Trump Card (and other stuff)

Up front, this isn't a political post.

Several situations at work today, I'll start with the amusing (in the dark kinda way):

First story:

*Paramedic report to their station*
Paramedic: We're not taking him in, he's dead dead.
Doctor's scribe in ER overhears report: Is there a difference between dead and dead dead?
Me: Of course there is. One is Mostly dead, they still might be alive. The other is all dead, nothing left in them
*Scribe stares blankly at me*
Me: Guess you've never seen the Princess Bride....

Second story:

I introduced myself to my almost 80 year old patient. After a couple of attempts she still couldn't figure out my name.
Me: I'm Ernesto, I'm your nurse
Pt: What's your name?
Me: Ernesto
Pt: How do you pronounce it?
Me: Ernest

It reminded me of a time when my coworker couldn't remember my name for over a year and she called me Lorenzo (and I answered cause I knew she was talking to me).

Final story:

A coworker created a problem that I spent almost an hour fixing. Long story my patient called out using the call bell and she answered. They requested pain medication, she called and told me but I was not on the floor. They called a second time and she cut them off. A third time and she didn't even let them talk before hanging up on them. I was back on the floor at this time and my patient called out to inform us they were leaving to another hospital.

I walk in the room to talk to them and they were gone.  I found them in the hall and the patient's IVs were still in.  I politely asked them to come to the room for me to remove them before they left the hospital.

They refused stating I could not touch the patient without permission or consent and they were not giving me their consent.  They obviously thought they had the upper hand in the situation. 

I agreed with them that I could not touch the patient without consent. I then explained that I could not allow them to leave the premises with the IVs in because that would be negligent on my part. I then dropped my trump card: if they left with the IVs in the patient's arm I would have to call the police to have them check on the patient and make sure they got removed.

They agreed to return to the room.

Now that the story is done I just want to thank my lovely coworker for doing her job so professionally. Her courtesy was so helpful in this situation....yes this statement is dripping with sarcasm.

Triage Hell

Spent the last 12 hours in Triage. Definitely one of the worst days I've had out there. 

I clock in at 11a and we're holding 10 admitted patients because there are no beds upstairs, 3 transfer patients, rapidly transfusing blood on another, with several overdoses. We have a really high acuity going on (unusual that we have this many at one time).

We get word of an OD needs help out of a car.  We drag his strung out ass into a wheelchair with the help of security. As we take him to a room, security disappears.  The patient becomes combative and we end up calling a code gray (violent patient). Everyone shows up who is supposed to respond (security, maintenance, basically everyone available), and NOBODY helps. They stand outside the room listening to the patient ramble on about being raped by the person living in his head (I think that's called masturbation) and how he's travelling at the speed of light.  Homey is tripping on something.

As we deal with all this in the back, people continue to come in to the department, obviously we can't exactly close.  I end up with 23 people in the lobby with a 5 hour wait time just to get to a room.

One person waiting tries talking to me about how he doesn't understand how this hospital can handle an emergency when we can't even get patient's in the back to be seen.  This is the same fucker that eloped with his wife because they had been there 4 hours (she had an ulcer on her ass with an abscess starting to tunnel to another location, and it appeared necrotic) without an answer. 

I told him they had to wait because of the large number of traumas/overdoses/unresponsive patients. He didn't seem to happy but it shut him up.

After triaging a few other people, I marked 2 for the rapid medical side of the department.  One of the RNs working that unit called me to ask if we could bring them back.  Mind you, I'm still 20 deep and trying to get protocol orders completed and still triage the rest. She had 4 patients, one of whom was being admitted and the others nearing the end of their treatment.

I asked her to come out and grab the 2 extra patients.  She starts bitching about patient abandonment and how she is the ONLY one in that section (not true) and how she is leaving the provider without help (maybe true, but they don't need us to wipe their ass while working).  Instead of calling her out on her bullshit I decide to ignore her and hang up the phone.  A couple of minutes later she comes out and is still bitching about all the work she had to drop so she could get more patients for herself.  Again, instead of calling her out on her bullshit I ignore her (and so does the other triage nurse).

Basically she needs to get off her high horse and take one for the team. It's not like we have a lot of options.

The other triage nurse gets a call from home and her grandma is sick and she has to leave.  I'm then left alone for over 30 minutes trying to get everyone triaged (yes, still 20 deep, people still coming in).

I'm then told by the charge nurse to take a lunch break whenever because people are going to keep coming in.  I'm not the kind of guy to leave my coworker alone to triage 8 people in 30 minutes.  I opt to not take a lunch break unless someone comes to cover for me and help triage (never happened).

Towards the end of the night it FINALLY starts to slow down.  I'm finally in the single digits for people needing to be roomed/triaged.  Rooms are becoming more available. Someone checks in and reports leg pain. She is making such a big scene that her boyfriend goes up to the registration desk and asks for the patient to go back twice in 5 minutes.  I opt to triage another person in front of her (had been waiting for almost half an hour for the triage and palpitations come before leg pain anyway). She's making such a big stink about her pain that everyone in the waiting room was happy to see her go back to a room (turns out she was just drug seeking and she was escorted out by security. I'm SO shocked by this outcome).

Overall there were a lot of variables I couldn't control in the ED. I thank my coworkers for helping us all get through this without any real incidents.  Over the course of the 12 hours I had more people leave without being seen than I have in the 5 years I've worked in the department.  I don't blame them (other than they probably didn't need to be seen if they left).

At one point someone asked if I hated my job.  Honestly, even through all this shit today, I still like my job.

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.

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.

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.

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.