so we saved a life before 1500

nothing good starts with the sentence "I don't like the way my mom is breathing". of course i would have to be the one to answer THAT call light...so i sent the nurse down to the room to see what was going on. she came out a few minutes later reporting that the patient was breathing at 8 a minute. not good, not good at all. she grabbed a vial of narcan to reverse the narcotics the patient had gotten earlier and i went to page the doctor. i looked everywhere for the patient's chart to find what resident was taking care of her and couldn't find it, so i just sent out a general page through the operator and went in to help. the nursing student got vitals, which showed that the patient's O2 sats were 78%. my coworker started pushing the narcan and i ran to grab a face mask and put the patient on 10 liters of oxygen. less than a minute later, the patient's sats came up to 100% and she woke up, thanks to the miracle of narcan. we titrated her O2 down to 3 liters and the nursing student stayed with her to take more vitals. it wasn't until this point than the doctor called back. apparently i paged the attending.

oops.


i could tell that things weren't going too well...the nurse was having to explain herself way too much and there appeared to be some lecturing going on. the attending told her that he didn't feel comfortable telling her that it was ok to give the narcan, and he needed to look up the policy. to which i say:

SERIOUSLY?

giving narcan is within our scope of practice. and when i see a patient who is struggling to breathe, turning white, and looking like she's headed to heaven i will give my narcan and have no remorse. feel free to look up the policy, because i'm pretty sure that it won't say that we should let little old ladies die while we wait for you to return my page.

five minutes later the attending called back. he looked it up and had decided that we were indeed allowed to give the narcan. gee thanks. oh, and YOU'RE WELCOME for helping your patient live to see another day.

well THAT'S a new one.

So my patient got hit by a car. He refused medical treatment and instead went to the bar. When he was done at the bar he realized that he couldn't walk so instead crossed the street on his butt. Then he got hit by another car.

1. stop drinking
2. don't sit in the street

Make good choices, people.

entitlement

people think that they deserve special treatment all the time, and it makes me crazy.

case in point:

we get a GSW patient from the OR...should have known it was going to be a disaster when the PACU nurse said that she had 30 family members in the waiting room. (for the record, THIS IS NOT OK!! you have no business having three dozen people in your room. this is a hospital, not a club.) so the family comes up and for awhile everything was just fine. i was running back and forth through the nurses' station when i saw one of the family members barfing into our garbage can...and by that i mean on the floor, on the secretary's desk, and on the paper shredder. i actually gave this woman the benefit of the doubt...figured maybe she had gotten all emotional and got sick. so i got towels and some bleach wipes and attempted not to gag as we tried to clean up the food chunks off the floor. (ok, so when you come to the hospital, YOU ARE NOT THE PATIENT. i do not owe you buckets to barf in. i am not getting paid to clean up your puke. and i certainly do NOT think it's ok for your to throw up on our carpet and then blame it on us because "that aide didn't bring my bucket fast enough.)

we came to a consensus: sick visitor needs to go home. so our charge nurse approached her and gently suggested that she leave. the visitor was quick to say that she wasn't sick, she was have a procedure tomorrow and was taking a bowel prep that make her throw up. (oh dear, there are so many things wrong with this....first of all, WHAT ARE YOU DOING HERE? bowel preps make you poop your brains out. go home and sit in your bathroom like a normal person. who goes to the hospital swinging their bottle of golytely around? it's just freakish.) the RN still thought that she should go home, but the visitor was not receptive to this and started yelling that we would have to throw her out. (to which i say...ok!!) the charge nurse was getting nowhere with this woman so she just walked away.

i'm going about my business doing meds in the front hall when the barfy visitor and her family posse walk by. she's talking loudly about how "that nurse think she all hard" and i knew we were going to have a problem. as the family walked by, a male visitor got right up in the charge nurse's personal space as she was talking on a hall phone. he sniffed really loud like he was going to spit at her. the woman visitor took this opportunity to throw the barf bucket at the nurse's feet and says "i don't need this anymore". (oh NO YOU DID NOT JUST. first of all, intimidation and harassment, much? and don't you dare think for one minute that i'm going to put up with that just because i'm at work. you DO NOT get to treat people that way, you WILL NOT get away with that behavior, and i WILL call security and the sheriff on you and laugh gleefully as they take you away).

well the RN handled things much as i would have and, shall we say 'deflected' the bucket back at this lady. the visitor picks up the bucket and raises it above her head to throw at the nurse...and i just snapped. i charged down the hallway waving my finger at this woman and yelling "you do NOT throw things!! put that down, this is a hospital!!". the woman and family quickly began to blame things on the nurse, calling her unprofessional and going on and on about how they were going to report us. things were escalating quickly, so i called security. the woman is standing in the middle of the hall yelling "call them, i stand right here...I'LL STAND RIGHT HERE" while throwing her purse at a family member so she can "beat your MFing asses". i'm trying to hold back the nurse who's not backing down, and stepped between the visitor and the nurse, basically just waiting for someone to start ripping hair out. by this time i'm yelling "get out. go. GO!!" at these people and now more of my coworkers are coming down and trying to get both of us to walk away. security finally came up and carted the visitor away. i then had to type up a written statement of the incident. as livid as i was, i ranted for awhile and then just finally sat in the back room and cried until i felt better.

