Monday, December 21, 2009
1. No waking up at 6am
2. I have no kids thus no reason to get out of bed during the day if I can sleep
3. I don’t try to have a life when I’m on night shift, so thus I prioritize sleep after work instead of trying to stay up as I would with day shift.
4. Sometimes patients actually sleep
5. Sometimes there is a 4am lull… until about 6 when the world wakes up again
6. No one calls you before noon on your days off, just in case you worked the night shift. They don’t know your schedule so they make it a rule!
7. No rounding at night.
I otherwise will leave all comments, good or bad. :)
Monday, December 7, 2009
NURSE! NURSE!! (spoken like a seal, often repeated numerous times, elderly gentleman are predisposed)
NuuuuuuuuuuuuuuuuuuuuuuuuUUUUUURSE? (by little old ladies who need something that is sitting beside them at the bedside table)
nurse? (by the patient, typically a young college student, who is scared about their condition and needs support)
$(%*#)@)*#$$*#(!!! Nurse @@#$#)($*$* (your average drug seeker/chronic paineur who was just told they could not have their morphine/dilaudid/Demerol/fentenyl combo)
nnnuURSE! (For the less/non-urgents when they are asking, AGAIN, how long the doctor is going to be so they can get a note for missing work because of their cough.)
NURSE?!?!!??!? for the boarded and collared guy who denied nausea x5 and then feels the need to vomit RIGHT NOW.
Saturday, November 21, 2009
Sunday, November 15, 2009
Thursday, November 12, 2009
I do not cry at work. Have never even been tempted- even when I’m overwhelmed. I have seen numerous people die, families crying, bad things happen, but I don’t cry. Internally I feel bad for the family, but I have never been emotionally connected.
But then you bring a puppy dog in and they don’t have a home and I’m waterworks.
Perhaps this is my way of coping- I invest my emotions in something not real.
H1N1 Flu has taken over my hospital. Between the politics of who gets the shot first, of whom is on influenza-type precautions and whom is not, and then the people storming the waiting room with a cough, it is driving me bananas.
Some are, in fact, very sick. And as typical with Emergency Departments* with the 'flu we don't really know if their respiratory distress is actually from Influenza, or if it's bacterial. Oftentimes it's both: a secondary infection with the primary immunosupression from the "Hi-nee". They get treatments for both bacterial and viral causes, and if they are not doing well, a trip to the ICU. Most of the people I've seen intubated lately for "influenza-type illness" are under the age of 50.
I know the media hype is going fanatical about who and who isn't getting the vaccine, the safety of it, and how the government is doing a piss poor job. All I have to say is that most of the 'flu can be prevented from people staying home when they are sick, from handwashing, and from the vaccine.
Getting the flu sucks. Getting this particular strain REALLY sucks (I have had it). Both my fiance and I were stuck in our house with 40C fever for 3 days and almost 3.5 weeks later I STILL have a mild cough.
Get the shot when you are able to. If you don't do it for you, do it for your children or your friend's children.
Oh and I've also learned that I look GORGEOUS in safety glasses, an N95, gloves, and a yellow disposable precautions gown :) One day I'll take a picture to show you.
* if Whitecoat would ever read my blog he would be so proud
Sunday, September 20, 2009
Thursday, September 17, 2009
Shipping body bags to First Nations reserves isn't a crime, people die there too and health care workers need proper materials to prepare the body. Sending them in larger numbers along with influenza supplies... I can understand the upset, but come on people.
Were they to ship all other supplies at a different time? We'd be complaining about Health Canada wasting resources next.
I highly doubt that the people of Health Canada were thinking: "Wow it's a First Nation community, we aren't going to help them fight the 'flu, so we're just going to send them body bags".
Asking for an apology: appropriate. Asking for their job? Not needed.
Friday, August 28, 2009
Have you found that the guys in your classes or at work are any less competent than the women? Do they get treated any differently at work by patients, nurses and doctors? How are they managing to fit in with the overwhelmingly female workforce?To start off with I think there are going to be 'bad apples' in any nursing class and workforce, so to say that one person was bad based on their gender wouldn't really be appropriate. I can tell you one thing, I think it would be harder to be a male nurse than a female one.
