unfortunately, i've learned the hard way that people will use just about anything against you to prove a point. i've recently had some issues with social media...long story short, i may have accidentally offended some people by talking about work.
actually, that's a lie...i got caught in the crossfire of two grown women acting like teenagers and got put on probation for several very nondescript, non hipaa-violating comments that were discovered during their adolescent fighting. i never actually violated the social media policy, but was still punished for it. apparently large, powerful hospitals need scapegoats to keep all the little people in line, and i was lucky enough to get to fill that role.
for the sake of clarity, i'd like to say a few things.
to state the obvious, the views and opinions expressed here are those of my own and not of my employer (duh). i don't speak for anyone but myself, and surely we all know that i'm just a touch biased with these stories :)
for the record, i work at a very good hospital with very good people. while some of my stories may highlight my frustrations, there are plenty of other fabulous things about work that i don't blog about. overall, i think that my place of employment provides great care, otherwise i (obviously) wouldn't work there. the issues that i have with doctors, patients, and really the hospital environment in general are pretty universal. i may rant and rave like a crazy person on a regular basis, but should i ever be in need of care i wouldn't hesitate to use my employer.
so to sum things up, i am taking a risk by continuing to blog. but even though other people might think i'm crazy, to me it's worth it. there is a type of satisfaction here that i'm not ready to give up. and frankly, i think it's pretty great to look back on the situations i've been it over the past year and see how far i've come.
so i'm going to continue. because if there's one thing that being a nurse has given me, it's a backbone. i spend most of my days advocating for my patients, now it's time for me to fight for myself.
Thursday, May 26, 2011
Sunday, May 22, 2011
cause we're not having fun until somebody is bleeding out
this week on my list of mortal enemies: the ER. the ER has certain habits that drive me crazy. for example, they frequently send their patients up to the floor naked, usually bleeding, and often with empty IV bags dragging behind them. so today when i got a stab wound to the chest from the ER, i was not surprised to find him pretty much as described above. the MDs had put in a chest tube, and i was taken aback when i saw that it had already put out about half a liter of blood since it was placed. i got the patient settled with another nurse and we pulled off the dressing that was leaking blood everywhere to put a clean one on.
still bleeding.
i called the doctor and told her how much blood was in the cannister...now about 600ccs. she told me to start fluids and she'd come see him. i did his admission.
still bleeding.
850ccs. paged the doctor again. she called back. now 975ccs. she said she'd call her attending and that we'd make him nothing by mouth for possible surgery. at this point the patient began yelling at me that he wanted dinner.
still bleeding.
the blood in the chest tube was now in the second chamber, so over a liter. vitals still ok. patient still yelling "i shouldn't have even come here" because i wouldn't give him his dinner tray. and finally, the bleeding seemed to slow down. 1130ccs. i took some vitals, and he was still ok. he fell asleep, and i let him be.
20 minutes later i'm (miraculously) seeing another patient when the doctor came in. apparently they had seen the patient and taken his blood pressure. 70/42. suddenly there was a sense of urgency. we needed fluids wide open, a type and cross for 4 units of blood and to get the blood right then then give it. all while getting pressure bags for the fluids and getting the patient hooked up to the dash monitor. um, not going to happen. i basically got as far as the fluids before the doctors started to yank the cords out of the wall so we could take the patient to OR. i managed to get one final BP in before that too got disconnected: 65/40. cue panic.
every once in awhile, the hospital really is like tv. and if i've ever felt like i'm on primetime, it was tonight as i ran down the hall towards the OR with a pressure bag in one hand and the other hitting the patient to make sure he was still alive. how we made it to the OR in one piece i will never know, but there i was under the bright shiny intimidating lights. the next thing i knew everyone was gowned and gloved and i was feeling very conspicuous. someone handed me a hat and mask, at which point i made my exit. frankly the OR freaks me out...way too clean and you can't touch anything in there...so that was that.
i honestly expected the patient to come back to the floor, but he got an ICU bed. when i took his belongings up, he was intubated and looked like a hot mess. and to think, 4 hours earlier he was stable enough to come to the floor.
so do i blame the ER for this? not really. they didn't really see the patient bleed all that much. and do i blame the doctor? she was actually pretty on top of things. and do i blame myself? no way, i rocked this one :) i kind of feel like this is just one of those things that happens...hopefully the patient will return to the floor no worse for wear and grateful that we helped him.
but for the records: it wouldn't kill the ER to throw a gown on a patient every once in awhile. sheesh.
still bleeding.
i called the doctor and told her how much blood was in the cannister...now about 600ccs. she told me to start fluids and she'd come see him. i did his admission.
still bleeding.
