The Price of Complacency..

This month we had a mandatory meeting on preventing injuries at work. This is always a big topic in health care. Health care workers (HCW) are at high risk for injury from their environment, ergonomics, patients, families and the tools we use. This meeting's topic was needlestick injuries.

Each year there are between 800,000-1,000,000 reported needle stick injuries to HCW. Out of that number it is estimated that 63% are incurred by nurses. With each injury there is the risk of exposure to Hep B/C, HIV, TB, Syphilis, Malaria and other infections. It is estimated that one in eight patients has one or more of these conditions.

HCW's are employed in an occupation that ranks second only to manufacturing in amount of time loss injuries. Every nurse in his/her career has a greater than 78% of getting a needle stick injury, from that stick they have a 30% of contracting Hep B, 3% Hep C, 0.3% HIV.

I have rolled that dice twice and won. My first stick was in the beginning of my career and the risk was minimal. My second was the one that took years off my life from the worrying.

I had a non English speaking undocumented homosexual Hispanic male patient in with high fever, sweats, one viral illness after another for months with large weight loss (Xray neg for TB) I was transferring blood from a syringe using an 18g needle (this is a big one) into a blood culture tube. For some reason I flinched and stuck the needle into my hand. I remember just staring in disbelief at the needle for what seemed like forever. When I return to reality I pulled the needle out, changed it, finished the transfer, then washed my hands and walked out of the room. I didn't mention it at all to the patient, and he didn't even realize it had happen until the Dr talk to him and asked for him to sign a release so that we could test him for diseases. I was so thankful that night that our Dr was Spanish speaking, and the patient agreed. I know of other nurses who's patient refused to allow the testing, and that nurse has been subjected to every 3 month blood testing for years.

My worrying was quite extended due to the fact that our employee health nurse was on vacation and I could only get the results from her. When the blood is drawn it is labeled with a number and not a patients name and we are not given the number. Only the employee health nurse has that information otherwise I would have just went to the lab and got the info I needed. I finally got the good news weeks later that the patient was negative for all tested. You should have seen the happy dance I did!

Since that stick 2 years ago I have had several bodily fluid splashes but nothing as serious as that incident. Working in the ER I know puts me at greater risk due to the type of patients that I deal with and the fact that I have often get into wrestling matches with them, and I never know what they have in their pockets until I get their clothes off. But I try to be more careful and more attentive when I have a sharp in my hand, where before I think I had become complacent.

A complacency that could have cost me everything.

Coming soon to an ER near you....

My ER has always been pretty relaxed about what the nurses wore to work. I think they were just happy we showed up. There were nurses that still wore the typical nurse scrubs , but most wore scrub bottoms and tshirts.

I hate nurse scrubs, I feel like a slob, and surprisingly find them very restricting of my movements..weird I know, so I typically wore cargo pants with a tshirt. I looked presentable, never had any complaints that my attire was hazardous to my patients health, never was revealing- granted I typically wore all black but I was comfortable and I thought that was the most important thing considering what I did for a job.

Well now the big-wigs have decided that we should all wear the same outfit, dark blue nurse scrubs. Why? Well some idiot voiced concerns that we could be bringing home MRSA and every other forsaken bug out there to our families on our clothes, so the hospital should provide us scrubs to change into. That is the dumbest thing I have ever heard.. really it is. I would love to find the person who voiced that concern and show my appreciation.


Since the nurses didn't have any input into what we would wear, and why should we, not like it is us wearing it for 10-13 hours straight, oh wait yeah it is, I thought I would fantasize about the uniform tops I would have picked out for the ER...

If only I was in charge.......

Who wants to play?

As an ER nurse, mother of a teenage boy, 2 more soon to be teen children, and the sister of a teenager this study frightens me.

One in four teens has an STD! A scary number I agree, but for me a worse number is 80%. What is that number? That is the percentage of those one in four teens that don't know they have an STD. Not those that chose not to disclose it but simply just don't know. That is where the problem is. It is those that don't know they are infected that cause the spread. And why don't they know? For some it is because they are symptom free therefore don't think they are infected. Those that have symptoms but are in Denial.( I love Denial... wish I could take vacation there more often.) Those that think they have symptoms but are too embarrassed to ask/seek for help. And of course the most prevalent of reasons among teens.. untouchable superhero. Those that just don't think it can happen to them. I think teens permanently move to Denial until they are about age 25.

