Buttkicking Certified

I spent 9 hours today in class at Big ER learning how to verbally de-escalate an aggressive patient and how to physically fight off an attacking one..

Rural ED could have cared less about my physical safety.. despite being attacked there several times by patients including one time warranting police to come and arrest my patient and charges filed, rural hospital never thought I or my co-workers were worth protecting so that we could go home to our families safely. (Administration never even called to check on me after that incident,despite the fact I was injured)

But Big ERs 1&2 are paying for me to have this training AND they also have 24/7/365 security with local police also making indoor/outdoor patrols. It makes me wonder why I stayed for 4 years at rural ER.

Class was fun today but tomorrow's 9 hours will be better.. I get to learn choke holds, subduing and how to drop a patient twice my size.... This is my kind of nursing class!!

TB/Demons/Gomers oh my

I went today to have my TB test placed and I swear the Employee Health nurse stuck me with a 14g needle! With all the bleeding I did I was wondering if maybe I should have my H&H checked!!

Next I went and did my pee test* ...Such a sad statement that it is required, but in actuality as I have talked about before there is a disturbing percentage of healthcare workers who "self medicate"---On a sad side note, this week a nurse I have worked with for years was fired for being high.. she is currently in the HPS program *** Health Professional Services (HPS) is a confidential program for chemically impaired health professionals. HPS ensures early entry into recovery for the impaired practitioner while providing maximal protection of the public safety *** But the challenge of sobriety was too much and she relapsed. I wish her the best and am THANKFUL I have never had to battle that demon.

*My test was of course (-)

Last night I went to #1 ER to bring a latte to a nurse friend working a late shift, since I do not have my badge yet I sat in the waiting room till she could let me thru to the back...if I had any concerns that I was going to miss out on the murky gene pool that rural ER served they were completely eliminated... This job is going to be fun

Love Me?

Where am I ?

ER nurse has finally left rural ER and now is working at the 2 biggest ERs in the county. I was going to just work at the biggest one, but as those in medicine know we are a small world and #2 in the county found out I was looking for a change and offered me a job as well. And as any good ER nurse I am a glutton for punishment and now scheduling myself for both jobs orientations, new hire education classes and precepting.. Thank God I am an experienced ER nurse so my precepting will be short as in a matter of days and not months as some new ER nurses need.

Hopefully working in these 2 ERs will bring more excitement, trauma and occasionally a good Tasing! Stay tuned ....

Nice try...

Rural ER has finally decided to listen to their staffs' concerns over safety and hired a security firm at night... that is great progress BUT they won't be armed, can't put a patient in restraints but hey at least they are trained in verbal de-escalation.

Great in other words it is up to the nurses still to physically deal with meth'd out, drunk, violent, psychotic patients... They just don't get it do they.

Stress Reducer

I saw this link on another blog and laughed so hard I was crying...

http://failblog.org/

W.A.G. System

Patient comes in tonight with an insulin pump infusing thru the skin on his abdomen. A new nurse had never seen this before and this patient was more than willing to explain it to the nurse.

Patient very seriously explains how the machine works, how it transfuses into the skin and that he changes the site every 3 days. He then explains how he decides how much extra insulin to give himself based on what he ate for his meal using the carb exchange. And then he talks about the basal (how much insulin infuses continuously every hour)setting and how he changes it based on the WAG system.

This new nurse looked at the patient and then at me in confusion.. I could tell that his mind was going back to pharmacology class trying to remember the WAG system. After a minute or so I decided to let the nurse off the hook and asked my patient to explain WAG.

WAG- Wild Ass Guessing! I love new grads--- they make my nights so much more fun.

Altered LOL

Grandma brought by family after having Mental Status change... Grandma has been falling, slurred speech, confusion and lethargy for 2-3 days.

Grandma has chronic pain issues and recent fall which exacerbated chronic pain.. Good intentioned PCP prescribed Fentanyl patches (25mcg dosage) to get her off oral narcotics and try and give continuous pain control.

Grandma did not understand directions of use (change patch every 3 days). Grandma arrived covered in patches.. Applied every time and everywhere pain was bad..

Grandma was STONED.

