Thursday, November 13, 2014

Frozen Toes and Oranges

I was outside about to close my garage since it got dark and the weather turned frigid. I noticed this little kid running up my driveway. He was completely under dressed for the weather and wearing only socks.
"What the hell?"
I recognized him when he got closer and saw it was my son's friend from down the block.
"Hey Bobby, what are you doing outside?"
"You have to come quick, Jason is choking and my mom sent me to get you."
"What?!! Is he breathing?"
"No, please come quickly, he's in trouble."

I yelled to my son to stay here and that I would be back.
I started running down the block in my slippers and sweats, halfway there I was absolutely freezing.
"What is he choking on?"
"He was eating an orange and I think it got stuck."

Once I arrived at his house, his mother was standing outside with the 2 year old. He was being held closely to his mother's chest and breathing.

"I'm so sorry to bring you out in this. He finally threw up and it cleared his throat."
I looked him over and made sure that I couldn't hear anything obvious when he breathed deeply.
"Did you call 911?"
"No, we had to call an ambulance one time and it took them 25 minutes to get here. I thought you could help faster than they could. Sorry again. He's fine now."

I told her if she had an emergency, she could call me, but to make sure to call 911 too.
Once I returned home my toes were frozen. I need to get thicker slippers.

Thursday, October 23, 2014

Back to School

I've spent a considerably amount of time trying to find something else to do besides nursing in my area. I've been unsuccessful. Or perhaps I'm not that creative. Regardless, I made the jump and started going back to school. I'm not thrilled with it, but I'll do it in order to get away from being a bedside nurse. I can't envision my aging future as an ER nurse, running around, dealing with the constant stress and frankly, turning into a geriatric grump.

We had a video information session that I missed due to work. The professor posted it for those that missed it. My God, it was frustrating. There are a lot of dumb asses in this course. The questions asked could have been answered by simply reading the message he wrote to all of us which was posted under "START HERE". I don't think many people started there. So...for an hour video, there must have been perhaps 10 minutes of quality information.

"Do I need my book for the first week? I haven't bought my book." Really?!
"How do I find my TA?"  He had just finished speaking about that and performed a demonstration on the whole process.
"I need a video chat with you because I can't find the TA."  Slaps head.
He would show us how to perform simple tasks that were already addressed in the START HERE message and people would still ask about it.
At the end, the cherry on top was the final question, asked for the 5th time, "Do I need my book or can I use the power point for the test?"
I couldn't help but yell out at my computer.

I noticed 4 categories of students in this class. Those that were totally clueless and verbal about it, one guy that was quite funny with good questions, one man that was a complete kiss ass (for lack of a better term), and the quiet masses that we're either trying to get information from the chat and yelling at their computer or they had simply fallen asleep.

I take my first test today.

-----On a side note: After 4 weeks, hubby's leg still hurt as much as the first day. We went back to the ortho doc who did another x-ray (making it his 4th). We discovered he's been walking around (if you want to call it walking) on a fractured leg for the past month. We were happy to finally have a diagnosis for his leg. It also means that he'll be spending another 2 months home. The motorcycle is still broken and sitting in the garage. I'm okay with that.

Friday, September 19, 2014

Time to Heal

Hubby is now in an ortho boot. Thankfully, after an ultrasound and follow up with an orthopedic surgeon, he does not have to have pins placed and his hematomas do not have to be evacuated. He tore ligaments in his lower leg which will require time to heal. So, he's gimping around in his franken foot. It'll be another 4 weeks and then a follow up.
He's not too happy about being incapacitated for such a long time, but that's a chance you take when you ride a motorcycle. Yes, you can clearly see I'm not a fan, not at all.

On the positive side, I get to see him every day. Normally, his career requires him to be gone for 24 hour periods. It's nice to have him home every evening. I figured I would have to wait until after his retirement to have this type of time together. The kids like it too. I'm going to enjoy it while it lasts.

Tuesday, September 16, 2014

10 Days Post Crash

It's been 10 days since the motorcycle accident.

The following Monday, I called his PCP to make an appointment for a follow up.
They asked the reason for the visit and once I told the receptionist, she cut me off.
"We don't see patients that have been in a car accident."
"He wasn't in a car accident, it was a motorcycle accident."
"Uh, yeah, we don't see those patients."

