ERnurseyERnurseyAn ER nurses blog. Stories are true to life, sometimes graphic, often humorous. Some healthcare policy. 
Articles
Unwelcome guest
2008-06-07 21:24:00 Being a beautiful Saturday I decided to take the kids and Kayaks up to a nearby lake. When I pulled the second kayak down off the rack I found a big, fat, juicy black widow spider on my arm! Fortunately I saw it right away and shook it off and stomped the hell out of it, but I'll bet my shrieks could be heard for miles.Black widow spider bites can be very painful, I would just as soon avoid all that. Not to mention that I find spiders to be the most gross and creepy things ever - I'd take ten rattlers over on big spider any day.I'll be calling the bug man first thing on Monday and in the meantime I'll be giving the garage a wide berth. *shiver* More About: Guest
Things that made me happy today, and things that didn't
2008-06-07 05:02:00 As I was driving to work today I passed a field of horse and their gangly-legged babies. The babies were all laying over flat on their sides, twitching their tales. It was apparently nap time in the nursery.My third patient of the day called me a "fucking cunt" when I refuse to give him any narcotics until he produced a ride.I parked by a Jasmine vine that smelled so heavenly I just wanted to sit there forever and breath that wonderful scent.While I was helping another nurse clean an incontinent, demented 92 year-old nursing home patient she somehow managed to kick me in the chest. Who knew a wizened up little old lady had that much flexibility?The wind was blowing and it cleared all the haze away so the mountain tops were so clearly visible they looked not more than a mile away. It was in the eighties and yet the peaks are still snowy.I had to spend half of my shift in triageI saw an eagle.A four year-old puked down my leg in triage. I must be getting old, the reflexes ain't ... More About: Today , Happy , Made , Things
Contrasting Patients
2008-06-04 06:29:00 First nursing home patient of the day was sent in for vomiting twice. She had a UTI, no fever so we gave her a bag of IV fluids, and antibiotic and sent her back - the staff could have just as easily called her MD and taken care of that from the facility.The second was sent in for not acting right. He was nearly comatose, skeletal and so profoundly dehydrated that his serum sodium was sky high - 179! He didn't get in that condition in the space of a few hours - it spoke of days of no fluid or food intake and gradually deterioration not recognized by the people who he depended on for care.Patient one didn't need to come to the ER and patient two should have been there a week ago. More About: Patients
Grand Rounds
2008-06-04 05:02:00 This weeks edition of Grand Rounds is brought to you buy The Happy Hospitalist so 'turn off your dang cell phone' and head on over!
Once again the government proves that they are idiots
2008-06-03 05:33:00 Home dialysis. It is cheaper, safe, more effective and results in less hospitalizations.In the article one of the patients had even returned to work, another was off all his blood pressure medications.But it has to be done 6 times a week instead of the three treatments done in the dialysis clinic so Medicare won't pay for it.They won't pay for it even though it is cheaper than the clinic treatments as well as savin money on hospitalizations. The government is made up of pencil pushing, bean counting MORONS!!!!!h/t Kim More About: Idiots , Government
Why I got pulled into the office today
2008-06-03 04:51:00 The mother of the ten-year old OD patient summoned me as I was walking by. I entered the room where the chubby sullen patient sat with equally chubby, toothless and tattooed parents on either side of the bed. (And by chubby I might mean grossly obese.)"he's trying to take his needle out." She told me, meaning his IV. I was taken aback for a minute, this was a TEN year old with a PARENT on either side of the bed and sure enough he had been picking at the tegaderm.I told the mom "Well don't let him." Duh. to which she replied "oh I can't make him, he's ADD."WTF?I looked the kid straight in the eye and told him if he pulled out the needle I most assuredly would be back to put another one in AND tie him to the bed to prevent him from doing it again since he couldn't seem to control himself.I also mentioned to the mother that drugging her child might not be necessary if she would engage in a little parenting.The kid behaved like an angel for the rest of his stay with us.The seco... More About: Office , The Office , Today
Old Way, New Way
2008-06-01 03:38:00 To any state contemplating nurse to patient ratios, please learn from California's mistakes.Old way: Med-surg floor with 32 patients would be staffed with a charge nurse, a unit clerk, two or three aides and 4 RN's. Each RN would have 8 patients but would have a clerk to answer phones and take off orders, aides available to answer lights, help with baths, transferring patients and passing trays. The charge nurse was also available to help with lifting and moving along with helping the nurses with med's and stuff.New Way: Same floor. 4 RN's each with 5 patients, the other twelve-bed's sit empty because there is no staff. There are no ward clerk, no aides. There is a charge nurse that covers two units . No one to answer the phones, no one to help you with baths, lifting and transferring, passing trays or implementing orders. The charge nurse is supposed to be the break nurse. She is responsible for breaking 9 people whose break time amounts to 11.25 hours - not including...
