Saturday, September 29, 2012

....But They're A Nice Person

Alright, so there's a subject I'm very opinionated on.  I know you're shocked, but I'm curious what other people think about this.  So like anywhere else, there are some shitty, lazy ass nurses where I work.  Like, not as in forget to hang a med every now and then shitty, but as in basically totally ignoring their patients for hours at a time while updating Facebook and skipping really important shit like CIPs on a patient with chest pain and a mile long cardiac history type of shitty.
These people also may be really good dancers or fun to go to the bar with or maybe they have a boat or an okay personality or whatever.  People still like them for these qualities and want to be their friend while still objectively being able to say, "yeah, they're a shitty nurse, but they're an alright person", to which I would say-naw.  Nope.  They're not.
Here's my thinking.  It's one thing to be inexperienced or tightly wound to the point of being ineffective- these people I can still love and try to help.  But as far as I'm concerned, if you're the shitty secondary to laziness type of nurse, you are probably not a good human being.  You can put on a nice face to your coworkers and buy people Starbucks and smile all the time, but if you have no desire to help patients that are actually sick that depend on you to take care of them, that speaks more to your true colors.  I take this job so seriously and it means so much to me to do a good job that I really cannot fathom how someone can take it lightly and just not care.
 I feel very strongly about this, to the point that I make a concerted effort to never have to interact with these people. When I do, I do very little to hide my disdain.  A lot of my good work friends do not understand this.  They're confused when they want to invite these types out somewhere and I don't want to come along.  It's just that I've seen all I need to see.  I'm not interested in knowing them any better.
I wonder sometimes if I'm maybe too harsh on this, but I really can't reconcile being an okay person with being a lazy nurse.  Am I wrong?

Tuesday, September 25, 2012

Code Blue, ER Waiting Room

Dude, I'm waiting for the day. Hopefully I'll be gone by the time we have to start CPR in the waiting room.  But we've had a couple false alarms in the mean time.
How about the drunk girl whose mom decided she was dead? Yeah, as opposed to calling 911, mom sure did scoop her early 20 something daughter up and throw her in the car when she became unresponsive.  She, um, monitored (?) her on the way to the ER, during which time her pulse became "weak" multiple times.  Mom then initiated compressions, until daughter woke up.  When she would drift off, mom would initiate compressions again.  Repeat the steps above until they reached the ER, when mom ran frantically into the waiting room screaming that they were doing CPR in the car. Poor newer nurse at the desk that night believed her, paged it overhead, stretchers were rolled out to the car until everyone got out there and... yeah.  Dr. Muscles, who is already high strung anyway, had a total shit fit when the girl got back to the room and the staff cancelled the code blue and activated code drunk.  Okay, great, how about a couple saline boluses.. hello.. ah, nope, you're already walking away.  Luckily I was charge, Dr. Muscles likes me, and the situation was diffused.  Well, up until ER BFF accidentally let on her feelings about the situation while giving report to the oncoming nurse.  It went something like... "Yeah, so they were having trouble waking her up at home, and then momm initiated comppressions? And...yeah" (add WTF shrug and wide eyes into the mix) when mom chimed in "I SURE DID!"  Yup, I guess she still probably thinks she saved her daughter's life, as opposed to doing a modified sternal rub.  MMKay, thanks for choosing Hood Hospital.
Then the other day, some girl fakes a syncopal episode at the triage desk. Yeah, it happens about once a week anyway, but this time some random patient runs up to catch her whilst yelling "CODE BLUE! CODE BLUE!", eliciting blank stares from the staff.  Another patient chimes in. "C'mon you guys, code blue!"  Everyone quieted down considerably when the ammonia caps were deployed.  Guys.  You have GOT to stop watching Grey's Anatomy. 
I think the foolishness people pull in the ER is so foreign to the average person that they assume anyone who falls down has actually passed out.  Very rarely does this ever actually happen.  Someone decided to play this game the other day.  She did a terrible job, but since she was twice my size, I just had to wait for the charge nurse to run out with the ammonia caps to expose the truth.  In the mean time, some sweet, unsuspecting big dude came over to render aid.  Poor guy, he was so concerned.  "Oh man, she must have finally passed out from the pain", he said.  "Yeah.  She's fine. People are coming, but thank you", I told him.  Yes, she looked like quite the fool whenever she immediately sat up while trying to bat the ammonia cap away.  I saw the same gentleman on the way out and thanked him again for helping.  He asked me if she was alright.  My triage partner chimed right in.  "Yup", he said.  "That happens sometimes when we have long waits."  The nice man was shocked.  "Seriously? WOW."  He walked away shaking his head.
Yeah. With the way it's going here, it'll happen one day.  But we'll be terribly skeptical when it does. 

