Posts Tagged Things Nurses Say

What I Have Learned from Nursing

The world of nursing on a couple of dozen flash cards. From The Nursing Channel on YouTube. While I don’t agree necessarily with every card — some of them, I think, play into some old stereotypes on how nurses behave —  it’s still  a fresh perspective on nursing. What do you think?

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The Guy in the Next Bed

Code Blue on the floor: a lot like a Code Blue in the Emergency Department, except we have to run to the elevators, take a ponderously slow ride up to whatever floor they’re doing compressions, and then run some more down some endlessly long corridors till we find a room full of telemetry nurses looking out expectantly the doc and me and the ICU nurse (who flew down three fights and turned an ankle in the process.)

The patient, of course, is already dead. We just haven’t decided yet to make it official. This is one of health care’s best kept secrets: once a patient has gone VSA he is, for all intents and purposes, dead. Chances of bringing him back are minuscule — and yet not tiny enough to give up all hope of resuscitation. Once even I shook the hand of a woman leaving the hospital who coded on the ambulance gurney while I was triaging her the week before. So we continue. I pull out the drugs, and direct traffic, while the ICU nurse pushes epinephrine and atropine. The ICU Respiratory Therapist manages the airway. One of the tele nurses is assigned documentation, and there’s a short rotation of three nurses for chest compressions. The doc yells at one of them: harder! faster!

After the second round of drugs, it’s becoming clear the effort is futile, and we settle into the routine. Nurses doing compressions change every two minutes. Epi every three. When we briefly pause for the change, the monitor shows asystole. The ICU nurse and I chat. The RT cracks wise with the doc, and the tele nurses giggle at this, We banter back and forth. We joke. Another of health care’s best kept secrets: we chatter like budgerigars during codes. Then, through a crack in the privacy curtain, I see just this: two fidgeting hands clasped across a flannel covered belly.

Shit. There’s a patient in the next bed. I make frantic hand signals. I finally get everyone to shut up. A couple of minutes later, the doc pronounces. The room is silent. I can only imagine what he guy in the next bed is thinking.

And this isn’t the first time this has happened in my experience. I can remember a few occasions in the Emergency department where the guy in the next bed was a child who for various reasons couldn’t be moved.

So what do we do about the patient in the next bed, apart from shutting up?

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Under Construction

Meaning me, of course.

I worked a (rare) Night 12 a few days ago. It was the usual dog’s breakfast of high acuity, walking wounded without end lining up at Triage, and the particular Emergency Department hell of having no beds for, you know, emergency patients, the department being a stunt double for a med-surg unit. But there was a small ray of hope. Or rather it was okay news-sucky news situation. We were to get  a bed, the element of suckiness resting on the fact the bed was on 5 North, my perennial nemesis, where, I swear, reside the most obstreperous nurses in the history of the Universe.

(Excuses I have heard over the years from 5 North for not taking patients: too busy, patient too sick, patient too combative, patient [with normal vitals] too unstable, patient a drug abuser, patient HIV positive, on break, short-staffed, still on break, patient restrained, patient not restrained, swabs not resulted, patient unsuitable, no one to take report, too close to shift change, just about to go on break, you just sent us a patient, the bed isn’t clean, the patient hasn’t left the bed, the room needs to be cleaned, too late in the night, too early in the morning, the patient will disturb the patient in the next bed, it’s a male bed and your patient is female, still on break — well, I could on.)

So I told the primary RN to call up report. We need to move some patients in.

They won’t take report, came the reply. All the nurses are on break.

“What the hell?!? All the nurses?!?” I was incredulous. “How can all the nurses be on break?”

I called up to 5 North. “Can I speak to the charge?”

“She’s on break.”

“Can I speak to any nurse?”

“They’re all on break.”

“All of them?”

“Yes.”

“Who’s looking after the patients?” As one might imagine, I was becoming a little agitated.

“I am,” came the reply.

“Who are you?”

“I am,” said the voice on the other end, “the nursing student.”

Dear sweet Lord, I thought. “Let me summarize,” I said.  “You’re looking after 24 patients all by yourself, because all the RNs are on break?”

“Well,” said the student in a tone which made it clear she thought she was dealing with a plain idiot, “there’s a nurse sitting beside me.”

‘”Oh,” I said, thinking I had misunderstood the entire situation. “Can I speak to her?”

