Saturday, October 23, 2010


Well, I'm pretty sure my feelings on Press Ganey are pretty well documented already. But for real. This shit is getting ridiculous. Not only can just about anyone talk their way into some Dilaudid- they know why.
This crazy lady checked in the other day with chest pain related to her "asthma"- apparently this disease cause you to make squealing whiny noises at the end of every expiration, despite the fact that the lungs are totally clear. Yeah. She told the nurse in triage that she had been there the last 3 days (she failed to mention that she had been escorted out the last two times for acting foolish), but she did tell us that her sister was a nurse on the floor, and that she knew we had all kinds of empty beds upstairs and that we had Press-Ganey so we had to do what she said. Yeeahh. She sure didn't get admitted, but she did get a full cardiac and PE workup. Whatever do you think the results were?
I always make sure to ask the doctors for pain medicine when people request it, but I always word it just like they did and I chart accordingly.. "Yeah, last time they gave me some D medicine and it made me feel so much better"... This no longer gets the "Hell no, they get 325 of Tylenol" and I might hope for, but instead an eye roll and an order for the D medicine they seek. Big bulgarian doc was going off on one of his little rants the other day when a patient of his from the night before came back with the same complaint. "What does she think we will do for her?" he said, "What does she expect to accomplish from this visit?" Uh, I don't know dude. Maybe it's the fact that we give her IV Dilaudid and a prescription for Norco? Why wouldn't she come back?
It's even gone past pain medicines and into treatments. Somehow good medical care has become synonymous with drawing blood. Oh, a hypochondriac, eh? Yeah, lets get a CBC and an FBP for that ear pain so that we'll feel that the complaint was taken seriously. Besides, the nurse has nothing else to do. One of the same doctors who once lectured me about mentioning gastric lavage in a patient who had actually taken the pills in timeframe in which it might have been useful later ordered the same treatment because some lady's hoodrat boyfriend insisted she have it. We never do this anymore, but we sure were ready to did do it for him.
Our former director of medicine, who I absolutely loved, developed this fake form for us to stick up in triage. He said we might as well just start putting them up there since we're apparently supposed to be Starbucks now anyway. He was not cool with us making copies, but from my memory, it read something like this.

Hood Hospital Triage Questionare

check all that apply:
1.Are you interested in the doctor's opinion or knowledge as it applies to your care today?
__ yes __no
(if the answer is yes, please disregard the rest of this form. If no, please continue)

2.What labs do you feel are needed for us to have provided you with good care today?
__ CBC __CMP __PTT/APTT __Complete screen for STDS
__Cardiac enzymes __BNP __Serum Spider Venom Titer

3.What kind of pain medicine would you like? Please circle dosage or indicate of not listed.
__Dilaudid- 2 mg, 4 mg, 8mg, all you've got.
__Morphine-2 mg, 4mg, 8 mg, 10 mg, a bag to go.
__Demerol-25mg, 50mg, 100mg
4.How fast would you like that pushed? Please indicate in seconds or minutes:_____

5. Please check any medications you feel may supplement your medication experience:
__Zofran __Benadryl __Phenergan __ Valium __Ativan __Reglan

6.Would you like to be admitted today?
__No __Yes
If so, for how long?
__Just for observation __Until my pain is gone completely __ Until my next check comes in __Indefinitely

7.Please check any medicines you would like to be discharged with:
__Norco __Percocet __Ultram __Phenergan __Dilaudid chewables
__Also, refill everything I normally take __Other (please indicate.)

Toward the end I know I'm making my own stuff up, but it's what we're coming to. I'm serious.

Thursday, October 21, 2010

Is this a national phenomenon?

So, I was talking to one of the NPs that I really like a couple weeks ago, and she was telling me a story about how she had to remove a makeup sponge from some lady's vagina that night. Of course, I always need to know the how and why, so she got back to me and it turned out the lady was on her period and had run out of pads and tampons. Next logical conclusion- shove a makeup sponge up there! It's absorbent, right? Right.
Fast forward to two weeks after that. Same NP. Same complaint. Yeah, I ran out of tampons so I stuck this makeup sponge up there because someone told me that would work. Why not? This time, though, there was a twist. Not only did she successfully recover the makeup sponge, but as an added bonus there was also a condom floating around in there. So she pulls it out and says to the girl, "Is there anything else up there you need me to get out for you?" Priceless. Apparently she was not as amused as I was.
I have never heard about this until this month. Anyone else heard any tales of makeup sponges being suitable feminine hygiene product replacements? I will do some research on Google and get back to you guys.

UPDATE- I've found one source that mentions makeup sponges being used for tampon substitutes in an article written by an escort addressing the problem of how to work on your period, because apparently all escorts know thats always the week when you fill up on appointments. OMGz, hate it when that happens. Anyway, even there it was only mentioned in passing about how it sort of works the same way as a real sponge designed for that sort of thing. Now, before you say, "Hood nurse, you lazy crackhoe, you probably just stopped after one google search", you would be wrong. Because I scoured Yahoo! answers for a good 20 minutes for various tampon replacements, and came up empty on the makeup sponge front. And anyone who has ever read Yahoo! answers knows that is the population most likely to stick use a makeup sponge or equally ridiculous item as a tampon. Seriously. Just read Yahoo! answers topics about STDS and pregnancy. You'll give up on humanity in 10 minutes.

