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.


  1. Too, too funny.(Wouldn't it feel good though?)

  2. In my ED days, I once spent quite a while looking for a good place to stick an elderly woman with terrible veins. I took far longer than I would in a routine case, because I didn't want to hurt her in vain (ha). The family. which I suppose noticed my obviously young age at the time (early twenties, working as a tech), interrupted my looking to ask me to get someone better. I was very good, by the way, possibly the best in the department, almost certainly the best there at that hour. I looked at the patient with surprise, and told her I'm just trying to find the best place. "You really think you want someone else?" She said she did. So I went to her nurse and told her that the patient wanted someone better. That nurse rolled her eyes, knowing that family and the situation. The providers get it, and that helps a bit, but I was still super-pissed at that idiot family. They have a right to refuse, but as far as I'm concerned (and I do feel a bit bad about it) they earned whatever extra sticks were required for their grandma.

    By which I mean to say, you do do your best and after that it's not your problem anymore. Don't let it follow you home. I know very well how hard that is - it can drive you to drink - but we're ultimately here to do the best we can for everybody, as you clearly understand. Whether they're able to understand what we're doing for them isn't the point.

    Again, I realize how hard that advice is to follow. I've been in the field a good ten years and still struggle with it. I hope you can take it and run.

    -an OR nurse

  3. 1) i always miss it when they DICTATE where the IV goes. so YAY -- gotta stick you AGAIN.
    2) love what you'd tell the floor nurses. esp the ones who asked me if the skin's intact.

  4. Me: "The patient is ambulatory and their only symptom (stroke patient) is slurred speech"

    Floor nurse: "Do they have any skin breakdown? Do they have any weakness?"

    Me: "The patient's saturation is 95% on 2 liters."

    Tele nurse: "Is the patient on oxygen?"

    Me: "Yes, they're on 2 liters."

    Tele nurse: "Two liters of what?"

    Me: "the patient is on 2 liter of oxygen by nasal cannula"

    Tele nurse: "what's the patient's saturation?"

    Me: "The patient is sating 95% on nasal cannula at 2 liters per minute"

    Tele nurse: "on room air?"

    Me: "Read the damn chart"

  5. OMG. I am so tired of the skin intact and "is the patient alert and oriented times three" question. I'm giving report the last shift I worked for a chest pain observation. I tell the floor nurse, "He's an otherwise healthy 40 year old man". Is he alert and oriented times three? What the fuuuuccck dude? Really? I just told you he was 40 with no medical problems. Why would he not be oriented? Really? That's the question you're going to spend your time asking? Shit.

  6. Where I have worked - we don't give report between ER and the floor....they just come up. Everything is on the chart. Why repeat what is on the chart? Unless there is something stat or critical - we don't wanna hear it - esp the obvious.
    Same with from the OR...everything's on the chart. What's the point?

    As for the patient who tries to tell me where to put an IV...unless he is an IV drug user..he probably doesn't know...I have actually told several people "here...try it yourself..." - they back off.

  7. ED and the floor don't communicate at my hospital either. As a nurse on a med/surg floor it used to bother me, but as I've worked longer I've realized that most of the things I wanted to know were easily figured out if I eyeballed the patient on the stretcher while they rolled past the nursing station.
    My ONLY wish was that nursing interventions were better documented in the ED. I look at the ED documentation in the computer before my patient comes up to figure out if this patient needs a pressure relief mattress on the bed, needs to be closer to the desk, or if they are stable enough to be on a med/surg unit, if our unit is appropriate placement, figure out tech assignments, what supplies i'll need in the room before they get there, etc. I often have to use the physician notes because nursing notes are deficient. I know you're doing something down there, take credit for it!

  8. Dear Rn in IL: I've never ever seen a floor nurse actually prepare a room for an incoming from the ED. As for the documentation, I'll get to it after I finish cracking a chest, doing CPR and taking care of a Stemi.By then, the charge nurse has already printed out the ED report and the patient is long gone.

  9. Get out of my dreams you creeper. Seriously, I have those exact ones, although mine seem real after a few vodka tonics instead.