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| "I'll take "Words That Rhyme With 'truck' for $1000, Alex..." |
Pediatric codes are the worst. Like somewhere between merely horrific, going all the way to hellish. We're talking three-pages-of-code-notes-charting hellish.
Always.
ALWAYS.
Every time I do one or see one, I pray it's the last one I'll ever do.
But it never is.
And that's all I'm going to say about that.
Just finished clinical rotations with another about-to-graduate nursing student (my second so far) who wants to work the E.D. Since they were joined at the hip with moi, the designated utility infielder of my stomping grounds, they tagged along for shifts in triage, trauma, and multiple shifts with pairs of critical ICU holds camping in the ED. Final shift bonus for training purposes: a full arrest.
We don't normally throw that at our actual licensed new grad RNs until a month or so into their ED preceptorship, but this not-yet-graduated nursing student took to all of this like a duck to water with minimal guidance and supervision. Huzzah.
My earlier one is now in their 15th month here, and about 8 months out of training wheels, and is doing great.
I'm not going to be doing this job forever, and it's satisfying to pass on some of what I know before I either start forgetting it, or become too mentally or physically decrepit to pay it forward. I'm still pretty pissed at what the Idiots In Charge did with my first new grad RN (who recycled in-hospital despite the Mean Girls in the ED to become a fantastic ICU nurse, after some horrible co-workers hamfistedly and short-sightedly crashed their quest to work the ED), but starting out some nursing students right, who will, to a 95% certainty, knock out all their certs (ACLS, PALS, NIH) before applying to HR for an opening in the ED and get fast-tracked to starting here takes some of the butthurt sting out of that earlier cardinal sin. Not all of it, but some.
I'll recommend my latest padawan to my director for hiring (I'm only one voice), but with current turnover, they'll probably be picked up after passing the NCLEX and knocking out the pre-requisite certs.
{New grad tip: Get all the crap (certs/cards/classes) your wished-for department/specialty requires before you send in a resume and apply. That moves you from Florence Nightingale Wannabee, in a stack of 1000 resumes from the same, which will sit in HR until they've exhausted all the great candidates, and move your application into the basket with the 10 other smart and motivated applicants who have all their crap together first, whom HR can and will interview and hire for next week, or the very next new grad class. Write this tip on your hand with a Sharpie, lest ye forget! Or wonder why no one has called you 3 months after you graduated, while you're still serving lattes as a barista. Your choice, kids.}
It's almost like I know what I'm doing, and the bosses' boss keeps funneling some good rookie prospects to me to impart some wee few tricks of the trade.
Sadly, their completion means I'll now be doing all my work again, instead of supervising a bright young acolyte at those tasks.
>Le sigh<. First-world problems.
Still worth it.
Way-too-pollyanna CNO, after too many years in a carpeted office, and too little time at the bedside in the last decade, still pumping happygas, and making her once-a-decade visit to the night shift ER, when she hears Moaning Myrtle, doing what she does best: sounding like a cross between an ambulance siren in Hell, and ghost on a serious meth bender.
"OOOOOOooooooooooooOOOOOOOOOOooooooOOOOOoooOOOoOooOOOOoOOOOoOOOOOoOOOOOooooooOOOOO!"
"Good heavens! Its that one of your psych patients?!?"
Night shift ER charge nurse, 10 years past "over it", 2 years from retirement, not buying the b.s. anymore, and celebrating about the 20th week of being drastically understaffed all night:
"No Jane. That's the sound the staff makes as the life is slowly crushed out of them."
We didn't plan on this post. It just happened. We don't hate the police. We don't love them. We mostly understand they have a thankless, dirty job most days, and try to work with them. And realize that some of them are really good guys, and some of them are asswipes, and we give them the benefit of the doubt unless and until they prove to be the latter. Pretty much like we expect they do in their jobs too.
We point out for the record that the entire reason this blog has illustrations and memes homemade by your host in shop class in the first place began specifically with the douchebadge actions of a couple of overwhelmingly @$$holish cops in Salt Lake City, when they arrested an ER nurse for refusing to violate the Constitution, state law, hospital policy, written police procedure, professional medical ethics, and common sense, by refusing to violate an unconscious patient's civil rights at the demand of those same badged and sworn @$$holes, long-since fired and demoted for that particular jackassery.
We bring this up because as we had just finished our last shift for the week, and were minding our own business and driving home this morning, when we noticed someone running barefoot up the street, in (some of) their scanty clothes, and still wearing what looked like a hospital wristband, moving at a respectable rate of speed away from the hospital for early in the AM.
We pulled over up the street, and called the front desk security officer on duty from our car.
"Are we perchance missing anyone who may have run out of the hospital in some of their clothes?"
"What color clothes?"
We described them.