Or is it (like the nursing theory you mention) that the male gender is just something you bring into your patient interactions, and you can make masculinity a positive part of the nursing experience?
First, stereotypes abound. You would constantly be correcting people and say that you are a nurse when you go to talk to a patient (they will think you are a doctor). That must be annoying. You will also be known as the 'male nurse'- and people will know who you are in both classes and in the workforce. You are one of the few (although growing in numbers) men who are willing to tackle a challenging job.
Second, I don't think there is anything against male nursing, but men tend do things... well... differently. In my experience I find women nurses to be 'mothery' - even I catch myself doing it sometimes (and believe me I am not maternal). Men tend to think practically and logically- it's hard to explain and I don't think I'm communicating it well, but it almost seems as they are more decisive and less coddling with their patients. Again a stereotype.
I know that having a male working in the pod oftentimes changes the nature of nurse interactions- for the better. Whereas group-think and interactions in a bunch of females can be quite catty, in my experience throw one man along with the women and it tends to be much more neutral workplace. As for fitting-in with a majority-woman workforce, I guess that would be up to you and where you choose to work. Set boundaries about dating coworkers and stick to them. Keep an open mind and be ready to listen to 'girl-talk'. It sucks but that's sometimes what my colleagues have to put up with.
As for interactions with the physicians, I really couldn't say because that is fairly individual. Most MD's that I work with prefer nurses to be knowledgable, inquisitive, on top of things, and keep them informed of what's going on with their patients. Male vs female... I guess it depends on the group of doctors. In my department there are quite a few women doctors, and I haven't really noticed any male/female nurse differences.
One area that you probably will never work as a nurse will be OB/Gyn. No matter how "PC" some women are, when it comes to their vajay-jays, they prefer female nurses over males. You could be the best nurse ever when it comes to labour and delivery, but you probably will find that it will not really be an option for you in the workforce.
I also find that men seem to congregate in certain areas of the workforce- ED, ICU, or critical care. I'm sure there has been a study on this- but why they tend to work in those areas I do not know.
Finally, similar to female doctors in a male-dominated role- there will be some resistance from patients. Most 60+ year olds are not expecting their nurse to be male, nor are they expecting their doctor to be female. Anecdotal evidence (n=1... me this time) has told me that some little old ladies do not feel comfortable with a male helping wash her private parts. Although this is few and far between, as a male nurse I would assume you would need to not let it bother you if a patient requests a different (aka female) nurse. That being said, I have yet to hear of anyone doing this (exempting some cultural practices where they requested females for EVERY part of their interaction with the staff at the hospital).
Overall if you feel like tackling not only nursing school, but nursing itself, you probably have the right attitude. However if you hate working with women, perhaps you could find yourself a male dominated department, but otherwise nursing may not be for you.
There are some great male-nurse blogs out there, I'm thinking they would be a better resource than me!. Here are just a few:
I'm sure they could be a great resource for you.
Monday, August 17, 2009
...were students in the compressed RN program treated any differently from the "regular" BScN students? Do you find that your health sci bachelors and epidemiology master's(?) helped you in understanding the BScN material, and made you a better nurse? Do you feel that one needs a Bio/Biochem/Health Sci background to succeed in the accelerated nursing program?Here's the scoop, and honestly this is just my opinion of my experience so I don't know if that will help you at all but here is my response.
Or does it all come down to being able to successfully shove a needle into someone's veins and a Foley catheder into their bladder with consistency anyway, and all the BScN/Health Sci course stuff doesn't matter anyway?
