BLOCKED!!!!

My hospital has blocked me from accessing blogspot at work!

I can understand facebook but blocking my ability to vent about how ridiculous the new policies and administrations decisions are in just going too far! I am sure this is a violation of some right I have. I'm sure I have a legitimate grievance here I can file with the union.... hmmm now if only I could remember which union I work for....

I'M BACK!!!!

After almost 6 months of turmoil in our ER and 75+ hour work weeks , I am finally back to writing!


In the last 6 months my ER has gone thru major changes both physically and personnel wise that has not always been for the benefit of the employees or the patients, but great for the hospital's bottom line. A few of those changes including firing the ER MD group and hiring a mega group from out of state, expanding our ER physically without hiring more staff and cracking down on the PC of the ER staff and environment. Our morale in the ER could not get any worse...


After 20+ years of service our ER group was fired and replaced by a corporation from out of state that is determined to make us over into a carbon copy of their other take overs. Our patients are losing continuity of care from MDs that has taken care of the community for 20+ years and they are losing the relationship our ER Drs have had with community and hospital based specialists.


Our ER has expanded physically by opening up an overflow area 24 hours a day but not having the appropriate amount of staff hired to do it.. on average the nurse in that pod works alone with 5+ patients without a tech or secretary and not properly stocked or set up to run as a full time unit. Our Express Care area (walk in clinic) has expanded it's hours--but oh yeah not hired the nurses to operate it....... Brilliant.


And the last major change amongst a million other small changes is the cracking down on inappropriate behavior AKA "NOT PC" comments, attitudes AND attire of the staff. Yes yours truly has been recently compared to (along with her other com padres) TRUCKERS! ( I wonder if I should tell my boss I take that as a compliment as I have always secretly wanted to drive one of those big rigs?!) Apparently it is not appropriate to swear or make judgemental comments in our nurse's station that is a 90% glass soundproof enclosure.. Seriously?


Sorry administration but I am a cranky bitchy nurse that isn't going to change who I am because your white shirt high polished shoe wearing candied asses are offended by what I have to say. If you don't like it, stay in your comfy offices pushing pencils and keep out of my ER where we aren't afraid to get a little dirty and real with our patients.

Front Row

We all know that the economy has gone to sh**, sadly those of us in healthcare have gotten a front row seat in the impact this has had on our communities.

In the last couple months our SI\SA (suicide ideation,suicide attempts) have drastically increased. Before we would get people "attempting" suicide more for attention getting behavior than from depression. Now on average I deal with 2-3 true attempts a shift. These are patients that by shear luck someone has found them and called 911.

The despair these patients and their families find themselves in I cant even imagine. The sad story is that time and time again there are children involved, so not only have they been helplessly watching their parents struggling to make ends meet but now have to deal with fact that their parent choose the easier answer of death than the harder fight of staying with them and protecting them albeit with a less flashy lifestyle.

While I fight to keep these families together, I cross the hall and walk into another patient's room and advocate for the destruction of another.. The DV (domestic violence) rates are shooting up. Patients ,in particular women are showing up in droves with injuries that only a closed fist or boot could make. They come in with their bogus stories and babies that look at me with timid faces telling me about their Mommy's "ouchie". My heart breaks for these children stuck in almost a lose lose situation.. Stay in the current situation and watch the abuse and become a victim of it as well, or have mommy leave and end up on the street or living in the car because so many shelters are full right now.

I wish I had a solution... I pray the President does as I see only things getting worse as my community looks down the barrel at the upcoming layoff planned for the end of this month at our local major employer.

Influenza update

Back in October I was wondering aloud about how effective this years Influenza Vaccination was going to be and B*tching about the CDC pushing for all healthcare workers and children under 18 to be vaccinated. I held the opinion that until they perfected the makeup of the vaccine and not making it an educational guess I would not get the vaccine for me or my children.

Well according to their website today 146 million vaccines were made.. of those they have projected 85.8 million adults and children have been vaccinated. As of today the CDC reports that 52,199 influenza tests have been given to patients with 1,173 testing positive and resulting in one death a pediatric. The CDC also admits that this years vaccine does not cover the Influenza B strain out there meaning that the vaccine is only 50% effective...

With this information I am still OK with my decision, but look forward to science perfecting this vaccine as I know the benefit of it for those at high risk..

MIss me?

YEAH I am back... After being sentenced to practically the last 2 months non-stop in the ER I finally have been paroled.

As those in the medical field the holidays are a bad time for us..we are swamped. For some reason people forget about taking their meds or not consistent with them..people start hitting the bottle pretty hard or over doing it with the high fat and salty foods, decide that maybe they don't need their psych meds, and my favorite deciding family get togethers is the place for knock out drag out melees... all of this leads to increased sick patients in the ER and admissions. We have had our hospital at capacity since Thanksgiving resulting in us boarding ICU patients for days on end needing 1:1 nurse care, causing an ER staffing shortage.

