Ah, the construction is done!! The plastic curtains are gone and the smell of paint and plaster have returned to non-toxic ranges! :)
The 'extra' staff in the Track have been retruned to the main and I am once again in my blessed cocoon. Just me and the PA and our fave lil painuers...
So much has happened in the Track since November; an influx of newbies, a shifting of staff assignments, and patient traffic. During the 'phasing' of construction we had extra staff shunted thru to the Track instead of using a rotating leave. Although this was fun for a while the extra bodies swirling in my 10x10 ft. workspace caused my claustrophobia to reach catastrophic levels. On any given day there were: RNs x2, tech, PA, and secretary all fighting for computer/seating/breathing space! We had a great time getting together in our lil cubbie and I must admit - it did help to get some of the nurses from the Main into the Track to see just how fun it is to get SICK patients in a curtained cubicle without so much as a call light or O2 outlet. I was taking bets on just WHEN the first code would be called in the Track!!
So here I am, freshly back from Vacay in the Florida sunshine (furiously playing the lottery to get back) and ready to tackle my Track...
First day back:
Me: so why didn't you talk about this painful wrist of 2 weeks duration with the Doc when you were here 2 days ago?
T19 Queen: I didn't 'member.
Me: what meds are you taking?
T19 Queen: you can jez look at the computer - I doan know them all.
Me: your homework assignment for today is to go home and make a list of your meds
T19 Queen: I aint got no computer - you do!
Me: THUNK (sound of head hitting desk)

Let me be your hero!

I got a candy bar from the ER admitting clerk and attained 'great legend of the ER' status with this one:

Young Chick: I need a pregnancy test cuz I need to prove to my boyfriend that I am pregnant

Triage Queen (me): Have you done a pregnancy test at home yet?

Young Chick: Yeah I did 3 so far.

Triage Queen: What were the results of the tests?

Young Chick: They wuz all positive.

Triage Queen: When was your last period?

Young Chick: I think about 3 months ago...?

Triage Queen: Are you having pain or bleeding now? Problems with the pregnancy?

Young Chick: No, I just want to have you prove to him that I am really pregnant! (points to tall, slack jawed male standing beside her)

Triage Queen (addressing slack jawed male): She really is pregnant...!

Slack Jawed Male: I want a 'real' test done an' I don't think it's mine anyway!!!

Triage Queen (to both): The home tests are "real" and are the exact same ones we do here. We will NOT determine paternity in this ER. You would waste our time and resources to check you in right now to 'prove' a pregnancy! No pain or bleeding? (TQ points to WR full of real patients who have waited 3+ hours to be seen for REAL problems) You would have to wait all night for a pregnancy test! Don't believe her? Go to Wal Mart buy a test and pee on the stick in front of him. The + sign means pregnant! In the morning make an appointment with your OB Doc and get some counseling on the side!

Young Chick to Slack Jawed Male: See I TOLD you so!!! I'm pregnant an I'm gonna prove it's yours!! (Slaps him on the arm)

Triage Queen (under my breath as they head for the door): Good luck with that stellar choice of sperm donor...

Don't come back!

Oh, we all have our fave 'painuer' story and in the Fast Track we see too many painuers to count. Apparently I was out of sorts and patience when confronted with one of the back pain variety...

First of all, do you need to give it that obnoxious fake limp while walking to the exam room? As you tell me that you are strong, have a high pain tolerance and consequently don't need a wheel chair? (Sorry, I can read you like a book!) Secondly, do you really want to tell me that you went bowling last night while off on work comp for this devastatingly painful injury?! Really?
Seems the pain has become incredibly intense only after attempting to work (released to go back today - surprise, surprise!) and then you had to leave after an hour on your shift as a counter person at the local fast food joint. I also enjoyed the whimpering behind the curtain - audio clues are needed sometimes to help the nurses in the ER understand just how bad that pain is for you! Other people feel sorry for you too and step to the desk frequently to 'let us know' that you need help in there. A pain scale of 15 out of 10 is a good way to enhance our understanding of your agony - that coupled with texting and chatting on your cell phone while in your curtained cubicle!

