The evening shift has its own vibe. At 3 PM I can walk into absolute chaos with staff spinning in their own individual orbits: nurses, secretaries, X-ray techs, lab techs, and let's not forget docs. I hate walking into chaos, people wound as tight as rubber bands. I like calm. No panic until it's time to panic. Breathe in, breathe out.
My first official act is to GET THE DAY SHIFT OUT. Currently, my colleagues are great people whose only fault is the mistaken notion that they cannot leave for the day with a single task undone. Often it has been such a busy day that after a full shift of fu*kery, there is not a single other thing you can do except leave. Quietly. And pour yourself a glass of wine when you get home.
I'm not really complaining. Every nurse who has walked this planet has, at some point, wanted to strangle with their own stethoscopes nurses who are so lazy that they waltz out the door in the middle of a shit storm, waiting with their coats on, purse on the shoulder, and car keys in hand. Being on the report-receiving end of a train-wreck with a shit ton of unfinished business just doesn't make anybody's day. Report not given to the floor nurse, charts not filled out, pain meds 2 hours overdue, no labs drawn, antibiotics not started and patients not updated for hours. Crazy busy happens, but when the nurse is chatting with EMT's and hasn't taken one of 10 people in the waiting room in two hours or is online shopping, that is unforgivable. Shame on you. That goes double for nurses who sit back reading the paper while directing the ER tech to do all the work.
Like I said, calm. Let's just all be one in the moment. Breathe in. Breathe out. Ommmmmmmmm............
Thursday, May 31, 2012
Wednesday, May 30, 2012
This....or That
Allow me to assist you in navigating the murky waters of the emergency department. We will bend over backwards to give you the best possible care. Truthfully, though, you need to be mindful that the best care may not be exactly what you want or what your friends think you should have; you may not necessarily have it Your Way just because you ask for it or demand it. Know that we are reasonable people and put on happy, smiley faces but don't do well when people are unreasonable or taking advantage. Rudeness doesn't help either, and we spend an inordinate amount of time squirrel wrangling. Or haggling.
What the patient wants: narcotics
What the patient expects: to call and ask to speak to Dr. No-narcs, thus ascertaining whether or not he should come in or wait for another day. Better yet, ask to speak to Dr. Santa Claus to ask a question, or ask to speak to any doctor for advice.
What actually occurs: No name shall pass my ruby red lips. I stonewall, hedge, hinder, thwart, oppose, hamper, block, resist, oppose or impede any efforts on the patient's behalf to get the information. Over my cold, dead body. I'm really good at rebuffs, too.
What the patient wants: weekend off
What the patient expects: that we will write a work excuse for an injury that occurred two weeks ago and wasn't even worthy of 1/2 day off then.
What actually occurs: come in for an exam. It's been two weeks, at most you will get a note giving the day of your visit.
What the patient wants: an ER visit that takes 10 minutes because she has to pick up her kids
What the patient expects: that her oh-so-minor complaint such as poison ivy deserves top priority and to be attended to ahead of chest pain, abdominal pain and head injuries because it "only takes a few seconds" to examine, treat, and write her a prescription.
What actually occurs: I waste 10 minutes of my life that I will never get back triaging and then explaining that her ass will be in the waiting room about an hour, so she leaves in a huff without being seen.
What the patient wants: whatever Dr. Google, Dr. Oz, or Dr. As Seen on TV prescribes
What the patient expects: magic cure
What actually occurs: themindless fuck doodles informed health care consumer argues with the ER doc for 10 minutes of his/her life that he/she will never get back about how antibiotics DO work for viruses every time.
What the patient wants: improving his odds of early demise from worsening obesity, diabetes, COPD and heart disease after a lifetime of non-compliance
What the patient expects: that there is a magic bullet that will extend his dismal life expectancy
What actually occurs: There is not a whole hell of a lot we can fix in one ER visit.
What the patient wants: me to drop everything and call the pharmacy right away with your prescription for foot fungus
What the patient expects: to pick up it up in under 5 minutes so she won't be inconvenienced
What actually happens: you have been a rude pain in my ass from the moment you hit the door, so I phone in your prescription at 5:05 PM, leaving it on the recorded line. The pharmacist picks those messages up every hour on the hour. Buh-bye.
