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.
Sunday, April 27, 2014
Sunday, March 30, 2014
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.
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.
Monday, December 23, 2013
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!
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!
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!
Tuesday, November 5, 2013
Stop Bit@hing And Do Something
The ER I work in has 4 areas. The area I was assigned to the other day is pretty detached from the main ER. This particular part of the ER has 10 urgent care beds for the not so sick folks and then another 12 beds for level 3 and 2 patients. The 12 bed area gets its fair share of stroke and septic patients. Unfortunately it is a logistical nightmare. Not only is it minimally stocked with meds, the new flavor of the month is not to have insulin stocked in a medication refrigerator because there were issues with vials not being properly labeled with "use by" dates. Needless to say trekking through the ER to the main ER's med room is time consuming. Upon getting to the med room and finding no insulin one might find themselves extremely annoyed… not because they walked all the way to the main ER, but because it was a complete waste of time when they are otherwise running around cleaning up the mess from the prior shift.
Having had this issue of no insulin in the ER in the past I called the pharmacy and offered to pick up a bottle of each type of insulin in order to restock the ER! During my conversation with the pharmacy tech I asked why when they restocked the refrigerator they didn't check to see if we had insulin. The tech informed me that it wasn't something they did. Knowing that they stock the refrigerator with other refrigerated meds it just seemed like a simple request…. but I wasn't getting anywhere. The only explanation I was given was that someone must have been stealing the meds.
After hanging up the phone on of my managers said that I was "mean" for calling them as telling them that it was unacceptable that the ER didn't have insulin. Well I do find it completely unacceptable to not have insulin stocked in an ER. I then pointed out to the manager and the charge nurse that this was a chronic issue, which it has been, and that we needed a solution. She quickly stated that pharmacy wouldn't perform a check and restock twice a day. I then suggested that the charge nurse at the beginning of the shift check the refrigerator to ensure that insulin was stocked as well as checking our stock levels for vital things like liter bags of normal saline. I was then told by the charge nurse that I "complain too much".
Maybe I do complain. But I think that I am right to complain and offer a few suggestions on how to fix this problem we have.
Its interesting how identifying a problem and offering a solution is met with such resistance.
I have decided to turn a new leaf. I'm not one of my apathetic coworkers, I refuse to give into that mentality. If there is an issue I will absolutely point it out but I will now offer no less than three solutions.
Having had this issue of no insulin in the ER in the past I called the pharmacy and offered to pick up a bottle of each type of insulin in order to restock the ER! During my conversation with the pharmacy tech I asked why when they restocked the refrigerator they didn't check to see if we had insulin. The tech informed me that it wasn't something they did. Knowing that they stock the refrigerator with other refrigerated meds it just seemed like a simple request…. but I wasn't getting anywhere. The only explanation I was given was that someone must have been stealing the meds.
After hanging up the phone on of my managers said that I was "mean" for calling them as telling them that it was unacceptable that the ER didn't have insulin. Well I do find it completely unacceptable to not have insulin stocked in an ER. I then pointed out to the manager and the charge nurse that this was a chronic issue, which it has been, and that we needed a solution. She quickly stated that pharmacy wouldn't perform a check and restock twice a day. I then suggested that the charge nurse at the beginning of the shift check the refrigerator to ensure that insulin was stocked as well as checking our stock levels for vital things like liter bags of normal saline. I was then told by the charge nurse that I "complain too much".
Maybe I do complain. But I think that I am right to complain and offer a few suggestions on how to fix this problem we have.
Its interesting how identifying a problem and offering a solution is met with such resistance.
I have decided to turn a new leaf. I'm not one of my apathetic coworkers, I refuse to give into that mentality. If there is an issue I will absolutely point it out but I will now offer no less than three solutions.
Monday, October 28, 2013
Compassion and Caring
"Love and compassion are necessities, not luxuries. Without them humanity cannot survive." ~ Dalai Lama
Compassion is something that one would thing is a given with nursing and the medical system. Compassion is the one thing that is not delivered in a pill, an IV push in a manufactured way. Compassion is genuine. Compassion is ignited from within. Compassion in the one thing that we can give of ourselves to comfort those who are suffering, as we give it, we also receive great benefits in return.
Why is it in our field there is a lack of compassion. In order to provide compassionate care we must have received compassion. As we care for our patients and provide compassion it is equally important that we treat the members of our hospital teams with compassion.
http://www.ted.com/talks/view/lang///id/1216
Joan Halifax highlights this concept in a short Ted Talks episode.
Compassion is something that one would thing is a given with nursing and the medical system. Compassion is the one thing that is not delivered in a pill, an IV push in a manufactured way. Compassion is genuine. Compassion is ignited from within. Compassion in the one thing that we can give of ourselves to comfort those who are suffering, as we give it, we also receive great benefits in return.
Why is it in our field there is a lack of compassion. In order to provide compassionate care we must have received compassion. As we care for our patients and provide compassion it is equally important that we treat the members of our hospital teams with compassion.
http://www.ted.com/talks/view/lang///id/1216
Joan Halifax highlights this concept in a short Ted Talks episode.
Sunday, October 27, 2013
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