From the home front, swan song part two

I have not worked since mid March.

My last shift was preceded by 10 days of the busiest I can ever remember.   The waits were hours long, it being high season for colds, flu, pneumonia.  I did 5 straight shifts in triage, much of it alone.   One week we had no COVID19 suspects.  Then, a patient with cough, fever, SOB.  The travel to Asia was not mentioned until I specifically asked about it.  Then it started to blow up.  Biogen conference fallout.  COVID suspects were isolated, most not sick enough to need immediate care, so delay in being seen, delay in turning over the room.  Over the weekend, the  COVID condo tent had been erected, staffed by useless people like department heads who never, ever did anything clinical... but they were pretty proud of themselves, high-fiving each other and planning their celebratory drinks after the tent closed at 5 PM.   We got a kick out of watching them congratulate themselves for remembering which end of an electronic thermometer to use, as evidenced by the high living and group congratulations.  They were having their butts handed to them in that tent because the ER was chronically understaffed and we regulars couldn't be spared.   

Then, nothing.  Patient numbers dropped, the tent dwellers dealt specifically with the hundreds of patients who, as usual, were sent to the ER by their PCP.  Most had no symptoms.  The only ER patients were actual ER patients.  No visitors allowed, which was actually....great.  Ghost town.  Not a soul in the waiting room.  

From crazy to eerily quiet.  I worked another couple of shifts.  Then I got sick.   

 BTC (Before the Time of Covid) I would have probably worked my next scheduled shift,  but...with the cough, I was feeling crappy enough (and just a little scared) to go to Urgent care on a Saturday.  I stopped just inside the door and announced myself to the masked nurse in the empty lobby, standing at the ready to intercept and direct the infectious public.  "I have a cough and I'm an ER nurse".

I was given a mask, asked one or two particulars (none of which was "are you short of breath") and sent back to wait in my car.  They would have the PA call my cell phone. 

After 3 or 4 minutes, I was beckoned to a side entrance, shipping door, whatever.   Not through the lobby.  Straight to a room where the PA did the intake, VS, exam, tested for flu and ordered a CXR for pneumonia.  Both negative.  Since I was an ER nurse with symptoms, to my own ER I was directed for Covid testing.  My.  Own.  ER.

I was taken to a negative pressure room.  "I feel stupid", I muttered to my colleague.  From outside the room I read her my VS from my urgent care sheet.  She handed me a portable pulse oximeter since that reading was not documented.  "It's 88", I called out.  "What?!"  "Just kidding, it's 98".

I tested negative for COVID-19.   I waited 4 days for the results.

While I waited, quarantined, I got worse. The cough was relentless.  And the fatigue.  I have rarely had an illness wherein it was necessary to stay in bed and pretty much sleep for three days.  When I wasn't coughing and dizzy, and short of breath from coughing. 

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I didn't go back to work. I was way too fatigued.  Simple tasks around the house required prolonged rest periods.  This lasted about a month.  Employee health called me every week until the end of April and asked me the same questions about the timeline of my illness.  I'm not sure they ever wrote any of it down.  

Mid-May I wasn't sure I wanted to go back. But I felt guilty.  And worried about money, although  there was no place to go to spend it.  "We're fine.  You don't have to go back to work if you don't want to" , said Mr. Ednurseasauras.  

In early June I was sure I didn't want to.  I still felt guilty.  

By July it was certain.   An impersonal letter from HR removed any doubt.  If I wasn't going to work the minimum required hours as a per-diem, I was done.  I never bothered to respond. 

I was fine with that.  

It took me another month to declare that  I was actually retired from Emergency Nursing after 40-plus years.  

I'm fine with that, too.  

But...would I recommend nursing as a career??

It just isn't funny anymore...a swan song in two parts

I started this blog a long time ago with a post about my husband's experience with his cardiac stent.  A bit over a year ago, he underwent a 4 vessel CABG by way of some mild chest pain and shortness of breath while bicycling.  AFTER we cavorted around Italy.  He has healed quite well, thanks, although not quite up to his own ridiculous standards of physical activity for a man 73-going-on-55.  For anybody else who routinely does not hike mountains and do strenuous bicycling, he is a superstar.  

I have always said as long as I still need the money find humor in the job, I will continue to do it.  The last couple of years have been a tough sell for me, as evidenced by the paucity of amusing posts.

If I thought I was a dinosaur nearly 13 years ago when this blog was born, well....what's older than a dinosaur?

 License on the line every day, every shift.

ER nursing just keeps getting tougher, and I don't mean just the physical aspects, which have certainly taken their toll.  Most of  my coworkers at Satan's Waiting Room for the last 6 years are no longer there.  Many have chucked beside nursing altogether to become nurse practitioners (a lot).  Some retired.  Several excellent nurses have been fired or forced out over some pretty minor shit.  There was an exodus of staff to Gigantic Mega Medical Center, for big bucks, a long commute, traffic, and no free parking.  All in a state tax state, which, to my mind, merely adds a boat-load of headache for even money.   My middle management boss:  a total upper management marionette of stunning uselessness  My upper management boss:  a troll with doctorate.  Neither of them would be safe to give a patient so much as a bed pan.

This pandemic has put the cherry on the turd sundae.