850ccs. paged the doctor again. she called back. now 975ccs. she said she'd call her attending and that we'd make him nothing by mouth for possible surgery. at this point the patient began yelling at me that he wanted dinner.
still bleeding.
the blood in the chest tube was now in the second chamber, so over a liter. vitals still ok. patient still yelling "i shouldn't have even come here" because i wouldn't give him his dinner tray. and finally, the bleeding seemed to slow down. 1130ccs. i took some vitals, and he was still ok. he fell asleep, and i let him be.
20 minutes later i'm (miraculously) seeing another patient when the doctor came in. apparently they had seen the patient and taken his blood pressure. 70/42. suddenly there was a sense of urgency. we needed fluids wide open, a type and cross for 4 units of blood and to get the blood right then then give it. all while getting pressure bags for the fluids and getting the patient hooked up to the dash monitor. um, not going to happen. i basically got as far as the fluids before the doctors started to yank the cords out of the wall so we could take the patient to OR. i managed to get one final BP in before that too got disconnected: 65/40. cue panic.
every once in awhile, the hospital really is like tv. and if i've ever felt like i'm on primetime, it was tonight as i ran down the hall towards the OR with a pressure bag in one hand and the other hitting the patient to make sure he was still alive. how we made it to the OR in one piece i will never know, but there i was under the bright shiny intimidating lights. the next thing i knew everyone was gowned and gloved and i was feeling very conspicuous. someone handed me a hat and mask, at which point i made my exit. frankly the OR freaks me out...way too clean and you can't touch anything in there...so that was that.
i honestly expected the patient to come back to the floor, but he got an ICU bed. when i took his belongings up, he was intubated and looked like a hot mess. and to think, 4 hours earlier he was stable enough to come to the floor.
so do i blame the ER for this? not really. they didn't really see the patient bleed all that much. and do i blame the doctor? she was actually pretty on top of things. and do i blame myself? no way, i rocked this one :) i kind of feel like this is just one of those things that happens...hopefully the patient will return to the floor no worse for wear and grateful that we helped him.
but for the records: it wouldn't kill the ER to throw a gown on a patient every once in awhile. sheesh.
Saturday, April 9, 2011
patients: hazardous materials? i think yes.
let me begin by saying that i should be making some sort of hazard pay. as a trauma nurse, patients try to beat me to a pulp on a regular basis. I've been scratched across the chest, pinched, had patients try to bite me, been kicked at, had people try to punch me in the face, been screamed at, sworn at, and called every name you can think of and some things you can't including an "f-ing bed whore"...seriously, what does that even mean? tonight was no exception.
it all started when i answered the call light...come to think of it i really should stop doing that. the woman on the other end was frantic. her son was having a seizure. so i gathered the other people in the nurse's station and we ran down to the room to find the patient seizing. we all did what you're supposed to do in a seizure, which is basically nothing. we watched the patient so we'd know what happened during the episode and kept him safe. for this particular patient, that meant putting his helmet on. he had recently had brain surgery and they'd taken out a piece of his skull. this means that he has his brain, then some skin, then the outside world. so on went the helmet, he stopped seizing after a minute or two, and we all thought we were in the clear.
haha.
of course after this seizure, he was confused. he kept grabbing at his oxygen and trying to rip the helmet off his head. his O2 sats weren't great, so i held his hands down so he couldn't get at the tubing. and needless to say, we didn't need the man with the exposed brain to start thrashing around. we kept him calm for a little while, but then he started to fight us. the more we tried to hold him, the harder he pulled away.
so i called for reinforcements.
then there were seven or eight of us trying to hold him down, and it still wasn't working. now he's screaming and thrashing at us. i unfortunately didn't have gloves on and couldn't let go to put on a pair, so he was trying to scratch me. when he still couldn't get free, he started kicking and biting. at this point we're yelling for restraints and i'm frantically calling for more help. we called a rapid response, then security to the floor. it seemed like FOREVER until the oldest security guard we have who must be at least 75 showed up. by this time we had respiratory therapists in the mix and the patient was almost totally restrained, but still clawing at people. it's kind of fuzzy to me when I finally gave up trying to hold him down, but i think it was around the time that i realized i was bleeding.
great. just what i need in my life, another incident report with my name on it.
the casualties included 4 people with claw wounds and 1 very unfortunate nurse with a bitten thumb. we all declined the trip to the ED, but there was free antibiotic ointment for all for our efforts. the patient eventually calmed down, after 4 mg of ativan and all of his extremities tied down.
