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.
Monday, April 20, 2015
Wednesday, March 18, 2015
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.
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.
Monday, January 5, 2015
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.
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.
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.
"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.
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.
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?"
"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 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!!!!
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