Not Paid Enough...

My night sucked....

Way too many drunks, way too many people getting their butt kicked, and too many who couldn't hold their own...

ER nurse got thrown up on TWICE last night..well almost three but the OD lady missed me.

The 1st was a good looking Marine...(If only I was 20 again!!) I forgave him... he lost it after I unwrapped his lacerated finger and he saw all the blood.. oh and he also fainted! He was so embarrassed and did I mention good looking?!

The 2nd..NOT so cute, a drunk (Schnapps and Flops) brought in by medics after being found down outside non responsive, with blood running out of his ears. Schnapps and Flops had a brain bleed and vomited everywhere including into ER nurse's hair during his stay..

Now why do I keep showing up for work?

How many can you take on??

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Say What??

I kid you not this is what a Dr wrote as an admission order---

"Treatment for Insomnia-warm herbal tea or milk, white noise at low level (tv or radio) and BACK RUB at HS (hour of sleep)" .

I am not sure what the Dr was smoking or the patient either for that matter, but that order is not going to happen... there aren't enough nurses as it is to take care of all the patients' "APPROPRIATE" orders...

Plus last I checked I work in the hospital not "Mona's Magical Hands Massage Parlor"!!!!

Got insomnia? Take a pill like the rest of us!

Nobody Move!!!

Fall Assessments on Everyone!!!!

At our staff meeting today the Boss revealed one more thing for us to assess while in triage. Starting immediately every single person that comes thru triage has to be given a fall potential score and we must then figure out how to prevent it from happening while in the ER .

Why now..because some family brought in Grandpa for agitation and while in the ER THEY were walking him around when he fell and fractured his hip. The family has gotten a lawyer and said it is our fault he fell and was injured because we did not educate them of the potential for falling and injury!!! Are you freaking kidding me?! What the hell is wrong with people now a days?!! Who doesn't know that the elderly fall? Plus wouldn't the family be better than me at assessing his fall potential?

So my question is what about toddlers just learning to walk? Every time they fall in the ER am I suppose to CT them? What about infants? Should I forbid parents from holding their babes because they might drop them, and do I have to fall assess the parents since they are holding the baby?

What about the potential of falling off the gurney? That could happen to anyone. Put the rails up? They could fall thru them or climb over them and fall...Hmm what to do??

I know...everyone who comes to the ER is immediately placed on a Back Board and strapped down and placed on a mat on the floor. That should solve the falling problem.

People's escape goating and stupidity..still no cure!

The Next Dozen are on Me!

Working in the ER I get a lot of interactions with the police.. almost as much as when I am driving (Er nurse has a little bit of a lead foot!!).

For the most part our interaction with the police consist of them dropping off their "gift" of a

(mental, injured, drunk, tweaking, screaming, spitting, fighting or any combination of) patient for us to deal with or they just need a quick "okey dokey for the pokey" otherwise known as a "clear to book" in jail. Then they are gone.

We also get their assistance when a patient is out of control and we need them to assist with restraining or tasing, as occasionally happens as we do not have security at our hospital (the suits don't deem us worth the expense of even a little old retired high water pants, white sock wearing grandpa). And then again they are gone..lickity split.

So this weekend when all hell was breaking loose, and I was running from one crisis to the next, multiple ambulances were stacking in the bay waiting to offload new disasters I was SOOOO appreciative that ONE officer realized what was going on and stayed with his perp and helped keep him in line during his stay, even though I know he was getting yelled out for not returning to the streets by his Lt.

So Mr LEO, to thank you I promise to slow down in your jurisdiction, and be mindful of those silly 4 way stops... well at least for this week!

Any Takers?

If someone were to offer me a million dollars right now I would walk away from nursing and never look back.

Actually I would settle for 250k, OK how about 100k...still no offers? Come on people.. work with me.. My night was so bad I am tempted to call off dead the rest of the week.

Alright since no one is willing to help me out I am off to bed I will blog later all about my nightmare night....

You smell smoke?

I will never understand my patients lying to me...

Do you think I am new at this, stupid, gullible, not paying attention, that you are the first to try these stunts or that I actually give a care what you do for recreation?

I actually don't care for the most part if my patients get high... it is your brain cells you are cooking not mine. What I do care about is if I ask tell me the truth. But time after time you patients look at me and bold face lie.

For the most part I already know this and just leave it at that but then there are patients that I absolutely need to know the truth to see if it is contributing to something I see that is concerning. Even in that situation you still chose to lie.. Why? Your blood will tell me how much you have had to drink and your urine will tell me what drugs are in your system. And when I get the results I will be pissed and confront you and for that little lie..no narcs for you and you get kicked out. So lets just skip that drama and tell me the truth.

