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.

Oops!

Quickest way to bring an ER to a standstill and tons of firefighters come running with bunker gear on at 1:32 am.... Burnt Toast. Poor nurse she was so embarrassed.... and the firefighters.. weren't too amused either....

MIA

New nurse shows up for first day orientation, is shown around the unit and then disappears. No joke. We have not seen her since, and that was 3 days ago. Now I know that nursing can be hard but come on.. only lasting 20 minutes on a unit? That has got to be a record!!!

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?

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"

Out of the mouth of babes...

My son asked me one time how many penises I had seen

in my career as a nurse.....

Yep that sounds about right...

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?!

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!

If only.....

There are days when I wish this really was a choice

... that the nurse could make!!!

Is that a fever? Typhoid? Mad Cow?

It is Friday morning and I head back to work tonight after having the week off. Not really looking forward to it..

Our ER is going thru big changes as there has been a overhaul of the hierarchy, and not all for the good.

Alot of the changes have been done without any input from the people it most affects.. THE STAFF! Not sure why that is.. I would think that in these days of nursing shortages that hospitals and really any facility would want to keep their nurses happy and thus employed with them.. I guess that would require actual fore- thought, and that appears to be lacking at my hospital.


So here I sit in bed 12 hours before my shift (why I am not sleeping?) hoping that I will come down with some as yet unidentified virus that makes me to weak to work, but yet strong enough to go out biking and enjoying what sun we have here in Feb. We all have heard of that virus, it is the one that brings our patients to the ER sunday night looking for the magically "off-work the next day" note, after trying to accomplish feats even their previous decade body baulked at.

As of yet not a sniffle to be heard, nor a cough mustered up enough to get my sleeping SO's attention.. I feel doomed to have to go to work.

12 hours and counting... no pressure right?!

We get breaks?

What a weekend from hell. I ran non stop.

It was another weekend of shifts where lunch breaks are what you can cram down while pulling your meds out of the pyxis, and legs bags should have been handed out when you clocked in. Nurses are truly the worse when it comes to taking care of ourselves, but we are the first to preach to our "care-taker" relatives of our patients about putting themselves first..yada yada... Why do we put our needs last? Why do we promise ourselves that bathroom break or bite to eat after we get that one patient's IV started, or triaged or painfree, and yet when accomplished there is always something else we view as more important than our own 1200ml bladder or 60s bloodsugar? I think after years of this it contributes to the burn out of us... or at least I am seeing it in me..

I have always prided myself on my work ethic.. Come in 20 minutes before my shift to get a feel for the night and get an idea of what is happening on the other floors so I know where my beds are available, always willing to stay over in the morning to help the dayshift get started, and make sure that my transfers and admissions are completed or at least the report is given. Consider true "leave the floor lunch" breaks as a luxury. And viewed the nurses that religiously took their breaks and left on the dot every morning as having poor work ethic and lazy.. But you know I think I am the one that needs a perception adjustment.. maybe I am a masochist.

This year I am really going to push myself to take my breaks or at least walk off the floor for a few minutes and take a breather... Go look at the moon, grab a soda or if nothing else go stand in the bay and watch our patients go from full functioning adults into complete debilitated crying/hyperventilating drama in the 30-50 yards it takes them to walk across the parking lot into view of admitting and the triage nurse. You gotta love those.

Ok so that is my plan as i sit here in bed typing this.. let's see what happens in reality.

Why Blog?

Welcome to my blog... After 11 years of nursing and about 4 of them in the ED I find that I need a place to "detox". There are some mornings as I walk to my car that I wonder why the hell do I keep doing this job, not just working in the ER but nursing as well.

I got into this job with all the good intentions, and thoughts of being the next Nightingale, when in actually I find myself night after night wrestling with my patients, watching them get tazed and then placed in 4 points. Most times I win the fight, but there have been times I have had my ass handed to me...

I find myself with each day becoming more and more cynical. Are they truly sick or just looking for drugs? I find myself feeling more like my patients drug dealer and not their health advocate. Now a days we prescribe/handout narcs more than ever before just to "shut them up and get them out" and because so many Drs fear getting sued for not providing adequate trx.

Come in for a fx(fracture) get 20 percs, stabbed 20 percs, assaulted 20 percs, migraine 20 percs, dp(dental Pain) 20 percs, nothing better to do at 0300 then come hang out in the ER 20 percs!

So I guess this is where I am going to come to detox and vent and hopefully meet others that are going thru the same, but not quite ready to throw up our hands and say enough.. on the other hand it might get us 20 percs!