madness: tales of an emergency room nurse

2008-07-07T07:46:00.000-06:00

you're old enough to know better

2008-07-06T21:20:00.003-06:00

After years of ER experience I have done a study and come up with ten things that those over 50 should not be doing. I mean, come on, you have lived half a century, use the brain God gave you.

1) Water ski - having seen the not so pretty results who has flipped several times after "hitting the wave the wrong way". Face it: you are not as flexible as you used to be
2) Roller skate - osteoporosis is setting in and you could break a hip...besides you look silly..
3) Street drugs - what is more pathetic then a middle aged old fart on crack? I mean for cripes sake you should have some kind of frickin' life by then. Loser.
4) Place objects where they aren't designed to be placed. 'nuff said.
5) Promiscuous sex - you are a loser with a capital L if you have an STD over 50...come on
6) Bring your elderly mother with you to the emergency room for support...
7) Need a bus token or cab pass. If you are 50 and can't afford the bus, go away.
8) Stink. You should have learned to keep yourself clean a long time ago...
9) Get so drunk you have to be brought into the ER.
10) Be a drug seeker. Why is it that a lot of the back pain drug seekers seem to be middle aged?

nurse k is everywhere...

2008-07-05T21:20:00.004-06:00

So I'm at work this morning and I go on the computer to look at something on the internet. I go to the address bar at the top to look for google. Well, what to my wondering eyes should appear one URL down, but Crass Pollination. Nurse K, she's everywhere, even at my frickin' job. Apparently my co-workers have found her. I hope they didn't find me.... its a small blog world.

fireworks

2008-07-03T21:49:00.002-06:00

For those of you who don't get to see the real thing.....happy 4th

the people I carry with me

2008-07-02T10:55:00.005-06:00

Its really hard not to be affected by the suffering you see in the emergency room. Not those people having pain necessarily. The people whose life is one of suffering, or at least my perception is that they are suffering. Well, maybe suffering is the wrong word. Every day of their life is a challenge with a capital C.
I had a man last week who has muscular dystrophy. He has had it since childhood. I can tell because his body is not that of a grown man. He is smaller. He weighed 80 lbs. He is on a portable ventilator. He is fed through a feeding tube. He moves his chair with his calf. He has someone with him 24 hours a day. He is dependent on someone else for survival. He never has any privacy. I wonder how does he do it everyday? How does he wake up and decide its worth it to go through another day?
Another man had been shot four times and is now a paraplegic. He is developing the common problems of those who spend their life in a wheelchair: decubitus ulcers. He needs a better wheelchair but is finding it hard to pry it out of medicaid. He has been in a wheelchair for two years. Lost his job, girlfriend. He told me he's not going to let it get him down.
Another paraplegic who immigrated to this country and speaks no english. He navigates the health care system not being able to speak the language. I know he is better off here then he would have been in his country.
I took care of all of these people in the same day, along with all the other patients who are routine. I can't help but remember those three I spoke about and the daily challenge they face just to live day to day. I carry them with me for a while afterward. It certainly gives me perspective on my own life.
These are the people who I remember.
*** painting is "Dusty Jeans" by Nancy Gale. It is from the mda web site art collection.

I ain't no Flo Nightengale

2008-07-01T16:26:00.003-06:00

Kim at Emergiblog has this entry about empathy. Is it realistic for nurses to have empathy for everybody? I don't think it is. In fact the idea pisses me off. It goes back to the notion that nurses are supposed to be superhuman. We are supposed to be everything to everybody. It's impossible. I, and I suspect you, are very human. We are subject to the emotions of humans.
I have been a nurse for a long time. I have been in the ER a long time. I have a lot of empathy. I empathize with the guy I had last week who is vent dependent, in a wheelchair, gets fed through a tube in his stomach and still manages to give me a smile. I empathize with another guy who tells me how much the last couple couple of years have sucked since he became a paraplegic, but that he isn't going to let it get him down. I have empathy for all those I see suffering with cancer. I empathize with those who suffer mental illness. These are just a few examples of those I empathize with. Do I empathize with everyone? No. I don't empathize with people who use the ER as a clinic. I don't empathize with those who abuse us. I don't empathize with drug seekers. Am I respectful? Do I do my best with them? Of course I do. I have to. Its what I do. I said I would when I signed up to be a nurse. But do I empathize with them. NOOOOOOOOOOO.
You see, I am a human being. I get mad, frustrated, sad.....I recognize myself as the human being that I am. I am not perfect. I am not Florence Nightingale. I get tired. But I'll tell you one thing - I'm one helluva nurse. I'm who you want if you are going down the toilet. But please, respect me as the HUMAN BEING I am, and stop expecting me to be Mother Teresa