i would like to take this opportunity to mention that NEVER ONCE IN NURSING SCHOOL DID ANYONE MENTION THAT I WOULD BE ASSAULTED ON A ROUTINE BASIS.
please excuse me while I go put in my transfer to the OB floor.
it all started when i answered the call light...come to think of it i really should stop doing that. the woman on the other end was frantic. her son was having a seizure. so i gathered the other people in the nurse's station and we ran down to the room to find the patient seizing. we all did what you're supposed to do in a seizure, which is basically nothing. we watched the patient so we'd know what happened during the episode and kept him safe. for this particular patient, that meant putting his helmet on. he had recently had brain surgery and they'd taken out a piece of his skull. this means that he has his brain, then some skin, then the outside world. so on went the helmet, he stopped seizing after a minute or two, and we all thought we were in the clear.
haha.
of course after this seizure, he was confused. he kept grabbing at his oxygen and trying to rip the helmet off his head. his O2 sats weren't great, so i held his hands down so he couldn't get at the tubing. and needless to say, we didn't need the man with the exposed brain to start thrashing around. we kept him calm for a little while, but then he started to fight us. the more we tried to hold him, the harder he pulled away.
so i called for reinforcements.
then there were seven or eight of us trying to hold him down, and it still wasn't working. now he's screaming and thrashing at us. i unfortunately didn't have gloves on and couldn't let go to put on a pair, so he was trying to scratch me. when he still couldn't get free, he started kicking and biting. at this point we're yelling for restraints and i'm frantically calling for more help. we called a rapid response, then security to the floor. it seemed like FOREVER until the oldest security guard we have who must be at least 75 showed up. by this time we had respiratory therapists in the mix and the patient was almost totally restrained, but still clawing at people. it's kind of fuzzy to me when I finally gave up trying to hold him down, but i think it was around the time that i realized i was bleeding.
great. just what i need in my life, another incident report with my name on it.
the casualties included 4 people with claw wounds and 1 very unfortunate nurse with a bitten thumb. we all declined the trip to the ED, but there was free antibiotic ointment for all for our efforts. the patient eventually calmed down, after 4 mg of ativan and all of his extremities tied down.
i would like to take this opportunity to mention that NEVER ONCE IN NURSING SCHOOL DID ANYONE MENTION THAT I WOULD BE ASSAULTED ON A ROUTINE BASIS.
please excuse me while I go put in my transfer to the OB floor.
Friday, March 25, 2011
be forewarned: this is a rant.
"those who can, do. those who can't...apparently run this place"
i have a love hate relationship with our trauma team. mostly hate. as a whole, the team is made up of underachievers. the residents are less concerned about quality patient care and interventions that make sense, and more concerned about guessing which orders their seniors would like them to write. they don't order tests, because they don't want to know what's going on. they hate labs, because then they will be obligated to come up with interventions. they loathe medicine doctors above all else, and frown on nurses who call on them for help in emergencies. i have decided this is because they feel threatened by these doctors because they know about medicine. they have taken nearly everything that i learned in nursing school and thrown it out the window. there are many days that i feel personally victimized by our trauma team, one of those being today.
i have a patient that i'm watching like a hawk. he's here because he stabbed himself. when i got him out of surgery, his heart rate was in the 140s-150s. not ok. the team ran a few tests, and determined that he wasn't having a cardiac issue and that his blood counts were decent. apparently this was good enough for them, so we let the patient sit at this heart rate for 24 hours.
the next day, he became short of breath. they sent him for a chest CT and found out that he had a pulmonary embolism. NOT OK. i have watched people die horrible deaths of PEs in front of my face, and as a result i live in fear of them. it's the kind of condition where a person is talking to you one minute and the next they aren't breathing...completely terrifying and emotionally scarring. so one can imaging how i felt when i found out that the patient had not one but two PEs in the left lung...kind of like i had just been handed a ticking time bomb. i started the patient on a heparin drip to thin his blood, and we kept a close eye on his vital signs.
so imagine my surprise when i come to work today and my patient is off his heparin drip. when i asked the day nurse why, she quoted the trauma team. "his PEs are little...he probably had them before he came in. and he doesn't have insurance". allow me to break down the things that are wrong with this into an itemized list.
1. the PEs are little. ok, so certain types of PEs aren't as serious. but personally, even the thought of little ones make me want to wet my pants.
2. he probably had them before he came in. maybe. although this would fall under another of the trauma team's biggest faults, the failure to acknowledge/treat/give a crap about pre-existing conditions. basically, the doctors will say "this is their baseline" and use that as an excuse not to deal with the problem. once again, not ok. and for the record, the patient's first EKG didn't show changes that would happen due to PE, and the second and third EKGs did. therefore, we might want to rethink this theory, people.
