September 6

How has it been 10 months since I last blogged? I can't promise that I'll ever update regularly again, honestly. I hit the point a while ago where I didn't really have anything interesting or funny to say, or at least anything that was new and worth reading. Most of my posts were about how much I hated my job which can't have been fun for you guys. There's also the tough spot that my new job is specialized enough that it's hard to write about it without giving away where I am. So many of our patients are a specific type and I don't want to jeopardize my job on the off chance someone found the blog. Although I guess reading back through fifteen years of bitchin would probably lose it either way, even if I was completely complimentary of the new spot (which I am). But I suppose I'll keep straggling along and writing when I can...

That said, I cannot believe I've been here over a year. I have been off orientation since November and I feel like I fit right in. The people are great, the department is fun, I have a great manager. It's all wonderful, seriously. There are mild annoyances, for sure - one of the managers isn't great and of course there are policy decisions that frustrate us but overall I love it. Today I was texting one of my friends who still works at the old job and jokingly said "I ain't even been stressed in a full year." But then realized it's kinda true. I had the expected learning curve stress, and trying to fit into a new place with new policies and new ways of doing things, but once I figured those out I have been genuinely, truly happy here. I used to have such deep rooted dread to go to the old place and you know what? I haven't hated a single second of the new job. Not a single moment, seriously. It's so wonderful to love my job again.

I also get to help new residents learn how to be doctors. It's a good time. Many of them are really good and while many of them are not yet, I think they will be eventually. There are the scattered few who we think may be in the wrong field, but mostly I love helping them all learn how to Emergency Trauma Care (tm). It's fun, for real. I personally have learned so much more because we have to be on top of our game. And interestingly enough, I've also gotten way better at reading CT scans. Obviously I'm not an expert at it, but I've gotten fairly proficient at it. Having a new set of residents every month means we have to be proactive in all things since they're still learning doctor basics. Often we'll say "hey, this patient looks like they might have a splenic lac" or "hey come look at this XR, I'm pretty sure that's a pneumo. Want me to set up the chest tube?" And then most of the time we're right, and they do, and then we do something about it all before the radiologist has read the scans. It's fun, for sure. It's also a bit nervewracking when the residents straight up ask me what they should do for the patients, but again that just makes me a better nurse. 

So, yeah. I love the new job, I'm smarter every day, I am not stressed, and it's a fun place. Good times! 

November 22

Well, it's official. I'm off orientation and on my own at the new job. It's a little nervewracking, but overall I think I'm doing okay. There's still a lot to learn and I've had a fairly vanilla set of training shifts so still feel slightly underprepared, but hopefully my coworkers are happy I'm there and think I'm pulling my own weight. I've got quite a few new adventures to share but for now just wanted to update yall that I'm still enjoying it, still glad I made the move, and still hanging in there. Happy Thanksgiving everyone!

October 24

I successfully ran a rapid infuser during a trauma the other day, and a coworker was surprised it was my first time ever running that particular one. Which was extremely unexpected, because I felt very unsure of myself and had lots of questions and needed to troubleshoot some issues.

Anyway, I've been going through the blog archive posts and deleting some old ones that are either irrelevant to nursing or just extremely embarrassing (GOSH I was a dramatic child at the age of 25) and the first one I came across today deals with a well-documented thing called Impostor Syndrome. Good to know I felt the same way in Ye Olde Times of 2009. I got over it, and it's good to know that I did it once and can do it again.

October 18

It's been two months since I started my new job, and there hasn't been a single shift where I've regretted making the move. Sure, there have been days that were overwhelming and it's definitely hard to be thrown into a new place with high expectations. But not once have I sat in my car outside the hospital filled with dread about the next 12 hours. Not once have I clocked in and thought about just turning around and leaving. Not once have coworkers asked me, with genuine concern, "are you okay? you seem so unhappy here."

I love my new job. It's still new and I'm getting used to the differences, but I actually enjoy going to work every day now. It's been so long since I've been able to say that.

