tag:blogger.com,1999:blog-12338741875931941262024-03-13T16:07:00.364-04:00Miss-Elaine-ious RNAn emergency nurse with some things on her mind.miss-elaine-ioushttp://www.blogger.com/profile/07971065972417378362noreply@blogger.comBlogger224125tag:blogger.com,1999:blog-1233874187593194126.post-39489644888387603102012-06-02T21:19:00.001-04:002012-06-02T21:21:09.429-04:00Emergency Department Charge Nurse Hitler Rant<br />
Thank you to Those Emergency Blues for the most hilarious charge nurse rant on the planet. See below or go to her link: <br />
<a href="http://torontoemerg.wordpress.com/2012/05/31/epic-hitler-emergency-department-charge-nurse-rant/">http://torontoemerg.wordpress.com/2012/05/31/epic-hitler-emergency-department-charge-nurse-rant/</a><br />
<iframe allowfullscreen="" frameborder="0" height="270" src="http://www.youtube.com/embed/wb2dv3f2ngg?fs=1" width="480"></iframe>miss-elaine-ioushttp://www.blogger.com/profile/07971065972417378362noreply@blogger.com0tag:blogger.com,1999:blog-1233874187593194126.post-33016598600763489052012-03-09T12:33:00.000-05:002012-03-09T12:33:18.041-05:00RIP Evelyn Gabbs<a href="http://www.cbc.ca/news/canada/manitoba/story/2012/03/08/mb-fred-douglas-home-delay-iteam.html" target="_blank">http://www.cbc.ca/news/canada/manitoba/story/2012/03/08/mb-fred-douglas-home-delay-iteam.html</a><br />
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As a nurse reading the article there are numerous questions I have, and I think the CBC did not do justice by getting the full story out.<br />
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Essentially a long-term care resident, aged 95, was found to have symptoms of a stroke in her wheelchair. After a delay, family was contacted and the resident was transferred to an acute care facility. Once assessed at the acute care facility, she was transferred back to the nursing home for palliative care, where the family stated she was not given proper care. The family was quoted in saying that "they might have been able to help her...brought her back a little bit". It was an emotionally charged article and many comments are very angry at the "abuse" and "lack of care" that nursing homes provide.<br />
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Was there a DNR/Do not transfer order? Many long term care facilities have lengthy discussions with family regarding this, and it sounds like this may be the case for Mrs. Gabbs. Typically only with consultation with family do those with the DNR/Do not transfer order get transferred to the hospital for acute care. If this was the case, the LPN was working within the parameters/goals that the facility and the family had initially agreed upon. In strokes speed is of the essence, so I don't know what happened to cause of the delay but perhaps the DNR/Do not transfer played a factor. Perhaps consultation between the LPN and RN and possibly MD took some time and who knows what really happened prior to contacting family. It also sounds like there was a delay in the family responding to the nursing home's repeated call.<br />
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As an Emergency nurse I care for many of those nursing home transfers, and some patients are quite sick, whereas other patients we oftentimes do not know why they were transferred. Most that arrive do have the DNR form, but have transfer modifiers. Please note that in Ontario all nursing home patients have a physician on call for any concerns (day or night), as well as an Registered Practical Nurse and a Registered Nurse to assess the patient. Having not worked in a long term care facility (but having had rotations in one as a student), I'm not speaking to all nursing homes but typically there are distinct policies about who to contact about transfers if it's deemed needed. Sometimes the wishes of the family override the policies, and at that point the ambulance is called. The family would pick up the tab for the cost of the ride, as well as the transfer home. In Ontario, some of the cost of the ambulance is not covered by the government, and billed to the patient. Intra-facility non-emergency transport is also covered by the family, or is billed to the family from the nursing home.<br />
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As for the palliative care, if there is no order for analgesia or it is deemed to not be needed, the LPN/RN would only give a moderate dose and would be titrated according to resoponse. If the order is not satisfactory for the patient needs, then a call to the MD is needed. If the MD does not order more analgesia or sedation, then it would be illegal for the RN/LPN to provide any further medication beyond the parameters set out by the physician. Again, without the health care record right in front of me I cannot comment on what occurred after Mrs. Gabbs returned. All we have is family reports of how their mother looked when she was dying- something that is never easy to see. My condolences to the family, and I hope they get more answers for their questions, and some peace.<br />