Before I could say another word, she placed me on hold. Someone else picked up the line and asked me what I needed.

"I need to make an appointment for my husband."
"Well, we don't see patients involved in accidents."
"Okay. Who does he need to see then? He was told to follow up with his PCP. He needs to see a doctor. Dr. *(^&)*^ is his doctor."
"Please hold."

I was not arguing with these people, more like flabbergasted that they refused to see an established patient.

"This is the office manager. We do not see patients that have been in any type of motor vehicle accident."
"Yes, that has been established quite clearly. What I am trying to find out is who WILL see him."
"Look the reason for this is because we do not get involved in disputes between parties about which insurance will cover what medical bills."

Ahh, so it's a money thing - always a money thing.

"There was no other party involved. If I call his medical insurance company, the one you have on file and they say they will cover the visit, then can he see the doctor?"

I had to have my husband call the insurance company because they said they had to talk to the patient directly. Sigh. Once that was all hashed out, I called back and got an appointment for later that day.

I went to change his road rash dressing and my heart sank as I took the bandages off. He had a massive infection that would need IV antibiotics. Shit! Now I had to call the doctor's office again and speak to the nurse about my assessment. She said she would call me back after informing the doctor. I waited, then waited a little more. I called back and wouldn't you know it, they were at lunch.

I wanted to kick small kittens and puppies at that point.

I guess once their lunch was finished, she called me back and told me that she would cancel the appointment and to go to the ER. I was already on my way, had texted my charge nurse that we were en route and she had saved a room for him.

What a cluster%^&*.

Ultimately, he got the antibiotics, his arm was improving the next day and I still had to make a follow up PCP appointment.

I saved that for another day. Small animals stay away from me!!!!

Wednesday, September 10, 2014

The PITA Patient

I looked at the patient and knew he was going to be a pain in the ass.
He was in a motorcycle accident and fell onto his left side resulting in road rash to the left forearm with a deep laceration, shoulder pain, and left lower leg pain.

I got some pillows and ice packs for his leg and arm. While I was elevating his leg, he exclaimed, "Urrgh! That hurts. Leave it alone."
"You need to elevate it. Of course it hurts, you were in an accident."
"Seriously, leave it alone."
"No, let me do my thing. Stop being so prissy - I know you're in pain."
He made a stern grimacing face at me.

When he returned from radiology, I had some things together to clean up his arm abrasions before the doctor irrigated the laceration.
"Okay, this is going to hurt," I stated.
"I know. Stop saying that."
"Saying what?"
"That it's going to hurt. You keep saying that."
"Well, it is."
"Ya know, your bedside manner sucks."
"Do you want to do this yourself?"
"Then be nice. Seriously, you're kind of a sucky patient."

I cleaned the area and it hurt - Just. Like. I. Told. Him.
I gave him some pain medications beforehand, but it was all raw, exposed skin.

After discharge, I rolled a wheelchair into the room.

"I don't want to be in a wheelchair."
"You can't walk on that leg. Just sit in the chair and I'll roll you out to the car."

He made a sigh and a grimace trying to get into the chair.
I drove the patient home.
I swear, my husband is going to be such a pain in the ass through this whole ordeal.
I hate motorcycles.

Saturday, August 23, 2014


From my 95 year old patient:

"You're kind of pretty for a white girl."

"Umm, thank you."

"I like your white teeth and you have pretty hair. Yup, you're not bad for a white girl."

"I appreciate you noticing. <lol> You're nice looking too."

"I know! I'm pretty for a black woman! But I do like your teeth!"

I smiled at her and said, "Thank you, but I'm not giving them to you."

She smiled a large toothless grin, "Dang it!!! I tried!!!"


I finally interviewed with the psych manager. She was very laid back and stated, several times, that it wasn't rocket science - the biggest responsibility was to keep the patients safe. I gave her my available days in September which were few because my schedule had already been made for my other jobs. I haven't heard back yet, so I'm waiting. I find it strange that there was such a big rush initially and now no rush. Oh well, I'll wait.

The common theme in the main ER where I work is that the computer charting system is "not conducive to our work." The throughput of patients slowed down to a crawl because of this inadequate system that administration has chosen to put in place. The doctors, NPs, PAs, and nurses have decided to chart and process all orders according to the wishes of the admin. This has resulted in a slow moving ER. They have cross trained several nurses from other departments into the ER and all have expressed their dissatisfaction with the chosen charting system. I find it amusing. I'll be interested to see what admin does or if they do anything. Anyway, I have decided to work minimal shifts here and stay out of all the politics.
We'll see what happens.....

