A family member had an ER experience. Although she had a medical issue, her room was located in the area where they house the psych patients. 5 security guards in the immediate vicinity. Text to Mr. EDNurseasauras:
“Guy 2 beds down is talking about how he rat poisoned his family’s thanksgiving dinner, not enough to kill them. Just to let them know that he could. A few minutes ago they were each claiming to be a nurse. Further clarified, one of them was a CNA a few years ago. The other one has spent a lot of time in mental health institutions, which he considers fully qualifies as nursing education.”
Sigh. Just another day at the office.
Thursday, December 20, 2018
Tuesday, December 18, 2018
...and now for something completely different.
One of my favorite security guards accompanied me to my car. After being accosted in the parking lot late at night last year, the older guys always ask me if I want an escort. As I was parked in East Bum, I accepted.
Steve was having a laugh at one of the nasty frequent flyer drunks. He was being his usual nasty, liquor-fueled courageous self, standing at the door of his room, making demands, hurling curses. After being repeatedly told to get back into the room by Steve (and since the rest of us were completely ignoring him) he pulled down his pants and exposed himself.
"There you go! How do you like that? Huh? Huh? Take that!" He waggled his hips pointedly for good measure.
Everyone within earshot froze in place and stared....for about 4 seconds. Then life went merrily on, as usual. Nothing to see here.
The police were called.
"What do you want to do with him?", the officer asked.
Steve: "I wanted to tell him to just put him in a trebuchet and fucking launch him across the city".
Me: "Fetchez la vache!!"*
*you either get that quote and are laughing your butt off, or you don't.
*you either get that quote and are laughing your butt off, or you don't.
Sunday, December 16, 2018
Saving fil
One of my favorite PA's is Fil. It rhymes with Phil. He's a good guy, careful, doesn't get rattled. He's very funny in a dry, Sonoran Desert kind of way. He is also one of the few providers who not only reads ALL the notes, but scrutinizes the medications and past medical history. He sees me heading out to triage, and rubs his hands in gleeful anticipation. Well, for him gleeful is a silent nod or raising his eyebrows.
"How's the storm out there?" Meaning the waiting room. "What kind of trouble are we getting into today?"
"How's the storm out there?" Meaning the waiting room. "What kind of trouble are we getting into today?"
I do all I can to get a reaction out of Fil. It makes my day.
Fil appreciates when my triage contains nothing but a rambling quote.
Fil: "So I enjoyed your triage note. I think you were trying to say she was crazy".
Me: "Yep".
I had a patient who is well known for her bat-shit craziness and over the top hysterics. In the dead of winter, she managed to get a fish hook stuck in her thumb.
She, as usual, plunged into hysterics, begging the registration clerk to see a doctor right away because of the horrible pain and serious nature of her injury.
Apparently her cat jumped up on the table while she was sorting and organizing her fishing gear. Fluffy absconded with a triple hook lure, the hook embedded in the patient's hand when she tried to take it away.
I kept the triage note brief, eschewing punctuation.
"Fishing lure embedded in thumb while trying to catch a cat"
Coffee spewed. Mission accomplished.
Thursday, December 13, 2018
I just know
Auntie is my fav charge nurse on the 3-11 shift. I've known her for years, we work well together. She says really great things about me on my annual evaluation.
Auntie usually has something to say if I show my face for part of any other shift other than evenings. "I need you on my shift, you aren't going to work days now are you? I think we have a contract", she jokes....kind of.
I always reassure her that it is a special case, a swap for kid's school play, doctor's appointment, whatever.
I agreed to work an unprecedented 7-3 shift in its entirety for one of the junior older nurses (meaning about 10 years younger than me). For a rarely offered TNCC class.
Actual text exchange with Auntie after she perused the schedule for the following week:
"I see a D next to your name on the 10th. I believe that goes against our contract" Frowny face emoji)
"I'm working for LA so she could do TNCC. I did much soul searching, agreed to do it, and hoped you wouldn't see it" (laughing so hard I'm crying emoji)
"lol I'm watching you" (monocle emoji x 5).
Oh, I know you are.
Auntie usually has something to say if I show my face for part of any other shift other than evenings. "I need you on my shift, you aren't going to work days now are you? I think we have a contract", she jokes....kind of.
I always reassure her that it is a special case, a swap for kid's school play, doctor's appointment, whatever.
I agreed to work an unprecedented 7-3 shift in its entirety for one of the junior older nurses (meaning about 10 years younger than me). For a rarely offered TNCC class.
