Change of Shift

Thanks Kim for including me in this week's Change of Shift. 

Visit her blog at Emergiblog.

IV's

My new favorite go-to spot for IVs has been the upper foot.  Something satisfying about a patient with no veins (from illness or IV drug user) and sliding the puppy in.  Obviously we don't use it all the time but when it works, oh, yeah, it's awesome.

Happy Hallowe'en

Tomorrow is Hallowe'en, and tonight, being a Saturday night, the college kids will be out in their beautiful (and freakishly small) costumes.  Tonight is the night of "sexy-pirate" and "sexy-kitty" and "sexy-Icangetawaywithitwithoutlookinglikeaslut" outfits.  This is also the night that the people who are scheduled to work the ED groan and kick themselves for not trading the shift.

Last year I had a horrible ED Hallowe'en experience.  Hallwe'en was actually on a Saturday night, and it was also the time change.  Not only did I have to work an EXTRA HOUR (fall back, remember?) but there was computer DOWNTIME for about 5 hours.  This meant that not only did we have a bunch of extra people (all drunk) in the ED, we also had to do everything MANUALLY.  Manual xray requisitions, manual lab requisitions, faxing lab results, the works.

If you are an Emergency nurse and do not want to babysit drunks, NEVER work Hallowe'en.  I'd rather work New Years Eve then Hallowe'en.

(Shudders)

Preceptor Elaine RN

Yep I was chosen as a preceptor.  Now to start thinking about screwing up their eager minds..... Hahah I'm only joking. I'm looking forward to it.  This is a good way of helping with my enthusiasm and review of the basics.

I'm not perfect, it's a great way to make sure my practice evolves to higher quality.

My friend (who coincidentally also was chosen to do her consolidation in the ED) is helping me relive my experience of being ridiculously excited for Emerg.  It's cute to watch her prepare.  She is way too eager, by doing ACLS already, and an ECG course.  I didn't do that until AFTER I was done nursing school and working in the ED.


I hope she flourishes instead of the ED overwhelming her.

Thoughts on losing enthusiasm

I did a side job as a flu-shot clinic nurse.  Gave over 100 injections today!  Phew.

It's very different from ED nursing, that's for sure, and I met some up and coming nursing students who were very excited about learning- something I've lost.

I volunteered to be paired with a nursing student this upcoming winter, but I'm not 100% sure I'll be chosen.  I think that there are some very-experienced nurses in the department who might also volunteer, which means my 2.5+ years will pale in comparison.

I'm losing enthusiasm for my job.  It's tiring work and I know it's rewarding but I keep finding myself looking elsewhere.  I have put some resume's out there for jobs I'm not 100% qualified for (as I've pretty much done NOTHING with my health-related MSc ) but are a better fit with both the RN and the MSc.  So far no bites.  That and it's hard to think about going to a temporary job (that will be great for the resume) and giving up a full time position (which will most likely not be there when the temp job finishes).  The trouble is that I enjoy being in Emerg- it's the best fit and when things happen I really LIKE it.  I just don't know if I enjoy being there ALL THE TIME.  As I'm sure you know, the real life ED is not as glamorous as it sounds like it could be.  I knew this going in, but once you're really entrenched (and almost literally up to your eyeballs in shit) you REALLY know.

What is keeping me from applying to those temp jobs is that I want the 5 years nursing experience that I'll need to do ANY nursing job or nursing leadership position.  These jobs aren't specifically nursing-related although still within the health care field. Without that nursing experience, I would not be able to advance further in hospital-type jobs... at the very least it would be extremely difficult.  I'm not saying I'd want to completely be a clipboard nurse but SOME clipboard action may be nice.  Haha. I'm sure some of my hero nurse-bloggers would scorn at the thought of being a clipboard nurse :P  It is a romantic idea to scorn leadership, keep it only about the patients and the patient-welfare without thought of politics or administration.  However, some part of me, even when I wasn't in nursing, thought I would like being a health administrator. Unfortunately in my town it does not host governmental type jobs in health admin except at the hospital level.


All in all, I guess the grass is always greener on the other side. I have a friend who was casual but working full-time hours, who moved to the next town to work as an physician office admin.  However, that job fell through (through no fault of my friend), and now she's straddling 2-3 jobs as a casual just to make ends meet.   She would be furious if she found out that I gave up a permanent full time position to go to a temporary job.

 I really don't know what the right answer is, or what's the best fit for me, but I'll keep pressing on and try to keep my chin up. 

Happy Emergency Nurses Week

As you can tell by the title of my post, it's Emerg Nurses week this week.

The management has done their due giving us lunches and having draws for prizes.

I know it's a ruse to boost morale, but after the summer we've had, I have taken the bait and am a bit happier.

