Tuesday, July 31, 2007
Vacation continues
I am still on vacation, third week. Bad news, because I am having such a great time that I don't care if I ever return to work! Too bad my bill collectors don't have the same attitude isn't it. Anyway. I will return soon to the daily grind and will resume posting. In the meantime, I have: hiked 12.7 miles, biked 42 miles, swam 2 miles, sunned 14 days, cooked 22 meals on a barbecue or campfire and eaten 13 s'mores. We have sand in every nook and cranny of the RV and ourselves. The furry members of the family are equally as sandy and having the time of their lives, although not smelling so great! I have big plans now to retire and spend my life as a full-time RV'er and camp host :) I will probably need skin cancer treatment when I return as my nose has burned and peeled more times than I can count but worth ever minute of it. Happy summer!
Uh oh, I was afraid of this!
Take the most scientific Harry Potter Quiz ever created.
The sorting hat says that I belong in Slytherinr!
Said Slytherin, "We'll teach just those whose ancestry is purest."
Slytherin students are typically cunning and hungry for power. Important members include Draco Malfoy (Harry's nemesis), Professor Severus Snape (head of Slytherin), and Lord Voldemort.
Take the most scientific Harry Potter Quiz ever created.
Tuesday, July 24, 2007
ER nurses VS Floor nurses.
AMEN! While the ER is constantly pressured to not go on diversion and keep all the patients happy, nothing is ever really done to fix the reasons why we can't take care of the ever increasing volume of patients coming through our doors. Thanks Girlvet.
Relaxing
Boy, once or twice a year it is nice to be reminded what it feels like to be relaxed and happy. Long walks on the beach with the family and beloved canines. Salt spray and sea air. Camping in the dunes. I hope that lottery ticket I bought pays off and this could be my life, ERnursey becomes happy beach bum. For all of you remaining in the trenches, I will be joining you soon, in the meantime we will be having 'smores tonight and sleeping under the stars, lulled to sleep by the pounding surf.
Wednesday, July 18, 2007
Grand Rounds
Grand Rounds is up at Vitum Medicinus, and I am the proud recipient of the Toothicus Clenchicus award! Please check out this weeks outstanding edition.
Monday, July 16, 2007
ERnursey is on the beach with the ERkids, please be patient for a couple of weeks as quality family time supersedes the need to vent on my blog! Happy summer to all.
Thursday, July 12, 2007
Why I HATE Triage, part 2
My first patient of the day has abdominal pain. Abdominal pain is one of the top three chief complaints seen in the ER, it usually requires lab work, urinalysis, xray's, often a CT and, if it is low abdominal pain in a childbearing age female, a pelvic exam. It is a lengthy process. This particular patient has been here 14 times in the last two months with the same chief complaint. She has had every conceivable test except for a full body MRI and they have all been negative. In those fourteen visits she has gotten a total of 62mg of Dilaudid, an average of 4mg per visit. She has received prescriptions for 280 Vicodin. Does anyone but me see a problem here?
Next is a young male who states he was bitten by a black widow spider. No visible mark is noted in the area he points too. Black widow spider bites are painful, and can cause severe muscle cramping. The patient in question is exhibiting no signs of distress. So no sign of a bite and no symptoms? Of course, rush right to the ER.
It is later in the afternoon and the lobby is full, most people have been waiting over 2 hours. In walks 57 year-old diabetic with nausea. I bring the patient into the triage room and notice that they are gray, sweaty and short of breath. Skipping triage, I grab a wheelchair and rush the patient back to one of the cardiac rooms where they are found to be having a massive MI. I return to triage and now everyone in the lobby is yelling at me because that patient got to go back when they had been waiting longer.
Don't get me wrong, not every patient encounter in triage is unpleasant. Most people are pleasant and thankful for your time. But the unpleasantness happens with enough regularity to make it a place most ER nurses don't like to spend time.