3. he doesn't have insurance. i think i can sum that one up with a OH NO YOU DIDN'T.
fine, so we aren't going to treat his PEs. but he also has chest pain. and blood counts that are half of normal. and suddenly, i understood!!! his body doesn't have enough blood cells to deliver oxygen to the heart. low oxygen equals chest pain. this can also explain his sickly grey death skin and the fact that he just sleeps all day long. it was like heaven opened up and the angels sang. we could give him blood and he would be better!!
so i did what a good nurse is supposed to. i went to the resident and presented my evidence. i had labs to back me up. i had a good argument based on pathophysiological principles. i followed the right steps. and then i got the order, gave him blood, and everything was perfect, the end.
oh wait. actually i was told that "it will be discussed", and then my (right) idea was completely shot down and the team decided to give him some lasix to get rid of extra fluid. apparently the idea de jour is that his blood counts are low because his blood is diluted. DID WE ALL GET OUR MEDICAL LICENSES OUT OF A CRACKERJACK BOX?!?!?!
i am tired of being rejected by the trauma team. i'm tired of working hard to think critically to have no one take me seriously. i'm tired of the groupthink. and i'm tired of caring about these patients and feeling like nobody else does.
but do you know what i'm not tired of? being right. mark my words i WILL give this man blood if it's the last thing i do. because he needs it. it will make him feel better. and it is medically appropriate. and i don't need the trauma team to validate my feelings.
but i will enjoy saying i told you so.
rant over.
i have a love hate relationship with our trauma team. mostly hate. as a whole, the team is made up of underachievers. the residents are less concerned about quality patient care and interventions that make sense, and more concerned about guessing which orders their seniors would like them to write. they don't order tests, because they don't want to know what's going on. they hate labs, because then they will be obligated to come up with interventions. they loathe medicine doctors above all else, and frown on nurses who call on them for help in emergencies. i have decided this is because they feel threatened by these doctors because they know about medicine. they have taken nearly everything that i learned in nursing school and thrown it out the window. there are many days that i feel personally victimized by our trauma team, one of those being today.
i have a patient that i'm watching like a hawk. he's here because he stabbed himself. when i got him out of surgery, his heart rate was in the 140s-150s. not ok. the team ran a few tests, and determined that he wasn't having a cardiac issue and that his blood counts were decent. apparently this was good enough for them, so we let the patient sit at this heart rate for 24 hours.
the next day, he became short of breath. they sent him for a chest CT and found out that he had a pulmonary embolism. NOT OK. i have watched people die horrible deaths of PEs in front of my face, and as a result i live in fear of them. it's the kind of condition where a person is talking to you one minute and the next they aren't breathing...completely terrifying and emotionally scarring. so one can imaging how i felt when i found out that the patient had not one but two PEs in the left lung...kind of like i had just been handed a ticking time bomb. i started the patient on a heparin drip to thin his blood, and we kept a close eye on his vital signs.
so imagine my surprise when i come to work today and my patient is off his heparin drip. when i asked the day nurse why, she quoted the trauma team. "his PEs are little...he probably had them before he came in. and he doesn't have insurance". allow me to break down the things that are wrong with this into an itemized list.
1. the PEs are little. ok, so certain types of PEs aren't as serious. but personally, even the thought of little ones make me want to wet my pants.
2. he probably had them before he came in. maybe. although this would fall under another of the trauma team's biggest faults, the failure to acknowledge/treat/give a crap about pre-existing conditions. basically, the doctors will say "this is their baseline" and use that as an excuse not to deal with the problem. once again, not ok. and for the record, the patient's first EKG didn't show changes that would happen due to PE, and the second and third EKGs did. therefore, we might want to rethink this theory, people.
3. he doesn't have insurance. i think i can sum that one up with a OH NO YOU DIDN'T.
fine, so we aren't going to treat his PEs. but he also has chest pain. and blood counts that are half of normal. and suddenly, i understood!!! his body doesn't have enough blood cells to deliver oxygen to the heart. low oxygen equals chest pain. this can also explain his sickly grey death skin and the fact that he just sleeps all day long. it was like heaven opened up and the angels sang. we could give him blood and he would be better!!
so i did what a good nurse is supposed to. i went to the resident and presented my evidence. i had labs to back me up. i had a good argument based on pathophysiological principles. i followed the right steps. and then i got the order, gave him blood, and everything was perfect, the end.
