Thursday, March 31, 2011

A Series of Poor Choices

Bad Idea #1- Driving a boat drunk and on anxiety meds.
Bad Idea #2- Attempting to escape police after being charged with PI by attempting to jump out of the back of the police car, thus sustaining a pretty ugly eyebrow lac to your face in addition to further charges of resisting arrest.
Bad Idea #3-Swearing at the officer posted with you and saying unsavory things about his mother, resulting in surely less leeway for you surrounding events to come.
Bad Idea #4- Wiping your piss covered hand on said officer posted with you after using the urinal, resulting in you getting further assault with a biological weapon charges or something of the sort, and you having to hold it for the rest of the visit.
Bad Idea #5- Threatening to sue the doctor for giving you steri strips instead of sutures (seeing as how you will now surely be in the county pen for longer than 8 to 10 days as a direct result of your actions) then asking him for pain meds.
Yup. This, ladies and gentlemen, is a classic example of when keepin' it real goes wrong.

Saturday, March 26, 2011

Things that really will not help your case in triage

I am spending a lot of time in the punishment booth lately as I seem to have become one of the only nurses where I work who was dumb enough to sit through this 2 hour triage class where they teach you how to appropriately rate the severity of all the STD exposures and dental pains we see everyday. Anyway. I've been exposed to dangerous levels of foolishness lately, and let me just say there are a few things you can do up there that will erase any guilt I may have had for sending you back out in the waiting room:
-Having a pseudoseizure- Well, obviously. But people still do it. I mean, why you would voluntarily get on the floor of the most ghetto hospital in the county is beyond me. But if you're feeling well enough to do the worm or whatever that motion is in my triage room then you are well enough to wait behind a couple of other people who aren't acting like that.
-Letting someone else give your triage information when you are perfectly capable of talking- For some reason this was the weapon of choice last night. All dudes having their wives or girlfriends give their complaint, their medical history, even the pain scale. Really man? There is no way she can know that. Use your big boy words and tell me your own medications, for real.
-Using a wheelchair when there is nothing wrong with your legs- Why does abdominal pain always require a wheelchair? No, I mean, I'm really asking.
-Bonus complaints- So I know you're here for lady problems and this may seem like it's an excellent time to tell me that you also may or may not have bed bugs, but it really isn't. Now I have another phantom itch, so thanks for that.
-Being crazy loud- There are a few good reasons for me to hear you from the waiting room, but not many. If I can hear you eating, chewing your gum, or wretching before I can see you, it's generally not a good sign.
-And while we're on the subject, eating- Yeah, if I'm getting interference on the oximeter from the cheeto dust on your fingers then I'm gonna go ahead and assume your airway is intact, next please.
-Talking on the phone- Yeah, if it isn't life threatening enough for you to stop your conversation for the three minutes it takes me to triage you it probably isn't really an emergency.
-Yelling at me- The ultimate. Yeah, if I'm opening the door to get someone else to triage, posting yourself in front of the door and screaming at me about why you're not getting a room for the dental pain you've left untreated for months is not going to get you back to a room or get you yet another prescription for Vicodin any faster. If I was in charge of who goes back to a room when, I would award you 200 douchebag points and let you think about your life choices in the waiting room for a little longer, but since I'm not, there is really no reason to raise your voice.
Am I forgetting anything?

Friday, March 18, 2011

Does that mean what I think it means?

Where I work, nurses are still doing paper charting but our physicians have this charting system that, from what I can gather, has a series of generated normal responses they can select- charting by exception, basically- not a bad system. So one of the notes for disposition and discharge I always see says something like "discussed care with patient, patient was in good condition, discharge was given by RN, patient was ambulatory ", except I see this pretty frequently in fast track in notes for infants and I find it hilarious every time. I just have a picture in my head of an infant walking out of the ER with it's discharge papers like, great, otitis media, yeah. I'll go fill this Amoxicillin right now, thanks guys.
I'm curious, though, is ambulatory now some blanket term for not dying, doesn't need to be admitted or transferred, or are all our midlevels actually rocking so hard back there that they are not only treating the babies with nasal congestion, but are also teaching them to take their first steps out to the parking lot? I must know their secrets.