Mmm I love free stuff.  Too bad it can't equal more pay or more staff.

Have you noticed?

It is a common phenomenon in the ED that things come in threes.   Three STEMI's, three sub-durals, three eye injuries, etc.

Last week we had multiple people with the same last name.  Not just hey there are the Jones's and the Smith's, but UNCOMMON last names and they WEREN'T related.

Odd.

Good day

I had a student with me today, to observe the what's what of Emerg in our small city.

We didn't do too much today, luckily it was a slower shift. Don't worry, he still got to hear the nursing-home-dump- little old ladies cry out "My God, why are you torturing me!" and "you hateful people!" when we are changing their diapers. Haha.

There's something refreshing seeing Emerg in a student's eyes. Makes me feel a little better about still working here.

I remember when I was so excited to be in Emerg. Now I'm thinking about a change. I still like emerg, but perhaps a different venue is needed. I'm tired of the admitted patients staying for 48 hours in the ED!

***********

I have averaged about a post a month lately. Honestly, there hasn't' been too much for me to post about, most of the same snoring same. I haven't given up on myself, as I really do enjoy putting my words on the page, so thank you for continuing to read.

"Sick" leave

Ross from Nurse in Australia had a great post today on sick leave in winter.

This triggers my own post. Yes, for the southern hemisphere it's winter, and I'm sure the flu season is kicking them pretty hard.

Here in the northern hemisphere, the days are sunny and it's warm, and many people are on vacation.

Lately at my work we have been very short staffed. I mean VERY. Sometimes nights are 5-6 nurses short (rare but true) and most nights we're at least 2-3 short. We have roughly a 36 bed department with about 8-10 nurses working at night. Some of the staffing problem is casuals not picking up hours, but most of our casuals are working almost full time hours. Oftentimes it is people calling in "sick". Again we have limited support staff and RNs provide ALL patient care (bloodwork, IVs, catheters, vitals, monitoring, NGs, toileting-- everything).

Vacation is given by seniority, and unless you've been working for 5-10 years in our department, you MIGHT get a day or two off in the summer, other than that, you'll have to take vacation from Sept-Nov, or from Feb-April (excluding March break).

Some less-senior staff are taking advantage of using sick days and stat days as vacation when they get denied their time off. As far as I know the management has been noting it (what the official ramifications are, I don't know). Unfortunately, this leaves the rest of the staff working short, and morale has been sliding downhill rather quick.

I'm not one to take time off unless needed nor am I one to call in sick unless I'm truly sick. However it bothers me that workers who do go to work get screwed by having to work short-staffed.

Already we had to cut staff due to budget cuts, if they keep seeing us working short they may just think that we can always handle that ratio: We're barely keeping afloat and patient care is compromised. Even the docs think something needs to be changed.

Thoughts?

Interesting...

I was working the other day with 1 full time RN, and 2 casuals. The casuals were ++experienced but were not familiar so much with my ED.

The other FT RN was busy with some sickies so I ended up being the go-to person to ask questions about different things in the area we were working in. OK I know this sounds stupid but this is the first time in my nursing career that I was the one that was knowledgeable.

It felt kinda cool. If only I had time to enjoy it... wow was it ever busy!

I'm still here.

I'm still here, keeping busy getting married and trying to enjoy life OUTSIDE the ED.

Staffing issues continue, but tempers have settled down. We're still trying to manage things and people are WAY TOO SICK lately but that's how it goes when you work inside an emerg.

I'm triage trained but yet to spend more than my orientation hours there. I triage at the bedside when there's no offload nurse but otherwise I'm mostly in a 3 or 4 bed assignment. It seems pretty good compared to other EDs but since we have hardly any support staff (we have someone who stocks things and another person to clean up things) we do all our patient care by ourselves. (Oh we don't do our own ECGs... that's about it)

Before I went on holidays there was a patient who had developed a GI bleed that had continued to bleed despite conservative treatment. She was young, and started to crash right before shift change (surgery wanted to wait it out to see if it would stop on its own and ended up doing a emergency surgery instead). It was the first time in a long time that I took a patient "home with me" . Usually I can handle seeing people die or almost die or see people really sick and it doesn't bother me. This time, for a few days all I saw was blood pour out of orfices and us scrambling to help her. I guess it particularly bugged me because I had been watching her like a hawk all night and then she started circling the drain rather quickly. I did what I had to do in terms of noticing she was getting worse at an early start of her circling, but then she crashed faster than I expected.

Luckily she made it to the O.R. and through surgery.

Phew

I think the other night I deserved a raise.

2 of my patients needed constant blood transfusions (which requires a lot of monitoring), and one kept having a BP of 70/40 due to sepsis. Needless to say I didn't sit down EVER.