Most compressed RN schools in Ontario have been introduced only recently as the need for RN's has increased. Because of this they are oftentimes working out kinks for the first few years. Also, most regular BScN classes are fairly well-established. My particular class was quite segregated from the 4-year program- because it was new and the student councils (etc) weren't used to including us. We received no 'pinning' ceremony or ritual nursey events, oftentimes the dates for fundraisers/events were planned the nights before major exams or while we were in clinical, we were forgotten for induction into special nursing organizations, and we weren't part of the general nursing graduation planning (this was our choice- by that time we just excluded ourselves from regular BScN stuff). I don't know if this has changed- it probably has as the program becomes more established. To be perfectly honest I pretty much preferred the way we kept to ourselves... I'm not one for the nursing fluff that is often generated surrounding 'social events'.
Not everyone in my class had a health science/biomed background, but most did. If you have never taken a science/health course, it may do you well to take at least one credit prior to nursing school (like anatomy or physiology) just so you can see how it goes. However if you enjoy the content and keep on top of things, doing the courses "excellerated" or "compressed" will be ok. It just means you don't have as much time for a social life or a job that you may have had if you were doing the regular time-frame. Most of my class, however, did have a part time job and managed to socialize regularly.
I find my background in health science helped more than my epidemiology when it comes to bedside nursing. It's all what you make of it though. Some days you are the task-completer. But most of the time you are constantly reprioritizing things based on data you receive, and the more knowledge you have, the better decisions you can make. The more you understand the global picture of both the patient and the disease the more I think you will appreciate things as well as provide better care. Anyone could start an IV or put in a catheter if given the training- not everyone could be able to understand why it is needed or what are its implications.
Did I need to have the other degrees to be able to do the job of the RN sucessfully? Quite frankly, no. My additional degree will help me later on when I'm trying to get a job in management or education if/when I go that route. I don't regret any decisions I made when I re-routed myself after a health science degree/masters, but sometimes I wonder where I would be now if I had done a double degree in Health Science/Nursing or gone right into nursing school out of highschool. Probably in less debt, but I would have still done a masters- albeit part time.
I'm not one to quote nursing theory (Gag me, please) but the one thing is true. No matter who you are your previous experience will play a part in your interaction with your patient. Whether it's a biochem/engineering/sociology/languages background, it will be a part of you and will influence you. It just depends on what you make of it.
Wednesday, July 22, 2009
She did, however, not see us for at least a day- not good. Her acetaminophen level was nil, but her liver enzymes were through the roof.
Despite treatment, they were still going up.
Shitty. Young one too.
Friday, June 26, 2009
Have you ever had an elderly patient for whom your rapport was so great that you have a soft spot in your heart for them? I definitely have. Usually it's the stubborn old coot who talks about his wife as if he still is in wonderment, and the sly one who, when on transport and asked where he is, states "the elevator" instead of the typical "hospital". It melts my heart.
It's not gender based either. Sometimes the little old ladies crack you up. Like when an 89 year old talks about her sex life (ew), or when she tells you a story of her youth and how she got into trouble through her escapades.
I'm not a fan of geriatric nursing, but sometimes I do develop a little old man-crush.
Monday, June 1, 2009
Her ECG looked great (confirmed by MD), Troponins were negative, and although she was still in pain on deep inspiration/expiration and cough, she was doing just fine.
We were having an incredibly busy night with people needing internal pacing, intubation, ICU-bound-type patients. Thus the doc's were behind on seeing the urgents and less urgents. They were getting to them, and we were letting people know there would be a wait, this particular patient was infuriated.
"Why haven't you done anything yet?" she states, 'Where is the doctor?" This is, of course, after we have placed an IV, drawn blood, did O2 therapy, gotten an ECG, and given her ASA. The only thing we haven't done is done a chest xray (which nurses can't order on their own through the medical directive). After explaining that the doctors were tied up with very sick patients, the lady then states these words: "If we were still in the States we wouldn't be waiting." When I explained the severity of the sick people in the department, and that people DO have to wait for a doctor in the States, she stated "If you have insurance, you do not wait".
I kept my mouth shut, knowing full well that even people with insurance in the States, especially at a busy Emerg, would be waiting just as long as she was. She left AMA, which was fine with me... If she wanted to complain about the 'service' here, she can go back where she came from.