What the patient wants: narcotics
What the patient expects: to call and ask to speak to Dr. No-narcs, thus ascertaining whether or not he should come in or wait for another day. Better yet, ask to speak to Dr. Santa Claus to ask a question, or ask to speak to any doctor for advice.
What actually occurs: No name shall pass my ruby red lips. I stonewall, hedge, hinder, thwart, oppose, hamper, block, resist, oppose or impede any efforts on the patient's behalf to get the information. Over my cold, dead body. I'm really good at rebuffs, too.
What the patient wants: weekend off
What the patient expects: that we will write a work excuse for an injury that occurred two weeks ago and wasn't even worthy of 1/2 day off then.
What actually occurs: come in for an exam. It's been two weeks, at most you will get a note giving the day of your visit.
What the patient wants: an ER visit that takes 10 minutes because she has to pick up her kids
What the patient expects: that her oh-so-minor complaint such as poison ivy deserves top priority and to be attended to ahead of chest pain, abdominal pain and head injuries because it "only takes a few seconds" to examine, treat, and write her a prescription.
What actually occurs: I waste 10 minutes of my life that I will never get back triaging and then explaining that her ass will be in the waiting room about an hour, so she leaves in a huff without being seen.
What the patient wants: whatever Dr. Google, Dr. Oz, or Dr. As Seen on TV prescribes
What the patient expects: magic cure
What actually occurs: the
What the patient wants: improving his odds of early demise from worsening obesity, diabetes, COPD and heart disease after a lifetime of non-compliance
What the patient expects: that there is a magic bullet that will extend his dismal life expectancy
What actually occurs: There is not a whole hell of a lot we can fix in one ER visit.
What the patient wants: me to drop everything and call the pharmacy right away with your prescription for foot fungus
What the patient expects: to pick up it up in under 5 minutes so she won't be inconvenienced
What actually happens: you have been a rude pain in my ass from the moment you hit the door, so I phone in your prescription at 5:05 PM, leaving it on the recorded line. The pharmacist picks those messages up every hour on the hour. Buh-bye.
Tuesday, May 29, 2012
I'll Load You Right Up
(Another) maladjusted, non-working, non-contributing, suck-the-life-right-out-of-me repeat offender for various complaints of pain and anxiety was "rushed" to the ER by an apparent new friend, breathless with concern. This was apparently her first performance for the new friend; we had seen this same one dozens of times, the very familiar "unresponsive" in the car act, followed by miraculous consciousness and hyperventilation. And pain. Yawn.
After demanding a wheelchair, assistance, a Go Directly to a Treatment Room hall pass, and yelling for "somebody to fu*king do something" for his new friend's chronic and life threatening panic attack and narcotic-needing pain condition he said:
"This is an emergency! She can't breath! She needs.....Spazepam!"
No shit. Let me just pull the pin on that Ativan grenade and let it fly, then everyone will feel allllllllll better.
After demanding a wheelchair, assistance, a Go Directly to a Treatment Room hall pass, and yelling for "somebody to fu*king do something" for his new friend's chronic and life threatening panic attack and narcotic-needing pain condition he said:
"This is an emergency! She can't breath! She needs.....Spazepam!"
No shit. Let me just pull the pin on that Ativan grenade and let it fly, then everyone will feel allllllllll better.
Monday, May 21, 2012
RIP, Paper ER Records....We Will Miss You
After months of hype, our ER will join the rest of the world in the 21st century and initiate electronic health records. Let the spinning begin.
It is an already out-dated program, cumbersome, not user-friendly, and fits awkwardly with our existing systems...when it works. The roll-out date is soon. Very soon. I agreed to be the super-user for our building, mainly because it is my 4th ER to have worked at when the electronic records have been the new thing....it is better not to rely on anyone else's wits but my own when it comes to computers.
I would say we are probably the last health care facility in the free world to finally put this into practice. As with any New Thing, the first thing people want to know is: how will this affect me, personally?