“No! She’s on break. I told you”

After which I lost it, just a bit. “So when your patient in 55 falls out of bed and fractures her hip because she’s been ringing the call bell for fifteen minutes because you’re trying to clean up the patient in 37, what are you going to do?”

“Oh, I’ll call the nurse to help.”

“But she’s on break!” I was nearly shouting.

Click. The student hung up on me.

Well, I thought. That didn’t go well. But then, after I went home and thought about it, wasn’t I guilty of the same bullying behaviour towards this student I have written about so critically? I heard afterwards I had reduced her to tears. Didn’t this make me the poster child for nurses eating their young? The student, after all, was not responsible for being placed in an compromising position, and being made to run interference against a nasty ED nurse (i.e. me) was fairly despicable. I should have recognized the circumstances and adjusted my own response accordingly — regardless of who answered the phone. In the heat and stress of the moments it’s all too easy to engage in awful behaviour and justify our bullying afterward in terms of providing good care or best practice. It’s all a lie. There isn’t ever justification for bullying. All I can say in my defence: I’m a work in progress. Like everyone

[Update: Yes, I misspelled "construction" in the title. I need a sub-blogger minion to proofread.]

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Bad Nurse! Bad!

I guess my venting, raging post the other day offended and/or ticked some people off, or at least the use of the strong language did. No sooner had I posted my screed than no fewer then five Twitter followers immediately dumped me, and I lost a couple of email subscribers to boot. (I’m losing sleep.)

Good nurses with pretensions of seriousness in all things nursey don’t swear. Especially in print. (They may mildly curse — darn it all — if they happen to break a nail, but never in front of patients, children, or their mothers.) Or so I have been informed by good, serious nurses.

I confess. I am a bad nurse. I swear. I sometimes have been known to swear in the clinical setting — O, the horrors! My Catholic-hospital-trained nursing instructors would be appalled. I also used to smoke, I wear scented products on occasion, and have been known to tipple a Cab Sauv.

I guess the point, if there is one, is that most times I can dress up the gripe-du-jour in a way that demonstrates gold-standard nursing practice. But being human, sometimes what you get is honesty, raw and unvarnished. Sorry.

Actually, no, I’m not sorry. Being Canadian, I just felt I had to apologize for something. If I were truly sorry, I would promise never to do it again, and to reform my sinning ways. This a hint.

Anyway, I’m very cranky. A few weeks among the heathen in middle and upper management, and I am now convinced they all worship Satan Satan worships them. The general snake-pitishness of it all makes one a little breathless.

Also, here’s a little song I like to really annoy a few more readers, because crankiness is something we need to share, and I’m all about sharing.

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Observations and Assessments

Notions too small for a blog post all in one place.

April Foolishness. I guess I got  — or more likely annoyed — a few of you with my little April Fool’s prank. In case you missed it, I faked a news report from Trout Creek, Montana (pop. 261) stating the local hospital was going to fire all it nurses and replace them with housekeepers. I even put up a picture of some hospital in India, complete with palm trees (in Montana!). Some of you waxed quite indignant before realizing it was the First of April. What’s interesting is how readily people believed it — which speaks volumes about nurses’ perceptions about how they are valued by their employers. Which is to say, not much.

Nurse goes all postal on Craigslist. This epic rant has been making the rounds — those with delicate sensibilities may want to avert their eyes:

Well, after a year of getting rejected I have finally decided to give nursing the bird. FUCK YOU NURSING FIELD! Too bad the schools and media are still insisting that people go to RN school. Believe me THERE IS NO FUCKING SHORTAGE! New grads are considered garbage. On top of that, the degree serves no purpose in any other setting. BSN is a complete waste of time and money.

I know, “some people got jobs”. That does not justify the majority (1000’s) who did not and are now working retail for minimum wage. There is something fundamentally wrong with this country. My school counselors, nursing instructors, media and nurses I know urged me to go into nursing. As soon as I got my degree and the check to the school cleared I heard the unmistakable sound of the door to nursing closing—slamming actually. And it is not just the economy. Hospitals turning huge profits stopped new grad programs and hire foreigners.

It is over. I am a stale grad and I am out of options. The new graduates fresh out of their precepts will be flooding the market to add to the already rancid oversaturated pool of disgruntled STALE GRADS. So, I guess giving up a nice job for school, dedicating 6 years (yes, I was foolish enough to get the BSN), dropping 20 grand and putting up with nursing school stress was all for nothing.

