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!

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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.