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.