Friday, October 15, 2010

I can't do this forever.

I've been entertaining the thought of going back to NP school next fall. I was talking to my husband about all this the other day after a rather exciting ER night with running around the unit giving emergent meds and saving lives and other such adrenaline charged activities. My goal ever since I started nursing school was to ultimately become an FNP- although I also thought I wanted to run a pedi clinic and now I'm pretty sure that's actually the worst job ever. After that particular shift, I told him I still wanted to go back to school but I was a little bit ambivalent because I thought I would miss critical care. And I will. But when I was saying that, I wasn't thinking about days like today.
The man I took care of today walked into triage and was wheeled out to a funeral home. I talked to him. We started IVs, central lines, arterial lines, every vasopressor under the sun, a Heparin drip, we intubated, I titrated, inserted tubes wherever I had to and it was all for naught. He still died. I had to watch his wife stand next to him and hold his hand and sob. And I still came home with the feeling that if I had just done something a little different or a little earlier that he would have lived, despite what anyone says to me. I'm still sitting here in my apartment crying in my beer. It's days like this that I think maybe I'm not the kind of person who's supposed to be a career ER nurse. Time to get my transcripts in order.

Thursday, October 7, 2010

And I thought I had a bad day.

I took care of my terrible horrible whiny-ass non-compliant patient from hell the other day. This time she was came to ER for a nosebleed that we were actually able to stop until she picked at it incessantly with a nubby towel and blew it every time the bleeding stopped. Why? Why not? She needs something to do, I guess. We packed one side and then she actually made the other side start bleeding by scratching it with paper towels. I swear she's doing this foolishness on purpose. I overall had a crap night, and it would have bothered me more were it not for the patient I took care of earlier in the evening.

No matter how bad it gets, at least I didn't wake up from my sleep to find my lips and tongue so swollen that I couldn't put my tongue back in my mouth, go downstairs to call an ambulance, fall down said stairs and get a compound ankle fracture on top of the worst angioedema I've ever seen in my life. Not only that, but this poor woman couldn't get conscious sedation or really even enough pain medicine for the doctor to reset the bone in her ankle because we didn't want her to lose her airway and end up getting a cricotomy. So she had to just sit there and feel all of it, after her husband totally bailed on her because he didn't want to see it happen.
Yup. All that makes a 12 hour shift 15 minute lunch, two bathroom breaks and histronic crazy patients sound pretty awesome in comparison.

Friday, October 1, 2010

Nursing daydreams

Sometimes, when I'm sitting at the nurses' station in my TURP blood/urine soaked scrubs, catching up on hours of charting drinking a warm coke, I space out a little bit and have these fantasies about the shit I would do if someone talked to me the wrong way on the last day of work. These things that run through my head that I would get fired for immediately if I ever actually did them.

I think about the family members with zero medical background who want to nitpick the ER staffs choices on IV placement. I mean, seriously? I don't try to tell the A/C repairman how to do his job. I don't break into the kitchen at McDonalds and tell you how to flip my burger. Why do you think you can tell me how to start my IV? I was telling my super awesome charge nurse about this today, after some douche lady kicked him out of her husbands room because he didn't attempt an IV start on her husband where she thought he should. By the way, he's the best IV starter of anyone in our entire ED. If someone did this to me on my last day, I would hand them the IV start kit and a saline flush and tell them to go to town. "Oh. You know how to do this then? Cool. Here you go. Yeah. We need a purple, two greens, and one blue tube for the labs the doctor has ordered on your husband. Yeah, I'm sure you do this all the time so you already know how much to put in each one. Awesome. Call us when you're done and we'll bring his meds. What, you're a bank teller and you don't start IVs at your job? Well, you seem to think you know everything so I'm sure you can figure it out. Make sure you use a 22 gauge or larger so it's easy for the CT tech to inject the contrast. Later!"
I have this other fantasy when I'm at triage and I type up this document in very classy script like they would use at a fancy restaurant to place next to the check in forms that reads as follows:
Dear Patrons,
Due to a high demand and a disappointing crop, we will not be offering Dilaudid or Phenergan on our menu this evening or for coming evenings until further notice. We apologize for any inconvenience this may cause and hope that you will still thoroughly enjoy your experience at Hood Hospital.
Sincerely, HH staff.
I swear. My night at triage would be so much better.
Or probably my most frequent, where I transport a patient to ICU, they give me attitude as always, and instead of responding in a passive aggressive manner like I usually do, I just throw off my jacket and take out my earrings and respond the way most of our patients would. "Bitch, why you looking at me like that? I drew your AM labs, ho, so you best step off before I tear out your weave. Yeah. That's what I thought." And then I would throw my Spectralink to the ground all gangsta like before the police show up in record time to escort me off the premises.

Ah. It feels so real after the 3 glasses of box wine I just drank. If only I didn't really, really, need the money.