Wit, wisdom & wonderfulness

Oh. My. God. I'm in a work-related heaven. Turns out ImpactedNurse continues to blog!! Many a time when I was ready to quit nursing (many, many a time!) I turned to his informative, humorous, RAW and REAL writing to turn myself around & cultivate a new love of the profession. The 3 free e-Books listed here http://www.impactednurse.com/?p=549 are what got me through.

New job at Milford is going great!  Less drama, more sanity, awesome experienced nurses who are calm, cool & collected, talking about how they used to smoke at the nurses station.  Doctors who are fast, smart, polite but firm and set limits with their patients immediately.  Not to mention only have to run 16 beds instead of 40.  Should have done this long ago.

Less attitude, More gratitude

Home early & sick.  Thank goodness for low census.  Had I stayed the full 12 hours I would have (1) strangled some people, (2) been completely useless to my patients seeing as I can't breathe & my head is about to explode.  Shift started out easy, my assignment was empty from day shift due to low census, so I had the luxury of checking all my rooms, cleaning up & stocking.  No sooner than I'm done in my last room the nasty charge nurse comes over and says I'm actually taking over the other side of the pod (where 1 patient awaited me) - I say to her "Well I've got 1 patient on my side and I'll take 1 patient from that side, but all my rooms are stocked and checked." -- "Yea well it's just easier for me to move your 1 patient instead."  Muttering under my breath I move my patient and begin my cleaning/stocking saga all over again in 4 new rooms.  I mutter some more as I take over the patient with a clear-cut (no pun intended) post-op infection with absolutely no pre-emptive orders done; the off-going nurse put his orders in an hour ago for labs & a line, but then he sat there for an hour and didn't do anything.  My LPN drops a line & I give the poor patient some pain medication.  While I do that EMS rolls in next door with a patient, whom I was initially, and in a rather nasty tone, told was not coming for 1-2 hours (which is a little bizarre for an ER patient, but whatever).  I get on the radio and ask for the charge nurse or the float nurse to come & triage my patient.  No answer.  Get on the radio twice more while I push Dilaudid on my post-op patient; still no answer, crickets chirping.  I finish the Dilaudid & step out to meet EMS who is now roasting marshmallows in the hallway (aka camping out waiting to give report).  I profusely apologize that no one has come to take report, and get a quick report from him.  My patient is pleasant, anxious, but very nice.  Multiple more times throughout the shift I get on the radio to either ask for help or ask who is on the phone, and multiple times I'm met with either silence or attitude.  I'm too sick to put up a fight with anyone.  I get all my patients settled, and discharge the possible miscarriage.  Only to get the mid-forty's mother who's battling breast cancer a second time after being told she has a 0% of getting it again; so much for 0%.  We last met 9/29/13, and she looks about the same: trying to be brave for her family, but completely overcome with pain.  She's a quivering mess of pain, fear, sadness; yet she continues to apologize for coming in and says "Please don't give me too much Dilaudid, I don't handle pain medication well, I just want something for nausea."  Her teenage daughter sits quietly in the room, and her attentive, exhausted husband sits too, soft-spoken, calm and caring, he provides information.  I access her port & very slowly give her Dilaudid & Zofran; she is immediately relaxed, drowsy & calm; I don't leave her side because of her previous problems with getting Dilaudid, I call out 6(!) times for someone to bring me a lab cart before the blood in the syringe clots.  Crickets.  I finally get Tammy (my favorite LPN & work BFF) on the radio & she brings the cart over.   Again, too sick to fight with anyone, and now emotionally drained after meeting my unfortunate patient and her daughter.

Decision made: time to leave and accept the job at South Base.  Had a great interview there 2 days ago, peer interview went well, staff likes me from the 2 shifts I've worked, Nurse Manager is excited to get an experienced (me? experienced?!) nurse on board.  She was quite appalled by hearing how some of  the staff talk to each other at Hood Hospital.  I'm tired of the drama, tired of the cliques, tired of rudeness.  Apparently I'm unapproachable and bossy, but everyone else is allowed to get away with their behavior.  I will not tolerate it anymore, I cannot seem to change it in any way, so to save my sanity & career I'm moving on.  Resignation letter is typed up, will go & speak with the Interim Nurse Manager tomorrow about leaving.  Did I mention the Director is quitting as well?  Leadership is falling apart at Hood Hospital, and it only lets more bad behavior go unchecked, and people with poor attitudes continue to get away with their bad behavior.  It's time to leave.