My painuer had the new PA in Fast Track buffaloed with afore mentioned theatrics which is probably why I got somewhat frustrated about giving the 5mg of Valium AND 2mg of Dilaudid! What the H***l??!! The final straw was the insistence that I give the meds and not wait for the ride. Seems she also convinced the PA that a ride was forthcoming and that we needed to end her misery - now! Amazingly enough her pain was down to a 2 with-in 5 minutes of the needle exiting her flesh. Again with the surprise!!!

Now comes my fave part of the evening. She got on her cell phone after her discharge and I discreetly followed her out to the the waiting room since she got my fake-dar humming. Hmmm...didn't sit down to wait. Heading right for the door; it is 38 degrees and drizzling out. Double hmmmm. No dry place to wait out there; the ride must already be here. Well what ya know? The 'limp' has totally disappeared once she got outside the ER door! Wow, she is walking like a pro and talking on her cell and digging in her purse...for her car keys!!!

I lost it! As she backed out of the stall I had gotten to the rear of the car and slammed my hand on the trunk lid. What a face she made in the rear-view mirror; part freaked out and part mad!! She blew out of the parking lot and headed for the street without another backward glance. I stormed back into the ER and made a few calls to the local chain pharmacy. That told me all I needed to know about her 'pain!' Copied the chart and notified the DIC doc (we love that one: 'Dr in Charge') and told the PA what happened and that it won't happen again with me!

I can only hope that she...doesn't...come...back...!

Do you prefer "Honey" or "Sweetie"

An interesting conversation came up the other day at work. It seems there was a housekeeper outside an exam room door who overheard a conversation. This prompted her to write a complaint letter that resulted in a written reprimand for one of our nurses. Apparently she overheard a nurse call a patient "Dear" and was immediately insulted for the patient and thus lodged her complaint.
Over reaction? Realistic? Implied or outright insult? Which camp are you in?

I read with interest the theories that state nurses need to connect with patients. We need to do more, be more, counsel, care, and in some cases heal. (In some institutions they are actually deemed "clients." Although "client" and "market share" are fully insulting in my book - these are not shoppers looking for the latest upgrade on a toaster oven - I prefer to call them patients. A wholly unique title for a unique role during the continuum of health.) In our nursing role in the ER we assess and treat and counsel and teach and empathize in a mere handful of minutes. How many times have you put in a line or a catheter or some other invasive pokey thing within minutes of meeting the patient? Therein lies the problem...how do we address the patient?
Sir? Madam? Hey You? Uhhmm, hey? Mr/Ms patient?

I don't know about you, but I have countless times been spreading legs on a female and trying to talk calmly while making eye contact and reassuring the patient that the procedure will be quick and relatively painless and then IT HAPPENS!!!! I forget the young ladies' name! NOT a good time to ask to look at the name band! Not only will you break a sterile field, you might also break what little trust this sweet stranger is trying to build with you while you have your hands on her nether regions! I used to break into a sweat and start to stammer, "uh, uh, yeah, I'm um, gonna stick this thing in here..." Well, that sounded mighty professional! We 'dinos' in the nursing world and especially the nursing areas that have limited time/contact with the patient have all had this happen at one time or another.

Let's think about this...intimate area exposed, short acquaintance with the patient and no name recalled at a critical moment. Viola' we have a situation ripe for a mode of address that is a bit more familiar than 'hey you' or 'sir/madam.'

Are we truly being rude or disrespectful? Given a reversal of roles, I would gladly be called honey or dear by someone slipping a piece of cold equipment into an orifice I currently own or an artificial one they are about to create - as long as they smile warmly and look me in the eye...

Feelin' purty good this morning - survived! Again!
Nine months of Hell to look forward to - yes we are expecting! A brand spanking new ED; ALL the bells and whistles! Nine months of torture to endure. I'd rather have morning sickness...
Fast Track has become a regular 'team' as of Monday because we are remodeling. (Oh Goody! Anyone in healthcare knows that pretty = good care; can't wait for our already incredibly high numbers to skyrocket!) We are now blessed with a tech and a unit secretary (yay for the team!) but this equates to higher acuity! Scared me to death to walk in to a stroke in progress in a cubicle on a gyne table and a portable O2 tank (no wall suction or O2 in our area) and a portable monitor. (I hope the family knows how to read the thing cuz it ain't displayin' on no monitor bank nowhere!) A few level 2 acutes and a transfer to Over There University and I was feeling the pressure. I think I did a pretty good job of managing to accomodate myself, the float nurse, a secretary (and her orientee) a tech, the FT PA, a doc, two consulting docs and their 5 combined students all in my computer station/work space that was built to house 2 chairs/2 bodies/2 computers at an 8 foot counter in a 8x10 wide spot in a hall. Got a bit crowded and I must say that my personal bubble was breached more than once. (I really get the creeps when co-workers insist on rubbing my shoulders while I chart!)
Thank God the charge nurse came over to assess the situation and freaked out about the level 2 patients - apparently NOT what they had in mind for the 'higher acuity' that will go to Fast Track. Yay!

