I already had a good rapport with a stable patient who had a previous stroke and experienced expressive aphasia as a deficit. (For the non medical people: it means the patient understands language, but cannot speak the words that he/she means to say.)
I popped my head into his room because I wanted to check on him quickly. I had some situations arise and I knew I would not be back for a while. I guess some other family members arrived while I was out of the room.
"Hi Mr. Soandso. Are you feeling any better after the medicine I gave you?"
He shook his head for yes.
I proceeded to tell him I would check on him later and that is he needed anything, all he had to was call. I was pretty much in a rush, so I started to head out the door.
The one family member there jumped up and stated, "He can't talk. He had a stroke."
"Yes, I already am aware of that. We've been communicating though." And I left the room, jotted some notes on his chart.
The woman approached me in the hallway. "What's your name?" I told her. "You were really defensive when I told you about how he couldn't talk. And you kept talking to him."
What I said: "Well, I'm sorry if you thought that. My intention was not to appear defensive."
What I wanted to say:
Ma'am, stop wasting my time right now with your petty hurt feelings. I don't have time for this. What you misconstrued as defensive was me trying to juggle 40 balls at one time - if I didn't even pop my head in there for a minute, he wouldn't have seen me for hours. Yes, I'm going to talk to him. I know he can't speak in complete sentences, but he understands. I talk to many patients that I don't know if they are mentally there - people in comas, post resuscitations, etc. It's called respect.
I just got done telling a mother that her child's symptom is cancer. She's in complete shock and is dealing with the horrible news by lashing out at her nurse. I don't enjoy it, but ya know something - she has an excuse.
In the other room, I have a patient that coded an hour ago and died. I have yet to talk to the family. I went into the room and saw that no one helped me out by cleaning up the body a bit. It was a very messy death. How can I let the spouse go in and see his loved one like that? I had to clean her up quite a bit and set up the room so her spouse can say goodbye.
As I running about for those patients, I had to check that the kid with a bleeding wound had enough gauze and pressure so his bleeding was controlled.
So, your delicate temperament is really, really low on my priority list.
Oh, and since you're giving me grief, I'm enforcing the one visitor policy rule - please head to the lobby.
<smile>
Tuesday, November 20, 2012
Saturday, October 20, 2012
Wednesday, October 17, 2012
Maybe I should have been a plumber.....
I'm all for chipping in, going above and beyond for the team, and working hard, but this was a little too much. I arrived to work before 7 and eyed the patient board. We already had a full load of patients. Not a very good start to the day. My hospital recently decided, in all of its wisdom, that a normal load of nurses is not needed between the hours of 0700 and 1100. So, they have cut us back to a charge, triage and 2 other nurses to handle the entire department. Brilliant!
As I was getting my report from the night nurse, it didn't seem too bad. I had a new patient in one room - stable and pretty simple with regard to chief complaint. My trauma room had a post moderate sedation who should be discharged within an hour, maybe hour and a half. As I was getting the report, I heard the fire dispatcher on the radio send an ambulance to an unresponsive person. I start checking on my patients and doing the normal morning equipment checks.
10 minutes later, an ambulance comes in and fills my other room. After triaging this person, my charge comes to me and states that she will be using the other unassigned room for a code (the unresponsive person call).
Now, since we don't have enough nurses to cover the ER and run a code and watch my post sedation - we're in a pickle and have to get the trauma coordinator to leave her office and help.
Code comes in and its pretty much a done deal. As I was working that code, the triage nurse fills up all of my other rooms with not so stable patients. Next I discover that my charge has now assigned me the code. Although the patient is pretty much stable (dead), I still have to deal with paperwork, family, notifications, etc. Now I have 5 patients with all immediate needs. I wish I could have been there for the family members, but I couldn't. I had to delegate that to the pastor and administrators arrived to help. The post sedation patient was flippin' mad about not being able to go home yet, but the more she yelled - she had an airway and was coherent enough to understand her situation - she's stable. The other patient, threw some pillows at her and told her to elevate her limb and chucked the cast cutter in his room. Eyeballed the other patient and she looked like her bleeding was controlled a bit - not going to die in the next hour. Then I went to my new patient and started working on her - she could go down hill quicker than the other ones.
I'm whining, I know, but it's all a bit much when you can't actually do the job as well as you would like to do. In nursing school, they fill your head with all kinds of crap about therapeutic communication and nursing theories when in reality, you will never get to implement them because of all you have to do. You're set up to fail.
