It still astounds me that the single most important need (aside from narcotics) for individuals in the ER is a meal tray. I have come to hate the hours between 4:30 and 6:30 PM. There is no room service available in the ER, unless the patient is a boarder (psych patients who have been there for days, usually). People are like rabid dogs when it comes to food, "My mother hasn't had a thing to eat all day!!", like it's my fault that mother hasn't wanted to eat, been vomiting, or has been lying around too weak to eat for the weekend because you went away.
Here is a handy guide as to why food is not on my immediate list of important tasks:
1. If you have come to the emergency room for abdominal pain, nausea, vomiting, or bleeding out the ass, we are not feeding you.
2. If your blood pressure is 250/120, and I am trying to lower it by giving various medications, we are still not feeding you.
3. If you come in with chest pain, we are not feeding you until you are seen by cardiology, which is after an EKG and many hours. Don't ask.
4. If you eagerly drink both quarts of the oral contrast (berry or vanilla flavored) for your abdominal CT and declare that it was delicious and hit the spot because you were so hungry, I am not feeding you anything else.
In case you are wondering what kinds of delicious treats and culinary magic we are able to whip up after the real kitchen closes, here is a short list of items we keep in our ER"s "kitchen".
Apple juice, cranberry juice, orange juice, milk
Gingerale (regular and diet)
Graham crackers
Saltines
Fruit cup
Custard
Peanut butter (individual servings)
Sandwiches (4 each: turkey, veggie, roast beef, ham and cheese)
Popsicles
At BWOM and the med center we had Lorna Doone's and Oreo's, which the nurses mostly ate. And REAL Coca-Cola. But not at Pseudocity.
Our refrigerator at Pseudocity is locked, by which I mean both the freezer and refrigerator. Padlocked. In order to unlock it, you must reach behind the fridge and find a magnet to unlock the cracker cabinet, then retrieve one of the keys to the padlocks for the fridge. The ginger ale is under the counter. It is unlocked.
It takes more concentrated effort to unlock food than narcotics, and takes twice as long. On the off-shifts when the kitchen is closed, the real food goes quickly in spite of large signs that says "Do not give out sandwiches before 6:30 PM!!". So does any motivation to make a meal out of crackers and peanut butter for the most part.
We don't have any soup or broth for grandma, or ovaltine or hot chocolate. We don't even have tea. And the coffee is just….horrific.
I am not going to feed your children. The cafeteria is that way. If it is closed, there are vending machines in the lobby with an array of delicious cereal, flash frozen hamburgers that just need microwaving, and candy. And Mac's is down the street.
Thursday, September 4, 2014
Wednesday, September 3, 2014
Reflection, Starting Over
I came across this post from a couple of years ago:
For years and years I worked at least two and often three jobs at the same time, but at at least one was always in the ER. I have had lots of different experiences. I've worked in schools, as a camp nurse, in home care, employee health, a travel clinic, a same day surgery unit, pediatrics, telemetry, and med surg. I have worked in large medical centers and community hospitals. I been a staff nurse, charge nurse, supervisor, director. I have done independent QA audits, worked for an agency. I have worked days, evenings, nights, weekends and holidays. I have worked from within walking distance to my job or traveled over and hour. I have worked with individuals who have become lifelong friends and others whose names I can't remember. I have been both student and a teacher. Sometimes I have felt unsure of myself and terrified, but have grown enough as a nurse to feel comfortable and competent, smart enough to know that I don't know everything. I have done a lot, seen a lot, learned a lot.
I have been restless and not altogether happy with my job lately. For the last 3 years, it has been my only job. It is close to home and I work with a small group of nice, accommodating people in a small ER.
I have been thinking that maybe it is too small. I feel as though I am losing my skills as an ER nurse. Few codes, trauma as rare as hen's teeth. I am SO TIRED of the constant parade of drug seekers and the pressure to just make everyone happy, even if what they want isn't what they need. Want antibiotics for a virus? Sure! An Xray for your three week old ankle injury that you insist must be broken? No problem! Dilaudid for your migraine of 10 minutes? Absolutely! Why do you need doctors with experience and expertise when you have WebMD? All we ask in return is positive customer satisfaction scores.