Actual text exchange with Auntie after she perused the schedule for the following week:
"I see a D next to your name on the 10th. I believe that goes against our contract" Frowny face emoji)
"I'm working for LA so she could do TNCC. I did much soul searching, agreed to do it, and hoped you wouldn't see it" (laughing so hard I'm crying emoji)
"lol I'm watching you" (monocle emoji x 5).
Oh, I know you are.
Monday, November 19, 2018
Dear Nurse-to be......
I recently took care of a high school student, mom confided that she wanted to be a nurse. I was curious what attracted her to nursing. She replied (monotone, and without eye contact):
"I want to be a nurse because I want to help people"
I love that response, but it's a knee-jerker.
So did I. I still do. So did we all.
If I knew then what I know now, I would say nurse candidates should be prepared for a different mind set.
Along with the mushy feels, having a sharp, inquiring mind, excellent critical thinking skills and an ability to problem solve is essential. Nurse Nancy expectations is a good start only.
I wanted to be a pediatric nurse. It seemed cool, helping sick kids. When I decided that I was, like, 7. I wanted to be an LPN. I liked the caps.
My parents wanted me to go to a 4 year college and be an RN, but I never thought I had the right stuff academically. Also, they didn't really have the money to waste on an average, unmotivated student who would probably drop out when there were a couple of genius siblings coming along. As the family was stretched kind of thin in spite of the earnings from my lucrative after-school baby sitting and pharmacy clerking, we compromised on a 3 year diploma program. I applied too late for the fall class after my high school graduation (ok, I procrastinated), but was immediately accepted for the following year. I took a six week nurse's aide course and did that at a busy city hospital for the year. Well, 11 months. I worked as a lifeguard for the next summer, it being in my DNA to sleep until 9:30 and be on the beach all day.
The three year diploma program prepared me very well. In my senior year I was, prophetically, voted most likely to be an ER nurse.
Which I did, about a year after I graduated, and I did work in pedi. In the last 40 plus years, I have worked in myriad other areas in addition to the ER. In the medical tent at sports events in my town. Giving flu shots. Lots of teaching. CPR, EMT's teaching first aid classes.
I burned out on teaching, but I still like the helping people part. I have become a bit more discriminating about the kind of help I provide because I am so inundated with tasks. I am really, really tired of the constant concierge demands. People are so grabby. Cab vouchers and gourmet meals do not exist in my realm. The drunks and constant psychiatric holds are tedious. We generally run out of turkey sammiches by 7 PM, and I refuse to make toast. Too many steps.
I never, not once, sought a degree in hospitality. My degree is is a BSN....bachelor of SCIENCE.
I use science every day. I dig it. I like how chemistry works, the human body is amazing. I like puzzles and problem solving. Human illness and injury present endless opportunities to figure out what makes them tick...or stop ticking.
Math is important, without solid math skills there would be medication errors galore. People would die. We convert pounds to kilos to ensure safe weight-based dosing. We figure stuff out like how to convert mcg/kg/min and how fast to run drips.
Thanks to relentless drilling from grade one, I can effectively utilize vocabulary and grammar to create coherent documentation.
I freaking love technology. I love computers, machines, gadgets, monitors, pumps, you name it. I'm always willing to learn new programs. I have fun figuring out work-arounds and trouble shooting. Vents are fun. New central monitoring system? New med pumps? Sign me up.
Am I a people person? Not so much. I like people less than I used to. It's not natural for me to put myself out there, unless a sense of humor (mandatory for a nurse) is deployed as an ice-breaker. I don a nurse-persona when interacting with patients. I've said it before: I am a good actress. More importantly, I am good at what I do.
Is it necessary to have empathy? Absolutely. But know that little pieces of your self (or soul) will be chipped away. Small bits of your humanity will be left by the wayside like breadcrumbs. I don't know for sure if these bits die, or will someday be reassembled. Maybe time simply blurs the painful memories. Its kind of like a hard candy shell forms, born of frustration, anger, and because of people who don't do your job constantly telling you how to do it. But mostly because of the hopeless cases, each drug addict you can't help, every sad, neglected, and pathetic elder alone with no family, every senseless death. You will weep buckets. It will change how you view illness, life, and death. And when you think you can't take another day, you will weep when someone survives against all odds...or someone says thank you for caring, and means it sincerely. You will bask in the glow of that save, that thank you, that hug, for days, weeks, You will come to know that is why you put up with so much bad. That one good thing that keeps you coming back.