And no, higher education is out for 2 reasons. One, you need RN experience to qualify for any NP program. Second, why would I throw more money at a system that just failed me and ruined my life? It is clear that the educational system is bunk. I am completely embarrassed at the education I experienced at the California State University–It is appauling.

I hate nursing. I hate it so fucking much now. The true colors of the profession are now clear. So, now society can have a derelict because that is what I intend to become. I now plan to make a living mooching off the system.

It would probably take a year of posting to unpack all of this. Suffice to say, I do have the tiniest bit of sympathy for her, as I graduated at the nadir of nursing joblessness in the ’90s and was forced to work part-time for the first three years of my career. That being said, I wonder at her commitment to the profession, despite the six years of expensive education; one senses she wants her dream job handed to her on a platter. It doesn’t work like that. So I’m with everyone else: don’t let the door hit you on the way out. Or else come to Toronto — I know some 5 North nurses who would love to have you as a colleague — and they’re hiring.

Uterus, uterus, uterus. In another take to the uterus-as-filthy-word story, now you can incorporate your womb. (Thanks Terri!)

Take me to your leader. In case my American friends and readers haven’t noticed, we’re finishing up the second week of a federal election campaign, where the forces of light and the agents of doom and darkness will collide in a colossal battle for the heart and soul of the nation, etc. Being the flaming left-wing commie-pinko-socialist I am, I will prevaricate until the very last minute till inevitably holding my nose and voting Liberal. All which is to say, if I seem more, um, political in the next few weeks, I can’t help it, it’s the environment.

Hope they were praying for epinephrine. Speaking of Members of Parliament, there’s a report in the Le Devoir this morning that three Conservative MPs witnessing a severe allergic reaction on a flight to Taiwan responded by laying on the hands and praying. I guess I slept through that part in my critical care courses where Prayer comes before Airway, Breathing, Circulation. [ Via. ]

Non-nursing blog shout-out:  Worcester College Gardeners — actual professional gardeners charged with the maintenance of 26 acres of grounds surrounding Worcester College , Oxford, U.K. Reading through the blog puts lie to the notion of effortless gardening: it becomes quickly very apparent all those charming, perfect English garden scenes Canadians wax green over are the result of some pretty intensive labour. What I could do with a flock of minions and unlimited cash!

A pair of quacks. I was happy to learn that both Mehmet Oz and Andrew Wakefield, the fraud-mongering anti-vaccination advocate, were recipients of the annual Pigasus Awards. Oz — and any self-respecting  nurse is always glad to see him taken down a notch or two — was given the award for promoting such quackery as energy fields and faith healing and advocating the bereaved call a psychic for consolation. (Why is this jackass still on television?) Wakefield got the award for continuing to peddle his nonsense despite being called out by the Lancet and the British Medical Association.

Mini-rant. To anyone who has cut and paste from this blog: it has come to my attention bits of my writing — which I remind you are not free, in the sense you can use them at will — are being circulated unattributed and altered contrary to the copyright notice on the bottom of this page. Please note that even if you did not see the copyright notice, you are still subject to its provisions. In other words it is your responsibility to ascertain your obligations.

I really don’t mind people lifting my writing so long as it’s unchanged and attributed to me. I actually like it, because it’s free publicity. But when I find my original work altered to the point where my authorship is in doubt, it starts to piss me off. When you don’t link back to me, you become a thief.

P.S. When I write “shit” I mean “shit”, not some milquetoast euphemism you have determined won’t offend your readers — which  incidentally doesn’t nullify the copyright either.

P.P.S. Why do I think it’s a losing battle?

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“Today’s Last Patient of the Night”

[One of the many great submissions to the Those Emergency Blues Prize for Writing. Posted here with permission.]

Author: TyRANTasauras Regina

Blog: EDNurseasauras, Still in the Trenches

Today’s Last Patient of the Night

Every so often there is a patient who will haunt me forever; our Last Patient of the Night is one I will think about often.

He was small for a 4 year old, a beautiful blue eyed blond little boy. He was whimpering strangely in the arms of a woman whom I assumed was his mother, also blond and blue eyed. They were accompanied by two little girls, probably 8 to 10 years old. They were silent.