No one died, thank God (well, except the code, but that person was already dead). It's just there are many more days now that it just.....well, sucks.
As I was getting my report from the night nurse, it didn't seem too bad. I had a new patient in one room - stable and pretty simple with regard to chief complaint. My trauma room had a post moderate sedation who should be discharged within an hour, maybe hour and a half. As I was getting the report, I heard the fire dispatcher on the radio send an ambulance to an unresponsive person. I start checking on my patients and doing the normal morning equipment checks.
10 minutes later, an ambulance comes in and fills my other room. After triaging this person, my charge comes to me and states that she will be using the other unassigned room for a code (the unresponsive person call).
Now, since we don't have enough nurses to cover the ER and run a code and watch my post sedation - we're in a pickle and have to get the trauma coordinator to leave her office and help.
Code comes in and its pretty much a done deal. As I was working that code, the triage nurse fills up all of my other rooms with not so stable patients. Next I discover that my charge has now assigned me the code. Although the patient is pretty much stable (dead), I still have to deal with paperwork, family, notifications, etc. Now I have 5 patients with all immediate needs. I wish I could have been there for the family members, but I couldn't. I had to delegate that to the pastor and administrators arrived to help. The post sedation patient was flippin' mad about not being able to go home yet, but the more she yelled - she had an airway and was coherent enough to understand her situation - she's stable. The other patient, threw some pillows at her and told her to elevate her limb and chucked the cast cutter in his room. Eyeballed the other patient and she looked like her bleeding was controlled a bit - not going to die in the next hour. Then I went to my new patient and started working on her - she could go down hill quicker than the other ones.
I'm whining, I know, but it's all a bit much when you can't actually do the job as well as you would like to do. In nursing school, they fill your head with all kinds of crap about therapeutic communication and nursing theories when in reality, you will never get to implement them because of all you have to do. You're set up to fail.
No one died, thank God (well, except the code, but that person was already dead). It's just there are many more days now that it just.....well, sucks.
Wednesday, October 3, 2012
100 and Counting...
I walked into my new patient's room while looking at her chart and prepared for the worst. She was a 100 year old lady with a chief complaint that I knew would warrant a hospital admission.
I was shocked when I walked into the room. The patient appeared to be in her late 60's. I looked down at her chart again to verify the age I thought I had read.
"Yes, I'm 100 years old dear. I don't think the people I spoke with earlier believed me."
Her daughter was bedside and I thought she was older than the patient. I started talking to the patient and began my assessment.
"When did you last eat?"
"I only had 2 cups of coffee this morning. I like my morning coffee."
"Me too, but I haven't had it yet."
"Oh sweetie, you really should get your coffee in the morning, it really perks me right up."
"What medications do you take?" I waited for pages of meds to list.
"Only 3....." Really? Wow. I've had patients who were my age taking pages and pages of medications.
"When was the last time you were in the hospital?"
"Oh, not too long ago....in the late 1970s"
"No Mom, it was in the 1980....I think 1988."
"Oh yes, that's right 1988. I can't believe I'm back here again."
My LOL (little old lady) was spunky, sharp as a tack and had a keen sense of humor that I took full advantage of.
As I was starting her IV, I asked her, "So, Mrs Soandso, would you tell me your secret to looking so young and being a vibrant 100 year old."
"Umm, I don't know."
"That's okay, don't tell me your secret then. You're keeping it to yourself. I see how you are."
She laughed and gently slapped my arm.
Then she asked, "Do you think the doctor is going to keep me here very long?"
"Well, I believe so. Your doctor wants you to be admitted to the hospital."
"Hmmm, what if I just jumped up and ran out of here?"
"If you're going to jump up and run out of here with all of these wires attached to you then let me know first. I want to get my cup of coffee and sit here and watch you do it."
"You want me to be your entertainment this morning? I'll oblige."
"Mrs. Soandso, you're already entertaining me!"
What a sweet, spunky lady. I have no doubt she'll live a lot longer than 100 years. It's so refreshing to have a patient like this. You have no idea.....
I was shocked when I walked into the room. The patient appeared to be in her late 60's. I looked down at her chart again to verify the age I thought I had read.
"Yes, I'm 100 years old dear. I don't think the people I spoke with earlier believed me."
Her daughter was bedside and I thought she was older than the patient. I started talking to the patient and began my assessment.
"When did you last eat?"
"I only had 2 cups of coffee this morning. I like my morning coffee."
"Me too, but I haven't had it yet."
"Oh sweetie, you really should get your coffee in the morning, it really perks me right up."
