Thursday, June 26, 2008

Nurses don't eat their young...

But some definitely don't make it easy.

I have had some great preceptors and helpful mentors so far in my Emerg experience (only about 2 months worth so far) so I can't say that nurses typically eat their young. I think that people are starting to realize that they NEED new grads, and if they don't help newbies succeed, there will be no help in the future. I did, however have an experience with a nurse on another floor that bothered me. Perhaps this can start the Emerg/Floor debate, and the animosity between them (at least, in my hospital there is some animosity).

The other day, during one of my precepted shifts in Emerg, I had a patient who had a fairly active GI bleed, whose hemoglobin was about 68g/L (normal is 120-140g/L). We start transfusing patients below 80 typically. She was elderly, was cared for by friends at home for the most part, but was basically immobile and the caregivers knew something more was wrong then what they could deal with. She also had melanous, loose stools (eww).

Anyway, General Surg came to see her, and admitted her so that she could have surgery the next morning (they didn't feel she needed surgery ASAP, but definitely soon). They had a long list of admission orders, and not knowing when she would get to the floor, we got started.

She needed two packed RBC's (which require multiple vitals and constant monitoring), a 2nd IV line, more bloodwork, a foley, 2 fleet enemas, not to mention the pre-op meds and other medications. I spent 2 hours at the bedside getting almost everything done for her. The only thing I didn't get to was the 2nd packed RBCs and the 2nd enema.

The foley took longer than expected because the woman was fairly tall and large ( requiring a bunch of hands to help roll), and she had wet her bed and her gown. So I got the foley in, changed the attend, changed the sheets, and the gown. THEN she needed the fleet (I was not going to let her stew in her wet attend for the fleet to start working. She already had a level 1 pressure ulcer and I didn't want it to break the skin by sitting in wetness). Twenty minutes later I had to change her attend AGAIN. To save time, I was also infusing the medications as well as monitoring her vital signs for the packed RBC's. In addition, I was slower then a regular nurse because I'm new at this stuff. It all adds up.

So as mentioned, 2 hours later we find out that a bed is available for the patient. My preceptor (who was helping roll my patient when needed and working with 2 other patients) helped fill out the fax sheet, faxed it to the floor, and then called the nurse using the handy dandy phones they have. I guess you dial into the computer the phone you want, and the nurse who carries the phone acknowledges the call, and that comes up in the computer. Then we called a porter, and packaged the patient up to go to the floor.

The porter came and stated that because the blood was infusing, she couldn't take the patient up herself. So I went up with her. I was extra staff anyway so it was fine. There would still be someone to help with the other patients.

So we get to the floor, and the nurses look at us as if we are from another planet. "Who's this?" they ask. "This is Mrs. X, we sent the fax sheet up about 10 minutes ago. She's going to bed 205a" I said.

"We didn't get a fax", they reply, annoyance in their voice.

I clearly remember my preceptor sending the fax. Trying to be political (and in a bit of a shock), I state, "Well I'm pretty sure we sent it, perhaps it's at the machine."

She sighs and goes to the fax machine. No fax. So that happens once in a while, the fax machines break down. So I ask "We called the nurse phone as well, and it acknowledged the call. But its ok, I'll give verbal report once we take the patient to the room". So they call the primary nurse for the patient and we get her settled in the room.

I give a verbal report (which in hindsight was silly because everything was already written on the faxed sheet which was in my hand because we send it with the chart), and the first thing she asked me was "We need to do Packed RBC's TONIGHT?? and the fleet HAS to be done tonight?" as if to say that she was annoyed with me that I didn't get it done downstairs, and that it would be too much work for her to do this.

Look lady, I thought, I just spent 2 hours with her to get almost all of her admission orders done BEFORE she even got to the floor. Doing a few set of vitals and changing her once more won't be that hard.

Of course I didn't say that, and I was kind of shocked with the way she seemed to blame me for giving her some work to do. I kinda just stammered and said "that's what's in the orders for tonight, so yeah. Sorry."

She then did the angry sigh and said thanks in a sarcastic tone, and then left the nurses station in a huff. The others at the nurses station looked at me as if I was scum. I left the nurses station in a hurry, shocked at the reception I received from the floor.

I didn't get mad until I was in the elevator, I think I was too shocked to be angry before. Plus, I was new. I hadn't worked in the hospital for 10 shifts yet. And I"m a new nurse. What if I had done something wrong? What if there was this policy that I haven't heard of? So I just kept my mouth shut.

There was NO reason for them to talk to me in that tone, or that way. I'm a person, and I worked hard to limit the amount of work that they would have to do. What if the bed had been available right away, and they would have had to do ALL of the work? They should be THANKING me that I was able to spend that time with the patient and get those things done.

I know that the floors are busy. I used to come home exhausted as a student during 12 hour shifts on the floor. I had even worked ON THAT FLOOR as a student nurse, and I don't remember it being that hostile. I know the patient load is tough, and there are post-op patients that are heavy. But that does not mean that they get to be rude to the emerg nurse that is bringing them a patient. We're swamped downstairs too.

