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
Wednesday, April 8, 2015
Respect the Reps!
Okay, so are any of you familiar with those little caps with alcohol in them that screw into the end of any IV insertion site, as well as any y-sites on the tubing? (If not see illustration) My per-diem job is to travel around to hospitals and educate the nurses on them. Ive only done 3 hospitals so far, and I find it so very frustrating.
First of all, these caps are awesome, and I'm not just saying that because I work for the company. You put them on and when you're ready to give an IV medication or hook up IV fluids, you don't have to scrub the hub with alcohol. It also keeps any lines completely disinfected...how many times does your central line end up in the patients armpit? Unless you're scrubbing with alcohol for a full 30 seconds, germs can still get into their blood stream. These stupid little caps are saving so many blood stream infections!!
Going to the units to educate the nurses on them is super frustrating. I get it. I'm a nurse. We're busy. And you hear "nurses come to the desk for a quick in-service" and the eye rolling starts. I've heard all the excuses on why they feel like they're too busy or don't need to listen to the rep. "My patient is leaving AMA" "I'm never going to use that" "I just have so much charting to do" My whole spiel takes literally 3 minutes. I want to tell you about it and answer any questions you may have, because most likely your hospital has already signed a contract with us requiring some compliance percentage from the nursing staff.
I've had nurses this past week yell at me because they "didn't have time", and when I came back later, I was ignored. I've had nurses yelling at me about how stupid and costly this was, and that they should get a pay raise instead of buying this product. At this hospital, we were implimenting a new size variation that now fits on the ends of IV tubing, as well as syringes. I've had nurses yelling at me because they weren't all rolled out at once.
None of this falls on me. I am here to educate you on something your hospital is mandating you use. And realistically, you're saving you and your hospital lots of time and money. But all that aside, why aren't nurses more respectful?
I think I get so frustrated because I hold others to the same standards in which I work. Unless I was with a very unstable patient, there is nothing I am doing that cannot wait three minutes. The reps/educators that come to the floors are just doing their job, and really whatever product they come around with is designed to help me do my job more efficiently, no matter how insignificant it may seem at the time.
*Side note* I find it interesting that the units that give us the most respect, and are receptive to the education are the ICU/critical care and the ancillary units (endo, IR, etc.). Medsurg/telemetry units seem to give so much resistance for a 3 minute speech. (seriously people. THREE MINUTES)
So I beg all of you. When reps/educators come to you unit, please be courteous of them. If they show up at your 8 o'clock med pass, ask them to come back at 10 when things slow down and I'm sure they will comply. Ask them questions related to the product. Don't bitch about how stupid it seems, or how upset you are without hospital policies. Don't roll your eyes. Listen to them and move about you day. They're just trying to do their job to help you do yours.
TL;DR. Respect your reps, reduce blood stream infections!
-K
First of all, these caps are awesome, and I'm not just saying that because I work for the company. You put them on and when you're ready to give an IV medication or hook up IV fluids, you don't have to scrub the hub with alcohol. It also keeps any lines completely disinfected...how many times does your central line end up in the patients armpit? Unless you're scrubbing with alcohol for a full 30 seconds, germs can still get into their blood stream. These stupid little caps are saving so many blood stream infections!!Going to the units to educate the nurses on them is super frustrating. I get it. I'm a nurse. We're busy. And you hear "nurses come to the desk for a quick in-service" and the eye rolling starts. I've heard all the excuses on why they feel like they're too busy or don't need to listen to the rep. "My patient is leaving AMA" "I'm never going to use that" "I just have so much charting to do" My whole spiel takes literally 3 minutes. I want to tell you about it and answer any questions you may have, because most likely your hospital has already signed a contract with us requiring some compliance percentage from the nursing staff.
I've had nurses this past week yell at me because they "didn't have time", and when I came back later, I was ignored. I've had nurses yelling at me about how stupid and costly this was, and that they should get a pay raise instead of buying this product. At this hospital, we were implimenting a new size variation that now fits on the ends of IV tubing, as well as syringes. I've had nurses yelling at me because they weren't all rolled out at once.
None of this falls on me. I am here to educate you on something your hospital is mandating you use. And realistically, you're saving you and your hospital lots of time and money. But all that aside, why aren't nurses more respectful?
I think I get so frustrated because I hold others to the same standards in which I work. Unless I was with a very unstable patient, there is nothing I am doing that cannot wait three minutes. The reps/educators that come to the floors are just doing their job, and really whatever product they come around with is designed to help me do my job more efficiently, no matter how insignificant it may seem at the time.
*Side note* I find it interesting that the units that give us the most respect, and are receptive to the education are the ICU/critical care and the ancillary units (endo, IR, etc.). Medsurg/telemetry units seem to give so much resistance for a 3 minute speech. (seriously people. THREE MINUTES)
So I beg all of you. When reps/educators come to you unit, please be courteous of them. If they show up at your 8 o'clock med pass, ask them to come back at 10 when things slow down and I'm sure they will comply. Ask them questions related to the product. Don't bitch about how stupid it seems, or how upset you are without hospital policies. Don't roll your eyes. Listen to them and move about you day. They're just trying to do their job to help you do yours.
TL;DR. Respect your reps, reduce blood stream infections!
-K
Thursday, April 2, 2015
A quick word about techs
Before I became a nurse, I worked as a float critical care tech for my hospital. I went to all units, including ICU, and was trained on blood draws and EKGs. I had some nurses that were awesome to work with and some that abused the ancillary staff, and I vowed that when I became a nurse I would delegate appropriately. I would not ask the techs to do things that I could easily accomplish so I could sit on my phone. If I'm asking them to do something menial, like grab vital signs, then I really am too swamped to do it myself.