Next is a young male who states he was bitten by a black widow spider. No visible mark is noted in the area he points too. Black widow spider bites are painful, and can cause severe muscle cramping. The patient in question is exhibiting no signs of distress. So no sign of a bite and no symptoms? Of course, rush right to the ER.
It is later in the afternoon and the lobby is full, most people have been waiting over 2 hours. In walks 57 year-old diabetic with nausea. I bring the patient into the triage room and notice that they are gray, sweaty and short of breath. Skipping triage, I grab a wheelchair and rush the patient back to one of the cardiac rooms where they are found to be having a massive MI. I return to triage and now everyone in the lobby is yelling at me because that patient got to go back when they had been waiting longer.
Don't get me wrong, not every patient encounter in triage is unpleasant. Most people are pleasant and thankful for your time. But the unpleasantness happens with enough regularity to make it a place most ER nurses don't like to spend time.
Wednesday, July 11, 2007
Why Nursing Ratio's are Failing Patients
I started to reply to a comment on my post about after vacation blues. ERmurse responded that only by strict adherence to the nursing ratio's can we force administration to change.
I'm all for nursing ratio's, I have been a nurse when things were downright dangerous, however: The ER doesn't get to shut it's doors when the floors are full. People continue to be sick and try to die and need our help. There are times when an influx of sick patients require us to pull up our grown up socks and do a little extra. Patients can't be made to suffer and perhaps die in the ER waiting room. The first plan needs to be REQUIRING hospital administration to staff someone on call to come in to meet surge capacity. If they can't do that then the unit directors need to be responsible for coming in and staffing their unit. That is how it was done in the old days when we were 'head nurses' instead of 'directors'. If all else fails then the floor nurses need to step up, the burden cannot always be on the emergency room. Plenty of times when we are holding patients due to staffing there are nurses on the floors with all their work done sitting around the nurses station.
The last hospital I worked at would go on 'internal disaster' when the ER was overwhelmed. When that happened, all of admin and the directors had to come in, day or night. You'd be surprised at how fast things got done when that happened.
If you think I complain too much then I invite you to walk a mile in my shoes. And remember, someday it may be you, your wife, husband, mother, father, child, brother, grandparent or other beloved relative who is sitting in our waiting room, sick, suffering and in pain because there is no bed.
I'm all for nursing ratio's, I have been a nurse when things were downright dangerous, however: The ER doesn't get to shut it's doors when the floors are full. People continue to be sick and try to die and need our help. There are times when an influx of sick patients require us to pull up our grown up socks and do a little extra. Patients can't be made to suffer and perhaps die in the ER waiting room. The first plan needs to be REQUIRING hospital administration to staff someone on call to come in to meet surge capacity. If they can't do that then the unit directors need to be responsible for coming in and staffing their unit. That is how it was done in the old days when we were 'head nurses' instead of 'directors'. If all else fails then the floor nurses need to step up, the burden cannot always be on the emergency room. Plenty of times when we are holding patients due to staffing there are nurses on the floors with all their work done sitting around the nurses station.
The last hospital I worked at would go on 'internal disaster' when the ER was overwhelmed. When that happened, all of admin and the directors had to come in, day or night. You'd be surprised at how fast things got done when that happened.
If you think I complain too much then I invite you to walk a mile in my shoes. And remember, someday it may be you, your wife, husband, mother, father, child, brother, grandparent or other beloved relative who is sitting in our waiting room, sick, suffering and in pain because there is no bed.
Dumb reasons to come to the ER
Young adult female presents BY AMBULANCE with a broken fingernail. (OK, I've broken a nail, and granted it was painful. But a little neosporin, a band aid and a couple of Tylenol and I suffered though it.) What kind of a person would think it is OK to call an ambulance for something so trivial? And before you ask, EMS in our area are not allowed to refuse to transport no matter how asinine the complaint.