In this day an age to have that many teens with STDs is outrageous and unacceptable. We need to do more about education, make healthcare more accessible to teens, teach both abstinence, and protection, and make sex less taboo, make it a dinner time discussion, along with other health issues. Make protection accessible to teens either in the nurse office at school or handed out with every big mac. ***Please note that when I talk about protection I am talking about barrier methods. I am not an advocate of teens on birth control pills/shots without parental knowledge or input for so many reasons. ***

We push anti-drug messages on kids from every corner of their world starting at a very young age. We teach our children to "JUST SAY NO!"so why can't we take that message and teach our children to just say no to STDs. Sex without awareness and proper protection is playing Russian Roulette with each act.

I don't know about you but one in four is too high to play. Even one in a million is too high..especially if that one could be your babe.

My Top 25 Patients

• Here is a list that I found both very interesting and also very depressing that my employer put out listing the top 25 reasons our patients come the ER. As you can see there are very few true "emergencies"that needed to be seen at 3am. The list is in order of the number of cases that were seen during the most recent monitoring period.
  
  
  
  
• CHEST PAIN (not a heart attack)
• ABDOMINAL PAIN
• ACUTE UPPER RESP INFECTIONS
• SPRAIN/STRAIN LUMBAR REGION
• GASTROENTERITIS (diarrhea/vomiting)
• PNEUMONIA
• ACUTE BRONCHITIS
• OTHER GENERAL SYMPTOMS (potpurri)
• HEADACHE MIGRAINE
• SPRAIN/STRAIN OF NECK
• VIRAL INFECTION (a cold)
  
• URINARY TRACT INFECTION
• LUMBAGO (low back pain)
• OTHER ACUTE PAIN
• SYNCOPE/COLLAPSE (fainting)
• ALTERED MENTAL STATUS (drunk,OD to more serious stroke)
• RESPIRATORY ABNORMALITY
• CONGESTIVE HEART FAILURE
• VOMITING ALONE
• ACUTE OTITIS MEDIA(ear infection)
• OBSTRUCT BRONCHITIS (COPD)
• ASTHMA
• SYMPTOM FEMALE GENITAL ORGANS(STD check)
• DIZZINESS/GIDDINESS (drunk,on drugs)

I call do over!

Here I am 10 days post-op and I will say I am so thankful I will never have to go thru this again. Knowing what I know now and given the choice I would go back in time and not have shown up for surgery to begin with!

The night before surgery I ate and ate until midnight that magical NPO hour that just about every surgeon picks. It is never 0030 or 2330, but straight up midnight. I often wonder how this hour was chosen. I understand the reason for it completely, but would one day love to hear a Dr say NPO starts at 0015 just for kicks.

Surgery itself I think went ok. I woke up and I didn't notice any burn marks across my chest from the paddles being applied in such rush no one put on the gel pads, my throat hurts, so it appears the Dr operated on the right surgical site. I had a hard time initialing my tonsils but I think he got it right.

Recovery..well that was fun. I am very sensitive to medications and I hate that euphoric feeling, that high from narcotics so many people come thru my doors hunting for. I also am a control freak, a real type A personality and alot of these drugs give the sensation of being out of control or not caring. So that being said according to my chart left at my bedside by my nurse I came out of anesthesia "emotionally fragile". Who me? The Er nurse from hell, that lives by the motto "K-Y optional" when placing objects into orifices. Yep that was me.. sitting up on my gurney with a pile of tissues crying for who knows what reason and who knows for how long. What co-workers and many patients would have paid to see that!

My time at home I wish had been uneventful, but because I am a nurse that goes against some cardinal rule in nature. At first my problem was rapid swelling of my uvula (you know that tissue hanging down in the back that everyone thinks is their tonsils), it swelled so much it was laying on my back tongue. Even for an ER nurse that is scary to see when you look in your mouth and you can't visualize your throat at all. In all reality I should have returned to the ER for close airway monitoring, I kept this little tidbit of info to myself because I am an ER nurse and we do that.

Next because of the airway issue and swelling I was unable to swallow so I was dehydrating, what does an ER nurse do? Put in her own IV!!!! I am quite talented! Next a family member brought me the gifts of viral influenza and cold symptoms. Yes can you imagine vomiting, coughing or sneezing after having your throat operated on? Let me tell you this is a bad mix. Needless to say this meant an ER visit. There are days when working in an ER has it's benefits. That day was one. No wait just straight into a room IVs started with meds. But because I was at my own ER HIPPA did not apply to me. My friends kept coming in checking on me after word spread that I was there. Which was ok... they had what I wanted ZOFRAN!!! Zofran that magical anti-nausea medication. I love the stuff. And thank god it works for me.

