christmas cray

...because it's not christmas until we're wrestling with a hallucinating amputee who's trying to run from the guy who's trying to kill him in his room.

restraints and haldol to all and to all a good night.

these are a few of my favorite things

lately i've been trying to find joy and satisfaction in whatever i can at work.  typically this comes in the form of things patient say and gross medical procedures.  so without further ado...

• patient diagnosis overheard in report "got shanked at the library".  dangerous places, those libraries

• awesome coworker's patient was vomiting non-stop and needed an NG.  i was her second set of hands and watched her put in a beautiful NG that pulled 2,125 ccs of bile out of the patient's stomach.  picture a 2 liter bottle of soda...yeah, that much.  it was a magical experience.  

•  new terminology: "chronic GSW".  you know, for when we take care of you after you get shot on more than one occasion.  you'd be surprised by how many repeat customers we get...they are the ones that i like to target with my "make good choices" speeches.  

• the patient satisfaction surveys... full of gems such as "you don't have MSNBC on the tv" and "the vending machine took my money".  my personal favorite were the responses from two different patients, one of which said "don't bring me water unless i ask for it" and the other "i shouldn't have to ask for water to be brought to me".  yes, these are the things that our patient scores depend on.  

• our developmentally delayed pt who wanted to go "take a tour" of some newly constructed rooms so he could request one for his next surgery, all while decked out in christmas gear with stuffed elves hanging from his IV pole.  cute.  

• we have had such good residents lately!!  attentive, smart, wanting to collaborate...a holiday miracle, for sure.  

• my wonderful coworkers.  they get me, and they remind me who i really am and the kind of nurse i want to be.  

the last few months have been hard for me, that's for sure.  but i DO have things that i love about my job and i DO have so much to be thankful for. 

on criticism

i had a painful meeting this week with management on the topic of "expectations and opportunities".  this is apparently a euphemism for 'everything that is wrong with you'.  it did not go well.

they were quick to tell me that i'm a great nurse and that i provide excellent patient care.  which, if i'm not mistaken, is my job.  take care of patients.  be nice to them.  work well with others.  follow policies.

did someone forget to tell me the part where i agreed to think only happy thoughts all day despite bleak morale, impossible expectations, and understaffing?  or the part where i said i would be only rainbows and smiles 24/7, on all the time with no trace of frustration or feeling overwhelmed?

THAT IS NOT MY JOB.

i have apparently become some sort of "leader on the floor", which is another management euphemism for "fall in line before others mutiny".  keep in mind this is not something i asked for, nor something i have been payed for.  no, this honor has been give to me because i'm one of the only people who has been able to survive 5.5 years on the floor, through 5 different managers, 3 directors, countless threats of physical violence, verbal abuse by patient and doctors, unsafe staffing/patient assignments, and little to no credit or thanks most of the time.

so you're probably wondering what i did that's so awful, right?  did i have a screaming fit at the nurse's station?  did i rant to a patient?  did i tell off my manager?

no.

i said that staffing was "not ideal" (which it wasn't).  and i said it to my coworkers (who are my friends and should get to know why their assignments suck).  while making up the day's assignments (which i am not payed extra to do).  which i actually have to do before i punch in for the shift, so i am doing them on my own time for free.

i for one thought that i was being pretty tactful, given what i would have liked to say, but i guess i should be ashamed of myself.

so anyways, something silly like daring to voice an unapproved thought led to almost an hour meeting about how i am in charge of my shift's morale.  i must be positive.  i must not say negative things about staffing to my coworkers.  if i must say these things, i should find my manager, go to her office and close the door (this was emphasized) and then i am allowed to speak with "candor".  otherwise, i must take time to "collect myself" before returning to work...apparently with a 100 watt smile and my pom poms, cheering the team on.

as i have previously mentioned, i'm at the end of my rope with this job.  i'm giving everything i have left to my patients, which doesn't leave a whole lot of energy to be fake around my coworkers.  i'm tired, and i'm sure it shows.  but i am TRYING.  and i don't understand why i'm being held to a different standard than anyone else.  i don't want more responsibility, or more pressure.  i basically want to be anonymous and to be left alone.

so to recap: i'm expected to take on additional responsibilities like being the charge nurse, precepting, and being a resource, which can be inconvenient, annoying, and stressful.  and this somehow makes me a "leader".  but instead of getting more of a say on the unit, or getting the right to voice an opinion and bring about change, i'm being stifled.

so which is it, management?  do you want me to lead or not?  do you want me to advocate for my people, to be their voice?  or do you just want me to do all the work, toe the party line, and shut up?

i think the answer is obvious.

at the end of the day, i need to answer to myself.  can i be proud of myself?  did i stand up for what i believe?  am i saying things that need to be said, or just whining?  there's a fine line between advocating for myself and my coworkers and being divisive.  but there's also a fine line between being a "leader" and being a drone.   

 

nursing in an urban war zone.

as i walked into work yesterday i noticed a police car heading pretty fast towards my side of the hospital.  then another as i got closer.  and another.  and another.  by the time i walked into the building, there was a gathering of dozens of squads outside.  there were employees huddled in the doorway murmuring something about bomb threats, and i got the general sense that i did not want to be walking in to whatever this was.  but as with most things, when normal people are running away, nurses are going in.  so i went about my day, only to get on the unit and learn of a man with a gun in a neighboring building.  and it felt a lot like this day.  the news was rabid outside the window of the unit, and on tv they were airing whatever "tips" that random people were calling in from inside the building, almost all of which weren't true.  the police ran crime scene tape around the trees outside our charting room window, and we watched from the inside as people gathered for a press conference.

it made me angry.

you shouldn't have to feel unsafe at work.  you shouldn't have to wonder if an angry family member with a gun is coming for you.  you shouldn't have to feel obligated to put your own personal safety at risk like some sort of martyr's sacrifice to take care of other people.  i signed up to be a nurse.  in the midwest, not some sort of combat zone.  and yet in the past 6 years i have watched the police push up ceiling tiles in a patient's room on the hunt for a weapon.  i've been handed a grainy picture of an attempted murderer who tried to kill one of my patients and have been told to "be on the lookout".  a little over a year ago i hid in a room with a patient, listening to news broadcasts saying there was a mass shooter with a gun in the hospital cafeteria, and waiting for him to come up to my unit looking to finish the job.  i've had veteran trauma nurses tell me the story of when US marshals came to arrest a patient's most-wanted family member with guns drawn and made all the nurses lay down on the nurse's station floor.

these are the things that are happening, and these things are not ok.  i NEVER thought that i would have to deal with anything like this when i became a nurse, and i still don't think that i should have to.  i care about my patients, and i want to keep them safe.  but at what cost?  and am i obligated to put myself in harm's way to protect people i barely know?

the man with a gun was shot by police.  then he ended up in the trauma bay, and we all were afraid that he would get admitted to the floor and we'd be forced to take care of this man who no one could muster up much compassion for.  but he didn't, and then it was done.  the news went away, and the helicopter stopped hovering overhead.  the crime scene tape came down and the squad cars left one by one.  and we were just supposed to go on with our day, like it didn't matter that we had another example of just how easy it is to waltz into a hospital with a gun down your pants.

it matters.  and it is NOT OK.  

fatigue & compassion

there is a thing called compassion fatigue, and that basically means that you are tired of caring for other people.

yes.  that.  

i am exhausted.  i have nothing left to give.  i sat down after my shift today not having charted anything.  ANYTHING AT ALL.  i felt like i gave my patients everything that i had to offer, and didn't even come close to meeting their needs.  

my brain injured patient has an ever-growing left arm that no one will address.  he won't eat and hasn't gotten out of bed.  he barely gets turned because he's a huge guy and just doesn't roll.  he sleeps all day, except for when he's screaming out in pain.  and i know he's brain injured, but it still makes me feel like a horrible person when he's yelling at me all the time that i don't understand his pain.  

my admit has a room full of nurses and is herself "medical".  she looked at me with accusatory eyes from the first moment i stepped foot in her room and right away i felt the need to prove my competence and live up to unrealistic expectations.  when she said "that medicine isn't doing anything for my pain", it was obvious that she meant that it was ME who wasn't doing anything for her pain.  and despite my ice packs and moving pillows all about and switching around pain meds and adding muscle relaxers and splinting her fracture, the pain got no better and i achieved nothing.

