. I really try to make it a point to stay positive. Unfortunately I have nights like yesterday where I feel like I get shat on.

Working in the ER is a complex beast. You have to be able to juggle a lot of situations at the same time and you have to be able to prioritize what comes first.  If a person isn't breathing they take precedence over someone with a sprained ankle (obviously). Sometimes it gets sketchy. What if you have multiple people who are very ill and an attention seeking drunk? Security isn't available to help you out.

This was very similar to my situation the other day. I get 2 ambulances at the same time. I help one person who doesn't have lung sounds and the oxygen saturation is 40% (that should be above 93%). As I am trying to get her stable and increase her blood oxygen my drunken ambulance starts wandering around the nurses station screaming "I need help, doesn't anyone care if I die?" 

Going back to the complex beast that is the ER, I am in a section where help is nonexistent at this time. I work with multiple other nurses who need so much help that it takes 2 people to do what one nurse should be able to manage on her own. The techs that work with us cannot get to me because they are being utilized by other nurses and the charge nurse is doing something else.

I am able to take care of both patients (and my other 2 less needy but just as sick patients) but by the end of the night I am just shy of yelling at my drunken attention seeking butthole. At one point after I tell him to get back in his room and get in bed he asked me "Just who do you think you're talking to?" I replied "A noncompliant patient who can't follow simple instructions to stay in bed." (security isn't available to help keep him in bed).

My patience was very thin at the end of the night. I am very grateful for the understanding my other patients had with the situation.

This is a situation that happens regularly. Occasionally I will get help from my peers and depending on what is going on I will sometimes get quite a bit of assistance. The problem is I usually get forgotten and dumped on.  I don't complain when I get a lot of sick patients. I do my job. I don't complain (a lot) when I have 4 patients when others have 1 or 2.  Maybe this is why it continues to happen to me.

Will I complain, probably not to anybody in charge. Mostly because I know I can handle the situations they throw at me. If I do get to a point where I'm drowning there are a few people that will come to my assistance.

Besides, when it comes down to it, I like my job. I don't want to be known as a "trouble maker". I do my job (most of the time well in my opinion) and I try to have fun.  I can see myself doing this for quite some time.

Which is better?

I recently had a patient complain to my boss about something out of my control.

Long story very condensed:

The last four hours of my shift I got four new patients.  Two of these people were septic (systemic infection, potentially fatal, both requiring a lot of attention), one had a small bowel obstruction (extremely painful, requires a tube that goes up the nose into the stomach), and the last patient (the one who complained) had chest pain with no other clinical signs or symptoms (usually send home with recommendations to follow up with cardiologist).

Each time I entered the room of the fourth patient I would begin by apologizing for the delay and the doctor was working as fast as he could.  I would continue by updating him with everything I could. He was always pleasant with me when I spoke with him.

At the end of my shift I reported to the nurse so I could go home.  Sometime after I left the fourth patient became irritated, stood at the nurses station and exclaimed we should not be working short staffed (by this point he had been in the ER for over six hours, one hour in the lobby, the rest waiting for the doctor). Referring back to the other patients I was working with, the doctor was also helping multiple other people.  We were a little busy.

After my coworker threw me under the bus (she claimed she would not use my name when replying to boss man), I clarified the situation to my boss.

His response confuses me.

1. NEVER apologize to a patient. They come to the ER, they should expect to wait
2. NEVER tell the patient we are busy
3. Instead tell them "the doctor is spending quality time with each and every patient and he will spend quality time with you as soon as he is available".

How is this better than saying "we've been busy, the doctor will get to you as soon as possible"?  In my mind I hear the exact same thing.  My wife agrees with how my boss told me to handle future situations.  She described him as a "Spin Doctor" (all I heard was Little Miss Can't Be Wrong).  

I make it a point to be upfront with all my patients.  I understand both statements are the same.  I also understand one is more politically correct.  

If I were your nurse which would you prefer me tell you?  If anybody reads this, please let me know in the response section.