Hopefully my days as a patient are quickly coming to an end. I don't think me or my family can take much more of this. I have been a terrible patient, but hey I am an ER nurse what can you expect..I learned from the best.. my own patients.

Say Ahhh Er Nurse.....

In 12 hours I will turn into a patient.. the worst thing a nurse can hear. In 12 hours I will become "that dreaded patient". Healthcare workers hate taking care of each other. There is always that feeling that the job we are doing is being judged, and worry about making a mistake an being called on it or "educated" by our patient.


In 12 hours I will walk into my hospital and let my co-workers ask me those horrible personal questions,"Now what medications are you on? and what are they all for?" Then place me into one of those gowns, and parade me down the hallway in full view of everyone, "OPPS sorry ER nurse we forgot to get you a robe..HaHa!, and then bring in the greenest nurse (with 20/400 vision) to place my IV.. "Opps sorry ER nurse looks like baby nurse put a 14g IV in.. that didn't hurt much did it?" Haha!

Why would I subject myself to this type of abuse you ask? Well if you were asking my SO he would tell you because I deserve as much pain/abuse as I dish out to him in life! But really I have decided to finally get my tonsils out. Are you crazy you ask? Well if you ask my SO... well we all know what he would say! So 20 years after I should have had them out as a child I finally have decided to get it done. Or should I say after 20 years I finally have the guts to do it. Of course waiting that 20 years has made this a more painful and dangerous procedure.. but hey I never claim to be the brightest patient, I am a nurse remember.

So all wish me well.. and wish my SO luck and alot of it, he is going to need it, he is going to be the one stuck home with this crazy nurse for a patient. Now where can I find one of those metal cow bells?!

Bad nurse! No breaks for you!

Here we are the 2nd week of March and already my NY's resolution is being challenged.. by my bosses!!!

As you remember my resolution was to make a real effort to take my lunch breaks or at least take time to leave the floor for a quick walk outside..get a mental break. Well I have been making great progress with the mini walks, I have only managed one 30 minute break. That was a great break, I even left the hospital for a trip to the store for something to eat..What a treat!!

Now a challenge has arrived to my resolution in the form of patient and administration temper tantrums. Our patient loads have really increased this year. The ski season has been great so we have been inundated with skiers and snowboards that went from riding their boards to strapped to one of mine. Also with the flu season in full swing and the flu vaccine only covering 40% of the strains out there we have been wall to wall patients. On most nights it has not been unusual to have every room full, all the fast track rooms full and resorting to parking gurneys in the halls wherever we can find a spot and taping a number above their heads. And nurses are being begged to stay overtime, night after night.

With this much influx of patients and no change in the staff levels to cope it only makes sense that the wait time for the non serious patients, ie cold symptoms, ear aches, headaches, and all other ridiculous reasons people feel to come to the ER at 2am has gone up along with the gripping about the wait. The nurses are moving, and so is the Dr and PA-C. But the patients in the waitroom don't see this. They just see the clock ticking by and are still sitting there. It is worse when we have Gold Card Members (patients who come to the ER once a week for "are you kidding " reason) who are use to being seen within 20 minutes.

As expected the complaints to the administration has gone up. So after much analysis by these suits, who have never worked the floor as a nurse, they have decided to lay the blame for treatment delay on the nurses. Yep they decided that the nurses breaks are causing a delay in care!!

So effective immediately nurses are suppose to delay their breaks until the waiting rooms are empty. Hmmm do I hear labor law violations? Union contract violations? Human rights violations? (I have a right to pee when I need to you know!!)

As you can imagine this has not gone over very well. As I have said before.. pissing off nurses is not a smart idea.. we have such creative ways of getting even.. so that being said let the games begin!! We'll see how long this new rule lasts!

You know it is going to be a bad night when...

• You show up for work and notice bars have just been installed on all the windows and there is now a metal detector at the hospital entrance.
  
• 
  The paramedics in the parking lot are all using mops to clean up their ambulances and the EMTs are using a hose.
  
• 
  The off-going shift has a hard time keeping a straight face when giving report, especially about Room 15.

• Your first patient of the day insists there is no way that she can be pregnant. As she's crowning.
  

• Your next five patients and their families all scream at you in different languages, none of which you speak.
  

• Your next patient screams at you in a language you do understand, but you can't remember hearing that many obscenities strung together at once.
  

• The intoxicated 250 lb. transvestite in Room 15 keeps trying to get your home phone number because you "are just too sweet."
  

• Your next patient has maggots but isn't dead.
  

• All the locked restraints are being used...on one patient.
  
• 
  The hospital has a surprise disaster drill. You were the only one who wasn't tipped off.
  