"Bingo! That's one of the psych patients who just ran out the door!"
So, we proceeded to follow the patient at a discreet distance, so as not to spook them, and notified 9-1-1 we had eyeballs on an escaped mental patient, on a legal hold (meaning they are either a danger to themself, others, or simply too cray-cray to manage their daily affairs), and kept them in sight to direct the local constables to apprehend them, and return them to medical care as quickly, simply, and safely as possible.
We gave the po-po dispatch a stellar description, exact location, and followed the pt. for two measured miles on foot for most of an hour, giving them a play-by-play, until said patient ducked into a residential block around a corner with multiple possible routes out, before we got to that corner. We lost our quarry at that point, but the constabulary's minions quickly found the patient walking nearby, made contact, and detained them.
Whereupon they ascertained that the person was the exact patient we had described and followed, confirmed name and birthdate with hospital staff, and confirmed that the patient was indeed on a psych eval hold before escaping our care.
And then the stupid motherfuckers, the pride of county law enforcement, for reasons known but to God and the hamsters in their otherwise empty heads, let the escaped psych patient go free.
Absolutely. M*****f***ing. F-R-E-E.
Guys who wouldn't let you talk your way out of a ticket with your dying grandmother bleeding out her ass in the front seat, turned loose a half-dressed bona fide certified lunatic, identified to them by name.
Who knows: maybe the patient used Jedi mind tricks.
Sleep tight, America. Professionals are on the case.
Top. Men.
It's not bad enough that these assclowns bring us every douchebag waste of skin drunk, junkie, or whackjob within 20 miles, even when they shouldn't, but that now, the one time we specifically ask the stupid bastards to bring one very specific whackjob back to the ER, and they detain that exact person, they turn them loose on society, because reasons, and a badged and sworn 70 point IQ.
So, Deputy Doofus, and Deputy Stumblefuck, this question is for you:
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| You had one job... |
Like sounding the depths of the Marianas Trench, We're beginning to realize that the answer to that question cannot be ascertained with existing instrumentation.
And, full disclosure here, there are screw-ups aplenty to go around, starting with who was supposed to be watching the Nutjob in question when they scampered out the hospital door to become a law enforcement problem, and how said Nutjob got their grubby mitts on some of their own clothes, which should have been removed and secured far out of reach and not anywhere close to them. The upcoming struggle sessions fisking that series of cock-ups are going to leave a mark or two.
But like soccer, the person who touched it last is at fault, so if patient Screwloose kills themself, or anyone else, or some harm comes to them as a result of being now at liberty, the lion's share of liability now belongs overwhelmingly to the County's Finest Knuckleheads, who had a chance to fix that small problem, but instead created an even bigger one.
And also, we generally try to expedite law enforcement custody patients getting in and out ASAP, on the theory that the best place for law enforcement is not sitting around the ER waiting for us to get things done, but rather on patrol, doing their job.
No points for guessing who's going to make sure and drag out those visits henceforth as long as humanly possible for some good amount of time, and who may even let their brethren in blue know why they're now being assured of going dead last, until suitable obsequious mea culpas are delivered appropriately from the agency responsible for this grand slam of cock-ups.
In the meantime, dickheads, this one's for you:
Sonofagun. Past it, in fact. As of early last month.
Didn't even notice in all the hubbub of normal life.
We are also damned near the last and only ER nursing blog that's not happygas and rah-rah pablum still in existence. Shrtstormtrooper, God love her, keeps plugging away on her blog, and more regularly, we confess, than we have on this one. But she sounds about ready to throw in the towel on the ER, and make a mental health move to something less soul-crushing. Time will tell.
We didn't realize ten years' time would get us the Sole Survivor crown in this endeavor, and as we said, we haven't been nearly as prolific or consistent dropping in over here as we have at our other endeavor.
Part of that is because after the first year or two, you've seen almost everything you're ever going to see in the ER, for 95% of patients. A sprained knee or appendicitis is exactly like every other one. (Thank heavens.)
The other 5% is unbelievably hilarious, jaw-droppingly horrific, or mind-bogglingly weird (sometimes all of the above).
But we've got, according to the Social Security Administration, probably another decade of shoveling coal down here in the boiler room before we can think about docking this battleship and getting off. And if we hit the Powerball tomorrow, while we love the job, and most of our co-workers, we'd leave skid marks out of the parking lot, and send the night shift a prepaid food truck every night for a month as a goodbye present, and never think about it again, unless writing a book or a script.
And sleep soundly every night, and walk around with a smile on my face every day afterwards.
But we took care of another...seventeen patients just last week, directly, and saved at least three of them from dying that day. And that part never gets old, no matter how tired we are of the drunks, addicts, and drug-seeking @$$holes who waste our time and effort, society's money, and their own lives.
