Tuesday, February 11, 2020

Restless

It's a little bit nuts that I've now been at my current hospital for as long as my original Home Hospital. I started my nursing career in January 2009, and left that job to go traveling in July 2012. I remember getting the itch to travel somewhere around winter 2011.

A couple months ago, I was feeling burnt out, sick of work, and actively looking for a job in a different department. I've gotten past that low point now, but when reflecting back on those rough few weeks I realized that was the exact same amount of time it took me to become restless in my first job. I decided to go traveling, but now that I'm a married homeowner in Texas I don't have the same solution available.

I suppose I'll have to find another way to push through the restlessness. Perhaps getting cross trained in a different unit? Maybe picking up an extra committee or class? Maybe I'll take a leave of absence and do a legit travel assignment somewhere! Wouldn't that be interesting...

Sunday, February 9, 2020

Continuing Education

I recently joked that I would die as a crusty old beside ER nurse, and that whatever hospital is dumb enough to keep me hired on would be stuck with my cranky ass forever.

All joking aside, I really do think that's true. I don't have any desire to go back to school for my NP, as I don't want to spend time sitting through BS nursing theory classes and I definitely don't want to be a prescriber. The NP market where I live is especially saturated, so I'd end up in a minute clinic or doctor's office anyway, which is about as far from ER as I can imagine.

I abhor the thought of becoming management - or at least upper management. I could possibly see myself becoming a charge nurse, or maybe even something like a clinical supervisor where I get to do low level stuff like scheduling, yearly evaluations, and conflict resolution between coworkers while at the same time being able to do some bedside nursing. But upper management? Fuck that noise. All these positions of chief people officer, chief nursing assistance big shot person officer, chief resource person...all of those may as well be titled Chief Bullshit Person. They're unnecessary, and a huge part of the reason why hospital costs are ballooning out of control while the ones actually providing care are wrung out until theres nothing left to do but quit.

I don't want to be a full time professor, as that requires a Master's Degree and thusly a big NOPE. Perhaps I could be a clinical instructor and help educate the brand new nursing students, but that would only be part time.

No, I think I just want to be the best goddamn clinical nurse you've ever seen. I want to be the nurse with a zillion certifications, not so I can list them but so that I can gain that knowledge. I want to be the nurse that everyone comes to for advice, or to run a question by, or to double check a skill against. I want to be the nurse who knows every single staff member in the hospital, who to call to find something, and all the door codes to all the secret supply rooms. I want every patient of mine to be able to subconsciously recognize that I can take excellent care of them. I want to be able to train new graduates and make them into good nurses. I want every staff member to think "she's really good at this." I want to be the best I can be, for the benefit of my patients.

Yes, I think I'm alright with being "just" a staff nurse forever.

Friday, February 7, 2020

Slow

While I love the chaotic intensity of the ER, I absolutely cherish the slow days. The ones where I get to hear the life story of a nonagenarian, ask their secrets to a long and happy marriage, and compare notes on interesting places to visit. The days where I get to spend an hour picking blood clots out of their hair without hurting their tender scalps. The days where the family and I hug each other when
I drop the patient off in their inpatient room. The days when the patient can't eat the turkey sandwich from the ER fridge, but tries to slip me a five dollar bill after I offer up the yogurt from my lunchbox. The days when I get to be cheerfully snarky to the sharp witted ones because they eat it up and love trading jokes. The days when, instead of struggling with unsafe work loads, I get to be a real nurse and actually take care of a patient instead of just their conditions.

I love those days.

Thursday, February 6, 2020

The Good Fight

Y'all, I'm still here fighting the good fight. We're standing strong against the dumb dumbs of the ER world, but the battle rages on without an end in sight.

Last night, a lady brings her very old grandpa with a very obviously broken tib fib up into the ER drive. She parks the car and walks in to ask for help with getting him out of the car. A few of us grab a wheelchair and head out, but she hesitated in the lobby instead of joining us back at the car. She nervously looked around, and then finally marches back up to the triage desk. "I'm going to take him somewhere else. There's so many people here wearing masks. I don't want him to get that coronavirus!"

She then comes out to the car, stops us from getting him out of the backseat, and tells him "okay grandpa, we're going somewhere else without any of these sick people!" Poor dude looked like he was about to cry, but there was no arguing with her as she sped away. People, man.

