Wednesday, December 28, 2016
It sucks coming in to the shift after the Christmas weekend, with the ER jammed, and the overflowing lobby looking like the tiger cage at the circus, at feeding time, and the triage nurse feeling like a staked lamb. It's even worse when every time you get a critical patient out of the ER, you get rewarded with another sick patient, even before you get back from passing along the last admit.
It starts getting better when you get everyone out, either discharged home or admitted, and it's really turned the corner when all your beds are empty, and the lobby has been cleaned out too.
Even when it doesn't happen until 6 AM.
Now all you have to do is make that last hour, hoping that nothing will go sidewa
"TWEEEEEEEEEEEEEEE...Medic Six...three minutes out...witnessed full arrest...CPR in progress...intubating..."
Leaving just enough time to clear the decks for action stations and grab the crash cart, because as the one with no patients, guess who's getting the run...?
And everyone shows up, just ahead of The Guy, the purpose of the exercise.
Including the uninvited party crasher.
I really hate that guy.
He tries his best, too. We get a pulse back, lose it, get it back, lose it, get it back, lose it.
The ET tube gets dislodged; the doc re-places it. We go through code drugs like Charlie Sheen at a cocaine lab. Everyone is on their game though. The guy comes in a deathly shade of purple, and we manage to turn him pink and warm with compressions and bagging. Lines go in like clockwork, IV, IO, central line, NG tube, foley cath. A pile of debris and detritus forms around the perimeter of the room, in inverse proportion to how our guy is doing. Apparently you need to fill a garbage bag to save a life, and we're doing our bit in spades on both counts.
Finally, the efforts start paying off, the pulse comes back for good, blood pressure and oxygen sats stabilize, and we start thinning out the garbage piles just ahead of the arrival of the family that last saw their husband/father/brother/uncle being loaded into an ambulance in the dark half an hour ago.
Sometimes, with some patients, the end is a welcome release from terminal pathology, but not this time.
And with an extra little push from timing, a short transport time, and rockstars on arrival, this guy got the A-Team.
And I love it when a plan comes together.
Oh, and f**k you, Death.
Not on my shift.
Not this time.
Thursday, October 13, 2016
Pretty much calling bullsh*t on that one.
Do all of us, as nurses, run into people that try to pee on our heads and make life hell?
Do some nurses wimp out and quit?
Does that mean everyone everywhere is there to jump you into the gang?
How do I know this? Because when I started out, it was at a great teaching hospital, unfortunately cursed with some of the most godawful bitter rotten bitches and bastards on the planet, stewing in their own little toxic cesspool. I got tough, and then I got out. And having seen it once, I can spot it in about 0.2 seconds, and don't put up with it.
Everybody, in every job or experience, has probably been hazed a bit (mostly in good fun, and just as a momentary prank). Some people get it far harsher, because you're working with a bunch of bitter, twisted douchenozzles. If your work environment is pissing you off after a month, it's Option B, every time, whether you're new, or you've been doing this for years. If so, GTFO.
I bring this up, because I'm currently somewhere they have a constant stream of new staff, between registry, travelers, new grads, residents, etc. ad infinitum. That was true at the first place I broke in too. What's different is that here, what's missing are the bitter old hags who think they were beknighted by Florence Nightengale personally (and honestly, some of them were old enough to credibly make that claim, but I digress), and they're metaphysically certain that their feces produces no odor. The only reason they wished nursing caps would come back was so that they could wear a tiara to work.
There's none of that here, nor most places. In fact, there's seldom more than a couple of nurses who try it nowadays, and they're usually the petty supervisors who substitute attitude for actual bedside skills. The ones who should retire, to save their own lives, and their patients'.
The reason it doesn't thrive so much anymore is that everyone knows we need the fresh blood, because we need the help period, and secondly, the days of the supervisor who can't help at the bedside are blissfully numbered as I speak. Anybody still pulling their weight knows that can't-hack-it supervisors are dead weight, and that includes their bosses, and their administrators. And much like the military, a constant stream of non-returning new hires points rather inevitably to crappy leaders and preceptors, and that metric comes up at annual raise and retention bonus time, in a big way.