so let me recap:

this is all the hospital's fault because we didn't get the visitor her bucket in time so she had to throw up on the floor. it's her right to be here as a visitor and demand nursing care, hospital supplies, as well and gum and mints from all of us. since she didn't want to go home she can yell and scream at people so she'll get her way. When that doesn't work, she can have her family members intimidate staff and then throw things at them. When that is not well received, she can scream in the middle of the hall and disturb sick people who are trying to rest. to get her point across she can call names and threaten staff. she's not finished until she's carried away by the sheriff and given a ticket for being "disorderly" that she will probably never pay. and as the real punishment for all of this, she isn't allowed to visit for 24 hours...but don't worry, she CAN come back!! because after all, visitor's have rights.

it's apparently just the nurse's who don't.

i'm WAY over these selfish, entitled, hateful people.



*UPDATE*
the visitor in question called to lodge a complaint against us. then we had to sit through a debriefing in which this entire situation was blamed on the nursing staff. in the future, we will be looking forward to some "de-escalation training". i have the following things to say:

1. bitch please.
2. this is a hospital, not a department store. the 'customer is always right' rule does not apply here. not to mention the fact that YOU ARE NOT MY CUSTOMER. you are my customer's rude, classless family member who's barf i just had to scrape up off the floor. you're welcome for that, by the way.
3. i'm pretty sure i'm going to start strapping a shank to my ankle. can't be too careful these days.

how rude.

being a nurse is pretty much like being a glorified punching bag. you don't like that you're in the hospital? be rude to your nurse. you're mad that you're in pain? yell at your nurse. you're upset with the doctor or the plan of care? go ahead, take it out on your nurse. after all, i am the source of your troubles, right? the reason you're in the hospital? the cause of your pain? oh wait a minute...i'm the one who cleans up your poop and brings you pain meds and smiles at you when i'd just as soon rip your face off. but go ahead, be mean. i mean it's not like i'm a real person, after all. i'm a nurse.

newsflash: I HAVE FEELINGS TOO!!

honestly, most days this stuff rolls off my back. patients are a little snippy? i can win over most fairly quickly. i'm pretty darn patient, and after almost three and a half years of being a nurse, i've gotten a pretty thick skin. but i have NEVER had a family member talk to me the way that a patient's sister did tonight.

icu transfer. altered mental status and an open abdomen. status quo. the patient was weird but otherwise fine. the patient's sister would have made the devil himself cry. i'm ashamed to say that it was a 75 year old lady with a skirt pulled up to her boobs that finally did me in. i first knew that we were going to have a problem when the sister found me at the nurses station and accused me of not giving my patient pain medications. we had a lovely conversation in which she essentially accused me of neglect and i threatened that if i gave too much narcotic the patient would stop breathing. she had the audacity to yell at me, but i managed to barely hold it together. being the professional that i am, i internally vowed to give her the silent treatment for the rest of the evening as punishment for being so evil.

i actually thought that i was home free, and that was my first mistake. we had made it to the end of the shift and i had been in the patient's room 45 minutes earlier to get her repositioned and settled for nighttime. she was comfortable. so i went to do about 234234 other things with my other patients. i was sitting down to give the night nurse report when the sister came up to the nurse's station. she was once again raising her voice with me and ridiculously rude. she dared to say that her sister was overdue for pain meds. EXCUSE ME. what part of pain medications are not scheduled do you not understand? and if you're in the room with your sister and she needs pain meds, why wouldn't you simply put on the call light and ask for them instead of coming up the the front desk to alienate your sister's nurse? have people no understanding of this simple concept? let me spell it out:

if you make me hate you, i will try to avoid you. simple as that.

so i went down to the patient's room so the sister would stop yelling at me in front of all of my coworkers. and what did i find? a very comfortable looking patient with her eyes closed. resting. and did she ask for pain meds? only after i brought the subject up. of course her sister took this opportunity to continue to berate me and accuse me of not following through. i made one last ditch effort to be civil, then decided to stop wasting my breath.

"I DON'T KNOW WHAT ELSE YOU WANT FROM ME!!"

that's right, i said it. and i'd say it again.

people have no boundaries at all. what gave her the right to yell at me for trying to help her sister the best way i know how? the patient is HALLUCINATING ELVIS. the last thing she needs is to be snowed on narcotics. i will give my patient medication to control HER pain, not to make her sister feel better/validated/like she's being a good advocate.

so at this point, i realized that i needed to remove myself from the situation and handed over care of the patient to the night nurse. apparently he wasn't quick enough for the sister, who went on a rampage. she walked into an occupied room to search for linen, then yelled and swore at one of my coworkers who tried to help her. all the while, she cursed my name and demanded to talk to a supervisor.

i don't care that she was old as god and looked like a librarian. lady needed to learn some manners. so i called security and they escorted her out.

even nurses have limits, people.

it's not a full moon. i checked.