Now don't get me wrong we ER nurses are very good, thorough, highly technical, advanced trained nurses...but we are NOT ICU nurses. Both types of nurses will agree with that. This is not a bad thing... just a difference. So when ER nurses are asked to work as ICU nurses it throws us for a loop causing us to change gears and thinking patterns causing our shifts to drag on for what seems like days..

So my 2 month sentence has felt like years... I am glad to see daylight again and be back here as I have missed you all and my place to vent...

HAPPY THANKSGIVING

No,Nope,Nada, Not going to happen

Dear ER Patients,

I know that for many of you our ER feels like home as you spend more time here than in your own home I am sure -but there are still rules you must follow. So here is a quick list of absolute "NOs" while you are here in case you have forgotten them in the last 2 days since your last visit.

1. No you may NOT eat Cheetos and drink Pepsi when you are here for Abdominal pain and waiting for your CT scan.. remember you are also nauseated!

2. No you CANNOT bring every person you ever met in your life back to your room. One visitor only, I might allow 2 if I think that paper cut you have warrants a trauma activation!

3. No you may NOT go outside to smoke... if you are well enough to participate in that disgusting habit then I am going to discharge you... and parents please don't make the mistake of asking me to either watch your child who is the pt so you can go smoke or ask if both you and your teen can go smoke... My lecture on your parenting skills will not be sugarcoated, will take time from my very busy caseload, and time away from your smoking as you call my boss with complaints to which she will repeat the NO SMOKING policy.

4. NO I will not watch your child who is my patient while you run an errand, go get something to eat or try and track down your BF who was last seen flirting with the cute chic in the waiting area. You brought your child here because you thought they were sick enough to warrant a 2am ER visit so place your butt on the gurney next to your baby and don't move.

5. I am an ER nurse. I am NOT your secretary..I will NOT take messages for you when someone calls the ER looking for you. I only answer phone calls from other health care workers dealing with my patients. So tell your buddies to save their quarters and use your cellphone. You can check your messages when you are discharged!

6. NO I will not arrange your transportation home. You got yourself here without my help so I am sure you can figure it out in reverse on your own.

7. NO I will not go looking for your missing friend, relative, spouse, SO, partner or whatever you choose to call them this visit... If they wandered off out of boredom and now can't find your room it isn't my problem you should have chosen a smarter more sympathetic person.

8. NO I will not call your medications into the pharmacy so you don't have to wait to get them. And NO I will not fill your narcotic prescription with our Charity Fund.

9. NO I will not get feeble grandma or grandpa out of your car for you.. you got them in you get them out or call 911 they always love that call.

10. And finally I will NOT jump every minute you push your call light. I will get to you in order of priority... please realize that some people actually come here only for TRUE life threatening emergencies and I might be a tad busy with them so that warm blanket you want is going to have to wait, Deal with it!

Thank You for Protecting My Freedom

Veteran's Day 2008

Emotionally Tapped

I am once again working too many shifts... I am tired, cranky and in desperate need of a vacation.. or even a couple days off....

The last 2 weeks we have seen some heartbreaking cases...

A 14 month old brought in by mom after drinking lamp oil.. inital oxygen sat 30% heartrate 280.. not responding to pain stimuli.... Ped trauma activated, attempts at IV placement successfull then quickly blow.. IO placed in her leg.. oil suctioned out of her lungs and stomach.. HCT dropped from 31-23, she was going into DIC.. transferred to Ped trauma hospital in big city.. placed on lung bypass machine.... and mom upon hearing that social workers needed to talk to her.... has disappeared...

A 26 yo male codes after a history of Percocet and Oxycontin addiction has put him into critical condition with pancreatitis and hepatitis..coded 4 time in 3 hours... 4th time we lost the battle.

A 16yo football player is head butted by opposing player after play ended.. CT scan + for C4 fx, spinal cord trauma.. shipped to trauma center for paralysis...

Foreign exchange student gets into argument with host family son... Goes to his bedroom and returns with knife and stabs himself multiple times in front of family in the stomach..

31yo male in with shortness of breath, cold symptoms for last 2 weeks... XR recommends CT for definitive diagnosis... Results Stage 4 lung cancer..

Actually I think I could use a hug more right now....

HAPPY HALLOWEEN!!

I work tonight... Let the fun begin!!

Stethoscope...Danskos..Taser.. ready for work!

Once again ER Nurse is working way too many shifts.. we have been crazy busy and flu season hasn't even begun yet...Here is a snippet of some events that has ER Nurse proposing routine tasing just to make me feel better.

