Good evening ladies,
I am a 2 year nurse ER nurse and I, along with 3 million other nurses in the US, were quite offended by your 36 second bit criticizing Miss Colorado Kelley Johnson's monologue.
You started off by saying, in a condescending tone, that she "Came out in a nursing uniform." Our jobs are not made to be sexy. We do not come to work every day wearing expensive clothes that show off our tasty bits. We wear something practical, because in one shift we might need to perform CPR, wipe urine off the floor, and place an IV while security is making sure our patient doesn't bite us. Our uniform is practical not fashionable.
You then said that Kelley, "got up there and basically read her emails out loud." What Miss Colarado did was get up on stage, in front of millions, and shared a very personal story. A story where she was personally affected by a patient. If you ask any nurse what our job is like or what's "the coolest thing you've ever seen??" we will immediately spout off 10 stories to entertain and gross you out. However, we all have that one story that we won't tell. Something that affected us on a deeper level. The patient that we cried over, the one that got to us. The patient that we will remember for the rest of our lives. For most of us, we keep this story deep inside, we don't talk about it, we certainly don't email about it. Kelley Johnson had the guts to stand up and share with the entire country, and is ridiculed for such.
Next, let's talk about "Why does she have a doctor's stethoscope on?" First let me say that I love my doctors. I work with the most brilliant people I have ever met, and if me, or my family, was sick I would trust my life in their hands. But here's the thing. The first people you interact with when you get inside the hospital are the nursing staff. The people that are in your room, literally HOURLY, are the nurses. The people that are atune to minor changes in your lung sounds, heart sounds, and bowel sounds, are these nurses. Things we hear with our stethoscope that can literally mean life or death.
The last thing stated was "She deals with Alzheimer's patients, which I swear, is not funny, but google it if you can." Miss Colorado 2015 is an Intensive Care Unit nurse. She doesn't just 'deal with' Alzheimer's patients. She deals with patients that are literally, teetering on the brink of death. It is her job to work with the critical care team to keep your family member alive. Her patients are getting discharged home because of her efforts. And whether you believe it or not, she is affected every time a patient gets discharged to Jesus.
I wish I could say "just wait until one of these gals gets sick and see what happens" but those of us in this profession know how it would go. No matter how much these ladies have offended us, we would still give them extra heated blankets, we would advocate for them when they were in pain, we would give them an extra packet of graham crackers, and we would greet them each time we see them with a smile.
As nurses, we treat everyone equally. The hospital CEO to the convict, to the celebrity that says that she doesn't view you as a professional, everyone gets a compassionate nurse to tuck them in and make sure they stay alive overnight.
-K
Tuesday, September 15, 2015
Tuesday, September 8, 2015
How does Bane eat?
1. Through a straw
This is very plausible. Protein shakes filled with nutrients to keep him going, and a straw to fit through the holes in the mask.
2. PEG Tube
Nursing home patients come in through the ED CONSTANTLY for dislodged tubes, Bane would be in and out of the hospital or doctors office for issues with the tube. A mickey tube would be a valid option but they are even more complicated when they dislodge, requiring a more complicated replacement procedure. Besides, his armor is pretty tight fitting and with the amount of physical exertion he does, this would not be a comfortable option.He could have some sort of metal stomach with a welded opening that hides conspicuously into his armor? I feel like this is a stretch.
3. TPN
He obviously doesn't have a PICC, we could argue that he has a port, however there is NO WAY this is the answer. TPN could not sustain Bane's gains. Next.
4. Rectal Feeds
Interesting unorthodox point. Nutrient rich enemas TID??
5. NGT/Dobhoff feedings
This might work as well, although that a lot of supplies to carry around to keep placing an NG tube on himself. Plus it would be near impossible to thread the tube through the mask, into the nostril and get it to the stomach without it looping back around and coming out the mask again. Besides, if hes going to be drinking through a straw to assist with placement, just forgo the whole thing and go back to the protein shake deal.
6. Snorting protein powder
I mean I guess he really doesn't need his nose for anything right? So errosion and nose bleeds wouldn't be an issue? But is it possible to remove enough of the mask to allow snorting in one nostril whilst still connected elsewhere?
Other Bane Issues:
-What happens when he has a tummy ache and vomits? Does he aspirate? Is this now septic Bane?
-How do we then intubate septic aspirational pneumonia Bane? Would we have to move right to a cric?
-How do we document on the oral care flowsheet? I'm not aware of a checkbox marked "N/A d/t large metal facial apparatus"
If anyone can add anymore insight, it would be greatly appreciated.