• No one remembered to buy coffee,candy or chocolate.
  

• You have writers' cramp and still have 7 hours of the shift left.
  

• The psychiatric patient who thinks he is Jesus was placed in the same room as another patient who thinks he is Satan.
  

• You get a subpoena for a lawsuit a on a patient that walked out of the department against medical advice two years ago.
  

• In the middle of a disaster drill two real trauma patients present themselves.
  

• The paramedics who offered to go out and pick up lunch (and coffee) just advised over the radio they have witnessed a motor vehicle accident involving a transit bus versus a minivan. "Stand by for update."
  

• It's the first day for the new medical interns, paramedic and nursing students all at the same time.
  

• The paramedics tell you the patient you just received with a closed head injury, flail chest, and positive belly tap is in "much better shape than the one still being cut out of the minivan."
  

• You hear there is an influenza epidemic traveling like wild fire through the local convalescent homes.
  

• The psychiatric patient's delusions are beginning to make sense.

**I wish I could take credit for this, but I can't. If you know who wrote this, please ask them to stop stalking me or at least put on some scrubs and help out!**

You have a what --where?

It my many years of nursing it never fails to amaze me the things that people feel the need to insert into their various orifices..


Of course in the ER we see alot of children with the usual bean up the nose, but we also have seen legos, toy car wheels, dice, beads, stickers, peas, barbie shoes and of course small marbles.


The thing with kids it is innocent curiosity. With adults..hmm that is a whole other realm.

I think I have seen the gamut..

*Fruits and Vegetables *Broom Handles *Flashlights *Sexual Devices
*Car Keys *Gun *Money * Drugs *Forgotten Tampon * Condom

*Drinking Glass *Kitchen Tools * Candles *Meat Products *Moths

*Lightbulbs* Glass Bottles*

My favorite part(if there can be one) of taking care of these patients is finding out WTF they were thinking that led them to my triage room. Some items on the list were self explanatory. But I think others need some more details...

Let's start with the innocent patients.. the ones who on a warm summer night decide to sleep with an unscreened window open and wake at 3am with something crawling around in their ears. It almost always is a moth. After calming down the hysterical patient we flood their ear canal with lidocaine paralyzing the insect and then drowning them making it easier to remove much to the relief of the hijacked host.

The car keys and money..well those were females out on dates and didn't have a purse to place their belongings during a romantic walk on the beach... *think about that the next time you place money in your mouth. The car key chic told us about them in triage.. The money I found when I went to cath a female for a urine sample...surprise!

The gun was also another female. The police were taking her to jail but she kept setting off the metal alarms. She was brought to the ER for exam and a CT showed a loaded gun in her V. She was taken to surgery for removal and then to jail. I would love to have seen the radiologist's face when those films came across his lightbox!!

Forgotten tampon? How can you forget that? That is one I will never be able to understand. Usually it is the smell that brings them in... yuck

Now I am a very open minded person, very liberal in my thinking when it comes to sex, but there are times for even me when I have said enough. One such case was the young, very successful male who came into the ER complaining of abdominal pain. What was not disclosed to the triage nurse was the guy had a sexual device stuck in his nether region. No big deal I thought!

Wrong! It turns out this was the 5th time this had happened. The 5th time that he would need to go to surgery. 5 times!! Are you kidding me?! You would have thought he would have figured out what was going wrong. Well I guess not, so I took it upon myself to do some patient education...

That is part of nursing, but I don't remember covering this topic in class. Must have been napping. So time to wing it. What can I suggest? Stop the practice.. not going to happen why waste my breath. I got it- longer toys! Well maybe, but I think the real solution A LEASH. Tie that puppy to a leash and then anchor it to the bedpost. Can't go wrong there, when things start to get a little "out of hand" just give a little yank and on with the fun.

I thought the idea was genius and should be patented.. The surgeon did not share my excitement, nor did the catholic administration of the hospital I was working at the time. But you know I never saw him again in the 4 years I was there afterward!! Score one for the nurse!

The newbies.....

They have graduated and now transporting to my ER.

I wish this was just a joke... but it is so funny because how many times I have seen this.

Don't forget the whip....!

"Grande size vanilla latte in a venti cup with extra whip

with a side iced water"

That is how I start my nights. I stop by the local coffee shop say "HI" to the girls catch up on their family issues and hand out a little common sense approaches to their medical questions and off I go to work.

I love starting my nights like this.. sometimes they are the only friendly faces I see in the night. And alot of times without them I would crash long before my shift would have ended.

So Thank You girls.. for getting my ass movin' with your hot luscious sweet drinks... from me, my co workers and patients!