Here, I'm seeing experienced nurses precept the hell out of new grads, and getting double-checked on it, so that once the training wheels are off, the new grads cruise, instead of crash. Better for them, better for us, better for patients, better for the hospital, better for the hospital's bottom line.
If you're one of the perennially bitchy nurses that can't stand new grads, don't let the door hit you in the ass on your way to retirement. In fact, why wait? Quit right now, and save even more lives than if you stayed. And if you're a new nurse, feeling like a cat toy for the experienced nurses, you either need to change you profession, or even more likely, change your work address. The nursing shortage is going nowhere, and all you'll get for trying a greener pasture somewhere else is a better night's sleep, and lower blood pressure. And the Queen Snottypants nurses at Jacked Up Hospital will be stuck where they were without you, doing the work themselves, because they suck.
Anybody can have a rough shift.
If you're having a rough trimester, on the other hand, either do some serious soul-searching, or update your resume, and start web-surfing.
Don't be afraid to ask for help, but if it isn't forthcoming when you ask, start making plans to bloom elsewhere. There are no reward points for being a workplace martyr.
You may be a victim, but you don't have to be a volunteer.
Monday, October 3, 2016
Drunk is not a medical emergency.
Note I am not referring to drug ODs, nor to intoxication to the point of cessation of breathing.
It is solely in reference to plain old intoxication. Something which used to occasion a visit to the local constabulary's drunk tank. Which, long and short of it, is where the problem reared its ugly head.
Because, gentle reader, despite a multiplicity of job skills, police officers, sheriff's deputies, and whatnot are many things, and jacks of a host of trades. But "licensed medical practitioner" is not any of them (and I'm okay with that, and about to tell you why).
Y'see, back in the day, Ofcrs. Reed and Malloy used to load drunks in the back of the squad car, and tote them to the drunk tank. Which was fine for drunks. The problem arose because people with head injuries after car crashes, and people having strokes, and people with diabetic-induced blood sugars of 20 all look exactly like drunks when apprehended. But unlike garden variety drunkaholics, they unhelpfully tend to die a lot overnight when placed in a large drunk tank holding cell. This causes consternation for the officers, annoyance for their families, runaway profits for said families' personal injury attorneys, and great aggravation and heartburn at the offices of the legally responsible municipalities concerned.
So the word has gone out, from city council to city attorney to chief of police to watch commander to desk sergeant to every Ofcr. Reed and Malloy and Deputy Fife:
Take all drunks to the E.R.
And I get that, boys and girls, I truly do. You don't have a CT scanner in your car, nor any medical training but the barest state minimums, so to preclude killing people by mistake, you bring them to those of us qualified to tell a drunk from a guy who took too much insulin and not enough dinner before he plowed into 3 cars and staggered into your arms.
Well and good it is, dulce et decorum.
But where all of you ministers of street justice screw the pooch, is that once you leave the few medical emergencies, and the overwhelming vastness of public wastrels, in our hands, or handed off to us by way of the local fire guys, whom you also had to wake up and drag into this mess, is that you, having happily washed your hands legally of them, don't return and take them to jail, nor even issue a summons for public intoxication, once it's medically certain they're simply drunken @$$holes in desperate need of a stay in the Greybar Motel.
Let me make it clear, lest I put it too mildly, that in every ED I've worked in, and on every night of every year of this century, that amounts to between 2 and 20 m*****f*****s every shift, in perpetuity. I'm sure you don't miss dealing with them, having happily palmed their vomiting, urinating, diarrhea, abusive and obnoxious behavior, and even their assaultive escapades, onto mainly a bunch of overworked nurses, techs, and doctors in scrubs. I'm sure your desk sergeants and watch commanders think that's a splendid thing. I'm sure your city minders don't miss the wrongful death lawsuits. And I know for goddamned certain (ask me how, I triple dog dare you) that the sonofabitches in the city attorney's office have never criminally prosecuted so much as one intoxicated drunk for any of the literal dozens to hundreds of techs, nurses, or doctors that are assaulted and battered daily and nightly in any place hereabouts, just like they don't statewide, or probably in any state.