So we're not going anywhere, anytime soon. Including online.
Just disappointed currently, because of having a preceptee/new grad for a couple of months, who was learning the gig ahead of schedule (95% her, and 5% us), and then was taken away and farmed out to good nurses and bad for the next two months, and is now struggling, hesitant, had her confidence shot, needing extra time in orientation training, and may possibly crash and burn, because manglement does what it does deaf and blindfolded, and can't figure out why they keep losing 90% of their new grad trainees, when they keep turning them over to nurses who couldn't teach their way out of a wet paper bag, let alone imbue a new grad with the skills to do this job. We could teach a motivated monkey to do it well, but we're not somebody's bestie, and thus not liable to get that opportunity again.
That absolutely and quite simply sucks.
And it's unethical, unlawful, and sadly against hospital policy to take the guilty jackholes into the supply room and do some one-on-one wall-to-wall counselling, to teach them the error of their ways.
That's a notable pity as well.
Because I like my job, and I'd like to download some wee quantity of what I know and learned in the last nearly thirty years doing it, before it's too late. But I don't love that enough to ride that concern right over the cliff.
And the Flying @$$holes always self-select for more Flying @$$holes, and can't figure out why better quality people always end up leaving, or not getting on their team in the first place.
Said every staff member at every hospital since Florence Nightingale was a new grad.
At any rate, since noticing the recently passed blogiversary, we are entitled to a party and some cake. And many happy returns of the day.
Best wishes to all who drop by here, and a commendation to those who continue to fight the good fight, in the professions and careers that matter, to the highest extent humanly possible in this lifetime.
What do you do at work? I save lives.
You too? Pretty effing awesome resume, right there.
Everybody walking into the building at the beginning of the shift:
Everybody walking out of the building at the end of shift:
This used to be one ER patient a month. Then it became one a night. Now it's 20% of patients every night, and some nights it's every patient. And over half of them are minors.
Remember those numbers when the hardcore potheads in your state say "Let's legalize pot."
21 years in the ED as of last Monday. (Yep, my first day in the ED was the morning of 9/11/01; the planes were crashing into the WTC as I was driving to work.)
27 years as an RN next week.
If you really don't love the job, no amount of money is worth it.
For some people, a year is too long. For others, after 40 years, they're just getting into the groove.
Find something you love to do.
I swore as a student I'd never be one of the bitter old burnouts I met who hate everyone, and suck at the job. But remember, some people need compassion manifested as tough love, not as fluffy bunnies.
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| Oldest working RN. 94 years old. Her last name isn't Nightingale. But no way in hell I'll be working to that age, if I even live that long. Not even if I could. |
When I started this gig, back in the late Pliestocene, the nurses TPTB put in the trauma area were all pretty good at their jobs, but with most of them, there was a definite Mean Girls/"Our poop doesn't stink" vibe going on. I was never going to be in The Club, and they let me know it right away, which was part of why I left there after a couple of years. Loved the training, and most of the staff, but I wasn't as impressed with them as they were with themselves, and I could recognize a toxic work environment when I saw it.
It took doing five years of registry, and realizing I was good enough that hospital after hospital asked me to hire in after about two shifts to know deep in my bones that I knew my sh*t, was a badass nurse, and that I really like doing my job. I probably always knew it inside, but that made me realize it out loud, I suppose.
So now, at Last Stop hospital, after several years, I'm finally getting shoved face-first into trauma again. I've been helping out all along, which is what pissed off the Mean Girls Club here from the get-go, and a couple of them still try to power trip, and shoo me away because they think they've got more experience at this. At this phase of my career, it makes me laugh, mainly because inside I'm thinking, "Look, Cupcake, I was doing trauma and kicking ass at it five presidents ago, when you were literally in diapers, and I nailed it then, so you can take your condescension and shove it right up your tailpipe."
Can't say it to their faces, more's the pity, but just like everywhere, time weeds them out, and I'm still around. After only a few years here, I can count the number of people with more time on the shift than me on my thumbs, because the youngling fools always think "the grass is greener", and off they go, face first into the brick wall of Reality.
The unspoken truth that people who last in this profession realize is that everyplace is better, and everyplace sucks harder, than your current job. The key is finding the place that's good enough at what matters, and where the things that suck are things you can tolerate, while still functioning. Some places, that slice of the pie is so huge no one should stay. Others may be not much at all, and someplace, there's a good fit for you. For as long as it lasts.
Because when you find a great place, hospital manglement will inevitably find a way to screw the pooch until it sucks there more than you can handle, or should tolerate. That's when it's time to go. Not a better rate, or massage chairs in the break room, or 27 other dippy reasons for leaving. And the best reason for leaving is that leaving has nothing to do with work at all, but rather with life, family, and important things, realizing that this is a portable job you can do anywhere on the planet, and family and life priorities always come before work.
