Patients Please Leave Your Crazy Friends, Friends With Benefits at Home

There is nothing worse than a crazy "friend" at the bedside.  This crazy "friend" is the type of friend who doesn't want to be present for an invasive procedure-- an IV or a foley insertion, but will get in everyones' face, and I do me everyone!  They will stop you from talking to your own patient, they will stop you mid sentence with a colleague, you might not have anything to do with their "friend's" care, but they will attempt to hold you accountable as if you have the power to know every patient and every patients' health issues and the plan for care.  And if you god forbid say, "let me find the nurse caring for XXX", it turns out that that is the kiss of death.  See the friend isn't really interested in shutting the fuck up in order of the staff to try to help, he or she is there pacing the hall, obstructing the hall, hanging over other patients for attention.  They rant and rave.  They complain and refuse to leave the area, but they were never actually in the area holding the hand of the "friend".  It is truly an amazing phenomena while you are actively attempting to help the patients you can't because the "friend" just wants to argue, and for what?

What's So Hard About Doing Your Job?

I've worked in a couple of ERs over the years and I am often left wondering why people find it so hard to just do their job.  I don't mean all people, but some people.  What makes it even more frustrating is when the job is to just stay awake and keep an eye on a psych patient.  Seriously why  is it so difficult?

What is even worse is when you wake up the sleeping employee or ask them to remove their earbuds so they can hear what you have already said to them, and they get pissed.

Seriously.  I run around for 12 hours and I'm lucky if I have the time to pee...  but somebody is actually getting paid to sit and their responsibility is to really just stay awake and get the nurse is the patient needs something.

My rant is over!!!

They Came By Air

"Trauma alert by air 10 minutes.  Trauma alert by air 10 minutes".  For those of us wearing protective lead, covered head to toe in surgical attire, medical ninja garb, we are prepared to receive whatever comes our way.  We anticipate the badness that has been air lifted to our helicopter pad 24/7.  We first greet you, but you cannot see our face, just our eyes.  You are disoriented from a flight up-up and away from your disaster site, and you are carefully lowered to a small roof top that overseas a metropolis with college parties, gang violence, corporate gatherings and trials and tribulations of everyday life.  

You are here now.  I greet you with a welcome to ____ Medical Center, I'm your nurse.  You're safe now.  We are going to take great care of you.  I do my best to absorb a readers digest version of report with just the highlights from the flight crew, knowing they will repeat it when we cross the red line in the trauma bay.  I explain to my patient that we are going to move fast but we are thorough.  I explain that we will be cutting their clothing off and giving their belongings to security.  I try to prepare them because they are no longer in control.  Their control ended on impact with whatever bad thing landed them on our roof.

In those moments we look at every inch of skin, we check for holes and check existing holes.  We invade your body with needles, airway devices, caterers, tubes, hands and fingers.  We are causing you pain to end your pain and save your life.  We do this out of love for our vocation-- because it is not just a job we show up for-- it is our passion.  We like to fix things.  We are fixers. 

Somedays when they come by air the fix is easier than we thought, but the pain for the body is brutal. The emotional pain can be worse.  One lands on our roof and another- perhaps a soulmate lands on another roof hours away.  Together they became powerless, they were impacted, they became patients, but they are separated and suffering physical pain and a deep hurt not knowing if the other is still breathing or alive.  I can give you drugs to lessen the pain from your trauma, but I can do little to mend your heart.  

I rarely think about the other, because I am so focused on you and fixing you.... but then hours later on the news or in the paper or via a call you learn about the others.  I hope for the best, but know that if you landed on our roof the badness was real and the stark reality of life comes like a speeding bullet.  My patient survives, but there are others who do not.  Maybe one or maybe a couple perish.  It is sad and I selfishly hope that my patients soulmate lives on and makes a recovery, because I have seen the news and it was bad! 

Good Bye ER It's been real

I've always had a love for the ER.  In my opinion there is nothing like the ER.  It is unpredictable and things can change on a dime.  I loved getting train wrecks and working with providers to stabilize them.  Unfortunately I had to walk away from my ER job the other day.  It wasn't because of the patients.  A bad day in the ER is never in my opinion because of the patients.  A bad day in the ER is because of a broken system.  Perhaps my ideals are just not in line with the world of Emergency Nursing.  Perhaps I had too much faith and hope that ENA would advocate for better conditions for ER patients, and really start promoting leadership amongst the ranks of the staff nurses that would force nursing management to grow a spine.

On to new challenges and a new environment.  Its time to step away from the toxicity and into the unknown.

Failure Of The System

Over the past few months my ED has had a steady nurse attrition.  This is never a good thing.  At some point there needs to be an awaking to the exodus and a real discussion regarding what the heck is causing this unfortunate cycle.  Like several of my coworkers I also left the ED--- sort of.  I jumped ship to the EMS side of the house.  I didn't leave for just one reason, I left for several.  Amongst those reasons was my need for growth--- not in a management way.  I wanted to do more and learn more.

Its only been a couple of weeks but wow what a different world.  Is it all rainbows and unicorns? Probably not, but it is certainly a much different environment.

They say I'm a great nurse and a biotch! I'm okay with that

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!

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!