Thursday, October 30, 2008
Tuesday, October 28, 2008
Nurse 2: What the hell? How?
Boy nurse: She tried to grope my ass when I turned to hang her antibiotics!
Nurse 2: She is demented though – maybe she was just flailing her arms and one hit you.
Boy nurse: Then why did she wink at me?
Wednesday, October 22, 2008
Yesterday morning at around 0630 (why an hour before shift end? Why?) I got assigned to a mean girl (with her mean girl posse in tow) complaining of carbon monoxide poisoning. So I dragged my mildly nauseous, severely bleary eyed self to the exam room and started my assessment. Each question I asked was met with the trademark mean girl death stare from her and her posse before she managed to spit out an answer. I started by asking her what made her think she had carbon monoxide poisoning to which she replied, “my friggin carbon monoxide detector like totally went off so like whatever”. Right. I just couldn’t resist so I asked her, “did it ever occur to you on your long drive over that maybe the detector isn’t working well?” I was met with the death stare and another “whatEVAH”. So I carried on my assessment and asked her if she was feeling lightheaded, dizzy, nauseous, short of breath, feeling better outside the building rather than within, other people in the building complaining of the same symptoms or any flu like symptoms. Did I mention that her vital signs were unremarkable and her O2 sat was 100% on RA? She denied any symptoms and then asked “what the fuck does the fucking flu have to do with carbon monoxide poisoning? Gawd, are you like a fake nurse or like a tech or something?” Normally I put on my professional face and try to be as diplomatic as possible but I just shot back with my own death stare and told her that the doctor will probably need an arterial blood sample. When she asked where she’d get the needle, I couldn’t resist and told her that normally it’s obtained from the wrist but if he can’t get the artery, he might need a sample from the groin. Her shocked look of horror made my night but unfortunately it wasn’t enough to stop her bitchy remarks. While the resident was getting the sample, I had a bag filled with ice and a requisition prepared so she didn’t have to stay a minute longer than necessary. The mean ditz then told the resident to “check over her shit cuz she asked me like the dumbest fucking questions”. Luckily for me the residents and staff docs I work with are extremely nice and understand that I’m new so he too shot her his own frighteningly effective death stare before saying, “my coworkers are among the best in the country so I don’t need to double check their work” before walking out. Turns out her carboxyhemoglobin level tested at 0.0000 which pissed her off even more but there was nothing more that we could (or wanted) to do. She dramatically told us that it would be our fault if she died before calling us retards and storming out. Another chart in the discharged pile.
Tuesday, October 21, 2008
What I wanted to say to him was, “You just got 6 mg morphine half an hour ago. You’re not getting any more from me for a while even though I’d love to see your respirations drop at this point. We’re severely short on pillows so thank your lucky stars that I rummaged all around the unit to get you one while the doc was getting pissed at me for not helping out more quickly for a conscious sedation as well as having to look after 10 other people. NO you can’t get a fresh new paper cup for each little sip of filtered and/or vitamin enhanced water you inconsiderate jerk! It’s bad for the environment and look around you – this isn’t a 5 star restaurant and I’m not your waitress here to kiss your monkey ass so you’re getting the giant pitcher with good ol’ ice water! If you keep picking at that damn IV I swear I’ll use a 16 gauge in the smallest vein you’ve got and then smack your dumb ass with the IV basket before giving you more meds!”
What I ended up saying was, “Sir, you can’t get more morphine for at least another 2 hours. Try deep breathing instead. Unfortunately we don’t have any more clean pillows on the unit. We’re an environmentally conscious hospital so we try not to create unnecessary waste. And the government does not give us enough money to buy vitamin enhanced water – we usually spend our money on equipment and medications. Please stop picking at your IV because if it comes out, we’re going to have to re-site it which as you know hurts.”
Not to be a total bitch about pain (because it hurts after all) but it’s really irritating to see people in moderate amount of pain being assholes making idiotic demands while someone in unimaginable pain thanks you profusely for everything you’re doing for them while suppressing a sob. Needless to say I wheeled him out after his discharge with a huge smile.