my sweet GSW to the chest has a necrotic liver, and just feels like crap all the time.  there is basically nothing that i can do for her, and that feels like failing too.

so i sat down at a computer to do 10 hours worth of charting, and started to cry.  the exhausted, frustrated, i'm crying about one thing but it has become everything kind of tears that don't stop.  and as i sat charting and sobbing and blowing my nose and creating a mountain of used kleenex next to me, the door to the charting room opened and one of the oral surgeons walked in.  and he sat with me and awesome coworker for almost an hour as i continued to cry and chart and try to cover my feelings with cheese bread and vent all my nursing guilt and inadequacies.  he told me that it's ok to care, and that i am making a difference, and that i'm not a failure.

a surgeon.  who has feelings.  who is not scared by my ugly crying, but as i found out later heard that i was having a rough day and sought me out just to talk.  there are no words for that.

when you live the kind life where you pour everything you have into other people and typically go home having been given nothing in return, receiving compassion and kindness for yourself is a shocking and wonderful thing.

my coworkers know and love me, and they are incredibly supportive.  we take care of each other, and they are the only things keeping me at this incredibly challenging and frustrating job.  but this doctor doesn't know me particularly well, and he doesn't owe me anything.  yet for some reason he took it upon himself to offer me support and reassurance when i needed it.

and because of that, i have lived to nurse another day.

enough.

i've never been very good at accepting less than perfect.  five years of nursing has taught me that there is a limit to how much i can give, that sometimes doing 'the best i can' is all i've got.  but lately that hasn't been enough.  you'd think that i'd get used to being so frustrated, seeing as how i've spent the better part of my career feeling that way.  unfortunately not.

this week, which sadly has only been 3 days, has made me realize a lot of things.  i'm not happy in my job at all anymore.  the compassion that used to come so naturally to me just doesn't anymore.  i've started to view almost everyone that i come in contact with as an inconvenience to me and an obstacle to me making it through one more day at this miserable job.  i don't remember the last time i loved my work or the last time i thought something at work was fun or exciting or interesting, in fact i'm so unhappy that i can't even remember what made me want to do this in the first place.  i've lost all joy and wonder; the reality of nursing and working on a toxic, thankless floor has killed that for me.

because the truth is, nothing i do is enough.

i work in a place where all we hear is "good job with that, BUT...".  management nags us constantly.  now i realize that this is their job, but it's excessive.  we can't just be piloting one new project that no one wants to participate in, it has to be three.  there isn't one new required form of duplicate charting, there's two.  it doesn't matter if patient acuities are through the roof and nurses with 10 years of experience are literally crying, half the floor WILL go to a mandatory meeting to discuss what we can do to make the floor better...oh the irony.

but it's more that that, really.  it's the feeling that my patients deserve more than what i can offer them, not because i'm incapable but because i'm so stressed and spread so thin.  it's the feeling that i've never had to work so hard to be such a failure in all my life.  i'm tired of sucking at my job all the time.  i'm tired of trying my very hardest to barely keep up, and to fall short of the 'expectations' that i'm being held to.

every ounce of care that i used to have for this job and this floor has been sucked out of me.  i have become the 'things will never change' nurse, and i'm sure it shows.  you can only give more than you have to other people with nothing in return for so long.  after that you apparently become bitter and washed up and sad and old.  well who knew?

i feel like a caged animal.  i am desperate to escape, and i'm willing to claw anything that keeps me from my goal of making it through another day.

i used to be kind and now i'm calloused.  i used to be optimistic and now i'm a downer.  i don't have compassion and i don't have patience and i probably have no business working with people at all when i feel this way, but i have bills to pay and no other choice.  i've begun to desperately search for another job.  i've sent applications, i've emailed managers.  at this point i will do ANYTHING to escape...leave my friends, work nights, lose my seniority...ANYTHING.

i  can't work like this anymore.  i can't live like this anymore.  i've just had enough.

favorite things.

fav new RN on working with the 'laid back' nurse: "my back is killing me...from carrying the team"

----------------------------------------------------------------------------------------------------------------------


new work motto:

----------------------------------------------------------------------------------------------------------------------


awesome coworker on the elevator music we're forced to listen to: "seriously, this music sucks"
me: "um, that's your patient's chair check"
(awesome coworker sprints off)

----------------------------------------------------------------------------------------------------------------------

two new forms, new IV pumps, and mandatory triple charting on patient med teaching this week.  as favorite float pool nurse says "they should just tell me when to show up to get the chip put in my head".

----------------------------------------------------------------------------------------------------------------------


brain injured patient to my fab pregnant nursing assistant: "you know what you gonna name that little gangsta boy?"

----------------------------------------------------------------------------------------------------------------------
and this:

"i tried carrying the weight of the world, but i only had two hands".  yes, that exactly.

hood life.

i grew up in the hood.  not the mean streets of new york or anything, but still ghetto enough that when i say i'm from ___, people make comments.  we had the token airbrush store at the mall where you could get your tall-t "RIP" shirts made.  we had a police liaison office at school.  during lunch i would watch the hispanic girls fight each other (after taking off their giant hoop earrings first, of course) and little balls of yanked-out weave would roll around in the halls.  after school we had a paddy wagon that would pull into the school bus circle and people who were trying to start something would get thrown into the back.  maybe that's not normal...to me it is.  i'm not saying that i was ever a gansta myself, but that kind of life is pretty familiar to me.  i think that's part of the reason why i took to the trauma unit right away.  it feels like home, in all of its dysfunctional glory.  the ghetto made me (or at least that's the joke), and it's what i know.   and this week at work was par for the course.  

one day i was urgently called out of the nurse's station by a family member who said a patient (not mine) needed help (not true) and her call light wasn't working (also not true).  when i got to the room the multiple grilled/weaved/false-eyelashed visitors argued for awhile if i could even help them or if they needed a doctor (good luck with that one).  after i encouraged them to go ahead and try me, they asked me if "yo blood in yo body be blue".  this is apparently why i went to nursing school.

a few days later i got this patient who was in for his second evading the police car accident.  turns out someone has 5 kids (in his mid-20s) and hasn't been paying his child support.  apparently this guy has also been shot a couple times...so classy.  the "trust no bitch" and "only god can judge me" tattoos were a nice ironic touch.

for better or worse, these are my people.  and now that trauma season is drawing to a close, these are the people that i'll miss for the next 6 months where all i see is slid-on-the-ice MVCs and old people falls.  until the summer, my friends from the hood...i'll be waiting for you. 

taking pills

this week's important lesson: don't buy random unmarked pills from people in bars.  

so i get this patient out of the ICU s/p MVC with multiple rib fractures.  the guy is 70 years old and was driving his car when he suddenly lost control of the vehicle/passed out/basically has no idea what happened.  

fortunately, this is why social work notes were created.

turns out that grandpa likes some percocet for his arthritis (don't even get me started on primaries overprescribing pain meds), and ran out.  so he did what most people would do (NOT) and bought a bunch of pills off "some guy" in a bar.  

so after the crashing is done and the patient is in the ED, the unmarked bottle of pills comes out.  pharmacy looks them up and turns out that grandpa got himself 4mg Dilaudid tabs.  WHY DO 4MG DILAUDID TABS EVEN EXIST??  to be abused, that's why.  

he ended up taking "some" (aka ODing on narcs) and then getting behind the wheel.  

on the plus side, he probably didn't feel a thing when he slammed himself into a tree.  

on the minus side, he now has 10 broken ribs and his dilaudid was confiscated.  

on the plus plus side, he now gets to take oxycodone AND oxycontin. 

STOP BUYING PILLS OFF STRANGERS IN BARS.  

that will be all for today. 