-K
PS. Special shout out to Rella for being a major contributor to this intellectual discussion that proved to be far more interesting than my CEN studying.
Wednesday, June 10, 2015
5&2 for You&You
Those of us that work in the emergency department unfortunately have grown used to dealing with the unruly intoxicated patient. Whether it's due to drugs, alcohol, or a lovely combination of both, we know the look as soon as they walk in the door. They didn't ask to be brought in here, but either the police, a family member, or a concerned citizen deemed it necessary that they be plucked from their natural habitat and brought to the hospital.
They do not wish to be here, but now that they are, the responsibility falls on healthcare professionals to keep them safely within our doors until they have the functional capacity to be let loose back into the "real world"
Under the influence, people become unreasonable. They resort to verbal and physical aggression. They yell, kick, scream, bite, spit, and run. And we must stop them from harming themselves or us. And I do not have the patience.
My rule is that I will give a patient 2-3 attempts at verbal redirection before I call the doctor, requesting medications and restraints.
Other nurses try over and over to reason with them, redirect them to calmly sit on their stretchers, and five minutes later they're up and hollering again. Not happening. It takes too much of my time, as well as the techs, security and doctors. The other "normal" patients are watching and hearing the ruckus and enough is enough. They get restrained. They get an IM injection. They fall asleep. The restraints come off, and when they wake up calm anc cooperative in a few hours they can go home.
Yesterday I was in the process of calling the doctor to get orders to put my patient down when another nurse walks over. "Well let me just talk to them first. I know how to talk to these people. I know how to settle them down." No. These are not rational humans in the frame of mind to reason with you. This is my patient, we've attempted to calm him down, and that's it. I refuse to play these games.
On the other hand, I'm not heartless. If a patient comes in with a psychiatric disorder, I don't jump as quickly to sedate them. They are more reasonable, and can usually be calmed if you set boundaries, and reward with TV privileges or extra juice boxes.
So that's my two cents. Let this be a lesson to all you in these coming summer months. If you come to my ER and you're AFU and causing a scene, you're getting tied down and a big needle in your thigh. Then its sleepy time.
TL;DR: If you're coming to me because you're drunk and unruly, remember that I get to pick your needle size.
-K
They do not wish to be here, but now that they are, the responsibility falls on healthcare professionals to keep them safely within our doors until they have the functional capacity to be let loose back into the "real world"
Under the influence, people become unreasonable. They resort to verbal and physical aggression. They yell, kick, scream, bite, spit, and run. And we must stop them from harming themselves or us. And I do not have the patience.
My rule is that I will give a patient 2-3 attempts at verbal redirection before I call the doctor, requesting medications and restraints.
Other nurses try over and over to reason with them, redirect them to calmly sit on their stretchers, and five minutes later they're up and hollering again. Not happening. It takes too much of my time, as well as the techs, security and doctors. The other "normal" patients are watching and hearing the ruckus and enough is enough. They get restrained. They get an IM injection. They fall asleep. The restraints come off, and when they wake up calm anc cooperative in a few hours they can go home.
Yesterday I was in the process of calling the doctor to get orders to put my patient down when another nurse walks over. "Well let me just talk to them first. I know how to talk to these people. I know how to settle them down." No. These are not rational humans in the frame of mind to reason with you. This is my patient, we've attempted to calm him down, and that's it. I refuse to play these games.
On the other hand, I'm not heartless. If a patient comes in with a psychiatric disorder, I don't jump as quickly to sedate them. They are more reasonable, and can usually be calmed if you set boundaries, and reward with TV privileges or extra juice boxes.
So that's my two cents. Let this be a lesson to all you in these coming summer months. If you come to my ER and you're AFU and causing a scene, you're getting tied down and a big needle in your thigh. Then its sleepy time.
TL;DR: If you're coming to me because you're drunk and unruly, remember that I get to pick your needle size.
-K
Wednesday, May 27, 2015
The Protocol Nurse
So our dept has been slammed lately. We've had so many admit holds, the waiting room has had an avg of 4.5 hour wait times. So we implemented the protocol nurse. And I think it's amazing.
Basically, we have a nurse to pull people from the waiting room, place an IV, and put in any protocol orders we deem necessary. Chest pain x2 days? CK, troponin, CBC, chem basic, chest xray. Elevated blood sugar? Chemistry, urine. Rule out DVT? PT/INR and ultra sound. Anything were unsure of, we ask an attending to peek in, and they can point us in the right direction.