Monday, September 17, 2012

Acute Lawsuit Opportunity

Blergh.  People are soooo incredibly not subtle in regards to their ulterior motives when visiting the ER. Every now and then, sure, we get the creative drug seeker who fool us all, but usually people are just not subtle enough and blow their cover in triage by making requests that are way specific. 
The worst are the ones that are clearly trying to establish grounds for a lawsuit.  In adults, this usually manifests itself in the form of symptoms far out of proportion with the actual mechanism of injury, lots of talk about said mechanism of injury, and me having to explain what a contusion is upon discharge. (You've got a bruise, bro, go to the house).  Bonus points for asking for documentation of injuries and putting it on blast that your insurance won't be paying for this visit when the unsuspecting registration clerk comes to collect your information.   Nkay, whatever you say, dude!
It's a thousand times worse when people bring their kids in for this crap.  I'm talking Toddler and Tiaras style coaching.  "OH, honey, weren't you saying your back was hurting on the way over here?" "But sweetie, your pain is only that smiley face with the 2 underneath it? Are you sure it isn't the one that's crying? You were crying earlier!" At this point the parent usually goes totally rogue talking about all the injuries the child sustained and was complaining about at the time.  I always chart these exactly as they say, including the part where the parent said them and what the child is doing at the time.  For example, "Pt's mother states pt was crying and c/o lower back and neck pain at the scene.  Pt denies pain at this time, playing game boy at time of triage.  No pain or guarding noted upon palpation of pt's low back or neck."
We had one like this a couple of days ago that might have taken the cake.  Bonus points for this one when half the triage is spent talking about how something was spilled on the floor at the Wal-Mart and no one had mopped it up and they should have mopped it up.  Allegedly, the kid slipped in whatever slippery substance was spilled on the floor and fell to his knees for a minute. Mom was totally spazzing talking about how she was worried and wanted to get her baby checked out, etc. after the bad people at the Wal-Mart were so negligent as to let this happen, except, yeah.  The kid had not a mark on him.  I'm talking not a skinned knee, no bruising, no swelling, no redness.  He had at least three varieties of chips in his hand at the time of triage, and he rated his pain a 1 when prompted.  I sent them out to the waiting room, as absolutely nothing was wrong with him AT ALL and thirty minutes later mom's bum rushing the desk saying that her son's knees hurt and he needs pain medicine.  The kid is still chilling eating chips in the waiting room. 
WTF? Do these settlements really pay that well? Maybe I should slip on some shit at Wal-Mart so I don't have to keep dealing with this foolishness.

