Tuesday, July 31, 2012

Adventures of Charge Nursing, Part 1

Welll. I worked my first shift on my own as big girl charge, y'all. The ER did not collapse into a pile of rubble or burn to the ground and no one made me cry.  Yet.
 I have a new respect for the position.  As in, I stand in admiration and awe of any of our charge nurses that are able to pull their shit together long enough to have time to help out frequently with patient care.  I had spaghetti brains in the worst way, like I haven't experienced since I was a brand new nurse. I was inundated with so many different requests that I would get distracted just walking across the nurses' station.  You've usually got the phone on one ear with multiple people talking in your other ear, so all the auditory input was just scrambling in my brain and all my responses were getting mixed together word salad style. I felt like a HUGE spazz. But I know I'm at least making progress. A few things I've learned already:
-Despite being less physically demanding, I feel about one thousand times more exhausted after charging than I do after working in staffing.  Probably because of the constant muscle tension associated with the underlying fear or doing something incredibly stupid, like transferring the wrong patient or something.
-People seem to respond to a work ethic at least. I mean, maybe I shouldn't have been, but I was very surprised by my teammates.  They seemed to take note of how much I was running around and either felt sorry for me or responded to my working hard and being nice, because every time I looked up, people were cleaning their own rooms and filling them up. So much that one of the doctors got mad about it.  Oh well.  Which brings me to...
-Shrugging with a whatevs look seems to be the best policy for dealing with most petty arguments/hissy fits/backhanded comments. Somebody hurt your feelings during report? Either ignore it, be a bitch back like I would, or file a complaint to HR. I have no real authority, I really don't care,  and I have real shit to do.
-When your manager calls to check to see how things are going, I guess responding with, "yeah, I have no idea how many people left without being seen, probably a lot, a million people just checked in, we've been getting killed with ambulances and also someone wanted to come in extra and I said yes I hope that's cool because they're already here" probably isn't the best thing to say.
-Unspecified department problems are by default, your problems.  The doctor's printer is out of paper? HELP ME CHARGE NURSE! The coffee machine is broken? Hello, did you not learn coffee machine CPR in nursing school? Cray cray people want to call and ask for medical advice about cray cray shit? Forward to charge phone. Random foot-fetishist who is neither a patient nor a visitor is scurrying around the unit sniffing patient's shoes? Get the charge net, gotta catch 'em all!

Anyway, the verdict is, this sucks, but I know I'm learning new things and that's good for me.  But if I was doing it for the money, it wouldn't be worth it. Such is nursing in general, I guess.

Thursday, July 26, 2012

Why I'm in the Right Place, I Guess

It's an amazing, unexplainable, but universal rule.  The people that have everything want even more. The people that have nothing are thankful for any scrap of kindness that's thrown their way.
 I encounter someone just about once a shift that is absolutely livid about something that is totally insane.  I am the type of person that cannot simply tell these people to just get lost.  I've tried.  I say to my co-workers all the time that it's what I want them to do.  But secretly, even more, because of some totally insane defect in my personality or malformation in some part of my brain, I really just want to make them happy.  But people like this never are. They expect the world, and I can't give it to them.  They feel it's owed to them.  I really can't wrap my head around it, because I don't really feel as if I'm owed anything.  So when the inevitable happens, and my efforts are still not enough, I get discouraged.  I feel bad.  I know it's not my fault, but my crazy, pathological people pleasing perfectionism still overpowers me with feelings that if I could only be better, or express myself more effectively, or if I worked harder, that I could make these people happy.  I've come to terms with the fact that this is nuts and I'm aware enough of it to see it in perspective.  I can help them, but they won't let themselves be helped. 
Then there are the other types of people.  The people that I actually, really, truly, can't help.  I took care of a lady the other night whose circumstances were so horrible that I actually felt physical pain watching her.  I was fighting back tears every time she looked me in the eye.  I was looking right into her, and I saw a desperate battle of pain and suffering beyond the worst nightmares any of us could ever dream up.  She was dying.  She knew she was dying, and she was watching herself in horror as her body deteriorated and turned against her for absolutely no reason.  I wanted to give her everything.  I tried so hard.  There was nothing I could do for her.  I begged doctors for medicine and I doted on her as much as I could but it was all for nothing.  Nothing on earth could treat that kind of pain.  I couldn't help her.
Finally, as she apologized for the hundredth time for me having to take care of her in this state she had absolutely no say in, I could hold my tears back no longer.  I did my best to hide them as I grabbed her hand. "Please don't apologize to me", I begged her.  "Please.  You can't help any of this.  You didn't do this.  You are why I'm here.  I want to help you.  That's why I do what I do.  Please don't say sorry for asking.  It's okay, I promise." She nodded and thanked me.  I sat down and cried discretely while I charted. It was a full load that day, and I was already feeling bad that I hadn't done enough for her when her father came out before she went upstairs to thank me for all I'd done.   At this point I couldn't even try to keep the tears hidden.  He was taken aback and apologized.  "I'm sorry. I didn't mean to make you cry, but we've been in so my hospitals over the past few years and you have just been so attentive, and not everyone is kind like you and we're thankful." I hugged both of them and told them goodbye and I went back to work. 
I know I'll think about  them constantly for weeks and this will probably be one of the moments in my nursing career that I will remember forever.  I've been in a funk for a while, thinking about people like this and the ungrateful types, and how unfair it is that some people have everything and they don't even know, while people like this have to suffer so terribly.  I think sometimes that maybe if I devoted my career to people like this that things would be better for me.  But the more I'm exposed to this, the more I realize I emotionally cannot handle it.  I can shake the douches off, but things like this really do creep inside of me and cause me an incredible amount of sadness to the degree that it's probably really unhealthy.  I talked about hospice for a while, but I really think I'm in the right place.  I'm here, fighting through the bullshit with a smile on my face, trying desperately to hold on to my compassion when I'm occasionally faced with the reason why I do.  Perfect, no, but perhaps a little bit better for me than putting myself in the line of completely merciless emotional devastation and exhaustion every day.  I really want to help people like this.  But I fear after a while there would be no more pieces of myself to give. 