 

lies

there is something about being lied to on a daily basis that has made me stop trusting a thing that people say.

case in point.  i had this patient awhile ago....8 months pregnant, accidentally stuck her hand through a window and severed an artery.  almost bled to death on her front porch.  upon arrival to the ED, they almost did a C-section in the trauma room, which is NOT DONE (i know, i know, the TV show ER lied to us all).  they finally got a blood pressure on mom in the 40s systolic, so they ran her to the OR and did the C-section there.  after a ridiculous amount of blood...like 16 units PRBCs and 9 of FFP, everybody was still alive.  baby ended up doing pretty well in the NICU, and the patient came to me in less than 24 hours from when she was almost dead.

she had some problems, to say the least.  drug and alcohol issues, didn't have custody of some other kids...that kind of stuff.  but when she told me that her issues were in the past, something made me believe her.  and when she teared up every time she talked about her baby, she was genuine.  she didn't even want to go home on narcotics, such was the dedication to the idea of changing her life.  i don't usually drink the kool aid about that kind of stuff, but with her i did.  i was convinced that she was going to change her life, and when she got discharged i was hopeful for her.

a few days later one of my pregnant coworkers saw her in the OB clinic waiting room.  she was falling out of her chair, dropping things, eyes half closed...obviously on something stronger than percocet.

i guess i shouldn't be surprised.  it still makes me sad, though.  i wanted better for her.  i wanted for her to prove everybody wrong, for her to prove to the state that she can be a good mom.  for her to be able to keep her baby, to fight her addictions.  but i guess she just doesn't have it in her.

now that i think about it, i don't think that she was lying to me as much as she was lying to herself.

it's an age old question: how do you give your best on a daily basis to people who most likely will never change the behaviors that brought them to your door in the first place?  or do you just do your job and stop caring about the rest?

i want to believe that people can wake up one day and say 'enough is a enough', stop living out destructive behaviors and making poor choices, and completely turn their lives around.

i WANT to believe it.  i'm just not sure i actually do anymore.  

run and tell that.

a while ago we had a visit from some governmental friends.  while they who will not be named were in the house, we had an unauthorized dog running around the floor, a patient trying to bathe themselves with cavi wipes, and a patient elope to mcdonalds playland for 3 hours because "nobody told me that i couldn't!!".  cue widespread panic and cover ups to ensure that we didn't look like morons and get dinged 234098234 times for violating like all the policies we have.

and while our visit with 'the man' went fine, it always ticks me off when they're around.  mainly because we have to spend more time worrying about timely charting than about actual patient care.  and because i have to hide my coffee.  but now they're gone...let the use of unauthorized hand lotion begin!!

in which i am traumatized by camp nursing.

so i do this thing every year where i work a 70 hour week and then head straight to kids camp and be their nurse for a few days.  every year i dread it, and every year i leave happy and feeling like i did something good.  for the past few years, i have soothed the hypochondria of children and put on some band aids.  this year, i expected more of the same.

that was, until, the very first night of camp.  when a mere 5 hours after the kids arrived, i heard the horrific screaming that only comes when someone is very very hurt.  my suspicions were confirmed when people started yelling for me, so i followed the noise to the kid writhing in pain on the ground with a very obviously broken arm.

now i'm a trauma nurse.  but i don't work peds, and i'm not a first responder.  the fractures that i see are all splinted or ex-fixed or at the very least, covered in some way by the paramedics.  i'm definitely not used to seeing such a little hand just hanging there, especially when it's attached to a terrified little kid.  i would like to say that i launched into nurse mode, but i actually think that it was more like mom mode.  i grabbed the crying child, pulled him into my lap, and held on for dear life.  the arm was bleeding, and even when i was asking him if he remembered falling on anything, i was pretty sure we were dealing with an open fracture.  and instead of my nice shiny sterile hospital setting with all of my supplies, i'm sitting in dirt at the bottom of a hill with a first aid kit that somehow doesn't have gloves.  and this is my fault, because i was the one who "restocked" the first aid kit....just not very well, apparently.

i honestly think gloves wouldn't have mattered anyway, because the kid wouldn't let me do anything to his arm.  i had nothing to splint it with.  the open area was all the way underneath the arm, where i would have had to twist it to look, and he was having none of that.

so there we sat.  in the dirt.  at the bottom of a huge hill.  him in my lap, his broken and bleeding arm laying on top of my intact one as i acted like a human splint.  i held his hand on the broken side, and we waited.

i have never been so relieved to hear sirens in all my life.  we packed him up in the back of the ambulance and went to the hospital, where the xray showed a both-bone open fracture that needed to go to the OR right away.  i stayed until his mom got there, then went back to camp.

i talk about being this mighty trauma nurse who's seen everything and is not phased by anything, and that night it just wasn't true.  sitting on the side of a big hill, in the dirt, with a crying and terrified child in my lap...it was SCARY.  none of my supplies, no resources, no higher authority than myself...everyone looking to me to decide what we were going to do.  you would think that someone who loves to be in control would be thrilled with such power, but i wasn't.  i was out of my depth.

so once it was finally over, i called my nurse bff and cried.  and then i felt better, and went on to nurse another day.  a day in which i had to deal with this:

it turns out that it's a bad idea to wrap a t-shirt doused in lighter fluid around a piece of wood to make an "olympic torch" and then run with it through camp, as one of the counselors learned the hard way.

such.  big.  blisters.

i hear both 'patients' are recovering well, and after a week i finally have too.

hats off to those who make a living listening to the panicked screaming of people who are healthy one minute and broken the next.  i have officially learned that is not for me.

you found it WHERE?

so awesome coworker goes to put in a foley on this lady who's admitted for a GSW to the butt.  the lady is a bit large and in charge, so awesome coworker is hunting around for the urethra, only to discover something very unexpected.  namely a bullet in the patient's vagina.

yes.  a real bullet like from a gun.  

just sitting there.  

in lady town.

NO idea as to how it got there, because there was no bladder injury, and no injury upon pelvic exam.

i'd call it a magic bullet, but i'm pretty sure that's that thing on TV that chops up food.

you don't see THAT everyday, people.  

more H&P gems

"patient states the symptoms started after she ate a Nachos Bell Grande from Taco Bell"

which was closely followed by

"patient states she has a dog but it does not lick her toes"

...whaaa??

it's like a bad match.com ad, and also the best thing i've read all day.  thank you, ID, for being creepy stalkers with a love for the overshare.

july, god help us.

the baby residents just hatched.  on the plus side, they are usually friendly and eager to please.  on the other hand, i get tired of hearing "i'm just going to run that by my senior...".  um, i asked you for tylenol.  lets use that shiny new degree, shall we?

thus, i have put together a little list i like to call 'helpful tips for new residents'.  the rules are as follows

1.  let me help you.  i know the floor, the patients, the team WAY better than you do.  i have been here 1825 times longer than you (literally, i did the math).  ask my opinion.  take my advice.  i want you to succeed so our lives can all run smoother.

2.  if you don't know, ask.  seriously.  this will save me a lot of time calling you to clarify your nonsensical/unsafe orders.  if you don't know the doses for things, check with pharmacy.  if you want to know how we usually do things, ask one of the nurses.  if you are worried about a patient call your senior.  if you don't, i will ask you to, or i'll do it myself.

3.  answer your pager.  SERIOUSLY.  if you are in the OR, have the nurse call me back.  if you're in the ED, you are one of 234098 people in the trauma and can take 2 seconds to let me know you're busy.  i will wait for stool softeners and FYIs patiently, if i have someone screaming in pain or crashing i will stalker page you and all of your superiors.  don't mess.

4.  let me know if you are overwhelmed.  if you are so far behind that you're about to cry, i will stall a family or save my discussion on lab values for another time.  you need to eat.  you need to take a moment to pull yourself together.  maybe you need to ask your peers for help, or ask me if there's something i can do for you.  talk to me.  at the very least, i can get my coworkers to back off of you for a little bit so you can catch up.

5.  there is no reason ever to be snotty or snippy or rude to me.  NONE.  use your words.  if you are frustrated with something i did, tell me.  you'll get an explanation or an apology.  if you're stressed, see above.  i can remember every resident who has crossed me by name, and i will not trust you for the next 5 years if you are evil.

6.  doctors and nurses can be (gasp!) friends.  i'm not asking you to go shopping, but we can have fun at work.  when i like you and we have a good working relationship with mutual trust, things will be easier for the both of us.  trust me.

7.  keep me posted.  if you're doing something with one of my patients, i want to know about it, especially if they need to be medicated.  do not pull my tubes/lines/drains without telling me.  when they disappear, it freaks me out.  a heads up is all i need.