3 am on a Tuesday and a thirtyish male comes in, WITH HIS MOTHER, to see if we can remove some warts. The ER doc showed the patient his name badge and asked him if he saw family medicine or dermatology written on it anywhere. While we found that quite funny I'm sorry to say that the patient and his mother didn't get it. (Males above 20 take note. You should now be old enough to do things without your mother.)
Friday night, the waiting room is packed and the wait times are approaching 6 hours. A mom brings in her six-year old who has been seen by his pediatrician that day and diagnosed with pneumonia. She wants a second opinion.
Foreign body in belly button. Diagnosis? Lint.
I could go on and on and probably will.........another day.
3 am on a Tuesday and a thirtyish male comes in, WITH HIS MOTHER, to see if we can remove some warts. The ER doc showed the patient his name badge and asked him if he saw family medicine or dermatology written on it anywhere. While we found that quite funny I'm sorry to say that the patient and his mother didn't get it. (Males above 20 take note. You should now be old enough to do things without your mother.)
Friday night, the waiting room is packed and the wait times are approaching 6 hours. A mom brings in her six-year old who has been seen by his pediatrician that day and diagnosed with pneumonia. She wants a second opinion.
Foreign body in belly button. Diagnosis? Lint.
I could go on and on and probably will.........another day.
Monday, July 9, 2007
Post Vacation Blues
Well here I am, back from vacation.
I went in today determined to be positive and it didn't take a half an hour to have that dashed on the rocks.
At 6 am I took report on a patient that had been admitted since 3am after being in the ER since 8 pm and had been holding for a bed until after change of shift because of staffing. So here is a nice 72 year old lady with CHF who has diuresed nicely but is still in need of a little tune up. At 6 am she has been in the ER for 10 hours not because all the beds are full but because there isn't a nurse that doesn't already have 5 patients.
Before I go any further, let me present my first bitch. PATIENTS SHOULD NEVER HAVE TO STAY IN THE ER IF THERE IS A BED AVAILABLE. That is a grave disservice to the patients who are uncomfortable and can't rest. They are paying for a hospital room and that is what they should get, a hospital room with a bed, phone, TV and some privacy. There are options. Instead of trying to save every last dollar, the hospital could keep a nurse on call, they could offer a day shift nurse a little bonus to come in extra. If nothing else, the unit director should be required to come in. NO PATIENT SHOULD BE DENIED A ROOM UNTIL ALL ELSE HAS BEEN TRIED AND FAILED.
OK, I call report to the floor. I tell the receiving nurse that the patient is on oxygen and a nitro drip and will need telemetry. (Meaning, she will need oxygen,an IV pole and to have the tele box ready.)
I load up the patient, put her on the travel monitor which weighs 30 pounds and because we are short staffed and there is a code going on in the critical rooms, push the gurney up to the floor. When I get up to the floor there are 4 nurses sitting at the nurses station. They all look up as I push the gurney by. None of them get up. I maneuver the gurney into the room which means I have to move two visitor chairs, two over bed tables and push the patient in bed A's bed out of the way. I get the gurney next to the bed. There is no IV pole and no oxygen connector on the flow meter. I put on the call light and wait several minutes but no one comes in. I am getting stressed because I know I have three other patients downstairs with full workups to do and it is 6:45 and I am already close to an hour behind. I smile at the patient and tell her I will be right back. I go out to the nurses station and ask for the nurse. I have to ask several times before someone gets up and comes to help.
What kind of message does that send to the patient? I am not important enough for a nurse from the floor to come in and greet me? Do you really think that she didn't notice how rudely the other nurse treated me? Why do we persist on acting like this toward our patients and each other? Nurses piss and moan about not being treated like professionals and yet this is how we act.
Well this patient noticed. She happened to be the mayor's mom-in-law. She didn't want anyone to know who she was but I hear she raised holy hell with administration this afternoon. Good for her!
I went in today determined to be positive and it didn't take a half an hour to have that dashed on the rocks.