Friday, September 14, 2012

Big Happenings and Stuff Maybe

Welp.  The time has come, sort of.  I've finally reached my breaking point with this place.   Charge did it.  It's not that people are giving me shit, or that I can't handle the pressure (well, maybe partially), so much as it's really brought to light how insanely fucking dangerous a place this is to work as a nurse and I don't feel okay doing it anymore. It's almost okay sometimes as a staff nurse.  Yeah, your patient acuity is crazy and most of us probably have more on our plate than we can handle at any given time.  But at least there's a limit to how many they can make us take.  Charge and triage? Forget about it. 
We do not have the resources we need to take care of all these people. And we haven't since I started here.  Every year it gets worse. They keep telling us to hold on, that we'll do this or that, and it will get fixed.  And okay, great, we don't have to hang Levophed on a fucking dial-a-flow anymore, am I supposed to be impressed at this progress? There are still good nights. But the bad nights are becoming the norm.  And it's not alright anymore.  It's seriously just not okay that I look at the tracker and consider it a "good night" if the waits are in the single digits and I don't have to scroll down to see how many people are in the waiting room.  The conditions here are setting us up for failure. With as sick as our population is, someone is going to either die in the waiting room or go home after waiting to be seen forever and die and it's going to be all of our asses.  Not the people in suits who keep making excuses about why we have so many holds all the time and why we never have any staff.  Not even my manager who's been begging them to do something.  Us.  The nurses.  We're the ones that are going down when this happens.  And maybe when it does they will finally do something about how this place runs.  But our lives are gonna get ruined in the process.
I've felt so loyal for so long, because I really love it here.  I really care about our patient population.  Among the ridiculous hood foolish behavior, there are some really sick, sweet, hardworking people that really need good nursing care and are really grateful when they get it.  I actually genuinely like my manager.   And damn it, my coworkers.  That is the hardest part.  They have kept me here for so long.  Worrying about leaving them here with a bunch of people who don't give a shit.  About who is gonna teach the baby nurses how to work on a team and how to deal with the crazy shit and how to deal with all the messed up stuff they feel in the first year or so.  I absolutely adore these people. About who my charge nurse buds are gonna put at triage on the nights they have a quarter of the rooms they should and they need someone who's only gonna call about the really sick people.  They have reached out to me and held me up when I was at my wit's end with the crap this place dishes out.  It's like having a second family.
But ultimately, I can't do it like this.  I can't continue looking these patients in the eye and telling them it's acceptable to wait to be seen for 10 hours with chest pain and a cardiac history.  And can't keep sending these people I care about more ambulances when I know they're already overwhelmed.  I can't continue to be part of an environment where I don't have the tools I need to be successful and practice safely.  I worked so hard to get my license.  I'm not gonna lose it for the dignity of staying on this sinking ship.  I feel like I can't do anything good for these people anymore, and it's breaking my heart. I'm constantly anxious days after I'm in charge or triage, because I it's gonna come back that something bad happened on my watch.  I feel like crap for days on end thinking about how sub-par the care I'm able to give these patients is when I want to be doing so much more.  I'm generally having nightmares about being at work after I get off a shift.  It's gone past being a tough job at this point- it's crept into my entire life. 
So I'm looking for jobs.  I'm gonna stay in the ER.  Preferably one that's still busy, but one that isn't a total shit show in the way it operates.  I'm sure I'll still be here for a bit, and even then that I'll still have stories.  I just can't take the way things are here anymore.

Saturday, September 8, 2012

New Item on My Last Day To-Do List, Courtesey of Emesis Bag Nurse

World Famous Emesis Bag Nurse: Yeah, I've been looking into going into the trophy store and buying a whole box of those acting statues with the little gold man on them so I can just hand them out to people in triage after they roll all over the floor and shit.  It's getting ridiculous up there. 
Gawwwdd that would be amazing.  I've been daydreaming what the reaction might actually be for days now. I'm thinking in order of likelihood, it would be angry yelling, total confusion, or slinking back into the waiting room in a defeated manner.  Either way it would be the most hilarious shit ever, and when I finally become a dusty old nurse who is about to retire, I'm doing it.  It's happening. I wonder how much they cost.  

Oh, and in other slightly related trophy news, I'm seriously considering hot-gluing a troll doll to a piece of plywood and spray painting it gold, thus creating the golden troll award (trademark pending).  This honor would obviously be granted at the end of the shift to the nurse who took care of the most abusive/terrible patient. I think it would boost morale, but probably also land me in the office. But still. Worth it?