Some of our techs are awesome. They do anything I ask without rolling their eyes. They are constantly look through the charts, checking the orders to see who needs an EKG or labs drawn, and offer to do it before I even ask. They ask me who they can bring me from triage, and have them set up on the monitor before I even walk in the room. When a medic comes in, they work like clock work with the nurses and doctors. They know the airway cart inside and out and when the docs ask for weird supplies they run and get it before I can even figure out what they're talking about.
Other techs are awful. They roll their eyes when I ask them to do something and say "I'll get to it." and I know they won't. They'll disappear. I can't count on them for anything but making sure the inventory of the patient's belongings are done before they're admitted. It will take me longer to find them and ask for help then for me to just do it myself, and put me further behind in my work.
Scenerio: We get a patient back from CT scan, hook him up to the monitor and SpO2 is 60% on room air. Obviously we're freaking out. Doctors are in the room, the plan is to preoxygenate with bi-pap then intubate. The tech is walking around the room, getting in everyones way to inventory the belongings. While the doctor is updating the wife on the plan, he interrupts to get her to sign the sheet. Then he disappears. Completely unacceptable.
I've noticed that most of the good ones are in nursing school, even if they're just working on their prerequisites they still want to further their career, and they want to be a part of the team. I know we're only going to have for a short time because once they graduate they're gone. I feel bad sometimes, because I know they're over worked. When I have a sick patient I go to them when I need help, because I know I can count on them, even if they're in another area of the department. I don't feel comfortable transporting an intubated patient to CT scan and then ICU unless I have a tech I can count on when shit hits the fan.
When I have a tech that really helps me throughout the day I make sure to let them know I appreciate it. I thank them endlessly, and they always reply with "Stop thanking me, I'm just doing my job." I've written star employee cards for them before because I want them to know I truly am thankful for what they do. If I see a lazy nurse abusing them, I don't mind stepping in to help. It's a mutual respect thing.
So If you're a tech reading this, know that we really value what you do. You make our days so much easier if we can count on you. If you're a nurse reading this, I'm sure you can attest. I think it's important to thank them for what they do, and to delegate appropriately.
TL;DR: Techs really can make or break your day, appreciate and delegate.
-K
Some of our techs are awesome. They do anything I ask without rolling their eyes. They are constantly look through the charts, checking the orders to see who needs an EKG or labs drawn, and offer to do it before I even ask. They ask me who they can bring me from triage, and have them set up on the monitor before I even walk in the room. When a medic comes in, they work like clock work with the nurses and doctors. They know the airway cart inside and out and when the docs ask for weird supplies they run and get it before I can even figure out what they're talking about.
Other techs are awful. They roll their eyes when I ask them to do something and say "I'll get to it." and I know they won't. They'll disappear. I can't count on them for anything but making sure the inventory of the patient's belongings are done before they're admitted. It will take me longer to find them and ask for help then for me to just do it myself, and put me further behind in my work.
Scenerio: We get a patient back from CT scan, hook him up to the monitor and SpO2 is 60% on room air. Obviously we're freaking out. Doctors are in the room, the plan is to preoxygenate with bi-pap then intubate. The tech is walking around the room, getting in everyones way to inventory the belongings. While the doctor is updating the wife on the plan, he interrupts to get her to sign the sheet. Then he disappears. Completely unacceptable.
I've noticed that most of the good ones are in nursing school, even if they're just working on their prerequisites they still want to further their career, and they want to be a part of the team. I know we're only going to have for a short time because once they graduate they're gone. I feel bad sometimes, because I know they're over worked. When I have a sick patient I go to them when I need help, because I know I can count on them, even if they're in another area of the department. I don't feel comfortable transporting an intubated patient to CT scan and then ICU unless I have a tech I can count on when shit hits the fan.
When I have a tech that really helps me throughout the day I make sure to let them know I appreciate it. I thank them endlessly, and they always reply with "Stop thanking me, I'm just doing my job." I've written star employee cards for them before because I want them to know I truly am thankful for what they do. If I see a lazy nurse abusing them, I don't mind stepping in to help. It's a mutual respect thing.
So If you're a tech reading this, know that we really value what you do. You make our days so much easier if we can count on you. If you're a nurse reading this, I'm sure you can attest. I think it's important to thank them for what they do, and to delegate appropriately.
TL;DR: Techs really can make or break your day, appreciate and delegate.
-K
Tuesday, March 31, 2015
Nurse K's anger response
So here's the scenerio:
I get a patient at 1900, the report was right sided weakness and slurred speech from 1100-1500. Symptoms have since resolved. BP is 114/60. I rush him to CT and neurology says its most likely a TIA, will admit to the stroke unit for observation. We get back to the ER, the patient also mentions he has had a cough for a couple days. Chest x-ray is ordered, hes got a touch of pneumonia.
2100: BP is 112/59 and IV antibiotics are going in at 250 ml/hr.
2200: Admit orders come through with the second antibiotic ordered at 250 ml/hr and maintence fluids at 40 ml/hr.
2230: BP 102/55. I think "Ahh poop I still need to hang fluids. Well we're super short on pump channels and he's getting much more than that from the antibiotics, I'll come back to it." Pt is still AAOx3, no neurological deficits.
2300: Code comes in. Being a team player, and loving a good code, I jump in to help.
0000: I'm supposed to be leaving now, but the code just came in and I have to clean up my patients. Neurology calls me.
Neuro: "I've been trying to call you for an hour!?!"
Me: "I'm sorry, a code just came in. Whats going on?"
Neuro: "Why is the patients blood pressure so low?? Why haven't his fluids been hung?! This is unacceptable! He could have had a stroke! Bolus him with 250, hang the fluids, get a new bp and call me back when the bolus is done!!"