Things really are different. I have lots of bedside clinical care, which has been the hardest part of it all surprisingly. Spending most of the last three years doing charge has really shaken my confidence at the bedside stuff. I know I'm a good nurse, but it seems like those skills just slipped away without me really noticing and now I'm on the uphill to get them back. Or maybe it's the unease of functioning in a hospital that is almost the same, but just different enough that the muscle memory isn't there yet. Whatever it is, I'm feeling better and better with every day regarding the bedside aspect. And the case management/paperwork aspect of it is great. I really enjoy that side of it, honestly. 

So TL;DR. My new job is hard but good and I like it and wow the lack of toxicity is super nice. Also I get to wear black scrub pants and a t shirt every day so I look way cooler than I actually am. Cheers to not looking like a blueberry anymore!

September 2

It's been quite a long time since I've been the noob at work, feeling lost every day and like I'm drinking from a fire hose any time someone teaches me something. This new job has me feeling such a way but I'm slowly getting the hang of it I think. Switching hospital systems is a big jump and I kinda took for granted all of the little things that made it so easy to go to work every day. Things like knowing the hospital zip code, or where to find extra Christmas tree adapters, or the shortcut from the parking lot to my unit. Another one that gets me is phone numbers - I knew literally every phone number at the old job by heart and it's hard fumbling around for a phone list when your patient is crashing and you need to call CT quickly or to call the triage desk to retrieve a family member or even just tell the transporter what your unit number is. 

There are also much bigger changes, like going from a hospital where I could take verbal orders all day long to one where I can't put any orders in at all. Or working with just the ER attending, Trauma attending, and maybe a PA to dealing with a whole team of residents. The charting is still the same EMR, but the setup is totally different and way more comprehensive. Also I carry a pager now, since I guess I went back in time 25 years too. 

All these changes are the part that makes a new facility overwhelming, but so far I think I like the actual job a lot. Every place has it's faults and this new hospital is no different although I'm sure I made the right choice. Every day is a bit easier than the one before and I fortunately have a full three months of orientation. Maybe by the end of it I'll feel like a competent nurse again. Maybe.

July 27

I had to go to the new hospital today for all of my pre-employment stuff screenings and fittings. It was strangely exciting to be back, although I have two more full weeks off before orientation and I plan to soak up every moment of that time.

The new hospital is big and shiny and overwhelming. It makes me feel like how I did as a travel nurse back in the day. I'd plaster a smile on my face and ask anyone who didn't look lost how to get where I needed to go, then walk confidently towards the wrong elevators (noooooo I FOR SURE did not do that today, definitely not) until someone else takes pity on me and redirects. 

I also finally went through my work bag to get rid of all the usual detritus that accumulates over the years at a place. Things like old flushes, suture packs, and badge pulls. I found a mason jar that does not belong to me, my spare shears that had been lost (or so I thought), and after sorting through the trash I now have a mostly empty bag ready to fill with more bits. 

I had also done a locker and mailbox sweep on last day but was too salty about how things ended to actually go through it all until now. But get this - I found some paperwork that truly underlined how unsafe the hospital had gotten, and reinforced my decision to leave as the right one. One of my coworkers, on a day that I wasn't there, had filed for Safe Harbor during her shift and gave me a copy of it. Between 3 nurses, there were 51 patients in the lobby. One nurse was the triage RN, one was the arrival nurse, and one was responsible for the care of every single patient out there. Fifty one patients, many of them inpatient holds. 

Everyone knows hospitals across the country struggle with staffing, but when will hospitals learn that it takes nurses and medics and RTs and PCTs and CNAs to actually do the work that the metrics are measured against. You want your patients happy and fall-free and to avoid CLABSIs and everything else bad? You want higher reimbursement and insurance payouts? Hire more staff and pay them. If you don't, well, the hospital will still run. But bad outcomes will happen, your senior nurses will leave, and everyone will watch what was a fantastic hospital take a sad spiral into being a bad one.

July 6

What's up, yall?! Hopefully everyone still has all their fingers after this July 4th holiday, yes? Actually, that's why I'm updating so soon again - I got a job! In a trauma department, where people lose fingers by various means on a regular basis!

I have a few more weeks off thankfully, but managed to land a job as a trauma nurse clinician at a good hospital in my area. I'll be doing a good chunk of bedside nursing, some paperwork, some chart auditing, and some inpatient rounding. I know every hospital has its faults, and this one will be no different, but I have a few former coworkers who are also at this facility and speak highly of it.