air evac is fun AND dangerous

2008-06-30T16:49:00.003-06:00

When I started out in nursing I wanted to be a flight nurse. That's why I joined the air force, to get experience in order to be a flight nurse. I WAS a flight nurse in the air force. I didn't fly on helicopters though. I evaced on C-130 cargo planes. It was dirty, noisy, rushed, challenging - there's no doctor - you're it and you handle what comes up. It was also fun. There is not another kind of nursing like it. So I have a special place in my heart for air evac flight crews.
When I left the air force I didn't become a flight nurse. I guess I had had enough. I have known several people who who do medevac on helicopters. It is a dangerous job. I'm always amazed that those pilots can set down on miniscule copter pads on top of hospitals.
I understand the attraction to this kind of job. Its adventurous, exciting, out of the ordinary. I bet I would have really liked those people who died yesterday. They were my kind of folks. May they rest in peace.

nightmares about ER

2008-06-30T09:15:00.003-06:00

OK, weird stuff is happening.
1) People I really like are leaving the blogosphere.
2) I was up dere on the shores of GG this weekend, walking along the beach and what did I spot(I'm not kidding) - an armband from a local ER that somebody had discarded. Its following me people! I can't escape it! The ER is now following me where I go....yikes!
Makes one wonder what that person was seen for, that they could go to the beach so shortly after the visit. Were they morose - given bad news? Were they happy - there was nothing really wrong with them? Were they a drug seeker who took some narcs and went to veg out on the beach? Were they angry when they tossed the old armband - didn't get what they wanted? Oh the possibilities are myriad. One thing I do know is that they are a real doorknob because they littered on a beautiful beach...
3) Last night my husband dreamed that he was the intake person for the ER. I gotta stop talking to him about this shit...this ER had a policy that if you weren't really an emergency they wouldn't see you. They even had an area where they would see you if you had a complaint about that policy. Thing is, that line was really loooooonnnnngggg....oh boy. When your husband is dreaming about your job, its a sign...a BIG sign....perhaps its time to get a new job. Oh well, we had a good laugh over it....

is medical blogospher imploding?

2008-06-29T18:56:00.003-06:00

Wow. One of my all time favorite bloggers - ER nursey - is leaving the blogosphere! Say it ain't so....yours was one of the few that I read EVERY DAY. NOW WHAT DO I DO? Its like losing a friend. Man....I too have thought about quitting, got bored with the whole thing, didn't have anything to say,etc etc etc. I'm not sure why I stay with it. Maybe its become a habit. I don't know. I really don't spend that much time at it.
Now, Monkey Girl says she'll be back "WHEN SHE FEELS LIKE IT!!!" Another daily read of mine...come back to me gals!
Whats next? Nurse K? When she goes the ER nurse blogosphere will implode...

on the shores of GG

2008-06-29T18:51:00.001-06:00

Here's where I was today, on the shores of GG. This is what keeps people up in the frozen tundra, the beauty of the tundra when it's unfrozen.

change o shift

2008-06-28T07:14:00.003-06:00

Braden at 20 out of 10, a recent addition to the nurse blogosphere, does a great job with change of shift. Check it out.....

profitting off the old and vulnerable

2008-06-27T21:19:00.004-06:00

Are we ever going to get to the point where we are not doing these expensive complex tests on those above 90? Like today I had a patient over 90 who had a slight (we're talking SLIGHT) facial droop. No other neuro changes. The patient had mild dementia. They decided to do an MRI on him! Now, my question is what were they going to do if she had a head bleed or a tumor or a big stroke? Were they going to operate? Of course not. So, tell me, what the hell is the reason for putting a 90 year old man through an MRI in which you are enclosed in a tomb like fashion in this machine? Its insanity. This man could not do the MRI checklist so I called his even
older brother to ask him the questions. He told me he has had that droop for a long time after having a small tumor removed. So the entire thing was a colossal waste of time.
Even the patient, in his demented state, questioned whether this expensive test was necessary, but agreed to it, like old people do because they don't want to disagree with the doctor. So off they went....
This is fear of liability crap at its worst. There is really no excuse for it.

