Student and Phones...No Bueno

I think I've mentioned it previously, I love having students with me while at work. I like to teach them things. They'll learn at least one new thing when they are with me. I really love when the student is as geeky as I am. That's a bonus. For those students who do not have their 'geek on', I try to get them involved as much as possible...maybe they're shy, unsure, not confident.....you get the idea.

We normally get two high school students when it's clinical component time for their class. The students will spend some time in pre-op, usually observe a surgery, and/or go to PACU.
The one student asked questions and was present in pre-op waiting for his chance to go back to the ever mysterious and interesting world of the operating room. He was chosen for the next surgery. The other student was MIA. She would duck into the hallway and look at her phone for long periods of time. As silently as she left, she would reappear and stand in a corner for a few minutes, then disappear again. The other student returned from the OR and was present in pre-op to be chosen to witness another surgery. The girl disappeared entirely. The pre-op nurse said she was not going to let her back because she expressed no interest in doing anything.
I had come in early to help out as much as I could before leaving 30 minutes prior to a faculty meeting I had on the other side of town. Of course getting out later than anticipated, I ran into the OR locker room to go to the restroom (the only one for employees), get my stuff, and jet off to the meeting. The bathroom door was open, but the student was in there. It appeared that she was looking in the mirror, I thought perhaps getting something out of her eye. So I stood in the locker room and waited.
After almost 5 minutes, I was getting pissed. I walked in the bathroom and asked her if she was done. She was playing on her phone. I seriously hate kids being on their phones all the time. ALL OF THE TIME!

"Hey, are you done in here? This is the only employee bathroom for surgeons and nurses. If you're going to play on your phone, then go somewhere else. Better yet, you should go back to pre-op and do your clinical."
She ran out of the bathroom cowering - literally- saying, "I'm sorry, I'm sorry, I'm sorry..."
Holy crap, I wasn't going to hit her or anything although she acted like it.  (?????)
I do, at times, have an intimidating tone and face - so I've been told...many times. I still don't have complete control over it, so perhaps my 'mommy tone' popped out and took over. Who knows?
She exited the bathroom and then she sat down in the locker room.....still on her phone.
Seriously? SERIOUSLY?!!
In the distant future if you have a physician or nurse or some sort of healthcare personnel who will not put down her phone, it's probably her. Or if you're paying at a drive through fast food joint - same thing.

Updates and What Not...

I haven't been on here in a really, really long time.
To make a long story somewhat short, I did move an hour and half (give or take) from my last house. I like my new neighborhood and town. I live closer to the city, but miss the smaller town where I lived.
I finally did quit my hospital ER earlier this year. I worked there 10 years. Ten whole years! The hospital managed to replace all of the doctors that had worked there for a really long time. All the nurses, except myself and another one, had been replaced. Now she is the last remaining one who remembers when the times were good (or somewhat good, okay...usually bad, but fun).
My 'foo foo' freestanding ER job is gone too. The manager was replaced with a new one from corporate. When I say new, I mean she was a paramedic who 3 months prior to taking the position, got her RN. No experience, the ink still drying on her license. She cut my hours down to 2 shifts a week, then asked me to train a new nurse she had hired. Afterward, I was told my shifts were cut to one a week, and then the manager took my one shift away stating that she had to work it. I was still on the schedule for all upcoming holidays only. I worked Thanksgiving, then gave notice 2 weeks prior to my Christmas shift. I had spoken to her prior to all of this shift downsizing and she lied to my face. C'est la vie!
I am no longer in any ER at the moment. I guess I'm taking an ER vacation. For lack of a better description, it's like being in an abusive relationship. I feel unappreciated and stressed out while being in the ER, but feel nostalgic and miss it when it's gone. There's no happy medium, not ever.

I'm currently working in an ambulatory surgery center as a PACU nurse in order to try something different. I've been there 2 years now. Everyone is super nice....and I mean everyone - nurses, doctors, patients....it feels unnatural to me and I'm in awe of the friendliness. It's weird.
I was also recently hired as an adjunct professor at a local community college. No, I'm not teaching nursing, they didn't have openings for nursing. I'm teaching EMS (EMT Basics and Paramedics). So far, I like it and enjoy the students.
I'm not stressed from work anymore and have felt at peace. I think that was a good way to start 2018.

First 2016 Post

This is the first post of 2016....in March. Huh. I thought that when I had finished school I would have oodles of time to spend catching up on things I've neglected over the past year. I was wrong....apparently.

I graduated with my 4.0 and felt like Atlas shrugging the world off of my shoulders. I felt light and free. I was absolutely giddy with excitement about what I wanted to do first. Then the decision was made that we were going to sell our house (due to various reasons) and move about an hour away. Well, that put a damper on my giddiness. After meeting with the realtor, we had the month of February to get our house completely ready for showing in order to meet our goal of moving right after the kids get out of school for the summer. Oy vey.