Once upon a time I thrived on learning new things, taking care of really sick patients, knowing how to do all the tasks, run all the machines, anticipate all the meds, trauma, codes, train wrecks of all description.  I loved to be considered a resource for other nurses, a leader, mentor and team player.  I didn't mind the physical aspects so much.  Then.  I've worked for employers good and bad.  Some who valued me for my commitment, or work ethic.  Or comic relief.  A few who saw and cultivated  my leadership potential.

But...the job has changed drastically.  The priority is not the patient.  It is a numbers game, about the money.  Always.   Documentation is directed toward charges, which is not litigation friendly.  Nurses have become chess pieces, more specifically pawns.

As a nurse who has been an advocate of what is best for the patient, I found that I was having to pick my battles.  I had to, you can't fight every minute of every day.  Exhausting.  Providers are gonna do what providers are gonna do.   You can beg, or take a hard line, try to move further up the food chain in time to prevent a really big error.  Others have done that, with predictably poor results for them.  Fortunately, I never had to take things to that level.  

Would I recommend nursing as a career?

To be continued....

It had snowed 2 days before.  Not much, just a couple of inches of fluffy, sugary white stuff.

For days, her little footprints were still clearly visible.  Into the woods behind my house.  Headed half way to my neighbors house to check on his dog.  The flattened area where she rolled.  She loved to roll in snow.

The steady cold weather ensured that those footprints would remain undisturbed for weeks.  Looking at them crushed me and always brought another round of weeping.

When the temperature climbed to  just above freezing, the gradual melt made the prints bigger, then bigger still, until it was  large patches of grass with little snow.   She loved to roll in that, too.  I could somehow still see footprints.

My heart is broken into a million tiny pieces still.  But I can more often think of her without tears.

 I miss her.

  

It was the shoes

The purpose of a triage interview is to gain pertinent information about the patient as quickly and efficiently as possible.   It is best to let the person triaging direct the questions.  It saves a lot time.  It helps when it is actually not painful.

In truth, it is acutely painful at times.

While I was watching the Wizard of Oz recently, it occurred to me that explaining how the triage interview works can be compared to the tale of how Dorothy comes to be present in Oz.  I leave out the Tin Man and the Cowardly lion due to time constraints.


Me: "Why are you here?"

Patient: "Well, there I was, living with Auntie EM and Uncle Henry, and Miss Gulch was mean to Toto**... so I ran away, and.."

Me: "Why are you here TODAY?"

Patient: "Well, because Miss Gulch was taking Toto away, and  I decided to run away from home.  I met this man, a fortune teller, who told me there was a  tornado..."

Me: "What are the SYMPTOMS that caused you to come to the ER today?"

Patient: "After I went up in the the tornado I landed on a wicked witch, then the munchkins told me to follow the Yellow Brick Road...

Me: "Excuse me..."

 Patient:  (keeps talking)... with Toto and the scarecrow, and we were headed to Emerald City because..."

Me: "I'm going to stop you there.  If you could use one word to describe to me the complaint that brings you here today?"

Patient: "Well not really, it's complicated, its about way more than one thing..."

Me: "STOP.  One symptom, impulse or concern.  Just one"

"Oh.  Headache.  But...."

Me:  () Actually, I don't say anything.  The thought bubbles have stolen my speech.

**In my scenario, Toto is an emotional support iguana because Dorothy says he is.  In my opinion he is poorly trained.

ER nurses are really good at IV's.  Patients who profess to have "bad veins, being a really hard stick" and ask for someone "very experienced with difficult veins" are frequently not all that difficult....if you know where to look.    It begs the question, "how do you get good at starting difficult IV's if you don't do it often enough to get good at it?"  Often patients who will pick their IV spot have done so repeatedly, so "that one good vein"  is no longer a viable option.  

Here's what doesn't help:  Snarky and stupid  comments, superior attitudes, and straight up  challenging.  I'll let you decide which is which.  

1.  "Oh, good luck with that"

2.  The last nurse who tried an IV stuck me 15 times (bullshit.  There isn't a nurse on the planet who would do that many sticks.  Most are 3 and done, I'm 2 and done myself).

3.  I can't have any IV's in my hand.  "Why?"  I don't like them there

4.  I'm left handed, suck my thumb, text with that hand, etc, etc, etc.  

5.  It just always hurts if you put it there.

6.  I can only have a butterfly, and a really small one,  

7.   I've never had an IV there before

8.  You get one try.

9.  Trying to explain things to a 10 month old
10. Telling kids "it's not going to hurt".  I never lie.  It will hurt.  I say "pinch", not beesting like many of my cohorts.

I tell the ones who demand the best that I'm better than average with 40 + years of experience.
I tell them I only try an IV if I'm confident.  That is most of the time.
For those who tell me "I usually get blood drawn in this vein", (AKA choosing your IV site) I will always try there first.  Even if I think it's not going to work.  Even if I am dead certain it's not going to work.   You can blame yourself for that, having painted me into a corner.   I have forgotten more places to try IV's than you will ever dream of, even if you are an IV drug user.  And that's saying a lot.

The current trend of using ultrasound for IV's has hit a frenzy in my ER.  There are a few docs who are good at it, really good.  Now we have training available for RN's and paramedics who want to learn, but I will definitely not be one of them.   I have found that with so many people wanting to use the ultrasound and practice this shiny new skill, it has taken the art out of it.  IV starts will go the way of the dinosaur.  As will I, I suppose.  As will I.