Say Seizure Pads Again!!!

We have a bunch of new graduate nurses working now. Most of them are males and I think they add a fun, new dynamic to the place. One is incredibly funny in an annoying little brother way. I like him. He's smart, witty, and knows his stuff. I'm actually surprised that he's a new grad - he's just that good. Another one is personable, amusing, and seems to know a lot, I think the rest will come with time. He's got potential.
The other one is ....well, down right annoying. He thinks he knows everything already, talks more than any chatty Cathy I know, and is a STAN. In the fire service, a STAN is someone who always tries to 'one up' anything you happen to be talking about. STAN is an acronym for "Shit That Ain't Nothing". Every profession has a STAN, it's not exclusive to firefighting.

I'm not the only one who finds this incredibly annoying where I work. Sometimes, when I'm in the mood, I'll try to top his story and make stories up just to jack with him. Naturally, he's always got another story to one up my fictitious one. I find it extremely funny in a juvenile way.

Anyway, he was my replacement one shift and I was trying to give him his patient pass on reports. Prior to his arrival, I got an ambulance with about 15 minutes left before shift change. I didn't have any assistance, but was able to get the patient into the computer, perform an assessment, and notify the docs that the patient needed to get C-spine clearance. The patient was in the ER for a seizure and was backboarded. I thought backboard removal was priority in case the patient had another seizure and was injured due to being restrained.

I'm giving report to STAN and he asks if I put seizure pads on the stretcher. Umm, no not yet. After doing everything I just mentioned to him, I saw him and wanted to give report on that patient since I was waiting for a doc to clear the board from the patient. I literally just walked out of the room.

STAN: Oh, well we need to get seizure pads on the stretcher.

Me:  Yes, I know. Did you hear what I just told you? The patient just got here and I didn't have time yet to do that. I want him cleared from the backboard. The doc is aware of it.
I started to tell him about the patient and was interrupted.

STAN: Seizure pads. The patient needs seizure pads.

Me: Uh huh. The patient had a generalized tonic clonic seizure....

STAN: Yeah, he needs seizure pads.

At that point, I felt like screaming at him like Samuel L. Jackson did in PULP FICTION with the boy who kept saying "What?!"
Say "SEIZURE PADS again M***** F*****! I dare you! Say it again!!

For those of you have not seen this movie, it is very graphic in language and situations. ***WARNING*** the video is graphic, but expresses my thoughts at that time. Replace WHAT with Seizure Pads and you get my drift.

Schizophrenic or not?

I was admitting this patient into the ER. He was a paranoid schizophrenic who had been off of his medications for a while and was experiencing an agitated episode. He was extremely polite and answered my direct questions coherently. I was quite impressed. He continued telling me about his theories regarding life, the government, and a stream of thoughts about whatever he was thinking about.

The longer I sat there speaking with him and listening, the more he made sense. He made some remarks that I secretly fully agreed with him. He was very articulate and intelligent. Hmmm...it really made me wonder.
Has anyone else experienced something like this?

More for Less

Okay, this is not an ER post, but it's been something that I've noticed lately.

In this economy, prices have increased for everything. I'm getting sick of it, quite frankly. I noticed that the items I buy at the grocery store have not only gone up, but I'm getting less of it. The packaging is the same, but the particular item is either smaller or there are less items per package.

I like to eat a couple of granola bars before going to work. God only knows if I'll get a lunch break during my 12 hour shift, so at least I had something to eat during the day. The actual granola bar is about 25% smaller, yet the price for the box went up around 40 cents and the wrapper is the same size. It really irks me.

I make sugar free juice for my kids and keep a container in the frig for them. It takes 2 packets to fill the container. The package that the mix is in has 6 packets - now there are only 5 in them. I discovered that this morning.

I guess I could be the crazy lady and write my rantings to the companies. Give them a good tongue lashing and let them know that we, the consumers, are on to their little scheme. However, I don't think it'll do anything. I guess I'll either research alternatives to my favorite things or just suck it up and take it like everyone else.

6:00 PM

I realize that the ER is considered an orchestrated flow of chaos, however, being the Type A/OCD-ish person I am, I still have a few rituals that I need to perform when I'm there.

For instance, at the beginning of my shift I will always check out my rooms and stock them. I know the techs are suppose to do this, but you know, they have so many rooms to do and rarely get to all of them once the place get jumping. I absolutely hate when I need something in the room during an emergency and it's not there. It gets all over me. Even if I'm busy from the time I start the shift, I will still make lists and stock as I go.
At the end of my shift (I normally work 7a-7p or a variation of that), around 5:30, I'll get all paperwork in order, restock any stuff I've used, and try to get my patients all situated before I give report. That way, if I get a new ambulance, then there is just one person to work on. It doesn't always work out that way, but I do my best to give the night shift a fair start.