“He’s an orphan”, said the mom. “We’re his host family for the holidays, and we have a folder of his medical records. He burned his finger tips when he touched the glass screen of the fireplace”.

I took a look at the little boy’s fingers; the 2nd, 3rd, and 4th fingers of his left hand had a blister on the pads where they had come into contact with the blistering heat. He was alternately putting his hand on the ice covered in a wet paper towel, and removing them and sobbing, clenching his fists with pain. These types of burns usually do fine, but are excruciatingly painful for the first few hours.

The mother went on, “He’s from Latvia, and he’s deaf. He’s from a program where orphans spend time with families for the holidays; we would like to adopt him”.

“We love him”, the youngest of the little girls said simply.

Normally immune to such situations, my heart melted on the spot.

His records were, uselessly, in Latvian. We tried some numbing medicine on the burns, gave him some Tylenol with codeine and tried to make him comfortable. I got a sterile cup, filled it with room temperature saline and had him dip his little fingers in it. Immediately he stopped crying. After several seconds, he lifted his fingers out of the cup experimentally; his face crumpled with pain, and he howled like a wounded animal. I gestured to him to put his fingers back in the water and was rewarded with a surprised grin. He put his head on the mother’s shoulder and sighed contentedly.

I really didn’t want to pry, but I asked, “Does he have to go back to Latvia after the holidays?”

“Yes, and that’s going to be so hard. He’s such a precious boy; he never cries, well, at least until he hurt his fingers. I wonder, do you think it’s because he’s deaf?”

“It’s an orphan thing”, explained the older of the two little girls sagely. I was astonished at her insight.

“Does he sign at all?”, I asked. I vaguely recalled that American Sign Language (ASL) is not universal; most countries have their own sign language and their own rules. From some deep, forgotten part of my brain I recalled some signs I had learned years and years ago when my friend Geri and I took 2 semesters of an evening school sign language course.

The little boy had started to shiver; I balled both my hands into fists with the thumbs sticking out between the index and middle fingers. Shaking my hands in front of my I said, “Cold”.

No reaction from the little boy, but the mom was interested. “What’s the sign for ‘hot’?”

I just couldn’t remember. I remembered “play”, “mom”, “girl and boy”, “friend”. The two little girls quickly picked up on the few signs I could remember. One final sign popped into the front of my brain; I made a motion as if to pull at the visor of a ball cap, followed by touching my lips with the fingertips of my hand and then touching my other hand with both palms up.

“Good boy”. Such a good, sweet boy; this family was in love.

” I know how to say ‘I love you’”, offered the youngest little girl, as she extend her thumb, index and pinky finger and held her palm side out; “That’s the most important sign of all”.

They were ready to go home. The two little girls wordlessly gathered up their coats, the mom’s purse and car keys. The oldest gently put the little boy’s hat on his head and softly kissed his flushed, tear stained cheek. They went out into the snowy night.

My New Year’s wish is the hope, with all of my heart, that this lovely family will be able to make the little guy a permanent part of their family. They all deserve a happily ever after ending.

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First Group of Submissions for the First Annual Those Emergency Blues Prize for Writing

In no particular order or priority, the first group of nominees/submissions for the first annual Those Emergency Blues Prize for Writing. If you don’t see your name here, rest assured, there are more in the docket and these will be posted on the weekend. There are some really good pieces submitted or nominated and I am pleased we’re going to have to make some hard choices.

Don’t forget, the deadline for submissions and/or nominations is midnight 31 December 2010. Submissions can be made to torontoemergencyrn@gmail.com.

At any rate, click through and enjoy!

10 gifts you should buy this Christmas – Under $100 dollars & they keep on giving!


Hugs And Kleenex


Today’s Last Patient of the Night


Facebook in the ER


The one month anniversary of…well, of waking up, I guess.

Tell It Like It Is


Do This, Not That


The Wonderful World of Versed


Haste


Going Beyond the Scope of Practice

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Maxims for New Graduates

Courtesy of Will Hardy

Will Hardy over at Drawing on Experience wanted advice for new grads.  My two cents.

Learning never ends.

Learn by doing.

See one, do one, teach one.

Pay attention when a patient complains of imminent death.

Go to codes.

Never pass up the opportunity to see a procedure.

Not everything can be fixed.

Eat.

Pee.

Breathe.

Patients die unexpectedly for reasons unrelated to the quality of your care.