At 6 am I took report on a patient that had been admitted since 3am after being in the ER since 8 pm and had been holding for a bed until after change of shift because of staffing. So here is a nice 72 year old lady with CHF who has diuresed nicely but is still in need of a little tune up. At 6 am she has been in the ER for 10 hours not because all the beds are full but because there isn't a nurse that doesn't already have 5 patients.
Before I go any further, let me present my first bitch. PATIENTS SHOULD NEVER HAVE TO STAY IN THE ER IF THERE IS A BED AVAILABLE. That is a grave disservice to the patients who are uncomfortable and can't rest. They are paying for a hospital room and that is what they should get, a hospital room with a bed, phone, TV and some privacy. There are options. Instead of trying to save every last dollar, the hospital could keep a nurse on call, they could offer a day shift nurse a little bonus to come in extra. If nothing else, the unit director should be required to come in. NO PATIENT SHOULD BE DENIED A ROOM UNTIL ALL ELSE HAS BEEN TRIED AND FAILED.
OK, I call report to the floor. I tell the receiving nurse that the patient is on oxygen and a nitro drip and will need telemetry. (Meaning, she will need oxygen,an IV pole and to have the tele box ready.)
I load up the patient, put her on the travel monitor which weighs 30 pounds and because we are short staffed and there is a code going on in the critical rooms, push the gurney up to the floor. When I get up to the floor there are 4 nurses sitting at the nurses station. They all look up as I push the gurney by. None of them get up. I maneuver the gurney into the room which means I have to move two visitor chairs, two over bed tables and push the patient in bed A's bed out of the way. I get the gurney next to the bed. There is no IV pole and no oxygen connector on the flow meter. I put on the call light and wait several minutes but no one comes in. I am getting stressed because I know I have three other patients downstairs with full workups to do and it is 6:45 and I am already close to an hour behind. I smile at the patient and tell her I will be right back. I go out to the nurses station and ask for the nurse. I have to ask several times before someone gets up and comes to help.
What kind of message does that send to the patient? I am not important enough for a nurse from the floor to come in and greet me? Do you really think that she didn't notice how rudely the other nurse treated me? Why do we persist on acting like this toward our patients and each other? Nurses piss and moan about not being treated like professionals and yet this is how we act.
Well this patient noticed. She happened to be the mayor's mom-in-law. She didn't want anyone to know who she was but I hear she raised holy hell with administration this afternoon. Good for her!
Sunday, July 8, 2007
Tuesday, July 3, 2007
Email joke
I read this in my email today, it was anonymous so I cannot give credit where credit is due. Pretty dang funny!
Which is Worse?
True Story from Houston Medical Center
A man went to the hospital to have his wedding ring cut off from his penis.
According to the Nurse attending, the patient's girl friend found the ring in his pants pocket and she got so mad at him, she used petroleum jelly to slip the ring on his penis while he was asleep.
I don't know what's worse:
1) Having your girl friend find out you're married.
2) Explaining to your wife how your wedding ring got on your penis.
3) Or finding out your penis fits through your wedding ring.
Monday, July 2, 2007
Telephone Calls
My friends and family wonder why I never call. Little do they know that I spend hours every week listening to the incessant ringing of the phones in our department. I hate it, by the time I get home one little ring is all it takes to put me over the edge.
We are not allowed to give medical advice. In fact, when you call our ER you get a recorded message stating that we cannot give medical advice. You would be amazed at the number of people who wait through the whole message and then ask a medical advice question. Here are a few of my favorites:
"Ummm.....I know you can't give medical advice, but......."
" I just had surgery and there is pus coming out of my incision." um, did you try calling the surgeon?
" I have a sore on my penis, can you tell me what it is?" um, no sir, I can't see your penis through the phone.
"I have chest pain, should I come in?" Duh, yes please - get off the phone and call 911. Don't waste time talking to me.
"How can you tell if someone is dead?" !!!!!!!!WTF? Turns out yes, the roommate was dead of an apparent OD.