Sunday, July 22, 2012


While discharging a young man for his 4th visit for STD symptoms:
Hood Nurse: "Okay, so it looks like you've been here for the same thing a couple of times in the last couple of months.  It's important to make sure your partner is getting treated so you don't keep re-infecting one another, and you probably need to make an appointment with a regular doctor to get actual STD testing done to make sure that you're not dealing with a drug resistant strain, got it?"
Hood Nurse: "Alright then, well, here's the prescription for your antibiotics.  I just need you to sign right here and then you're through, but do you have any questions before I let you go?"
Patient: "Yeah, are you single?"

Um. No.

Monday, July 16, 2012

Lord Save Us

After all the protesting, list of things I would rather do (eat broken glass, get new boobs and find a job at hooters, be up at triage every day for the rest of my career) I have agreed to be charge nurse at this place like an idiot. So. That's happening.
I'm ambivalent. On one hand, I've exhausted all my options as a regular staff nurse as far as doing new things, unless I want to go somewhere else, which I'm also considering, oddly enough.  I know  make me stronger, and maybe more confident, and it'll look good on resumes and stuff if I do decide to leave. I'm sure it will help me with decision making skills and with being assertive, which I absolutely need to improve on.
On the other, I am scared shitless.  I feel like I am way too dumb to be doing this already, and that I know absolutely nothing, but sad as it is, being a nurse in this ER for three years and a couple of months is what some people call "experienced". The thing I'm most concerned about it is not having the emotional fortitude required to do this job.  People can be serious dicks to the charge nurses.  Like they think that being bitchy and bratty and whining about who has what (obviously you aren't too busy to take an inventory of everyone else's patients) is going to make the ER less full and make them less slammed.  I don't know.  I just don't really complain to other people and I don't have a ton of patience with people who do.  I honestly worry that I will end up getting stabbed in the back by someone I'm cool with or more likely, that I will have to listen to someone bitch about trivial bullshit on what is already a crappy day and that I will completely lose it on them.
Either way, it's happening and I guess I'm on my way to being a grown up nurse.  Any tips from the adults out there? Can I have a couple more years at the kid's table, please?

Saturday, July 7, 2012

Least Favorite Complaint?

ER BFF and I were having a deep philosophical discussion the other day about which complaint is the absolute worst.  For me, it's a toss up between vaginal bleeding vs. elderly constipation.  Not always, but vaginal bleeding usually has at least somewhat of a dramatic spin that requires hostage negotiator  level de-escalating skills.  Plus it's a guaranteed pelvic set up, which is a pain in the ass, and at my facility you're guaranteed to wait at least 10 years for a transvaginal ultrasound to get done, so, yeah, you better hope the patient is nice. Elderly constipation really doesn't require an explanation I hope.  Once you've done a fleets enema on one old person with unsteady gait and then had to watch them on the bedside commode for half an hour so they don't take a monster dump all over the floor and then fall in it while the room fills with the smell of 5 days worth of angry hardened turds, you understand.
I figured at least the last one was universal, but her answer surprised me: toothaches.  Her explanation was that the situation pretty much always turns into drama.  The patients that come to our ER with dental pain generally tend to think it is a life threatening emergency.  Most have Lortab at their disposal at home, so when they aren't offered anything more than that once they've waited 6 hours to be seen, they are PISSED. I get her point, but I would still rather talk down 10 angry toothache patients than administer one fleets enema to just about anyone, so I guess it's just a personal preference.
So. What say you, internets? What chief complaint gives you the most nightmares?