8.  you don't have to mop the floors, but you'd better keep my rooms clean.  i do not expect to walk into a room covered with casting plaster and a freshly-pulled chest tube sitting out with the end in the garbage.  i am not your maid.    

those are the basics.  guess we'll see how this batch does.  

and it always starts with someone naked and bleeding.

it started when i went to answer the call of my people, aka the bed alarm.  i was two steps behind another nurse, and we were equally surprised to find...well basically this:

but naked and bleeding from the chest tube that he had just pulled out.

so now sucking chest wounds equal panic time, so i grabbed gauze and my coworker tried to get the patient to sit back down.  we tried to get an occlusive dressing over the site and meanwhile he's swinging at us, screaming obscenities.  we wrestled him back into bed and it took four of us to get him in restraints, as i'm frantically paging for a monitor, security, the stat team, the doctor and everyone else you can think of.  so the guy looks creepy at baseline, but now he's breathing at 30+ breaths a minute and i'm getting scared that he's ready to go out.  so on went the O2 facemask, which only spun the patient up more.  so picture this little terrifying man, still naked, covered in old blood, cursing through his facemask and trying to claw and bite it off his face.

this is what i call a typical saturday night, sadly.

haldol is my friend, yes it is.  after 5mg IV he was more like this:

i can work with this.  believe it or not, the chest xray looked decent, so he bought himself a night with no "motherf*ing hose shoved in me you sons of bitches!!"  

and also a sitter and four point restraints, so there's that.

happy sunday!!  hallelujah.  

 

new favorite

so my patient has 2 wives, one real and legal wife, and one "wife" who showed up at the hospital with her lawyer in tow calling herself by his last name.  the whole situation is a cluster...the patient is a brain injury and no one wants to claim responsibility for him.  the only one who visits him is his AA sponsor, which is especially generous of him considering that the patient got hit by a car while wandering out into traffic drunk and high.  so our social worker goes into the room to get the low down from the sponsor about the wives situation.  turns out that the "wife" with the "same last name" and the lawyer is actually a "crack whore tryin to see if he got money".

i'll give you a dollar if you can guess what the social worker wrote in the chart.

that's right.  word for word.

so now the "wife" is an officially documented crack whore tryin to see if he got money.

i swear, sometimes i love this job.

no good deed...

"room 28's wife says her water just broke.  what do i do?".

our newest nurse looked nervous as she grabbed me out of the hallway.  i went down to the room and talked to the wife.  sure enough, she was 37+ weeks pregnant and was leaking fluid out onto the floor.  i called the ED, who told me to call L&D.  i talked to the charge nurse up there and told her to expect the patient and her s/p motorcycle crash husband with his chest tube in tow.

apparently this is where everyone started freaking out.

first my assistant manager says that we can't go to L&D, we have to go to the ED "because of EMTALA".  seriously.  there is a law about that?  ridiculous.

then transport freaks out because the chest tube is to portable suction.  mmmkay...not like you take people with chest tubes on suction to tests EVERY SINGLE DAY or anything...

so the wheelchair caravan of terrified first time parents/trauma patients and spouses heads off to the ED...where they are immediately sent up to L&D (um, told you so.  ok).  the nurse settles her patient in and reminds him that L&D can't give him meds or any cares, and gives him all of our numbers to call when he needs anything.  she comes back to the floor to update the trauma team

...which is where everyone resumes freaking out.

the intern apparently asks "did you get permission for that", which is where i will begin side rant.  permission...seriously.  this from the service that acts like any nursing request is inconvenient to them.  the service that will let patients get as sick as humanly possible before intervening just to 'make sure' or something like that.  the service that has been in the ED with traumas for the past 4 hours and has made it clear a million times before that floor priorities are NOT priorities.  you wanted us to ask PERMISSION for the STABLE patient to go WITHIN THE HOSPITAL with his very pregnant and terrified wife to help her give birth to their baby.  mmm.

i'm still not understanding why everyone is so riled up, but i feel responsible because the nurse asked me what to do and this is what i came up with.  so when i saw the attending come to the floor, i excused myself from my patient's room and went to see what was up.

"WHERE IS ROOM 28!?!?"

 i haven't really seen this attending raise his voice before, and i am about to pee my pants in the nurses station because i'm the one who did this.

new nurse (bless her) stood her ground and replied simply "L&D bed 12".

"WHY IS HE THERE?!?!"

i couldn't take it anymore "this whole thing is my fault..." and i explained that i had done this before with another patient several years ago.  that the patient can come back to the floor for assessments and whenever he's needed by the doctors.  that the L&D nurses are not responsible for him and that we need to provide all his meds and cares.

the attending relaxed.  "oh, that's reasonable.  we had been told that he had a bed on L&D".

they seriously thought that we transferred the patient to L&D.  

after we all finished laughing hysterically, i was a little offended.

so the nurse went over to L&D to give the patient his night meds, and who was there but the attending. telling the patient that he should come back to the floor.

I.  GIVE.  UP.

you ask those people things, and they act like you're the biggest inconvenience in the world.  you try to be autonomous and make reasonable decisions for yourself and this is what comes of it.  NOW they care, when every other thing that you bring up gets you an eye roll.  NOW they want to be involved, when they were previously very busy in the ED and not to be disturbed.  NOTHING that we do is right, EVER, and i'm over it.

i tried to help a couple have a decent birth experience, and all that i got out of it was a headache and the knowledge that the trauma team thinks that its nurses are stupid enough to transfer one of their patients to L&D.

so it's true.  no good deed goes unpunished.

year five.

five years.  five years.  five years.

what have i done with the past five years?

what have i done with the past one year?

i guess that's a little easier.  2012 was a blur of worry and stress, so for the last 6 months of it, i did exactly nothing.  and i needed that.  the beginning of this year started out pretty rocky.  i finally cracked under the pressure of trying to do too much, and i took a step back from all of the 'extras'.  i've been trying to get ahold of my emotions and facing the fact that i'm old enough to have to act professionally, whether i like it or not.  thus i've been trying to express my feelings and my job concerns constructively, through carefully written emails and well placed, fully thought out comments.  as someone who enjoys saying outloud the first inappropriately direct thing that comes to her head, this has been difficult.  but when you start to wonder if you are becoming enough of a troublemaker to be fired, it's time to shut your mouth.

the phrase "it is what it is" is an unofficial floor motto, and i kind of hate that.  but for the first time, i actually understand why people feel that way.  there are things that i would have dug my heels in and fought over three years ago that i've just given up on these days.  i just don't have enough energy to get worked up over every injustice like i used to.  does that make me bitter and washed up?  i hope not.  i can still work up some passion over the big stuff.  i guess i'm just trying to let the smaller things roll off my back...finally learning to accept that there are a whole lot of things with management and new policies that i'll just have to deal with.

i don't think that i'll be on the floor too much longer, to be honest.  i'm tired of being constantly running and feeling like none of my patients are getting as much care as they deserve.  i think that my personality is better suited to someplace like the ICU, where i could focus my energy on taking really good care of a few people.  i'm ready for new challenges.  i'm ready to do crazy things.  i'm ready to save lives, and not just heat up people's dinners and bring their family members extra blankets.

five years on the floor has taught me A LOT.  but five years on the floor might be enough for me.

whatever happens, i'm not who i was five years ago.  i always joke and say that i used to be a nice person before i became a trauma nurse, that the floor ruined me.  sometimes i worry that it's true.  but overall i think that i've changed for the better.  i might not be as nice, but i'm not a pushover.  i might feel like the weight of the floor falls on my shoulders a lot of the time, but i actually know what i'm doing.  i might have people who are sick, but i'm confident in my ability to get them what they need.

i started out five years ago, straight out of school and terrified.  i didn't know how i was going to make it from week to week in the beginning, and i'm sure that people thought that a basket case like me wasn't going to make it very long on the floor.  and here we are.  five years later.

the job probably didn't get any easier, i just got better.

i've officially survived five years as a nurse.

thank god. 

it's always the good ones...

there is some sort of murphy's law/perfect storm/cruel fate phenomenon that makes the really bad things only happen to wonderful people.  

as a rule, i would say that i like most of my patients.  but lately i have been REALLY liking them, and have had this groove going the past couple of weeks.  they keep giving me wine and candles and raining complements on me, and it is both creepy that things are going so well and also amazing.  