Saturday, November 2, 2019

Eyes, part 2

Hey everybody! Remember that time I said I had witnessed the grossest thing ever in my ten years of nursing? Yeah well I beat that last night. Not trying to brag on myself or anything but I'm pretty proud of the fact that I didn't vomit directly onto the patient when I saw this. Or, more appropriately, heard this.

Let me set the scene.

Typical middle aged generally unhealthy guy who thinks "I can definitely do that activity even though it requires getting on a roof and I've been north of 270 lbs for at least twenty years" comes in to the ER. He's got a litany of injuries, including an eye injury causing proptosis and a non-reactive pupil. It's either lose the vision or do a relatively uncommon procedure to temporarily relieve the pressure.

We called in the OMFS guy, who very excitedly came in to do a canthotomy. Only a few of the people in the ER had seen this actually done before so when we sedated the guy everyone gathered around to watch. OMFS gave us the anatomy lecture, pulled the corner of the eyelid out, then just poked a pair of sterile scissors in and cut. He then told us that to really relieve the pressure, the tendon needs to be released from the skull. It honestly wasn't that bad, until one of the ER docs asked how he knew he was in the right spot and how he didn't go too far.

And you know what he did? POKED THE SCISSORS IN EVEN MORE. He goes "oh, it's just eye socket here, you can't really hit anything important. You just listen for this - " AND SCRAPED THE SCISSORS ON THE SKULL - "and then scrape everything off the bone." If you've ever heard the sound of someone scraping scissor points along a skull, it's not a good sound. It gave me goosebumps and heebie jeebies and extreme nausea. It's not a natural sound. It's...awful.

The canthotomy itself wasn't even that bad, compared to the aftermath of the only other one I've seen. Apparently when the doctor is competent and it's done right it's not even really a thing. It just looked like a little laceration by the eye. Oh, but I know. I know that sound, and it's forever in my brain now. Bleegh.

***

I will say that I would have been debilitatingly grossed out by this whole eye thing except that the next patient to come in was even worse and while looking for identification in his pants pocket I accidentally dropped a piece of his leg bone on the floor. Femur? Tibia? I don't know, but it wasn't where it was supposed to be and there were lots of openings it could have come from. Really puts things into perspective, honestly.

Friday, July 26, 2019

Fresh Feelings, 2.0

I thought I should update you guys on the guy from the last post, because it's not often that I have feelings and I want to get the full effect here.

The other night I found out the post-arrest guy was on one of the inpatient floors. Not the ICU, but med surg. Med surg! He had been downgraded through the hospital ranks, so when I realized I was admitting another patient to the same floor I offered to transport them myself so I could check in on him. I rounded the hallway corner and came face to face with the patient's wife - she immediately recognized me, and asked me to come in to say hi. When I dropped the other patient off, I walked into post-arrest guys room - and he was sitting up! In bed! Awake! Without oxygen! And talking!

I said "I don't expect you remember me, but I'm the one who started chest compressions on you." He immediately burst into tears and asked if he could give me a hug. Let me tell you, he was not the only one crying.

We had the most wonderful conversation, and as he kept repeating, "we're talking to each other! I'm here because of the work everyone did for me!"

You guys. Sometimes we really do make a difference. It's a fantastic feeling, for everyone involved. I love my job.

Saturday, July 13, 2019

Fresh feelings

Part of being a nurse for ten (10!) years is that the mundane, ridiculous stuff no longer warrants a blog post. I have seen a lot, been called a lot of names, and witnessed such a wide variety of foreign bodies in rectums that I no longer rush home to write about all these events. The shit that I used to write about four times a week is still happening, but there's only so many times I can reword the same feelings into fresh posts.

But this week, I experienced a patient that truly made me want to come home and write about it. So here I am!

***

The highest potassium I had ever seen before, up until this week, was 8.3 - I thought that would be a record to stand for a long while. But a few days ago we pulled a patient out of a car who was pulseless, gray, and apneic. I jumped onto compressions and we got started with the usual code process.

When the labs came back a few minutes later, the potassium was 8.9...EIGHT POINT NINE. You didn't read that wrong.

We gave more calcium, bicarb, insulin, and dextrose that I've ever given to someone before. After 45 minutes and the third round of CPR with subsequent ROSC, a coworker called out to the doctor that the patient had opened his eyes. I thought that surely she was imagining things but when I went over to the patient and asked him to squeeze my hand he promptly followed that command.