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To go saying the nursing home is corrupt and only thinking about money is placing judgement without the full picture. There are many long-term care facilities where the care is exemplary. All the patients we receive are clean and looked medically cared for. The emotional care is the responsibility of the family.miss-elaine-ioushttp://www.blogger.com/profile/07971065972417378362noreply@blogger.com0tag:blogger.com,1999:blog-1233874187593194126.post-63314863263523633872012-01-05T21:47:00.000-05:002012-01-05T21:47:30.976-05:00A new year, a new beginningHappy belated new year to all that read this humble blog.<br />
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I worked New Years Eve, and it was surprisingly not too bad. We kept waiting for things to get out of hand, but luckily they did not! I hear that the next day it was brutal.<br />
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I've been asked to precept again this semester, this time full time. I know what I'm getting into this time, and I hope it will be smooth sailing. <br />
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Every time I think I want to leave and do another job, something keeps bringing me back. We had a guy come in pretty sick and within 5 minutes I had assessed him, started a line, drew bloodwork, got vitals, ecg, and had the doc swing by for an assessment. All done by myself as any/all help seemed to be with other patients at the time. I've been working in the area enough to anticipate what is coming, but its nice to hear a "good job", which the doctor provided.<br />
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What I have found is that I'm tired of certain people complaining about the department. Yes, its hard work, yes it can be frustrating for certain things, but GET OVER IT OR DO SOMETHING ABOUT IT. Perhaps it's the "cool" thing to do, but it gets frustrating to work with those people.<br />
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Anyway, here's hoping to a great year!miss-elaine-ioushttp://www.blogger.com/profile/07971065972417378362noreply@blogger.com0tag:blogger.com,1999:blog-1233874187593194126.post-62231136845036020242011-12-02T01:32:00.000-05:002011-12-02T01:32:59.290-05:00I'm still hereTime goes by fast when you're having fun, or when you're burnt out and the last thing you want to think about is work when you are not working.<br />
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I fully admit it, for about 8 months there I was not happy about my job. I also, however, was not willing to leave it. It's funny how that happens- you start in a place and you're proud to be there, and make it part of your identity. Then, the job/people change and move on, but you stay on because "it will get better". Well that 'getting better" moment has started to happen- to a point. We've hired more staff, they are young and eager to learn, but they are newbies to Emerg. Which means the people who have been working there a while now have to make sure they aren't missing anything. My role has changed from staff nurse to preceptor, and now a lot of times one of the more senior staff in the pod if not the department. For someone with less than 5 years on the job, that can be scary.<br />
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I've offered to take a student again for the next term, and I hope it's as good as the previous experience. I've trained over 5 people to Emerg by now, and I hope I have contributed to their success in the ED.<br />
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Although I am not actively looking for a new job, I still keep looking on job postings, and one day perhaps I'll leave the ED. For now, however, I"ll keep my "geriatric acute medicine" ward/ED.miss-elaine-ioushttp://www.blogger.com/profile/07971065972417378362noreply@blogger.com2tag:blogger.com,1999:blog-1233874187593194126.post-24767526425741130832011-06-29T15:51:00.000-04:002011-06-29T15:51:03.037-04:00My least favourite time of yearIt's soon approaching.. the sun is high in the sky, the birds are chirping their summer song... and the newly fresh minted residents start their training.<br />
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Urrgh and I work July 1st! <br />
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A not-so-happy Canada day to me!miss-elaine-ioushttp://www.blogger.com/profile/07971065972417378362noreply@blogger.com1tag:blogger.com,1999:blog-1233874187593194126.post-54437050095298693592011-06-14T00:32:00.000-04:002011-06-14T00:32:34.777-04:00Junior nurse... very interestingSo nursing bullying is in full swing.<br />
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A colleague who graduated one year before me told me that I, a 'junior staff member', couldn't dare correct or contradict them. The colleague was making a sarcastic, inappropriate remark at a critical time in patient care. <br />
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I told them I dont apologize for advocating for patients, and 1 year more experience does not a "senior" nurse make.<br />
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~Miss-elaine-iousmiss-elaine-ioushttp://www.blogger.com/profile/07971065972417378362noreply@blogger.com4tag:blogger.com,1999:blog-1233874187593194126.post-44617602980340782602011-02-28T16:14:00.000-05:002011-02-28T16:14:54.344-05:00Condolences, but time to let go.Lately this turn of events has been in newspapers all over the province, and apparently in the USA as well.<br />
