Monday, May 25, 2009
Sunday, May 24, 2009
So darn slow
Bottomline: Patients should not feel like they have to leave without being seen by a doctor after sitting in a room in the ED for 4 hours. That is not 4 hours in the waiting room, that is 4 hours inside the ED because there are plenty of rooms for the patients to go to - we are rarely full for very long.
Wednesday, May 13, 2009
Thursday, April 16, 2009
Back from the Dead
Things went from bad to worse. The patient ended up intubated, scoped, and then decided to code. We worked on her for 25 minutes and then ultrasounded her heart and had no cardiac activity. Her husband was in the room and the ED attending broke the news to him. As I was turning off pumps and trying to kind of get her a little more presentable, I looked down and SHE WAS BREATHING ON HER OWN!!! We had been changing the paper roll in the cardiac monitor and darn if she didn't pop up in a normal sinus rhythm. So basically after 25 mintues of CPR and meds, shocked 6 times and probably 2 minutes of doing nothing this woman came back to life! We got her to the ICU and she was hanging in there.
I went up to check on her three days later and she had been extubated and was up and reading a book. HOLY COW! Apparnetly no neuro damage (go CPR) and she was breathing on her own. Crazy.
Yep - this is a new post!
Big news at Big City ED! Last summer my hospital decided they did not want travelers in the ED anymore so they hired 12 New Grads and 2 new ER nurses at one time. What the hell were they thinking? Basically the 2 new ED nurses are great, they did wonderful since they were already nurses they just needed some ED experience. Now 11 of the 12 new grads came off orientation on the same day (one couldn't cut it in the ED). It has been horrible. There have been some night shifts where the entire staff other than the Charge nurse and the Triage nurse came off orientation within in the past month or so. This has resulted in much discontent among the "old" staff. So much so that 4 of us have moved on to other hospitals. Yep, that is right - I have left Big City ED and moved on. So, I'm sure that I will have more new and exciting stories from Slightly Smaller ED.
Tuesday, July 08, 2008
One Year In
So after a year, I have realized a few things:
1. I could never be a med-surge floor nurse. You guys must have the patience of saints. We board a lot of admitted patients in our ED - that is tough work.
2. I don't think anyone has or goes to a doctor's office. I'm confused about why I can never get an appointment - they clearly aren't seeing patients - they are sending them all to the ED.
3. I don't like management.
4. Travelers are great to fill out your staff but they are the most complaining bunch of people I have ever met.
5. Please do everything you can to control your diabetes or not develop it. If I see one more infected to the bone toe I will vomit.
6. 27 years old is far too young to be on the liver transplant list because of alcoholic induced cirohsiss.
7. Med students are annoying as all get out - especially in July.
8. I like Urgent Care - use it, please.
9. I love both Haldol and Ativan.
10. I find many days I am working for my fellow nurses and not necessarily for my patients. I feel stronger about showing up to make sure my workmates don't have to work harder than normal than I feel about showing up for my patients. There is probably something wrong with that, but as long as I keep showing up and doing my part, I guess it doesn't matter what gets me there.
That is all.
Thursday, November 22, 2007
Monday, November 12, 2007
I also had, for the first time, one of our frequent fliers. This patient is actually very ill and so is one of the ones that you don't mind coming in repeatedly. So my preceptor is giving me the background info, yet leaves out one important piece of info: this patient is deaf. I didn't know that and I go in there talking to this patient and I get a look that equates to "you are really, really not very smart." But hey, I was also armed with Dilaudid and Phenergan - so I'm pretty sure I was forgiven!
Happy 232nd Birthday to the US Marine Corps! 10 Nov 2007
Thank you to all of our Veterans - 11 Nov 2007
Thursday, November 08, 2007
Final Exam Tomorrow
So, my ED has some serious personnel issues. We actually have more travel nurses than staff nurses. This means that the bulk of our workforce does not actually work for my hospital and they only stay 13 weeks at a time. Good things - they are experienced and bring in new perspectives. Bad things - they complain all the time, they come and go quickly. Well, this staff shortage came to a head the other night. I was on a 7a-7p shift with my preceptor and it was a good thing there were two of us. Somewhere along the way, we ended up with 3 ICU admits (no room in the ICU, they stay with us), a ruptured ectopic pregnancy (very sad, been trying to get pregnant for years), and another vag bleed. This is a lot to have in the ICU. And the waiting room was starting to really back up. Everyone was swamped with no kidding actually sick people. Not the usual overload of not really sick enough for the ED people that we normally get. We had like 2 or 3 rule out strokes, chest pains, amputated fingers, broken bones, guy who ended up with a ventriculostomy (drainage tube in the brain). Needless to say it was crazy and we were getting overwhelmed. Shift change comes around and the nurse educator (I'll blog about this idiot later - she gets her own entry) decides she needs to get into the patient assignment business (wrong answer, this is the charge nurse's job) and pisses everyone off. Pisses them off to the point that no one will take my last patient. I ended up staying late because no one would take my patient. I really didn't mind staying, but the thing that pissed me off was that they were trying to make a point but they would never stay late in the morning when we come in. So, selfishness wins in the end and it was a good lesson for me.