So imagine you're the patient, you've been in the waiting room for 3 hours. But your labs have been drawn. You got an EKG. You got an x-ray. Even though you're in the waiting room, you're having tests completed, and you don't feel as though you're forgotten. By the time you FINALLY see a doctor, they are able to see all the results of your testing and are able to provide treatment and a probable disposition pretty much as soon as you get in the room.
Now imagine you're a nurse. You just discharged 2 of your patients, so you know you're going to get two fresh from the waiting room. But they both already have their IVs in and their labs drawn. Suddenly, your work is cut in half! You pop in, say hello, write a quick note, then wait for the doctors orders.
I think this new protocol nurse is amazing. I've done the job- and its super boring. I probably placed 20-30 IVs today. But the patients feel like they're moving through the system instead of just sitting and twiddling their thumbs. Being on the receiving end is wonderful, getting a patient with most of the busy work completed so I can focus on what comes next is a HUGE help! I hope we keep this practice going.
TL;DR: Protocol nurse: patients feel loved, nurses love it!
-K
Basically, we have a nurse to pull people from the waiting room, place an IV, and put in any protocol orders we deem necessary. Chest pain x2 days? CK, troponin, CBC, chem basic, chest xray. Elevated blood sugar? Chemistry, urine. Rule out DVT? PT/INR and ultra sound. Anything were unsure of, we ask an attending to peek in, and they can point us in the right direction.
So imagine you're the patient, you've been in the waiting room for 3 hours. But your labs have been drawn. You got an EKG. You got an x-ray. Even though you're in the waiting room, you're having tests completed, and you don't feel as though you're forgotten. By the time you FINALLY see a doctor, they are able to see all the results of your testing and are able to provide treatment and a probable disposition pretty much as soon as you get in the room.
Now imagine you're a nurse. You just discharged 2 of your patients, so you know you're going to get two fresh from the waiting room. But they both already have their IVs in and their labs drawn. Suddenly, your work is cut in half! You pop in, say hello, write a quick note, then wait for the doctors orders.
I think this new protocol nurse is amazing. I've done the job- and its super boring. I probably placed 20-30 IVs today. But the patients feel like they're moving through the system instead of just sitting and twiddling their thumbs. Being on the receiving end is wonderful, getting a patient with most of the busy work completed so I can focus on what comes next is a HUGE help! I hope we keep this practice going.
TL;DR: Protocol nurse: patients feel loved, nurses love it!
-K
Tuesday, April 21, 2015
My Nursey Senses are Tingling!
UGH. So I had this post written a month ago, and me with my clumsy fingers deleted the words and it autosaved nothing. So I'm going to try to recreate what I had. Forgive me if I'm missing bits.
The report I got from the nursing home paperwork said my patient was AAOx3, spanish speaking, but pretty much independent, only needed assistance transferring. He was sent to the ED for "lethargy, vomitx1 with dark brown emesis."
The patient I had in the stretcher would only open his eyes to loud verbal/tactile stimuli. We used the translator phone services to get information from him, but he was unable to form cohesive sentences. There were dark brown specks on his gown. Immediately I think GI bleed, so I drop B/L 16Gs in the ACs (like a boss). However, his SpO2 was barely breaking 90ish on 4L O2 via NC.
The resident and attending were not impressed with his presentation. His basic labs came back pretty normal, but after all that time, he was no more responsive and they wanted to admit him to a med-surg floor.
I kept insisting that something was wrong, that we were missing something. This guy was, at baseline, normally functioning, and now he was barely awake enough to speak a full sentence.
Finally, the internal medicine resident comes down to evaluate him, agrees with me that we're missing something, and orders an ABG. His Co2 was waaaay elevated! He orders bi-pap and consults critical care.
I was so frustrated. We could have saved so many steps if the doctors had just listened to me! Ive been an ER nurse for 2 years, and I don't feel as confidant as the seasoned nurses are, but I feel like I should have pushed harder. I knew something was wrong with this patient, and when all the labs came back normal I should have pushed to keep digging. Yes, this is the doctors responsibility, but I still felt partly responsible. No harm came to the patient, but now I know for next time. I have more experience than I give myself credit for and I need to trust my instincts.
On the other hand, docs, if your nurse is concerned about something...fricking listen!I may be young, but if I'm concerned about something, give me the benefit of the doubt.
TL;DR: Don't doubt when your nursey senses start tingling!
(also don't accidentally delete a post that was written two weeks ago...sorry if there are pieces missing!!)