I was so exhausted.. Thank god the other nurses took pity on me and took away one of my patients and gave me an easier one!

One good thing: I've earned my time and have been asked to do the triage course. Soon I may be the one greeting you when you come to my ED. Yikes!

And the cuts begin...

It started with a hiring freeze a few months ago.

Then it was cutting a nurse or two (but keeping beds open!) for each shift.

Now they are outright laying off.

But they are not letting go middle and upper management.

Patients keep on pouring in, and they are SICK.

Soon we will be... and then they wont' replace the sick calls so we'll be even more screwed.

I'm still liking my job, and I *think* I'm safe from layoffs, but it's hard to say. I have a permanent job right now that I'm working hard to keep.

Wish me luck.

The pro vaccine people fight back.

Enjoy.

I'm worn out

I have done quite a lot of shifts lately, more so then normal do to some switches I've made to accommodate Mr E's and my wedding.

So I've been working my butt off.

The other day I came home after a day shift, ate dinner, and then sat on the couch for a bit. It was my transition day, where I go from day shift to night shift the following day. Usually I try to stay up as late as I can, usually until midnight, and then sleep in as long as I can the next morning.

Well I was exhausted from working multiple day shifts in a row, and as I have already posted on this blog about loving night shifts, working multiple days is like torture to me.

I fell asleep sitting up on the couch at 8:30pm. My fiance woke me up and gave me a cookie for dessert.

I ate the cookie. He sat beside me. I leaned in for a cuddle, and next I knew it was 10pm. I gave up and went to bed, was asleep by 10:30, and didn't wake up until 11:30am.

Now you know why nurses can get grumpy or forget things. They are so sleep deprived they need almost a full day or two to recover.

Old man to Emerg

A man in their 70s comes to emerg yesturday with a vague complaint of slight weakness. Hasn't felt well lately. No chest pain, no diaphoresis, no SOB, no.. anything, except a bit of leg weakness.

Also doesn't have a family doctor, and hasn't been to one in over 15 years.

First thing I think of is that this guy could be a ticking time bomb. Weakness could be anything from cardiovascular, to endocrine, to neuro, to ... well... anything! Especially if he hasn't been routinely checked for CAD, pulmonary, diabetes, cholesterol, etc.

Well his vitals weren't bad P 105, R-18, BP 150/100, SpO2 98 T 36. I could see that perhaps he had longstanding hypertension with his pulse being tachy and his pressure being what it was. The guy wasn't on beta-blockers or any form of hypertension meds... something he would most likely need.

Well we did a bunch of tests, including an ECG and things were ok. Then we repeated his ecg. Ooops! ecg changes? Shit. We hook him up to the monitor and things get wacked out from there.

I'm wondering if he had a primary care physician, would he be in this same situation? Perhaps, but probably not. He has most likely sustained a high BP for a while, which increased his risk for cardiovascular compromise.

Canadians have a good thing going with their coverage, but definately they are lacking in primary care. Even I don't have a family doc right now. Mine left primary care to do work claim forms and direct consumer billing for minor plastic surgery.

Spammers suck

I have been getting a lot of spam commenters lately so unfortunately that means I have to close down the open commenting section and pre-approve things. I don't mind but I hate spam and it sucks that my old posts are getting comment spammed.

200+ posts

Only took 2 years. Oh and I missed my blogversary(??) in September. Happy BELATED two year blogday(??) to me! (which one is it called? or is it just a blog anniversary or blog birthday?)

I’m back with more frequent posting because I write them away from the blog and come back later. Seems to work so far. That and I think I finished my writing funk that lasted about… 8 months? I guess sometimes when you’re not completely enjoying your job you can’t find the humour in it.

Yes it’s true: the honeymoon is definitely over. But on the bright side, I’m still in the trenches in the ED. I don’t plan on leaving anytime soon.

Happy new year.

Forgot to greet the new year. 2010. F. 10 years ago I was graduating high school.

No resolutions this year, I'm sick of reading everyone elses. I'll just do the standard lose weight, be nicer, blah blah blah BS. I'm tired of being cheerful this season. I haven't had a vacation and I'm feeling it. Saving all of it for my honeymoon(!) in May.

There was a doc (who is notoriously rude to nurses on purpose as a joke) who stated that his resolution was to be nicer to the nurses. He stated he makes this resolution every year and this year he lasted a whole 5 minutes.

Not too shabby sir. Just let me have verbal orders for everything I need and we'll get along just great.

F off people

WTF. One night shift of the most whiny, can't-do-anything-for-themselves SOB's (and I dont' mean short of breath!).

Trying to see their good side, as part of nursing requirements, is bullshit.

And if you have been nauseated and vomiting, and we give you something for nausea, don't refuse to eat because you are 'scared' despite you stating you feel better. Drink the damn juice.