Blessings

Many things we encounter in the ER makes us count our blessings.  A 45 year old who survived breast cancer & was told there was 0 chance of recurrence is now battling breast cancer (despite a double mastectomy) AND liver cancer.  Her quiet, gentle and loyal husband is sleeping at her feet, waking at the slightest noise.  A family of 5 who lives in a shelter, the most polite kids, an exhausted mother, and a polite, kind, firm father.  A 9 year old who gets panic attacks when anyone talks about her father who's in jail, and she asks the doctor to write a note to the jail telling them she needs her daddy home and she misses him very much.

Count your blessings.

A way out

A full-time position at the stand-alone ER 30 minutes away has just been posted... Hmmm... lots to think about.

It's a dog's life

EMS rolls in the door with a CPR in progress on a 70-something year old man, his furry companion in tow.  The man was walking the dog when he collapsed of a massive MI, unable to even identify the man at the time, let alone call a family member to get the dog, EMS did the best they could & brought the dog along with them.  They said he gracefully rode in the front seat, periodically turning around to look back at his friend.  He calmly walked behind the stretcher, his Great Dane head towering at the level of the stretcher, and when they all went into the trauma room he laid down in the corner of the room, staring at his friend.  Never once did he utter a sound, not a bark, not a whimper.  When the code was called and most of the people shuffled out of the room, the dog walked over to his friend and nudged his hand.  Not getting any response he nudged again and whimpered.  The cool hand confused him, he couldn't understand why his friend wouldn't acknowledge him.  He let out a long slobbery dog sigh, then leaned his front paws on the stretcher and leaned in to give his friend one last wet slobbery dog kiss.   He slowly understood; he laid down in the doorway, his head flat on the floor & stood watch over his friend's final moments while the nurses cleaned him up and packaged him up in a body bag.  And as a loyal friend, he accompanied them to the morgue, where he sat in the doorway, not moving, and watched them put away the body.
That night he went home with the nurse that took care of his friend during his last hour.  The man still hadn't been identified, and she couldn't bear to take the dog to a shelter; he had just lost his forever friend, she didn't want him to lose everything else too.  He slept at the foot of her bed, whimpering occasionally in his sleep, but easily reassured that she was nearby.  

Cross-sensitivity Allergies

In all medico-scientific seriousness... isn't the chemical make-up soooooo very similar?  It's like saying you're allergic to strawberries but you can have the really really expensive organic strawberries

Don't poke the bears

Doctors,

Please do not piss off the nurses.

1).  There are more of us than of you in this ED, end of story.

2).  We talk to each other, a lot.  We have a running list of "If I collapse at work here are the doctor's I DON'T want working on me".

3).  We understand you want to reduce door-to-doctor times, LOSs, diversion time and LWOTs.  Guess what, those are mostly provider-related, not nursing related.  If you keep our patient-nurse ratios at 3:1, we can get a lot more done for you and keep all those numbers down.  However, do not come on shift, look at the 15+ in the waiting room, 75% admitted holds, and then tell us you want 1 nurse to drop everything and run your split-flow room.  "I just need 1 room."  And all the patients that the other doctor's have admitted just need 1 pillow, 1 pain pill, 1 neb tx, 1 insulin drip, 1 EKG, 1 round of evening meds, and 1 "what's taking the doctor so long".  We monitor these patients 24/7, while you pop in the room for a few minutes, do an assessment, make up a plan and then stroll out the door.  Trust me, if these patients didn't need anything done I'll gladly take on extra patients, but with the myriad of orders you put in, it can take me an hour to get everything done.  And by then, guess what, time to go check on everyone else.

So please, stop making unrealistic requests and asinine comments about the night-shift, and focus on what you do best, seeing patients and dispositioning them quickly.  If your management bone is itchy, go manage some other providers, not nurses, we have our own management for that.