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<a href="http://www.lfpress.com/news/london/2011/02/28/17440436.html">http://www.lfpress.com/news/london/2011/02/28/17440436.html</a><br />
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My condolences for the family, but it's time to stop the poor baby's suffering.<br />
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miss-Elaine-ious RNmiss-elaine-ioushttp://www.blogger.com/profile/07971065972417378362noreply@blogger.com3tag:blogger.com,1999:blog-1233874187593194126.post-23640764023756513832011-02-01T08:18:00.000-05:002011-02-01T08:18:58.111-05:00Heard around the EDResident Verbal Diarrhea MD: "I think there should be an opportunity for residents to moonlight as nurses while they are training"<br />
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Nurse Logical: "MMMnnn wouldn't work, completely different skillsets."<br />
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Nurse Awesome: " You couldn't hack it."miss-elaine-ioushttp://www.blogger.com/profile/07971065972417378362noreply@blogger.com1tag:blogger.com,1999:blog-1233874187593194126.post-10840023038442190182010-11-11T17:28:00.000-05:002010-11-11T17:28:04.510-05:00Change of ShiftThanks Kim for including me in this week's <a href="http://www.emergiblog.com/2010/11/change-of-shift-volume-5-no-10.html">Change of Shift</a>. <br />
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Visit her blog at <a href="http://www.emergiblog.com/2010/11/change-of-shift-volume-5-no-10.html">Emergiblog</a>.miss-elaine-ioushttp://www.blogger.com/profile/07971065972417378362noreply@blogger.com0tag:blogger.com,1999:blog-1233874187593194126.post-38058320755337005012010-10-31T22:46:00.002-04:002010-10-31T22:46:45.216-04:00IV'sMy 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.miss-elaine-ioushttp://www.blogger.com/profile/07971065972417378362noreply@blogger.com2tag:blogger.com,1999:blog-1233874187593194126.post-50740649527462687552010-10-30T21:54:00.000-04:002010-10-30T21:54:41.125-04:00Happy Hallowe'enTomorrow 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.<br />
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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.<br />
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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.<br />
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(Shudders)miss-elaine-ioushttp://www.blogger.com/profile/07971065972417378362noreply@blogger.com0tag:blogger.com,1999:blog-1233874187593194126.post-80114905657028749732010-10-29T13:35:00.000-04:002010-10-29T13:35:05.509-04:00Preceptor Elaine RNYep 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.<br />
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I'm not perfect, it's a great way to make sure my practice evolves to higher quality.<br />
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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.<br />
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I hope she flourishes instead of the ED overwhelming her.miss-elaine-ioushttp://www.blogger.com/profile/07971065972417378362noreply@blogger.com1tag:blogger.com,1999:blog-1233874187593194126.post-84663462790306214372010-10-20T21:35:00.000-04:002010-10-20T21:35:25.873-04:00Thoughts on losing enthusiasmI did a side job as a flu-shot clinic nurse. Gave over 100 injections today! Phew.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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. miss-elaine-ioushttp://www.blogger.com/profile/07971065972417378362noreply@blogger.com4tag:blogger.com,1999:blog-1233874187593194126.post-14469851014803059652010-10-13T23:59:00.000-04:002010-10-13T23:59:26.238-04:00Happy Emergency Nurses WeekAs you can tell by the title of my post, it's Emerg Nurses week this week.<br />
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The management has done their due giving us lunches and having draws for prizes.<br />
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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.<br />
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Mmm I love free stuff. Too bad it can't equal more pay or more staff.miss-elaine-ioushttp://www.blogger.com/profile/07971065972417378362noreply@blogger.com0tag:blogger.com,1999:blog-1233874187593194126.post-44389573709075403642010-09-29T23:23:00.000-04:002010-09-29T23:23:50.581-04:00Have 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.<br />
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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.<br />