Thursday, March 17, 2011

I bear the curse

WTF. Listen, I just have to feel around on the internets to see how common this is, i.e., am I really special, but WHY is it that seriously every time I go to triage, a family of at least four, and upwards to six so far checks in together with scabies? And why is someone always like, "Yeah, hood nurse would love to spend more time in the company of La Familia Scabies, lets have her discharge all of them from triage because I heard scabies were actually her favorite animal and she finds them adorable."
So, obviously I am afflicted with the phantom itch right now and I'm really wondering what I did to deserve this. At some point in my life I had to have wronged an old gypsy woman or discharged a patient who practices voodoo without a script for Vicodin or something, because it's an unusual night in triage when this doesn't happen. The six-fer actually checked in when I was working a partial shift in another area 5 minutes before I had to go up to triage. Yup, really. Aye! Sufriendo!

Sunday, March 13, 2011

Fun TImes at the Check-in Desk

Hood Hospital, 3 AM, Friday night:

Girl #1- Uh, yeah. I'd like to get checked for STDs. See, my boyfriend went to the doctor and they told him to tell me to get checked and I think I might have that chlamydia like when I first broke my virginity because I be leakin'.
Girl #2- Yeah, I wanna get checked too. I'm not having any problems or anything but my friend didn't wanna go alone.

Yeah, really

Orders for some lady who checked in for effin menstrual cramps:
8 mg Morphine IM
Vicodin 5 mg po
Zofran 4 mg po

Yeah, how about 6oo mg of Motrin and a swift kick in the ass? Really? Listen, I am not unsympathetic to the cause of menstrual cramps but this shit is getting ridiculous. I just don't understand. If you have pain and you know what's causing it, since when do you need to go to the ER? I had pretty horrible cramps until I got on birth control, and when I got them, I took some Midol and curled up in fetal position with a heating pad and dry heaved like a normal person. Now when I get them I just drink margaritas until the pain stops. No ER necessary.
Even if you don't think this is acceptable solution, take for example a friend of mine who has legit, documented lady problems that cause her to have the cramps from hell. She goes to her doctor, who prescribes her Vicodin, which she takes AT HOME. By the way, she is a college student who works and she is uninsured. So no, as far as I'm concerned there is no excuse for this foolishness.
Unless... maybe this is first line treatment now. Sign me up! I'll be there in a little less than a week, which is probably why I'm so crabby. Have the Propofol ready, I'd like to be asleep for the first three days of this. I'll take some Phenergan for my nausea and some Lasix for my bloating too, if you don't mind.

Saturday, March 12, 2011

Proud Moments in EMS history

Report on a late stage CHF, home 02 dependent for several years patient c/o difficulty breathing:
EMS- Well, the room air sat was 85%.
Hood Nurse- Wait, the room air sat? I guess I'm confused? Didn't you just say she was on home O2?
EMS-scoff. Yeah. We took her off it? Is that clear enough for you?
Hood Nurse- Well. Why?
EMS- Uh, snort, we wanted to see what she did?
Oh yeah, that's right. And I'm the stupid one.

Report on a 3 month old infant with a witnessed apneic period during which it turned blue, then became began breathing again:
Hood nurse: Soooo, why is this baby here instead of at the children's hospital that is ten minutes from here where they actually admit pediatrics?
EMS: Cause the baby was riding with us, and we were coming here.
Hood nurse: Oh. Great. Excellent work.
He then proceeded to sit at the nurse's station for twenty minutes hitting on my coworker and showing her things on his cell phone. The baby was transferred via private EMS later in the evening.

Report on a 27 year old who tried to tell us that "someone" drugged his black and mild:
EMS: I dunno, like, he just said he was feeling funny. His vitals are all stable and stuff.
Patient, with a heart rate of 160 on the monitor: Maaan. My chest hurts.
Yuuupp. Good job.
You know, it was said best by a friend of mine I work with, who happens to be an excellent paramedic: If you aren't going to do shit for your patients other than take them to the hospital and drop them off, I'm gonna repaint your fucking ambulance yellow and write "TAXI" on the side, because that's all you are.

