the truth about nursing.

so it's nurses week and i'm bombarded with all the flowery, happy words and sentimental thoughts about healing and it makes me want to throw up a little.  then you dig a little deeper, and you reach all the jokey ecards about sponge baths and stealing narcs.  can nobody come up with something honest?  because i can tell you exactly what nursing is, as illustrated by my night saturday:

so while everybody else in the world got to go out this weekend and wear fancy party hats and watch the kentucky derby and/or drink margaritas and celebrate cinco de mayo, i spent all of saturday getting screwed over, as usual.

we had eleven admits.  ELEVEN.

everyone was in pain.  or just dramatic.  anxious.  crying.  generally needy.

i get the morbidly obese man with the enormous leg tumor...we're talking toddler-sized here, people.  NOTHING would go right with him.  his PICC from the outside hospital wouldn't draw, and it took me 15 minutes of pulling to get a syringe of blood.  then lab called to say that everything was clotted and needed to be redrawn.  kill myself.   his large tumor smells and is leaking all over everything.  i had to roll him like 6 times to adjust his sheets and put him on the bedpan and so the doctors could see the back of his giant tumor.  and before i even had his admission done, the next one had arrived.

who was in uncontrolled pain.  who broke both arms.  who arrived to the floor 30 minutes before night shift starts and therefore i was expected to do all admission paperwork and charting and then go buy a FREAKING BOW AND PUT IT ON TOP OF HER HEAD.

and then there was my drama king patient with the rib fractures.  seriously?  i rubbed his back and listened to him discuss all his fee fees and murmured soothing words and put up with his histrionic crap all night.  pity=gone.  if you don't want to be in pain, maybe you should stop refusing everything i offer you because "that will make me throw up and i can't throw up with these riiiiiiiiibs".  sir, you do not have stomach problems, YOU HAVE MENTAL PROBLEMS.  now take your damn vicodin and leave me alone.

and while we're at it, i'm sorry that your 0.5 mg of xanax isn't as good as the 3 mg that you take at home.  i know you are anxious and angry that none of your friends came to visit you.  perhaps you should make your way down to the other end of the hall and sit with my other patient with borderline personality disorder.  he, too, would like someone to sit in his room and "just talk".  while you're at it, he would like someone to rub his back.  so get on that.

and, for the record, we got not as much as a cheap pen set/gross cake for nurses day yesterday.  as always, the appreciation from management is awe-inspiring.  but not to worry because, as always, my love of bending over backwards for people and running my butt off night after night (with little gratitude and no thanks whatsoever) keeps me warm at night.


THIS is what nursing is:

it's doing 3 things at once while knowing that you're so far behind you'll probably be sitting for an hour after your shift catching up on charting.

it's driving home at night kicking yourself because you forgot to chart that PO intake, or forget to double check your I&Os, or didn't look at the 2000 vitals.

it's simultaneously doing a huge dressing change and fielding phone calls about staffing and placing new admits.

it's your phone ringing 4 times when you're in a patient's room with people calling about beeping pumps and patients who need pain meds.

it's calling a doctor, waiting 15 minutes for them to return a page, and then having them call back the second you go to the bathroom.

it's sitting at the nurses station trying to chart and not being able to because the call light goes off every 30 seconds and family members are continuously coming up to the desk for refills on water and to get more blankets.

it's like being a mother of 4 toddlers, all who depend on your for their every need.  it is a job where people will bleed you dry then demand more.  and there is ALWAYS something more you can do: another committee to join, another responsibility to pick up on the unit.  and instead of recognizing that this is an impossible job and congratulating you on being able to do remotely what you need to, management will take all possible opportunities to tell you what you're NOT doing.

nursing is HARD, but people have no idea why.   most days, it's not that i have to do gross things.  or that my patient's stories make me really sad.  it's that the system is broken.  people take no responsibility for their own health.  patients are often rude and entitled.  and it's just so FRUSTRATING.  i have spent the better part of the last four years completely frustrated.  

so hallmark, why don't you make me a card about THAT.

in which i pretend i am an ICU nurse, AGAIN

yeah yeah yeah, my patients are sick and there are lots of them and only one of me and i get people who really should be in the ICU for closer monitoring.  i know i'm a big whiner.    

but SERIOUSLY.  where do you draw the line?

when you have 4 different oxygen delivery devices at bedside and have to keep switching back and forth 234234 times during the shift?  ok, 93% means we can go to the high flow nasal cannula, yay!  then 79% after turning...boo...back to the simple mask.  still only 85% on 10 liters?  guess it's back to the nonrebreather again.  91% on 15 liters...what a nice stable floor patient.  

i'm talking q 15 minute checks on this patient for 10 hours.

continuous pulse ox...yeah know i'm not supposed to do that but it's my "ICU" and i can do what i want to.

constant cheerleading to "take nice deep breaths" and "cough that out" and "iiiiiiiiiin through your nose".

and 3 other patients with needs.  you know, like to see my face every once in awhile.

i'll tell you right now, i love this stuff.  i like the critical thinking and the stat labs and scans and i like it when the doctors actually get concerned about something and prove that they are not indeed robots, as i sometimes believe.  

but i would like to do all that without neglecting the other 75% of my patient assignment.  and i would like the doctors to respect my opinion, like in the ICU.  and i'd take more money for my trouble.  

just saying.  