And as another monumental douchebag opined in a similar vein, "What difference, at this point, does it make?"
Well Sparky, it means that sooner or later, you or yours is going to come in the door with your wife, or kid, or parent, having a heart attack or stroke (or, if God is just, it'll be you yourself, and better yet, your chief), and I'll just be too busy to get to you right away, because I and ten or twelve of my colleagues, without bulletproof vests, batons, tasers, or pepper spray, are doing the wild hog rodeo with some out-of-control 300-visit-a-year @$$hole that should have been doing six months in county for multiple arrests for intoxication that you never bothered to make, because policy; or because the loss of $500K per offender, year in and year out for this happy horseshit caused staff members to burn out and leave, and budget cuts due to those ongoing financial losses have left filling the job impossible.
And then your kid, your wife, your parent, or you, are going to sit in the waiting room, and maybe even die. Sucks to be you on that day, huh?
Or, long before it gets to that point, some one of you with two wits to rub together, could be proactive, and start taking the repeat offenders off the menu, and let some judge set them to filling potholes in the summer, and shoveling snow in the winter, for six months at a stretch, and while we might see them once in six months, after a couple such bed-and-breakfast arrangements with the county, either they'd decide on another life trajectory, or we'd have the best-maintained roads in decades.
Maybe think about that the next time you're sure we'll have time for you when you crash your unit, or take a bullet fighting crime. It'd be a real shame to find out the last bed in the ED was filled by Roscoe the Sterno Bum, for the 200th time this year so far, a half an hour before you rolled in on a stretcher, wouldn't it?
Think it over, and do the right thing.
Friday, September 16, 2016
Dear @$$hole military veteran wannabees:
If you're going to try and sell yourself as a tragically drug-addicted PTSD-suffering veteran of the Vietnam War, you might want to either
A) CRACK A FRIGGIN' BOOK, or
B) Come up with a better birth certificate.
Specifically, when your date of birth reveals that you would have been aged 15 years when the Vietnam War ended, it's probably not a hot idea to try BSing your sad tale, laced with requests for more pain meds, by piggybacking it onto your tragic story of heroin addiction caused by all that heavy incoming fire and buddies blown away you suffered during your imaginary service there in such exotic places as Gang Bang Wang and Sum Dum Ly.
Especially when your nurse is a military veteran, with a keen lifelong interest in history in general, and military history in particular, and oh yeah, an older brother who spent the summer after high school ducking rockets on the DMZ in '67, and turning his parents' hair prematurely grey, until he returned home with all his original body parts and no extra orifices.
And you should probably ask for the hospital chaplain to visit you, to offer thanks to a merciful God on your behalf that it's both unethical, and against the best practices in the employee handbook, for me to give you the dick-punching you so richly deserve.
Save your Special Agent Orange resume for the other dope addict losers under your bridge. As a very wise person once wrote, "A lie is a poor way to say "hello".
Saturday, September 10, 2016
Hi there, and welcome to The Waiting Room Channel.
Are you here for abdominal pain?
If so, then NO, YOU CAN'T EAT OR DRINK ANYTHING.
You can come here for our world famous turkey sandwiches, or you can come here for treatment of your abdominal pain, but not both.
Did you bring your child here for abdominal pain?
If so, then NO, HE CAN'T HAVE THE BAG OF FLAMING HOT CHEETOS, UNLESS YOU WANT THE DELUXE "Discharged by MD from Waiting Room" TREATMENT PLAN.
This is because your abdominal pain could be caused by something that requires surgery. If you eat, you can't get anesthesia for 6-8 additional hours, during which time your potential surgical emergency could kill or seriously afflict you. Which our Risk Management Department, and your insurance company (unless you have ObamaCare) really frowns upon.
And if the abdominal pain is accompanied by nausea/vomiting/diarrhea, we really don't think it's in your best interest (or ours) to load the catapult for the next launch.
But if you'd really like to come here and throw up anyways, could you please do it in one of the boxes pre-addressed to Press-Ganey, so we can ship it right out to them?
This message repeats in Spanish in 10 seconds.