another reason why getting old sucks

2008-06-26T20:47:00.001-06:00

aquagenic pruritus: fact or fiction? you decide

2008-06-25T21:31:00.004-06:00

Ever wonder why ER nurses are a gnarly bunch? It's because we deal with people like this:under the allergy section on the chart among the allergies: WATER. That's right water....the stuff that composes 65-90% of the human body. In other words you are allergic to yourself? Well it turns out that this person is allergic to water on their body. IN the allergy comments section is this corker: "takes very quick showers". I'll just be they do...har har har.
After dealing with this patient I am not surprised they have a bizarre allergy....they were there for 5 1/2 excruciating hours.
It turns out there really is a condition in which a person is allergic to water (according to internet sources). Its called Aquagenic pruritus. It is a skin disease in which you develop severe, intense itching when in contact with water.
Whatever....I put this one up there with someone who was allergic to cold....and living in the frozen tundra of the north.....ya can't make this stuff up folks....

you will get your reward in heaven

2008-06-24T21:17:00.004-06:00

"End of the spring and here she comes back
Hi Hi Hi Hi there
Them summer days, those summer days

That's when I had most of my fun, back
high high high high there
Them summer days, those summer days

I "cloud nine" when I want to

Out of work, yeah

County fair in the country sun

And everything, it's true, ooh yeah

Hot fun in the summertime

Hot fun in the summertime

Hot fun in the summertime

Hot fun in the summertime

First of the fall and then she goes back
Bye bye bye bye there
Them summer days, those summer days"

What group did this song? What line did I change? If you answer correctly you will get your reward in heaven....

sex and icky critters

2008-06-23T21:24:00.003-06:00

People have sex. Sometimes when they have sex they passed icky critters to each other because they are too dumb to wear a condom. The ones with the intelligence of a gnat come in to the emergency department. A pelvic is done. Or a rotor rooter (culture in the urethra) is done on the guy (although now a days they can just provide a urine). The icky critters take a couple of days to grow. It used to be we treated people prophylactically for STDs, but that seems to have gone out of fashion these days.
So people are instructed to call back, or we will call them if it comes back positive and it needs treatment. So they call back, usually at the most inopportune of times, to get test results.
Every day our ER gets a print out of all the various culture done on ER patients - STDs, urine cultures, blood cultures, wound cultures. We go through them every day and have to go back in the chart and see if they were treated adequately. If they weren't we have to get a prescription, call them back to come in and get it. We also have to fill out paperwork for any STD that is positive and send it to the state board of health. They then call dumb person and get all their equally stupid sexual contacts and call them and so and so on. (Your tax dollars at work....)
So anyway, all this stuff is done by RNs in one of our areas of the emergency room. To say it is a pain to try and do this and take care of the patients too, is an understatement. It sometimes takes a lot of time.
My question is this: What do other ERs do? How do you handle this necessary task?

where are all the nurses going?

2008-06-22T17:07:00.004-06:00

I am amazed at all the nurses who are going back to school to get their BSN, NP, CRNA. This is all the rage among the late 20's early 30's nurses at work. I noticed people doing it in the blogosphere too. I was saying to another nurse at work the other day, I feel like a slug because I'm not going to go back to school. I'm waiting to do early retirement.
It makes me wonder with all of these young nurses wanting to do non hospital nursing, who is going to be taking care of the hospital patients in the future? I think I read that the average nurse graduate is in their late 20's. They work a few years and then go back for a masters. Then there is the generation that is in their late 40's and early 50's who will retire in the next 10-15 years. That's when the shortage is really going to hit when those nurses start retiring.
Actually, it will be pretty good for nurses, the demand for us will go up. They will have to pay us a lot more. We may finally dictate our employment. What a concept.....
At about the time a lot of the older nurses retire, the baby boomers will explode into retirement and old age. They will demand all of the more complex care to save their lives. Skilled nurses will be like gold.
If I had it to do all over again, I would probably go for CRNA. That's where the money is - up to 185,000 dollar a year.

JCAHO says: no poop for you!!!