I have never felt less valued as a professional nurse anywhere. It's not my boss, she's great. It's the organization we work for. Our director talks a good game, but there is no visible support for the activities of nursing. There is a part-time research nurse, nobody really knows what she does and I have never seen her. Committees? The same dull people with the same dull ideas.
I have a really crappy attitude and no real goals since finishing school. For the first time in a long time I have no concrete plans to move on, move up, or move out. Maybe it is because I am working only one job in a small town, I don't know. I am in a real rut. I have to work about 10 more years until I can retire and that pisses me off. I can't see myself doing what I'm doing for another 10 years.
I keep telling myself I am lucky to have a job.
And then I didn't have a job two years later. Serves me right for being too comfortable and complacent. While I didn't exactly lose my skills, many of them were seriously misplaced and difficult to regain.
The funny thing is, if I hadn't been forced to find a new job (actually, three new jobs) I would still be in the same rut. But…it has not been a seamless transition. I have had to learn, and re-learn, a lot. I finally broke down and bought a couple of sets of new scrubs. Yes they are black and grey, but color blocked and not cutesy. OK, I drank the Kool-Aid of my fashion forward co-workers, but just a little sip. Anyway, the unit teacher noticed my new and smaller sized duds and said I looked like I had lost a lot of weight and wanted to know how I was doing it. "Oh, you know….stress and not eating", I joked. But I really wasn't. It isn't the people, it is the environment and my own need to do everything flawlessly. Of course, that is near to impossible.
She had some helpful thoughts about not being too hard on myself. "It takes about a year for a nurse to get completely comfortable in this busy environment, I think you're doing great". I have a lot of trouble reporting off to the next nurse sometimes, especially if I don't feel like I've done everything. I never want to be "that nurse" who walks off the floor in the middle of a shitstorm….can't do it.
But I get more comfortable every day. And I still tell myself I'm lucky to have a job.
For years and years I worked at least two and often three jobs at the same time, but at at least one was always in the ER. I have had lots of different experiences. I've worked in schools, as a camp nurse, in home care, employee health, a travel clinic, a same day surgery unit, pediatrics, telemetry, and med surg. I have worked in large medical centers and community hospitals. I been a staff nurse, charge nurse, supervisor, director. I have done independent QA audits, worked for an agency. I have worked days, evenings, nights, weekends and holidays. I have worked from within walking distance to my job or traveled over and hour. I have worked with individuals who have become lifelong friends and others whose names I can't remember. I have been both student and a teacher. Sometimes I have felt unsure of myself and terrified, but have grown enough as a nurse to feel comfortable and competent, smart enough to know that I don't know everything. I have done a lot, seen a lot, learned a lot.
I have been restless and not altogether happy with my job lately. For the last 3 years, it has been my only job. It is close to home and I work with a small group of nice, accommodating people in a small ER.
I have been thinking that maybe it is too small. I feel as though I am losing my skills as an ER nurse. Few codes, trauma as rare as hen's teeth. I am SO TIRED of the constant parade of drug seekers and the pressure to just make everyone happy, even if what they want isn't what they need. Want antibiotics for a virus? Sure! An Xray for your three week old ankle injury that you insist must be broken? No problem! Dilaudid for your migraine of 10 minutes? Absolutely! Why do you need doctors with experience and expertise when you have WebMD? All we ask in return is positive customer satisfaction scores.
I have never felt less valued as a professional nurse anywhere. It's not my boss, she's great. It's the organization we work for. Our director talks a good game, but there is no visible support for the activities of nursing. There is a part-time research nurse, nobody really knows what she does and I have never seen her. Committees? The same dull people with the same dull ideas.
I have a really crappy attitude and no real goals since finishing school. For the first time in a long time I have no concrete plans to move on, move up, or move out. Maybe it is because I am working only one job in a small town, I don't know. I am in a real rut. I have to work about 10 more years until I can retire and that pisses me off. I can't see myself doing what I'm doing for another 10 years.
I keep telling myself I am lucky to have a job.
And then I didn't have a job two years later. Serves me right for being too comfortable and complacent. While I didn't exactly lose my skills, many of them were seriously misplaced and difficult to regain.