I went up to visit him in the ICU the next day. He's awake and though still critically ill, intubated, and on pressors is following all commands.

As any of you ER people know, this is the rarest of occasions. We don't usually get wins like this. Normally the okay people stay okay, the really sick ones we often prevent from getting sicker, and the dead ones stay dead. There's only been a few times in my career where I can look back and say definitively that I and my coworkers took a dead person and made them alive again. This week it happened, and I am still so happy I was a part of his care.

***

If there's anyone out there still reading this blog, thank you for caring about what I have to say!


Tuesday, March 12, 2019

Gowns

We all know that the Hill I Shall Die Upon when it comes to nursing is the sad and confusing story of why people all across the nation can't seem to understand that the order of operations for ER dress code is CLOTHING OFF, GOWN ON. Why, for the love of all that is holy, is this so fucking difficult?! WHY?!

Anyway, I have another boulder to lay in the foundation of this hatred.

Last night a woman comes in for vaginal bleeding. The ER doc very thoroughly explains that she's going to do a pelvic exam and why it's needed, and then steps out. I stay a minute longer to set up the bed/pads/speculum and to explain that she needs to take EVERYTHING off from the waist down and that I would be chaperoning said pelvic exam. I handed her a gown and put a few blankets on the bed.

After vacating the room for a couple of minutes, the doc and I walk back into the room. The woman is sitting there, gown on, under the covers. She says she's ready for the exam. I lay the bed back and pull up the blanket, and for fuck's sake she still has her pants and shoes on.

The patient then says "wait, I have to take everything off?" Can't I keep my pants on?"

FFS, people.

Tuesday, February 19, 2019

Discharge instructions

Me: Okay sir, you're all set for discharge. The doctor came in to talk with you and give you results - what did she tell you?

Patient: First of all, I can't believe you told her I did meth. I told you because you asked, but I didn't think you'd tell her.

Me: Well, you came in for anxiety and insomnia. Your tests were all normal, but the meth is FOR SURE a cause of your symptoms. It's a pretty important thing for us to know.

Patient: Yeah, but I've been doing meth for years and it's never given me any problems before! It can't be the meth. It's gotta be something else!

Tuesday, February 5, 2019

Help

One of the best feelings in nursing is knowing that your coworkers have your back. That best feeling gets even better when said coworker is someone in management. Take, for example, the shitty day I had yesterday. Of all my patients, only one was discharged...and it was a discharge home to Jesus. The rest went to the ICU.

During the management of my eventual home-to-Jesus patient, a significant trauma rolled in the doors which split the available nursing resources as many of them went to assist that patient. Another nurse was in with my sick septic pop pop a few doors down, and when my sick respiratory problem on BiPAP patient started having more difficulty breathing, there just wasn't anyone left to help. It's hard to prioritize care sometimes, but doing CPR means I'm assisting the literal sickest patient in the department and I couldn't step away.

Help arrived in the form of the most BAMF house supervisor ever. She poked her head into the CPR room, asked who the nurse for BiPAP patient was, and then says "is this your patient too? Cool, don't worry about the other one, I got it."

And then she stayed in that room for 90 minutes! She straight up assumed care, paged the admitting MD, medicated the patient, reassured the family, and facilitated a discussion on plan of care. She. Was. The. BEST.

When I finally got my critical patient out of the ER, she accepted no praise whatsoever. Her words were just "well, you were busy!"

It's been a bit of a shitshow at the hospital recently, but man it is so amazing to know there are some people that will grab a shovel and jump into the trench with you instead of sitting in a office and judging from afar.

Saturday, January 12, 2019

Tears

Instant tears. The ones that spring up, uncontrollably, with no warning. Tears that are triggered by the deepest of emotions. Have you ever felt those tears?

Taking care of little old grannies in the ER for vomiting or weakness is a daily routine for me. Start an IV, get an in-and-out cath urine, gently rehydrate, and repeat everything you say at least twice because a hearing aid battery is inevitably not working well. I feel for these patients for so many reasons. The stretchers are uncomfortable. I deny them water at first because they might have a small bowel obstruction. We're out of sandwich trays. The blankets are never warm enough. It's four in the morning and their children went home for the night, and now they're all alone in the room in a strange place. Each little incident wears on them.