Welcome to entitlement land
2008-05-31 02:06:00 I was discharging a young lady who had called an ambulance because she didn't want to walk to be seen for her armpit abscess. I was reviewing the discharge instructions when she interrupted me in the middle of a sentence - "you gonna give me dressing stuff?" Now to be honest, we often do give dressing supplies for a couple of days but this girl was just too much, she had been rude when she got sent to triage, she was snotty when she had to wait for the doctor, who was in the middle of a code. She had asked for a blanket, a phone and a sandwich the minute she got put in the room. Frankly I was fed up and not inclined to give her any favors so I told her that mini pads make great dressings - which they do, we recommend those and maxi pads quite a bit - they are cheap and stick inside your clothing or stick good to tape. Then she wanted a free cab and when she was told no she snottily said "WELL......I GUESS I'll just have to WALK since you won't pay for a cab."Yep, I guess yo... More About: Land , Entitlement
Message to administration
2008-05-28 06:20:00 I got a letter marked CONFIDENTIAL in the inter-departmental mail today.I opened it with a lot of trepidation. Inside was a letter informing me that it was the end of the month and I had failed to get my PPD. It went on to say that I had until Friday to get it or......I WOULD NOT BE ALLOWED TO WORK.So, Attention Administration and employee health......That is not a punishment! More About: Message
Memoral Day
2008-05-26 14:09:00 God Bless the troops.I give my thanks to all the members of the armed forces, past and present, who have sacrificed so much to ensure we can live in a country where we are free to believe what we want and speak our minds.Where there is always abundant food on my table.Where I, a woman, can enjoy the same freedom as a man.Where I can openly badmouth politicians without fear of retribution.Please take this day as it is intended, to remember our service men and women. Visit a military graveyard, invite a troop members family to a picnic, send a care package to the troop overseas to say thanks.
How the ER Works
2008-05-25 16:38:00 A previous commenter wondered what we do when we aren't in triage so I thought hey, I bet a lot of people really don't know much about the ER other than what they see on TV, which aren't very accurate.In my ER when you come in the front door you see a 'greeter' who takes some basic info to get you into the computer - name, date of birth, social security number and why you are there. Then you see the triage nurse, this may be right away if the ER isn't busy but more likely you will have to sit and wait a bit.Triage means to 'sort.' We use a 5 level triage system but what it boils down to is: can go to fast track or not. for the 'or not's' they can either wait or need a bed now. The triage nurse is very important, they need to have the experience to sort through all the extraneous information people give to figure out what might be going on with the patient and how sick they really are. In my ER we don't even think about putting you in triage until you have at least a... More About: Works
Ouch, my aching back
2008-05-24 21:26:00 Healthcare is hard on our backs.There is a lot of lifting and moving of people that aren't able to assist us. People are heavier than ever - it used to be a rarity to have a patient over 300 pounds and now we see several every day. Many employers pay lip service to 'no lift policies' but do they really provide the equipment?For instance, in my hospital there is supposed to be a special, slippery sheet placed under every patient to help scoot them up in bed. These sheets have to be laundered after each patient. We might be able to scrounge up five. We see 250 patients a day. You do the math.We are supposed to have a lift belt. We have 78 employees in our department. We have no lift belts. You do the math.We are supposed to have a hoyer. We do, it has 1 sling that has to be laundered after each patient. You do the math.Patients have to be moved several times every day, in and out of bed, on and off the toilet, ambulated, turned, scooted up in bed and so on. Healthcare s... More About: Back , Ouch
SPAMMED!