oh wait. actually i was told that "it will be discussed", and then my (right) idea was completely shot down and the team decided to give him some lasix to get rid of extra fluid. apparently the idea de jour is that his blood counts are low because his blood is diluted. DID WE ALL GET OUR MEDICAL LICENSES OUT OF A CRACKERJACK BOX?!?!?!
i am tired of being rejected by the trauma team. i'm tired of working hard to think critically to have no one take me seriously. i'm tired of the groupthink. and i'm tired of caring about these patients and feeling like nobody else does.
but do you know what i'm not tired of? being right. mark my words i WILL give this man blood if it's the last thing i do. because he needs it. it will make him feel better. and it is medically appropriate. and i don't need the trauma team to validate my feelings.
but i will enjoy saying i told you so.
rant over.
Friday, March 11, 2011
a day in the life
today was quintessential trauma drama. for the entire shift, i found myself scowling and holding back tears. now that i am home and halfway through a glass of wine, however, i can see the hilarity in many of the situations that made me think that i was (finally) going to lose my mind. here's the rundown.
1400: pick up patient named after pop icon. said patient insists on doing dances with his IV pole, repeatedly running into walls and nearly falling over. patient gets 8 beers a day. insists on calling my nursing student "the apprentice". immediately love said patient.
1700: patient's wife complains that bathroom is "filthy". bite back comments about not being able to control explosive diarrhea. scrub poopy bathroom with bleach wipes. try to smile like i mean it. rue the day i became a nurse.
1845: receive patient from ED. no report given. patient is 305 pounds and 5'6''. cannot get patient off cart. call more staff, almost drop patient on floor. call ED and ask if report was recorded. talk to developmentally delayed ED nurse who allegedly recorded report and yet can tell me nothing about patient. hold back angry rant against ED nurse and hang up.
2045: go into favorite pop icon patient's room and notice epidural is leaking. must have been from the dancing. call doctor, stop pump. answer 234235 million call lights. call different doctor for new pain meds. call doctor again for benadryl for another patient. stalk doctor in halls and get cough syrup for a third patient. take phone call from yet another doctor and am warned of the dangers of epidural hematoma with displaced epidural line. talk to pop icon about dangers, then feed him more beer. call yet ANOTHER doctor about new admission, as patient was admitted with weakness and all admitting orders say constipation. cry.
2100: go into chart of new admission and read note from ED RN. RN has written that i called for report and that it was clearly recorded in the system. complain to nurse manager. receive apology from ED. plot revenge.
2115: respond to screaming match from patient's room. listen to patient's gf yell "YOU WAS TRYIN TO KILL THE MOTHER OF YO BABY". watch security remove gf from room. observe as patient attempts to go after gf and then hits security with crutches as they try to hold him back. police arrive, listen to patient swear the whole thing never happened. go into room of patient next door and assure her she is not in danger.
2130: remember i am supposed to be holding a meeting for night shift nurses. have no time for meeting. feed nurses instead and continue to run around floor.
2200: pass meds. console crying patient that i have neglected for hours. drop meds on floor, and have to order new ones. hold down elderly woman for straight cath. try not to get bitten. listen to patient threaten nurse for taking away his crutches.
2300: finally begin to chart.
2330: listen to report from ED patient. incorrectly recorded. feel vindicated.
2345: punch out. contemplate self harm. consider winding up as patient on floor and reconsider. decide to drink wine and sob myself to sleep instead.
so here we are.
1400: pick up patient named after pop icon. said patient insists on doing dances with his IV pole, repeatedly running into walls and nearly falling over. patient gets 8 beers a day. insists on calling my nursing student "the apprentice". immediately love said patient.
1700: patient's wife complains that bathroom is "filthy". bite back comments about not being able to control explosive diarrhea. scrub poopy bathroom with bleach wipes. try to smile like i mean it. rue the day i became a nurse.
1845: receive patient from ED. no report given. patient is 305 pounds and 5'6''. cannot get patient off cart. call more staff, almost drop patient on floor. call ED and ask if report was recorded. talk to developmentally delayed ED nurse who allegedly recorded report and yet can tell me nothing about patient. hold back angry rant against ED nurse and hang up.
2045: go into favorite pop icon patient's room and notice epidural is leaking. must have been from the dancing. call doctor, stop pump. answer 234235 million call lights. call different doctor for new pain meds. call doctor again for benadryl for another patient. stalk doctor in halls and get cough syrup for a third patient. take phone call from yet another doctor and am warned of the dangers of epidural hematoma with displaced epidural line. talk to pop icon about dangers, then feed him more beer. call yet ANOTHER doctor about new admission, as patient was admitted with weakness and all admitting orders say constipation. cry.