So first I start to freak out. Did I do something way wrong? I'm still pretty new to this nursey thing, and I'm super anxious about making sure I don't do anything to cause harm to my patients.
But then I start thinking and getting angry. His blood pressure dropped 10 points since arrival, which is completely normal. Neurology saw this patient twice, and internal medicine evaluated him. No one was concerned about his blood pressure. His fluids were ordered at 40/hr, so because of me he didn't get 120 mL's from when the order was placed until neurology called. He did, however, get 750 mLs from the IV antibiotics.
At this point I'm getting angry, because of the way he was talking to me and for what he was accusing me of. (Plus, my shift was over, and I felt like I needed to clean this up before leaving.)
When I get angry I shut down. My face turns bright biohazard red. My eyes well up. My hands shake. My voice cracks. I'm not sad or upset, I'm angry, but people can't tell the difference and it's so frustrating. I don't want to cry. I'm not upset because someone yelled at me. I'm ANGRY.
So I'm trying to fix this (and leave for the night) and people keep coming up to me "Whats wrong?? Are you okay??" Yes. I am. Leave me alone. NOW.
I infuse the bolus in 15 mins and hang the fluids. Recheck the pressure and (shockingly) it's the same. I call neurology. "Well how long ago did the bolus end??" Uh. Just now. I did exactly what you asked me to do. He makes no changes to the orders but insists that I travel with the patient to the half hour MRI he just ordered because "the blood pressure is unstable." NO ITS NOT! It dropped 10 points since arrival! This guy is fine! And then he said "Once the MRI comes back, if it's negative, I don't really care about the blood pressure."
I'm fuming, and I cant find anyone to give report to.
Finally, one of the murses who is precepting said he would take it. I can barely get through report because I'm shaking and trying not to cry.
I clocked out at 0130, got in my car and finally the tears started flowing. Not sad tears, angry tears.
You may read this and think I was completely wrong, and maybe I was. But if the doctors felt it important for him to get fluids, I would expect an order > 40 mL/hr. If it was at 150, I probably would have searched for the part I needed and hung them. I was angry that they all knew what his blood pressure was on arrival, they had been down to check on him, and that this 10 mmHg change was enough for them to yell at me. I work hard and I do the best for my patients. The condesention in his call threw me into third gear. I can't work when I get like that. My mind gets all foggy, I don't talk to my coworkers, and everyone knows something is wrong. I hate that I have such a dead giveaway.
The patient ended up being fine, I got home around 0215, to wake up at 1000 and do it all again the next day.
TL;DR: I look like a lil bitch when I get pissed.
-K
I get a patient at 1900, the report was right sided weakness and slurred speech from 1100-1500. Symptoms have since resolved. BP is 114/60. I rush him to CT and neurology says its most likely a TIA, will admit to the stroke unit for observation. We get back to the ER, the patient also mentions he has had a cough for a couple days. Chest x-ray is ordered, hes got a touch of pneumonia.
2100: BP is 112/59 and IV antibiotics are going in at 250 ml/hr.
2200: Admit orders come through with the second antibiotic ordered at 250 ml/hr and maintence fluids at 40 ml/hr.
2230: BP 102/55. I think "Ahh poop I still need to hang fluids. Well we're super short on pump channels and he's getting much more than that from the antibiotics, I'll come back to it." Pt is still AAOx3, no neurological deficits.
2300: Code comes in. Being a team player, and loving a good code, I jump in to help.
0000: I'm supposed to be leaving now, but the code just came in and I have to clean up my patients. Neurology calls me.
Neuro: "I've been trying to call you for an hour!?!"
Me: "I'm sorry, a code just came in. Whats going on?"
Neuro: "Why is the patients blood pressure so low?? Why haven't his fluids been hung?! This is unacceptable! He could have had a stroke! Bolus him with 250, hang the fluids, get a new bp and call me back when the bolus is done!!"
So first I start to freak out. Did I do something way wrong? I'm still pretty new to this nursey thing, and I'm super anxious about making sure I don't do anything to cause harm to my patients.
But then I start thinking and getting angry. His blood pressure dropped 10 points since arrival, which is completely normal. Neurology saw this patient twice, and internal medicine evaluated him. No one was concerned about his blood pressure. His fluids were ordered at 40/hr, so because of me he didn't get 120 mL's from when the order was placed until neurology called. He did, however, get 750 mLs from the IV antibiotics.
At this point I'm getting angry, because of the way he was talking to me and for what he was accusing me of. (Plus, my shift was over, and I felt like I needed to clean this up before leaving.)
When I get angry I shut down. My face turns bright biohazard red. My eyes well up. My hands shake. My voice cracks. I'm not sad or upset, I'm angry, but people can't tell the difference and it's so frustrating. I don't want to cry. I'm not upset because someone yelled at me. I'm ANGRY.
So I'm trying to fix this (and leave for the night) and people keep coming up to me "Whats wrong?? Are you okay??" Yes. I am. Leave me alone. NOW.
I infuse the bolus in 15 mins and hang the fluids. Recheck the pressure and (shockingly) it's the same. I call neurology. "Well how long ago did the bolus end??" Uh. Just now. I did exactly what you asked me to do. He makes no changes to the orders but insists that I travel with the patient to the half hour MRI he just ordered because "the blood pressure is unstable." NO ITS NOT! It dropped 10 points since arrival! This guy is fine! And then he said "Once the MRI comes back, if it's negative, I don't really care about the blood pressure."
I'm fuming, and I cant find anyone to give report to.
Finally, one of the murses who is precepting said he would take it. I can barely get through report because I'm shaking and trying not to cry.