2008-05-22 16:00:00 I seem to have been spammed by someone annoying but not trying to sell anything. I've turned the word verification on for a bit, sorry - I know that feature is annoying but I hope it won't keep you from commenting.
Burnout Meme
2008-05-20 04:39:00 Monkeygirl created a new meme and I've nominated myself to play.Six things that are causing me to burnout:1. JCAHO I've explored this subject to death but their self-procreating idiocy and it's attendant reams of paperwork to prove that you are doing excellent patient care without taking into account that nurses now spend all their time charting instead of actual patient care. To meet all their requirements most hospitals have a nurse to administrator ratio of 1:1 - complete twaddle. Take the clipboards away and take care of the patients for crying out loud.2. Not having the equipment to do my job. Today I had a shocky patient and needed to do a manual BP but there was not one working cuff in the department. Last week the hospital was out of pediatric IV catheters - what in the hell do you want me to use? a 16 guage on that neonate?3. Lazy ass co-workers Stock your fucking rooms. I'm busy too but I get it done. If you take the last blanket out of the blanket wa... More About: Meme , Burnout
Music to my ears
2008-05-19 05:27:00 We had a float from the telemetry floor today that had never been in the ER so she got buddied up with me.That being said, we had the worst day I think I have ever had in the ER - and I've had a lot of them.At 5 pm there were 14 hallway patients, 42 people waiting to be seen in fast track and the main ER and 4 ambulances waiting to unload patients. The ER nurses had been working like dogs all day but not making any headway against the never ending tide of sick and injured. No one had a break, a lunch or even a pee.I could go on and on about how awful it was but you can use your imagination. It was about that time that the float nurse said "I get it now." Having seen it with her own eyes she finally understood why we were so pushy about getting the patients to the floor.Music to my ears. More About: Ears
Triage
2008-05-18 05:48:00 Let me start by saying I hate triage.But everyone has to have their turn and today it was mine. So with only a little grumbling I headed up to "the box."The first card I pick up says "lump." I call the patient in and it is a twentish male who states he has had a lump on his neck for 3 years. Yes he has a doctor. No he has not gone to his doctor about this problem. No nothing has changed recently. I want to say, but I don't-"so let me get this straight. you've had this lump for three long years. In all those three long years you never thought to go see your doctor about it. Nothing is new or different today but you have suddenly decided, after three long years, that it is an emergency and has to be looked at right away." Like I said, I want to, but I don't. Out to the waiting room he goes.The next patient has dental pain. I see from the visit history in our hand electronic medical record that she has had 42 visits in the past two years for dental pain, migraines and ba... More About: Triage
Hot
2008-05-17 05:38:00 It was 103 degrees today in Sunny Califonia! HOT, HOT, HOT!There are a lot of wonderful things about living in California, summer isn't one of them. We have 9 wonderful months where you can do all kinds of wonderful outdoor activities and then comes summer. From mid-June through September it just sizzles and we scurry from air conditioned place to air conditioned car to air conditioned place.It's a little early in the year for such heat. I sure hope it goes away.
Who's in charge here anyway?
2008-05-15 06:06:00 I was discharging a 3 year old with strep throat and giving the discharge instructions to the parents. I was going over the prescription for Amoxicillin when the mom says "Oh, I can't get him to take medicine." WTF? He's three. Who is the parent in this relationship. If you don't have some control over your three year old your life is going to be HELL when they get older.When did parents stop being parents and turn into a bunch of namby-pamby pussies? Children don't know what is good for them and what is dangerous. It is up to you, their parents to make rules to keep them safe and healthy and ensure they grow up to be responsible, productive adults and you are FAILING MISERABLY!Yet another reason why people should have to take a test before they are allowed to reproduce. More About: Charge
Tachycardia
2008-05-14 05:23:00 It always amazes me how the people with a cold will call an ambulance but the really sick people will make their own way to the ER and sit patiently in the lobby until they are called for triage. They often give a vague, non-specific complaint when they sign in so the greeter doesn't catch that they need immediate attention.We were short staffed one morning so we didn't have a triage nurse, we were all busy with patients in the back so when they called from up front for a lady with "weakness for a week" it took a minute for one of us to break away and get out front.It happened to be me. The lobby was already full, when I called her name no one got up. I was about to give up when someone mentioned casually that they thought she was sitting next to them. I went over to check it out and found a woman slumped over minimally conscious, pale and diaphoretic with no palpable pulse. (Gives you an idea of the usual ER clientele that no one out there was worried about how she looked.)W...