I sit here, on March 18th, (im)patiently waiting for the carpet installers to arrive. They're about 2 hours late, all the bedroom furniture is in the bathrooms, the dining room, and the living room. We've missed our deadline due to the wait on the carpets. The house is literally turned inside out. I still have hope that a summer move will be possible.

On the nursing front, my foo foo free-standing ER was bought out by another organization. The nursing staff was cut in half and I luckily was not laid off. The changes have been disappointing to say the least. Patients have been turned into 'widgets' on a conveyor belt. Everything must be done in the allotted time frame regardless of the patient's situation. It's placed a stress on the doctors and the nurses because sometimes a health problem that has been festering for days, weeks, months cannot be resolved in a 30 minute time period. People are not widgets.

Since the matrix of the free-standing was changed to only one nurse, I'm not getting as many shifts, so I've had to return to working more shifts at my failing hospital ER. During my last shift which was absolutely nuts - every room full with critical patients and holding patients, 15+ people waiting in the lobby and endless ambulances - I was eating a cold pizza slice over the garbage can in the break room because I didn't have time to sit down and I thought, "this is not what I want to do anymore." I'm a seasoned ER nurse, but maybe it's time to move on. Is it selfish to want a 30 minute break to not scarf food over a garbage can during a 12+ hour shift?

Catching Up

It's been a while since I've blogged here - obviously. School, work, family, and daily life has eaten up every spare minute I've had this year. Such is life, right?
I have my last class, my capstone project class, remaining until I get my degree in December. The kids are excited, more excited than I thought they were going to be. They even know the last day of class, December 5th. I didn't realize how much harder this past year was on them. I thought I was doing an okay job of trying to balance everything, but I guess they thought otherwise. The kids are relieved that this holiday season I will be free to do the things we normally do. I can't blame them. When a semester ended, I usually picked up as many shifts at work as I could. Sometimes I would work 5-6 days in an 8 day stretch. When classes began, I would be home, but not really 'there' because of the schoolwork. No wonder they're excited.

If all goes well, I'll have a 4.0 in every class I took this past year. I'm happy about that because I thought it would give me an edge when applying to graduate schools. My plan was to take a semester off, take the GREs, and apply to grad school. I think this past year has altered my plans because of the toll it took on my family. I don't want to put them through this chaos another 3 years. I'm going to have to think of another plan.

Untrusting New Grad

I had a shift the other day in my old, crazy hospital based ER. They are not short many day shift nurses anymore; however, they have filled those positions with non ER nurses and several new grads. I was a floating and helping out when the charge asked if I could help one of the new grads prepare an intubated patient for transport to the ICU. I walk into the room and she is absolutely freaking out. She immediately asks me what the amount of the medication she has on the pump.
I asked her before looking at the pump, "Did you use the library on the pump?"
"Umm, my preceptor did it." She's being trained by the charge nurse who also has a full load of her own patients.
I look over at the pump and told her, "No, she didn't use the library."
"Yes, she did."
"No, she didn't." I was taking my critical care booklet out of my pocket when she turned and left the room to get the charge nurse.
I turned to the tech, "Where did she go?" The tech shrugged.
I walked out of the room to see that she was standing next to the charge who was on the phone dealing with another problem.
"Would you come back in here? I'm trying to help you. How much does the patient weigh?"
She ran back inside the room and told me.
While looking up the medication, I asked her if she gave report. She did, but she said she didn't know the answers to many of the questions the ICU nurse asked in report.
I told her how many mg/kg/min the medication was running. She then ran outside of the room again and stood next to the charge nurse to ask her if that was right. By that time, respiratory showed up to transport the patient. Normally, the nurse should have packaged up the patient by that point so the RT doesn't have to wait long for transport. She was nowhere near ready. I got the patient ready for her. She came back into the room and I asked her what the hell was she doing. She said she wanted to check with the charge nurse about the medication.
The new grad had a bottle of extra medication with her. She asked what she should do with it. I told her she could send it with the patient and document that it was sent with the patient to ICU. I guess she didn't like that answer because she ran out of the room to the charge nurse who was busy with a patient. At that point I felt like slapping her. The RT rolled his eyes and sighed loudly. I told him that I would transport the patient to ICU because at this point, the patient would be here forever.
She ran back into the room and looked completely frustrated. I understand how she could feel that way, but hell, she had people helping her and she didn't trust any of them.
I told her to calm down and I'd transport the patient which she said she would do without my help.