Plan B: job app for the big Ortho group on my desk at home; completed.

Last night was mucho better - a steady stream of level 3's sprinkled with a delightful mix of level 4's. Throw in my fave PA and we had ourselves one great evening! And HELP! WOW! I did not know what to do with the lil' darlin's most of the evening. How did I function without a tech or secretary for over 2 years?! Rooms magically cleaned, telephones answered, orders appeared, pts transported (and OMG! ice water for me!) it was Heaven!

The job app for the Ortho guys is officially on hold...

Fast track is apparently the bastard child of the ER! Does everyone hate the Fast track patients and the staff there as well? Why does triage try to dumb down chief complaints? Why does FT have to accept higher acuity (no extra staff, no equipment = extreme frustration!) when, conversly, the main department feels no need to take the lower acuity???
Another shift in the FT and I am dragging! Higher acuity AND orienting a new grad PA are sucking the life out of me. Angry patients, angry nurses - somehow it's MY fault that the new PA takes a while to assess. How can people sit and wait for three hours to be seen and then think they are going to get good care by pissing me off the minute we get to the exam room?!

And what's up with retirement age folks? What is it that they do at home that makes a wait for treatment the worst thing that has happened in their day? Bring a book, watch a flat screen TV stuck in every corner of the WR, but for the love of God stop telling triage every 10 minutes that you need to get going...what else do you have to do with your day anyway???!!! Good sized lac and on Plavix and ASA. Yeah, it's bleeding and really needs stitches and a pressure dressing. Sorry you had to wait 2 1/2 hours to be seen. Yeah, I know that there are others who got in before you but they were having heart attacks and/or making a really good effort to stop breathing and some were succeeding. Thanks for trumpeting to the other 20+ folks in the waiting room that you had been there over 2 hours - that helped 1/3 of the waiting room decide to sign out AMA. I really appreciate you interrupting me 15 times to let me know that you were still waiting in your exam cubicle and that you had to get home to your dog. (Feel free to send one of your 5 family members who came with you to go home and take care of Fido) Thanks for standing outside another patients' cubicle while I'm assessing and giving meds to tell me how little time this actually would take at Huge Private Hospital across the river. I know you thought about going there - next time, Please do!!! And BTW, I had no idea how lazy I am until you pointed out that I was just sitting there and could have placed those stitches myself (I do love to quilt and sew - maybe I should have!) instead of charting and calling for consults. I was so glad to have you offer to do something to help "get the job done" please, go right ahead! I request help on a weekly basis and never get some! Transport that guy to CT for me, clean this room where we opened a MRSA abscess, hang a new IV for the migranoid who has sucked up a boatload of meds but won't stop complaining til the Dilaudid is a runnin', grab a couple of ice bags (From the other area of ER since we can't have one in FT - the machines cost too much!) for the work comp ground level fall (aka: I need splints and crutches and a week off of work cuz I fell down in front of co-workers and I need validation that I am REALLY injured not just totally embarrassed!) and get the x-rays ordered. Do this while you finish that chart for the psych admit that plopped into FT an hour ago and "needs to get going to the admit bed, now!"

I did find an ad for an interesting new job...does anyone else think that an RN/BS qualifies for a vet's office assistant?

Survival of the Fastest

I have decided to jump in feet first to the blogosphere!

As an older, seasoned ER nurse (read antique) in Big Religious Hospital, I find my interest waning and frustrations growing in a world of lightening fast changes. Do others hate doing more with less? Do you have an employer who changes process and procedure more often than our drug seekers change their stories? How many days have you arrived for shift to find that one more step has already been added to your back (and knee) breaking load?

Please come journey with me as I evolve. Do I remain in the ER? Nursing? Or do I follow the many before me and find a path the leads out the doors of BRH into the wide scary world!