Thursday, July 2, 2020

COVID-19 (7/2/20)

Hey guys! I'm still here. Still kicking, and still stressed, but in a much better head space than I was a few weeks ago.

COVID is getting horrible here in Texas. Wear a mask, you guys. For fucks sake, wear a mask.

I had another training shift as charge yesterday, and boy was it a doozy. I kept taking critical lab values, and they were all for COVID. All positive. I took two at a time, more than once. Everyone is sick. Our department is on the verge of getting overwhelmed, and I'm scared. I thought I was scared back in April and May, but this is next level. I don't think we'll get to NYC levels as our population density is much lower and supply chains are less fucked than they were two months ago, but....then again, with the way things are trending we might not be far off.

I took two weeks off, and went to visit my parents in Home State. This was before things got real bad again. I social distanced, safer at home (besides work, of course), zoom friend hangouts only before I visited them. I also got tested for COVID, and while I know it's not 100% my negative test made me feel a lot better before seeing them. I'm glad I did when I had the chance, because while I was on the East Coast all I kept reading about was how Texas has done a complete 180 and was taking a nosedive directly into the shitter.

My first shift back was unbelievably awful. So many sick people, so many non-sick people just out doing their thing, and an astounding number of people who wandered into the ER without a mask already on - and then got pissed at us for requiring it.

I think we're fucked. Really.

But at least my head space is better, like I said before. The time off, lounging in the sun, talks with friends, and then knowledge that I have counseling resources available any time has been a huge help. I never did get into seeing a counselor, but that is still on the agenda - since I knew I had those two weeks off I pushed it back a bit to see if the time away helped. Thankfully it did. But the stress and anxiety are still there, and I'm still working on it.

I'll be updating more often, but I hope you guys are staying well and staying safe. Also, WEAR YOUR FUCKING MASKS, PEOPLE!

Wednesday, May 27, 2020

Tired

My Monday night shift was one of the most emotionally wrecking shifts I've had, ever. Not all bad, but definitely draining. I've been thinking that I wanted to utilize the employee assistance program counseling at our hospital for a while now just with all the stress and anxiety from COVID, but after that shift...yeah, I'm gonna need it.

***

A coworker of mine called me in to help sit her patient up in bed, and she had warned me earlier that this patient wasn't doing well at all. The patient was a million years old, and had refused all care because she "just wants to go home." At first, my coworker thought that she wanted to go back to her residence, but the patient then said "don't do anything, I'm going to take my last breath here and I know where I'm going." My coworker was a little freaked out, so she called me in to help. Just before walking into the room, she told me that she was afraid when we sat that patient up that she would pass.

I helped my coworker sit this ancient patient up, she took a few deep breaths, and then over the next ten minutes we held her hands as she died. It was peaceful. It was devastating. It hurt me, to know that she would have died all alone if we weren't sitting there. I was thankful that I was the person my coworker asked to come in with her, but it was hard. We both cried, a lot. You could see the patient just...let go. She was there, and then she wasn't.

After that, we took a few minutes to gather ourselves and then immediately went into the next room to take care of a patient slowly, excruciatingly, trying to fight end stage liver failure and a wound infection. Their family wants everything done so they can get better and come home. They aren't going to make it though this.

***

I spent part of the shift in triage as well, getting yelled at by everyone in the city who doesn't want to wear a mask, or gets pissed when they can't have four friends come back to their room with them, or went out to a big house party two weeks ago and now feels short of breath with an SpO2 of 84% but flat out denies that they had any exposure to COVID.

I also had to help keep an eye on the waiting room for the family members of a traumatically deceased patient, which is a moment I absolutely dread.

***
The last half of my shift was up in our trauma bays, where we took care of a very critical patient for hours. The trauma surgeon, normally excellent and one of my favorites, got sloppy and left a sharp on the tray. When I was moving the tray off the patient, I felt a poke in my finger and realized that he had left a needle unaccounted for even after saying he had gotten them all. I scrubbed and scrubbed and scrubbed my hands with soap and water and betadine, but we all saw the blood it drew. Everyone in the room witnessed it, including the surgeon who instantly and profusely apologized.

I had to go through the whole process of paperwork, lab draws, house supervisor, everything. It sucks. I go in to employee health on Friday to hear his lab results and find out if I have to start taking any medications, but this waiting period is the absolute worst. Does he have HIV? Hepatitis? Do I? It fucking sucks. This is the first time I've ever had an exposure to anything. I feel a little bit numb, but mostly I'm angry.