Nobody on their death bed ever said "If only I'd spent more time at work...".
When I was new, all I worried about was doing things right. At this phase, I'm starting to consider the day when I won't be able to do things right. You want to go out on top of your game, not fighting gravity and the inexorable march of time, so you can leave when you want to, and not because you have to. I'm nowhere close to the latter, but every trauma now reminds me that there but for the grace of God...
That never crossed my mind thirty years ago, but it does now sometimes, and it's pissing me off. 52 is the median age of RNs, and 58 is the average retirement age. And I expect to be doing this way over to the right edge of that bell curve, unless some idiot at the Powerball gets the right numbers for me to leave skidmarks in the parking lot. But I can see the last punchout at the timeclock getting closer each passing year.
I loves me the kids that work for the local ambulance companies, most trying to become firefighter/paramedics, doctors, nurses, physician assistants, etc., but no matter what the Department of Transportation says, sometimes the brevity of their medical training leaves some rather largish gaps in knowledge and competence.
Case in point:
The other night, Local Ambo Co. crew brings in Mrs. Older Than Dirt from the local convalescent warehouse, for intractable pain.
Medic: "She's having intractable pain from an L-12 fracture."
ER Doc: *blinks*
ER nurse: "L-12?? Are you sure...?"
Medic: *looks at paperwork* "Oh, yes, definitely. Fracture at L-12!"
ER Nurse: "L-12...I see. Did she grow a TAIL...?"
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| Those pink feet tell you this photo was posed with a live person. Ask me how I know. |
Some people think fixed and dilated pupils is how you know someone's dead. Others will tell you it's flat brain waves, or asystole on the EKG monitor.
They're wrong.
I was reminded of this fact by the real actual everything-proof acme of you looking down at your own body from outside it, and knowing things are bad.
As someone observed at his own son's funeral, "Being dead is like being stupid. Everyone knows it but you."
But I've gotten pulses back from asystole. It's rare, but not unheard of. I've even seen patients recover from what everyone in the room thought was certain death. Some of them even walked out the front door some days later, to the astonishment of the doctors and staff.
But nobody - NOBODY - who comes in with feet the color of parchment, ever comes back.
I'm pretty sure while the spirit of the former person hovers around, while we all push drugs and do compressions, Death, courtesy of Terry Pratchett, shows up to put the final stamp of approval.
"Wow, I look pretty bad, I wonder if I'll..."
"NO. SORRY. YOU WON'T."
"Are you sure? I mean, I was pretty young and healthy and..."
"AS IF THAT MATTERS. BUT NO, I'M AFRAID NOT. LOOK AT YOUR FEET."
"Wow! Why are they so yellow?"
"BEGINNING TO BE RATHER OBVIOUS WHY, DON'T YOU THINK?"
"Oh. OH! Yeegads! So I'm really...?"
YES. QUITE. SHALL WE BE OFF, THEN? I'VE GOT SEVERAL MORE STOPS JUST YET THIS TRIP..."
And no matter how many more rounds of epi, and bicarb, and calcium, and whatnot, we give, nor how hard the tech is pumping your rib cage to circulate them around, once we see the parchment yellow Feet Of Death, it's because we just can't squeeze enough blood through your corpse to turn your tootsies that lovely shade of rose pink they ought to be, and would be, if you hadn't already toddled off with Death at some point annoyingly prior.
One minute you were coming home from a party, and the next thing you know, some bony-handed gentleman is dropping you off at the reception desk at the Pearly Gates.
And all the king's horses, and all the king's men, can't undo the rude unhinging of the mechanism of life visited upon you by Fate, Physics, and Physiology.
We're all really sorry about that. Hand to God, we are. But there's just some things we can't fix, and your fate was sealed long before you got to our back door, no matter how much everyone, including people we haven't even met yet, wish it were not so.
I really fucking hate that. I thought, long ago, that one day I might have gotten over it.
But this many decades in, I'm afraid that's just never going to happen. And I suppose if it ever does, that's the signal it's time to get out of this business for good.
It was a long night. It'll be better after I finally get some sleep.
Better still, after I spend a long, quiet day in the park enjoying fresh air, warm sunshine, and a brilliant blue sky, and see the things you can no longer see, and go to the places you will never again go.
But in the pitch darkness of 3 AM, it's just cold. And the only thing making it easier for me is knowing I'll never hear the moans and wails when your parents are located, and get the call no one wants to make, nor be there when the sheet comes back, and they see it's really you there on that table.
Seeing your yellow feet is bad enough. I'm oh so glad I don't have to see the whole show in this tragedy. And I'm really hoping it doesn't cross my mind again tomorrow night.
Sufficient unto each day are the troubles thereof.
O, you can just bet they are.