but the more you care about people, the worse you feel when things go wrong.

i had this lady last week.  young, pretty, with an awesome family and little kids.  so of course she has some rare genetic disorder, and of course this means that she has perfs her bowel and requires a permanent ostomy.  and she's sad, and she's anxious about it, but she still is doing everything that she needs to be doing and trying to have a good attitude and being all around gracious and inspiring.  

so i was surprised, but also not surprised, when i came into work yesterday to discover that she eviscerated bowel through her suture line and needed to go back to the OR.  she did great, but ended up in the ICU postop.  

i kept running into her dad in the hallway during her surgery, and i just felt so awful for them.  and then her sister came down after surgery and cried on my shoulder, just so incredibly frustrated and worried and sad.  it made me feel so helpless, like i should have done something more.  like i should have been able to prevent it.

so i went up to the ICU last night after my shift to see her.  and she looked good, but also exhausted and broken.  being that she's such a good person, all she kept saying was what a good nurse i was and how i have a gift.  

just not the gift of being able to prevent this, i guess.  

sometimes this job just wears on you.  it's exhausting watching bad things happen to nice normal people and not being able to do anything about it.  and while it's flattering when they think i'm amazing and feel well cared for, the truth of the matter is that i can do very little for them in the grand scheme of things.  i can make it feel better, but i can't MAKE it better.  

and while that's definitely something, sometimes it just doesn't feel like enough.

 

omens

so i was fired from a patient within an hour of being at work on a monday.  

she was completely insane.  my offenses?  well first i asked her to put her gown down because she was flashing the hallway.  then i had the audacity to ask her to use the call light before she got up out of bed and set off the bed alarm.  and the final blow was when i tried to assist her into the chair and reminded her not to use her nonweightbearing foot.  

what commenced was a screaming/swearing fit so loud that it sent the doctors running out of the back room and to my rescue.

apparently i'm a "bitch with an attitude".  well if the shoe fits, i suppose...  

i kindly removed myself per my patient's request, and then thanked jesus for sparing me from hours of torment with this psychotic woman.

this may not bode well for the rest of the week...

AMA: you're doing it right.

this one comes courtesy of cardiac nurse bff.

so they got this patient on the floor who was regular.  this guy is a classic manipulative patient in a 'sickle cell pain crisis' who required a PCA, yet spent the majority of his time off the floor out smoking or trying to scam people.  he apparently would get a few hits of dilaudid then disconnect himself from his pump and disappear for an hour, only to return to get some narcs and disappear again.  everyone was fed up with him and his alleged "pain crisis" and the doctors finally gave him an ultimatum.  if he took himself off of his PCA and left the floor one more time, it was going to be considered leaving AMA and he wouldn't get his prescriptions for all of his pain meds upon discharge.  they patient apparently agreed to this, and then went MIA from the floor again.

when he finally got back, the intern went to go talk to him and, wouldn't you know, the patient refused to go AMA.  after much bargaining, threatening, and the like, the intern finally caved and told the patient that he would write him a prescription, but he was still considered AMA as per the original agreement.

so at this point in the story, i'm pretty much livid.  THIS IS WHAT IS WRONG WITH THE WORLD.  entitled people making your life a living hell to the point that you just give them what they want so they will finally go away.  but still, not ok.  shame on that doctor for giving in, i thought.

so the patient signed the AMA papers and the intern handed over his prescription.

it was for tylenol.

and the intern for the win!!  it's about time that someone took it upon themselves to not give in to manipulative, drug seeking bs.

and THAT is how you do AMA.

youtube and a nurses week shout out

first of all, a very happy nurses week shout out to all my people.  go enjoy your dry cake and keychain, or whatever it is that your hospital graces you with.  secondly, i saw this ecard today and almost peed myself, as we got a 'youtube gone wrong' admit a few weeks ago.

the kid was young, like maybe 18, and had decided to jump out of a moving car and try to do some sort of tuck and roll so he and his homeboys could get rich off of being an internet sensation.

...turns out no one really wants to see you give yourself a grade IV spleen lac.  well fancy that.  

HAPPY NURSES WEEK to all...remember that we are fabulous even if no one else appreciates it.  

derp derp derp

do you ever have one of those days where you feel stupid all the time?  i just did.  i deserve it, probably, for thinking that for once in my career i finally kind of have it together.

lies.

so i had this sweet, innocent, kind GSW (no sarcasm intended) who started out the week with me with bile coming out of his chest tube.  oops.  a diaphragm repair and a few days later, he got his chest tube pulled and was going to go home.  except for the fact that he had whooshing sounds coming from under his chest dressing.  we did a stat chest xray, and it was so bad that i could even see the pneumo...because it was like half the lung.  not.  good.  the doctor called me to say that i needed to bring the patient up to the ICU for a new chest tube, so i went to let the patient know.  except for the fact that he wasn't in his bed.

...or in the patient lounge....

....or in the front lobby...

ok.  so my guy with the collapsed lung is nowhere to be found, and now i look like a total tool trying to explain to the ICU nurse that it's going to be a minute until we come up because i can't find my patient.

fortunately, he WAS in the cafeteria.

after an extremely awkward conversation in the checkout line where i tried to explain the situation without compromising patient privacy to the other half dozen people in line, the patient came back to the floor and i delivered him to the ICU.  at this point i'm sweating from running all over the hospital, but felt pretty ok...

...until i realize like 15 minutes later that i pulled out the patient's IV two days before because he hadn't needed it and then i just delivered him to the ICU with an urgent situation and no access.

derp derp derp.

so this nurse already thinks i'm an idiot, because first my patient was lost and now i'm the stupid floor nurse who doesn't have a line in my patient and didn't even notice.

well.  there's that.

so that situation was a loss, but i still was doing ok overall.  and i still had my guy down the hall who totally had an ileus that the doctors were ignoring.  we had FINALLY gotten them to turn the IV fluids back on for this man who had a belly like he was 10 months pregnant, and that was a victory.

so i wasn't a total failure.  until i went into the patient's room and realized that he had gotten a meal tray.

technically his diet was still general, but i had been advancing him slow because of his bowel function. the patient was developmentally delayed, so i didn't think that he'd be able to order dinner without me helping him.  except for the fact that i forgot when people miss two meals, the cafeteria calls them to ask them if they would like to order.

apparently what my developmentally delayed, 3 days post-op with an ostomy reversal, not fully returned to good bowel function patient would like to order was a personal pizza, a plate of french fries, and a brownie.

he ate the whole thing.

derp derp derp again.

and i quote the resident "have fun sinking an NG and sucking out pizza.  i'm going home."

some days you just have to chalk up as a loss.

exorcism, stat.

i just experienced a level of crazy that i was shocked existed.  i present the following:

a man and a woman are in bed.  she's 400 pounds with 12 kids.  he decides that she needs to be "cleansed", so he pours holy water all over her and her brand new mattress, then proceeds to eat unleavened bread in the bed.  she gets mad because he's wrecking the mattress, and they start to fight.  he starts choking her, and she calls out for her kids to help her.  the kids come running and the man starts threatening them, saying he's going to rape the 17 year old daughter and her 3 year old child.  the man starts chasing the girls around so the other kids go into the kitchen, get some knives, and start stabbing him.  by the time the police get there, there's water, blood, and broken glass all over the entire house and the man has almost a dozen stab wounds.  