Wednesday, September 5, 2012

Worst Admission EVER

Ugggh. You can always tell when Dr.Septic Workups and Dilaudid for everyone has been on for a few days, because there will always be shit-tons of holds in the ER.  Because he single-handedly fills up the entire hospital by admitting everyone.  His behavior is so notoriously ridiculous that I've seen it lead to multiple hospitalists having public meltdowns, including one of my favorites, an awesome Vietnamese doctor, who once famously exclaimed to him at the nurses station, "I cannot take this many patients! You fuck me over!"
If a patient still requests more pain medicine after the insane amounts of Dilaudid he usually prescribes, he will admit them for "intractable _____ pain" and order some ridiculous regimen like 3 of Dilaudid Q 2 hours until the hospitalist sees it and changes it to something reasonable because, I don't know, maybe they like their patients breathing.  Which often leads to huge confrontations and AMA signing, own IV pulling dramz when the abrupt Dila-da cutoff is discovered by the patient, but hey, at least that's one more hold that can get a bed?
Anyways, this is all standard procedure at this point, deliver us lest we receive a complaint from a drug seeker.  I guess I get it.  Why bother fighting when you can admit people for whatever they want and make them happy?  However, that still leaves me without an explanation for his most recent insane admitting diagnosis: "acute alcohol intoxication",  The BAC in question? 0.12.  In a 23 year old.  With no other medical history.  Who, with homeboy's crazy long dispo times, was most likely under the legal limit by the time his bed request was put in.  Awesome.  Way to reduce they unnecessary medical costs you're always bitching about, guy. A good friend of mine was taking care of this one, so we had a field day with it.
"0.12, huh? Dude, I guarantee that my BAC was higher than that last weekend.  And I'm pretty sure you bought me one of those drinks.  Obviously, I needed to get admitted to the hospital and I just went home and ate macaroni and cheese.  Why did you not call me an ambulance? You're a shitty friend."
"Right? We should always come up here after we drink.  We've been playing with fire all this time when we were out eating pancakes and stuff."
Seriously, though.  If we're going to start doing this we need to have a whole new wing that's open only for this purpose on weekends and holidays.  Bring on the life saving banana bags!

Saturday, September 1, 2012

ER Fashion Trends

Back in my shiny, noob nurse days, when I was all excited to go out and buy my uniform for my exciting new job in the ER, I wandered into a scrub shop while out running errands with my husband, found some relatively cute shit, and bought it with my fancy new nurse intern money.  As I was checking out, the lady at the counter asked me if I was a medical professional.  I replied that yes, I was an RN, with the typical shit-eating grin of someone who hadn't yet had to start drinking to cope with my chosen  profession. Okay, she told me, you get a discount then.  Just write your name down here.
I remember thinking at the time that it was so odd that they did that, because who the hell buys scrubs that isn't a medical professional? Who exactly is buying this scratchy, expensive crap to wear in their downtime?
Um, yeah.  My patients, that's who.  Most of the time they present to triage in their scrubs, I guess in the attempt to trick us into thinking they're some kind of medical professional or nurse or whatevs, except when you open your mouth and start talking about your vaginal discharge that you've had for two weeks and how your baby's daddy had that gonorrhea last month, it kind of ruins the illusion, but thanks for playing. One girl even showed up a while back in a scrub top with a little cutesy print with "RN" as part of the pattern, and then proceeded to blow her cover in record time with a chief complaint that not even the dumbest of RNs would present to the ER for.
Even better is when they show up wearing this shit as we're taking care of their family member like they're at work here (bonus points for showing up in the uniform of whatever fly-by-night 6 week medical assisting/phlebotomy program they're currently enrolled in) and then stand at the bedside trying mean mugging anyone involved in their family member's care.  Even more bonus points for googling the shit out of everything we say and then trying to argue about what we're doing.
Come to mention it, a general rule of thumb ER BFF and I have come up with is that if you are wearing scrubs and advertising the fact that you're a "nurse", chances are, you're NOT. This comes from several years of empirical evidence during which we've looked up face sheets and verified people's licenses online. Most of these people are actually lab techs, in the best case scenarios, they are nursing aides, but a good portion of them are also just total liars/cray-crays. Most actual nurses, myself included, wear street clothes and say nothing about being a nurse.  People are more likely to show the real time of care they intend on giving when they aren't trying to impress you, and you can more accurately judge whether or not they're a douche.
Anyway, complete tangent, but are my patients the only ones who try and pull these kinds of shenanigans? It's really a terrible waste of money.