"What medications do you take?" I waited for pages of meds to list.
"Only 3....." Really? Wow. I've had patients who were my age taking pages and pages of medications.
"When was the last time you were in the hospital?"
"Oh, not too long ago....in the late 1970s"
"No Mom, it was in the 1980....I think 1988."
"Oh yes, that's right 1988. I can't believe I'm back here again."
My LOL (little old lady) was spunky, sharp as a tack and had a keen sense of humor that I took full advantage of.
As I was starting her IV, I asked her, "So, Mrs Soandso, would you tell me your secret to looking so young and being a vibrant 100 year old."
"Umm, I don't know."
"That's okay, don't tell me your secret then. You're keeping it to yourself. I see how you are."
She laughed and gently slapped my arm.
Then she asked, "Do you think the doctor is going to keep me here very long?"
"Well, I believe so. Your doctor wants you to be admitted to the hospital."
"Hmmm, what if I just jumped up and ran out of here?"
"If you're going to jump up and run out of here with all of these wires attached to you then let me know first. I want to get my cup of coffee and sit here and watch you do it."
"You want me to be your entertainment this morning? I'll oblige."
"Mrs. Soandso, you're already entertaining me!"
What a sweet, spunky lady. I have no doubt she'll live a lot longer than 100 years. It's so refreshing to have a patient like this. You have no idea.....
Friday, August 31, 2012
Paging Dr. Ass
A patient arrived by ambulance for some very minor injury, very minor. She was triaged at an ESI level 4.
I got her situated in the room and told her that her chart would go into the doctor's rack. She would be seen soon.
"How long is soon?"
"As soon as a doctor picks up the chart and comes into the room. I don't know what patients they are seeing right now, but you will be seen soon."
"You tell the doctor to get his ass in here now!! ASS HERE NOW!!"
"I'll relay your message..."
I told the doctors in their computer room what the patient had said. One of them took the chart, looked it over, and placed it back in the rack.
"I'll be in there later.....I just ate lunch and my ass will be ready to talk to her in about an hour."
I got her situated in the room and told her that her chart would go into the doctor's rack. She would be seen soon.
"How long is soon?"
"As soon as a doctor picks up the chart and comes into the room. I don't know what patients they are seeing right now, but you will be seen soon."
"You tell the doctor to get his ass in here now!! ASS HERE NOW!!"
"I'll relay your message..."
I told the doctors in their computer room what the patient had said. One of them took the chart, looked it over, and placed it back in the rack.
"I'll be in there later.....I just ate lunch and my ass will be ready to talk to her in about an hour."
Tuesday, August 28, 2012
Waaawa Waawa Wawaaaa....
I was assigned to triage the other day. In one of my previous few entries I've written - it sucks the ever loving life force from me and transforms me into a bitter shell of a person. Like I enter the triage area a plum and leave a prune, like a grape to a raisin, like a .....you get the idea.
After a few hours of it, all patients begin to sound like the adults on Charlie Brown/ Peanuts cartoons....Waaawaaa wawaaawa waaaawa.
I have 3 people at this point to triage and look out of the door to eyeball them. The one I was going to take next is laughing, playing with her phone and ignoring her children who were running around the waiting room.
So, I took someone else.
When I got to her, she walks in with her 2 rambunctious kids and her husband/boyfriend/babydaddy/whatever (H/B/BD/W). Both can't bother to look up from their phones. I start triaging her and she still won't stop texting or surfing or whatever the hell she was doing. I told her she would have to get off her phone during the triage time, cells phone are not allowed to be used during triage.
"Here, finish my e-mail to the DOCTOR'S OFFICE about how SICK I AM." and she hands her phone to H/B/BD/W. Then turns to me with a disgusted face and says, "WELL..."
H/B/BD/W who can't take his eyes off of his own cell phone mumbles something.
I ask him to repeat what he said because obviously it was directed at me.
"If you gonna be rude then we can go somewhere else. We don't have to go here."
"No, you don't. Our policy is no cell phone use in the triage area" <He's still not off the frickin' thing> "That is why I asked you to stop using it. Do you want me to continue or are you going to leave?"
I triaged her and sent them back to the lobby to wait since they had so much texting and e-mails to send.
She went right back on the damned thing and he never looked up once.
I secretly wished that they would trip over something while looking at their phones, so I could have had at least one laugh that day.
After a few hours of it, all patients begin to sound like the adults on Charlie Brown/ Peanuts cartoons....Waaawaaa wawaaawa waaaawa.
