Monday, December 19, 2011
He did, however get me thinking about nursing education in general. I have worked with many students from the school that my student was enrolled at and they all mentioned that their school concentrated far too much on nursing theory and not enough on research and data interpretation skills. Based purely on anecdotal data collected during three night shifts, nurses who had another degree in the sciences were much more comfortable with gathering and interpreting data and understanding the biochemistry behind medications and disease processes. Sometimes I think that perhaps there should be a greater barrier to entry in the profession but I realize that the nursing shortage issue would be exacerbated. So nurses discuss – do you think that new grads are adequately prepared to face the job? What do you wish was taught more in school?
Monday, September 12, 2011
I’ve noticed that my department’s staffing demographics are somewhat unusual because we have a lot of young staff. I’m defining ‘young’ as under 35 with 3-6 years of nursing experience. We also have a few ‘well preserved dinosaurs’ (their term, not mine) who work mostly part-time/casual hours. I have nothing but the best things to say about our dinosaurs because they took me under their considerable wings and set me on the right nursing path. However, when it comes to adopting new technology, some of them are downright useless! Every shift worked with them involves listening to how the order entry system is an abomination upon God’s Good Green Earth and could possibly be an additional horseman of the apocalypse that’s not mentioned in the Bible. Many of them are also viciously opposed to the new defib pads because they feel that the glue is inferior to the previously used brand.
So imagine my luck when I got partnered up with one of the dinosaurs in resus and we got a patient having a big ol’ stemi. We did the usual stuff to stabilize him for a transfer to the cath lab. On the way there the man went into v-fib. We tried to shock him but for some reason the shock wasn’t delivered. Absolutely panicking, I start throwing things out of the emergency transport bag looking for a new set of pads when my partner took the paddles attached to the defibrillator and used those to shock the patient. The baby docling accompanying us was speechless as was I because the monitor showed an organized rhythm and bought us just enough time to get the patient to the cath lab.
In summary – lesson learned. Dinosaurs may be old and roar a whole lot, but their bad-assery is NEVER to be underestimated. Ever.
Tuesday, August 9, 2011
Friday, May 20, 2011
Tuesday, May 17, 2011
Moral of the story:
When nauseated, start by taking one PILL of gravol, not one BOTTLE.
Strength training has benefits beyond being a tool to be really really ridiculously good looking!
Tuesday, April 26, 2011
Tuesday, April 5, 2011
Thursday, March 17, 2011
A couple of weeks ago the department was absolutely swamped and really short staffed due to a particularly heinous strain of cold and gastro making its rounds with the staff. The staffing situation was dire enough that the manager changed her shirt into a scrub top and started helping out. It was quite a funny sight to see a woman in a pencil skirt, flats and a scrub top walking around the department carrying urinals full of hematuria. But I digress – that’s not the point. She eventually triaged a patient to fast track for back pain. Long story short, the woman was a drug seeker who’s very familiar to most of the staff. She didn’t let me examine her nor did she let the doctor do the same. Eventually, the doc told her to eff off (not quite like that, but her intention could not be mistaken) and that she could either get toradol or nothing before leaving. She then pretended to have a syncopal episode (seriously, how many times does a syncopal episode result in someone falling neatly onto the egg-crated mattress?). When she realized that the nurse was clearly ignoring her, she sat up and started to threaten her and swear at her using profanities that would offend a seasoned sailor’s sensibilities. Rightly so, my colleague didn’t put up with it for too long before she called security and had her ass dumped back out into the cold. Like any good nurse, she then documented. Then documented some more. She also included some direct quotes from her in her documentation because the patient was just that vile.
Lo and behold, this issue was brought up during our education day by the nurse clinician and our manager. Their position was that including some of her direct quotes was unprofessional and that now this charting would follow the patient around in her future encounters with the healthcare system.
I do see my manager’s point of view. Once something is written, there’s no taking it back. If she ever cleans up and has to access an ER again, this documentation is going to unfavourably affect how another nurse treats her. I can also see how in the midst of illness, one says things that they later regret and a person’s actions in one moment of time are not necessarily reflective of who they are. However, had I been in my colleague’s place, I probably would have documented in a similar style. Why? I’ve also dealt with this patient many times before and each encounter ends in almost the exact same way. A friend of mine who works in an ER across town also gets sworn at by her every time he invokes the fury of the triage gods. And yet, the only thing I’ve seen documented is that “patient is verbally abusive to staff”. I don’t think that this statement covers exactly how vile she is towards the staff. We regularly use quotes to capture what patients tell us so I don’t see why we can’t use direct quotes to document verbal abuse thrown our way. Moreover, in the unlikely scenario if she ever decided to sue my colleague, she would have documentation about the patient’s thoroughly reprehensible behaviour to back up her actions.