My mentor later stated that if I get run through the coals again, just think of yourself as a PERSON first and a NURSE second. No one should be treating me like that, despite my limited nursing and hospital knowledge. If I had done a nursing task wrong, it would have been my preceptor's task to mention it. I had done nothing wrong.

The only thing I did wrong was being at the right place at the right time for her to bitch. And the sad part is, she was a new(er) nurse herself. Probably younger than me.

Change of Shift

Change of shift is up at 20 out of 10. Enjoy!

Tuesday, June 24, 2008

The patient I did not like

Surprisingly, despite my glowing personality and ability to get along with almost everyone (insert sarcastic tone here), sometimes there are patients I just don't like.

Yesterday was no exception. I was looking after a 65 yo COPD'er who was in for aspiration pneumonia. He was on 50% oxygen and his SpO2 was only 92%. He was fairly frail, I've seen 90 year old ladies look sturdier than him. By the time I arrived for the night shift, he was admitted and awaiting a bed on the floor. He had a reclining chair in his room, and except for breathing treatments, we had nothing to do for him until midnight.

But he made himself known. "nuuuurse. Put the bed... up?" he would ask. Then "nurse.. I cant sit... in the bed... I neeed to go... to the chair" so we put him in the chair. "put... the pillow... behind my back... and I want... a warm blanket.. around it. And a table... and a pillow to lean on".

Later when doing routine vital signs:
missE- "do you have any pain?"
him- "all over my body"
missE-" there is pain medication available to you, do you want it?"
him" what is it?"
missE- "dilauded, 1mg"
him" that won't touch me. I need 10... and I want some... morphine 100mg as well... that's what I normally take... If you can't... get that for me... than I don't want anything"
missE (getting annoyed). " did you want to try the 1mg Dilauded and see if it works? If it doesn't, than I can see about getting something more."
him "no... it won't work"
missE: "so you dont want any pain medicine?"
him "go away"

Later, when taking his bloodwork....
MissE- "hello Mr X, I'm here to get some bloodwork"
Him "you always take blood. I can't get comfortable.... how come other people have gone upstairs.. and I haven't... I can't sleep down here... "
MissE- "I know this can be frustrating, but they are working on getting you a bed upstairs. Sometimes there are certain beds for certain illnesses, and the people going upstairs qualify for those beds. I can try to make this area more comfortable for you as best I can, but its more likely that you will be spending the night in the emergency department"
Him "you always poke me... and the bed is uncomfortable... and you said... that they are getting something.. upstairs for me... I just want to sleep... I hate it here"
MissE- "Mr. X, we're doing the best we can. Are you comfortable enough where you are? Is it ok if I draw your blood now?"
him- "you ... keep on.. giving me needles.... I hate them.. and I'm uncomfortable.... and I need my table closer... watch my feet... fix my pillow... I need more blankets"

This went on and on all night. Did I mention his family was just as crusty and needy? We finally had to limit visitors to one at a time so that we could appropriately give time to our other patients.

Needless to say I was glad to leave work that day.

Just.. need.. sleep

Onto night 2 tonight, but the phone today kept ringing. I maybe got 4 hours sleep.

Caffeine, you are my lover.

Saturday, June 21, 2008


To preface this post, I have to say that despite our area being a teaching hospital, not all services run 24/7, and that includes the cardiac catheterization lab.

STEMI's and other MI's that come into our emerg don't automatically go up to the cath lab. Only those between 0700 and 1700 Monday-Friday. So today when we had a STEMI come in, we used TNKase.

At one point in my training I was told that TNKase can cause arrythmias. Well today, I saw it happen. The patient had stereotypical chest pain, 7/10, unrelieved by nitro. A STEMI was revealed, and TNKase initiated. Then about 20 minutes later, the patient became bradycardic, had some trouble breathing, and had worsening chest pain.

The monitor started screaming. Vtach. O shit. We scramble to get to the bedside and set up for a code. The code never happened as the patient was still awake, complaining of chest pain. The CCU doc was debating to pull out amiodarone, or whether to see if the patient would convert back. After about 5 minutes, we started seeing some regular QRS waves (with elevated ST) intermixed with the Vtach. Finally, within 20 minutes and without amiodarone the Vtach resolved completely. THAT WAS SO F'n COOL.

Sign me up for another day.

Friday, June 20, 2008

Today kinda stank....

Physio, Occ health appointment, then 6 hours of data entry.

Not my favorite day.

Start days again tomorrow. Perhaps some day I'll have something interesting to write about!

Getting into shape

I've been sitting on my ass too much because of my knee (which is markedly better, but still no stairs), so I decided that today is the day I start to get myself back into shape. I remember the days of playing a full soccer game without pain, and without being winded. I would love to get back to that.

I should preface things by saying that I HATE going to the gym. I always have. I'd rather be doing soccer suicides, then doing a cardio class or doing free weights. I'm weird, I know. I guess it was because when I was a kid I swam competitively, and I didn't have to worry about staying in shape because I was at the pool 10 times a week to train. Now that I'm 10+ years and +30lbs post swimming days, I feel the flab on my ass, and although my shoulders remain muscular (a not-so-fun remnant from swimming) I'm in terrible shape.