What a cluster. I think new grads can start in the ER, but they really need a strong preceptor program and a dedicated teacher. These kids are going to make some major mistakes and hurt someone.
They already have had one of the new grads leave because he said he wasn't cut out for the ER due to its incredible stress and pace.
I wonder if this nurse will do the same.

When the Poop Literally Hits the Fan....

Hospitals have protocols for what they will and not to do in the ER. One of my ERs will not perform manual disimpaction in the ER. Rather the hospital wants the patient to be temporarily placed on the observation floor for that procedure. For whatever reason, that is their decision.

In the past, we had a few doctors who actually traveled from out of state to pick up shifts in our ER. I thought that was strange, but the financial incentive must have been great for these doctors to fly into our area each week to work. This one doctor was a real gem. He liked to get into your personal space in order to make you uncomfortable, told off colored jokes, and basically was an asshole - Dr. A-hole. He did not like any of the policies in my hospital, so when I had a chronic constipated patient turn up in my room, I knew it was going to be an interesting day.

He said he was going to fix this patient's problem. I reminded him of the hospital's policy and he scoffed and said it was a fu&%ing stupid policy. Maybe so, but what can I do about it? Next he told me to go in there and disimpact the patient. Uh...no. For some reason, the hospital felt strongly about this procedure and nurses are not allowed to perform it and especially not in the ER. He was livid. He marched into the patient's room, told the patient that he better relax because he was going to, "Dig the shit right out of him." What the hell?!! He proceeded to do just that. The patient started screaming in pain as this doctor entered him.  Dr. A-hole began talking about how stupid it was to not do this in the ER and began flinging feces into the garbage can. As he did that, fecal matter flew around the whole room - on the walls, the floor, the cabinets. Perhaps this is why the hospital didn't want it done down here? Ya think?

"You're not much of a basketball player, are you?" I said this deadpan.

I was trying to break the tension. With that, his face turned red and he flung more across the floor violently, not even trying to hit the garbage. I left the room, afraid he was going to start throwing it on me and went to find my charge nurse for back up.
Needless to say, this particular doctor did not last very long at my hospital - not for the poop party, but for his general attitude and treatment of others. The patient turned out to be okay, the room had to be closed for a few hours for a terminal clean after his 'monkey at the zoo' fecal flinging fiasco , and the whole ER smelled like crap for the rest of the day - literally.

My Holiday: Leave Mommy Alone, I have to Study.

The holidays were rough this year. Mostly due to time - there was not enough of it for me, it seems. I started my journey to obtain my BSN in a year. Since I already have a degree, I mainly have to take nursing courses except for 2 classes. In order to follow my year plan, I had to figure out how to take a 3 credit computer class in the least amount of time.. somehow. I found a 15 day "mini-mester" course at a local community college. I have never taken one of these courses, so I expected the course load to be heavy, but really...how much could you fit into 2 weeks? Well, I discovered - all of it.
In those 2 weeks, they managed to map out reading the whole text, a quiz on every chapter with 3 exams and one comprehensive final, 10 discussion posts, and 10 labs in various computer programs and online research. Unfortunately, I had scheduled some shifts to work during this time which added the stress of doing double on the days I had off. Most days I had around 10-14 hours of schoolwork.
This was a big mistake on my part because it was during the weeks of Christmas & New Years. I have no real background in computers - I was sitting at my computer trying to learn how to write html code in notepad because I had to design a simple website and thought, "What the f#@* was I thinking by taking this class?!!".

I had to pass on a lot of our Christmas traditions this year. I didn't have time to send out cards (except one to my former patient that lived when I was in EMS - see previous year's post), I couldn't have my Christmas cookie bake day that my kids look forward to, I didn't have time to take them to see the light display at a local park. I did manage to triple up on one day (it nearly killed me) in order to have Christmas Eve with no school work so I could make 2 batches of cookies with the kids. They were very understanding and still enjoyed it.

My daughter asked me if I plan on taking a class like this again. She said it was too crazy because I would go into my office around 9am and ask them not to disturb me. I would pop out for breaks and ultimately be done well after they went to bed. Laundry was piling up, housework was non existent although everyone helped as much as they could. I'm glad it's over, but I feel like I missed the holiday experience this past year.

I'm still catching up with doing things around the house and my other obligations that were ignored. I've got 2 weeks before my next class starts and 3 weeks until my second one begins. This is going to be a rough year.

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.

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.

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.

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?"
"Yes."

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!!!!

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?"
"No."
"Then be nice. Seriously, you're kind of a sucky patient."
"Fine."
"Fine."

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.

Pretty

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!!!"

Interview

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.....

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?

Yup.

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.

Psych

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.

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.

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.

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.

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.