I know the surgeon didn't maliciously leave that sharp on the tray, but this is the second time in a month that I have personally berated him for leaving sharps on the a tray - he left an open scalpel in a tray a few weeks back that nearly nicked me when I moved the trash aside. He apologized then, but after Monday I'm wondering if I'll be able to trust him anymore when working a trauma. We rely on each other to stay safe - there's so many opportunities to get hurt in a busy trauma. I do my part to keep my coworkers healthy, but who is looking out for me?

***

The other day I found out that a physician I used to work with at Home Hospital lost both her sister and her father to COVID. They were also physicians, which is just heartbreaking.

***

I'm just exhausted. COVID has really stretched us thin, and after this night and everything else going on in this world, I'm realizing I need to take advantage of the free counseling at work. No shame in doing that. I'll keep you guys updated on how it goes. Thanks for listening.

Wednesday, May 20, 2020

Idiocy, part 2

Halfway through my charge orientation, you guys. It's going...well? Horribly? Who can even tell, these days.

It's a very weird sensation to be at the bottom of the knowledge pile again. With every new role I've taken on over the past 11 years, it's been the same feelings of crushing inadequacy and slight panic that I'm doing a terrible job but have fooled everyone into not realizing it. I guess those same years have given me enough foresight to realize that those feelings will pass, though. I've managed to adapt and learn and grow enough that I became proficient at the things I've tried, from triage to travel nursing to trauma care to precepting. I've even been through this charge thing before.

I got suckered into doing charge as a way-too-new nurse years ago. I was very fortunate to work at a great facility that supported me and taught me everything I needed to know, but I was definitely not feeling ready to charge at that point. Somehow, though, I got through it and managed not to accidentally burn the ER down.

Fast forward 8 years and I'm learning that my old relief charge job was almost...easier? While I wasn't as strong clinically, I think that ER had a much better flow and there was far less paperwork than my current one. It's only been a week of orientation here but it seems like I spend most of my time documenting all the things that happen - a sticker in the book of traumas, paging the stat system for every elevated lactic acid, remember to put a sticker in the stroke book AND page the stat system AND call the neurologist. STEMIs get paged to the stat line but you don't call the cardiologist on-call, you have to call the interventional doc. Everything goes into an email at the end of the shift, including all the information you just put into the log books. Keep track of your bed board, too! You're the one who has to make sure there are admit orders before requesting the bed. It's also global pandemic time so make sure the bed requested is for the right COVID floor. Sometimes there are airborne negative pressure rooms on other floors, but it's anyones guess as to which rooms those are. Better figure it out before you request the bed! All COVID-suspected patients go into a log as well, and you've got to keep a running tally of how many are admitted vs discharged. Sometimes people have to get tested twice! Especially psych patients, which means they get stuck in our ER for hours, maybe days. We've got exactly six rooms with glass windows/doors, and four of those are our negative pressure rooms. If you have a psych patient who gets swabbed, they're now on airborne isolation and have to go to one of those rooms. Where do you put the truly sick COVID patients when all rooms are taken up by psychs?

It's a massive juggling act, made so much more complicated by COVID. So far I feel like I've been doing nothing but paperwork, and really haven't been able to round the department to check on people, support them, re-distribute resources and make sure people have what they need to do well. Hopefully after learning the processes I will be able to get better at being an actual good charge nurse, not just a warm body sitting in the chair and getting yelled at by everyone while I'm busy putting stickers in books. Hopefully.

Saturday, May 16, 2020

Charge

BOY HOWDY was my first charge orientation...interesting.

It seems that I am in fact a shit magnet, so much so that the shift supervisor wandered by and after finding out that it was my first day kindly asked me to leave and not do this again. 

I felt a little overwhelmed with the amount of mundane details I have to learn, and I think the hardest part is going to be navigating the ever-changing COVID processes. Overall though I think this will be okay - everyone that has found out I'm going to be charging has been very supportive, which is a very nice feeling. It definitely makes me feel like I've been a positive part of the department, which is what I hope for. I'll never go so far as to drink the Kool-Aid and be like "this hospital is the be all, end all and you should be thankful you get the privilege to work here," but I do want to be a person who isn't a drag to work with and who actively strives to make the workplace better.

My most important goal is to become someone who doesn't charge to get out of work, but in fact does it to make everyone else's work better. I want to be the person who takes whatever frustrations I have with being a staff nurse and works to resolve them, as opposed to viewing charge as a way out from dealing with those daily issues. 

I also won't be doing charge full time. It will only be 1-2 shifts every two weeks, as they want to split the available shifts equally amongst the charge nurses. Their intention is to keep the charges from being solely a charge nurse. They want to have the charges also have regular staff shifts, which I think is a good idea. That way everyone has to deal with the regular COVID rooms, or take a group of four patients, or generally get shit on with a crappy assignment, just like the staff nurses do. If you regularly work a shift in the trenches, you can't get all high and mighty doing charge - you then split assignments and send help and cover your nurses as if you were the one taking that group, because on your next shift you probably will be.