I do this so often that while it wears on me too, it's just a routine.

Until it isn't.

It ceased to be a routine the moment I turned her arm over to place an IV and saw a row of old, faded numbers tattooed there. I froze. I couldn't think of anything to say or do. After a long, uncomfortable pause, I dumbly looked up at her and asked "are those...?" Her daughter nodded, and the tears were instant. I managed to apologize for losing it, and after a few minutes was able to compose myself enough to place the IV. The patient was sweetly oblivious to the entire interaction.

At the end of the ER visit, I apologized again to the woman's daughter. "It's okay," she said. "If she were feeling better, she'd tell you about it all."

Auschwitz saw an estimated 1.3 million people during the years its camps were in use. Around 1.1 million of those people were murdered or died in other horrible ways. Of those 200,000 survivors, even fewer are alive today. I am so incredibly humbled to have met and cared for just one of them.

There are moments in life that irrevocably change you, and this was one.

Thursday, January 10, 2019

TEN years?!

This week marks the 10th anniversary of starting my first nursing job ever. Ten long, short years ago. I remember how nervous I was to take care of patients, even though I hadn't yet passed my NCLEX and thus was still considered a new nurse graduate not even allowed to chart or administer medications.

It's been a wild ride. I worked my way up from terrified brand new nurse, to mostly competent baby nurse, to proficient trauma/critical care nurse, to occasional charge nurse, and then decided to leave my confidence level in the dust to start travel nursing. I spent nearly five years doing that, where I met friends all around the county, worked in varying levels-of-shitshow hospitals, learned to adapt out of my comfort zone, and then met and married some dude I met halfway across the US. I'm now back to full time nursing at a single hospital. I bought a house and generally live a pretty cushy life full of caffeine, friends and family, and instagramming about my cats. I get cursed out pretty regularly at work but that's to be expected because I do work ER after all. I precept new grads occasionally, and have had the opportunity to change some of those new grads for the better. I mostly have my shit together at work, although sometimes the day does wear me down and defeat me.

I don't know if I can do ER forever, although I swore up and down when I started that I absolutely would. The changing environment of emergency medicine is probably the biggest obstacle, but the lack of respect from hospital administration, my aching feet after 3 long consecutive shifts, and need to challenge myself are also factors.

I do love my job though. I love the ER, and honestly can't see myself doing anything else for the forseeable future. I'm good at this job, and when I need a change or to challenge myself I take on a new grad orientee, or learn a new skill, or ask to be trained into a new role. When or if I do get tired of all this - perhaps hospice nursing? I think I'd enjoy that. We see so many people yanked out of this life violently, tearfully, unwillingly, that I imagine it would be a welcome change to be with people who know their time has come. I don't think I'm mature enough for that job just yet though, but maybe in a few more years.

It's also been a fun ride with this blog. I started it over eleven years ago! ELEVEN! I haven't even had my all time #1 comfy sweatpants for that long. Shit, I've had this blog for double the time I've known my husband - even weirder is that this thing is how I met him in the first place. Life is funny sometimes.

Here's to another ten years of nursing and blogging about it, although I ain't even gonna lie and say I'll post more frequently. Y'all know better than that. Cheers!

Tuesday, December 4, 2018

A post about that time I felt extremely uncomfortable due to a physician's comments towards me

There's no cutesy blog post title here, because this is a serious topic and I'm still fighting mad about it.

A coworker and I were starting heparin the other day, as the vascular physician was at the bedside talking to the family. For background, I'm 33 and have been a nurse for 10 years. My coworker is in her mid twenties, and is new (it was TNG from a few posts back). The physician is male and I'd guess to be in his forties or fifties. The patient was somewhere between 20-35, and more importantly WITH HIS WIFE.

TNG and I walked into the patient's room with the heparin drip. As we walk in, the doctor notes that we have the med and says, "good, my nurses here are about to start that heparin we talked about." First of all asshole, I'm not your nurse. I'm an employee of the hospital and I work for the Emergency Department. Not you, not your practice, and also I'm a grown ass woman who isn't a possession. But whatever, I let it slide because it's busy and I'm not about to make this awkward in front of a patient.

Dude MD can't shut his mouth there, though. His very next sentence is this: "If these girls didn't have that medication, I'd say they're just coming in here to flirt with you." I look up, glare at him, and flash my wedding ring towards all present.