Don’t think you know more than you do. You don’t.

Ask for help.

Ask questions.

More importantly, know when you must ask questions.

If you still don’t understand, ask more questions.

Advocate. For your patients. For your profession. For yourself.

Be skeptical.

Critical thinking is not optional.

Bedbaths are an essential skill, even for RNs.

Chart. Then chart some more.

Read Notes on Nursing.

Walk before running. Basic nursing before Swan-Ganz catheters.

Listen. Carefully. When someone offers you a piece of chewing gum, you’re not thinking your breath stinks, right?

ABCDs.

Wash your hands.

Foley catheters are not a substitute for good nursing.

Housekeepers and ward clerks are your best friends. Treat them as such.

Bring chocolate.

Your most recent assessment is the most important one.

Find a mentor.

Sixth sense counts. Ignore it at your peril.

Five rights. Three checks. Always and forever. No exceptions. Ever. Amen.

If you’re giving more than two of anything — tablets, capsules, vials — you’re giving too much.

If your colleague is drowning, throw her a life ring.

Specialize in a skill. Be the go-to guy for hard IV starts.

Make it your rule: take no shit from anyone.

Feel free to add your own: I’ll make a page for them.

[Update: Will's cartoon added]

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Once Again, Triage Nails It

Overhead at Triage:

20-something guy arrives via EMS for a penile fracture. (How he fractured his penis — well, it’s a story Not Suitable For Work, though suffice to say, it involves repeated dosing of beer and shots.) Granted, it’s a horridly painful injury, and a true urologic emergency: I guarantee all of my male readers are wincing and all of my female readers are snickering. However, our buddy is drunk and carrying on far, far beyond the call of duty, thrashing around and fluently and imaginatively cursing out the paramedics, the housekeeper, the nurses, the physicians, anyone, in fact, within earshot or seen from beery, bloodshot eyes. He’s not only an caterwauling idiot, but something much worse, a drunken, caterwauling idiot.

Triage listens to the (slightly ridiculous) story from EMS, listens to the continuous, matchless bellowing on the EMS stretcher, and pronounces her verdict:

“Clearly,” she says,  “A brain injury.”

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Cootie-Proof Forever

Some days I think my colleagues are the most amazing group of people I could possibly work with, and would gladly and gratefully place the lives of myself and all my loved ones in their capable, clever hands. Other days, I think they are hopeless, bitter, gossipy old skanks, and I throw up my hands in despair.

We have a problem-child nurse in our department, who I’ll call Sarah. She’s actually a pretty good nurse, but she’s loud and opinionated, doesn’t listen well, doesn’t play well with others, and she’s managed to offend in many and manifest ways (for reasons I won’t go into here) the crusty twisted old princesses RNs* who like to think they run the department — or at least public opinion.†

I don’t actually mind this nurse (mostly) and will converse with her in a friendly-like manner, and will even be seen to do so in public. Shocking, I guess. There was a pub night the other night and the subject of poor unloved Sarah came up. When nurses drink, the knives come out, and you’d better get out the sawdust, ’cause there’s going to be blood on the floor. The next day my closest friend in the Emerg, who was attending and witnessed the repeated eviscerations of various nurses, told me (by way of having my back) that the Old Crusties feel I am becoming associated too closely with Sarah by being friendly and speaking with her and that I had better knock it off.‡

I went away and thought about this one for a long while.

Apparently, I have concluded, Acme Regional Emergency is actually an elementary school-yard. Sarah is the little ugly girl with the cooties, and I am in mortal danger of getting Sarah-cooties, which seemingly are very catching and will destroy me forever.

I think this is what it comes down to. Honestly. Nurses behaving badly, and cooties.

But you see, I said “cootie-proof forever” beforehand, so I’m in the clear.

When I think about it, it seems to me we generally often treat our colleagues on the basis of whether they have cooties. Call it the tyranny of conformity, or horizontal violence or having the temperament and mentality of a eight year-old or whatever you want.

This makes me so proud of nurses.

__________

*I mean crusty as in peel-the-paint-of-the-walls-with-a-glance crusty. Angry-spitting-camel crusty. They even frighten me.

†I meant to ask, are you guys bored with my endless fascination with intradepartment politics? I’m sure the nurses among you find it as equally entertaining, but. . .

‡I also strongly suspect some highly critical and nasty things were said about me, but ignorance is bliss.

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