Anyway, I'm optimistic that I won't be dog shit at this, and I'm excited to try something new. I hope I can be a good and positive charge nurse, and will strive for that by acting as if I am assigning myself those patients. Hopefully this goes well, and I'll keep y'all updated!

Tuesday, May 12, 2020

Idiocy

You guys, I'm an idiot.

COVID has wrecked our comfy little ER way of life, in addition to being the Great World Fuckery of my lifetime. My job is stressful at baseline, and dealing with this pandemic has brought on so many changes. Hospitals are losing money hand over fist, so budgets are being cut wherever possible. The first thing to go at our ER was any overtime shift. As in, you can't work it. We operate at a below-par staffing level anyway, and cutting out all the overtime shifts has meant twice the work with half the staff. Oh, you're gowned up in a COVID room and need something? Better hope your coworkers aren't also taking care of a COVID patient because there is no one extra available to help. Two priority 1 traumas coming in? No extra nurses coming to the rescue, because ain't no one there. You're intubating your respiratory distress patient in the isolation corner? Sucks to be you, because our isolation rooms are staffed by ONE person.

There's a wave of new graduate nurses, which while new grads are great I'm not a fan of having twelve of them at once. I mean that literally. There are four orienting now, four more that just finished two weeks ago, and four more starting in another two months. Plus another eight that have less than a year on the job. Training in the time of COVID has been an especially big beating. Try teaching hospital policy to a new grad when the policy will change by the time you've finished explaining it.

It's been one of the hardest, most stressful times of my life.

So what did I do? I said, "how can I make my life more stressful right now?" and replied to the department-wide email asking for charge nurse applications.

Y'all. I applied for one of the two open charge nurse positions available. They picked me (and another coworker who I think will be absolutely fantastic as charge and I want to be like her when I grow up).

I'm an idiot.




Wednesday, April 8, 2020

COVID-19 (4/8/20)

I'm still kicking, y'all.

It's been a weird couple of weeks since my last post. Our ER is still like a ghost town, since most of the usual BS complaints have finally figured out to stay home. It's amazing how few of the hypochondriacs come in with their typical complaints, once they've figured out that they can actually get sick and die just from being in a hospital waiting room. On the flip side, there's lots of people waiting too long to come in with serious complaints because they're scared and thus we're seeing worse outcomes in stuff that may have been treatable earlier.

And, of course, we're seeing a shit ton of MVCs and other random traumas because people can't STAY THE FUCK HOME. Seriously. The number of single-vehicle car accidents coming in with intoxicated people has just baffled me. We're all quarantined. You're not shopping at Kroger with a BAL of 280. Why are you driving? Who are you drinking with? WHY?!

On a much brighter note, our surgeon from a few posts ago is doing well! He's finally extubated and was recently downgraded from the ICU to tele. This really feels like a win for our hospital. Shit has been so stressful and I am so, so relieved to hear this news. He's obviously not going to be back seeing patients for the foreseeable future, but this is a huge step in the right direction.

One entire floor of our hospital has been converted to a COVID unit. I know there's a lot of shit talking between areas of specialty, in both directions, especially between ER and ICU and med/surg. It's what we all do. But I have got to hand it to these floors. They have literally nothing except COVID patients. I do not envy them, and I try to be encouraging when I bring a patient to them. There will be time for shit talking later, but for right now they need all the positivity they can get. Also they've got our surgeon up there and as long as they manage to not somehow fuck up and kill him, I may even refrain from shit talking them ever again.

I'm doing okay in my home isolation. My husband and I have managed to not kill each other yet, and we in fact have tackled house projects, hung artwork, done all the yardwork, deep cleaned, and not gained the COVID 19 pounds yet from eating everything in the house. I've been running outside since January - I was training for a 5k and when that was cancelled in March I just kept at it anyway. I'm up to an easy 4 miles now, and running a couple of times a week has really helped me clear my head and stay sane. A coworker of mine also gave out a phone number to a therapist friend of hers who has offered to do free video counseling for any of us in the hospital. I plan on taking her up on that next week, just to make sure my brain stays right.

I hope all of you readers are doing well also. These are weird, fucking hard times, and everyone has lost something - whether it's someone you know, financial stability, sanity, or a combo of all three. Do what you can to support those in a worse spot than you are, be kind to each other, keep an eye out for your neighbors if they need something, and do your part to stay home. 


Monday, March 30, 2020

COVID-19

On a lighter note, one of our doctors had to briefly stop by work yesterday. He put his mask on as per policy, and walked back into their charting area where he instantly caught a ton of flack for his attire.