I am super excited to start. It's been a long time since I've had a fresh beginning and this place has a lot to teach me. Walking away from my previous job was hard to do, but I feel joy over the decision and now a lot of excitement about the challenges of the job I'm about to start. I dreaded the thought of just jumping to another random ER to continue the beatdown, but this job is combining my love of trauma care with a good facility and lots of resources. Perfect!

Currently I'm going to continue my old lady gardening and hanging with the family at the pool summer break, and I'll keep yall updated on how the new job goes once I start!

June 21

Road trip and race time! This was my second half marathon, done through the Vacation Races company. Their whole bit is to host races by National Parks and have stupidly scenic routes. It really was incredible.

Last year I also did a two week long road trip to run the Yosemite NP race, and along the way saw Petrified Forest NP, Antelope Canyon, Zion NP, Death Valley NP, Sequoia NP, Kings Canyon NP,  and Saguaro NP. It was incredible and I was so pumped to do it again. So this year, the race destination was Grand Tetons NP. I spent a week driving out there and stopped at Rita Blanca national grasslands, Capulin Volcano national monument, Great Sand Dunes NP, Garden of the Gods, Pikes Peak, Rocky Mountain NP, Split Rock on the Oregon Trail, Jackson Hole, and Grand Teton NP where I also ran the race. Afterwards, I took a week to drive home and visited Yellowstone NP, Teddy Roosevelt NP, Bear Lodge (aka Devil's Tower) national monument, Deadwood SD, Crazy Horse monument, Mount Rushmore, Wind Cave NP, and Badlands NP.

It. Was. Incredible. 

I'll just leave these here.

June 20

Hey guys!

Remember that time that I was fed up with the unsafe staffing levels, unhappy with my job, and just generally over the whole thing? Well...I quit my job about a month ago and decided to take a month or two off without stressing over it.

My last 6 days of work were hands down among the worst - in a department that should have 12 nurses overnight, we often had just 7-8. Staff is 6:1 with extremely sick patients on an every night basis. Most nights I had to take hall patients in addition to being charge and having the whole department under my care. Ambulances lined up for hours because there were no beds. Trauma patients and CPRs and other critical patients had subpar care because staffing was low. If we're a busy department with appropriate staffing levels doing this, that's one thing - but when the main area for ambulances only has 1 or 2 nurses...that's a problem.

I had gotten to the point where my manager felt that me speaking up over shitty conditions was toxic to the department and not in line with management. No shit, sherlock. I've never been one to fall in line and be a yes man to the higher ups, but this was exceptionally painful since my hospital used to be a fantastic one. I found a bunch of daily staffing grids from pre-COVID showing our 12-13 nurse par level, and brought them in to emphasize the staffing issues we currently have. I was told that financial analysis of the patient load in the department did not support those numbers any more, and that 10 nurses is in fact overstaffed. Well, fuck me I guess because between management and I, only one of us is actually working those overnights and seeing firsthand how bad it is. My nurses were in tears on a regular basis with how overworked and stretched thin they were. 

So, yeah. I had long conversations with people about how unhappy I was, and finally my husband was like well, why don't you quit? I agonized back and forth about it and finally realized that he was right. So, I quit!

I then immediately took a two week long solo road trip from Texas to Wyoming for a half marathon, and spent those two weeks not even worried about work. I have worked in the ER for 15 years and other than a few weeks between travel contracts I have never really taken any time off. My husband pointed out that people change jobs all the time and that is is okay for me to do it too. So here I am, between jobs and searching for one that will make me happy and also pay the bills.

It's a nice change, truly.

Next post up: trip pictures!

January 12

A half-naked lady is brought in by EMS after being picked up from outside a gas station. She's loud and twitchy and disheveled but also surprisingly re-directable and coherent. I'm trying to figure out if she needs to go to a room immediately or if she's stable to park on the wall for a bit since we're super busy. The EMS crew is reading off her vitals and mention a blood sugar of >400. I ask her if she has a history of diabetes, and she nods in between wild arm flails. "Have you been taking any diabetic medicines?" I ask.

"I've been blazing and stargazing, baby! No time for meds, only time for meth!"