...you know where this is going.  right to my door.  

the man comes in wearing a spit mask because he's out of control.  we get in report that he's some child rapist, so everyone is shocked when at 5 am the police guard at his bedside takes off the handcuffs and leaves.  after many calls to the police, they tell us that their investigation showed that he was the victim, so he's not in custody.  

no surprise here, but the man continues to act erratically.  he was restrained in soft points after he was found naked in the hallway, soaking wet and wrapped in a bed sheet.  he then got out of his restraints and was discovered drinking his urine, yelling "it is the blood of christ!!  i am jesus!!".  at this point he's completely out of control, threatening staff and staring at everyone with creepy dead eyes, so he's put in 4 point locked restraints.  

it's obvious that this man is extremely mentally ill (duh).  i came on shift and called the sheriff to make the patient a mental health hold.  the sheriff arrives to the bedside just as security comes to help me unlock the restraints so i can change the patient's sheets.  at this point he's peeing himself and screaming "change my sheets, bitch" at me.  his brother arrived to bedside just as the patient arched his back up off the bed and starting screaming and shaking and speaking in tongues.  i am wedged in the corner of the room, biting my lip as hard as i can so i don't laugh or cry, because this man is absolutely, terrifyingly insane and also appears to be possessed by some sort of demon.  the brother starts screaming and swearing at the patient to stop it, and when that doesn't work he hauls off and slaps him hard across the face.  

if that were my brother i would have done the same.  he was then escorted out by the sheriff, and we went about our day.  

it was one of the worst shifts that i've ever worked.  

the patient was dead.  he was jesus.  we were persecuting him.  the patient across the hall was satan and he and my patient we locked in "the ultimate battle".  my patient foretold of this 77 billion years ago that he would come to earth and die.  he was the king, and food will be brought to his mouth by beautiful women like milk to a baby.  there was sexual innuendo and inappropriate suckling whenever i offered him his glass of water.  there were erections when we put him on and off the urinal.  he would take ice chips into his mouth and then spit them out all over the floor because "i am god".  he had animate conversations with angels and every once in awhile would just open his mouth and scream at the top of his lungs.  he called me a liar and every other name under the sun and then talked about how this was heaven and we were "appreciating each others beauty".

it didn't help that the patient across the hall from him was also a mental health hold, and the screaming spun him up to the point that he tried to elope, and "ran" off the unit with his quad cane and his 1:1 sitter holding on to his gait belt for dear life.  

it also didn't help that my other patient is a fresh brain injury who's not oriented at all, combative, and climbs out of bed every time he has to pee and it takes 4 of us to hold him up because he's so unsteady.  

security was on the floor 3 times in 3 hours for 3 different patients.  

the moon is not even full.  this doesn't bode well for summer.  and i'm going to have nightmares about the burning flames of hell.  

you think you're cooler than me

every once in awhile we'll get a chief resident "on loan" from another hospital.  they rotate to us for a few months and then disappear, never to be seen or heard from again.  they're supposed to be coming to us for some great learning opportunity, but more often than not they just try to show us how superior they are to us.  this month's chief is no exception.

he's an jerk, plain and simple.

he'll walk away from you when you're asking him something.
he's rude to all of the nurses.
he's cold towards the patients and has a horrible bedside manner.
he's condescending and writes orders like "bathe patient".  bitch please, i KNOW YOU DID NOT just try to tell me i don't bathe my patients, mmmkay?

the other day one of my patients looked sick.  tachypnic, tachycardic to the 140s and had a temp of 102.  i followed him in the room and watched his two second "assessment" in which he didn't bother to introduce himself, stuck his stethoscope on the sore part of my patient's chest, and then ignored the patient when he said that it hurt.  he didn't acknowledge my presence at all, and on his way out of the room he tossed me a dismissive "he's fine" and turned off all of the lights to the room leaving me in the pitch dark wedged between the bed and the recliner.

the phrase 'nobody puts baby in the corner' comes to mind.

seriously.  rude.

he can take his attitude back to wherever he came from, and my condolences to the poor nurses who end up with him forever.

H&P gems

there's nothing that brightens my days quite like a good giggle while reading a patient's chart.  i have recently enjoyed the following:

• "patient states he 'put the pedal to the metal' and hit a wall going 100 mph.  denies meth x1 week". (oh good, way to cut back)

• "patient currently resides at big mama love's carehouse " (homeless shelter vs. brothel...hard to say...)

• "patient agitated, stating 'you sons of bitches aren't going to keep me from seeing my cats!!' " (delirious patient on why she needed to DC to her house and not to a nursing home)

• "patient states reason for admission is 'i use the bathroom too much' " (actual reason for admission: rib fractures x4 with hemo/pneumo that needed a chest tube)

good stuff, all around.

until staying is worse than leaving

i'm at a crossroads here in my little career.  i've been unhappy at work before, and i've considered leaving before.  but then i still had some hope that things could change, that they could get better.  i don't believe that anymore.  things aren't better, and i've reached my limits.  it's ridiculously frustrating to care so much about a place and to still be treated by management as if i'm nothing but trouble.  my opinions?  they don't want to hear them.  they want me to shut up and do what they say like a good little nurse soldier and i'm over it.  i've been involved in committees and i've gone above and beyond to be in a position to change things for the better.  i've dedicated way more of my time and my energy than i've had to, and the fact that there is no appreciation for that burns me.  i want to leave, and i want to do it out of spite and i want them to know it is their fault and to feel my wrath.  and i know i'm only one person, but i'm one loyal person who has worked 5 years on a floor with insane turnover rates and i would like to believe that the fact that not even i can take this BS would mean something.

but i'm so torn.  like always.  despite management's beliefs to the contrary, i really HAVE tried to look on the bright side.  i've tried to learn to love the skies i'm under.  i've TRIED.  but nothing ever changes, and no one ever has a good thing to say about you and i'm tired of going home every night feeling like a total failure.

my coworkers are leaving.  my work bff who i started with and who has been by my side for the past 5 years is changing shifts.  even the steady day shift crowd is looking elsewhere.  the floor is a sinking ship, and everyone is jumping off.  i don't blame them.  and it makes me sad, because i know what the floor could be, i know what we've been before.  but then i saw this:

"how do you know when it's over?  maybe when you feel more in love with your memories than with the person standing in front of you."

i'm already there.  and i can't help but thinking how nice it would be to be anonymous again.  to be a new person with no responsibility, a person who no one expects anything of.  to be in the ranks of experienced nurses who are vocal about their opinions because they have been nursing since god was a child and they won't take crap.

so i went on the website and saw a job in the surgical ICU and i clicked on the apply button before i could think about it too hard and now here i am.

there are a few key people that i work with who i can't stand the thought of leaving.  they make me almost wish that nothing will come of this.  but next time i feel smothered by the job, or next time management tries to make me feel like i'm not enough, or next time we get forced to do something that none of us cares about and wasn't our idea, or next time we get short staffed for the sake of the budget, at least i will have this.  i will have this moment of action where i wasn't afraid to take the first steps towards change, and maybe i can feel a little better.

because right now staying IS worse than leaving.  and until that changes, i've got one foot out the door.

negligence

now i'm sure we all know by now that i have a lot of emotions.  but i think that this patient situation made me the maddest that i have ever been about something at work.

so we get this admit called up...85 year old with diagnosis of kidney stone.  "stable" they say in report.  the admit went to my work bff and i went about my business.

that is, until, i see an elderly man being rolled down the hall with a nonrebreather bobbing above his face.  i can see from half way down the hall that his eyes are rolled back in his head, and by the time i got within a few yards of him i could hear him gasping for air.

"how long has he been like this?!?!", i asked transport.  he looked at me like i was crazy.  "he's like this since ED".

this particular transporter has a bit of a language barrier issue, and clearly all he was concerned about was trying to get the patient into a bed.  i'm frantically calling for work bff, and the code cart, and the stat team, and our friendly transporter is putting down the side rail to slide the patient across.