I clocked out at 0130, got in my car and finally the tears started flowing. Not sad tears, angry tears.
You may read this and think I was completely wrong, and maybe I was. But if the doctors felt it important for him to get fluids, I would expect an order > 40 mL/hr. If it was at 150, I probably would have searched for the part I needed and hung them. I was angry that they all knew what his blood pressure was on arrival, they had been down to check on him, and that this 10 mmHg change was enough for them to yell at me. I work hard and I do the best for my patients. The condesention in his call threw me into third gear. I can't work when I get like that. My mind gets all foggy, I don't talk to my coworkers, and everyone knows something is wrong. I hate that I have such a dead giveaway.
The patient ended up being fine, I got home around 0215, to wake up at 1000 and do it all again the next day.
TL;DR: I look like a lil bitch when I get pissed.
-K
Wednesday, March 18, 2015
Brief hiatus
Hay yall! I am currently in the middle of a two week vacation. It is wonderful. I am spending my time doing absolutely nothing. I apologize for my lack of posts but to truly take advantage of this time off, I am thinking about work as little as possible. Do not fret, I shall return!
-K
Saturday, March 7, 2015
An open letter to floor nurses
Dear floor nurses,
You hate us. We know you hate us. My goal here is to see things from your side, and tell you how it is on our side. Everyone has those stories "One time the ER sent me up this patient and it was a TRAIN WRECK." I ask you to put aside that, and read with an open mind. I accept that floorbies and ERs will never walk hand in hand to get coffee together, but if one person reads this and isn't as sassy in their next patient handoff, I'll consider myself a success.
This complaint irks my soul. I'm sorry kids, but it does. I know it sucks to get a patient at change of shift. But if you're getting a patient from me then I'm getting a brand new one as well. Believe me, I'd much rather hang on to this admission that I finally have settled in bed then ship them off for a new one. Just as its unacceptable to tell your night shift "I got this patient at 1830 so I didn't do the admission stuff", I cant tell my relief that I didn't complete any orders on my brand new one either. And it is completely untrue that we hang on to the patient for the day, and send them up at the last minute. As soon as the bed shows up as ready, the secretary is calling transport and the patient is going to their bed. The timing sucks. And we really can't help it.
Plus, imagine it from the patient's point of view. They've sat in an uncomfortable stretcher for hours, waiting for CT results and admitting MD evals, while watching a psych patient running down the hallway. They come to the desk every hour asking when their bed is going to be ready. They are miserable, and the family members are about ready to walk upstairs and clean the rooms themselves. Please, don't bring any irritation onto them when they get wheeled into their room at 1845, because they've probably been waiting ALL day for this.
Y'all have to understand that our job, and our mentality is to stablize the patient, then get therm where they're going. We fix things pertinent to the issue at hand, then send them away. If the ER nurse isn't giving antihypertensive medications and the blood pressure is out of control, that unacceptable. If the PCA or the heparin gtt or the blood transfusion was ordered hours ago but never given? Unacceptable. But the NSS 80mL/hr, the subq lovenox and the colace? It's not our priority. Personally, I try to at least draw any due labs I can before my patient goes upstairs because I can draw from the line and the floor nurses at my hospital can't. Half the time the pharmacy takes hours to send us the medications. Flowtrons? Forget it. Good luck trying to find a pair. But if an ER nurse is feeding the patient and not covering with their sliding scale insulin, or giving their needed blood pressure medications that's unacceptable.
Our report/patient hand off is very different from yours. Mostly "Mr Johnson is here for L sided CP on and off today. We gave him 2 sublingual nitro and that decreased his pain. He has an IV, I sent labs. HR has been SR 80s, blood pressure has been on the high side, 150s systolic, but the docs are just watching it for now. He'll probably be a tele-admit." We don't do a systems run through or delve into the past medical hx unless, like mentioned before, its pertinent to the issue at hand. I know it's frustrating to get half the story, but it's just not our priority. We operate to focus on the problem in front of us, not to plan care for their entire hospital stay. It's two totally different approaches to patient care.
That being said, it's inappropriate for the nurse not to know what hip is fractured, what the vent settings are, what heart rhythm the patient is in, etc. That is bad nursing practice, and should not reflect the department as a whole.
Eh, yeah, guilty. We aren't required to give report to med-surg or tele floors in my hospital, just ICU and stepdown units. So when I give a courtesy call to the floor and they won't come to the phone I get irked. And I shouldn't. I am sorry for rolling my eyes over the phone. You guys are just as busy as us, and I understand that. However. If you do take my call, please don't use this as the opportunity to get out of taking the patient. The patient has already been accepted and approved by the doctors and the nursing supervisor, take it up with them and not me please?
TL;DR: Floors and ERs are both as busy, just totally different. Respect each other.
-K
You hate us. We know you hate us. My goal here is to see things from your side, and tell you how it is on our side. Everyone has those stories "One time the ER sent me up this patient and it was a TRAIN WRECK." I ask you to put aside that, and read with an open mind. I accept that floorbies and ERs will never walk hand in hand to get coffee together, but if one person reads this and isn't as sassy in their next patient handoff, I'll consider myself a success.
We give you patients at change of shift.
This complaint irks my soul. I'm sorry kids, but it does. I know it sucks to get a patient at change of shift. But if you're getting a patient from me then I'm getting a brand new one as well. Believe me, I'd much rather hang on to this admission that I finally have settled in bed then ship them off for a new one. Just as its unacceptable to tell your night shift "I got this patient at 1830 so I didn't do the admission stuff", I cant tell my relief that I didn't complete any orders on my brand new one either. And it is completely untrue that we hang on to the patient for the day, and send them up at the last minute. As soon as the bed shows up as ready, the secretary is calling transport and the patient is going to their bed. The timing sucks. And we really can't help it.