I do really like my job. I do enjoy going to work and I really am not bitter yet. Or at least not any more bitter than I was before I took up this career. My issues are basic management and leadership problems and really don't have anything to do with nursing.
On a positive note - there are days when I actually think I know a little bit of what I'm doing. I put an NG tube in a woman that had a self-proclaimed strong gag reflex (it probably helped that she was fairly comatose), I haven't killed anyone yet (to my knowledge), and my preceptor doesn't think I'm a total idiot (most of the time).
Tuesday, October 30, 2007
The ED smells bad
So, yesterday was oozing leg wound day in the ED. For some reason, the cellulitis/gangrene bus pulled up in front of our ED and let everyone off. And just so you know, peppermint oil spray does not make it any better. It actually makes the smell worse.
Saturday, September 29, 2007
More classes = More complaining
While we are on the topic of classes, let me rant about the lack of teaching experience. If you are going to call yourself a nursing educator then take a class or two on how to educate. Reading powerpoint slides is not education - that is patronizing. I can read the slides myself. You are wasting my time and your time if you stand in front of me and provide me with no other information than what is on the slide. You are being paid for your technical expertise and your self proclaimed vast amounts of experience. Share that with me.
I shared all of this with our new Nursing Educator in the ED. It was her first day. She LOVES me already.......
Friday, September 14, 2007
Ok, ok you talked me into it
So, nursing is no different from many other careers - your education never really ends. However, I was kind of looking forward to getting away from the classroom setting for a while. HA. This is not to be the case. Today, I spent 8 hours in a classroom (the second of two sessions) learning about how to analyze EKG strips. Ok, definitely a useful skill. A need to know. A professional requirement. I'm paid the same for this time as I'm paid on the floor. I have no problem learning it. I have no problem sitting in a classroom with 50 of my fellow new grads while you teach it to me. But DO NOT talk to me like I am a toddler. I am a grown human who graduated from college - I am not a total idiot, you do not have to speak slowly and over enunciate your syllables.
I am all about the pre-test for a lot of these things. Would it be that hard to give us a pre-test and if you pass it, then you just tested out of the period of instruction. I really think it would save us and the educators a lot of time and effort. And that way, they would have much more time for the people who don't understand the stuff and need a little extra instruction. Some of us had this stuff in school and listening to it again in such a patronizing way is like sticking ourselves in the eyeball with the calipers. It is really sad when I would rather be reading my required reading for my Marine Corps Command and Staff course than listen to Heavy D (that is what we nicknamed the instructor owing to her big size) drone on about junctional rhythms again.
So, I am a person who learns best through doing things. Lucky for me, my preceptor understands this and she is of the, "watch one, do one, teach one" philosophy. I like this - I get to do a lot of new things this way. The new grads in the ED are way ahead of our counterparts in the ICUs. They are not allowed to do anything. They are not even allowed to suction their patients, they don't pass meds, they can't even document in the patient chart. They are still being treated like students, complete with clinical conferences where they discuss their clinical experiences for the day. I'm all about supervised practice, having preceptors, I don't want to be thrown to the wolves all on my own too soon. But it is almost as if they have gone back in time to their first semester in nursing school. I get that we don't have very much experience, but the way you get experience is by doing things, not just talking about them.
Ok enough. I have two days off in a row - I've got to get a whole lot of fun in during those 48 hours!
Friday, September 07, 2007
Last Post - probably
Do I think that a new grad program in an ED is for everyone? Absolutely not. There were people I interviewed with who would have been a pile of mush after the first day. My management had the foresight to not hire them - go figure. All four of the new grads in my unit have ED experience both prior to and during nursing school, 3 of us are 2nd degree, and the one who is not is very mature. I mean heck - I have spent 11 years in the Marine Corps and been to two war zones - chaos and multi-tasking is not a stranger to me! Ok, soap box done.
I, so far, really enjoy my co-workers. I have not seen a nursing staff yet with the morale of this group of nurses. They actually like each other AND, shocker of all shockers - they like their job!!! I have yet to hear someone complain about the nursing shortage or the patients or how much they wish they had never gone into nursing. And believe me, we are busy enough to invite some complaining. At any given time, we can have up to 38 patients in our ED - not counting those in the waiting room - and oh yeah - those who are "boarding" waiting for rooms upstairs. Plus, we are a teaching hospital with like 900 residents and students milling about. I promise - I haven't forgotten my roots - I'm nice to the students (even the medical students). The nurses I work with actively seek out ways to help each other. They ask each other questions about patient care, they look up meds if they need to, they work with the doctors without that animosity that always seems to develop. Short story - I think I have found the jackpot and what a great place to start working!
So, chances are this will be the last post on this site. Who knows - I might make some more.....