Saturday, October 18, 2008
ER nurses have to collect a lot of blood. Many times it’s from patients that are either acting like total douche bags or from HIV/Hep C positive patients. My unit also uses a lot of butterflies to collect blood. I have also used my fair share of butterflies because they are really easy to manoeuvre but I can never activate their safety feature with one hand. I’m of course reluctant to put my hand near a used needle to try to cover it up. I also find that sometimes I can’t draw blood fast enough even when I see flash in the chamber. On top of all that, half the time the lab sends back a report that tells me I need to draw up another set of INRs/PTs because the first sample did not yield adequate results. Patients really love me when I have to tell them that they’ll have to wait for at least another two hours and that I’ll have to poke them again. But then I discovered the passive shielding blood collection needle. I freaking LOVE this thing! I get the vein EVERYTIME, get my blood drawn super fast and don’t get back angry lab reports. The passive shielding needle is a bit harder to manoeuvre than the butterfly but once you get the hang of it, you can’t go back. Best of all, as soon as you withdraw the needle, the safety shield clicks in automatically which means I have no chance of getting a needle stick when someone flinches their arm away or decides to have a seizure in the middle of venipuncture. I’m still working on my dexterity with this, but I think I’ll be reserving the butterfly for really tiny veins and smaller people.
I realize that this post sounds like a total testimonial for the BD folks, I (unfortunately) was not paid to write this. Its just something I now love! And yes, I’m a big time nerd.
Friday, October 17, 2008
I had a lady come in complaining of pain in her butt. Literally. She said that it hurt to sit and it felt like there was a pimple there that was pushing out other tissue. Sure enough there was a giant abscess and was right in the middle of her butt. In case you're wondering what it looked like, here's a picture of an abscess on a leg. Imagine that on your bum. Ouch. I was surprised as hell when one of the docs (who knows I’m a complete newbie) asked me to assist during the I&D but nonetheless jumped at the chance to see something gory and bloody. I was not disappointed. When the doc made the first incision, I gasped at the amount of pus that started to gush out of the abscess. I think it had to be about 50 cc. I haven’t consulted literature regarding average pus volumes in abscesses but that seemed like a lot. Apparently this woman had a history of abscesses in that region. Trying to critically think about why that could be, I started talking to her and found out that she used harsh soaps and scrubbed extra hard to “get rid of the bacteria”. Poor woman – she just kept breaking down her skin and letting the bacteria get in. Moral of the story; be kind to your behind.
Thursday, October 16, 2008
Currently, I’m ‘buddy-shifting’, meaning that I’m following different nurses around trying to get the hang of things. Some of those nurses understand that I’m a new grad but I need to learn so they let me try to run things and help out when I need it. In fact, a couple of shifts ago, I was pretty much running the fast track area. I actually felt like a NURSE instead of a scrub clad monkey with opposable digits. On the other hand there are some nurses that just make me feel like crap. For example, yesterday I was working in the fast track area with a nurse who kept telling me that I’m insanely slow and that I can’t keep up with the patient load. She was right that I couldn’t keep up but I think it was partly because she kept slamming me with new patients every 10 minutes. When I worked the fast track area previously, I discharged at least 2 patients before bringing another one in so I could keep a stretcher free in case a lol (little old lady) with a query hip fracture is brought in by EMS. When I explained my reasoning to her, she just looked at me like I was a total moron and started giving me report on 4 new patients. There are some days when I get really pissed at myself because I keep forgetting the details about patients. I still feel like I’m having the hardest time remembering who is going for what test at what time. I feel like an idiot giving report while realizing I forgot about a test or a new set of orders.
Another shock to my (nursing) system was the sheer number of patients I can see in a given day. When I was consolidating on the floor, I memorized the patient list, admitting diagnoses and med times within a week. I got sick of handing out the same pills every day. In the ER, I can see up to 30 patients a day presenting with everything ranging from abscesses in the ass crack (its true) to bleeding eyes and insane joint deformities. Throw in the Friday and Saturday night Drunky McDrunkingtons (my pet name for the drunks requiring a B&B) and I’m well on my way to climbing the steep learning curve.
I really hope that I don’t screw up and get tarred and feathered out of the ER. Now that I’ve had a taste of the autonomy nurses can have, I really don’t want to go to another unit. Attaining competence, confidence and beyond is my biggest goal – I really hope I get there sooner rather than later.