Break

Well folks, I'll be out of commission for a little while. Camping, lake, and then a weekend with friends.

Epic times on the horizon. Holla!

Always learning

I might be able to hold my own in running a trauma. They might trust me enough to precept a new (to the ER) RN. I might be able to manage my group on a hellaciously busy Monday night. I might be turning into a competent nurse.

But I am inexperienced. There are still so many things I have never seen, and I am lucky to work in an ER that recognizes that fact - and is willing to teach me.

The other day at work, I was up at the main nursing station waiting to get some discharge paperwork signed. It was busy, the docs were busy, I was busy, and trying to get stuff moving so we could clear the waiting room. In the midst of all this, one of the docs yells across the station at me. "HEY SHRTSTORMTROOPER! You ever seen a copperhead bite before?!"

I shake my head no, and he goes "well then get your ass over here!"

Obviously I oblige, and head into the room with him. I got a three minute impromptu lesson on how to recognize different types of bites, what to do for this one, and what we'll need to monitor. It wasn't my patient, and I was busy. But I will never, never pass up an opportunity to be taught.

While that doc is very genial, there is another doc that I am still terrified of. She is freaking smart, fearless, experienced, and probably the single most intimidating person I've ever met. While in the break room recently, we were all joking about who in the ER is scary and who isn't. In the midst of the joking atmosphere, I tell the staff that seriously, I'm still scared of this doc. One of the grizzled nurses starts in on a lecture about how she is scary, but only wants people to be confident and the best they can be. So with that in mind, I sucked it up and went to her regarding one of my patients on the next shift.

"Dr. H, I've got a question for you..." I start. She looks and me and tells me to spit it out. "I'm just wondering...why are we doing this?" I ask.

She looks at me for a second. I start to sweat. She looks at her watch. I start wondering if I have a change of pants in my locker. She looks back to me. I open my mouth to say never mind, I'm sorry to bother you and I'll never make eye contact again - when she cuts me off, pulls out the chair, and goes "I'm really glad you asked. Have a seat, let me explain, and I'll quiz you on it later."

She isn't any less scary after that, and I'm still waiting for the quiz. But you know what? I'm a better nurse because of asking, and if I keep that up I'll only continue to improve.

Because no matter how highly administration might think of me, and trust me with orientees, the real measure of a good nurse is whether or not I can take my uncertainties or deficiencies and learn, improve, and use that new information to take better care of my patients.

And there will always be room for improvement. Always.

SahCURity!

Welcome to King Burger, where we can do it yo way - but don't get crazy.




I swear to you, BonQuiQui's entire family visited the ER this week. It was tragic. I wanted to cuuuut themmmm.

Business in front, party in back

Oh dear lord. The Pittsburgh Zoo has lowered admission prices for anyone with a mullet, in an effort to "catalogue the species." As a human race, we are doomed.

Lab

At our hospital, the lab sucks. Like, really. I want to pull my hair out regularly when dealing with them. I understand they are busy, and I understand that I think of them as "the lab" when really it's two people on nights spinning dozens of blood samples in the bowels of the basement - they aren't all knowing. But really, do they have to be such raging idiots?!

For example, I recently partook in a massive resuscitation and trauma code. Over 25 units of blood products were pumped into the patient in the ER, and when it was discovered the patient had maybe fixable internal bleeding, he was shipped to the OR. As the primary nurse, I went with so I could help out. By "help out" I really mean stand in the corner of the OR without booties or a hair net while the anaesthesiologist sends me dirty looks, and frantically dial the lab every 8 seconds for the trauma surgeon. "Hi, this is Shrtstormtrooper again, I'm calling for the results of that repeat CBC which we sent 35 minutes ago. I'm in the OR, and Surgeon really wants the results. Like yesterday."

"Oh, they aren't resulted yet. Can you call back in 10 minutes?"

Um, no. Its been more than enough time, and this is the priority. How about I just hang on the phone line until it's ready?

"Whatever. it won't be resulted for a while."

So I'm on the phone, and hear the lab hmmm to himself. "That's weird," he says, "that still can't possibly be right. Let me run it again..."

Naturally I ask what the results were, and no shit, he tells me, "well, I'm not going to release that information to you because it can't be right. There is no way there was that much of a change from the last set."

I'm raging inside, and as politely as possible inform him that well yes, this is a massive resus and I don't expect it to be normal. You do realize, lab tech, that this patient has gotten his volume in blood multiple times over, and was a code, so was pumped full of drugs? Yes? His labwork won't be peachy. Finally, after arguing with him for over 5 minutes, he relents and gives me the numbers. Whatever.

Fast forward to this week. I had a patient with some weird serologies ordered. Usually I call the lab and double check with them to make sure I sent the right tubes. Usually I speak to someone who isn't a total asshat, and who takes 14 seconds to tell me which tubes I need. Not this time. Instead, I get "you can look it up online, I don't feel like going through that with you right now."

Seriously. Not even an excuse. Straight up - I don't want to do this. It took me, no lie, 10 minutes to look up all the tubes. Because the info system is crap, our computers are crap, and the lab is lazy. Whatever. I sent the bloodwork, and fumed and then moved on to more important things, since it was hella busy and I don't have time to deal with that.

Until last night. I had a dialysis patient, and the lab ordered a redraw on his stuff. Obviously the patient had no good access, and skipped dialysis for a week because "I had better stuff to do." Whatever. I find the tiniest vein in his eyebrow or something, and send off the redraw. 20 minutes later, redraw. Again. I call lab, and they tell me they can't result it due to "faulty blood" or some crap like that, and no, they won't come redraw it themselves. I'm fruitlessly arguing with them to just release the results, and the MD notices.

Now, this MD is the nicest, most soft spoken guy ever. Nothing phases him, he isn't rude to anyone, and you can always ask him questions. Sometimes I wonder if he is even real, since he's that nice. Very politely, he ambles over to me and asks for the phone.

"Hi, this is NiceMD. I'm the attending for this patient. I understand there is some problem with the resulting? Why so many redraws?...Oh, the results are abnormal? That's why you're not releasing them, they can't possibly be right?...Let me ask you something. Which medical school did you go to? What letters do you have after your name? Where is your license from? Because I went to medical school, and I went through residency, and I'm the doctor for this patient, and that means I know what his labs should and should not be. You are not a doctor. You are a lab tech. Your job is to run the bloodwork, and my job is to interpret the results. This patient is sick, and this patient in the ER. His blood will not be normal. I expect it not to be. You withholding results on this patient is tantamount to practicing medicine without a license on him, and I strongly suggest you result the bloodwork to me right this second - If you would like to continue withholding results to interpret without a license, go ahead, but know that you will be written up and I will take this to your supervisor or whoever else I need to. Have a nice night."

And he hung up. Every one of us stared, slack jawed and googly eyed, as the nice doctor turned back to his computer and kept charting.

It. was. AMAZING.

Score one for the ER!