Friday, July 15, 2016
Monday, July 11, 2016
I really, really enjoy my job. (When I get to do it. The three dozen things a shift that have jack and squat to do with actually caring for patients still suck my soul out.)
There's always bad shifts, even bad weeks, but when I catch myself getting overly grumpy about it, I make a mental game out of kicking its @$$.
Life really is 10% what happens to you, and 90% how you decide to feel about it. I realized it's a lot more fun going through life as the cat than as the litter box.
And when it's time for time off, GTHO and have fun. (Also, if you never go away, they never miss you. Really.) At least one county away by car is great; if it involves a plane ride somewhere else, so much the better. This year I'm picking off the 27 states I've never been to - and probably finally getting the (online, now!) BSN they swore I couldn't live without as a nurse - by 1995 (snort!). Next year, I'm either doing countries, or destinations. I want to see what a full passport looks like.
But after a week, 10-14 days tops, I start getting twitchy to get back to work. I've never not had a job (except during part of college) since I was 13. That's
BTW, assuming someone does 3x12hr shifts weekly, if you pick up 1 extra shift/wk at a different facility, you network, see how other people do things, have a fallback job when your main gig craps out on you (and they will!), and you have about 20-25% after taxes of your annual pay in your hand as your Better Life slush fund if you simply put it in a jar every payday. I highly recommend it for anyone with 5+ yrs. experience. That's vacation, retirement, a down payment on a mortgage, or a new car, in return for one extra set of clean scrubs every laundry day. Times the rest of your career, that's one helluva better place to be in. Wish I'd started doing it ten years sooner.
One other thing: if you have an ounce of discipline, keep a shift log.
E.g., I'm about to embark on a 13-week contract. Or, 39 shifts. Potentially, as many as 65. Whatever.
But if you'd like to put what you do in perspective, start a little tally:
Say, something like : 4 GSWs, 19 MVCs, 42 MIs, 23 CVAs, 37 hot appys, 59 fractures, 107 psychs, 317 FDGBs, 81 peds, 126 admits, and a little boy with a toy soldier up his nose.
1423 doctor's orders implemented, 917 meds passed with no errors, 182 IVs started, 12 NG tubes, 56 foley caths, 918 phone calls, and 2 teddy bears successfully returned home with their smiling owners.
It lets you see just what an actual difference you make, and it's a metric fuckton more persuasive than the jacked up ratings on annual evaluations if you want to point out what you've actually done for your facility, if you're there long enough for an annual evaluation and raise discussion.
Trust me on that.
Like that slush fund, consider the tally another way of paying yourself first.
Thursday, July 7, 2016
Tuesday, June 28, 2016
Working ten to fifteen consecutive shifts consistently just wasn't challenging enough (no, really). So for even more greenbacks, I'm picking up a contract at a county teaching hospital/trauma center. In July. Just after the fresh residents have hit the floor. The phone interview, where they told me they love registry and travelers because they use so many, and that there are always plenty of overtime shifts to pick up, tells me that they're either stupid, or don't realize what that means to me is that most of their staff is new/short-term/swamped, so I'll pretty much be on my own once they take off my training wheels. Otherwise they wouldn't be glad to get people, and paying top dollar to make it happen.
Except unlike the last time I did this, this time with fluent Spanish and nearly 15 years of ED experience. (Note: never start a new ED job on 9/11/01, or amidst any other world-changing terrorist attack, if you can help it. Just saying.) This should keep me ahead of the residents. But I'll probably renew the contract a time or two if things work out. Because seriously, every time I start a new one, the 16-hour marathon of compliance modules on the computer, either there or here at home, is a total buzzkill. If there were an option that would let me skip the modules and substitute just being punched in the junk for half an hour while being tazed, I'd really have to think about which way to lean.
Which will be inevitably followed by more hours of orientation, that mostly just provides rent for the people in HR who lead orientation. But somewhere I have a book on Korean War POWs resisting brainwashing sessions, so I'll be brushing up on those tips beforehand, and working on keeping a slightly bemused look on my face, just to be ready for the first day of school before I hit the department.
Life should always be an adventure.