Gotta respect the honestly, seriously.

December 9

I can't believe it's been six months since the last post...although I keep saying that every time I go months without posting, so maybe I should stop being surprised at this point.

The past few months have been tough. Very, very tough. I took the full-time charge position back in April, and now I understand why every full time charge nurse I've met seems to be beaten down and crusty all the time. I'd like to think that I am a good nurse, and a decent charge - I genuinely love nursing and the ER, and I love taking care of the wildness that we see. I love seeing new grads grow up into great nurses and being a resource for them. I love managing the chaos of a busy department. But man. The past six months have been brutal for so many reasons. In one of my most recent posts, I mentioned an email I wrote railing about unsafe staffing levels and the general safety issues of the department, and how we would be in danger of losing all our staff if we stayed that course. Well, it happened.

The last two months or so have seen approximately 20 nurses quit. Most from night shift, some from midshift. We made our unhappiness known with the unsafe conditions of the waiting room setup, the lack of medics and PCTs due to extremely high psych volume requiring 1:1 sitters, multiple assaults on staff with little to no repercussions, and increasing expectations without the needed resources to support them. A real bricks without straw situation, honestly, and finally the staff decided they didn't need this shit and went elsewhere.

We are now desperate. In the previous posts I mentioned a Saturday night with skeleton staffing and how horribly unsafe it was. That staffing level is now our best case scenario. We often run the department with 12 beds plus a fast track area of 10 chairs. That's 22 beds for a wildly busy department, and it's on a good night. Being charge in a situation like that is more stressful than I could have imagined. I'm responsible for every walk in and EMS that comes thorough the doors, and scrutinized when I have to make patients wait. But what can I do? When I have six ambulances at once and no open beds, and every nurse is already in a 5:1 ratio, how can I give them more patients? How can I make everyone happy? How can I safely take care of patients when placed in a no-win situation?

It's untenable. I am unhappier than I've ever been in this job - which is so sad, because I absolutely love my career. But I have reached the point where I am actively looking to get out of this position. Healthcare in America is collapsing in general, and our hospital is no different from any other in the city. I could ditch for a different ER, but that will be just a same shit different place scenario. So I'm looking outside of ER nursing. I honestly never thought I'd get to this point. When I first started, I saw myself retiring as an old ER nurse, maybe picking up a different specialty every now and then but ultimately coming back to the first love. But now? I can't see myself in this job a year from now, let alone twenty. 

So I'll keep everyone updated on where I end up, but know that this is the reason this blog has mostly ground to a halt. I'm just trying to stay afloat here until the right moment of escape presents itself. 

July 1

A staff bathroom in the ER - placed head-scratchingly close to the ambulance queue spot in the hall and also the charge desk - broke the other day. Something with the pipes, or sink, or whatever, it's irrelevant. Anyway, it was broken. 

So I put this up. 

April 7

I promised y'all a followup post to the spicy email saga, so here we are. And yet the fall out was much, much different than I expected. 

Let me preface this by saying that I generally frown upon all forms administration, in that the C Suite people are so far removed from patient care that they've forgotten the one thing a hospital is actually supposed to do. There are still great administrators out there, it's the fallacy of the entire system that is bad. Our ER director is one of those great administrators, stuck in that broken system.

When I had my post-email meeting with her, there was an explosion of frustrations from me. I genuinely let loose, to be honest. I sort of apologized for the unprofessional tone of the email, but not what it contained. I also told her that I stood behind everything said, and would read it again to the president of the hospital if given the chance. There were also lots of good points made by her, and a lot of the frustrations I had were things she is aware of and actively working to fix, as much as is possible. There's a lot of transparency issues with major hospitals, and ours is no different - she promised to make our staff more aware of what they're working from the top, and I very much appreciated that. Staffing is our other big problem, in that we're constantly working short. I told her this was unacceptable, and that there is no other way around it and that the department will lose the rest of their employees if they don't address it. Within a week, we had a slightly better staffing grid.

So there were lots of positive outcomes from this. The one I was least expecting, though, was to be offered the position of full-time charge. In their words, "we appreciate your spiciness and willingness to say the difficult things while still being open to learn why things are the way they are." So there's that.