Now for my other patients that like to lie are my pseudo-suicide patients. The games you are playing with your family I do not find amusing, nor will I fall for your attention getting BS. When you tell your family that you took an OD of pills and hand them an empty bottle I WILL KNOW THAT YOU ARE LYING and for that you get to drink charcoal or get your stomach pumped even though you are fine. Do not tell your family you took an OD of narcotics, I can test for those and when the test comes back normal I will be pissed. Do not tell your family you took an OD of sleeping pills and alcohol, cause I can test for those also and I can tell from your vital signs that you are lying. And when I have proof of this I will show your family and educate them on the games you are playing.

Do not try and fake seizures or unconsciousness either with me.. I have ways of proving your are faking and you won't like what I do to you...but me and my co- workers will get a good laugh out of it.

So in general don't insult me and my co-workers and think you can get one over on us. We are smarter than you, more conniving than you and have ways of making you pay.

Remember KY is always optional!! So just tell me the friggin truth!

Why me....

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

There is no one at home to make you a lunch, your latte girl is on vacation and the new girl has no idea your drink and you have to explain 10 million times and she still screws it up.. there is no parking when you get to work so you have to hike Mt Everest to get there, there is standing room only in the waiting room and they look like vultures at you when you walk thru the door , the first thing they say to you as you hit the floor "Really we aren't dumping on you" . And when you pitch in for take out your order is the only one messed up.

Damn I knew I should have called off.

Never Acceptable......

Foster Mother’s Pain Patch Is Responsible in 6-Year-Old Girl’s Death

NY Times
By AL BAKER
Published: May 20, 2008


A foster mother in Harlem has been arrested and accused of accidentally killing a 6-year-old girl in her care by placing a powerful medicinal patch on the child’s neck as treatment for pain, the authorities said on Monday.

The girl, Taylor Webster, was pronounced dead at Mount Sinai Medical Center in Manhattan on Sunday evening, and her foster mother, Joanne Alvarez, 54, was arrested and charged with second-degree manslaughter, which is a felony, criminally negligent homicide and endangering the welfare of a child, officials said.

The pain-relieving patch, known as a fentanyl transdermal patch, delivers through the skin a narcotic drug that is more powerful than morphine. Ms. Alvarez also gave the child some Motrin by mouth, the police said.

The strength of the prescribed dose is based on the patient’s weight. Ms. Alvarez weighs 260 pounds; Taylor weighed 59 pounds. A detective found that the label on the fentanyl stated that it should be kept out of the reach of children, the official said.


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Where do I begin on this one...? YOU STUPID FREAKING MORON!! You are so lucky you did not cross my ER doors with that child Ms Alvarez, if you had there would be nothing left of you to prosecute!


You brainless idiot you gave that sweet child a drug that is used primarily in advanced cancer patients who's pain is thru the roof. Fentanyl is *ONE HUNDRED TIMES* stronger than morphine and you gave it to a 56lb 6 year old! Where in your minute brain did this sound like a good idea?


Hey NY let me know when you need me to show up for jury duty! I hope they throw the book at you Ms Alvarez.



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Parents PLEASE do not treat your child's illnesses with your own prescription medications. We dose children's medications on their weight, and there are A LOT of drugs out there that are fatal to children when dosed wrong. For pain Tylenol/Motrin works great, if you think your child needs something stronger call their Dr, so this tragedy never happens again.

The patient always knows...

Old man Jacobs the sweet, lonely slightly kookie neighbor we all have in our neighborhood was brought in by medics last night after neighbors noticed that he was a little "Kookier" than usual.

Upon his arrival I asked him all the neuro questions I ask everyone..and the only question he had problems with was time... Old man Jacobs must have had a good 1943 because he was hell bent that was the year.

During my questioning he told me that he had felt a bit off for the last few years but he could not exactly say why. He said he had seen numerous Drs over the years but no one ever found anything but also never really did any testing. He stated that he felt they didn't listen to him and he hoped we could figure out what was wrong. To be honest I did not have high hopes for this. But if I had to have guessed right then I would have said senility or your basic geriatric changes.

All blood work was normal. Urine normal (Urinary tract infections in the elderly causes mental changes) EKG normal. Chest Xray negative. Old man Jacobs blood alcohol 0.00, and his drug test was negative. Time for a brain scan...

After returning from the CT scanner, and while waiting for his results he told me about being widowed a decade earlier and of never having had children, or any family for that matter. He considered his neighborhood his family, and enjoyed his daily walks as he stopped and chatted with some and gave gardening tips to others. He watched as the children grew and had made friends with all the animals.

Old man Jacobs with his peaceful voice and great story made me wish I was his neighbor..