Thank you,

The very tired, very angry nurses

Checking e-mail at home

I keep telling myself I need to stop checking my work email when I'm not at work.  Case in point #1, email from the Director of the department last year about a patient complaint, read the email while on vacation.  Case in point #2, email today from the charge nurse who got a phone call saying I don't need to go to court on Monday for a subpoena because the case was pled out.  Obviously this is the first I'm hearing about a court case.  Lets see what professional lawyers are available in my area, it's better to have and not need than to need and not have.  So much for taking a nap at 1pm before shift tonight :(.

Mental Health Professionals for the Professionals

On my 3rd attempt I was finally able to navigate the automated menu for the head shrinker office I was referred to (I can't imagine someone calling in who was upset, mentally unstable, or not cognitively intact) and made my appointment for August 7th.  I'm patiently waiting and not throwing a fit or questioning the staff about what's taking so long; I understand there are others, perhaps sicker than me, that need to be seen sooner.  I am undeniable curious to see how effectively someone can shrink my head though.  Nurses (as well as doctors, paramedics, techs, etc.) are notoriously hard to shrink, especially those that work in the ER, because we know exactly what not to say.  I know that even the slightest hint at a suicidal ideation will yield me a 24-hour vacation, and quite frankly, I've got stuff to do!  I know that any indication that I use alcohol to help me "relax" after a long day or pills to help me sleep (once or twice a year I take Benadryl when my mosquito bite itching gets out of control) they will deem me unfit for nursing practice and cart me away to rehab.  Luckily, I don't experience suicidal ideations or use drugs & alcohol to cope, I'm one of those cheesy, sunshine & unicorns type of people that can go to the gym to let loose, sit down & read Facebook or a couple of blogs to decompress, and then do some arts & crafts in my spare time to distract myself.  I can't imagine what it's like to shrink other professionals that know exactly what they need to say.

Head Shrinkers

The phone menu at the head shrinker's officer seriously sounds something like this:

Hello and welcome to the mental health hot-line

If you are Obsessive Compulsive , press 1 repeatedly.

If you are Co-dependent, please ask someone to press 2 for you.

If you have Multiple Personalities, press 3, 4, 5 & 6.

If you are Paranoid, we know who you are and what you want.  Stay on the line so we can trace your call.

If you are Delusional, press 7, and you call will be transferred to the Mother Ship.

If you are Schizophrenic, listen carefully and a small voice will tell you which number to press.

If you are Dyslexic, press 96969696969696.

If you have a Nervous Disorder, please fidget with the hash key until a representative comes on the line.

If you have Amnesia, press 8 and state your name, address, phone number, date of birth, social security number and your mother's and grandmothers' maiden names.

If you have Post-traumatic Stress Disorder, slowly and carefully press 000.

If you have Bi-polar Disorder, please leave a message after the beep. 

Or before the beep.  Or after the beep.  Please wait for the beep.

If you have Short Term Memory Loss, please try your call again later.

If you have Low Self Esteem, please hang up.  All our operators are far too busy to talk to you.

Wait times

ER wait times across the country have been out of control.  People are waiting hours in the ED for an in-patient bed, not to mention hours in the waiting room just to get into the magical roller-coaster land of E.D.  5.5hrs at 05:15am on a Tuesday?  Seriously?  It's depressing to see that on my nights off, because this trend will probably continue all week.  Since February I had 1 (count 'em, ONE!) slow night, the night of July 3rd (going into the 4th, when everyone was relaxing).  What is it about all the other days & nights that makes people come out of the woodwork & en-masse travel to their local ER?  I understand we are the only hospital  in a county of 165K+ people, and that our sister hospital is in the adjoining county and maybe the doctor doesn't admit there or your mother/father/brother/aunt doesn't want to drive there... But seriously?  When is this going to let up just a little bit?  I'm waiting for the giant healthcare bubble to burst, and the purulent pus that will come out will affect people at all levels, nationwide, as well as local community health systems.  I'm actually nauseous and I don't have to go to work for another 13 hours.  Time to call the head shrinker today.