Tuesday, July 15, 2014

Makes sense....

So I decided to take the plunge and told the counselor from the behavioral health unit that I wanted to interview with their director. He told me what to do to submit my resume to her. I did what I was instructed to do and received a call from HR.
She told me that I would have to put in transfer paperwork and have my director sign it. I said that I haven't spoken to my director yet about cross training to psych and would not quit the ER, just pick up shifts over there.
"Oh, I don't know if anyone has done that before.You were hired specifically for the ER and not the float pool."

Now I know I can because I've picked up shifts in the ICU when I was getting bare minimum shifts in the ER. As a matter of fact, they recently used another nurse in the ICU that way too. What's the difference?

I asked her, "How can I put in a transfer when I don't even know if I have a position over there?"
She said this is how it is done. So....I put in for a transfer to a unit that I haven't even interviewed for or have a secured position and flag myself to my director that I want to spend time on another unit?


This has happened to other nurses who get so frustrated with this process that ultimately they leave the hospital all together. So, instead of allowing them to transfer to another unit in the hospital, the hospital loses a good nurse.

Makes sense.

Thursday, May 22, 2014


I recently attended a class which was mandatory training for all ER personnel. It was a CPI class (Crisis Prevention Intervention). The instructor was the director of the behavioral health department. Now I have worked with him many times because he performs the psych intake interviews in the ER when we have a behavioral patient. I did not know he was the director of the department. The class was suppose to be a large one, but only 3 people showed up. Not too good for the first day of this particular class.

The good part was we could go quickly through the material and the instructor wanted a lot of input from us. He surprised me after I answered a few of his questions regarding 'what would you do in this situation' or 'how have you handled a patient like this in the past?" and offered me a job in his unit.
Throughout the class, he heavily recruited me. He offered me the job, training and said he would pay me more than what I made in the ER - all in front of my coworkers.

I'm thinking about it. However, I don't know if psych nursing is a good fit for me. I remember when I was working on my psychology degree, I got a part time job in a residence for children with autism. My assigned child was a kid with severe symptoms who had parents that would take him home every weekend and basically reverse all of therapy during the week by not following his plan of care. He performed self stimulatory behavior every chance he got. When I had him, I was suppose to perform positive reinforcement to stop his behavior. He would pick up pencils, straws, his hands, etc, and flap them in front of his face. I was mentally exhausted by the end of the day. My last day there (I didn't keep the job very long), they had a BBQ outside for all the residents. The landscaping did not have mulch, but little sticks - everywhere. It was a field day for him and a nightmare for me.

I'm wondering if it'll be like that. I guess I could speak to the director and see if I could start training - sort of a trial. The one thing that did concern me was the fact that there is no security at the facility and only 4 staff members in the unit which is a free standing building and not attached to the hospital. My concern would be my safety. I may talk to him about it - I haven't decided yet.

Monday, April 28, 2014

Foot Tickler

I already assessed my patient who was here with a complaint of leg pain. I had forgotten to mark his pedal pulses, so I entered his room. He was talking on the phone which normally I mind, but in this instance, all I had to do was mark his pulses. He continued to talk, so I decided to just do what I came to do.

"Hey Joe, I've got to get off the phone, there's a nurse who just walked into my room."
Then he laughed.
"Yeah. Yeah. Listen, I've gotta go - this hot nurse is tickling my feet and drawing smiley faces on them."

I stopped what I was doing and looked up at him.
He gave me this big smile, wiggles his eyebrows up and down, and then continued talking.

I silently pointed at him then shook my finger to say no, no, no and left the room.
Some people are amusing.

Friday, April 25, 2014

It's Not What You Think....

Recently I've had a string of patients with ordinary complaints that turned out to be something entirely different. I think I have good assessment skills, both verbally in interviewing patients and in physical assessments. I've been labeled a "sh!t magnetic" in the past, meaning that if I was working on your shift that day, our ER would receive a lot of critical patients. Now the term defines me in a way that we will get strange situations.