Well, the simple answer is that electronic health records in my universe will not do two things: it will not lessen my work load or decrease my current responsibilities and it will not mean I have lots and lots of free time to spend with patients. Triage, which I can normally accomplish in under 3 or 4 minutes, will now take about 20 minutes. There goes your door-to-doc time. Of course the new plan is to put patients immediately into a treatment rooms, fill 'em up with unregistered patients, add lots of confusion about who is where and then have no place to put a cardiac patient. But hey, overall that should really help those all-important patient satisfaction scores. Naturally, electronic records should mean a lot less paper work, right? Wrong. We will have approximately 1/2 metric fu*k ton more when all is said and done.
There is much fear and loathing, wailing, and gnashing of teeth. Ellen is beside herself. New Cathy is ready to go work at Burger World.
I took another stupid phone call from one of the Suits about an aspect of my job that she could never, ever do.
Suit: "Are you excited? Go live will be here before you know it!"
Me: (dead pan) "Beside myself. What a joyous occasion".
Suit: " I know, right? Hey, we have something for you! It's a t-shirt that says SUPER-USER! Isn't that awesome? I got you a large, is that OK? You can wear it the first day so everyone knows who you are!"
Me: "Oh. Cool."
Really? A t-shirt that says super-user? That is so....wrong. On several levels.
1. I don't wear t-shirts.
2. I would never wear one to work even if I did wear them.
3. There are about 6 people who work here on the evening shift. They all know who I am
4. Think very carefully about the connotations of labeling anyone a super-user. That would also apply to 2/3 of our frequent fliers seeking narcotics.
It is an already out-dated program, cumbersome, not user-friendly, and fits awkwardly with our existing systems...when it works. The roll-out date is soon. Very soon. I agreed to be the super-user for our building, mainly because it is my 4th ER to have worked at when the electronic records have been the new thing....it is better not to rely on anyone else's wits but my own when it comes to computers.
I would say we are probably the last health care facility in the free world to finally put this into practice. As with any New Thing, the first thing people want to know is: how will this affect me, personally?
Well, the simple answer is that electronic health records in my universe will not do two things: it will not lessen my work load or decrease my current responsibilities and it will not mean I have lots and lots of free time to spend with patients. Triage, which I can normally accomplish in under 3 or 4 minutes, will now take about 20 minutes. There goes your door-to-doc time. Of course the new plan is to put patients immediately into a treatment rooms, fill 'em up with unregistered patients, add lots of confusion about who is where and then have no place to put a cardiac patient. But hey, overall that should really help those all-important patient satisfaction scores. Naturally, electronic records should mean a lot less paper work, right? Wrong. We will have approximately 1/2 metric fu*k ton more when all is said and done.
There is much fear and loathing, wailing, and gnashing of teeth. Ellen is beside herself. New Cathy is ready to go work at Burger World.
I took another stupid phone call from one of the Suits about an aspect of my job that she could never, ever do.
Suit: "Are you excited? Go live will be here before you know it!"
Me: (dead pan) "Beside myself. What a joyous occasion".
Suit: " I know, right? Hey, we have something for you! It's a t-shirt that says SUPER-USER! Isn't that awesome? I got you a large, is that OK? You can wear it the first day so everyone knows who you are!"
Me: "Oh. Cool."
Really? A t-shirt that says super-user? That is so....wrong. On several levels.
1. I don't wear t-shirts.
2. I would never wear one to work even if I did wear them.
3. There are about 6 people who work here on the evening shift. They all know who I am
4. Think very carefully about the connotations of labeling anyone a super-user. That would also apply to 2/3 of our frequent fliers seeking narcotics.
Monday, May 14, 2012
Smoke Signals
This man walks into the ER (classic start of a bad joke, why should today be any different). He noticed that some thick, black smoke was pouring out of one the the chimneys in our very old building as he was passing by a couple of hours ago. He was on his way to an appointment and just didn't have time to stop but, hey, nice of you to check in with us on your way home to make sure we were not burned to a crisp in the interim. He suggested we might want to have our maintenance guy check it out.
Ellen gets nervous about these things and wondered if we should call maintenance now, on the off-shift and also off-site, or if I thought it could wait until the following day. Or if she should call the fire department. I'm the nurse in charge which I guess also makes me in charge of everything else. Besides, six months earlier there was a back-up of thick smoke that cleared out the building and left an odor for days.
Me: Yeah, put a call in. What the heck is a little overtime when we might be fully engulfed in flames in a little while?