2100: go into chart of new admission and read note from ED RN. RN has written that i called for report and that it was clearly recorded in the system. complain to nurse manager. receive apology from ED. plot revenge.
2115: respond to screaming match from patient's room. listen to patient's gf yell "YOU WAS TRYIN TO KILL THE MOTHER OF YO BABY". watch security remove gf from room. observe as patient attempts to go after gf and then hits security with crutches as they try to hold him back. police arrive, listen to patient swear the whole thing never happened. go into room of patient next door and assure her she is not in danger.
2130: remember i am supposed to be holding a meeting for night shift nurses. have no time for meeting. feed nurses instead and continue to run around floor.
2200: pass meds. console crying patient that i have neglected for hours. drop meds on floor, and have to order new ones. hold down elderly woman for straight cath. try not to get bitten. listen to patient threaten nurse for taking away his crutches.
2300: finally begin to chart.
2330: listen to report from ED patient. incorrectly recorded. feel vindicated.
2345: punch out. contemplate self harm. consider winding up as patient on floor and reconsider. decide to drink wine and sob myself to sleep instead.
so here we are.
Thursday, March 10, 2011
today i get to eat my words. yum.
sadly, i am not as nice as i used to be. somehow after almost 3 years of trauma drama, i've gotten cynical. nursing is a frustrating job. you watch the same types of people make the same types of bad choices and you aren't supposed to be angry. you have to deal with patients manipulating you and dish out drugs like candy and you're just supposed to smile as you get walked all over. it's hard, and it makes me mad, and as a result i can be judgmental and snotty.
but really. excuses get me nowhere. today i was wrong and here is why:
i was sitting up at the nurse's station with a couple of coworkers working on charting. the tele monitor was alarming, as it had been all night. we have a patient on the floor who is constantly pacing the halls. she's always out to smoke, or otherwise disposed and her tele is either too far away to give off a signal or her leads are bouncing around and the monitor thinks she's in v-tach. at this point, the monitor was saying that her heart rate was in the 140s. one of the nurses asked why, to which i replied "she's probably out smoking or doing whatever she does". well (surprise surprise) the patient is actually NOT out smoking, but right outside the nurse's station, overhears everything i say, and proceeds to tell me so and then yell at me. enter me. dying inside. because, unfortunately, she's right.
yes, i said it.
this patient is a drug addict. she manipulates the system. she has a history of doing naughty things in bus shelters. but that doesn't mean that i am judge and jury of the trauma unit. that doesn't mean that she gets treated with any less respect, or that i get to say whatever i want about her. because, really, she is none of my business. i (thankfully) am not her nurse and her antics are not my responsibility, so i don't get to have an opinion.
this is hard for me. i see injustice and i want to stamp it out. i would like things to be fair and right, and people like this DRIVE ME OUT OF MY MIND. i don't get to go around and do anything i want without consequences. i don't demand things and have people fall all over themselves to grant my requests. i don't manipulate the system. but once again, it doesn't matter. because i am not the drug addict, i am the professional. and because of that, and also because i was wrong, i got to go and apologize.
can i just say that i thought i was going to get beat down? she actually said to me "if we were out on the street it wouldn't have gone like that". but despite the threats of bodily harm, i apologized. i told her that i was wrong and that my comments were uncalled for. that it was inappropriate and none of my business. and that i was sorry. and she accepted my apology. and then ranted about me to anyone who would listen for the next 2 hours.
frankly i am horrified by the whole incident. do you know what is not fun? taking care of shallow selfish people. do you know what is even more not fun? stooping to their level. so tonight i ate my own words and i deserved every bite. and tomorrow? i may need a disguise.
but really. excuses get me nowhere. today i was wrong and here is why:
i was sitting up at the nurse's station with a couple of coworkers working on charting. the tele monitor was alarming, as it had been all night. we have a patient on the floor who is constantly pacing the halls. she's always out to smoke, or otherwise disposed and her tele is either too far away to give off a signal or her leads are bouncing around and the monitor thinks she's in v-tach. at this point, the monitor was saying that her heart rate was in the 140s. one of the nurses asked why, to which i replied "she's probably out smoking or doing whatever she does". well (surprise surprise) the patient is actually NOT out smoking, but right outside the nurse's station, overhears everything i say, and proceeds to tell me so and then yell at me. enter me. dying inside. because, unfortunately, she's right.
yes, i said it.
