I had an interview within the hospital system for a critical care transport gig. I've been considering getting the heck out of my ER for the past year, but really haven't done much in planning an exit. Earlier in the month I interviewed in a trauma center in the hood, I was offered a position, but I haven't set up a start date yet. I guess I was weighing my options. Do I stay in my dysfunctional ER or tough it out until after the "new ER" opens and see if the new CNO makes much needed changes? Fortunately I was approached about a critical transport opening and a CCU opening, not to mention the other ER gig. So I have options.
I love the ER. I think I'm a kick ass ER nurse, and my peers, patients and docs compliment me often. Unfortunately lately I have been utterly disenchanted. I love the work, I love the patients, I truly love working in the ER, but I am so incredibly disappointed with the quality of care that some of my peers provide and it is frustrating. Recently one of my coworkers told me that some of the nurses on dayshift fear giving me report. He finds it hysterical. I find it amusing as well. When I asked him why he told me that they are always scrambling to get things done because they know if I come in and the shits not done there will be hell to pay. I'm not sure that I would say that I would say I'm that rough on them, but I have written people up for neglecting to give meds or start IVs that were ordered hours ago.
I guess I learned the old school military way. You treat every patient like they belong to your family, and you make sure you do your job.
If this expectation has given me the title of biotch, so be it. I wear it well.
I am more than happy to point out when someone does a great job, but I will not coddle a lazy incompetent person!
Monday, December 23, 2013
Thursday, December 5, 2013
Jackass OBs and their little friends too
I haven't spent a ton of my nursing career in labor and delivery, but I have spent enough time dealing with egotistical OBs as well as my own experience as a patient and a support team member to other moms to offer this rant:
Dear Labor and Deliver Staff:
1) Please stop saying "you're not in labor" when a mom is having palpable contractions every 6-3 minutes.
2) Please don't be the ass who asks the mom in labor with contractions every 4 minutes, "Do you have a low pain tolerance?" --- here's a clue if the person is having repeated contractions--- of course its painful- if its their first birth chances are it's going to be very uncomfortable. If you have a penis ask yourself how would that feel if your penis was contracting every 4 minutes!! If you can't imagine it please come closer and I will find a way to make you uncomfortable every 4 minutes and follow it up with "do you have a low pain tolerance?".
3) Please don't tell the mom in labor that although the monitor shows a contraction of 75, it really doesn't matter, because the numbers on the monitor are only really valid when the internal transducer is in place--- moms in pain don't give a crap about that, and it doesn't reduce their pain.
4) Please don't tell moms who are having a difficult time pushing because of an epidural that they "aren't trying hard enough".
5) Please don't tell the mom who is 37 weeks, bleeding, having strong contractions every 4 minutes and was on bed rest at 22 weeks for preterm contractions and an incompetent cervix that they can go home because there are not in labor and they shouldn't be having pain because they aren't in labor because their cervix is only 3 cm dilated.
6) Please put an IV in and hydrate the mom when she has not been able to eat or drink appropriate amounts due to pain and vomiting, within 2 hours of being at the hospital, and not 10 hours later!
7) Please do not blame the dehydrated, pregnant, scared mom who is in pain with contractions for not having plump veins.
8) Please do the right thing for dehydrated moms in pain and find the best vein for the time being--- if its an AC vein so be it-- hydrate them, manage them with an antiemetic and pain meds, find a more suitable vein in the lower arm later after they are hydrated--- don't stick the patient 7 times when you could have inserted an IV the first time! Take care of the patient first! find the vein that suits you better later when they are comfortable!
9) Don't ask the support team and husband to leave the room because your IV skills, and the skill of the nursing team suck!
10) After essentially blaming the patient for "not being in labor" and taking up a bed with symptoms of labor in a high risk pregnancy, don't try to shove them off to home or an antepartum unit, re-check the patient. And by the way you look like a complete ass when the patient dilates to 4 from the 3 they were at and now all of a sudden they are in labor! And when you say "I've never seen this before"… you are a liar… it happens all of the time! Women can be slow to dilate and have close strong contractions! It happens all of the time!