Patient's complaint: simple cough. Diagnosis: ischemic stroke.
     The patient denied all questions regarding some type of infection. Once I dug a little deeper while triaging him, he answered some questions which revealed he had some tongue numbness and the weakening of his writing hand. "I can't write things anymore." Boom!

Patient's complaint:  knee pain from a fall  Diagnosis: third degree heart block
     The patient didn't want to be there. His wife just wanted his knee checked out because he had problems with it before.

Patient's complaint:  possible urinary tract infection  Diagnosis: PSVT (paroxysmal supraventricular tachycardia) meaning a very fast heart rate.
     While the patient was receiving some antibiotics, she mentioned feeling like there were bubbles in her throat. I threw her on our cardiac monitor and her heart rate was in the 180's.

Patient's complaint:  follow up visit from an infected animal scratch. Diagnosis: nonSTEMI (heart attack without ECG changes).
     Who could have guessed this?! The patient felt really sore from an injection - it was actually atypical symptoms of chest pain.

Patient's complaint: feeling bad all over and a cough that over the counter cough medicine won't get rid of.
Diagnosis: Stage 4 lung cancer with metastasis.

Patient's complaint: partial facial paralysis, already diagnosed with Bell's Palsy. However, his hearing and vision on the affected side had diminished. Diagnosis: Ramsay Hunt syndrome.
     This was a new syndrome for me. I did notice a rash on the side of his ear and his pupils were unequal. I didn't know the diagnosis, but I knew something other than Bell's Palsy was occurring.

Patient's complaint: leg pain of unknown cause. Diagnosis: leukemia
     Now the mom of the kid told me he wasn't eating as well, felt really tired lately and he had an enlarged lymph node. I was seriously hoping this would not be the diagnosis.

It's always interesting to hear about a complaint and dig a little deeper. Sometimes a cough is just a cough and then, sometimes it's not.

Saturday, April 19, 2014

It is Done.

It's the straw that broke the camel's back. The last nail in the coffin.

My main ER job went paperless. Now, I have another ER job where we use computers for all charting, triage, etc. It's the wave of the future (unfortunately). The program we use there is emergency department friendly, so it really doesn't take away from patient care and the speed in which we work has not been affected.
The system my main ER decided to use is not designed for the ED. It is a program designed for the floors and completely inefficient for ER use. I know whenever you change a process, it will take the participants some time to adjust and get back up to speed. However, the administration has changed every process the ER. Everyone was slow, extremely slow. For example, a patient I had for a simple antibiotic injection and discharge normally took about a half an hour. That included triage, the nurse's assessment, the doctor assessment, the injection, injection wait time and then the discharge teaching. Not too bad for everything that had to be done. The whole process now took around 6 hours for a simple visit. 6 HOURS.
I had a simple oral dose of benadryl to give to a kid. Before, I could do it in a minute - give the med and chart it. It took over 20 minutes for the whole process to be completed. The inadequate computer charting for medication administration has added 15 additional steps to be completed and this is prior to giving the med. I have more steps after to chart. It also didn't help that the area where my rooms were located does not have good WiFi access. That's just peachy when you have to rely on computers for every task you perform.

We had numerous patients leave in the lobby without being seen, multiple AMAs (leaving after the doctor has seen the patient) and elopements (people leaving after being in a room and not telling anyone).

People were angry. Patients were hostile because they were waiting hours for the doctors to get in there, all the doctors and nurses were because no one knew what the hell was going on and the computer people were miffed because we did not like the inadequate system they had chosen for us. No ER doctor, ER nurse or any ER personnel for that matter was involved when this 'system' was being revamped.

The day and patient load was actually not bad if we had used our old system. It was intolerable with the new system. I'm wondering how we'll have to work when we have a busy day.

I dread going back to work on Monday. Absolutely dread it. I decided to apply for some positions I found online and quit this ER. Although we have lost a lot of nurses recently, I still enjoy working with the remaining nurses and the doctors who I know well and have had a great working relationship with for years. I've been at this ER for over 6 years. I've seen the ups and downs and rode through them. This downward spiral is something I can't ride through.

I hope I get hired for something soon. Very soon.

