The police are more-or-less a permanent fixture in every Emergency department. They bring in the drunks, the suicidal, the psychotic, the homeless and yes, the criminal, who have either sustained injuries as a result of their activities, or else have developed sudden (and convenient) cardiac symptoms upon their arrest. Most of us in Acme Regional’s ED will cooperate with the police to the point of expediting whatever they need us to do, which usually means filling out the Form 1 or medically clearing the patient. At the same time, most of are pretty clear that ED nurses and physicians are not an extension of the Police Service: police objectives and those of health care, to state the obvious, are not the same.
It isn’t exactly mistrust. It’s more a wariness. There are ethical and legal issues involved. We cannot, for example, divulge patient information, so there is the constant dance of the police asking for information they know we won’t give them. Come back with a subpoena, we tell them. They try anyway.
Then there is this: what do when the police bring in someone who, well, they’ve been beating on. It isn’t common, I should emphasize, but it isn’t so rare that it excites comment either. The police will say (nudge, nudge) the patient fell on the pavement while being arrested. Or banged his head while getting into the cruiser. Or the wall hit his face. Which may even be partly true. The patient usually says nothing at all.
So what do we do about it? Approximately nothing. We might document the injuries, in case there are legal problems down the road. Or not. We are definitely not going to make any allegations about misuse of force. Who wants to travel that road, full of traps and pitfalls and paper by the mile plus, of course, the undying enmity of the local cops? I have seen a few pretty egregious cases, and we did exactly that — nothing. As well, I suppose many of us don’t want to second guess the police: I mean, who knows how things really go down, right? And we say, didn’t he deserve it anyway?
But how does this make anyone accountable? Including ourselves? And don’t we have a legal system in place to adjudicate innocence and guilt, and administer punishment?
It’s a moral swamp. And having thought about it long and hard, I’m not clear what, if anything, that can be done about it in practical terms. ED staff are not the guardians of the guardians. So we document. Poor excuse, I know.
…or the negativity they can spew….
“You wouldn’t know what to look for in that type of patient assessment anyways…”
How do you know I don’t know what to assess for? Are you the textbook I read from? The online periodicals I continue to educate myself with? Are you every patient I have assessed in the last 8 years? Did you teach me? Were you my preceptor in some nightmare? Well since you are none of the previous and you’re not a bound textbook (despite how wound up you are all the time) please do not assume that since I have less experience than you, I won’t know how to assess a patient with XYZ diagnosis. Perhaps just ask if I know what the presenting signs and symptoms may be and any associated complications to monitor for, what the normal would be, etc… and take a supportive and educative approach if you are concerned about my assessment skills without any condescending tone or implied disregard for my apparent limited knowledge.
I recently had a patient with a skull fracture, (the head injury happened a day earlier), and the senior nurse asked if the patient had battle’s sign, (bruising behind the ears), which they did not, I informed her, to which she rudely replied with, “you wouldn’t know what battle’s sign looks like anyways…”. Between being 0645 in the morning after a long night shift and the only words coming out of my mouth would have been immature and highly offensive, I felt it right to walk away from the conversation.
As per this blog post, I’m clearly still stewing.
No pigeons were harmed in the making of this short film.
I never thought I’d use the words “Epic” and “Hitler” and “Emergency Department” and “Charge Nurse” and “Rant” as a blog title, but what the hell. I was bored one night and thought it would be fun to make a Hitler rant parody.
So as J mentioned before, I was in a near catatonic state due to my VSA* computer which has fortunately been resuscitated. The hypothermia post resuscitation care was beneficial but it suffered an anoxic brain injury that may not be possible to overcome. Despite this crushing blow (more so financially really since I do not feel like purchasing a new computer) I am okay with the periodic laptop confusion for now. I’ll do neuro vitals qshift on the computer, continue monitoring and provide supportive care. (Sorry for the lame nurse humour; that I cannot fix.)
Aside from my near death computer experience I have been incredibly busy with working in the ER, updating necessary work courses, school work for a critical care course I’ve been taking as well as starting in Acme Regional’s CCU/ICU. It’s a very different world up there (literally not figuratively. . .it’s on the 4th floor). The pace will take some getting used to. On one hand I enjoyed just having one patient to dedicate time and care to, knowing their history and the pathophysiology of their recent admission and not feeling like I’m practicing unsafely or providing my patient with the bare minimum, however, at the same time, having only one patient is a bit boring. The ICU seems a bit tedious: lots of little details and new physician orders that my emergency brain isn’t wired for. We have a lot of autonomy in the ER, more then I think we realize. Either way, I welcome the change in general, be it pace, environment, meeting new people, learning some new skills and learning in general. I had been feeling stagnant in the ER for a while. I still enjoy the ER immensely and I am not leaving, simply picking up some hours in the ICU for now. If anything I hope the added critical care experience makes me a better nurse. I felt like I had hit a roadblock and I wanted to know more but I just wasn’t learning in my day to day work life, so back to school I went!