After you've done the job for awhile, you will not be the same person. Do you have the stuff, dear high school student? I hope you do. But know that the stakes are high. The potential for doing for others? The sky is the limit. So is the potential for harm, not only to your patients, but to yourself. It's not easy. I'm not sure anything that important should be.
"I want to be a nurse because I want to help people"
I love that response, but it's a knee-jerker.
So did I. I still do. So did we all.
If I knew then what I know now, I would say nurse candidates should be prepared for a different mind set.
Along with the mushy feels, having a sharp, inquiring mind, excellent critical thinking skills and an ability to problem solve is essential. Nurse Nancy expectations is a good start only.
I wanted to be a pediatric nurse. It seemed cool, helping sick kids. When I decided that I was, like, 7. I wanted to be an LPN. I liked the caps.
My parents wanted me to go to a 4 year college and be an RN, but I never thought I had the right stuff academically. Also, they didn't really have the money to waste on an average, unmotivated student who would probably drop out when there were a couple of genius siblings coming along. As the family was stretched kind of thin in spite of the earnings from my lucrative after-school baby sitting and pharmacy clerking, we compromised on a 3 year diploma program. I applied too late for the fall class after my high school graduation (ok, I procrastinated), but was immediately accepted for the following year. I took a six week nurse's aide course and did that at a busy city hospital for the year. Well, 11 months. I worked as a lifeguard for the next summer, it being in my DNA to sleep until 9:30 and be on the beach all day.
The three year diploma program prepared me very well. In my senior year I was, prophetically, voted most likely to be an ER nurse.
Which I did, about a year after I graduated, and I did work in pedi. In the last 40 plus years, I have worked in myriad other areas in addition to the ER. In the medical tent at sports events in my town. Giving flu shots. Lots of teaching. CPR, EMT's teaching first aid classes.
I burned out on teaching, but I still like the helping people part. I have become a bit more discriminating about the kind of help I provide because I am so inundated with tasks. I am really, really tired of the constant concierge demands. People are so grabby. Cab vouchers and gourmet meals do not exist in my realm. The drunks and constant psychiatric holds are tedious. We generally run out of turkey sammiches by 7 PM, and I refuse to make toast. Too many steps.
I never, not once, sought a degree in hospitality. My degree is is a BSN....bachelor of SCIENCE.
I use science every day. I dig it. I like how chemistry works, the human body is amazing. I like puzzles and problem solving. Human illness and injury present endless opportunities to figure out what makes them tick...or stop ticking.
Math is important, without solid math skills there would be medication errors galore. People would die. We convert pounds to kilos to ensure safe weight-based dosing. We figure stuff out like how to convert mcg/kg/min and how fast to run drips.
Thanks to relentless drilling from grade one, I can effectively utilize vocabulary and grammar to create coherent documentation.
I freaking love technology. I love computers, machines, gadgets, monitors, pumps, you name it. I'm always willing to learn new programs. I have fun figuring out work-arounds and trouble shooting. Vents are fun. New central monitoring system? New med pumps? Sign me up.
Am I a people person? Not so much. I like people less than I used to. It's not natural for me to put myself out there, unless a sense of humor (mandatory for a nurse) is deployed as an ice-breaker. I don a nurse-persona when interacting with patients. I've said it before: I am a good actress. More importantly, I am good at what I do.
Is it necessary to have empathy? Absolutely. But know that little pieces of your self (or soul) will be chipped away. Small bits of your humanity will be left by the wayside like breadcrumbs. I don't know for sure if these bits die, or will someday be reassembled. Maybe time simply blurs the painful memories. Its kind of like a hard candy shell forms, born of frustration, anger, and because of people who don't do your job constantly telling you how to do it. But mostly because of the hopeless cases, each drug addict you can't help, every sad, neglected, and pathetic elder alone with no family, every senseless death. You will weep buckets. It will change how you view illness, life, and death. And when you think you can't take another day, you will weep when someone survives against all odds...or someone says thank you for caring, and means it sincerely. You will bask in the glow of that save, that thank you, that hug, for days, weeks, You will come to know that is why you put up with so much bad. That one good thing that keeps you coming back.
After you've done the job for awhile, you will not be the same person. Do you have the stuff, dear high school student? I hope you do. But know that the stakes are high. The potential for doing for others? The sky is the limit. So is the potential for harm, not only to your patients, but to yourself. It's not easy. I'm not sure anything that important should be.
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