There has been another trend (aside from getting those 2 codes per shift) that I've been noticing the past few shifts. I find it weird. At 6:00pm, and I'm talking on-the-dot, I've been receiving critical patients.
One shift, a cardiac arrest who arrived at 6:00pm. The patient was saved and in the cath lab by 6:22. Well, any nurse knows the piles of paperwork to do with something like that and the subsequent tracking of controlled medications, equipment used, etc. It threw off my mojo. That's okay, I work in the ER - I expect it.
The next shift, around 5:40 a state trooper walks up to the desk. We figured he was there for a DWI blood draw.
"I'm here for the MVC (motor vehicle crash) patient."
"Umm....we don't have anyone here like that."
"You will. Everyone died in the crash except him."
The other nurse and I looked at each other then walked over to the docs to forewarn them. Upon hearing the information, one doc exclaimed, "Well, that patient is f***ed!"
Anyway, he arrived at.....you guessed it 6:00pm.

If this trend continues, then I guess I'll have to rearrange my OCD rituals. We'll see tomorrow....of course, I could get assigned to fast track and break the trend.

Callousness

It seems to be a trend - 2 Code Blues a shift. I'll hear the overhead announcement "Code Blue - ER room 2", "Code Blue - ER room 2". I blow my bangs off of my forehead, sigh, and think, "Jeez, I hope this doesn't take forever."

My husband and I were talking the other night and he was telling me about how some things he says to his friend (female friend) who he has known since high school shocks her. He said she literally gasps and her eyes widens and proclaims, "Oh my God, that's terrible!!"
He said he sits there, stunned for a moment, and has to explain or calm her down. She's a "normal" person meaning non medical and non emergency type of person. He had to explain to her that he sees a lot of horrible things that many people don't get to witness (except, maybe in movies) and has to DO something about it. He said that he is so accustomed to speaking to people that are in the business and they never even blink an eye during conversations like that.
Hubby: "I'm straight forward and direct when I speak and some people are shocked by it."
Me: "Yeah, you are." "I'm that way too."
Hubby: "Yes, but you're calloused."
Me: "What?! No, I'm not."
Hubby: "Honey, you're the most calloused person I know."

I thought about that for a minute. Could it be true? Hmmm.....
I protested some more and he gave me some examples of why he thought the way he did. Well, yes, yes I am. Interesting.

I had another student on shift and when I saw who it was, I told her, "Huh, this is ironic. What the hell am I going to teach you?"

My student is an LVN who is finishing up her RN. She worked in the ER years ago and was "let go" when our non profit hospital was bought by the mega corporation for profit system. She was getting her RN so she could be rehired and work in the ER again. She was my unofficial mentor when I was new to the ER. So she hung around with me for the day.
Later she mentioned, "Wow, it's interesting to see how calloused you all are. I haven't been here for a few years and I'm amazed by actually seeing it."
There was that word again.

Later in the day during a one of the two codes we've been getting, her and another newbie student nurse were in the room. Apparently, we shocked the newbie student.

Obviously, some information has been changed and there were no family members present. We weren't screwing around, we were working this patient, trying to bring him back, but we were also talking while working.

"When was the last Epi?"
"3 minutes ago."
"Give another Epi."
"Do we have a pulse?"
"Nope"
"Okay, continue CPR"

"Anyone eat lunch yet?" asked this one nurse.
"No" everyone exclaimed.
"Hey, *****, did (the charge nurse) say you can make a lunch run?" I asked.
"Umm, yeah", he answered while doing chest compressions.

"Doc, time for another Epi."
"Okay, push some Sodium Bicarb too."
"Ok."
"Okay, both given. Do you want to get in on the lunch run?"
"Yeah, where you going? ....stop CPR, do we have a pulse?"

"Huh, yes. A strong carotid pulse."
"Okay, let's see what we have on the monitor"
"Good. Let's hang some Levo."
"What dose? Hey, what about Chili's? Everyone feel like Chili's?"
"2 mics, Chili's is good."

We discussed starting a central line, what else the doctor wanted done with the patient and then he left to talk to the family.
I thought the code went smoothly and we had a good outcome. It was a good code for a student to see. The student nurse was shocked and upset according to my former mentor. The student thought we should have been somber and crying/sad. She said she smoothed things over with her explaining how working in the ER will change a person's outlook on suffering/sad situations and dealing with stress.
"Did she think we were calloused?"
"Yeah, but I told her that her day will come and she'll be that way too."
Sigh.

And that sort of thing and stuff...

Well, this was a long week. After 3 full shifts (which we worked 4 codes), I had the pleasure of renewing my TNCC certification. For those non nursey readers - it is the Trauma Nursing Core Course. If you work in any ER, they require you to have it.
Unfortunately, the closest recertification course offered is a long way away. That class is only a one day deal. So...I had to take the whole 2 day course. I know, what's another day? However, I really would've preferred to be home with my family instead.