Plus, imagine it from the patient's point of view. They've sat in an uncomfortable stretcher for hours, waiting for CT results and admitting MD evals, while watching a psych patient running down the hallway. They come to the desk every hour asking when their bed is going to be ready. They are miserable, and the family members are about ready to walk upstairs and clean the rooms themselves. Please, don't bring any irritation onto them when they get wheeled into their room at 1845, because they've probably been waiting ALL day for this.
We put IVs in the AC
So when a patient comes in, sometimes they're really sick, sometimes they're putting on a really good show. You could be getting a nice, stable patient that looked completely different when they walked in. Either way, we have to get an IV in, fast, and a nice big one is optimal. Certain medications require that placement. CT scan prefers 18G or larger above the wrist for any imaging with contrast, so if they have any type of trauma or we think they're getting imaging, that's the spot. Sometimes they're so dehydrated on arrival, that's all that's popping up. Sometimes they REFUSE to let us go in the hand. It's annoying to us too..."Mrs. Jones, remember leave your arm flat so the fluids can drip in!" If I have time to search around for a different spot, and if the patient doesn't require a large bore IV, I try my best to go somewhere else, otherwise I'm going to be happy with what I've got.
We don't start admission orders.
Y'all have to understand that our job, and our mentality is to stablize the patient, then get therm where they're going. We fix things pertinent to the issue at hand, then send them away. If the ER nurse isn't giving antihypertensive medications and the blood pressure is out of control, that unacceptable. If the PCA or the heparin gtt or the blood transfusion was ordered hours ago but never given? Unacceptable. But the NSS 80mL/hr, the subq lovenox and the colace? It's not our priority. Personally, I try to at least draw any due labs I can before my patient goes upstairs because I can draw from the line and the floor nurses at my hospital can't. Half the time the pharmacy takes hours to send us the medications. Flowtrons? Forget it. Good luck trying to find a pair. But if an ER nurse is feeding the patient and not covering with their sliding scale insulin, or giving their needed blood pressure medications that's unacceptable.
We give incomplete reports
Our report/patient hand off is very different from yours. Mostly "Mr Johnson is here for L sided CP on and off today. We gave him 2 sublingual nitro and that decreased his pain. He has an IV, I sent labs. HR has been SR 80s, blood pressure has been on the high side, 150s systolic, but the docs are just watching it for now. He'll probably be a tele-admit." We don't do a systems run through or delve into the past medical hx unless, like mentioned before, its pertinent to the issue at hand. I know it's frustrating to get half the story, but it's just not our priority. We operate to focus on the problem in front of us, not to plan care for their entire hospital stay. It's two totally different approaches to patient care.
That being said, it's inappropriate for the nurse not to know what hip is fractured, what the vent settings are, what heart rhythm the patient is in, etc. That is bad nursing practice, and should not reflect the department as a whole.
We get irritated when the floor won't take our call
Eh, yeah, guilty. We aren't required to give report to med-surg or tele floors in my hospital, just ICU and stepdown units. So when I give a courtesy call to the floor and they won't come to the phone I get irked. And I shouldn't. I am sorry for rolling my eyes over the phone. You guys are just as busy as us, and I understand that. However. If you do take my call, please don't use this as the opportunity to get out of taking the patient. The patient has already been accepted and approved by the doctors and the nursing supervisor, take it up with them and not me please?
We don't pay attention to skin care
Eh, yeah, not as much as I should, I'll admit to that. Anyone coming from a nursing home or incontinent at baseline I turn them, get a look at their back/sacrum and document. In my department, we don't carry all the fancy wound care dressings that the floors have, so its usually just an abd pad and some tape. The floors also take pictures of the wounds, so I'm hesitant to do a baller dressing that's taped down like cement when it's just going to get ripped off during the admission assessment. I will say that I'm really bad at remembering to take off their socks to check for pressure ulcers on their heels. Sorry yall, I'll do better I promise!
In conclusion, I realize there are some things I need to work on from my end. I hope this didn't come off as pompous, I just wanted to give things from my perspective. I give you floorbies a TON of credit, I could never do your job. Everyone fits a different specialty, and we each have a different job to do. And like I said before, if one floor-ER interaction is a bit less sassy after reading this, I'll be a happy nursey.
-K
Wednesday, March 4, 2015
Roles in a Code
When a patient is coding, everyone works as fast as they can to save the life of the patient on the stretcher. While doing clinical rotations in nursing school, watching the ER nurses work together during a code is what enticed and enthralled and sucked me into this specialty. So, here's a list of the roles/responsibilities (in my opinion, of course) that seem like just the right amount of people to be in the room during a code situation. (When it's my patient, I like to do the things marked with a *)
As the ambulance crew is rolling the patient into the room:
RN*: Write down the story from the medics, any medications they gave, what size ETT they used, etc., along with any known patient history and medications. WRITE IT DOWN, you will forget it otherwise.
Tech 1-2: Place the patient on the monitor. Obtain an EKG and a blood sugar. Grab another tech or two if CPR is in progress.
RN 1-2: Get an IV. Two if possible. Tape them suckers down, and draw labs, a whole rainbow, blood cultures, lactic acid, ammonia.
So the patient is now on your stretcher, connected to your monitor/code cart. Docs are doing their thing. And the patient is pulseless.
Techs: CPR, hard, fast and deep. Having two or three techs in the room helps so at pule checks they can trade out.
RN1: Give the medications and guard that IV. If someone accidentally rips the line out, everyone is screwed. When giving a medication, make sure to clearly communicate what you're doing. Saying "1 mg epi is in" loud enough for everyone to hear is key.
