On perfecting the art of hiding

When I am working in the biggest pod in my department, the one shared by three nurses, the nurse/patient ratio is generally less clear-cut.  A nurse could have a single trauma or STEMI patient and be bogged down, or five psych hold patients who are being watched by techs….which would mostly be an easy assignment.   Or two drunks who are sleeping.  Or three stable chest pain rule-outs but with nightmare families.   Or one soul-sucker (now in  restraints)  throwing chairs against the wall and threatening to slice off our heads with a sword.  Whatever.  The point is that some days you are the dog, some days the hydrant.  And when it is your turn to be the hydrant, you hope your teammates will remember what it was like and pitch in accordingly.

As ER staffing is a cyclical thing, we currently have  a lot of Freshman ER nurses.  I am mostly impressed with how quickly many of them have assimilated on the off-shift hours.  They jump in where needed, ask great questions, and in general are a hard working  bunch.  But of course, there is always that one.  Newish ER Nurse has moved up the food chain to sophomore-headed-into-junior-year level in terms of experience and how long she has worked there.  Yet, during the times when it is truly crazy, Newish Nurse remains seated.  Or in hiding.  Not getting the teamwork thing.

She has been renamed "Lazy Nurse"

She can generally be counted on to have the lightest assignment regardless of what is going on in the department.  Among her evasive maneuvers for keeping her work load light:

Never taking an ambulance patch and just taking responsibility for it it.  She just walks in the other direction.

She absolutely rides the medics and techs like a cheap ponies: IV starts, EKG's, transports, vital signs.  She gets them to do it all.

She never, ever volunteers for the next patient when it is her turn.  She remains silent when, as a group we are asked, "Who's up?"

There is always a selection of snack items and beverages in her work area which keeps her very busy.

Hiding in the med room.  On her cell phone.

Once the night medic was managing a septic patient all by herself until I jumped in to help her.  Not that she wasn't doing a great job, but where the fuck was the patient's nurse?  Lazy Nurse.  Nobody knows.  Having a nice chat with someone, or preparing a meal in the break room.

Lazy Nurse's laziness has not gone unnoticed.

Auntie, the clinical leader on shift, has started to keep score and actively seeks her out when she is "missing".  She has vowed that it would be "a very long time" before Newish ER Nurse would be having the triage assignment (which, by the way, is my second home) when many of the sophomore-junior nurses with at least a year in the department have progressed to being assigned there if is an experienced nurse to help out.  "She is just not motivated enough, not fast enough, and there would be a line out the door and down the block.   Disaster.  Nope".

Auntie is gunning for Lazy Nurse.  Shudder.  I wouldn't want to be in her shoes.

You know...

…it's bad enough that a female senior management member was wearing a backpack.

 I observed her  casually cruising the portable desserts in the cafeteria line on her way out after a long day of sitting in meetings, creating forms, and adding to the existing metric fuck ton of workload for clinical staff (although she lacks any ability to actually do any aspect of the job).  But it was what was on the backpack that just made me crazy:

All Who Wander Are Not Lost.

Seriously.  

My daughter and I have the most meaningful text conversations….

Rocket Man

EMS dropped off a LOL with late afternoon "weakness", the universal label for non-specific maladies  affecting frail elders who have been left to fend for themselves most of the day.  They are  found in their La-Z-boy recliners, where they have spent the afternoon sleeping, by family members returning home for the day in a state generally described as "confused", or "unresponsive".  Often they are "fatigued".  Usually they have numerous co-morbidities, a med list as long your arm, and have "not eaten all day".  Cue the turkey sandwich.

This particular day found me floating in the department without an assignment, helping out as necessary as Float Fairy (or Everybody's Bitch).  Floaters mostly do EKG's, triage ambulance patients, and transport patients to other departments or inpatient units.  Or start a lot of IV's.

The LOL was brought by paramedics I have known for a long time, who are experienced and known to be thorough.   As I had taken the radio patch,  I owned the patient until I could find the resource person to assign another nurse.  Every room in the department was full and we were on overflow hallway beds.  This is never good.

"OK to triage her in the hall?"  I asked.  Sure, no problem she's been stable enroute was the response.

Except she had a heart rate of 30.  THIRTY.  And hypotensive.

A monitored room was cleared immediately.

I thought the EKG looked tremendously weird.  I checked and rechecked my lead placement.  The elderly patient roused a bit.

She whispered, "Situs inverses".

Ah.  This is a very interesting condition in which the organs of the abdomen are backwards, and in this case a mirror image.  Cardio came right away.

I had done (and labeled correctly for posterity) an EKG done the right way, the reverse way, and another weird way that I can't even remember.

As I excitedly whirled to present the latest tracing to the taciturn cardio guy, I found that he had sidled right up next to me.  I hate a sidler, I really do.  My fist connected with his groin, and he doubled right over, being a small an somewhat frail individual as all brilliant people seem to be.

Ooof.  Had he been taller than me it would have been a glancing blow to the upper leg, but no.  I muttered an apology, he muttered "no worries", and we both continued on as if nothing happened.

Man, there are a lot of people I would pay to punch in the rockets, but he wasn't one of them.  I felt kinda bad.

After I laughed for about a half hour.

Chicken Seizure Salad

BPOM told me:

 "I took that lady on the ambulance last Tuesday, we were called out for a unresponsive.  She was sitting in the car and said she thought she was going to have a seizure.  So, we transport her and on the way she started clucking like a chicken.  buck buck buck buck aback!!  Buck AAAch!!  BUCK AAAACK!!!!! While shaking her hands and arms.  After about 20 seconds of this, she stops, looks around calmly and asks, "What happened?"   "Well, you were clucking like a chicken".  "Oh, I had a seizure then.  I don't remember any of it".

Right.