Another One Bites The Dust

So today we got some rather shocking news: our manager, who had been with us for barely a year (but has already accomplished so much, and brought the department so far forward) is leaving for a director position.  It's heart-breaking to lose her so soon, to see her cry and stop halfway as she says she's leaving.  It feels like losing a super cool aunt, and knowing the date that she's leaving, makes it that much harder.  Looks like I need to embrace a new slogan if I continue working in medicine: "The only constant is change"; but that doesn't make the situation any easier to accept or deal with.  We'll see what the next few weeks will bring, I can only wish her the best and along with everyone else support her on her new journey.

Duty to Report

Got my notice in the mail to renew my state nursing license, with the usual reminder letter about a duty to report (seems like it's mandatory to report everything from child & elder abuse/neglect to rare & exotic new diseases to fraud to dangerous co-workers).  The last paragraph got me thinking: "Duty to report unsafe working practices", which mainly seems to pertain to reporting other healthcare providers (individuals) that are, for example, intoxicated at work or are performing jobs outside their scope of practice.  What about reporting corporations/organizations?  How do we as nurses complain to an authority about unsafe working conditions?  And I don't mean the time when the patient calls you a "fucking whore" for not giving him Dilaudid and tosses a urinal at you, no that's easy to remedy.  I mean the times when you have 3 intubated patients, 2 strokes, 1 non-STEMI and a chest tube in just the critical-care side of the ER, you've asked to go on divert and were denied that request.  How much and how far are nurses expected to stretch themselves?  And having been in the charge nurse shoes, I'm sick and tired of the "Talk to your charge nurse about your concerns" answer, they're only human, just like you, and most nights they already have a patient care assignment, on top of everything else that's going on.  Upper management & shareholders need to come to each unit (dayshift and nightshift) and shadow a nurse for a single, busy shift; and guess what, if the nurse doesn't get a pee break for 12 hours, neither do you, if the nurse doesn't get a drink of water (which sometimes helps during the "no pee breaks" situations) neither do you.  And please don't come to me saying how "well you chose this career" or "you knew what you were getting into".  Yes, yes I did choose this career.  However, it's inhumane to expect a person to work their ass off for 12+ hours without a pee break, snack break, lunch break, ANY break, while tolerating nasty attitudes from patients, family members, visitors, doctors, co-workers and do it all with efficiency  proficiency and a great big smile on their face because benchmarks and patient satisfaction is all that matters.

Untitled

There really is no appropriate title I can think of for a blog entry like this one. 

It's been a mix of weather lately, so even though it's almost May tonight proved to be a brisk night, probably in the 40s, and people coming into triage had their jackets & sweatshirts on.  I thought nothing of the scrawny 14-year old (who looked more like he was 11) when he limped in with his grandfather.  The child was complaining of generalized abdominal pain, holding his stomach and appearing all around uncomfortable and in pain.  Nothing unusual.  While I changed out the adult for the pediatric blood pressure cuff he pulled up his sleeve and stretched his arm out towards me.  My jaw almost hit the floor.  What's that, black-blue veins along the forearm and A/C region?  Perhaps noticing my hesitation the grandfather chimes in "He's Hep C positive, he did Heroin, he just got out of inpatient psych today".  I don't know how many more times I stuttered through the triage questions, but I did not think it was possible for my tongue to turn to ask a 14-year old "when was the last time you used, what did you use, and have you used anything else".  

Unapproacheable

So a couple of months back I had a conversation with the boss where she described some concerns the other staff had brought up to her.  Specifically I was called tough, unapproachable, and had a my-way-or-no-way attitude.  I was not given specific situations that generated these complaints, nor was I told who the people making complaints were.  Needless to say I was upset that my own co-workers couldn't come to talk to me, defensive because I was called unapproachable, and confused about how I was supposed to be responsible for the safety of all the patients in the department without delegating proper assignments to the staff.  On the nights in questions we had high-volume, high-acuity nights, and at times nurses ended up with 5 patient assignments, however I was constantly rounding and never asked nurses to do something I wouldn't.  I'm now channeling my energy of disappointment and frustration at finding my next career path in medicine, trying to decide if I want to stay at the bedside.  Ideally I would want solitary, independent work that involves high-tech, high-expertise skills: so currently it's a toss-up between an NP program or an MSN in Toxicology or Forensics or Legal Nurse Consultant.  Still have a dream to fly.  We'll see where this road leads.