But, if I want to be able to get back into soccer in the fall, I've got to be able to start running again. Hence the gym and specifically, the treadmill. I'm by far the worst runner ever, but in a soccer game I am fine because its a competitive sport and I'm not thinking about running. I'm NOT a fan of running in one spot, but since I can't play soccer yet, or even go to the practices (my knee can't handle the stops and starts), I'm stuck at the gym.

I have a follow-up appointment with the Sports Medicine doc next week, and hopefully she'll give me the green light for other activities.

Thursday, June 19, 2008

Found a new blog to read

Every once in a while I find a new gem on the internet.

She's sarcastic, witty, and went to med school at age 29 for an MD/PhD program. She's even doing her PhD in EPIDEMIOLOGY. Heh.

I'm scrolling her archives now.

Monday, June 16, 2008

Admitted patients....

I have been working with a lot of admitted patients recently. I feel like I'm doing floor nursing, with half the supplies, lack of comfortable beds for my patients, and of course about 2 pages of admission orders. It was not what I signed up for when I started working in Emerg, but apparently this is the trend at most hospitals... admitted patients will stay in the ED for sometimes up to 48 hours before getting a bed on the floor.

What's causing this delay? There are many causes:

1. Lack of staff on the floors- beds closed because no staff are available to man them.
2. Lack of long-term care placement beds. Many acute-care patients are awaiting placement in a long-term care facility, and stay sometimes 6-months if not longer.
3. People are sicker. We are keeping people alive longer, with complicated comorbidities which require intense medical care.

The other day we were so swamped that we had to hold patients in the RESUS room. There were absolutely no beds in the ED for admitted patients, and no monitored beds in the hospital. This is getting ridiculous.

And yet, all we hear is about the wait-times for the emergency department. The problem is not the ED, the problem is the lack of floor beds, and lack of long-term beds.

Tuesday, June 10, 2008

Accomplishments and expectations

Graduation ceremony was yesterday, and it just so happens I received BOTH my masters and my BScN degrees at the same time. I still qualify, however, to walk across the stage one more time on Friday, which I will be doing with my parents in the audience.

There are officially no other tasks I could possibly do related to my former university in relation to my degree(s). It feels very weird to be done.

I can now list my name as: Elaine, BHSc, BScN, MSc, RN. OK the RN is still a temporary license until my results come in for the exam I wrote last week, but wow that's a lot of letters.

The question now to be asked is: Do I need all those letters? I know I want to be a bedside nurse for a few years to solidify my skills, but after that? Where do I see myself? Being a clinical instructor? NP? Meds? Management? I have no idea what will make me professionally fulfilled.

I'm also in my late 20s and have to start thinking about procreation (yes I'm a geek and called it that), and if I wait 2 years and go to med school, how the heck am I to have a family and not be too much in debt or divorced?

I have a friend who says women are stuck between a rock and a hard place... especially ambitious women. The expectation is that not only do we have to be successful professionally, but we also have to be a perfect mother and wife. And, we put the pressure on ourselves which makes us somewhat unhappy.

I do want a family, but I also want a career. I don't know what I'm prepared to sacrifice, or if I have to sacrifice anything at all.

Thursday, June 5, 2008

Another step completed.

I wrote the CRNE yesturday. 300 questions, a lot of "what would you say if" questions. I think I did ok but because of archaic technology, I won't know if I passed until August. I'm just glad its over. The final step of becoming an RN is done. After this point, it is up to me to study and keep in touch with the research.

After 4 shifts, I'm still up in the air whether I really like my new job. It's in the ED, so there will always be something new coming in and the day will be different, but I guess because nothing too exciting has happend yet, I'm feeling a little disappointed. I was trying to not have expectations, and so far its working, but that tiny part of me is saying "it's a bigger hospital, there's gotta be SOMETHING cool going on". I'm sure I'm just one of those "Angels of Mercy" where when I'm on shift people don't die, and people don't get that sick. Some of the nurses I'm in a line with are shit magnets, so I'm sure my luck will change.

Isn't it sad that I WANT something to happen on my shift? I feel a bit morbid.

Monday, June 2, 2008

Knee deep in studying

So after mucho procrastination, I am at my final study day before the Canadian RN exam. I sit on Wednesday, and unlike the NCLEX, it is paper written, and a full day process. Urgh. Some of those questions they offer are so obscure, I think I'll get them wrong no matter what I think is reasonable. So instead, I'm focusing the rest of my studying on making sure I can at least recognize the disease and what the priority nursing component is, so I don't get those wrong.

All I have to do is pass, so I'll be ok. But still. Scary!

I have a shift in the ER tomorrow during the day, so hopefully I'll have something to write about soon. Talking about old ladies with constrictures from a stroke 2 years ago isn't that fun.

Private Health Insurance...

This is one reason why I would not want to have to look for private health insurance for basic medical care.