2008-06-20T22:13:00.006-06:00

Well, it seems that JCAHO has decided that the ER staff (MDs, RNs, NPs) are not capable of handling poop anymore. By this I mean we are no longer able to do hemoccults at our hospital. A hemoccult is something in which you you obtain small samples of stool and place them in two boxes on a card, turn it over and put a couple of drops of solution on the sample and if it is blue there is blood in it. It requires waiting an allotted amount of time.
Now for nurses this is really not as big of a deal as it is for docs. Docs tend to do a lot of rectal exams in order to do a hemoccult. Now JCAHO is saying that they must send the card over to lab. Have they been doing that? No. Will they do it? Who knows. Apparently it will involve recording lot numbers in the chart, doing quality controls, etc.
Now, you are probably thinking - hey, you should be applauding - you won't have to deal with it anymore....true....but it is a blazing example of how idiotic the regulations are becoming in hospitals. You would think that the goal would make things more efficient, easier....but NOOOOOOOO....they just create more steps. This is the kind of stuff that makes you want to bang your head against the wall....

life is good

2008-06-19T21:18:00.002-06:00

The last few days on these beautiful evenings I have been sitting in my lounge chair watching my son and his baseball team slaughter the other side....

"I'm suicidal" gets you 3 hots and a cot

2008-06-17T20:32:00.005-06:00

There's an article on USA today's front page about ERs holding mental health patients too long. Duh.....they are just now realizing this?
Mental health has been in a crisis for years. Our units are constantly full. Often times patients have to be transferred to hospital 150 miles away. It really is out of control. I know that a lot of psychiatrists don't want to work in hospitals because the reimbursement is so bad. So there is a shortage.
Mental health still carries a stigma in this country and still isn't viewed by a lot of people as a legitimate illness. We as a nation still think that people should pull themselves up by their bootstraps, etc. Too bad its not that simple for a lot of people.
Mental health services in an ER seem to be so much of a game sometimes. We talk about people coming in and saying the magic words "I'm suicidal". Those words allow you to pass go and collect $200 and be admitted. Many people manipulate the system that way. They know they will get in if they say it. There are a lot of chronically mentally ill people who become frequent fliers. They show up with their suitcase at the triage window assuming they will be admitted. And they usually are. The homeless sometimes claim suicidal thoughts to get three hots and a cot.
Doctors fear liability it they discharge someone who states they are suicidal. So they keep admitting them. Admitting them gets them out of our hair.
Really ERs are not set up for the mentally ill. They are chaotic, nosy environments. The staff is really not trained to deal with mental illness. Some staff avoid them, are scared of them. We waste a lot of security's time having them standby people who say they are suicidal.
There should be separate areas in ERs for psych patients, that are set up for psych patients with staff that knows how to deal with psych patients. We are doing them such a disservice in so many different ways with the current set up. They deserve better.....

complacency slaps me in the face

2008-06-16T18:10:00.002-06:00

Working in the ER, you can become complacent. Seen it all, done it all. You think you can predict what will happen, its not rocket science etc. Certain types of patient are annoying, like gnats buzzing around your head. Something you just want to deal with, get rid of as fast as possible.
Such is the case with drunks. We see a whole lot of them. They are tiring. They are hard to deal with. They are annoying. They make you mad. They take up your time when you have other things to do. You just want them to go to sleep and not bother you.
Such is the case with a drunk I had. Brought by medics from the local bar after getting into a fight with somebody there. They had knocked her down and she hit his head. No loss of consciousness. She was agitated and difficult to deal with on arrival.
The doctor orders some labs, CT, thiamine injection. Drunk lady doesn't want any of it. She just wants to walk home that happens to be a few blocks away. Okay, I put on my "lets talk this lady into what they doctor wants" hat. With prodding and talking she eventually has labs drawn. Its an ordeal. I give her something to eat thinking maybe that will shut her up and sober her up quicker.
And that's where I make my mistake: I GAVE HER SOMETHING TO EAT. A no no for someone with a head injury that hasn't been scanned. See where this is going? That's right the lady has a fractured skull and subarachnoid hemorrhage. Hey doc she only took a couple of bites!!! Doc is not pleased.
Fortunately, this patient did not require immediate surgery. They went to ICU. Why am I telling you about a mistake I made even after years in the ER? I don't want you to make the same mistake I did. Sometimes that agitation can be a sign of something else or maybe they are just agitated. Assume nothing.