Friday, May 15, 2009
It was around this time last year that I was hobbling myself (because of a broken patella) to citywide ED orientation. I was so excited about getting into the ED and learning so much.
Today, I wouldn't call it excited- more settled but still glad to be there- and feeling much more confident.
I still don't know a lot, and I'm learning everyday. However I now can look after all my patients on my own and help out my teammates. I have seen chests cracked open, people go into Afib right in front of my eyes, and septic patients tank as I work desperately to help them get better.
I have learned about more medical conditions that I have never heard about before. Who know what labyrinthitis was when they were in nursing school?
I'm starting to feel more part of the team, versus that 'new grad'. To those just graduating, I'm no longer the new grad. People are actually going to go to ME for help and for advice. Scary.
Thank you so far for your support. In the last few months I have been so swamped at work, and feeling fairly overwhelmed that I didn't feel I had anything to contribute to this blog. I just wanted to get away from work. Now I'm starting to get back into it (I guess vacation can do that!).
Yours at the bedside,
Tuesday, May 5, 2009
I wonder if they were prepared for a case like this:
30 year old person comes into the ED with 'epigastric' pain. They have been worked up extensively for this pain and have diabetes, but no medical condition that affects the abdomen specifically. Already referred to a pain specialist, the patient was on 500mcg of fentenyl patches changed every 2 days, 10 oxycodone controlled release BID PO, as well as a PCA pump with hydromorphone which gives 10mg/hr as well as potentially 2 patient initiated boluses of 5mg/hr prn. This patient, because of the investigations and interventions, also had a J tube and was on dialysis for renal failure.
We had nothing in the ED that would really touch her additional pain. Giving 5 of hydromorph every hour (per MD order) seemed pointless, the patient would settle for 5 minutes and then act up by slamming their body against the side rail and screaming. THe patient had no problem getting out of bed to get to the commode. Some of this I'm sure is behavioural and some of it could be actual pain, but this seems to be an extreme form of drug seeking.
At what point should we be treating the behaviour versus the 'pain'?
Thursday, March 26, 2009
I'm not terribly busy on my days off, and although the last few months have been really bad in terms of acuity and volume, I have been able to recover enough that I don't dread going to work. I just haven't been motivated to write much. I read my favorite blogs everyday, so to those that return the favor- I haven't forgotten about you!
Updates on the life factor- Mr E proposed! :) We'll get married in 2010 but already my family has been pushing me to set a date and plan! I'm hardly a girly girl so getting into flowers is not my thing.
I have some ideas for posts so you'll hear from me again soon!
Monday, March 16, 2009
Be unconscious for a few days. Get better enough that they can kick you out for lack of money.
Fly back to Canada on a 20+ hour flight with no medical care. Go to the nearest hospital once you arrive. You have only 1 working appendage.. the rest are scarred from surgery from the foreign country and you have a severe infection.
Demand treatment- state to the doctor upon your arrival that if you don't get what you want, you'll go to another hospital 10 hours away- in a threatening voice as if the doctor really cares that you go to another place. Demand to those same docs they fix you TODAY. State to the nurses that the care was better at the other country because they let you smoke in your room and have something to eat. Conveniently forget that you were told not to eat or drink, or to use your cell phone while in your room.
Yell at your mom and grandma because they are hovering and wanting you to listen to the staff at the hospital. Yell at the nurses because they 'lose' your chart. Meanwhile your chart is with your mother and she has already told you this.
You are really the most important person in the world.... better let everyone know it, ya know?
Thursday, March 5, 2009
You know when you get so busy that you have no desire to do anything but laze around and sleep? That has been my life lately. I feel like I'm drowning a bit, and although I like my work I don't want to go back. I need a vacation.
As you can see it’s been a while since my previous posts. Work has been insane lately. Slowly but surely I have become a ‘shit magnet’, with STEMI’s and Aortic tears and sepsis patients arriving and end up being taken care of by yours truly. I enjoy the heavy stuff so that’s not the problem. The problem is that we’re short nurses lately and it seems as though all the sick people are coming in all at the same time… literally.