The funny thing is, if I hadn't been forced to find a new job (actually, three new jobs) I would still be in the same rut. But…it has not been a seamless transition. I have had to learn, and re-learn, a lot. I finally broke down and bought a couple of sets of new scrubs. Yes they are black and grey, but color blocked and not cutesy. OK, I drank the Kool-Aid of my fashion forward co-workers, but just a little sip. Anyway, the unit teacher noticed my new and smaller sized duds and said I looked like I had lost a lot of weight and wanted to know how I was doing it. "Oh, you know….stress and not eating", I joked. But I really wasn't. It isn't the people, it is the environment and my own need to do everything flawlessly. Of course, that is near to impossible.
She had some helpful thoughts about not being too hard on myself. "It takes about a year for a nurse to get completely comfortable in this busy environment, I think you're doing great". I have a lot of trouble reporting off to the next nurse sometimes, especially if I don't feel like I've done everything. I never want to be "that nurse" who walks off the floor in the middle of a shitstorm….can't do it.
But I get more comfortable every day. And I still tell myself I'm lucky to have a job.
Thursday, August 21, 2014
Friday, August 15, 2014
Playing Nicely With Others
I try to be nice and pleasant to everyone, until it's time not to be. One of my young co-workers has a tendency to rail (volubly) when there seems to be an over-abundance of career drug seekers in the department. This makes her furious. I keep my mouth shut and vent my frustrations in obscurity. There is nothing I can do about it anyway, so I direct my energy elsewhere.
"She will get into trouble with that mouth, one of these days", observed another co-worker. She has a tendency to mouth off in areas where patients and visitors can hear. She has not yet learned that there is absolutely nothing she can do about it.
Most of the time patients are told by the provider that they can take tylenol or motrin for their pain. The provider will then leave it up to the nurse to get the signature on the discharge instructions, whereupon the patient will be pissed and continue to argue for narcotics. It is not so much education oriented as it is getting through the instructions, getting them to sign, and having them leave. With a minimum of bullshit. This is not always the case.
Me: "I have your instructions and will go over them with you now". The alleged injury was minimal.
Unhappy Patient: "So all I'm getting is Motrin? I explained how bad my pain was, this is bullshit". The patient had not iced, elevated, or taken OTC pain killer in several days.
Me: "Yes, I'm sorry you are not happy with the medication the doctor has prescribed. Perhaps if you use it the suggested three times per day as directed, and be sure to take it with some food so it won't irritate your stomach"
UP: "Motrin is not a medication! I've been taking motrin, it does absolutely nothing for the pain, this is bullshit. There has to be something really wrong for it to be this painful". Patients frequently forget the timeline of their own fiction.
Me: "Yes, I understand. Also, in addition to the Motrin, you should rest it as much as possible and use ice on it 20 minutes at a time. Elevating will help minimize or relieve any swelling, which will also facilitate healing"
UP: (getting louder) "This was a waste of time! Nobody cares about my pain! This is bullshit". The security guard now makes his presence known in a casual manner, but an obvious presence nevertheless.
Me: "Yes, I'm sorry you were not happy with the care, sir. Please follow up with your own provider if the condition does not improve or gets worse after following these instructions. Also, please lower your voice as we have a zero tolerance policy on shouting and cursing. I hope you feel better soon. Please sign here, and this is your copy"
I do not encourage too much discussion. What is the point? I do not egg them on. I do encourage them to complain about their dissatisfaction (in writing) to my boss/administrator/CEO. I stay pleasant and noncommittal. My co-worker frequently makes the mistake of either being defensive or confrontational. This is not a practice that is healthy for anyone.
Often the patient will refuse to sign, frequently accompanied by:
1. Throwing the discharge instructions on the floor and stomping out of the department on the affected, excruciatingly painful ankle.
2. Stomping out of the department after throwing the discharge instructions on the floor, and then stomping back in to demand the name of the treating provider, which was printed on the instructions. I helpfully circled it after retrieving from the trash.
3. Storming out of the department while loudly complaining on the cellphone what bullshit the patient had been subjected to (with the excruciatingly painful elbow) and then having to return to ask for the phone charger he left in the room.