those lessons in life

2008-06-15T21:20:00.005-06:00

Its so obvious, these three lessons in life:

1) don't smoke
2) don't drink excessively
3) don't take drugs

There are obvious things that will happen to you if you smoke: emphysema, lung cancer, heart disease. Drinking: liver failure, pancreatitis. Drugs: heart attack, HIV, hepatitis, increasingly kidney failure and dialysis.
Most people are aware of the big things. But I don't think they realize that sooner or later the longer you abuse your body, you ARE gonna pay the price. You are more susceptible to all kinds of diseases. If you get sick, just ability to heal will be lessened. You can start off with something small and because of your debilitated state it turns into something big. Even if you quit, some damage has been done.
Sometimes I think, if you took away all the smokers, drinkers, junkies - how much business would a hospital have? A lot less. If is really sickening to see what we do to ourselves. People in their 30's dying of liver failure. Drunks falling and fracturing their skull and causing brain hemorrhage. Young people with emphysema. Its pathetic and sad. And we see them over and over...

bring back the draft

2008-06-13T16:58:00.007-06:00

The cover story of Time magazine right now is about how about "12% of combat troops in Iraq and 17% of those in Afghanistan are taking prescription antidepressants or sleeping pills to help them cope". This is interesting because someone I work with (who is about to go back) worked in mental health over there and spoke of how many troops were on SSRIs, a surprise to me. Twenty years ago you would have been sent home if you were depressed. In fact, I evaced many a psych patient. Now those people are being given happy pills.
I have reached the conclusion that the draft needs to be reinstituted for a couple of reasons:
1) the people of these country are not really sharing in the experience of being at war with these two wars. Since this is a volunteer army, it doesn't affect the everyday American like past wars have. So its easy to support something that is not going to affect you personally.
2) It is unfair and wrong to expect this volunteer army to go back 2 and 3 times to fight in the same war. No other generation of soldiers has been asked to do this.
3) If we as a country decide to enter into a war, then we as a country need to fight that war and everyone has to sacrifice. Sometimes it feels like we have hired some people (this volunteer army) to go and fight for us, so that most of us don't have to get our hands dirty. This is our country fighting this war, and we all need to be getting our hands dirty.
Now, me of all people, a person who has been part of a war...you would think I would want nothing to do with a draft. I really don't. I personally don't believe in this war. War sucks. I don't want anyone to have to go. But I find myself getting angry about the lack of sacrifice in this country and what we are asking our soldiers to do. Bringing back the draft would affect my 15 year old son directly. But at what point is the sacrifice of this group of people too much? At what point do we as a nation put our money where our mouth is? How many people would still support this war if their son or daughter had a good chance of going there?

love those Mormons

2008-06-12T19:06:00.003-06:00

Hold on to your hats folks and take a deep breath....someone is actually addressing the fact that those on medicaid shouldn't be coming into the ER for pregnancy tests, tootaches, hangnails. The state of Utah has received a grant to address misuse of the ER by such individuals. They are actually initiating a state wide program in Utah which tracks medicaid recipents visits to ERs and follows up to "educate" them about finding primary care. What a concept! They would actually have to do what those of us who pay for our health insurance do, not go to a ER for minimal problems. Be still my beating heart!
Here's the only problem with this: I would be willing to bet that at least 30% of the patients who visit my ER have medicaid which would drop the ERs income 30%. Who cares? Bring it on......may it spread to all the other states in this wonderful land of ours.

keeping a straight face ain't easy

2008-06-11T19:07:00.003-06:00

One of the things that you have to learn in the ER is to keep a straight face. Especially in triage. 'Cause there are people who are comin' in there who are bizarre. Like the guy who smoked (he said cigarettes) too much and got chest pain, apparently arrested, his girlfriend did CPR and brought him back to life. He came in to be checked. OK sir...have a seat.
Wait a minute....what is that low level buzzing accompanying that patient I am bringing into triage 1? Uh-oh...they must a member of that group of folk who for some reason feel a need to put foreign objects into parts of their bodies that aren't designed to have such items placed there. They matter-of-factly tell you that they won't be sitting down for triage 'cause they have voluntarily placed somethin' where the sun don't shine as it were. That item has decided it likes it there and ain't coming out voluntarily.
And we are thinking to our self, bite the inside of your mouth quick, to quell the urge to laugh...the control of the average ER nurse is astounding.