A Good Day
2008-05-13 05:00:00 I had the best day today.All of my patients we nice and thanked me for all I did for them.We weren't balls to the wall so I had time to talk to them and explain what was going on and even do some teaching.My kidney stone patient go 30mg of Toradol IV and went from pale, sweaty, writhing and vomiting to pink, dry and smiling. I believe if he could have a statue erected of me he would have done it, he was that thankful.I got a bouquet of flowers from my son in the Air Force, a belated mom's day present.I triaged a delightful 99 year old man with no medical problems AND on no medications that still lived alone independently and volunteered at the homeless shelter once a week. And he asked me out on a date.I took care of a pale, lethargic, sick looking baby that perked up and looked like new after a couple fluid boluses. I was able to spend enough time with the mom to put her mind a little bit at ease.My boss got a thank you letter from a previous patient of mine with praise.The d... More About: Good
You Know It's Gonna Be a Bad Day
2008-05-10 05:19:00 I went in to see my first patient at the beginning of the shift only to find he had been incontinent of urine - the entire bed was soaked. I rounded up all the linen and bathing supplies and got one of the other nurse to help me. She rolled him over and I washed his back and bottom and pushed the dripping wet linen underneath him, usually I would start the dry linen but his old stuff was so wet we elected to roll him completely off of it to avoid getting the clean stuff wet. I reached across him and grabbed his shoulder and hip and rolled him to face me. He was kind of a big guy and ER gurneys are notoriously narrow so I had to roll him up against me to give the other nurse enough room to get the linen under him. Suddenly I felt a warm flood going down my leg and into my shoe. He was peeing and it was running off the mattress and all over me.The sad thing was the rest of the day was so bad being peed on was the high point. More About: Gonna
Happy Nurses Week
2008-05-09 05:16:00 It's nurses week and the blogosphere is full of tales of gifts received from employers, pens, coffee cups, fleece jackets and so on.So what did my fine institution do for their nurses this year?Not a damn thing! More About: Happy , Week , Nurses
"We Need Some Help Out Here!"
2008-05-08 05:27:00 We got the panicked call from the ER greeter - "There's a mom here with her baby and it's having trouble breathing - I think you better get right out here."Our greeters are a very seasoned bunch and tend to not overstate things so we went right out there. Mom was about 20 and crying holding a limp, gray, grunting infant. I just grabbed the baby right out of her arms and headed to the 'crash' room without even looking to see if she was following. As I ran by the nurses station I yelled for help.Not only was she not breathing well she was having some sort of seizure activity. Like a well oiled machine the team swung into action. One nurse started assisting respiration's with an ambu bag while another searched for an IV site, a third put on the monitor leads which showed a HR of 210 and a pulse ox of 79%. Cap refill was delayed and the abdomen was hard as a rock."What happened?" the doctor asked the mom, who was hovering in the doorway.She came home from work and found the b...
