Memorial Day 2009

Nick F., Jamie E., Megan M., Joe M.

So darn slow

I think someone needs to explain the term Emergency to some of our doctors. In my job, we see just enough patients that we should be busy most of the time but no one should really be waiting in the waiting room. The majority of the patients are non-acute and really could be in and out pretty quick. Even the acute patients are not that difficult and are usually consulted on pretty quick so the ED docs can move on. We don't have many med students or residents so we don't have to wait for that entire process to play out either.

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.

Its Ok.

So, I've started my new job. It's Ok. Lots of the same issues as my last job but a slightly different clientele. And hey, it is nice to be paid more, work slightly less, and get free parking! I'm still getting used to the fact that my 2 years of Emergency experience makes me one of the more experienced people there.

Back from the Dead

My last weekend shift at Big City ED ended up being one of my most interesting. I was given a patient early in the day who was a chronic alcoholic and was having some GI bleeding. Her hematocrit was very low - low enough to get a super quick, non-crossmatched blood transfusion. So, I had two large bore IV's in her, had her on the cardiac monitor and was transfusing blood in the course of about 15 minutes after her arrival in the ED.

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!

So, I'm contemplating changing the name of the blog now that I have been doing this for a year and a half. I've precepted two cycles of new grads at this point so I don't really consider myself a new grad anymore. I'm thinking just Pissed Off Nurses or Pissed Off ED Nurses but that sounds a bit redundant since I have yet to meet an ED Nurse who isn't pissed off.

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.

One Year In

So, I have officially been a registered nurse for a year. I can't believe it has been a year, since I really don't feel any different than I did a year ago!

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.

Gobble, gobble

Happy Thanksgiving! I did not have to work, but I do have to work all of this weekend, so no shopping for me. Oh well, I don't have any money anyway!

Good Day

I worked yesterday. It was a good day in the ED. Not super busy, but not totally slow either. We had a whole lot of kids - it is croup season - fun. I did start an IV on a 4 month old. My first time and I got it on the first try. Probably beginners luck, but I was pretty happy.

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!

Belated

I apologize for my tardiness on both of these occassions:

Happy 232nd Birthday to the US Marine Corps! 10 Nov 2007

Thank you to all of our Veterans - 11 Nov 2007

Final Exam Tomorrow

Tomorrow is the final exam for my critical care class. There are not too many things that I have been less motivated to do. I did, however, get paid to study for 4 hours today. So, one of the girls that started with me has been fired from the ED. She did not pass the midterm or the makeup midterm which was a stated requirement for staying in the ED. True to form, the management handled the whole thing in the most inappropriate manner possible. I wouldn't have even fought to stay in the ED (she did) if they had treated me that way. It will be tough for me to ever respect these people again. I will not make waves over this because there are enough personnel issues in the ED right now, I think it would be counterproductive on everyone's part to make a stink. However, if things don't change for the better, I doubt I will stay where I am longer than a year or two. The main reason for staying that long is that I would lose my signing bonus if I left before a year. But also, I feel like I need to stay at least that long in one place in order to really solidify my skills before moving on. Besides, like I said in my last post - I really like the people I work with and honestly, I'm new and can avoid the management fairly well.

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).

Happy Nursing!

The ED smells bad

So, we are almost finished with our ICU class - this is really, really good news. We got lectured last week on our attitude in class - I won't go into the whole thing, suffice it to say, we were not the problem but we are now silent, never ask questions and no longer provide our opinions, even when asked. Anyway, I have decided that I love the people I work with, but I have no respect whatsoever anymore for the people I work for. They handled an easy situation unprofessionally and with no respect at all. Someone never told these people that respect works both ways - you can't expect it if you never give it.

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.

More classes = More complaining

So, we have had 3 of the 13 ICU classes I am being forced to take as part of my orientation. Yes, I said ICU and yes I am working in the ED. The classes are definitely geared toward the ICU and not the ED. Here is the deal - most of the time, by the time a patient makes it to the ICU there is at least an inkling of what is wrong with the patient. This is not so in the ED. The patients come in and unless they have a previous history of their problem or they are bleeding profusely - it is kind of like a game of Clue to figure out the problem. Therefore, our approaches to our patients are different. I am not complaining about taking the course. It is a great review and I needed a review since I had almost 4 months off between finishing school and starting my job. Besides, they pay me the same. But is it too much to ask for them to throw in one slide that says, "oh yeah - this is probably what you might see in the ED patient..."? I don't think so.

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.......

Ok, ok you talked me into it

Ok, ok. You talked me into it. I will continue to post - a little. The title for the blog has changed a little - it is now Pissed Off New Grad Nurses. I'm not as creative as the person who came up with the original name - this was the best I could do. One other change - I will now be blogging with my real first name. I will still not divulge what school I went to, what hospital or what town I am working in, and all my coworkers names will be fake - I've got to keep some anonymity!

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!

Last Post - probably

Well, I realize it has been several months since my last post. In that time, I took and passed my NCLEX (with the minimum number of questions - take that whomever waitlisted me for nursing school!), moved to a new city and started my job as a Registered Nurse in the Emergency Department. Yes, I am a new grad in an ED. Yes, I realize this pisses off many experienced nurses who do not feel that there is a place for new grads in the ED. The hospital I am working at has a phenomenal program for new graduates. At no point will I be unleashed on patients without my preceptor, clinical leader, clinical educator, and nurse manager feeling that I am entirely well prepared. I will be taking the same 3 month classroom course as the ICU new grads at my hospital (in conjunction with supervised clinical work) so I will be well prepared to serve my patients. I will spend at least 4 months under an experienced preceptor, with the option to extend that if I (or my boss) thinks I need it.

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.....

It is about darn time!

Well, it was about darn time but now I am no longer a student nurse and I am now a graduate nurse! Yep - it is true - my school in it's infinite wisdom has awarded me a Bachelor of Science degree in Nursing. So now I am in that really fun limbo period where I am not a student, but not a real nurse yet. I don't start my job until the end of August, so I am fulfilling my duty to the US Marine Corps and at the same time studying for my NCLEX. Ok, well I am a little less enthusiastic about that - just can't seem to motivate myself. It will come - especially after I catch up on all the re-runs of the TV I missed this year!