March 22

One of the reasons I'll never be in administration is that I am completely incapable of keeping the spiciness at bay enough to be a Real Professional Adult (tm). I know this about myself and it's never been a problem before, mostly because I know exactly what I want out of my nursing career and it doesn't include being admin.

I turn in a summary report at the end of each of my charge shifts. Nothing super complicated, just an email with any weird happenings, broken or missing equipment, and a list of any activations or transfers. Well, I came off quite possibly the worst shift of my career a few nights ago. I'm pretty sure I said this about another shift recently, but whatever that shift was like was completely demolished by this disaster. It was a perfect shitstorm of critically low staffing, trauma activations, and incredibly acute and complex patients. The most terrible part of the shift was the low staffing part - for a well known trauma hospital, we had fewer than fifteen beds open on a Saturday night, plus missing staff for the rapid track/triage portion of the unit that normally sees about 50% of our volume. 

Anyway, I got in to work knowing it was going to be terrible, but we all said a word to the trauma gods hoping for a smooth night. Alas it was not to be. At 1906, our first trauma activation rolled through the doors. At 1945, the second. The third, may an hour or two later. Lots of trauma transfers in. A fun little medical intubation or two. Around bar closing time, our fourth, fifth, sixth, and seventh traumas came in within an hour or so. Our rapid track was at a 15:1 ratio for the single nurse out there for most of the night. And just for that little extra razzle dazzle, another massive trauma in the wee hours of the morning. It was relentless. 

So at 0730 I fired off quite possibly the spiciest shift report ever, railing against the unsafe staffing levels, the lack of planning ahead for getting traumas when we're a trauma center, and problem of all of our medics having to sit on psych patients instead of being actual medics. It was a brutal email. And it goes to not just our ER administration, but the hospital administration too. I knew that. I'm not sorry about it. But BOY HOWDY does a very spicy email highlighting horribly unsafe nights really light a fire under some people.

The next day saw multiple follow up emails, and today I had a meeting with our director about it. It was...interesting.

Next post will be the fallout from the spicy email saga and why exactly I'm not cut out for admin. It's a wild ride!

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But in the meantime, please enjoy this picture of my now planted garden...which is currently under frost cloth because spring somehow still isn't fully here yet in North Texas and it's too cold out for the plants these next couple of nights. Come on, spring!

March 10

It's no secret that one of the worst parts of the ER is dealing with the awful, terrible people that come in. Not the "I'm having an awful day and so I snapped at you guys" kind of people, or even the "I have money and therefore think I'm entitled to the world" kind of people. Those people are tiring, but not what I'm referring to. I'm talking about the ones who are, truly, a piece of shit.

Like our patient the other day. He came in handcuffed with the local police to be seen for an arm injury, and as soon as he stepped foot into the ER he sucked in a deep breath and launched into a nonstop verbal tirade. Racial slurs, sexually explicit threats, spitting at staff and on the floor, insults about staff's physical looks...if you can think of it and it's awful, he said it. And since this is the ER and we don't do anything about it, instead of throwing the guy out he got to stay in our department all night long. Once he started spitting at staff he got medicated with some haldol and ativan, so we were blessed with a few hours of quiet at that point. 

When the patient first came in he had a backpack full of stuff. We emptied it out to check for weapons, and sure did confiscate like three knives and a meth pipe. Also found were multiple CLEARLY stolen items - watches, credit cards with different names, money, earrings, plus a couple of lottery scratchers. Why he didn't go to jail instead of the ER is still something I'm fuming over. BUT - I got my revenge. Oh boy, did I ever.

I can't take his money because that's stealing. I can't throw his stuff away because it's "his" stuff even though clearly stolen and the police didn't want it back because they don't give a shit. I couldn't throw him out of the ER or refuse to treat him.

So you know what I did? While he was sleepy from the medications, I scratched his lottery scratcher tickets. Every single one of them. None of them won anything, but that's not the point. The point is that I LEFT THEM WITH HIS STUFF. I scratched his lottery tickets, they lost, and I put them back into his stuff so he knows someone did it and wanted him to know they did.

Maybe it was wrong and I shouldn't have done that. But you know what? The medic who was the target of most of the racial slurs thought it was brilliant, so I'm okay with my choices here.