 

role reversal

so i'm going out with a friend and we call a cab (safety first, right?).  the cab pulls up, the door opens, and i am face to face with the cab driver.  a former patient.  

ack.  

this patient has some very identifying features and i am POSITIVE that it's him.

perfed appy.  needed a drain.  liked popsicles.  had an odd roommate.  all sorts of random facts about him are running through my head, including the embarrassing call that i made to our central supply requesting an awkward medical device that he needed that i will be unable to discuss further due to the fact that the memory still traumatizes me.  

he doesn't seem to recognize me, which is good, because i'm staring at the little cab screen in front of him that is telling him my full name, address, and phone number.  the thought of any of my patients having all that personal information about me makes me slightly gaggy.  but what a double standard, you say!!  i know all about him and his medical info...which is undoubtably more personal than my address.  don't care, still creeps me out.  

so we're driving along, and i'm getting more and more anxious about this encounter.  is he going to say something?  i am DYING to say something, but my friend is in the cab and i think it would be inappropriate.  so i suffer in silence for twelve dollars and seventy five cents.

that was the first time that i ever saw a patient out in the real world, and it was very strange.  

shortage

at the risk of sounding like a paranoid schizophrenic, the world is ending, people.  and this is how we're all going to go.

every day i go to work is a day that i find out that we're short another drug.  first they took our IV zofran away.  this is after most of the other anti-emetics were already in shortage (goodbye droperidol, i miss you compazine). hey, do you know who gets all barfy?  surgical patients.  trauma patients.  ALL MY PATIENTS.  but that's ok, stick this tablet under your tongue and try not to actually vomit until it dissolves.

then they took my IV metoprolol.  hello unsafe swallow dementia patient who is 81 years old and has the A-fib.  allow me to chop this pill up and swirl it in applesauce, then say a prayer to the hospital gods that you don't 1. aspirate in front of my face 2. spit it back at me or 3. refuse to swallow the yummy mixture until i have to go in after it with the yankaur.

IV benadryl?  don't need that.  when the anaphylaxis sets in and my patient is unable to swallow a pill due to her rapidly expanding tongue, i'm sure that pharmacy will be able to sent me a vial from the medicine vault before she codes.  

and who really thought that IV ativan could be adequately substituted with PO?  i would like them to come try to hold down the CIWA patient who's in full DTs while i try to shove a pill down his throat.  

but the worst of all came last week, the shortage that has truly made me think that the apocalypse is upon us.  

OUR PCA SYRINGES ARE IN SHORTAGE.  cue widespread panic and looting and pillaging and angry mob-bage.  

summer is coming, and my unit becomes land of the PCA.  so you got shot 8 times while "just sitting" in the car outside your house eating yourself some chicken?  please have a PCA!!  oh, you got stupid drunk and then hopped (helmet-less, of course) onto your motorcycle and ran yourself into a wall?  enjoy delivering your own medication, via PCA, for your comfort.  

all sarcasm aside, the shortages really are starting to scare me.  sometimes a PCA is the only way to get pain under control on the floor.  with 4-5 patients, i don't have the time to sit in one patient's room pushing small doses of narcs every 10 minutes, nor to i have the monitoring capabilities to give high-dose narcotics.  therefore, summer will go one of two ways.

1. you will get your 2-4 mg of IV morphine or 0.2-0.4 mg of IV dilaudid q 1 hour PRN and like it.  i will make you ice packs and heating pads and prop up your broken limbs and fluff pillows and emotionally support you until you are vilified.  and everyone will be pain-free and happy. (likelihood: haha, yeah right)

2. first the MDs will try to make the nurses human PCAs and write for PCA dosing to be giving IV push.  after that gets shot down, they will begin to write for larger doses of meds and i'll be back to the days of keeping an extra vial of narcan handy.  then narcan will go into shortage and the world as we know it will really be over.

makes me want to go all doomsday preppers and start hoarding dog antibiotics to prepare for end-times, i tell ya.  

ode to trauma

why, oh trauma, must you make my life so hard?
the patient comes up bleeding, big circle on the pillow
why did you not find the lac in the ED?
fix her there, and i will not have to give my firstborn for a skin stapler.
nor run to the OR myself to fetch it for you.
and why, oh trauma, do you ask me to wash her hair?
it is monday, it is the start of my shift, this is my 5th patient.
i have not seen the others, and i don't know if they are all alive.
while you're at it, trauma, please address this patient's gaping ankle wound.
you need more supplies? but of course.
i will sell my body to the OR in exchange for some 4.0 nylon and a needle driver.
and also, trauma, where have you hidden her orders?
they do not come up with the chart.
they are not at the desk.
oh!!  they are in your pocket.
"that does me no good"
that may have been hostile, but it is the truth.
lastly, dear trauma, would you please give me ointment?
this patient is covered in scratches
bacitracin? neosporin? triple antibiotic?
"whatever you want.  you decide"
now THAT is the best thing you've said all day.

DDS

we must be getting desperate for residents to fill the trauma team month after month, because it's april and we've got us a DDS.

really?  sir, you are a dentist.  what are you doing here?  i have the utmost respect for your profession, and see my dentist on the regular (shout out to dr. p!!), but why?  just why?

i assume this is because you want some oral surgery experience?  perhaps you should have been placed on the oral surgery team then, hmm?  i mean really, can i even take orders from you?  i spend many a day wondering if the residents i come in contact with did indeed graduate from medical school.  you did not even GO to medical school.

it's no wonder that you wrote that order for fluids to be D5.45 half normal saline with 60 mEq of K+.  first of all, the .45 is the half normal saline, and secondly giving 60 of K bolus is something akin to lethal injection, or at the very least a very bad idea.

i'm sure you're going to be a very nice dentist, because you have pretty eyes to look into and you're personable enough to chat with, but you have no business managing trauma patients.  i am, in fact, scared of you and your cohorts, seeing as how this month we got some of "not the brightest crayons in the box" so to speak.  between you and your pal who likes to try to kill dialysis patients, its been a long few weeks.

seriously, is it may yet?

things patients say

RN: "so, what happened to you?"

Patient who has been shot on 4 separate occasions: "guess I didn't run fast enough."

no.  no, you did not.