Wednesday, March 9, 2011

Patient safety and therapeutic charcoal

Last night I worked triage for the second night in a row (FML) and naturally because it's me and my life it was stupid busy and everyone had some kind of complicated complaint and I didn't pee until the wee hours of the morning, etc. Beds are just not happening, half of our ER are holds so actual sick people are waiting for hours on end when some teenage girl comes in with her mom for dizziness.
Mom actually seems like a normal person but clearly shook her daughter either too much or not enough when she was younger because she is acting completely foolish. The story is that the daughter took some unidentified meds that a friend left at her house because she had a headache- great plan, I know I always take someone else's random meds when I have a headache that I don't know the purpose of instead of just taking a damn tylenol. Anyway, they bring me the pill so I type it into the database and see that it's a prednisone tab. Well, it may make you nauseated but two certainly won't kill you. To the waiting room you go. So then, out of nowhere, this fool suddenly remembers some other pill that she took that is of course very generic in it's description that she naturally did not bring with her.
Mom is clearly about to slap her, as all this fuckery supposedly went down while she was at work. She asks her if she took anything else, to which she of course replies " I can't remember". May I also just say that 16 year olds really suck at lying. Really. Despite all that, I'm in a bind where I have to call the charge nurse and just let her know. She is a friend and very similar minded in what bullshit all this is, but we are put in a very bad place if any drama goes down if we admit to sending what's technically a pediatric patient who ingested an unknown med in unknown amounts back out to the waiting room because she sounded like she was lying. So homegirl then gets to skip over all the chest pains and such that have been waiting 4 hours patiently, and take our last available room.
Now. I know it's not in my scope of practice to order meds, but I truly believe that this situation calls for some charcoal with sorbitol, stat. I mean, she didn't know what pills she took or how many! Patient safety! Instead she got Ativan and Maalox. Um, no sir. You're fired or at least suspended until you are re-educated on the hood hospital therapeutic charcoal policy. It's in your manual between right after therapeutic NG tubes and O neg transfusion worthy IV sites for people who might be vomiting blood. Safety first, people.

Monday, March 7, 2011

Top 5 ways to get dayshifted

As I may have mentioned before, day shift and night shift do not like each other so much at my hospital. Now before you people get all bent out of shape and are like, "Hood nurse, you stupid douche, I've worked the day shift all my life because I have kids/pets/ houseplants/narcolepsy/other rare medical condition that prevents me from working nights, I hate you and I'll never read your blog again", calm down. I am just talking about the ones at my job and not about you.
It just so happens that most of the anal retentive, self righteous, extremely type A management ass kissing types are also the ones that are okay with getting paid less to wake up and do their makeup at 4AM so they can come to work and talk to administration, go down to the cafeteria and get breakfast, gossip about their coworkers and occasionally work. Not all of them are like that, but pretty much all the ones that are work days- kind of like how not all trapezoids are squares but all squares are trapezoids. Anyway. Glad we could have that little math talk.

But on the subject of my ridiculous coworkers, we had some down time the other night at the 4 AM stretch so we compiled an unofficial list of all the lame ass excuses they come up with in report that leaves you getting screwed but usually not realizing it until they have already skipped out to the parking lot- known more commonly where I come as getting dayshifted. I will now share them with you.

1. "I don't know anything about this patient, the charge nurse just put them in the room 5 minutes ago and I haven't seen them. Nothings been done." Now. About half the time this is true, because day shift charge nurses do love giving people ambulances and bringing people straight back to their room from triage at the same time, and rarely is anything done because that would require effort and the charge nurse getting her ass surgically removed from the charge desk chair. Luckily we have trackers that show how long the patient has been in the hospital and how long they've been back in a room, so we can see if they got there at the exact same time as two other patients, and whether the nurse really did get screwed, or whether they've actually been in the room an hour and half as opposed to 5 minutes. And if this is the case, I won't bug you about it, but I will chart when I assumed care, when I connected the patient to monitoring equipment or did something to help them not die, and that I never received report, so that if shit goes down, you're done, son.

2. "All they need is the urine" I hate this shit more than anything. Again, trackers ya'll. I can put together the story that Dr. Lazybitch ordered urine on this patient 4 hours ago and that despite your best efforts she cannot and will not dispo this chest pain patient without a UA. But since you were too lazy to get up for 15 minutes to ambulate your elderly patient to the bathroom, now I will do it while I get passive aggressive notes from the MD. Thanks a million.

3."She's been in there asleep" Why is it that I hear this statement from the same nurses and every time I go in to find their patient writhing in pain, saying they've been hitting the call button for 2 hours. Really? How hard is it to ask the doctor for some effin' Morphine?

4. "He was a hard stick and the paramedic wasn't available so I didn't even try" Really? Are you a fucking nurse? Then act like one. Maybe if your skills are really that shitty you should go work at the nursing home where you can send your patient to the ER every time they need an IV start. Or maybe you should start your own IVs occasionally and then you might remember how to do it right.