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Odd.miss-elaine-ioushttp://www.blogger.com/profile/07971065972417378362noreply@blogger.com0tag:blogger.com,1999:blog-1233874187593194126.post-15199585536752033922010-08-28T20:53:00.003-04:002010-08-28T20:58:39.415-04:00Good dayI had a student with me today, to observe the what's what of Emerg in our small city.<br /><br />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.<br /><br />There's something refreshing seeing Emerg in a student's eyes. Makes me feel a little better about still working here.<br /><br />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! <br /><br />***********<br /><br />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.miss-elaine-ioushttp://www.blogger.com/profile/07971065972417378362noreply@blogger.com0tag:blogger.com,1999:blog-1233874187593194126.post-83195438753381105532010-07-04T23:10:00.002-04:002010-07-04T23:30:10.916-04:00"Sick" leaveRoss from<a href="http://www.nurseinaustralia.com/"> Nurse in Australia</a> had a great post today on <a href="http://www.nurseinaustralia.com/nurses-sick-leave-in-winter/">sick leave in winter</a>.<br /><br />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.<br /><br />Here in the northern hemisphere, the days are sunny and it's warm, and many people are on vacation.<br /><br />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).<br /><br />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). <br /><br />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.<br /><br />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.<br /><br />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.<br /><br />Thoughts?miss-elaine-ioushttp://www.blogger.com/profile/07971065972417378362noreply@blogger.com1tag:blogger.com,1999:blog-1233874187593194126.post-1006101226507822022010-06-22T23:33:00.002-04:002010-06-22T23:36:35.065-04:00Interesting...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.<br /><br />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.<br /><br />It felt kinda cool. If only I had time to enjoy it... wow was it ever busy!miss-elaine-ioushttp://www.blogger.com/profile/07971065972417378362noreply@blogger.com1tag:blogger.com,1999:blog-1233874187593194126.post-55511533560090953902010-06-15T00:10:00.004-04:002010-06-15T00:20:10.880-04:00I'm still here.I'm still here, keeping busy getting married and trying to enjoy life OUTSIDE the ED.<br /><br />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.<br /><br />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)<br /><br />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.<br /><br />Luckily she made it to the O.R. and through surgery.miss-elaine-ioushttp://www.blogger.com/profile/07971065972417378362noreply@blogger.com1tag:blogger.com,1999:blog-1233874187593194126.post-22632440267143161412010-04-02T00:30:00.004-04:002010-04-02T00:34:38.408-04:00PhewI think the other night I deserved a raise.<br /><br />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.<br /><br />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!<br /><br />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!miss-elaine-ioushttp://www.blogger.com/profile/07971065972417378362noreply@blogger.com1tag:blogger.com,1999:blog-1233874187593194126.post-76024292426130607162010-02-16T22:00:00.001-05:002010-02-16T22:03:11.207-05:00And the cuts begin...It started with a hiring freeze a few months ago.<br /><br />Then it was cutting a nurse or two (but keeping beds open!) for each shift.<br /><br />Now they are outright laying off.<br /><br />But they are not letting go middle and upper management.<br /><br />Patients keep on pouring in, and they are SICK.<br /><br />Soon we will be... and then they wont' replace the sick calls so we'll be even more screwed.<br /><br />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.<br /><br />Wish me luck.miss-elaine-ioushttp://www.blogger.com/profile/07971065972417378362noreply@blogger.com4tag:blogger.com,1999:blog-1233874187593194126.post-55750375953768563402010-02-04T00:45:00.001-05:002010-02-04T00:47:16.877-05:00<a href="http://www.jennymccarthybodycount.com/Jenny_McCarthy_Body_Count/Home.html"><span style="text-decoration: underline;">The pro vaccine people fight back.</span></a><br /><br />Enjoy.miss-elaine-ioushttp://www.blogger.com/profile/07971065972417378362noreply@blogger.com0tag:blogger.com,1999:blog-1233874187593194126.post-19586499512577301202010-01-27T16:59:00.002-05:002010-01-27T17:05:30.099-05:00I'm worn outI 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.<br /><br />So I've been working my butt off.<br /><br />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.<br /><br />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.<br /><br />I fell asleep sitting up on the couch at 8:30pm. My fiance woke me up and gave me a cookie for dessert.<br /><br />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.<br /><br />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.miss-elaine-ioushttp://www.blogger.com/profile/07971065972417378362noreply@blogger.com1tag:blogger.com,1999:blog-1233874187593194126.post-29254167292725711982010-01-27T16:36:00.002-05:002010-01-27T16:48:47.271-05:00Old man to EmergA 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.<br /><br />Also doesn't have a family doctor, and hasn't been to one in over 15 years.<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />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.miss-elaine-ioushttp://www.blogger.com/profile/07971065972417378362noreply@blogger.com0tag:blogger.com,1999:blog-1233874187593194126.post-37495399799283277872010-01-27T16:35:00.001-05:002010-01-27T16:36:33.466-05:00Spammers suckI 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.miss-elaine-ioushttp://www.blogger.com/profile/07971065972417378362noreply@blogger.com0