*Dilaudid is 8x stronger than Morphine. Fentanyl is 80x stronger than Morphine.

New ICD 9 Diagnosis

A trucker from the southern US passing thru our town was brought in after drinking too much and passing out at a bar while on stage...(medics informed me of his musical preference) His BAL was 0.456 almost 6x the legal limit so he was less than alert and orientated.. Every time he would arouse to stimuli and see me he would say " You sure are purty" and then promptly pass out again. This line must work for him as he had numerous different women's names tattooed on him.

Occasionally he would ask why he was in the ER and each time I would tell him "Because you were singing bad karaoke" to which he would nod and smile and pass out again.

After numerous hours in the ER Mr Trucker was coming around and asked again why he was there.. I told him his BAL "That's not illegal I wasn't driving" No I replied just a drunk trucker, with a big cowboy belt buckle belting out Barry Manilow karaoke. Now that should be illegal!

Tastes like chicken

Eyebrow bit off during fight.

We have WINNERs!!

4th of a July this year was horrible in the ER... We were way understaffed for such a major holiday that fell on a Friday night and there was great weather for.. the combination was perfect for all those that murk up the gene pool.

We saw so many burns and firework injuries that we actually ended up turning the back half of the ER into a burn unit and called in an additional MD to run it (but not additional nurses..that would make sense!).

It amazes me year after year the things people do in order to celebrate the 4th with the biggest boom...

This year the winners of the 4th of July Darwin awards are my patients who thought

“ Hey let’s fill up an extremely thin piece of rubber with a highly explosive, volatile gas that could explode at any moment and put a flame to it! " .... aka filling balloons with Acetylene (gas used in welding torches) and igniting it. Several of these guys unfortunately also learned about static electricity mixing with these balloons resulting in severe burns to legs, chest, arms, hands, stomach and face.

A close runner up are the ones that light off mortars in their hands and aren't quick enough in throwing...

And of course my favorite irresponsible parents that let their young children play-light fireworks. One child came to the ER after sibling stuck a lite punk into his eye.. parents decided to wait a few hours before coming in to see if vision would improve on its own...Morons.

So what do these lucky winners get... For those that really "out did" themselves a trip to our Trauma Burn Unit in another county aboard a $800 "taxi" red lights and siren free of charge.

For the rest they get to learn all about pain, wound care, infection, and scarring.

For an application for next year contact ER nurse.. Only entry requirement--Stupidity

The Gamut...

This weekend has been crazy.. the firework injuries, drinking, stupidity, MVAs, short staffed , I think my last weekend here has been just about my worst ever... gotta run to another shift will blog all about the last 48 soon...

Happy 4th of July

PS I work tonight... I am praying for rain.

Come one come all....

The ER gives out the TB tests to the night shift workers so they don't have to come during the day..it is a convenience thing. It only takes a minute so we don't mind this mundane task, but the other night was a first...

A new housekeeper comes in and asks me if I can give him his new employee shots (Hep B series) No I explain but I can give him his TB test. And this is how the rest of the conversation went...

HK-- "How often do I need that"
Me --"Once a year unless you are + then you need XR upon hire and when you become symptomatic"
HK-- "Oh I just had one a few months ago"
Me-- "Ok go get a copy of the paperwork from your previous employer and that should suffice"
HK-- "No the jail gave it to me"
Me--"Excuse me"
HK--"When I was doing time, they said I was fine, is that enough"
Me--"Let's figure this out outside the med room"

Amazing, it took me 3+ years to get badge access to the EXTERNAL doors of our hospital.. yeah it is time to leave.

Nice hospital corners..

A nurse is a nurse is a nurse.....hmmm not quite

We have had several nurses out for various reasons and been struggling to find coverage for them... This is not a problem isolated to us, this is a national problem and will only get worse as more nurses reach retirement..

Because we are small rural ER it seems harder to get agency nurses for coverage than the bigger hospitals so the nurse supervisor gets creative and tries to utilize what staff we have.. this we all appreciate...

But on a weekend night shift sending a nurse from med/surg with less than 2 years experience, unable to place IVs, triage, order tests, nor has pyxis access and never been in a code.. or even seen a dead body for that matter.

Kinda makes you ask "What can you do?"