...but you would think so from the clientele we've got this week. The highlight of tonight was the guy who insists on wearing an isolation mask and gloves and makes capes out of the bed underpads. He is frequently found in the hall attempting to make phone calls from the hospital phone. He enjoys moving the wet floor signs to the middle of the hallway and attempting to read his own chart. Other pass-times include ripping down all the papers on the inside of the chart cabinets and rifling through the phone book in an attempt to call a cab to leave. I think that he's brain injured as half of his head is shaved, but something about the way that he rants on and on about the president getting assassinated smacks of schizophrenia. Said individual went on the warpath around 9 pm and was discovered in his room throwing butter knives at his one to one sitter. As the staff felt threatened by his violent behavior, they closed the door to his room and held it shut so no one would get hurt until security arrived. This all attracted the attention of a doctor from across the hall who opened the door to the cabinet outside the room so he could talk to the patient. I unfortunately missed this entire exchange, but the thought of this particular doctor talking to this crazy patient through a secret passage makes me giggle with glee. End result? The patient was restrained until he calmed down. And I laughed until I cried.

{yawn}

NG tubes that don't work right are a special kind of hell. I just spent 10 hours watching my poor patient vomit through his wired jaw while praying that he wouldn't aspirate. He's exhausted. I'm exhausted. He has a new NG tube. I have a headache. Here's hoping for a better day for the both of us tomorrow.

in the beginning...

i recently came across this little gem from about a year after I had started nursing. it's funny to look back and see how i would handle things differently now. also how some things never seem to change. without further ado:


Why this week was the worst I have ever had, a litany:
o Milk and molasses enema…need I say more? I actually had to stir together milk and molasses, heat it up, pour it into an enema bag, and spend AN ENTIRE HOUR waiting for rock hard stools that I had to attempt to pull out of my patient. And then the next day, I got to do it AGAIN with a soapsuds enema. Fabulous.
o I have a big mouth that I can’t keep shut. I did an impression of a new resident, accent and all, that he overheard. So for the next year, I owe him, and he will probably hate me.
o Dr. {name removed to protect the guilty}. He is Irish. He is hot. But he has zero bedside manner. First he told me that I had to do an inappropriate discharge, then he alienates a family by talking down to a patient’s wife who has been a nurse practically longer than I’ve been alive. And who gets to deal with the aftermath of this? Me. Thanks.
o Above mentioned inappropriate discharge…my patient was 23. Pregnant with a perirectal abscess. Two other kids at home. No support system. Admitted for pain control. We kind of controlled her pain, then sent her home on the exact same meds she was on before that didn’t work. Had been back and forth to the ED every few days for the past two weeks. Was admitted as an Obs. patient, and had spent a day with us in which NO ONE DID ANYTHING TO HELP HER, and then she was dumped on me. She needed a social worker, she needed better meds, she needed a lot of things which I was unable to give her, and when I shared my concerns with Dr. {McMeanie}, he implied that he knew her, I did not, she is psychotic, and I should fall in line and do what he says.
o Families from hell. All week long. Demanding, rude, demeaning. Three out of four patients had medical people at bedside. I was referred to as “nurse” and ordered around by an orthopedic surgeon from {town an hour away}. He demanded I call the senior resident, because “he’s in house, and can stop banging the nurses to come talk to us”. Later, this patient’s son tells me, in a nutshell, that I don’t care about his mother and asks if I would treat my own mother this way. Leading me to-
o Yes, I cried in front of families this week. Twice. Once when Dr. {jerk jerk jerk} was rude to my patient’s wife and once when I was being chewed out for not emptying a hat in the toilet.
o ICU disaster…I transfer a patient upstairs for respiratory issues. He’s on 7 liters on a CPAP and is desating. He can maintain his sats only if his family sits at his bedside constantly and convinces him to cough and deep breathe. He doesn’t want to do this, because he just wants to die and is upset we keep “resuscitating” him. We have him up to 15 liters on the CPAP, at which point he is apparently sick enough for the unit. Of course he starts looking real good the second we start to transfer him. And by the time I get back downstairs, after working through my lunch, of course, the ICU is on the phone saying they’re going to transfer him back.
o At this point, I am done. I begin to cry, then sob, then hyperventilate. I breathe so fast that my lips turn numb, and I realize that not only am I coming off as a total crazy, but that if I don’t stop soon I will probably pass out. Such was my very first anxiety attack. And that was my week.

names have been changed to protect mahself from being sued and/or terminated. however details are in their original form, including my very embarrassing breakdown in the back room in front of a half dozen coworkers. i read this and i think:

THANK GOD the days when i would just cry cry cry all day long at work are over.

THANK GOD i've been growing a backbone to stand up to mean and arrogant doctors.

and THANK GOD i'm not a new nurse anymore.

seriously, if i would have known it would be that bad, i probably would have run screaming in the other direction. but i had no clue, and now here i am 2 years later WAY more prepared to do my job. and also more mentally stable :)

amen.