I was relieved to be assigned to fast track for a shift. I'm usually assigned the trauma rooms along with the other critical care areas, so it was a nice change of pace. The nurse who normally is assigned there protested a bit.
"I thought you hated working there."
"No, I never get assigned to fast track. I never said I hated it."
"I thought you only liked working with the critical patients."
"No, I always get assigned to work the critical rooms."
What I wanted to tell this nurse is that the charge nurse feels like she couldn't handle the critical patients and that's why she doesn't get assigned there. The charges have expressed that sentiment. There are a couple of nurses who fit that description and I think it does a disservice to them.
I happen to disagree with it. If you're going to be an ER nurse, then the nurse should be able to handle all types of patients - not just the weenie cases. Those that don't have the experience need to be assigned the typical critical care beds and have a strong nurse willing to help them. It makes the nurse stronger and the unit as a whole. But what do I know? I'm not a charge nurse. But if I was......
All of my patients were either on shot time, waiting for discharge or waiting to be sutured, so I had an open bed. I figured I'd help the triage nurse out because she had a bunch of doc office type patients in the lobby waiting to be triaged. I plucked out the longest waiting patient and brought her back to the available bed.
She was a wispy, bone thin woman. I started taking a good look at her while typing in the triage information in the COW (computer on wheels). Emaciated, scabs all over her face, bad teeth, long sleeve short on a warm day. I concluded she was a meth addict and possibly IV drug user. She had a wound that I originally thought would need sutures then discharge.
"I hate the hospital. I didn't want to come here."
"I understand. Let me see where you're hurt."
Shit. What I saw wasn't a fast track type of wound. She would need surgery. Great. That blows my whole 'bring you in, get you out' type of fast track flow.
She denied all of the drug use questions - of course. Patients always lie about it, but we're going to find out about it anyway. Why don't they just fess up in the beginning? It would make it easier for everyone involved.
So....fast forward to when I was told that the OR team was on their way NOW.
"Where's the dang chart? If you want her ready for surgery - I need it now."
When I finally get it in my hands, I roll my eyes. Couldn't the NP say anything to me about all the extra crap I have to do before calling the OR team? Nah, that would be too easy.
I went to the patient and started drawing some extra labs ordered and hanging her antibiotics.
"I'm really scared. I don't want to stay overnight. Can't they just let me go home afterwards?"
It was then that she confessed all of her drug use.
"I know."
"How do you know about that?"
I told her and she was blown away.
"Did you tell the surgeon who is in here talking to you?"
"No."
"Well, he needs to know. You'll have to stay in the hospital after the surgery and he needs to know how to take care of you. I'm not judging you, but if you go cold turkey on these drugs, you'll run into more medical problems while you're here. I need to tell him about it for your own sake."
She was whisked away by the OR nurse. As she left, she thanked me for being nice to her.
It made me think. Here was a person who didn't want to abuse the system to get her drugs, but really needed medical care because of a simple accident which grew into something worse because she was afraid of being morally judged by us.
Sometimes it's little scenarios like this that change one's thinking.
Monday, December 10, 2012
Thursday, November 22, 2012
Beauty Salon
When I worked in the ICU, I worked nights. Normally, it's as busy as days - emergencies come up, dementia patients become disoriented, critical patients mysteriously have perfect timing to start crashing.
This particular night, it was the "q" word. We learn never to speak it's name. The place wasn't full of patients. I had 1 stable patient and the other was iffy. The iffy patient never had family visits. I went into her room to assess and spend some time with her. She had dementia, but tonight she seemed incredibly lucid.
I peeked in on my other patient, stable and sleeping. The other nurses were reading books and playing on the computer. It was a "q" night.
I went back into my patient's room and sat down to talk with her. It looked like she hasn't been bathed in a long time, she smelled bad and was completely disheveled. Personally, I can't stand that. Wherever she came from, they weren't doing a very good job of taking care of her. You can just tell by her hygiene.
I ran around getting all of my items to clean her up. I spent over an hour in her room washing her hair, doing mouth care (which I absolutely hate doing because it's one of my weaknesses - oral care. It can be disturbingly gross.), bathing, changing her gown and bedding. I had a nurse come in and check on me because I had been gone so long.
Once I was done, she looked good. She actually didn't look as sick as she was. We talked about her life and she told me some interesting stories about her past. I joked that she looked so good right now, we should go have a night on the town. She agreed and said when she felt better, she wants me to drive her to a place where she can sing again. I told her I'd be back on shift in 2 days and I would see what we could do about singing. She was happy and thanked me for a nice night. She fell fast asleep.
When I returned to the ICU two days later, I didn't see her. Her room had another patient in it. I asked the day nurse during handoff report where was Mrs. So and so?
"Oh, she died yesterday morning."
"Oh."
She died a few hours after our beauty salon night.
I was sad, but I felt comforted knowing that her last night on this earth was a good one. I was happy that we had that time together.
This particular night, it was the "q" word. We learn never to speak it's name. The place wasn't full of patients. I had 1 stable patient and the other was iffy. The iffy patient never had family visits. I went into her room to assess and spend some time with her. She had dementia, but tonight she seemed incredibly lucid.
I peeked in on my other patient, stable and sleeping. The other nurses were reading books and playing on the computer. It was a "q" night.
I went back into my patient's room and sat down to talk with her. It looked like she hasn't been bathed in a long time, she smelled bad and was completely disheveled. Personally, I can't stand that. Wherever she came from, they weren't doing a very good job of taking care of her. You can just tell by her hygiene.
I ran around getting all of my items to clean her up. I spent over an hour in her room washing her hair, doing mouth care (which I absolutely hate doing because it's one of my weaknesses - oral care. It can be disturbingly gross.), bathing, changing her gown and bedding. I had a nurse come in and check on me because I had been gone so long.
Once I was done, she looked good. She actually didn't look as sick as she was. We talked about her life and she told me some interesting stories about her past. I joked that she looked so good right now, we should go have a night on the town. She agreed and said when she felt better, she wants me to drive her to a place where she can sing again. I told her I'd be back on shift in 2 days and I would see what we could do about singing. She was happy and thanked me for a nice night. She fell fast asleep.
When I returned to the ICU two days later, I didn't see her. Her room had another patient in it. I asked the day nurse during handoff report where was Mrs. So and so?
"Oh, she died yesterday morning."
"Oh."
She died a few hours after our beauty salon night.
I was sad, but I felt comforted knowing that her last night on this earth was a good one. I was happy that we had that time together.
Tuesday, November 20, 2012
Defense
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>
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>
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."
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