Obviously, I’m still not decided on where exactly I stand on the issue but I feel that I better pick a position soon because she’s not going to the only aggressive and abusive patient I’ll deal with.
Wednesday, March 9, 2011
But things rarely work out the way I want them to. I walk into a department that’s on the fast track to hell in a hand basket. Waiting room was packed leaving only standing room. An insane amount of eyes were trying to bore into the triage nurses’ skulls, probably hoping that if the gatekeepers to the department spontaneously combust, they would be quickly seen by the shining knight in a stethoscope and save their day. Inside the department, there were two codes (at the same futtha-muggin time!!!!) going on, one of which was a paediatric code and there were old, obtunded, septic patients circling the drain in every corner. It's as if every single nursing home had an outbreak of the plague and sent thier residents to our lovely department.
Not even fast track was showing any signs of patient movement. Everyone had a broken something with neurovascular symptoms and the simple lacs were gushing blood – almost as if arteries were involved. Which they were. Of course, the cherry on the crap sundae that was fast track were the FOUR patients that had bed bugs. FOUR of them. Getting them isolated and bathed made my skin crawl a thousand different ways. I’m still itching at the thought of it. Fast track spilled onto the outpatient surgery unit after a while, which isn’t too far away from one of my favourite Starbucks.
At least I still had my super-power of blood drawing. Got 4 vials from a knuckle vein! It's good to be back.
Wednesday, February 9, 2011
Saturday, February 5, 2011
Just as I settled into a really deep sleep, my sister woke me up in a panic and said that she just got a very sharp and sudden pain in her stomach and she feels like throwing up. Sister hasn’t been sick, hasn’t had any changes in her diet and wasn’t injured. She also never ever EVER gets abdominal pains, nor does she take any meds. I asked her some detailed questions and of course asked about her last normal doody (yes even family members aren’t safe from doody questions if they bring up abdo issues) and if she had any urinary symptoms. She said no to everything. Since I was too lazy to get out of bed, I asked her to gently palpate around her abdomen and tell me if any part hurts or is relieved by palpating. She told me that everything was normal. Not being able to think of anything else, I told her to take a gravol, go back to bed and if the pain worsens, wake me up. Naturally, she fell asleep.
The next morning, she told me that her stomach was still hurting and asked if she should go to our family doctor. I was at a complete loss. “When has your stomach been hurting since?”
“Since last night loser!”
Baffled by her annoyance, I shot back, “Well how the eff was I supposed to know that?”
“Dude wtf is wrong with you? We had this conversation at 3 this morning. You told me that if my stomach was still hurting, I should go to the doctor”.
At this point, I was completely baffled. “Alright imma hold you up a minute. What exactly did we talk about and what did I say?”
Now it was sister’s turn to be lost. “You don’t remember?” She then repeated everything I had told her up to and including the part about me telling her that if I didn’t sleep at that moment, my eyes would bleed out of my head.
I honestly don’t remember a single word of that conversation. In fact, the only thing I remember is getting into bed at around 0130 and waking up refreshed at 1230. As far as I’m concerned, I slept for eleven straight hours. This is troubling because up until now, I have never had a conversation that I haven’t remembered. My sleep assessment is the first incidence of amnesia I’ve experienced (or at least, the first incidence that I've been made aware of). However, once I managed to snap out of the ‘holy exhaustion related memory loss batman’ frame of mind, I was quite impressed that even while I was half asleep, I was able to go through an abdominal assessment. Maybe I should sleep through assessments more often at work (kidding – sort of).
Btw, the sister is not 100% fine but we did have a yummy lunch together. She is no acute distress at present :)
Saturday, January 29, 2011
One of my most irritating encounters happened with a middle aged man who came in complaining of shortness of breath. It was clear he had pneumonia (what with the raging fever, gunky sounding lungs and the dramatic expectoration of army fatigue coloured phlegm) but he absolutely refused the antibiotics citing concerns about antibiotic resistance and his consumer power. And yes, he had stacks of printouts, mostly with ads for weight loss remedies on the side, to ‘argue’ his case. Logic did not have a place in that exam room. I hate to get all flustered, but WTF??! Why bother coming into emerg at all?
This whole business about the customer always being right is total crap when it comes to providing safe, competent, evidence based care to a ‘customer’ who picked up their medical knowledge from internet pop-up ads and snippets of TV shows.