5."Yeah, yeah. Everything's been done" (whilst holding the chart to their chest) Ohhh man. The kiss of death. If it looks like they're hiding something, they probably are, like the fact that their patients have been dangerously hypertensive and in pain all day, they didn't notify the doctor, and they didn't give the meds that were ordered at 1400. When it's all the charts, you better get into the urinary cart and grab yourself some economy size lube, because shit is about to get bad for you.

This is in no way a comprehensive list. What kind of tricky shit does the "other shift" where you work like to pull in order to bamboozle you into doing their work?

Saturday, March 5, 2011

ER staff abuse and douchebags

So in my wandering around the internets I came across this blog entry that someone had described as offensive to ED workers in that it seemed to blame ED violence on the employees. I actually found the post itself to be relatively neutral- there was a blurb about verbal de-escalation and basically responding calmly and with compassion when someone acts a fool, which I really do believe in- I've dealt first hand with many an agitated patient who I've been able to talk down by apologizing and showing concern. No, I got all irritated by some troll who is supposedly a patient advocate who thinks that if all emergency medical staff are not Jesus incarnate that they should just shut up and GTFO of the medical field.

I won't sit here and quote this hateful person who obviously has some serious issues with med professionals and ED staff particularly, but I do want to address this idea that I've seen brought up multiple times, almost always by someone in health administration, that if medical staff were just kind and compassionate enough that all our patients would stop acting out and being violent and verbally abusive.
Theoretically this doesn't sound so offensive, but think of it in any other scenario. What if my husband comes home after a really awful day. Work sucked, he got sick, the car broke down. Let's say in this scenario that I reply in a less than chipper tone about his request to get him a drink, to which he responds to by hitting me and calling me a series of obscenities. That's wrong, isn't it? Now, what if he does to the gas station attendant on the way home instead because the line is too long and they had an attitude? It's a felony, isn't it? Would anyone say to either of these people, "If you had just been a little nicer and more understanding, you wouldn't have gotten beaten. You should have known he was upset and treated him better"? No. Because that is victim blaming and excusing abusive behavior.
I have no idea why people think that it is then acceptable to act that way in a hospital setting. Look, I understand that people get agitated and frustrated, that they're having the worst day of their lives and most people in the ED just want to know what is going on, be made comfortable and be listened to. I make it a point to address those needs for each patient I take care of every time I come to work, to the extent that I often neglect my own basic needs like eating, drinking and going pee. I give everyone who walks into my room the benefit of the doubt about being sick and in pain, and even if I'm suspicious I still treat them with respect and kindness. Despite all that, guess what? The ER is a pretty good representation of the world in that most people are just there minding their business but some people are assholes. Some people lie to and manipulate the staff trying to help them to try and get something. Some people are high or drunk or just abusive and think it's acceptable to grope the staff. Some people have minor ailments but are abusive and threatening about waiting behind the sick and dying.

There are the cases where a patient is so sick that they're hysterical and rude and very difficult to deal with. I have a great deal of patience for people like this. I fall short with them sometimes and when I do I apologize. This is very seldom the case, though. As I'm sure many other ED doctors and nurses have observed before, the sickest patients are generally the most sweet and polite. A good friend of mine still tears up telling the story of the dying cancer patient she took care of last year-despite her horribly painful condition, she was so grateful for her care that she gave my friend a hug and a kiss for just bringing her some orange juice.
On the other end of the spectrum, I got cussed out the other day by a completely pain free, healthy and ambulatory patient because I relayed the message from the NP that she would have to get a urine sample prior getting the pelvic exam she demanded. I can't speak for anywhere else, but where I work this is usually where the problems come from- mostly healthy people who use the ED as a clinic who have figured out that aggressive and abusive behavior goes unpunished, as opposed to fragile sick people at the end of their rope.

There's no way of knowing whether violent behavior could always or ever be prevented with better communication. Ultimately it doesn't matter. Unless you have some kind of neurological problem, you are still responsible for your actions, and that kind of behavior isn't okay. I invite anyone who says otherwise to try to work a shift with me in the hood for one day.

Thursday, March 3, 2011

Well, yeah

Seriously all people I treated today alone:
Headache and nausea s/p drinking too much last night.

Pain after eyebrow piercing today.

Vaginal irritation after rough sex.

I mean, really? I look forward to the day I become an NP because I will write discharge instructions that simply say LEAVE NOW. Depending on my mood they may also encourage a vasectomy or tubal.