Friday, July 26, 2013

Everyone has choices....

I had a rambunctious little patient who obviously didn't like to listen to his parents or behave or do anything he was told to do. In other words, he was a brat. The PA came out of the room, rolled her eyes and said, "Good luck with that one." Obviously, the parents didn't practice the art of discipline, in any form.

Later, I went in the room to give him some Zofran ODT. He wouldn't take it and threw a fit in his mother's arms. I didn't have time to deal with this. I gave him a choice - I told the little devil, "You can take this pill which tastes like candy or I can give you a shot in your leg with a very big needle. Which one do you want to do?"
The little monster pointed to the pill and immediately ate it without complaint or resistance.

There's always more than one way to skin a cat!

Tuesday, July 23, 2013

More of the New Job

Well, I worked this entire weekend plus Monday at the new PRN job except at a different facility. Unfortunately, I had to miss a family reunion on my husband's side during this time. It was quite lonely to return home after working 12 hours to open the door to silence. Normally, the kids run to me and give me big hugs and start to chatter away about what I missed that day. I realized just how much I miss those ankle biters!

I had an 8 hour orientation to the new place - to learn the flow or process of the ER. I think the most annoying aspect was the underlying attitude of the nurses. Many of them have around 1 year of experience and they treat the new people as though they have none, even if you let them know your experience. For example, I was helping the triage nurse take vitals for a pedi patient which required a rectal temp. I grabbed the thermometer and the first thing she asked me was, "You got the red one, right?" I laughed (surprised that she would ask me that) "I'm certainly not going to use blue". She got kind of miffed by my comment. <For those non medical people: Red = rectal thermometer, Blue = oral thermometer - a very basic fact that nursing students learn their 1st semester> Ah....I decided to just roll with it, they continued to say stupid little things like that, but what the heck - no use getting pissy about things I can't control. I guess I proved my worth when I discovered a serious cardiac condition in a patient and assisted the doctor. There was another nurse who knew what she was doing, so we both took control.

When I showed up on Monday, I was on my own, so to speak, with another nurse to run the entire facility. As we introduced ourselves, he asked if I could show him around. Ummm....WHAT?!! Apparently, he had an orientation sometime 2 months ago and haven't worked since. I was the experienced one. HAha. We both had enough ER nursing experience, so I was comforted that if anything bad came in, then we were covered. I shrugged and told him I'd show him what I was taught yesterday and the rest we could either figure it out or wing it. The doctor stopped by the nurse's station to say hello and we advised him that it was collectively our first day, so be prepared and let us know if we mess up any of the ER flow. I guess he wasn't too happy when we asked him if he had a swipe badge to open the med room since we were never given one. It would be difficult to treat patients if the nurses couldn't get into that very important room.

I must say, I haven't had this much fun at any job in a while. We got along and clicked right away. We had more problem solving phone calls and paperwork than patients, but we solved them all - perhaps not in the official process way of this ER, but it got done. No attitudes, lots of stories and laughs, a very mellow day. I hope I work with nurse again, it was certainly a pleasure 'winging it'.

Wednesday, July 3, 2013

Another PRN job...

I started a PRN job recently at a freestanding ER and clinic.
When I went on the job interview, the ER director told me that it would be a slower pace than what I'm probably accustomed to and less acute patients. "Actually, more like clinic patients. Sometimes we get a patient to transfer to the hospital ER, but not very often." The interview was more like a "you're hired already - this is what it's like, do YOU want to work here?"

During my first training day, we saw a bunch of patients and transferred 3 out. The nurses and doctor were amazed at how busy they were. I was surprised because compared to my usual ER shift, this was the slowest day in comparison.

Every ER is different, but I have always found that there is a good working relationship between the doctors and nurses. This place is odd. There was really no talking between the two. Everything is computer based - documentation, orders, etc. So, the doctor would walk out of the patient's room, not even say 'boo' to the nurse sitting right in front of him, go to his computer and type in the orders. The nurse would wait until something popped up on the screen and then would know what the orders would be. I don't know, I find it strange. No speaking, no heads up, nada.

I placed a patient in the room and he had a laceration that needed sutures. I then placed all of the items in the room so the PA could walk in, assess and suture. He walked in as I was finishing up.
"What are you doing?"
"I got all of your things together for a lac repair."
"Oh wow, thanks!" He appeared bewildered.

Very, very odd. The nurse training me said, "well, they like to get their own stuff. We don't get it for them"
All righty then.
One of the nurses said he was going to go on a Starbucks run. He collected our orders and I noticed that the doctor and PA weren't on the list. My God, they sit 10 feet away from us! I turned my head and asked them if they were ordering. They declined, but the nurses were surprised by my asking.

The nurses told me about how certain doctors like certain things. For instance, this one doctor does not want the paper lining for the exam table UNDER the band, he wants it OVER the band. I was in disbelief - who the hell cares about something like that?!! Seriously?? This isn't the OR!

As we were going through shift change, this one night shift doctor walked out of a patient's room after performing a lac repair and literally threw all of the items to be autoclaved  (they were wrapped in a towel) onto the counter next to me. It landed with a big crash. I looked down at the mess and then up at him with no expression, back down at the pile and then back to the other nurses. He looked at me and then walked on. OH HELL NO! I hope I don't have to work with this guy a lot because I'm not playing that game. How unprofessional and juvenile.

Like I said, strange place. I guess I'll see how it goes this weekend when I work again. This will be my first time on my own - I sure hope I remember how to place that paper liner! <sarcasm> ;-)