I have 3 people at this point to triage and look out of the door to eyeball them. The one I was going to take next is laughing, playing with her phone and ignoring her children who were running around the waiting room.
So, I took someone else.
When I got to her, she walks in with her 2 rambunctious kids and her husband/boyfriend/babydaddy/whatever (H/B/BD/W). Both can't bother to look up from their phones. I start triaging her and she still won't stop texting or surfing or whatever the hell she was doing. I told her she would have to get off her phone during the triage time, cells phone are not allowed to be used during triage.
"Here, finish my e-mail to the DOCTOR'S OFFICE about how SICK I AM." and she hands her phone to H/B/BD/W. Then turns to me with a disgusted face and says, "WELL..."
H/B/BD/W who can't take his eyes off of his own cell phone mumbles something.
I ask him to repeat what he said because obviously it was directed at me.
"If you gonna be rude then we can go somewhere else. We don't have to go here."
"No, you don't. Our policy is no cell phone use in the triage area" <He's still not off the frickin' thing> "That is why I asked you to stop using it. Do you want me to continue or are you going to leave?"
I triaged her and sent them back to the lobby to wait since they had so much texting and e-mails to send.
She went right back on the damned thing and he never looked up once.
I secretly wished that they would trip over something while looking at their phones, so I could have had at least one laugh that day.
Monday, August 27, 2012
Testicles, Girlie, testicles!
I walk into the patient's room after seeing his chief complaint and had time to start the ball rolling before the ER doc came into to see him.
He was in the bed, crumped down with a scowl on his face. He was like the typical cantankerous old poops I've been dealing with lately.
"You gonna take my blood?"
"I'm going to start an IV and draw blood."
"Good luck with that. Are you any good? No one gets me on the first try. I have crappy veins."
I began to look at one arm, getting the lay of the land so to speak.
"I asked you are you any good? Haven't you found anything yet? Ahh, you're not going to get it."
"What's your hurry? I'm looking at your arms. Let me do my thing"
I asked him about his pain while looking.
"It starts here and goes down into this testicle. Girlie.......testicle. Testicle! Do you even know what a testicle is?"
"Ummm, no. I missed that day of nursing school. Is it like a tonsil?" I smiled at him and I saw a glimmer of a smirk back. His wife had a great sense of humor and laughed.
"You're going to totally not get this IV. Are you good at it?"
"I guess we'll see....they usually only let me clean the rooms, but the nurses said I can stick you with needles today."
I got the IV - no problem.
"Well, damn. I didn't think you were going to get it."
" No, you didn't"
"What? What did you say?"
"I said - In -Your- Face! Mr. Poopy Patient. In your face." I said this as I bundled him up like a little baby in a bunch of warm blankets. "There. Now you're almost cute."
"Get the hell outta here," he said with a smirk.
"Oh, I'll be watching you.....I'm watching you..."
I love my little cranky ole male patients. I'd like to smack them upside the head, but it's fun to try to turn them into smiling cranks.
He was in the bed, crumped down with a scowl on his face. He was like the typical cantankerous old poops I've been dealing with lately.
"You gonna take my blood?"
"I'm going to start an IV and draw blood."
"Good luck with that. Are you any good? No one gets me on the first try. I have crappy veins."
I began to look at one arm, getting the lay of the land so to speak.
"I asked you are you any good? Haven't you found anything yet? Ahh, you're not going to get it."
"What's your hurry? I'm looking at your arms. Let me do my thing"
I asked him about his pain while looking.
"It starts here and goes down into this testicle. Girlie.......testicle. Testicle! Do you even know what a testicle is?"
"Ummm, no. I missed that day of nursing school. Is it like a tonsil?" I smiled at him and I saw a glimmer of a smirk back. His wife had a great sense of humor and laughed.
"You're going to totally not get this IV. Are you good at it?"
"I guess we'll see....they usually only let me clean the rooms, but the nurses said I can stick you with needles today."
I got the IV - no problem.
"Well, damn. I didn't think you were going to get it."
" No, you didn't"
"What? What did you say?"
"I said - In -Your- Face! Mr. Poopy Patient. In your face." I said this as I bundled him up like a little baby in a bunch of warm blankets. "There. Now you're almost cute."
"Get the hell outta here," he said with a smirk.
"Oh, I'll be watching you.....I'm watching you..."
I love my little cranky ole male patients. I'd like to smack them upside the head, but it's fun to try to turn them into smiling cranks.
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