"YOU DO NOT PUT HIM IN THAT BED."

i was absolutely livid.  LIVID.  how DARE the ED nurse send up this patient?  how DARE she not tell us how sick he is in report?  and how DARE she let a transporter who has no clue what's going on take this man halfway across the hospital on 15 liters on a nonrebreather with agonal resps?

so we stat-teamed him right there on the cart.  of course we had no admission orders, so no one could determine what team was taking care of the patient (this was before we had computer charting).  the nurse had gotten verbally that the patient was a DNR, but we had no orders to that effect and no signed paperwork.  we put a nasal trumpet in, and after that didn't work, started bagging him.  we drew ABGs.

his pH was 7.19.  he was pretty close to being dead.

it turned out that the "stable" patient with a kidney stone was actually wildly septic and had been completely unresponsive since he got to the hospital 4 hours earlier.  he had required a nasal trumpet airway in the ED, but his nurse in the ED apparently took it out, put him on max O2 via a nonrebreather, and sent him on his way without a word of warning to the floor nurse.

he arrived to the floor at 2140.  he was transferred to the medical ICU at 2205.  

the ED nurse sent the patient to us to die.

hey, i get it.  he was really old and a DNR and beyond fluids and antibiotics (which they gave him) there wasn't much else to do.  the ED is no place for palliative care.  the trauma unit is also no place for palliative care, but i can work with you if you let me know what's going on.  the patient is 85, has dementia at baseline, is wheelchair bound, and lives in a nursing home.  if he's a DNR and these are his wishes, there are worse ways to go than fast from urosepsis.

however, i think that a warning would have been more than appropriate.  a clarification of his code status and documentation of it also would have been nice.

upon arrival to the MICU, he was immediately intubated and his family revoked his DNR status.  he was in the ICU for several days before he coded and died.

this happened three and a half years ago.  i was cleaning out my work binder today and dug up my notes on the patient.  at the time, i think i printed out some information and gave it to my manager to look into.  as far as i know, nothing ever came of it.

now i might sit down in front of my computer and night and rip into people on the blog to vent, but i am pretty forgiving at work.  i have never written up another nurse, and i don't think that people should get in trouble for innocent mistakes.  i'm a big believer in "well, you'll never do that again".  learn and move on.

but this was no innocent mistake.  you don't put 15 liters of oxygen on someone who you think is stable.  if you think your patient is unstable, you don't send him to the floor alone.  if you know the patient is sick, tell me.  if you don't know that your patient is sick and they are completely obtunded and unresponsive with agonal breathing, YOU SHOULD.

there is NO excuse for this.  that ED nurse, whoever she was, was negligent in her care of this patient.  plain and simple.  i've never seen anything so blatantly incompetent before, and i haven't seen it since.

i hope she knows what she did was wrong, and i hope that she learned from it.  i hope she hasn't forgotten this patient.  i know that i won't.






***disclaimer:  this is an incident involving one nurse from my hospital's ED.  it does not mean that i think that all ED nurses are this way (because i don't).  while i've had some negative experiences with our ED nurses that i've blogged about,  these experiences are the exception and not the rule.***

   

  

clean underwear

so we have this guy with a laryngectomy.  big fan of creeping around the unit gesturing wildly at anyone who looks his direction and making them read long winded notes off of his note pads.  he's a well-meaning gentleman, just entirely and completely stubborn.  left AMA from the last floor is was on, went home and ripped out his neck JP, that kind of thing.

he gets assigned to our float pool nurse who used to work nights on the unit, who is ridiculously hilarious.  she goes to his room to assess him, and he's not there.  this is not that weird, and figuring that he's probably walking around the hospital, she thinks nothing of it.  until his brother calls.

all we can hear is the RN side of the conversation, which goes something like this:

"wait, where did he say he is....hmmm...ok....ok....well can you call him and tell him to come back?  ok.  ok.  well cocaine shouldn't interfere too much with his surgery, and we can check.  mmhmm.  mmmhmm. can i have his number?  ok, thanks".

cocaine?  ok, now we're all curious.  apparently the brother had gotten a text from the patient saying that he was at some apartments like 20 blocks away from the hospital.  keep in mind that he has no car and he's still an inpatient.  the brother was concerned that the patient was off doing drugs, and was going to miss his G tube placement, which was the whole reason he was admitted in the first place.

so the RN calls up the patient.  and we hear the following:

"hi, i'm ____ from ____ hospital and i'm your nurse today.  i'm going to have to ask you to come back to the hospital.  (long pause).  well....i know that you can't talk to me, but if you could make your way back this way that would be great.  one beep?  is that yes?  two beeps....is that no?  yes?  no?  ok.  ummm...well i'll see you when you come back."

there are literally laughing until we cry tears in the nurses station right now.  communicating via cell phones with beeping codes is a new one, and there aren't too many of those left these days.

guess who came back?  that's right.  and apparently he wasn't doing drugs, because all he came back with was a bag.  from the store.  of what?

clean underwear.

he left the hospital for hours and walked to god knows where (there are no stores around us) to get some clean underwear.

you can't make this stuff up.

it's so hard when it doesn't come easy

'burnt out' came and went a long time ago.

and i could write for days about how all of my autonomy in my job is gone, and about how new "more efficient" ways of doing things are being forced upon me against my will, and how management has bled me dry over the past five years, but i'm not going to.

it doesn't matter.

i've tried fighting it, and it doesn't work.  speaking up, standing up for myself and my coworkers and trying to make my opinions heard has just made me frustrated and angry, and it has put a target on my back.  i've wasted too many emotions on this job, and i've cried all the way home too many nights.  i've sat in the manager's office twice in the past two weeks, and still can't seem to get my point across.

the unit is broken.  the nurses are on the edge of sanity.  morale is at an all-time low, and management is going to have to do better than emails scolding us like naughty children and admonishments to "see the glass as half full".

so what is the answer?

i think it's time to move on.  either somewhere that will appreciate me or somewhere that the staff stands up to idiocy.  seeing as how the list of other units that i think i could tolerate working on is verrrrrry short, that might not be a quick fix.

so until then, i'm getting back to basics.  i'm not doing charge.  i'm quitting my committee.  i won't be precepting after this semester.  i'm not doing any extra education unless i feel like it or it benefits me. and for once, i'm gonna do me.

that's right.

i'm going to be a normal floor nurse who busts her butt for her patients and then goes home and tries not to think about work.  i'm not going to sit here and make workflow powerpoints in my free time, or come to work early to put up bulletin boards, or make glittery posters as per management's request.  and i hope that they notice the difference, and i hope they feel the loss and i hope that it burns real bad and they see the error of their unappreciative ways.

and when they don't, i hope that the fact that i know the truth is enough, that doing MY REAL JOB is enough.

because, right now, doing anything besides that is just too much.

overheard in report

"...so he found out he has a baby momma that he didn't know about, and went out and did some cocaine.  and some pot.  and some booze..."

sounds about right.  

haters.

people are such evil little witch-hunters.  what is it about the public at large trying to find new and engaging ways to hate healthcare?  i feel like i'm screwed before i even walk in a patient's room because now everyone is "educated" and thinks that they know more about my job than i do.

i got talked to by management yesterday because a patient's granddaughter complained that i didn't wear gloves when i touched him.  i'm sorry, i missed the memo that i was no longer able to touch another human being without a protective layer.  apparently granddaughter missed the issue of Reader's Digest that explains that gloves protect ME from YOU and not the other way around.  so if i want to use my bare hands to check radial pulses STEP OFF ME.  you just watched me wash my hands like a good little solider, what else do you want from me?

and then i came home and read this, which pissed me off even more.  you, ryan from buzzfeed, are a hater, and from the tone of your article you would think that this doctor took pictures of dead babies and put them on her newsfeed.  it's obvious to me that this doctor is frustrated taking care of people that are rude and entitled and is only putting up with this patient so her next baby doesn't die.

and was it the smartest thing to go there on facebook?  no, probably not.  but that doesn't mean that she should get fired and stripped of her license and burned at the stake like all the internet crazies are demanding.

not to mention the fact that these weirdos who are so worked up about "HIPAA violations!!" and "breach of patient privacy!!" have taken a story that would have stayed local and plastered it up all over the internet, greatly increasing the number of people who know all about this woman.  except, of course, for the fact that ALL WE KNOW ABOUT THIS WOMAN IS THAT SHE HAD A STILLBIRTH AND IS CHRONICALLY LATE.

but maybe i'm a little sensitive on the subject.  because i've been there.  a few years ago one of my coworkers posted a quote from a patient when we had a bunch of prisoner patients on the floor.  the little old man kept seeing officers walk by his room, and asked the nurse "is this a hospital or a jail?".  i commented back saying something about how half of our patients come from jail, and several days later ended up getting hauled into HR and read the riot act.

keep in mind that i do not have any affiliation with my employer on facebook, and that i did not say anything about a specific patient, and that this was not even on my profile.

yet this cost me 6 months "in discipline" and will sit forever in my file.  because my comments were "unprofessional and people reading them could think that you would give this patient population poor care".

three years later, and i am still livid.  having and voicing frustrations and opinions does not make me evil, and it doesn't make Amy Dunbar evil either.  you can bet i've learned never to say a word about work on facebook again, and i think that we can all probably assume that Dr. Dunbar has learned the same.

so move along, healthcare haters.  move along.