this patient is a drug addict. she manipulates the system. she has a history of doing naughty things in bus shelters. but that doesn't mean that i am judge and jury of the trauma unit. that doesn't mean that she gets treated with any less respect, or that i get to say whatever i want about her. because, really, she is none of my business. i (thankfully) am not her nurse and her antics are not my responsibility, so i don't get to have an opinion.
this is hard for me. i see injustice and i want to stamp it out. i would like things to be fair and right, and people like this DRIVE ME OUT OF MY MIND. i don't get to go around and do anything i want without consequences. i don't demand things and have people fall all over themselves to grant my requests. i don't manipulate the system. but once again, it doesn't matter. because i am not the drug addict, i am the professional. and because of that, and also because i was wrong, i got to go and apologize.
can i just say that i thought i was going to get beat down? she actually said to me "if we were out on the street it wouldn't have gone like that". but despite the threats of bodily harm, i apologized. i told her that i was wrong and that my comments were uncalled for. that it was inappropriate and none of my business. and that i was sorry. and she accepted my apology. and then ranted about me to anyone who would listen for the next 2 hours.
frankly i am horrified by the whole incident. do you know what is not fun? taking care of shallow selfish people. do you know what is even more not fun? stooping to their level. so tonight i ate my own words and i deserved every bite. and tomorrow? i may need a disguise.
Thursday, February 10, 2011
patient advocacy, yet another joy of nursing.
i am trying to think of a way to say this diplomatically. nope, can't do it. SURGEONS TOTALLY SUCK. ok, so today it was just one in particular. let me explain.
i have a 91 year old post-op patient. this in itself is actually very bad. 91 year olds shouldn't have surgery. please, if i am ever that old and someone wants to cut me open, slap a DNR bracelet on me, cover me with a palliative care quilt and call the harpist to play me into the light. i want this on the record!! unfortunately, this lady wasn't so lucky. she had surgery, then had complications, then her extremities filled with fluid, her lungs went to crap, and she got a couple of infections. Now she has so much fluid in her legs that my handprint stays on her when i touch her. and her lungs are so wet that you can hear her rattling from the doorway. and as all this fluid is in inappropriate places, she is actually dehydrated and has had only a small amount of urine output in 24 hours.
enter me. i came to work today feeling the need to right wrongs. i had the patient the night before, and was concerned about her fluid status and urine output. the on-call doctor that night didn't want to do much because he didn't know the patient. so when i got to work today, i was anxious to find out what was being done.
enter the surgeons. what was being done? ABSOLUTELY NOTHING. now on some level i understand this. we can't give her fluid because it's not going to the right places. we can't pump her full of diuretics because her kidneys can't handle it. we can't cure her because she is 91 and she's probably going to die. but we CAN do something, namely making her a palliative care patient and getting her comfortable.
enter me talking to the surgeons. i really did try. i sat down with the chief resident of the surgical service, the nurse practitioner, the intern, and the med student. i explained my concerns. i went through her edema, her lungs, her urine output, etc. and when i was done, i waited for the chief resident to respond. and what did he say?
"no."
that's right, no. just no. ok, excuse me? what part of what i just said did you not understand? so i repeated myself. the conversation went a little something like this.
-i explained that if the patient is not palliative care, we have an obligation to treat her.
"well what do you want me to do about it"
-i explained that i thought we should make her palliative
"no"
-well then we should really have a meeting to discuss what we're doing with this patient, because there's some confusion and not everyone is on the same page
"what do you mean there's confusion. who exactly doesn't understand."
-NURSING! I DON'T UNDERSTAND WHAT WE'RE DOING. AND YOU OBVIOUSLY DON'T UNDERSTAND WHAT I'M SAYING.
"well what can we do to make YOU happy then"
-i explained that we needed to make a decision about the plan of care
"well i don't understand why you're so concerned about putting a label on it"
-i explained that these 'labels' exist so that we're not passively killing people. and if i don't have such labels, i will treat my patient accordingly. thus when she starts circling the drain, i will call my resources and we will do labs and tests and oh i don't know TREAT HER, because i have no reason not to. i believe this is also when i started throwing around phrases like 'failure to rescue' and 'obligation to my patient'. i finished up by saying that i didn't feel comfortable with this grey area of medicine, and with watching her slowly drown to death. if the surgeons want to kill their patients in the OR, that's on them. but when they try to do it on the floor, thats on me. (ok i said that last part a little more politically correctly, but the gist is the same). then i told them that i would let them discuss things and they could get back to me with their decision.