One night in our 3 bed resuscitation room we had one person actively seizing, one septic patient needing intubation, pressors and transfer across town to the other hospital’s ICU (no beds in ours… seriously), one patient who was unresponsive, and one who was having crushing chest pain. Yes, that’s right, 4 patients. Not to mention that the rest of the emerg was clogged with admitted patients, and there was only 1 RN assigned to the whole room. I wasn’t even supposed to be helping, but after I did my initial assessments on my patients at change of shift, I went in to help out. Chaos, I tell you, chaos.
Our shifts start around 7pm, and we didn’t’ get any form of break or relief until after 2am. It was THAT busy.
That’s just a start of the insanity. More to follow.
Friday, February 13, 2009
And no, drug seeker IV drug user COPD pneumonia guy, I can't give you another 6mg of hydromorph 1 hour after you got your last q4h breakthrough dose. Especially when you leave the department for the 6th time in the last 2 hours to have a 'smoke break'. Oh you want to chat huh? Tell that to the other 6 patients that I had to leave so that I could find you and drag your ass back to your room.
What, it's a nice Sunday afternoon? Plus 2 degrees and sunny? Well why don't all you RN's call in sick. I can totally look after 12 sick patients by myself until additional staff come in. Being 5 nurses short is a thrill I tell you!
Been in the waiting room for 3 hours? Poor baby. Let me get you a warm blanket and a sammich so you can complain about your ingrown toenail a bit more.
Oh and hyponatremic-waterdrinking- highglucose guy. Yeah you can leave AMA right before the doc comes to dispo you... Dumbass. The doc literally was coming over to see you and yet you "gotta get going" despite you waiting all night to find out why you're vomitting. I look forward to greeting your ambulance when you de-sat and are diaphoretic with chest pain because you are a 35yo obese diabetic 2-pack a day smoker.
I'm in a piss-ass mood. Work has been hell. Fuck off.
Thursday, February 5, 2009
Tuesday, January 27, 2009
Today I rectified the situation, and went through over 185 posts and eliminated all pictures that didn't have credit on them or that I didn't take myself.
Thank you to those people who have lent me their pictures with permission.
Monday, January 26, 2009
The other day was a poignant experience for me- one that truly brought home how important advocacy and education is, and why nursing is a profession to be proud of.
I met a patient who had unfortunately fallen through the cracks of prenatal care. She didn’t have a family doctor, had gone to some prenatal ultrasounds through a walk-in clinic, but did not know how to access the results. Unfortunately, she was to be set up with a women’s health clinic, but in the hustle of a busy walk-in, nothing was set up and the patient was forgotten.
The patient was a young, first time mother, who didn’t know how to get access to prenatal care in the city. She came to emerg with abdominal pain. She was not bleeding, the baby was moving fine and the fetal heart rate was perfect. She was, however, terrified that she would lose the baby. With no family in the area and a laissez-faire boyfriend, she didn’t have much social support either.
I received her into my care at the beginning of my shift. The previous nurse pulled me aside and expressed her concern for this patient- not because the baby was in distress or because the mother was in trouble medically, but because of her concern over the lack of prenatal care and the lack of support this patient had received thus far.
The care and concern that this nurse had for my new patient blew my mind. Most of the Emergency nurses in my department aren’t known for wiping brows and hovering just in case the patient needed another glass of water or their pillow fluffed. They are known for being intelligent professionals, with a dedication for medical needs and providing specific nursing care. Our emerg nurses are at their best in a crisis- when a patient is coding, when the patient is obtunded and needing RSI*, or during STEMI’s*, CVA’s*, trauma, DKA*, etc. Although they do provide the pillow fluffing and water bearing for the patient when they can, most emerg nurses I know are fairly tough and aren’t the pillow fluffing type. ABC’s – that’s the motto.
This particular nurse is one of those tough nurses. She would tell you things as they were. However, now I can say she is also one of the best patient advocates I’ve ever seen.