Monday, March 17, 2014

Baseball and Hematomas

Well, it's that time of year again for my kids to start baseball and softball season. This means hours spent at the fields in cold weather watching them run around the bases, drop fly balls and swing endlessly at curve balls.
I was at the parent/ coach meeting outside where we would get all the information and have the kids fit for their uniforms. My son was playing with some other boys running around like escaped lunatics. This one in particular was especially rowdy past the point of being obnoxious. I told my son to stay away from him when he started throwing dirt and rocks at other kids. As the meeting progressed, suddenly we hear a scream, crying and a bevy of children running up to parents to 'tell on' the rowdy kid who threw a large rock at another kid's head. The boy came limping up to his father looking like a horror movie actor - blood all over his face and arms, blowing snot everywhere.
I must say, the father showed more restraint than I would have. He loudly told the kid a thing or two and then attended to his bleeding son. I figured that the dad and another adult had the situation under control, but then by watching them, I decided to walk over there to see if I could help. I got a roll of paper towels someone had grabbed out of the little concession stand at the field and led the boy into the bathroom so I could see the cut.
He didn't require sutures, but had a decent hematoma with no obvious skull deformities palpated. I cleaned him up and helped him blow his nose because snot was dripping off of his chin and it was grossing me out. I told the dad what I thought, that ice needed to be applied to the head and then started to advise him of signs and symptoms to watch for and then he interrupted me, "I know these things, I've coached in the past."
"Oh. Okay. Well, I'm going to tell you anyway and you can ignore what you already know."
I continued on and when I was finished, he said, "Oh, I didn't know about those last two things."
Yeah, well, if you notice any of them then take him to the ER for a head CT.
By the time I returned to the meeting, it was wrapping up and I only missed the boring parent behavioral agreement that they have to review with us.
The kid is fine now. I never saw that derelict kid's parents. I wonder if they were even there.

Wednesday, March 12, 2014


Update to the downward spiral of my ER:

To my knowledge the last of the nurse resignations happened a few weeks ago. We had two mass movements of resignations, so we are extremely short in the nursing department. The admin decided to fill in with agency nurses for the time being. Last week, 2 new nurses were fired for legitimate reasons and our brand new director was also canned. She since has been replaced with a newer director. Also, our hospital chaplain retired because according to him "he saw the writing on the wall" and knew he would be laid off next. Unfortunately, he won't be replaced. He provided an invaluable service to our patients and families during critical times and codes.
I was begged to work the other day because they only had 3 nurses on shift for the whole ER for all of day shift. I agreed to work because I felt bad for my coworkers stuck in the schedule and I knew it would be a horrendous day regardless of how busy it was for them. Well, it was a terrible day. As I triaged patient after patient in the little triage room without a break (I managed to leave once to use the restroom), I became angrier with all the bullshit reasons coming into my triage area. I had to take a little mental break because I wouldn't be able to finish the day without yelling at someone. Everyone felt like they had an emergency or that their problem was the most important of the day. People had to wait, a long, long time and they got angry about that. A patient actually called ahead of time to make an appointment which we told her she couldn't do.
I was able to get quick rooms for the truly emergent patients, thank goodness. Those who had to wait for trivial things such as not wanting to buy tylenol for their kid or decided that today would be the day to take care of a problem they had for over a year sat in the lobby. After hours of hearing the snide remarks, the yelling and the insults - I stopped caring about catering to their whims and complaints. We did not have the nurses to open more rooms, their problems were not emergencies and simply put - they would have to wait.

Wednesday, March 5, 2014

Flying would be fun.

Surprisingly, I had an opportunity proposed to me for a different job. There is a flight nurse position open and I have a contact to get me in the door. This has always been the most difficult part, you have to know someone in order to get your foot into the door. However, there are many drawbacks. The base is 2 1/2 hours away from me. The upside is that they offer 12 hours shifts instead of the usual 24. They do have a base very close to my house, but presently, they are waiting to move it to a neighboring town, so no new positions at the moment. I was told that I could start at the one 2 1/2 hours away and transfer later. The closer base would be massively hiring sometime in the future. The other down side is that the salary is depressingly low. I'm guessing they bank on everyone wanting to have the cool job of being a flight nurse, so they get away with paying lower than normal for a critical care nurse.
Although I want to jump for joy about the possibility of flying, I have to be realistic under the present circumstances. I guess I'll have to wait and see about the hiring at the closer base and make a decision then.