How to tell if you have a problem
2008-05-06 05:31:00 So we have this doctor in town, there is one in every town, we call him doctor feelgood. All of his patients are on some cocktail of Oxycontin, Vicodin, Soma, Klonopin and so on. But.....to give him some credit, he expects his patients to adhere to the rules, he only gives out a months supply at a time and if he finds out you are going to other doctors or ER's - you're fired from his practice.Recently we had one of his patients that gave a history of being on high dose narcotics for back pain come in with vomiting. His story was nausea, vomiting and chills for 24 hours. On exam it was fairly obvious he was in narcotic withdrawal. When the doctor confronted him the patient admitted he had been out of his med's for two days.Brother, you've got a problem. You've used up a month's worth of med's in 17 days AND when your doctor finds out you've been here he'll probably give you the boot.When the ER doctor explained all this to the patient and told him that he would not giv... More About: Problem
Too Much Sun
2008-05-04 04:38:00 I. Am. Sunburned.Too much yard work even with #50 sunblock but I made a lot of progress, got my drip irrigation set up and working so it will all be automatic now. But I'm absolutely glowing right now and sleeping tonight will be hell.With my pale Scandinavian skin I try to be very careful, I never go out unless slathered in sunblock, wearing a hat etc. Thankfully I don't burn all that easily, which you'd never believe if you saw me - fish belly white comes to mind. Not to mention that I am getting to the age when you don't want to actively seek out anything that will contribute to your wrinkles - they are doing fine on their own. But my care with the sun comes from another reason, one patient I just can't forget.I had a patient a few years ago that came in for vomiting. He was in his mid-forties and had metastatic melanoma. He hadn't noticed the unusual mole on his back - it was discovered after a visit to the doctor for some shortness of breath that just wouldn't go aw...
Things you hope never happen
2008-05-03 05:49:00 A long time ago in a hospital far, far away.It was January, the temperature was approaching zero and it was snowing like hell. The ER I worked in was in a resort town that was all but deserted in the winter. There was a PA and myself and we had seen a grand total of seven patients so far that day.It was after lunch. We had two patients in the department, a lady with vomiting getting IV fluids and waiting for lab results to rule out an appy and a little old man with chest pain that was waiting for an ambulance to transfer him to bigger hospital down the road to repair his broken hip. Both were sleeping and the PA and I were finishing up charting and charges.A car pulled up to the ambulance dock and a man helped his heavily pregnant wife out of the car. I went out with a wheelchair to help them."My water broke and there is something hanging out of me, I think it might be the cord."Oh my God. My heart almost stopped. We were a half an hour away from the closest hospital that did ... More About: Hope , Things
Mylie Cyrus Scandal. Not.
2008-05-02 05:44:00 This IS NOT naked.What is the matter with people? I'm sure she shows a lot more skin at the beach without people getting all in a flap.I don't care for the makeup that makes her look like a freshly dug up corpse but other than that, there is nothing offensive about her back showing.Give the girl a break and get yourselves a life. More About: Scandal , Cyrus
Things are never what they seem
2008-05-02 04:37:00 My patient was a petite, thin 16 year-old. She sat on the exam table, shoulders hunched and staring at the floor while her mother told the story."I found a towel saturated with blood in her hamper." I listened but mentally wondered exactly saturated was. People tend to over-estimate the amount of blood.The girl said she had started her period and had bled more than normal. She had awakened after it started and used the towel to clean up. She said the bleeding had pretty much tapered off and showed me a half saturated pad that she said was over an hour old.I wondered if she was pregnant and miscarried and was trying to hide it from her mom. I started an IV and drew blood for chemistry, blood counts and type and screen. I explained that we would have to do a pelvic exam. She had never had one before so I spent some time explaining the procedure and getting her ready.The doctor, a woman, had a reputation for unshakable calm. We positioned the girl in the stirrups and she gently... More About: Things
Your Tax Dollars at Work
More articles from this author:2008-04-29 05:12:00 When we came on today we inherited a patient that had come in around 10 pm. She had been brought in by the police for being 'suicidal.' Her real problem was that she was extremely drunk and kept crying nearly incoherently "I just want to die." She had been incontinent of urine and stool as well as vomited all over herself. The night shift nurse, wonderful soul that she is, had bathed her from heat to toe, sent her clothing to the incinerator and found clean stuff from our closet where we keep clothes for the homeless. Now it is 7 am and her BAC is finally under 0.2 and she has told the psych resident that she is not suicidal, never has been - she must have just said those things because she was so out of it.Since she is denying suicidal thoughts we can't hold her so we call the police and they take her away for being 'drunk in public.'At noon we get an EMS report that one of the squads are coming in with a patient who was found by a passerby, passed out on the sidewalk. ... More About: Work , Dollars 1, 2, 3, 4, 5, 6, 7 |
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