Ellen: Wouldn't we have a lot of black smoke if there was a problem in the boiler room?
Me: Well it's a catholic hospital so white smoke means that a new pope has been elected. Black smoke would mean they haven't made a decision. Although I'm pretty sure the old pope has to be dead first but I don't really keep up with that type of thing.
Ellen: I don't understand.
Me: I'll go check the boiler room; you call maintenance.
Ya gotta love Ellen. She is so earnest; she always means well and would do anything for anybody. She has at least 10 "get well" or "Happy Birthday", cards going around. New people are powerless to escape the Spanish Inquisition when it comes to Ellen's Vital Records: Life Events, Spouse's name, Children, Pets (and their names), and especially Birthdays. Everybody gets something; a cake, brownies, raspberry bars, or our favorite, Whoopie Pies. And hers are goooooooooooood. But I digress.
On another night I had a problem with a strong odor of smoke. Cigarette smoke. It was coming from somewhere......close. REEEally close. From inside the building. From....Holy Shit! That asshat was smoking.... in the bathroom?
Old Drunk: "Nope, I wasn't smoking"
Riiiiiiight. "Sir, you cannot smoke in here. If you do it again, I will call the police and have you escorted out"
I had to open up the ambulance bay doors to get the smell out. It is bad enough that people reek of cigarettes in triage while they claim to smoke "2 or 3 cigs a day"; sometimes at the end of the day all I can smell is stale cigarette smoke. It is so disgusting.
I am a reformed smoker. I last smoked 33 years ago, my final pack of cigs hitting the trash bucket at the same time as my first positive home pregnancy test. It was tough to do, no doubt about it. I just don't get that people with kids think that they are not exposing them to the dangers of third-hand smoke by merely smoking outside. The chemical residue clings to clothing, skin, hair, furniture, and builds up in the car. If you are "only smoking outside", you are exposing your family unnecessarily to harmful toxins.
OK. Off my soap box.
Ellen gets nervous about these things and wondered if we should call maintenance now, on the off-shift and also off-site, or if I thought it could wait until the following day. Or if she should call the fire department. I'm the nurse in charge which I guess also makes me in charge of everything else. Besides, six months earlier there was a back-up of thick smoke that cleared out the building and left an odor for days.
Me: Yeah, put a call in. What the heck is a little overtime when we might be fully engulfed in flames in a little while?
Ellen: Wouldn't we have a lot of black smoke if there was a problem in the boiler room?
Me: Well it's a catholic hospital so white smoke means that a new pope has been elected. Black smoke would mean they haven't made a decision. Although I'm pretty sure the old pope has to be dead first but I don't really keep up with that type of thing.
Ellen: I don't understand.
Me: I'll go check the boiler room; you call maintenance.
Ya gotta love Ellen. She is so earnest; she always means well and would do anything for anybody. She has at least 10 "get well" or "Happy Birthday", cards going around. New people are powerless to escape the Spanish Inquisition when it comes to Ellen's Vital Records: Life Events, Spouse's name, Children, Pets (and their names), and especially Birthdays. Everybody gets something; a cake, brownies, raspberry bars, or our favorite, Whoopie Pies. And hers are goooooooooooood. But I digress.
On another night I had a problem with a strong odor of smoke. Cigarette smoke. It was coming from somewhere......close. REEEally close. From inside the building. From....Holy Shit! That asshat was smoking.... in the bathroom?
Old Drunk: "Nope, I wasn't smoking"
Riiiiiiight. "Sir, you cannot smoke in here. If you do it again, I will call the police and have you escorted out"
I had to open up the ambulance bay doors to get the smell out. It is bad enough that people reek of cigarettes in triage while they claim to smoke "2 or 3 cigs a day"; sometimes at the end of the day all I can smell is stale cigarette smoke. It is so disgusting.
I am a reformed smoker. I last smoked 33 years ago, my final pack of cigs hitting the trash bucket at the same time as my first positive home pregnancy test. It was tough to do, no doubt about it. I just don't get that people with kids think that they are not exposing them to the dangers of third-hand smoke by merely smoking outside. The chemical residue clings to clothing, skin, hair, furniture, and builds up in the car. If you are "only smoking outside", you are exposing your family unnecessarily to harmful toxins.
OK. Off my soap box.
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