now this should have felt awesome. and actually, it was very satisfying. i said what i needed to, and i stood up for myself and my patient. i didn't get intimidated, and i didn't back down even when it was clear that i wasn't going to get what i wanted. but i don't particularly enjoy eye rolling and snippy comments and tall bald men in white coats talking down to me. so was i mad all shift? yes. and do i harbor revenge fantasies involving me running over said chief resident with my SUV? yes. and will i add him to my list of people that are not to touch me should i ever need surgery? yes. and i will underline his name.
for the record, i didn't get what i asked for. the patient is still hanging out, not being treated but not officially palliative care. but for my trouble, i got 20 mg of lasix by mouth! i like to think of that as my consolation prize. i'm sure that i also got a reputation as a crazy vigilante nurse. but at this point, who cares? i can go to sleep tonight knowing that i advocated for my patient. and that evil chief resident? he'd better watch out in the parking lot.
i have a 91 year old post-op patient. this in itself is actually very bad. 91 year olds shouldn't have surgery. please, if i am ever that old and someone wants to cut me open, slap a DNR bracelet on me, cover me with a palliative care quilt and call the harpist to play me into the light. i want this on the record!! unfortunately, this lady wasn't so lucky. she had surgery, then had complications, then her extremities filled with fluid, her lungs went to crap, and she got a couple of infections. Now she has so much fluid in her legs that my handprint stays on her when i touch her. and her lungs are so wet that you can hear her rattling from the doorway. and as all this fluid is in inappropriate places, she is actually dehydrated and has had only a small amount of urine output in 24 hours.
enter me. i came to work today feeling the need to right wrongs. i had the patient the night before, and was concerned about her fluid status and urine output. the on-call doctor that night didn't want to do much because he didn't know the patient. so when i got to work today, i was anxious to find out what was being done.
enter the surgeons. what was being done? ABSOLUTELY NOTHING. now on some level i understand this. we can't give her fluid because it's not going to the right places. we can't pump her full of diuretics because her kidneys can't handle it. we can't cure her because she is 91 and she's probably going to die. but we CAN do something, namely making her a palliative care patient and getting her comfortable.
enter me talking to the surgeons. i really did try. i sat down with the chief resident of the surgical service, the nurse practitioner, the intern, and the med student. i explained my concerns. i went through her edema, her lungs, her urine output, etc. and when i was done, i waited for the chief resident to respond. and what did he say?
"no."
that's right, no. just no. ok, excuse me? what part of what i just said did you not understand? so i repeated myself. the conversation went a little something like this.
-i explained that if the patient is not palliative care, we have an obligation to treat her.
"well what do you want me to do about it"
-i explained that i thought we should make her palliative
"no"
-well then we should really have a meeting to discuss what we're doing with this patient, because there's some confusion and not everyone is on the same page
"what do you mean there's confusion. who exactly doesn't understand."
-NURSING! I DON'T UNDERSTAND WHAT WE'RE DOING. AND YOU OBVIOUSLY DON'T UNDERSTAND WHAT I'M SAYING.
"well what can we do to make YOU happy then"
-i explained that we needed to make a decision about the plan of care
"well i don't understand why you're so concerned about putting a label on it"
-i explained that these 'labels' exist so that we're not passively killing people. and if i don't have such labels, i will treat my patient accordingly. thus when she starts circling the drain, i will call my resources and we will do labs and tests and oh i don't know TREAT HER, because i have no reason not to. i believe this is also when i started throwing around phrases like 'failure to rescue' and 'obligation to my patient'. i finished up by saying that i didn't feel comfortable with this grey area of medicine, and with watching her slowly drown to death. if the surgeons want to kill their patients in the OR, that's on them. but when they try to do it on the floor, thats on me. (ok i said that last part a little more politically correctly, but the gist is the same). then i told them that i would let them discuss things and they could get back to me with their decision.
now this should have felt awesome. and actually, it was very satisfying. i said what i needed to, and i stood up for myself and my patient. i didn't get intimidated, and i didn't back down even when it was clear that i wasn't going to get what i wanted. but i don't particularly enjoy eye rolling and snippy comments and tall bald men in white coats talking down to me. so was i mad all shift? yes. and do i harbor revenge fantasies involving me running over said chief resident with my SUV? yes. and will i add him to my list of people that are not to touch me should i ever need surgery? yes. and i will underline his name.
for the record, i didn't get what i asked for. the patient is still hanging out, not being treated but not officially palliative care. but for my trouble, i got 20 mg of lasix by mouth! i like to think of that as my consolation prize. i'm sure that i also got a reputation as a crazy vigilante nurse. but at this point, who cares? i can go to sleep tonight knowing that i advocated for my patient. and that evil chief resident? he'd better watch out in the parking lot.
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