Services that are Pissing me off!*

1) Gyne
I was working the gyne area and almost each and every one of my patients got referred to them. The new batch of gyne residents SUCK! They’re rude, they NEVER answer their pages unless you threaten them with bodily harm and they leave their patients hanging for hours. When they finally get down to the ER, they held up all 5 of my assessment rooms while the pile of charts at triage kept building up. One lady in particular was kept waiting for 17 hours – did I mention that she was an IDDM and was kept NPO for no reason?? The ER staff doc got so pissed at the whole sham that he just referred her to outpatient services and wrote her a script for some percs.

2) Internal Medicine
The senior is a mean BEEYOTCH! She’s mean to the patients, she’s meant to the nurses, and she’s mean to other doctors. On top of that, she took a chart from the nursing station, took it apart and left the pieces on the FLOOR on the other side of the department. I wasted half of my shift looking for that damn chart. When I called her about the chart, she yelled at me for wasting her time and then hung up on me. I was forced to be just as mean to her underlings and make them stay within my range of vision with the chart.

3) General Surgery
They NEVER pass along their patients to another service or discharge them when they’re finished with their assessments. I end up making a thousand calls just to figure out what the eff they want to do with the patient. Meanwhile the patients and their families hover over my head glaring and bitching at me.

*I'm waiting for the new batch of residents and students to take over so the staff with the nasty attitudes can get out of my hair.

Fall Down Go Boom

Our ER has been a heavy duty construction zone lately.

“Of course we can (BAM) provide a somewhat (THUD) quiet place (OWWWW) for your easily startled formerly (SMASH) shell shocked grandfather”

BUT there is a reason – we’re upgrading our layout, adding new beds and also getting a boat load of some kickass computers and flat screen televisions (to umm keep a track of patients). However, I’m firmly convinced that the ghosts of technologically averse administrators past are haunting us. As a beautiful Sony flat screen panel was being brought into the newly refurbished nursing station, one of the men let go of his end and cracks the screen in 3 jagged pieces. He was a code STEMI. The construction worker is doing well. I rejoice for him and his family. The flat screen panel could not be resuscitated. I mourn for the loss of a beautiful piece of technology.

G8P1A4, Age 25

Yep that’s right – 7 pregnancies, 1 live birth 2 miscarriages and 4 induced abortions all before the tender age of 25. Oh and lots of drinking. Lots. She comes in with vague complaints and abdo pain. She had her last menstrual period almost 4 weeks prior to her coming in and her beta was almost 10,000. She was genuinely surprised to find out that she’s pregnant – again. The father was her friend from elsewhere and they both got piss ass drunk when the blessed event happened. Her 22 month old daughter was accompanied by another friend and was passed along to grandma because “mommy always wanted grandkids”. I don’t think mommy wanted grandkids to raise – she probably just wanted to spoil them like a grandmother would want to. Instead, mommy is now stuck working god-awful hours just to make sure that the innocent little toddler is well taken care of because obviously the daughter has shit for brains. I think the staff doc said it the best; “How can one person be so stupid?” and I agree with her completely. After all of those pregnancies and referrals to birth control clinics, you think she might have learned to take better care of herself? Nope. Not at all. She just smiled sheepishly and said, she didn’t think she’d get pregnant this time. Because 8th time is the charm. I fulfilled my nursing responsibility and talked to her extensively about birth control but it was a total fucking waste of my time because apparently she knew all this. “I don’t like to put unnatural things in my body”. Technically speaking, vodka and cigarettes aren’t natural either. And the biggest irony of this entire miserable story – she lives a block away from one of the most respected and accepting birth control clinics in the city if not the province. Somehow I doubt ‘the system’ let her down. Some people are beyond the help of the system.

A Small but Perceptible Shift in my Position on the Totem Pole

Apparently the powers that be feel that I’ve got enough experience in the non-critical areas to orient new staff. So that’s just what I did. For two weeks straight.

I must say that I really enjoy teaching. It’s an opportunity to not only help another person get their bearings in a new setting but it helps me learn from their experiences as well. Unfortunately, a particular new hire does not feel the same way. I tried to go through several protocols including chest pain with cardiac features and hip fractures but she talked over me the entire time. I heard all about her kids, her husband’s habit of not filling up the gas tank, her mother-in-law’s crazy tarot card obsession, her sister’s multiple affairs and her favourite shampoo’s magical hair softening effects. When I finally got a chance to speak, I redirected her to a patient who was brought to us with a possible hip fracture. I told her to do the initial work up which we would discuss afterwards. She talked and talked and talked and then talked some more with the hip pain guy without checking for distal pulses, checking for shortening or rotation, drawing blood, doing an ECG or even putting in a freaking catheter. When she came out of the room, she tells me the guy’s entire life story but nothing clinically relevant. She didn’t even ask him about HOW he fell! What really kills me is that she’s been a nurse for 4 years! FOUR years! Had I known that she wouldn’t even do basic assessments, I wouldn’t have left the patient to her because I had to give up my break to catch up on the work she created for me. While she sauntered off to break, she had the audacity to comment to another nurse that *I* was slowing HER down. It was a miracle that I didn’t end up strangling her!

However, the day was saved when I had to orient two new grads – they were brilliant. Smart, great critical thinkers and asked lots of intelligent questions. Even though I was still swamped with a bunch of unworked-up patients, I genuinely enjoyed teaching them as much as I could. Unlike nurse with 4 years experience, they did a great job with their assessments and were able to very intelligently explain their rationales.