One patient demanded both a new doctor AND an new nurse, as she did not consider the bedside manner up to her standards based on her past innumerable visits. That nurse was not my mouthy co-worker, oddly enough.
"She will get into trouble with that mouth, one of these days", observed another co-worker. She has a tendency to mouth off in areas where patients and visitors can hear. She has not yet learned that there is absolutely nothing she can do about it.
Most of the time patients are told by the provider that they can take tylenol or motrin for their pain. The provider will then leave it up to the nurse to get the signature on the discharge instructions, whereupon the patient will be pissed and continue to argue for narcotics. It is not so much education oriented as it is getting through the instructions, getting them to sign, and having them leave. With a minimum of bullshit. This is not always the case.
Me: "I have your instructions and will go over them with you now". The alleged injury was minimal.
Unhappy Patient: "So all I'm getting is Motrin? I explained how bad my pain was, this is bullshit". The patient had not iced, elevated, or taken OTC pain killer in several days.
Me: "Yes, I'm sorry you are not happy with the medication the doctor has prescribed. Perhaps if you use it the suggested three times per day as directed, and be sure to take it with some food so it won't irritate your stomach"
UP: "Motrin is not a medication! I've been taking motrin, it does absolutely nothing for the pain, this is bullshit. There has to be something really wrong for it to be this painful". Patients frequently forget the timeline of their own fiction.
Me: "Yes, I understand. Also, in addition to the Motrin, you should rest it as much as possible and use ice on it 20 minutes at a time. Elevating will help minimize or relieve any swelling, which will also facilitate healing"
UP: (getting louder) "This was a waste of time! Nobody cares about my pain! This is bullshit". The security guard now makes his presence known in a casual manner, but an obvious presence nevertheless.
Me: "Yes, I'm sorry you were not happy with the care, sir. Please follow up with your own provider if the condition does not improve or gets worse after following these instructions. Also, please lower your voice as we have a zero tolerance policy on shouting and cursing. I hope you feel better soon. Please sign here, and this is your copy"
I do not encourage too much discussion. What is the point? I do not egg them on. I do encourage them to complain about their dissatisfaction (in writing) to my boss/administrator/CEO. I stay pleasant and noncommittal. My co-worker frequently makes the mistake of either being defensive or confrontational. This is not a practice that is healthy for anyone.
Often the patient will refuse to sign, frequently accompanied by:
1. Throwing the discharge instructions on the floor and stomping out of the department on the affected, excruciatingly painful ankle.
2. Stomping out of the department after throwing the discharge instructions on the floor, and then stomping back in to demand the name of the treating provider, which was printed on the instructions. I helpfully circled it after retrieving from the trash.
3. Storming out of the department while loudly complaining on the cellphone what bullshit the patient had been subjected to (with the excruciatingly painful elbow) and then having to return to ask for the phone charger he left in the room.
One patient demanded both a new doctor AND an new nurse, as she did not consider the bedside manner up to her standards based on her past innumerable visits. That nurse was not my mouthy co-worker, oddly enough.
Wednesday, August 13, 2014
Keeping Count
I had inexplicably become the week's IV Ninja, having been asked to start a number of difficult ones. Apparently I am more accommodating than Best Paramedic on the Planet who always seems to have 5 (minimum) other tasks to accomplish before he can get to it. I have learned to trade tasks, such as requesting vital signs or medication for one of my patients. This usually works well.
I came out of the 3rd room within 45 minutes after my latest success to, "Did you get it? Did you get the labs?" Yes, and yes.
"But I think that's it", I said. "I am probably out of Hail Mary's for the day, maybe even the week."
"Indeed", said Partner sagely. "Like heartbeats, there are only a finite number of miraculous IV starts. You never know when it will be your last, grasshopper".
True. Karma is a bitch.
I came out of the 3rd room within 45 minutes after my latest success to, "Did you get it? Did you get the labs?" Yes, and yes.
"But I think that's it", I said. "I am probably out of Hail Mary's for the day, maybe even the week."
"Indeed", said Partner sagely. "Like heartbeats, there are only a finite number of miraculous IV starts. You never know when it will be your last, grasshopper".
True. Karma is a bitch.
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