The offense? Wearing flip flops.

As stated by a coworker, "He's fucking lucky this isn't ToeVID-19..."

Wednesday, March 25, 2020

COVID-19

Well, my last post was early this month. To use a metaphor, at that time I was standing on the dry shores of the healthcare ocean and thinking "I wonder if the tsunami will hit us?" A few days after  my post I noticed the waters start to recede, ever so slightly. The hospital volume dropped, we were wildly overstaffed for a week or two, and lots of people made jokes about hoping to get the coronavirus because then we'd get quarantined for two weeks at home.

It's now March 25, and I've found myself on that same dry shore, staring at a wall of water rushing towards me and knowing that even though I've tried to prepare it's still going to crash over everything. I'm officially fucking scared.

We've had plenty of positive cases at our hospital. I'm starting to see young, healthy people get admitted for respiratory compromise due to full blown pneumonia. We've had lots of older and higher risk people coming in, lots of whom are doing poorly. But that's all theoretical. I take care of hundreds of patients a year and don't know any of them. I don't know their life stories or kids, or inside jokes. It makes it easier to treat them, when I can view them as a medical problem in need of fixing.

But now it's real. A coworker of mine, a surgeon employed at the hospital, is the first one to be admitted from within our own ranks. He was doing well until he wasn't. Now we're wondering if he's going to be lucky and pull through this, but in reality we all know that he probably won't. And just like that, one of the people who helps keep our hospital afloat, one of the nicest people I know and such a fantastic surgeon, has been removed from the equation.

Yeah, I'm scared. And the scariest part is that this really hasn't even started yet.

***

I'm as prepared at home as possible, with a decent supply of food and water, a generator and accoutrements, and other necessary survival goods. I am not, however, emotionally prepared to lose people I care about. I was wondering what the defining moment of my life would be - some people have WW2, some remember market crashes, or JFK. I work with people too young to really remember 9/11, but for a long time I though that would be it for me. I was wrong - I think this is about to be the event that I remember for the rest of my life.

Tuesday, March 3, 2020

COVID-19

Well, here we go!

While my hospital has not seen any coronavirus cases yet, it's only a matter of time. I personally am not worried per se. I am cautiously realistic though, and recognize that while the current advertised mortality rate is around 2%, it's only lower in reality due to under-diagnosis. For treatment purposes this is definitely worse than the flu. We expect to see a rising influx of seriously to critically ill people in the coming weeks to months.

Our hospital has introduced updated screening criteria, including travel screening and as of this weekend, symptom based screening. I get annoyed having to read a bazillion emails daily from administration, but it is useful to know if one is working triage.

I am confident that our hospital can handle a patient coming in with coronavirus. I bet we can even handle a couple at a time. Where I start to lose faith, though, is if this really does balloon into a serious pandemic. I'm doubtful that our hospital can handle more than a few patients simultaneously. Each patient has to be isolated in a negative pressure room, and if samples are being drawn for the CDC then appropriately high level PPE gear donning and doffing procedures are followed. Each nurse donning/doffing gear has to have a coach to walk them through it. What if we have multiple patients, each needing this gear coaching? Our hospital is a trauma, heart, and stroke center. Will we be able to function as such, if staffing is spread so thin on the coronavirus patients? What will we do when receiving multiple critically ill trauma or stroke patients, but have no extra resources due to all the staff being sucked into the coronavirus cases?

It will also be interesting to see if all the usual minor ER bullshit patients stay home if this does blow up. I remember hearing from friends that when Ebola hit the Dallas-Fort Worth area, those hospitals were like ghost towns. Will the ankle sprains and chronic belly pain and dental aches stay home if there's a known coronavirus case around? I dunno, but I sort of feel like that will be the only way to handle the distribution of staff. Ain't gonna be a staffing problem if there's no patients!

Monday, February 24, 2020

Spa Day

One of my coworkers was telling me about a little old demented granny she took care of the other day. This LOL kept trying to climb out of bed, and even though we set the bed to the lowest ortho height possible it still wouldn't be a desirable outcome to fall and break a hip. My coworker tried everything she could think of to keep this lady in bed - but that granny was DETERMINED to get out of bed so she could make it to the salon for her manicure.

I'm not even lying. That was the reason for the great escape attempts.

After many failed attempts at redirection, my coworker finally decided to go get a bowl of warm water, a surgical scrub brush, and some soap. She sat there for ten minutes and scrubbed this lady's fingernails, put a bit of lotion on her hands, and then towel dried them.

It was like there was a new patient in the bed. She was calm, cooperative, and decided to take a nap after the manicure. I am a big fan of this coworker of mine, and it's for reasons like this. Also if I ever need a manicure, I know who to go to.

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.