Friday, February 28, 2014


This post is meant to be extremely vague.
Recently, I have seen the aftermath of true, raw evil and it has haunted me. I haven't felt the desire to write this month because of it.
I came home from my shift, hugged my children tightly and told them how much I loved them.
It is unfathomable to me that someone could perform those acts of cruelty on a child.
I've prayed long and hard for this patient. Although the damage will never be undone, I hope there's a chance of a normal life for this little person in the future.

Monday, February 10, 2014

Vasovagal Morning

One morning this weekend, I was about to get ready for work. It was early in the morning, my family was still asleep. I walked in to the kitchen to get a drink before jumping in the shower and somehow slipped, lost my balance and fell backwards. I didn't seriously hurt myself, but hyperextended my thumb and it hurt like crazy. I couldn't move it and it started to go numb. What happened next was bizarre and uncontrollable.

I had a vasovagal response to my thumb trauma. I suddenly felt that something was not right. I sat on the stairs and couldn't catch my breath. I was acutely aware of what was happening. My heart rate dropped, my blood pressure did the same and I became extremely hot. Sweat was pouring off of my face as I tried to take deep breaths to keep from passing out. The tachypnea was a response to the hypotension and bradycardia.
I thought, "Wow, I'm having a vasovagal epsiode. I need to lie down. Damn, this is my IV starting hand - I hope I can function."
It took about 10 minutes for it to pass. Once my breathing had normalized and my heart rate increased, I felt better. I got up, got ready for work and left.

It was a strange occurrence and I wondered why a simple thing like thumb pain caused it to happen. I've been injured worse before. Who knows? My thumb is sore and swollen, but functional.

Saturday, January 25, 2014

And It Begins.....

The first wave of the predicted mass exodus of nurses has begun. Four nurses have given notice and we are in our last two weeks of having a full complement. One of the nurses said that she knows that another clump of resignations will happen soon, but she didn't want to give any names.
I heard the next wave of lay offs are going to be implemented soon. I was told that CNAs, techs and unit secretaries will be next. I don't know if there's truth in any of it, but if that happens, then I guess I'll have no choice, but to give my notice and move on to less hazardous pastures.
I hope this is just a nasty rumor although I thought the same thing with the rumors about security and housekeeping. I asked our big honcho ER doc if they were planning on closing our hospital and he said 'no'. He said that if we see him jumping ship, then we should do the same.
All eyes are watching him closely.....

Wednesday, January 22, 2014

We Don't Need No Stinkin' Badges!!

Some recent developments at my hospital has everyone in an uproar. The CEO decided that my hospital no longer needed security. The whole department was laid off. Now I know the CEO did not realize (or care) that security is mentioned throughout our ED SOPs or that we normally require their presence in the ER for violent or unruly patients. Basically, we were told that we were on our own - wait, no......the clinical staff was not told anything, we found out by one of the guards who had the heart to finish his last shift.

Some of the staff, doctors and nurses alike, started scouring our state's laws regarding carrying weapons in a hospital. Some decided that they were going to carry a piece of medical equipment that could double as a weapon. One called the police department and asked how to handle a future threatening situation and was told police would only come if we were already assaulted and would not respond to the threat of assault. Others (mainly nurses) are looking for other jobs. If things don't change, I'm quite sure that the CEO is not prepared for a mass exodus of nurses. No nurses means no one to care for patients which means the revenue that the CEO thought he was saving by firing security will be moot.

The other gem is the cut back on housekeeping. Last year, the hospital fired the housekeeping department and replaced them with contract employees. Now, the CEO cut back on the working hours of the contractors and told the nurses to clean the rooms. Now, working in the ER, we (sometimes) have a quick turnover of patients. The nurse or tech will perform a wipe down of the bed and areas touched by the patient and change the linens. This is typical in the ERs in my area. Now they want us to sweep, mop, take out the garbage, etc. We just had to shake our heads and sigh. Yeah, right....we have all the time in the world to do this. We rarely get to eat a lunch due to dealing with the amount of patients we have, when do they propose we do this? Will the CEO come down to the ER and clean rooms? Will the administrative staff come help us with watching a suicidal patient? Come help us deal with a drugged out violent meth patient?

There will be some bad mojo on the horizon for my wonderful, dysfunctional little ER family. Although I have vented and complained about my job, the one shining star has been the awesome people I work with on a daily basis. I guess we'll see what happens from here.......