RN2: Draw up the medications, and work the code cart monitor. Get those epi bristojets ready. Spike a fluid bag. Be prepared with extra flushes to hand to the med-giving RN. Know how to set the monitor to the correct amount of joules to shock the patient. And MAKE SURE everyone is clear of the patient before hitting the shock button.
RN3*: Watch the clock, take notes, and be the communicator for the team. Make sure everyone is aware of what medications have been given. Know the ACLS algorithm and when it's time for a pulse check or another round of epinephrine. Position yourself by the door, so you can watch the entire team working, and so you can call out for supplies if something is needed.
It's so helpful in situations like this if you can have another nurse or tech standing right outside the door, so if your code cart runs out of epi, or if you forgot to grab an OG tube, they can grab it without taking people away from the room.
It's also important to have a nurse watching the rest of the pod while this is going down. If you look around and realize that you don't need to be in the room, GET OUT. You are probably in the way, and can be so much more useful going out to the desk and seeing what you can do to help everyone else out. The department doesn't come to a halt just because a sick patient comes in. Everyone else still needs IVs started, pain medications and those delicious chicken sandwiches.
*Disclaimer* I'm not trying to say this is the ONLY BEST way to run a code, just how I've observed to make things run as smoothly as possible.
TL;DR: Know what needs to be done while a patient is coding, & if you're not doing anything productive.. GET OUT!
-K
As the ambulance crew is rolling the patient into the room:
RN*: Write down the story from the medics, any medications they gave, what size ETT they used, etc., along with any known patient history and medications. WRITE IT DOWN, you will forget it otherwise.
Tech 1-2: Place the patient on the monitor. Obtain an EKG and a blood sugar. Grab another tech or two if CPR is in progress.
RN 1-2: Get an IV. Two if possible. Tape them suckers down, and draw labs, a whole rainbow, blood cultures, lactic acid, ammonia.
So the patient is now on your stretcher, connected to your monitor/code cart. Docs are doing their thing. And the patient is pulseless.
Techs: CPR, hard, fast and deep. Having two or three techs in the room helps so at pule checks they can trade out.
RN1: Give the medications and guard that IV. If someone accidentally rips the line out, everyone is screwed. When giving a medication, make sure to clearly communicate what you're doing. Saying "1 mg epi is in" loud enough for everyone to hear is key.RN2: Draw up the medications, and work the code cart monitor. Get those epi bristojets ready. Spike a fluid bag. Be prepared with extra flushes to hand to the med-giving RN. Know how to set the monitor to the correct amount of joules to shock the patient. And MAKE SURE everyone is clear of the patient before hitting the shock button.
RN3*: Watch the clock, take notes, and be the communicator for the team. Make sure everyone is aware of what medications have been given. Know the ACLS algorithm and when it's time for a pulse check or another round of epinephrine. Position yourself by the door, so you can watch the entire team working, and so you can call out for supplies if something is needed.
It's so helpful in situations like this if you can have another nurse or tech standing right outside the door, so if your code cart runs out of epi, or if you forgot to grab an OG tube, they can grab it without taking people away from the room.
It's also important to have a nurse watching the rest of the pod while this is going down. If you look around and realize that you don't need to be in the room, GET OUT. You are probably in the way, and can be so much more useful going out to the desk and seeing what you can do to help everyone else out. The department doesn't come to a halt just because a sick patient comes in. Everyone else still needs IVs started, pain medications and those delicious chicken sandwiches.
*Disclaimer* I'm not trying to say this is the ONLY BEST way to run a code, just how I've observed to make things run as smoothly as possible.
TL;DR: Know what needs to be done while a patient is coding, & if you're not doing anything productive.. GET OUT!
-K
Urgent vs Panic
Working in a critical care setting, I've learned very quickly that things can go bad, fast. One minute you're joking with your coworkers and drinking your coffee, the next minute an ambulance is rushing in and you're doing CPR. Some nurses are FANTASTIC to have on your critical care team. The ones who never seem to get their feathers ruffled, who are always anticipating what's going to happen with the patient and always seem to be a half of a step ahead of the residents. It's awesome working a code with nurses like this, everything seems to happen quickly, yet systematically. Then there's nurses that PANIC. When they have a sick patient, it's like the world is ending. They scream and seem to be running around in circles, without actually accomplishing anything. They get super excitable and it rubs off on the whole team, as well as the patient. They aren't thinking rationally. This is where mistakes happen. When you're in this panicked state of mind, it's so easy to trip over the code cart wires, stick yourself with a needle, or have a medication error.
The other day we had a transit bus pull into the ER circle because a rider had collapsed on the bus. The tech and the nurse that ran out to the bus were of the 'instant hysteria' category. I attempted to bring them a stretcher, and about 10 security guards were all running around circles screaming for help.
I went back inside to clear out a room for this coding patient and I can hear them coming screeching and stampeding down the hallway. They try to rush their patient into the room, while a tech is doing CPR on the stretcher, before we had even moved the stable patient into the hallway. Talk about traumatic.
It was one of the more chaotic codes I've been involved in. If they hadn't been so hysterical, it could have completely changed the atmosphere, and they way the entire situation was run. Yes, it was an insane sequence of events, but keeping your wits about you is so important when you work in an emergency setting.
So I beg of you all, know yourself, know when you're starting to feel overwhelmed, and ask for help. DON'T SCREAM. Don't run around with a chicken without a head. Know what needs to be done and do it so mistakes don't happen.
TL;DR: Work urgent, not panicked.