The hospital system that provided the course held the class in a church. It was a beautiful old church. Large stained glass windows, dark wood ceilings that arched high overhead. It was magnificent.
I believe they did an excellent job except for one thing: the breaks. Now anyone who has set up or taught classes has learned that the max you can truly keep a student's attention is around an hour. Every course/class I've attended has had some sort of little break at the hour mark. To get up and stretch your legs. To go to the restroom. To move.

We had a break after 2 1/2 hours of sitting. I kept shifting in my seat because my ass was numb. Seriously, it got really uncomfortable. Most of the class had the "shifts". The second day, it was cram time. They still had a half day of lectures, then our patient scenerio test and written test. We began at 0715 and finally got to get out of our seats at 1200.

I was good until around the 2 hour mark. Then my internal dialogue got the best of me.
The instructor was discussing ocular, maxillofacial and neck trauma. Gory pictures of hyphemas, ruptured globes, and dismembered faces didn't even hold my interest.
"oh God, please stop talking. please. please. please."
I started to do something that I hadn't done since high school. I began to doodle on my notes for heaven's sake. I drew pictures of eyes, wrote, "please stop talking" in various forms of letters.
It was then that I noticed it. I wish I hadn't, but I did.
The instructor had this annoying habit of continually repeating one phrase. Over and over again.

"And that sort of thing and stuff."

It literally drove me mad. When I noticed she was saying this mantra, I started counting it. I guess that's pretty OCD of me, but it was mesmerizing. She used that phrase 34 times in a 30 minute time frame.

34 times!!!! I have the hash marks to prove it.

By the end of her lesson, I was screaming inside of my head, "AAAARGH, shut up! Let us go. Please stop talking. Please don't say"

".....so that is why a blind nasal intubation is contraindicated AND THAT SORT OF THING AND STUFF."

I survived. She finished her lecture. I'm sure she used that phrase as her "umm" that so many of us use as a filler when speaking in front of a crowd. I made a mental note to always give a break, even a couple of minutes to students if and when I teach in the future. Numb asses are not good listeners!

Progress....

I have been working on my perspective change lately. It's been slow, however, I am making some progress. I believe I'm making some progress....or maybe I'm just fooling myself, but I'm going to stand by the idea that I'm really trying.

My charge nurse asked if I would take a nursing student for the shift. Ugh. Normally, I like having students. I like to teach. I love it when that 'aha' moment crosses his/her face. We'll perform some task and they do it without difficulties. I then ask the student WHY we do it and why we perform it that way. They learn some good lessons that way and things click for them. I find that exciting.
However, at this time I'm in the middle of burn out and trying to deal with it. Like you already know, I'm not there yet.

"Please? She's a final semester student, you can give her all the gross things you don't want to do."
"ugh. Okay."

She turned out to be an awesome person. Enthusiastic without sunshine blowing out of every orifice, eager, and not a lazy bone in her body. The ER got super crazy and she was right there, following me around like a little chick. She received a good education that day, many skills to perform and things to see. I actually had fun teaching her things. I told her that once things got crazy, our conversations would become schizophrenic because the pace would be extremely fast. She did a good job. She stood back when appropriate and jumped in at the right times. I was impressed.
She got to see her first Code Blue. We spoke briefly about it between a chest pain protocol and a stroke that came in. She was amazed by how fast everyone worked and that everyone knew where to be and what to do. She got to help me quickly prep a patient before that person was swept away to the cath lab.
I think she had a good time.
Another nurse asked me to access a Mediport for one of her patients. I asked the student if she's done one before. She said only in lab. I looked at the clock and it was time for her to leave.
"Oh, your shift is done. You probably have a meeting with your instructor."
"Yes, but I can be late. Do you mind me staying for this?"
"Sure, because you're going to do it."

Her eyes widened with nervous excitement. As we gathered the supplies, I questioned her: What patients would have this kind of port? At what angle would you introduce the needle into the port and why? What is different about a Huber needle? Where are these ports in a patient? Why is this a sterile procedure? How do you set up a sterile field? Etc. Then we reviewed the steps before going in.
She did great. I knew this patient, so as long as he was going to get his dilaudid, he didn't care who accessed his port.
Before she left, she asked me if I was a preceptor for their final semester clinicals. This is where they are assigned to a hospital unit and work under an RN. I'm a PRN nurse, so my schedule varies and is not set like a full time nurse. They don't assign us students for their semester clinicals. Too bad. I've had many day clinical students ask me to be their preceptor. Those students said that I explain things in a way that it all makes sense for them. They also said that many nurses are mean to students or ignore them. I don't understand that school of thought.
Anyway, she helped me in my progress to correct my burn out attitude.
Perhaps when I'm old and crusty, I'll consider becoming a nursing school instructor. Who knows.