-K
The report I got from the nursing home paperwork said my patient was AAOx3, spanish speaking, but pretty much independent, only needed assistance transferring. He was sent to the ED for "lethargy, vomitx1 with dark brown emesis."
The patient I had in the stretcher would only open his eyes to loud verbal/tactile stimuli. We used the translator phone services to get information from him, but he was unable to form cohesive sentences. There were dark brown specks on his gown. Immediately I think GI bleed, so I drop B/L 16Gs in the ACs (like a boss). However, his SpO2 was barely breaking 90ish on 4L O2 via NC.
The resident and attending were not impressed with his presentation. His basic labs came back pretty normal, but after all that time, he was no more responsive and they wanted to admit him to a med-surg floor.
I kept insisting that something was wrong, that we were missing something. This guy was, at baseline, normally functioning, and now he was barely awake enough to speak a full sentence.
Finally, the internal medicine resident comes down to evaluate him, agrees with me that we're missing something, and orders an ABG. His Co2 was waaaay elevated! He orders bi-pap and consults critical care.
I was so frustrated. We could have saved so many steps if the doctors had just listened to me! Ive been an ER nurse for 2 years, and I don't feel as confidant as the seasoned nurses are, but I feel like I should have pushed harder. I knew something was wrong with this patient, and when all the labs came back normal I should have pushed to keep digging. Yes, this is the doctors responsibility, but I still felt partly responsible. No harm came to the patient, but now I know for next time. I have more experience than I give myself credit for and I need to trust my instincts.
On the other hand, docs, if your nurse is concerned about something...fricking listen!I may be young, but if I'm concerned about something, give me the benefit of the doubt.
TL;DR: Don't doubt when your nursey senses start tingling!
(also don't accidentally delete a post that was written two weeks ago...sorry if there are pieces missing!!)
-K
Saturday, April 18, 2015
Rotten Tomatoes gives 5 Stars for this award winning performance
Enter stage left, patient with chief complaint:
"I need to have my hands surgically removed. They are on fire and Jesus Christ will give me new ones."
ohhhhkay. Are you hearing voices?
"Not voices. Just one voice. From JesusChristMyLordAndSaviorYahwehAllahGodAlmighty"
Montage of a calm, cooperative patient being changed into paper scrub garb.
One hour time lapse...
"I decided I no longer want my hands amputated and I would like to leave"
*thorough voice-over explination why the patient cant leave the hospital*
Cue the hysterics: "THIS IS THE USA I WANT MY FREEDOM! USA! USA! USA! USA!"
Grand Finale:
"I need to have my hands surgically removed. They are on fire and Jesus Christ will give me new ones."
ohhhhkay. Are you hearing voices?
"Not voices. Just one voice. From JesusChristMyLordAndSaviorYahwehAllahGodAlmighty"
Montage of a calm, cooperative patient being changed into paper scrub garb.
One hour time lapse...
"I decided I no longer want my hands amputated and I would like to leave"
*thorough voice-over explination why the patient cant leave the hospital*
Cue the hysterics: "THIS IS THE USA I WANT MY FREEDOM! USA! USA! USA! USA!"
Grand Finale:
*Nurse K takes her bow as the rest of the staff applauds*
Sunday, April 12, 2015
Nurse Jedi with the 20G lightsaber
Very nice older black gentleman visiting from his home many states away forgot his COPD inhaler and comes to my ER with SOB. Medics got an IV en route but I couldn't get blood from it, so I decided to throw another one in.
While searching for a vein to hit the patient gives me the usual "My veins are tiny and they roll, they usually have to use a butterfly" line that makes my skin crawl. But he was a nice, normal guy so I didn't let it bother me.
After I easily drop a nice 20G in his AC..
Pt: Wow! The force is strong with you!
Me: Have some faith in me man! I am the Obi Wan Kenobi of IVs!
Pt: You are the Jedi Master girl! Darth Vader is NOT the Father!
We instantly become best friends, and the nurses and doctors in the next room are hysterically laughing at this interaction
While searching for a vein to hit the patient gives me the usual "My veins are tiny and they roll, they usually have to use a butterfly" line that makes my skin crawl. But he was a nice, normal guy so I didn't let it bother me.
After I easily drop a nice 20G in his AC..
Pt: Wow! The force is strong with you!
Me: Have some faith in me man! I am the Obi Wan Kenobi of IVs!
Pt: You are the Jedi Master girl! Darth Vader is NOT the Father!
We instantly become best friends, and the nurses and doctors in the next room are hysterically laughing at this interaction
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