I wished even harder that the radiologist was wrong with his diagnosis.. A large mass in his brain that was so big it was actually shifting his brain toward one side.

Old man Jacobs has brain cancer and when told of this the first thing he said was "Thank you" he thanked us for figuring out what was wrong and for telling him honestly and too the point.

As we were getting ready to transfer him to the big neuro hospital for care I asked him if there was anyone I could call for him.... he thought for a minute and asked if it was possible could I locate the neighbor who called for medics and apologize for causing them such concern and let them know he was ok and he would be home after he took care of something..

Anything for you Old man Jacobs.. in our brief few hours together you won my heart and reminded me why I put on those blue scrubs.

Happy Dance!!

Good News!!!!

Rumor is the Boss giving ER Nurse such a headache is on his way out!!

Hopefully he takes those new ugly blue scrubs with him!

Primum non Nocere

I am always the first to say that any monkey can pass the nursing boards when people express their awe that I am an ER nurse.

But truth be told, in actuality it is tough to get into a nursing program in our state. For most of the programs there is a 18-24 month wait list. It takes more than good grades to get in. You have to also be interviewed, have a good work history, go thru extensive background checks and be highly recommended by past and current employers and acquaintances.

Once in the program it is even harder to stay there. On the first day of class you can look around and know that come graduation 50% will have failed or bailed out.

With all the obstacles,work,sweat and endless nights studying to get your license it always amazes me that a nurse would do anything to jeopardize it. I protect my license with my life. It is what makes it possible for me to support my family and keep them well taken care of.

There are many ways to lose your license including practicing outside your scope, substandard care, falsifying documentation, assaulting patients, being convicted of DV in your personal life, and the one I find the most unbelievable the diversion of narcotics.

It is estimates by the ANA that 1 in 7 nurses has a drug/alcohol addiction. With approx 3 million nurses holding a license that is a lot of caregivers in need of help themselves.

I have worked with several nurses that have had drug issues and been caught diverting drugs but thru a drug rehab program for medical personnel have been able to keep their license all be with extreme limitations and hoops to jump thru.

They must first go inpatient for detox, after completing they must submit to random drug testing, attend either AA or NA weekly, have their work schedule modified, are not allowed any overtime, working nights, or be a supervisor. They are restricted from handling narcotics for at least a year, and must go thru psych counseling and comply with their recommendations. These requirements last for a minimum of 2 years but can be extended if they deem necessary or the nurse messes up.

When these nurses complete all that the state nursing board asked of them their record is cleared of all charges and their license is return to full activity, but for me I have a hard time just letting it go.

I have a hard time trusting them again and refuse to ever sign off on a narcotic waste with them, as I have no idea if the clear liquid in the vial is a narcotic or water. My biggest issue with these nurses is that generally they obtained their drugs by signing them out in the pyxis under the guise of medicating a patient in pain, and instead pocketing the med. And later when the pt request pain medication I have to refuse them because according to the records they had already been medicated. A patient has to suffer in order for them to get high.

And that I find unacceptable. Our patients trust us to care for, comfort and advocate for them. But nurses can not do that if they are high or preoccupied with how to get their fix instead of remembering "Primum non nocere" FIRST DO NO HARM"

Wakey Wakey ER nurse....

Last night I was suppose to be off, after working 5 nights straight and one hell of a weekend..I was looking forward to curling up in my bed with a good TV show and nodding off for a good nights sleep... It was not to be.

At 11:30pm my phone rang and it was the ER saying they were slammed and I needed to come in and help. The big hospital ER in the county got slammed and went on DIVERT, so the ambulances that typically go there came to us quickly filling us to over capacity causing us to go on Divert. That is when they called me... I might have said no, forget it I am already in bed, but they used an unfair tactic...they had my best friend who works in the ER call me and ask me to come in and help.. Of course I could not say no... damn her!

Here is a sampling of what pulled me out of my bed....

One pt was a surprisingly nice chronic drunk who was 5x the legal limit out riding his bike when he fell and at first appeared to have just facial lacerations and extremity abrasions. But since he was my pt we all know that would be too easy.. His head CT showed a brain bleed with numerous facial fractures and broken ribs. Off to the Level 1 trauma center for him.

Another pt came in with multiple burns to face/arm and leg after spilling the broccoli she was cooking... Her and her companions were placed in a room and while there they rummaged thru the cupboards and drawers were unable to sit still, turned equipment on and off, twitched and tweaked and generally scared her "roommate"... Broccoli my A** more like cooking meth and it exploded. A common hazard in that "line of work". I kicked her companions out and placed her in a chair next to the nurse station so we could keep a closer eye on her till discharge.. Once again this tweaker entertained the rest of the patients with her antics.