"I've had this rash for six weeks, should I come in?"
"how much Tylenol should I give my infant." Call your pediatrician, he will be able to advise you.
And the all time winner was........
"ummm........my girlfriend and I um...........well...........we were um...........Playing around and um............." (foreign body in the vagina)
We are not allowed to give medical advice. In fact, when you call our ER you get a recorded message stating that we cannot give medical advice. You would be amazed at the number of people who wait through the whole message and then ask a medical advice question. Here are a few of my favorites:
"Ummm.....I know you can't give medical advice, but......."
" I just had surgery and there is pus coming out of my incision." um, did you try calling the surgeon?
" I have a sore on my penis, can you tell me what it is?" um, no sir, I can't see your penis through the phone.
"I have chest pain, should I come in?" Duh, yes please - get off the phone and call 911. Don't waste time talking to me.
"How can you tell if someone is dead?" !!!!!!!!WTF? Turns out yes, the roommate was dead of an apparent OD.
"I've had this rash for six weeks, should I come in?"
"how much Tylenol should I give my infant." Call your pediatrician, he will be able to advise you.
And the all time winner was........
"ummm........my girlfriend and I um...........well...........we were um...........Playing around and um............." (foreign body in the vagina)
Sunday, July 1, 2007
Abuse of the ER
It's Monday afternoon, the ER is full with 5 patients on beds in the hall and 16 patients in the waiting room, some waiting over three hours. My ER physician takes a call that Dr. X is sending over a patient that has a history of Leukemia and now has fevers. Shortly after that I get a call from said Dr. that he doesn't want his patient to have to wait in the waiting room and to get him right back. I tell said Dr. that the ER is bursting at the seams and I will do the best I can for his patient and ask why he hadn't made him a direct admit since he already knows he will need to be admitted. Dr. is rude and surly. When we get the patient back to the room he is angry at us because his doctor told him he wouldn't have to wait, for the rest of his visit we get nothing but hostility from him and his wife. The people in the lobby are angry also and for good reason.
This really burns my ass.......First of all, PCP's, quit abusing the ER and do your own work. If you know that the patient needs to be admitted then admit them. Why make them incur an ER bill on top of things if they don't need it. You are not a resident any more and the ER is not your intern to handle your scut, do your own work and do what is right for your patients. If you are going to send them to the ER don't fill their head with impossible expectations, be up front about it. "I don't really know what is the matter with you so I can't admit you and am going to send you for the ER for evaluation. They are really busy and there will be a bit of a wait but please be patient and they will do the best they can for you.
I wanted so bad to tell this patient that he was directing his hostility to the wrong person, that his doctor had failed him, but I didn't. We took their hostility and did the best we could for them, even though nothing we did could make them happy. You can bet that they didn't give us good scores on Patient Satisfaction either.
This is the kind of thing the ER faces day after day and contributes to ER overcrowding.
Think about it.
Thanks to Shadowfax who gave me the idea for this post.
This really burns my ass.......First of all, PCP's, quit abusing the ER and do your own work. If you know that the patient needs to be admitted then admit them. Why make them incur an ER bill on top of things if they don't need it. You are not a resident any more and the ER is not your intern to handle your scut, do your own work and do what is right for your patients. If you are going to send them to the ER don't fill their head with impossible expectations, be up front about it. "I don't really know what is the matter with you so I can't admit you and am going to send you for the ER for evaluation. They are really busy and there will be a bit of a wait but please be patient and they will do the best they can for you.
I wanted so bad to tell this patient that he was directing his hostility to the wrong person, that his doctor had failed him, but I didn't. We took their hostility and did the best we could for them, even though nothing we did could make them happy. You can bet that they didn't give us good scores on Patient Satisfaction either.
This is the kind of thing the ER faces day after day and contributes to ER overcrowding.
Think about it.
Thanks to Shadowfax who gave me the idea for this post.
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