Not only did she express her concern and have everything set up for the patient’s discharge, she also made sure I understood her concern, introduced me to her patient, and stayed later to follow up with things she had initiated. She wasn’t doing it because she thought that I wouldn’t do well for the patient (in fact she told patient that she would be in good hands) but because the nurse CARED. The emerg doctor who was seeing the patient also understood the gravity of the situation, but unfortunately did not have the time to manage the non-medical side of the patient.
Although this nurse didn’t have a lot of time either, she made it important to go back and reassure the patient, to provide her further instructions for prenatal care, to provide phone numbers for physicians accepting patients, and much more. The patient left the hospital less scared, and more hopeful for the care of the baby then when she came to emerg. She also had an ultrasound appointment, a women’s health appointment, and understood the importance of advocating for herself and knowing who to go to in the sometimes confusing healthcare environment. All because of this hard-edged, but amazing advocating nurse.
That is why I’m proud of this profession. This is why nurses are an important part of the health care system. This is whom I will strive to be.
*RSI- rapid sequence intubation
*STEMI- S-T Elevated Myocardial Infarction (heart attack… a bad one)
*CVA- Cerebral vascular accident (stroke)
*DKA (Diabetic ketoacidosis)
Friday, January 23, 2009
I have been actually happy with my shifts. They have been both medically interesting, as well as challenging enough that I have to think a lot of my plan for the patients.
I can even say that my organization skills are improving. My patients are getting the care they need, when they need it. Before I was on my own, I was still struggling with that. However, mostly I think I was frustrated because I wanted to test myself and there would typically be a 'mentor' who wouldn't back off and let me try.
I know I'm new: I'm new to nursing, and I only have 1 year of experience with Emerg. However, the stuff I DO know, I know well. I try to be a sponge. I ask questions if I don't know something. I get senior nurses to show me equipment that I'm not comfortable with.
I don't have as many questions as I used to, and I'm proud of that. I see repetitive patterns. I also learn from my mistakes.
Last night for example, one of my patients was nauseated and was in a collar from a fall. The patient would need log rolling if she vomited. I was on guard. However, this patient stated she was nauseated just before she went to CT. Our CT is not in the department, they have to go with porter to second floor. I made the right decision to go with the patient to protect her airway, but I didn't think to grab some Gravol first. Next time, I would definitely grab some and administer it before we go! Everything ended up fine (aka no vomiting) but it was a definite lesson learned!
Friday, January 9, 2009
And boy did I need it tonight. I had one lady on bipap and another working his way towards the ICU, as well as a confused aggressive patient and a medicine patient.
By the way, in the hospital where I work there is no support staff to do your vitals for you, or to help people to the commode or do the bedpan stuff. It's all on the nurses. So not only was I prepping for an adenosine cardioversion, I was also wiping people's asses, getting vitals, prepping beds, reassuring confused people, etc.
It was a great experience to learn to organize, but still I have my doubts about my shift.
Questions run in my mind: Did I miss something that we could have noted earlier about the patient going to ICU now? Is there something subtle that I missed? How can I improve for next time? What would I have changed?
Am I ready to be an ED nurse? I think I am.. I have a lot of knowledge now that I'll carry with me to inform my decisions. Do I still need to learn? Absolutely. I have spent a year in Emerg nursing, and there is still more to learn.
I have absolutely no idea how some nurses can carry a patient load of 12:1. No idea. Kudos to them.
Saturday, January 3, 2009
I wasn't sure if I was actually going to apply. Summers are great for overtime in my emerg department, and I also want to spend some time enjoying the outdoors, which I didn't do much of last summer because of my broken knee.
But I figure even if I did teach the commitment would be approximately 10 hours a week, and the money I'd make would go straight to my student loans. No one really WANTS to pay off their student loans, but the sooner I do, the better I'd feel about money.
In case you are wondering, I would also continue to work full time at my regular job.
Speaking of which, I may have finished my last mentored shift today. Although I'm not sure as things are wonky in the scheduling department, technically my new contract starts on January 5th. I don't work again until the 6th, so I'll let you know whether I will be on my own or not.
Hope you had a happy New Year!