A tonsillectomy patient that was now bleeding post-op..never a good thing. Because this was my worst fear after my recent surgery this patient was pampered by me.

A co worker's child that had the "stomach flu" what we call gastroenteritis.. This child had such severe vomiting and diarrhea that he was beyond dehydrated and actually was in acute kidney failure. Not something we see in the young very often.

Of course there were numerous babies with fevers, and runny noses, several patients with broken bones, a child with an allergic reaction to his antibiotic, and patients with asthma exacerbation, and congestive heart failures.

All in all I stayed 4 hours and got paid for 8. Nice bonus and my patients were actually pretty decent, even the meth head.

I could get use to working 4 paid for 8. I wonder if they will let me make it a permanent thing?!

Self treating to the Extreme!!

Man Uses Knife for Self-Tracheotomy
AP
Posted: 2008-05-09 15:30:50
Filed Under: Health News, Nation News


OMAHA, Neb. (May 9) - An Omaha man struggling to breathe used a steak knife to perform an at-home tracheotomy. Steve Wilder said he thought he was going to die when he awoke one night last week and couldn't breathe.Wilder said he didn't call 911 because he didn't think help would arrive in time. So, the 55-year-old says, he got a steak knife from the kitchen and made a small hole in his throat, allowing air to gush in.


"It just blocked all the way and I just got up and I panicked," he told a local TV station, WOWT in Omaha. "Got a knife and located it and pushed in and blood went gush."Wilder suffered from throat cancer and related breathing problems several years ago. About that time, he had an episode where he couldn't breathe because his air passages swelled shut. He said that's what happened this time around.Doctors don't expect Wilder to suffer any adverse affects from the tracheotomy once it's healed.

Why can't more of my patients be this resourceful?!

Our Week

Happy National Nurse Week!!

Buzzed Geezers

Grandma and Grandpa went to the tavern this weekend for a nightcap...witnesses later called 911 after seeing them falling down while walking home.... Grandma had 'just a wine" and Grandpa "2 Gin and Tonics"...

Our State's Blood Alcohol Legal Limit 0.08

Grandma's Blood Alcohol 0.307

Grandpa's Blood Alcohol 0.431

One glass of wine and 2 Gins....? Righhhhhhhht!!

Final Answer...

"The crime of suicide lies rather in its disregard for the feelings of those whom we leave behind."
E. M. Forster quotes (English Novelist and Essayist, 1879-1970)

My ER beds have been filled the last several weeks with lost and desperate souls. We have never seen so many genuine attempts at suicide, that if not been found by someone would have been successful.

Working in the ER we get alot of pseudo suicide attempts. In actuality they are attention getting stunts, Lonely Laura takes a bottle of pills and then immediately calls 911, resulting in getting her stomach pumped and a consult with our emergency social worker(ESW), or Dumped Dan who cuts his wrist then calls his EX to tell her what "she " has caused him to do, resulting in police bringing him in, after tazing him, for sutures and a consult with a ESW. Each case causing family and friends to rush to the ER and giving the patient what they wanted=Attention.

These patients are very frustrating to deal with. They typically are very emotional, dramatic and manipulative. They treat their loved ones horribly and hold them fully responsible for their own self harm. They put their families thru these emotional rollercoasters time and time again.

They bring out the worst in us nurses.. resulting in us wanting to tell them how to do it right next time. But sometimes they figure it out on their own.....

This last week we had a 30yo paraplegic hang himself with the machine used to lift him out of bed leaving his wife and children behind; an elderly man who placed a hose from his car exhaust to his passenger window after losing his wife, a loaded gun was found at his side; a 50yo man who took a massive OD of pills and alcohol because he faced foreclosure on his house due to an injury keeping him from working; a mid 40's male who ran into traffic on the freeway after fighting with his wife; a 30s male hung himself when faced with an extended prison sentence; a 50 yo woman distraught over a relationship ending slit her wrist in front of her daughter, a 14 yo girl in teenage turmoil took everything in her parents medication cabinet, and finally a 12yo boy with a long history of mental/emotional problems in his short years, mixed alcohol and his psych meds. (These were just my night shifts, there were several more on the other shifts.)

These cases take a toll on ER staff for different reasons.. When they come in it is a fight to save a life they no longer wish to live. When the patient is "successful" the families are hit with the shock of it, then grief, anger, confusion, and guilt... I watch them go thru it before my eyes and I struggle to find the right words to console them.. Families flood us with Whys? and How could they?... The answers elude us.. Forever locked in their loved one.

I will never understand the dark place these patients find themselves, where there is no other solution or person to turn to.. But I hope I am able to prick a hole in that darkness by showing them I cared enough to fight the fight to make them "Failures".