As I write this post, I received an email saying that I’m teaching for the next set of my shifts as well. Here’s hoping I get the later and not the former. Otherwise, I might stuff her mouth with a chart. But that would not be very professional of me, considering that now I have to uphold an image of someone with a mild bit of nursing experience.

Bad Dream, Worse Behaviour

Some nights I have a dream in which my boss and peers come up to me in the middle of a busy shift and tell me that I’ve actually failed my licensing exam and as such, I’m not actually a nurse. Then I see professors from some time long ago saying that my degrees have been revoked. Of course, my nursing license also gets revoked. All of this happens in front of a doctor who starts to lecture me on ER wait times being prolonged because of something I’ve done. It’s never a good sign when I dream this dream while on break AND when the doctor in question is on shift as well. Of course it doesn’t help that this doctor makes me incredibly nervous and I can’t figure out why. Rationally I know full well that I have the requisite knowledge to work as nurse. I am also completely cognizant of the fact that I have a long way to go before I reach the ‘expert’ level of nursing. And yet, there remains something about this doctor that makes me feel very very edgy (close to the point of full blown mind numbing anxiety) when he’s on the same shift as me. His presence makes me feel as if anything I say would sound foolish and anything I do would be wrong. I become consumed by the thought that I was hired over the other candidates from my class only because I might have stumbled across the right answer to some mundane question. And so, much to my own chagrin, I say nothing. I silently sit paralyzed with self-doubt and wait until he goes onto see the next patient before I can breathe a sigh of relief. He has never done ANYTHING that would warrant such a response from me, but I feel threatened by him regardless. Perhaps it’s his height (almost 6’7) though unlikely, or perhaps I think I see an expression of restrained surprise so subtle as to be nearly imperceptible when I speak intelligently about something. Or maybe, I still feel I have nothing substantial to offer next to the highly skilled and experienced nurses and doctors and this doctor just happens to work on the shifts in which I feel exceptionally shitty and under-qualified. I know I have to deal with this, and quickly, but I don’t even know where to start.

The Concern is Overwhelming – and Embarrassing

After receiving orders to prepare a massive amount of antibiotics, analgesics and anti-emetics for a patient diagnosed with a ruptured appendix, I dragged myself to the med room and starting preparing one med after the other. Problem is that I was feeling extremely queasy (midnight shawarma is a bad idea) and had a massive headache (from the call bell constantly going off from a room with no patient). Then I thought, "what the hell! I’m in the med room standing right smack in front of ibuprofen and gravol. I will take some!" So I did just that. Except the med room has a glass window and a few patients were sitting outside. One of them thought that I was trying to kill myself so he grabbed two staff doctors, a resident and the charge nurse. They burst into the med room and demanded to know what I took! Imagine my surprise when I was confronted with a miniature infantry of green while I’m holding up a giant syringe filled with ceftriaxone. After being forced to reveal that all I took was gravol and ibuprofen, the concerned patient turned beet red and skulked away while the my charge nurse told me try some of the more fun drugs next time. Maybe I will!

No-one is Looking After Me!

One of the things that irritate me to no end is when patients complain, “it has been __ hours and NO ONE is looking after me!” In fact, there’s a giant team of people working to get things done for them.

For example, if you come in complaining of abdominal pain and end up getting a CT, you have an ass ton of people looking out for you –they’re just not in the room standing by your beside holding your hands because they wrongly assumed that you are an adult and can handle the fact that people have to work on your behalf where they have access to needed tools and supplies. You get the triage nurse to assess you, determine how sick you are, and assign you to an area of the department. You get the registration clerks who put you in the hospital’s electronic system and get your insurance info which means that you don't pay out of pocket. Then you get a nurse in the area that you’ve been assigned who does a thorough assessment of your symptoms and makes sure that any relevant concerns are passed along to the charge nurses and the physician on call. S/he also takes blood samples which are sent to the lab for analysis. Lab techs are analyzing your blood along with many other patients’ blood samples. They prepare a report that can be accessed by your nurse and doctor so they know what to do with you. The physician assesses your medical emergency and prescribes a course of treatment which could involve diagnostic imaging.

Now getting back to the aforementioned CT – the doctor places a request to the radiology department who are not only covering in and out-patient scans, but emergency scans as well. Depending on your need for contrast, you get a tech to deliver it to you. If you don’t understand what to do with the contrast solution, your nurse comes and explain it to you while assessing your condition (again). You may also get medications drawn up and administered to you. When it’s time for your scan, a porter takes you there and brings you back. Meanwhile, the techs send the images to the radiologists who read your scan (while dealing with a million other scans) and send the report back to the emergency doctor who saw you. During this time, you’re still being assessed by your nurse frequently (especially if your bed is in front of the nursing station). If you end up staying for a long time, you have the kitchen staff preparing meals which are again delivered by the porters. When the doctor finally gets your results from the radiologists, s/he comes back and explains them to you. If you are discharged, the nurse prepares your discharge papers and if necessary, arranges outpatient follow-up appointments for you and quite possibly dumbs down everything your doctor told you so you can understand what is going on with you. If you get referred to another service (say for example, medicine of general surgery), your nurse is constantly on their ass to make a plan of care for you. If you get admitted, admitting clerks handle your insurance. Once again, porters deliver you to the floor while your emerg nurse gives report to the floor nurses to assure continuity of care.

So think about all of this when you decide to act like a petulant child and say that no one is looking after you. There are an enourmous amount of people who work their ass off to the point of exhaustion just so get the care you sought. Also, don’t bitch at your nurse when things get a little slow – you’re not the only one in the department and there are a multitude of variables that are completely out of our control. Oh, and you don’t have swine flu.