I’ll have some new posts soon on more phrases junior nurses and most staff do not care to hear, as well as some other burning ideas and issues (with possible sarcasm and complaints) that have been on my mind. I have a few patient stories I’d like to share also. So, I hope to be more active soon, sorry for the absence!
*VSA – vital signs absent
*ROSC – return of spontaneous circulation
Dinner last night with an old friend who toils in the mines of Labour and Delivery. She has worked there for four years. She told me of an incident not too long ago working the night shift, faced with a post-partum patient who was bleeding, hypotensive, and tachycardic, in short, showing all the signs of going into hypovolemic shock. She was running around, starting IV lines on flat veins and hanging blood products. Packed red cells. Platelets. Cryoprecipitate. And by-the-by, saline by the bucketful. She called for help from her colleagues. Apart from this patient and another who was walking the halls a few hours from delivery, it was a slow night.
Of course, you know the end to this story, don’t you?
No one came.
No one even popped their head in the doorway to ask, “Is everything okay?”
All of them were at the nursing station, playing Draw Something on their phones, watching the season finale of Grey’s Anatomy, what have you. Too busy to help a drowning colleague with a shocky patient.
My friend went to her educator and her manager. They shrugged it off. No biggie, they said. Clearly my friend had things under control. “The patient lived, didn’t she?” they said. And then: “Maybe you need to improve your organizational skills to handle critically ill patients.”
This last to a 50-something woman who has been nursing 25-plus years, almost all of it in critical care settings.
For my friend, this incident may well be the last straw. She is definitely leaving L & D. Why would she want to stay? The workplace culture on this unit is awful. She feels alone and isolated when going into work. She can’t trust her colleagues. “Why,” she asks, “would anyone want to work there? There is no teamwork. No solidarity. Nurses backstab each other at the first opportunity.”
The only question remaining is whether my friend will leave nursing altogether and take her 25-plus years of experience with her, which included not only the knowledge to provide expert care to patients, but the potential to share that expertise in mentoring and nurturing new nurses. She’s uncertain what she would otherwise do, but leaning towards abandoning the profession which has shaped her adult life. She only needs an out — which she hasn’t found yet. She is that disgusted.
You might tell me that stories like this are unusual and not representative of nursing. Unfortunately, we all know better. So in the end, I don’t blame my friend for wanting to leave. I would do the same.
So what would be your response?
UPDATE: Some comments from Twitter:
The second to last tweet from @NorthernMurse is probably the relevant question, don’t you think?
One of a series of YouTube videos from Bedsider, a program of the U.S. National Campaign to Prevent Teen and Unplanned Pregnancy, on having the birth control discussion with a physician.
Babies are great…when you’re ready for them. We think in the meantime women should have the right to a healthy, happy sex life without having to worry about unplanned pregnancy. For that to happen, women need to take an active role in their own reproductive health. We want to help with that.
Bedsider.org (Bedsider) is an online birth control support network for women 18-29 operated by The National Campaign to Prevent Teen and Unplanned Pregnancy, a private non-profit organization. Bedsider is not funded by pharmaceutical companies. Or the government. Bedsider is totally independent and the info on it is honest and unbiased. Our goal is to help women find the method of birth control that’s right for them and learn how to use it consistently and effectively, and that’s it.
Right now, seven in 10 pregnancies among unmarried women 18-29 are described by women themselves as unplanned. That sounds like a lot to us. We hope that Bedsider will be a useful tool for women to learn about their birth control options, better manage their birth control, and in the process avoid getting pregnant until they’re ready.
That any of this would still be controversial in this the year of God’s grace 2012 boggles the mind, especially the part where it’s okay for women to be sexually active and enjoy it.
One small quibble to Bedsider: nurses get to talk about birth control too.
Song on a May Morning
Now the bright morning-star, Day’s harbinger,
Comes dancing from the East, and leads with her
The flowery May, who from her green lap throws
The yellow cowslip and the pale primrose.
Hail, bounteous May, that dost inspire
Mirth, and youth, and warm desire!
Woods and groves are of thy dressing;
Hill and dale doth boast thy blessing.
Thus we salute thee with our early song,
And welcome thee, and wish thee long.
— Milton (1660)
*** *** ***
The year is ended, and it only adds to my age
The year is ended, and it only adds to my age;
Spring has come, but I must take leave of my home.
Alas, that the trees in this eastern garden,
Without me, will still bear flowers.
Su Ting (b. CE 680)
*** *** ***
spring when the world is mud-
luscious the little
whistles far and wee
and eddieandbill come
running from marbles and
piracies and it’s
when the world is puddle-wonderful
old balloonman whistles
far and wee
and bettyandisbel come dancing
from hop-scotch and jump-rope and
I saw this short from 2006 a few years ago and I wasn’t sure if I liked it — too precious maybe? — and on seeing it again I still found it annoying. But there is enough, I think, to make it worth watching, even if the sets and actors seem a little too perfect for my taste. Your mileage, of course, may vary.