-K
Sunday, March 1, 2015
Patience with Patients
I'm finding it a little difficulty to blog without making my post sound like a nursing note, but here we go
I had this 45 year old woman with cervical cancer, currently receiving chemotherapy, chief complaint of altered mental status. She was a hot mess. She wouldn't sit still, was writhing around in her stretcher, non verbal and not following commands. I could tell she was uncomfortable, and was understanding what I was saying, but was just in so much pain she couldn't listen. My patience was waning as i struggled to complete the simplest of tasks to figure what was going on with her. I had a tech hold her down while I accessed her port to draw labs. I hung fluids but she kept getting tangled up in the line. I couldn't get an accurate blood pressure because she wouldn't leave her arms still long enough for the cuff to inflate. She needed CT scans but there was no way she could lay still enough for her to do the imaging. She kept getting out of bed, and 3 family members and I had a struggle to coax her back in. I cringed every time they came to the desk, because I knew it was going to be another ordeal.
I had already had a really shitty and busy day. I had her, two new patients that I had just thrown IVs in, and one ICU step-down patient that was finally getting settled. Welcome to the ER. I needed coffee. Badly. I was the floor for 8 minutes, tops.
When I get back to the desk, her family member is waiting for me, "We tried to grab you! Her colostomy bag exploded!" I rush into the room and she is now kneeling on the stretcher, elbows on the bed and refusing to budge. Theres stool covering her and the bed, and all she is doing is rocking back and forth on her knees and elbows. At this point I'm about to cry. I can feel my self getting testy while I'm begging her to roll over so I can clean her up.
I had asked the previous resident for some pain medication to calm her down, but because of her altered mental status he didn't want to go that route. Since then, the residents had switched off, so I went to the doc with eyes brimming, BEGGING for medication to calm her down. After 50 mcg of fetanyl and 1mg ativan she was finally FINALLY starting to relax.
Her family came out to the desk, and stopped to see me before leaving. "Thank you so much for your patience with her. She's not like this. She's a CNA, she keeps herself clean, she drove herself to her chemotherapy appointment yesterday! We don't know what's going on but you've been wonderful and we really and truly appreciate the way you handled her."
And that made it all worth it.
TL;DR: Some patients need our patience
-K
I had this 45 year old woman with cervical cancer, currently receiving chemotherapy, chief complaint of altered mental status. She was a hot mess. She wouldn't sit still, was writhing around in her stretcher, non verbal and not following commands. I could tell she was uncomfortable, and was understanding what I was saying, but was just in so much pain she couldn't listen. My patience was waning as i struggled to complete the simplest of tasks to figure what was going on with her. I had a tech hold her down while I accessed her port to draw labs. I hung fluids but she kept getting tangled up in the line. I couldn't get an accurate blood pressure because she wouldn't leave her arms still long enough for the cuff to inflate. She needed CT scans but there was no way she could lay still enough for her to do the imaging. She kept getting out of bed, and 3 family members and I had a struggle to coax her back in. I cringed every time they came to the desk, because I knew it was going to be another ordeal.
I had already had a really shitty and busy day. I had her, two new patients that I had just thrown IVs in, and one ICU step-down patient that was finally getting settled. Welcome to the ER. I needed coffee. Badly. I was the floor for 8 minutes, tops.
When I get back to the desk, her family member is waiting for me, "We tried to grab you! Her colostomy bag exploded!" I rush into the room and she is now kneeling on the stretcher, elbows on the bed and refusing to budge. Theres stool covering her and the bed, and all she is doing is rocking back and forth on her knees and elbows. At this point I'm about to cry. I can feel my self getting testy while I'm begging her to roll over so I can clean her up.
I had asked the previous resident for some pain medication to calm her down, but because of her altered mental status he didn't want to go that route. Since then, the residents had switched off, so I went to the doc with eyes brimming, BEGGING for medication to calm her down. After 50 mcg of fetanyl and 1mg ativan she was finally FINALLY starting to relax.
Her family came out to the desk, and stopped to see me before leaving. "Thank you so much for your patience with her. She's not like this. She's a CNA, she keeps herself clean, she drove herself to her chemotherapy appointment yesterday! We don't know what's going on but you've been wonderful and we really and truly appreciate the way you handled her."
And that made it all worth it.
TL;DR: Some patients need our patience
-K
Friday, February 13, 2015
The one that hit me hardest
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| Code times notes as my mousepad |
It was a Saturday overtime shift, 9a-9p, and I was in the critical care pod. It started out like a chill day. I had 3 only 3 patients at 1130, and none of them sick.
At 1145 EMS had brought someone sick and I was pumped. The had patient called 9-1-1 for flank pain and shortness of breath. Upon EMS arrival, Pt was awake, speaking short sentences, but responsive to O2 via NRB, but when she was placed onto the ER stretcher she was nonresponsive with agonal respiration. Oh, and did I mention pulseless??
We coded this patient 7 times between noon and 1500. Yes. SEVEN. PEA arrest, 1-2 rounds of CPR and Epi and we got ROSC seven times. I had taken up both bays, we kept running out of epi. She was intubated, had an a-line, OG tube, central line. She was on an epinephrine and levophed drip. Her ABG showed a pH of 6.7 (no that is not a typo). It was a mess.
At 1500 I finally got a chance to pee. I left the room for literally two minutes, and when I came back in her eyes were open! She was absolutely mentally there, nodding to my questions, blinking on command, tracking my finger with her eyes. At this point I hadn't let any of her family members in the room because she was a mess (and her heart kept stopping), but her brother is one of our security guards. He walked in, she reached for him and I gave them a minute. I updated the family, told them that she had opened her eyes, and that my plan was to call report to the ICU, take her to CT scan then bring her upstairs.
I go back into the room and call report while in the room, instead of at this nurses station like I usually do. As I'm on the phone with the nurse upstairs, her blood pressure starts dropping again. ICU fellow is in the room, the techs are hooking her up to the portable monitor and I walk to get the chart from the secretary, as I walk back in room she codes again.