But wait, IT GETS WORSE. He goes back to discussing the plan with the patient and his wife, who look very weirded out at this moment. I'm thinking we're in the clear and I can get out of the room without further comment, but no. After we finish verifying med dose and rate and hit start on the pump, he says "oh good, these hot girls, I mean nurses, got everything started."

FIGHT ME MOTHERFUCKER.

I turned around, and just said "NO. You are NOT doing this." And I walked out.

If I had stayed in the room, I would have punched him right in the dick. I wish I had said something more specific about the blatant sexual harassment, but if I had opened my mouth again it probably wound have gotten me called to HR.

After TNG and I left the room we told coworkers in the immediate vicinity. I'm not sure if I need to escalate this further because I really don't feel like getting involved with management, but I'm debating the merits of getting a neutral male coworker of mine to be a witness if I decide to say something to the physician. It's not acceptable under any circumstances, but especially not in my place of professional business.

I dunno, I just can't believe something this blatant happened to me. I'm used to the stupid shit that patients say, but this is on a whole new level.

Please advise, internet blog readers.

Sunday, November 11, 2018

Pelvic adventures

I had the most adorable new resident corner me in the supply room the other day to ask me the most humiliating of questions - could I chaperone a pelvic exam for him, and also by the way could I walk him through how to do a pelvic exam while we're at it?

Apparently the ER doc sent him out into the wild, and the resident admitted that he's only ever done the exam on two real people before, but "it's been a while." I have to say, this is legitimately the first time I've ever had a doctor flat out admit that they don't know how to doctor yet. While I did enjoy giving him a bit of a hard time it was actually super encouraging to see a resident admit they don't know something, seek out a nurse who does know, and ask for their instructions and recommendations. I showed him all the supplies we would need, the order of swabs for STD testing, how to use our particular speculums, and what to tell the patient during the exam. He followed instructions perfectly and did a great job.

Too often we'll see a resident who has literally just graduated speak down to a nurse with 5, 10, 30 years of experience and dismiss anything we say or do because "you're just a nurse." Not this dude. He swallowed his pride, and came out as a better practitioner because of it.

He doesn't really need to know that I've actually never done a pelvic exam....watching hundreds of them is totally the same the real thing, right?

Wednesday, October 24, 2018

Bra-vo!

Work has been a real bummer recently - courtesy of Manglement (TM pending to Jo at Head Nurse), we've been chronically short staffed, in the middle of a mass exodus of experienced staff, and mass hiring of brand new nurses. Some nights, entire sections are staffed with nurses who have less than a year on the job. Don't get me wrong here - I love new nurses. Shit, I was one once upon a time. They're fresh from learning the newest research, excited to start working, and it's thrilling to watch them come into their own and become highly competent people. A good hospital ER balances the influx of new grads with a bevy of experienced ones, and makes sure to have enough support staff to keep the department running while they learn. Our place does not, and the short staffing means it's demoralizing and a beatdown many, many nights.

I reached a new low the other day when it came to barely having enough resources due to low/new staffing, but at least I get this blog post out of it!

My otherwise stable trauma patient needed a chest tube for a hemo/pneumothorax, and the doc finally was able to get into the room to place the tube. I had multiple other critical patients, so wasn't going be in the room for much of the procedure. A tech was there to help, but she was going to be opening the chest tube tray, taping tubes down, and generally functioning as a circulator nurse. There was no one to hold the patient's giant boobies out of the sterile field, though.

The doc, myself, and the tech stood in the room for a minute to try and figure out what to do. The patient was generally a badass with everything, and was like "do what you guys need to, I'll be fine." I looked at the chest tube set up. I looked at the patient's boobies. I looked at the doctor. I looked at the boobies again.

"Soooo...how awkward will it be if I tape your boob to the siderail? Are you cool with that?" I asked the patient. She laughed and then was asked if I was serious. I was.

I sure did get a roll of cloth tape and secure her tit all the way over to the contralateral side rail. I felt like a fucking MacGuyver. I'm sure the OR does this kind of shit all the time, but it was a first for me. I got a round of high fives from the doc, tech, and even the patient, and then I ran out of the room to go make sure my other patients were all still alive.

If low staffing weren't an issue, all of these patients would have been taken care of and no one's boobies would have been taped to any sort of ER item. I guess this is our department life now?