if you love him, let him die.

when your 86 year old father/grandfather starts to say things like "i'm going up there" while staring at the ceiling and "it won't be long now", it's time.

when he has been in the hospital for almost 2 months without signs of recovery, it's time.

when nothing we do makes any difference, it's time.

when he starts to swell with edema because his protein is so low, it's time.

when the deconditioning becomes so bad that he can't bend his legs, it's time.

when he's being kept alive by TPN and antibiotics, it's time.

it's time to let go.  it's time to let him get to where he's going.

and it's hard, this i know from experience.

but the TPN and the physical therapy and the labs and the scans....you're not doing it for him.  you're doing it for YOU.  he wants to die, this i have heard from his lips more than once.

so let him.  let him go.

if you love him, let him die.

goodbye to good care

i haven't ranted about the state of the unit lately.  be prepared.

what is wrong with people!?!  seriously.  would it kill management to staff us appropriately?  it is just ridiculous.  5 of the past 8 days we have been short.  we only have 4 nurses on the schedule for PMs this week.  and those of us who are left are killing ourselves.

we all sit there charting an hour after our shift ends
patient care sucks
no one has time for anything
people are unhappy.

i have 5 patients and am precepting and am charge and am taking the admits whenever i can because i'm afraid that if i give them to these people who are so ridiculously stressed they will either start to cry or quit.

they will quit, like everyone else is quitting.  and can i really blame them?  no.  who wouldn't want to go be a nurse who lasers hair off people's legs for more money and way less stress?  is it any surprise that we've lost 2 more nurses this week alone?

no.  it's not.  do you know why?

PEOPLE CAN'T WORK LIKE THIS!!!!

it makes me feel like there is a forest creature in my chest trying to claw its way out.  CONSTANT phone calls.  ignoring my coworkers who are asking for help because i'm drowning myself.  getting 3 admits called at once and having to give them to people who are so far behind that they're already in tears.  running all day just to do the bare minimum.  always hearing that this score is low and this form is not getting done, and wondering how on earth i'm going to squeeze even one more thing into a day.  and then telling this to management, and having them just stare at me with blank looks like they can't even fathom what i'm saying.

when i punched out tonight, i left one of my nurses with all of her charting left to do.  i asked her why, and she told me that she felt so bad about the care that she gave yesterday, that she had to really focus on the patients tonight and worry about the charting later.

that is not ok.  NONE of this is ok, or safe, or the type of care that i would like to give people.

it's not ok to walk into patient's room and find them with teeth that obviously haven't been brushed for many days.  it's not ok to find undocumented, hospital-acquired pressure ulcers.  it's not ok to turn a patient and find a dressing that hasn't been changed for a week.  yet these are all things that happened yesterday alone.

and can you really blame people?  yes.  but when you only have so much to give, what matters most?  when acuity is ridiculously high and resources are low and expectations are unrealistic, what are the things that you skip?  what are the corners that you cut?

because the corners ARE being cut.

it's the only way to survive.

and that is just sad.

you will just never know why.

just when i thought i had seen it all...

so tell me, how do you keep a straight face:

...when your patient seriously wants you to ask the doctors to harvest sperm from her boyfriend who has been deceased for 2 days so she can get herself pregnant?

...and when you hear that they plan on burying said boyfriend in a flat brimmed baseball cap that says "NayNay love you boo boo"?

...or when her mother, in response to the sudden need for $600, states that they're going to get the money no matter what,  "even if we gotta go out there and sell booty"?

i.  i just.  i can't.  i just can't.  there are no words.  i can't even believe the things that i have heard out of this group's mouths this week.  i thought i had patients who were hood before.  but these folks...there is only one word, and it is ghetto.  they are just ghetto.  

they are nice people.  friendly and personable.  they aren't entitled, they aren't disruptive, they are supportive of the patient and help her with her cares.  they are respectful to me and i like them a lot.  

i was trying to settle the patient after her surgery one day and was literally tripping over babies in car seats, massive balloon bouquets, and giant stuffed teddy bears wearing baseball hats.  one of the patient's cousins looked at me, smiled, and said "you probably ain't never seen nothing like this before.  this ghetto".  i smiled back and told her that i've seen a lot of things.

and i have.    

but sperm requests, "selling booty",  and having to postpone PT because my patient is getting a full weave put in...

the cousin was right.  i AIN'T seen nothing like this before.  

projectile vomit, DRAMZ, and the like.

there are no words.  but i'm sure i'll come up with something.

Monday: five patients, all high acuity.

1. GI bleeding Jehovah's witness, so no blood.  J tube meds and tube feeds.
2. TBI, total cares
3. skeletal traction s/p MVC,  having an MI
4. 80+ with ostomy, repos, feeder, oriented to self only (more total cares)
5. GSWs x8 with BLE fasciotomies and family drama

and i'm precepting and charge and we're down a nurse.

badbadbadbadbad

Tuesday:

80+er projectile vomits like 3 feet off the bed with no warning whatsoever, taking probably about 10 years off my life.  i actually shrieked.  i never shriek.  it was emotionally scarring.

then the crazy "auntie" of my GSW proceeded to go on a rampage in the halls, yelling and screaming about how "these MFers expect me to sleep in a RECLINER CHAIR" into her cell phone because she is crazy and entitled.  come to find out that "auntie" is a. not related and b. not actually from out of town like she spent the last hour telling me.  the only reason she was so graciously provided with a room to sleep in at all was because she spun this sad story about being all the way from florida and coming to support her "niece"...well that and she threw a fit, which will pretty much get you whatever you want.  come to find out SHE IS FROM 5 MILES AWAY (yet is here with suitcase packed) and is freaking out because she invited her man friend to the hospital and they can't both sleep in the recliner chair.  the highlight of my night was watching security chase her (literally) off the floor.

i'm charge again, we're down a nurse and a tech.

Wednesday:

more drama with the GSW....horrific bedside VAC change with about 32542390 family members and friends watching....keep in mind the leg is down to muscle and they're all just staring at it while trying to tell me how i need to do my job.  we have approximately 8 kids under the age of 10 in the room, including 1 crying baby and a three year old having some sort of coughing/URI issue.  the doctor finally had to ask that someone take the kid out of the room because exposed muscle was a little "mature" for her eyes.  i also found out that the body of the patient's BF (who was killed in her shooting) will be brought to the hospital in a few days and we will be pushing her in her bed to a room so she can say goodbye.  not the first time we've done this, probably not the last.  it's good for her, she needs closure, but will also be super hard and emotionally draining for everyone involved.

still charge.  precepting again.  jesus smiled on us and we're appropriately staffed (hallelujah!!).


it's one of those weeks where i'm kind of done, but will just have to suck it up.

so on to the next, may the rest of the week be better.

the new crack

so here's a question: what happened to all the crackheads?  does no one do crack anymore?  i thought that they were the worst druggie patients ever, with all their chest pain and moaning and whining and going outside to "get air" aka smoke more crack, but i have seen the error of my ways.  the new worst druggie patients make me actually MISS the crackheads.  yeah, that's right.  do you know who the worst druggie patients ever truly are?  the HEROIN PEOPLE.

seriously.  worst ever.

pain control?  you might as well not even try.  nothing comes close, not even chewing the handful of oxy i just gave you so it looks like i at least tried.

life choices?  bad choices.  like drive your car into a cement wall and smash every bone in your face, bad.  like shoot yourself in the back because "no one cares about my chronic back pain", bad.

had you not been high on heroin, sir, you may have rethought the whole 'a GSW to the back will force them to do surgery to help my pain' thing, seeing as how your back is *still* non-op, only now you have trauma to L4, a massive muscle hematoma, and bullet fragments that snuck into your vena cava circulating through your body.

also you are currently chaptered, so threatening to leave AMA if you don't get more Dilaudid is not the bargaining chip you think it is.

side note: this patient also happened to have five cell phones.  FIVE.  in the bed with him.  so while i already knew he is a heroin addict, now i am also inclined to believe that he is also a dealer.  or he has a lot of friends....who he sells drugs to.  ok.    

STOP DOING HEROIN.  STOP STOP STOP STOP STOP.

so apparently heroin is the new crack.  and all i have to say is bring back the crackheads.  at least i could deal with that kind of crazy.