We code her for 20 minutes and couldn't get pulses back. Time of death 1655.
The techs, my manager and I started unhooking her lines and wires and I started shaking, my eyes were brimming. I told my manager I needed a minute, walked outside and texted one of the murses that was working and asked him to meet me.
As soon as he stepped out side I lost it. I started bawling.We got her back. She was there. And now she's gone. She heard me giving report to the ICU and was like, "No, I don't think I want to go there...I think I'm done now." He gave me a huge hug and the perfect pep talk speech. "There was nothing you could have done differently. This was physically and emotionally draining. You're upset because you care, and that's what makes you such a great nurse. You're awesome, never stop caring."
I gathered myself together, finished my end of life care, called the organ donation line, charted on 5 hours of coding, then went back to work and picked up another two patients. I went home, had a bottle of wine and cried.
This day taught me a lot. I've been a nurse for a year and a half, and this was the first code where I felt like I knew what I was doing.
No matter how hard you work, people die. And when they do, there's a whole waiting room full of living people waiting for your care.
TL;DR: 5 hours, ROSCx7, Epix12, TOD 1655. Nursing sucks sometimes.
-K
A little about me
Why hello there! Let me start by saying that I don't even know if blogging is my thing. I made my anon twitter account in August of 2014 and it has been my sanity these past couple months. Interacting with people who share the same joys and troubles at work as I do is quite refreshing. It gives me an anonymous place to vent and talk about my day with people that understand all the nursey words, but I'm figuring there are stories I want to tell that are more than 140 characters- so I figured I'd give this a shot. (Also, my grammar and comma placement may suck, so sorry in advance.)
I am 23 years old and I work in the Emergency Room of a level 1 trauma center in a city that's always on the lists of of 'Most dangerous Places in America'. No-I don't get gun shot wounds every night. They go to trauma. Which is separate from the ER. So stop asking me that family and friends.
When I was in high school, I volunteered at the local fire department with my dad. My mom suggested I take an EMT class one summer, so I did and fell in love. At 16 I was an EMT in my small rural town, taking calls as a 3rd crew member since I was too young to legally treat patients on my own.
I went to college knowing that I wanted to be an emergency room nurse. I loved when I had clinical days in the ER and became obsessed with the organized chaos. A sick patient would come in and nurses, doctors and techs would rush in, everyone knowing what tasks needed to get accomplished to stabilize the patient.
Midway through college I got a job as a tech on the mother-infant floor of the hospital. I stayed there a year, then needed per diem hours so I went pool. I hated everything about the medical-surgical floors. (Seriously though, no offense to the floor nurses- it's just not for me.) I hated walking into the same patients days and weeks at a time. I hated how everything was so scheduled, but nothing ever happened.
On July 1st I sat for my nursing boards. I walked out of the building, turned my phone on, and before I could even call the boyf to tell him to pick me up, my phone rang- it was HR offering me a job in the ER! I was so emotional from literally just finishing the NCLEX, I'm sure I sounded like a nut job on the phone with the HR rep.
As much as I can complain, I absolutely love my job. I love the emergency room, even when we have 25 in the waiting room, a full admit board with no hospital beds and medics coming in the back door with STEMIs and strokes. I love working the urban setting, dealing with overdoses, psychosocial issues, and even their usual sassyness. I love (most of) my coworkers. I am so so lucky to have landed my dream job right out of nursing school.
So that's my story in a nutshell. I've been a nurse for 1.5 years, so I'm still a baby. I hope I'm not too boring for anyone that might read this. Stay tuned for more if you feel so inclined...
TL;DR: I'm an ER nurse and I love my job.
-K
I am 23 years old and I work in the Emergency Room of a level 1 trauma center in a city that's always on the lists of of 'Most dangerous Places in America'. No-I don't get gun shot wounds every night. They go to trauma. Which is separate from the ER. So stop asking me that family and friends.
When I was in high school, I volunteered at the local fire department with my dad. My mom suggested I take an EMT class one summer, so I did and fell in love. At 16 I was an EMT in my small rural town, taking calls as a 3rd crew member since I was too young to legally treat patients on my own.
I went to college knowing that I wanted to be an emergency room nurse. I loved when I had clinical days in the ER and became obsessed with the organized chaos. A sick patient would come in and nurses, doctors and techs would rush in, everyone knowing what tasks needed to get accomplished to stabilize the patient.
Midway through college I got a job as a tech on the mother-infant floor of the hospital. I stayed there a year, then needed per diem hours so I went pool. I hated everything about the medical-surgical floors. (Seriously though, no offense to the floor nurses- it's just not for me.) I hated walking into the same patients days and weeks at a time. I hated how everything was so scheduled, but nothing ever happened.
On July 1st I sat for my nursing boards. I walked out of the building, turned my phone on, and before I could even call the boyf to tell him to pick me up, my phone rang- it was HR offering me a job in the ER! I was so emotional from literally just finishing the NCLEX, I'm sure I sounded like a nut job on the phone with the HR rep.
As much as I can complain, I absolutely love my job. I love the emergency room, even when we have 25 in the waiting room, a full admit board with no hospital beds and medics coming in the back door with STEMIs and strokes. I love working the urban setting, dealing with overdoses, psychosocial issues, and even their usual sassyness. I love (most of) my coworkers. I am so so lucky to have landed my dream job right out of nursing school.
So that's my story in a nutshell. I've been a nurse for 1.5 years, so I'm still a baby. I hope I'm not too boring for anyone that might read this. Stay tuned for more if you feel so inclined...
TL;DR: I'm an ER nurse and I love my job.
-K
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