11) To the L&D staff. A mom that is "not in labor" is no different than another patient in the hospital.. they need to be assessed and monitored! Waiting hours to check a set of vital signs is not appropriate! You have that ability on your fetal monitor! Put the cuff on!
12) L&D nurses: Advocate for your patients!
13) Don't leave narcotic pain meds drawn up in a syringe sitting for 2 hours at the bedside until the anesthesiologist can come start the AC IV--- waste or return your meds! Bad practice! Very bad!
14) When a mom has been pushing for 3 hours and things are not progressing, change the approach, because when that baby is born and isn't breathing, has to be placed on a vent with a cooling cap, its hell on the family and the nice ER nurse friend is now your worst enemy!
15) When you see the meconium come out when the bag was ruptured, you need to explain to the family the significance of it right then and there, not wait hours until the very troubled birth! Because that C-section they requested before they fully dilated might have been a better idea than the chain of events that unfolded!
Dear Labor and Deliver Staff:
1) Please stop saying "you're not in labor" when a mom is having palpable contractions every 6-3 minutes.
2) Please don't be the ass who asks the mom in labor with contractions every 4 minutes, "Do you have a low pain tolerance?" --- here's a clue if the person is having repeated contractions--- of course its painful- if its their first birth chances are it's going to be very uncomfortable. If you have a penis ask yourself how would that feel if your penis was contracting every 4 minutes!! If you can't imagine it please come closer and I will find a way to make you uncomfortable every 4 minutes and follow it up with "do you have a low pain tolerance?".
3) Please don't tell the mom in labor that although the monitor shows a contraction of 75, it really doesn't matter, because the numbers on the monitor are only really valid when the internal transducer is in place--- moms in pain don't give a crap about that, and it doesn't reduce their pain.
4) Please don't tell moms who are having a difficult time pushing because of an epidural that they "aren't trying hard enough".
5) Please don't tell the mom who is 37 weeks, bleeding, having strong contractions every 4 minutes and was on bed rest at 22 weeks for preterm contractions and an incompetent cervix that they can go home because there are not in labor and they shouldn't be having pain because they aren't in labor because their cervix is only 3 cm dilated.
6) Please put an IV in and hydrate the mom when she has not been able to eat or drink appropriate amounts due to pain and vomiting, within 2 hours of being at the hospital, and not 10 hours later!
7) Please do not blame the dehydrated, pregnant, scared mom who is in pain with contractions for not having plump veins.
8) Please do the right thing for dehydrated moms in pain and find the best vein for the time being--- if its an AC vein so be it-- hydrate them, manage them with an antiemetic and pain meds, find a more suitable vein in the lower arm later after they are hydrated--- don't stick the patient 7 times when you could have inserted an IV the first time! Take care of the patient first! find the vein that suits you better later when they are comfortable!
9) Don't ask the support team and husband to leave the room because your IV skills, and the skill of the nursing team suck!
10) After essentially blaming the patient for "not being in labor" and taking up a bed with symptoms of labor in a high risk pregnancy, don't try to shove them off to home or an antepartum unit, re-check the patient. And by the way you look like a complete ass when the patient dilates to 4 from the 3 they were at and now all of a sudden they are in labor! And when you say "I've never seen this before"… you are a liar… it happens all of the time! Women can be slow to dilate and have close strong contractions! It happens all of the time!
11) To the L&D staff. A mom that is "not in labor" is no different than another patient in the hospital.. they need to be assessed and monitored! Waiting hours to check a set of vital signs is not appropriate! You have that ability on your fetal monitor! Put the cuff on!
12) L&D nurses: Advocate for your patients!
13) Don't leave narcotic pain meds drawn up in a syringe sitting for 2 hours at the bedside until the anesthesiologist can come start the AC IV--- waste or return your meds! Bad practice! Very bad!
14) When a mom has been pushing for 3 hours and things are not progressing, change the approach, because when that baby is born and isn't breathing, has to be placed on a vent with a cooling cap, its hell on the family and the nice ER nurse friend is now your worst enemy!
15) When you see the meconium come out when the bag was ruptured, you need to explain to the family the significance of it right then and there, not wait hours until the very troubled birth! Because that C-section they requested before they fully dilated might have been a better idea than the chain of events that unfolded!
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