23yo M in for asthma crying on his gurney because his O2 probe was "Too Tight".

19yo M with Fx ankle from skateboarding who reports not wearing a helmet because the "Type" of skateboarding he does doesn't require a helmet...

24yo M Jehovah Witness in for abd pain who refuses blood draws because of his religion...

26yo M who only drinks "a couple" quad shot lattes a day in with SVT- Heart rate- 268

The Fs on state assistance who come in 2 weeks late on their periods with "Abd Pain" for their "free" pregnancy test, then come back at 16 weeks for "Abd Pain" for their "Free" ultrasound to find out the sex of their baby. ---Since me the tax payer has to pay for all this "Free" care I think I should have a say in the tests ordered...right?!

The parents who bring in their feverish infant daughters but refuse my In/Out cath for urine... because then their dtrs won't be Virgins anymore.

78yo F brought in by concerned dtr who was afraid her mom "Might" get pneumonia this year.

21yo M brought in by mom after smoking marijuana for the 1st time and not acting himself.

Boarding..

We are overflowing with patients both in the ER and on the floors. This weekend we have lived on DIVERT.. average patients time in the waiting room 6+ hours. We had patients in the ER for 15+ hours. And now because of this we are Boarding patients that need to go to PCU.

I hate boarding patients and this shift I have 3. I medicate based on a MAR and if I want to give more medication than the DR ordered on the MAR I can't just wander down the hall and ask.. I have to page the admitting Dr. If my patient has hypotension and I want to bolus him I have to call for an order.. this kills an ER nurse.

We work so independently.. we take care of our patients and then let the ER physician know what we have done...This paging, waiting for a return call. summarizing who my patients is and problems and what I think should be done and then the Dr asking tons of questions and then okaying my suggestion is going to be the death of me....

ER nurse needs a vacation.......

Carribean?Hawaii? My Bed?

ER nurse has worked 131.25 hours in the last 2 weeks....

ER nurse needs a vacation.

Our Week

HAPPY EMERGENCY NURSE WEEK

Whoppers anyone?

SHE IS BAAAAAAAAACK!!

The drunk chic from the last 2 nights is back again for the 5 time, after getting drunk and passing out at----- Hold your horses..Yep Mc D's bathroom again !

OMG... again BAL 0.387, this time enough is enough we are sending her to involuntary secure detox. If not for her own good then for my sanity... though I am half tempted to get her a Burger King gift card and a one way ticket to the next county!

Who wants to party?

Two recent LOL (Little ole lady) stories...

Medics bring in 74yo after being found down at home by granddaughter with a blood sugar 38.
Granddaughter guilt ridden that she went out with friends and was not there for Granny...
ER nurse explained to distraught granddaughter that it was not her fault... It was Grandma mixing Glyburide and her 1 1/2 pint to a 1/5 of whiskey a day habit.

Mother and daughter bring in 68yo old grandmother for altered behavior, thinking Granny as having a stroke... Head CT neg and all lab tests neg except one. When asked if the patient minded that her family was in the room during discussion of test results and diagnosis the patient was adamant that family stay... OK Granny everything looks great no stroke, head bleed or brain tumor but you might want to reconsider your use of cocaine! I thought the family was going to fall out of their chairs..

Have I met you before?

ER Nurse rarely refuses to care for a patient.. but tonight I have had enough it is someone else's turn to care for the 33yo alcoholic that keeps getting drunk and finding her way to the local McD and passing out in their bathroom.

Normally this would be an easy pt to care for .. but this would have been the 4th time in 36 hours I personally have taken care of her for a BAL >0.377 after sobering her to 0.06 hours earlier and sending her home.

Nope it is my turn to throw the temper tantrum today.... I won't do it and you can't make me--- so there!! :-p

NH stunt

Dear Nursing Home Nurses,

It is NEVER EVER acceptable to send your patients to the ER via ambulance for the sole purpose of peripheral IV placement!

Love,
Your Very PO'd ER Nurse

Cold Shoulder...

Husband calls 911 after waking in the night and finding that wife is not her usually cuddly self and a little on the cold side.. Medics find her asystole..

On a side note...Medics bring her back and we admit to CCU...

Come in IV form?

Attention ER nurses : New cure found for abdominal pain!!!

Peanut M&Ms!!

It is amazing that my patient who was crying in triage and rocking back and forth with pain was found munching on M&Ms on her gurney under a blanket and when reminded she was NPO and in the "worst pain" of her life she explained "but these really help I have to finish them or the pain will come back."

That is why I love this job.. I learn something new every day. And to think the cure was there all this time... in the vending machine down the hall.. I wonder what other diseases I could cure with $1.25 in quarters.