I work in a hazadous waste dump

There are days I feel like I work in a hazardous waste dump.  A hazardous human waste dump.  Sometimes what we do is so gross.  It is gross to the point where I have to wear a mask with vaseline smeared in it in order to avoid vomiting.  Those are the times when I think: Why the hell do I do a job such as this?  I mean...seriously...am I insane?   Am I some kind of masochist?

These are the times when I think: THEY DO NOT PAY ME ENOUGH.  We should be making triple what we do. If the public saw what we really deal with on a regular basis they would be shocked:
Every disgusting thing that comes out of the human body has to be cleaned up by somebody and that person is a nurse.

From the smell of c diff to GI bleed to homeless feet to beer and cigarettes, we deal with it.  Day after day.  j

The worst thingl I ever smelled was burning flesh.  A doctor decided to removed some kind of skin growths in our ER (totally inappropriate).

Sorry this is a digusting blog entry, but it is the reality of what we do and Lord knows I'm all about being real. ...

Here's a question for you: What do you use to get rid of bad smells?  We use coffee grounds.


just trying to keep up

I am in the middle of hell week - five 12 hour shifts in 7 days.  The thing is I have 2 more days to go this weekend.  The first three sucked.  Monday we saw 60 more patients than normal.  That is 30% more than a normal day.  Did we have get staff to cope with it? Of course not, you fool you. Those are the days you feel like you have been run over by a truck.

What happen to the days when ERs took care of broken legs, appys, lacerations?  Those days seem to be gone replaced by patients who have multiple chronic problems and now they are in with a new one. Our patients are so heavy, so old these days.  They require so much care and, I guess, so many tests.  It is commonplace to see people in their late 80's and into the 90's.  It is also common to spend thousands of dollars in hospital admissions keeping them alive, when all they really want to do is die.

A typical shift brings a 98 year old decreased LOC who is intubated, on drips going to ICU.  In the next bed is someone from another country who is in isolation for possible TB.  Next bed over is a depressed combative drunk.  Next to them a heroin overdose.  Running between them are exhausted nurses trying to keep up.



Nurses please read this

From the Huffington Post (this is why I love and respect my fellow nurses so much)
ON THE WINGS OF A NIGHTINGALE
Today I ran into a Mexican restaurant to grab a quick lunch, and as I ate my meal I came across a table of nurses wearing hospital scrubs. As they chatted amongst themselves I thought about the many nurses my family has interacted with over the last five years, and I found myself filled with such appreciation for what these amazing women and men do for us.
It was in the Neonatal Intensive Care Unit that I initially saw how amazing nurses can be. My first child, Maddie, had been born almost 12 weeks premature, and the hospital staff, upon determining that Maddie's lungs were immature, rushed her to the NICU. There Maddie's life hung in the balance, and though my wife, Heather, and I longed to care for her ourselves, her condition made it so that we couldn't. We had to trust the NICU nurses to take care of our baby for us, and that was incredibly hard -- especially at night when we went home to catch a few hours sleep.
Sleeping was, of course, almost impossible. My sick baby was not with me, and the phone loomed ominously on the nightstand. If it rang before dawn it would do so for only one reason -- to tell us that Maddie had passed away. I can't tell you how scared I was of that phone ringing. Thankfully, it never did.
Each morning I called the NICU at 7:00 a.m. to get an update from the night nurse about how Maddie had done through the night, and the moments waiting for her to pick up the phone were horrible. Was I going to hear Maddie had done poorly and that things didn't look good? Or, if the nurse took a long time to come to the phone, did that mean that she and the other medical staff were desperately fighting to stabilize Maddie at that very moment (something I'd witnessed in person a number of horrible times)? My hands never failed to shake as I waited for the phone to be picked up.
Once the night nurse picked up, though, I began to feel better. She always told us about Maddie's night in great detail even though she'd just finished a long, exhausting shift. The lengths the NICU nurses went for Maddie were incredible. One night, we were told, Maddie wouldn't respond to the ventilator, and the only reason she survived was because the night nurses took turns hand pumping air into her lungs for hours on end until their hands were cramped and throbbing.
As amazing as all that was though, the thing I appreciated the most about the nurses was how they loved and valued Maddie. She wasn't just some nameless baby behind the glass of an isolette obscured by wires, medical tape, and breathing tubes. She was an amazing little girl named Maddie (also "Bunny" or "Little Mama" as they called her), who was beautiful and strong. I could see that they considered my daughter to be amazing and a gift, and to see others felt about her as I did was incredibly meaningful to me.
Maddie was finally released from the NICU, but there were a few times over the next 17 months when she came down with an infection and had to again be hospitalized. Those days in the hospital were both frightening and incredibly dull, and again nurses were wonderful to us. They were always there when we needed them, quick to bring a blanket or to explain what medications Maddie was taking. Like the NICU nurses, these nurses showed Maddie so much love, mooning over how cute she was and making faces at her to keep her entertained.
Though it still hurts to admit, on April 7, 2009, two days after she was hospitalized with a respiratory infection, Maddie passed away. On that horrible day there was a nurse who stayed by Heather's side the whole time, and I am so thankful for her kindness to my wife. There was a nurse that mattered to me that night, too, though she didn't stay by my side, bring me a glass of water or even say a word to me. In fact, I don't think I saw her until the very moment I walked out of the pediatric intensive care unit, but she made a difference nonetheless.
You see, that day my life shattered. I watched my daughter die in front of me, and it was an experience so horrific that even now it seems almost surreal, like, Did that actually happen? To me and family? But it did, and one of the things I remember most about it was how the key medical personnel there didn't make me feel like they found Maddie to be beautiful and strong or amazing and a gift. The lead doctor may have been under a great deal of stress, but the way he pronounced her dead was not right. It was more like a referee calling the end to a heavyweight fight than the end to a beautiful child's life. Then, as we held our dead child in our arms and kissed her goodbye, doctors stood behind the curtain discussing the specifics of what had happened with about as much feeling as mechanics discussing a broken down car.
It was only as I left the PICU that I felt humanity. There, sitting on a chair with a single tear rolling down her cheek, was my nurse. Her tear told me that she cared. About Heather, about me, and most importantly, about my beautiful Maddie.
That's what nurses do that is so important. In addition to all of their medical expertise, they bring a human element to the cold, sterile world of a hospital. Doctors do great things, but have a heavy case load that means they can only visit each patient briefly each day, but the nurses will hold your hand -- figuratively or literally -- and remind you that you are not alone, and that your life is valued even if it can't be saved.
When the nurses at lunch today finished their meal I wanted to thank them, but I didn't, and I wished I had afterward. I can do one better now though:
To nurses everywhere: You should know that you have made a difference to so many people in this world, my family included, and I cannot thank you enough.

too close for comfort

OK this is getting to close for comfort.  I had my 3rd person who either tried to die or died in the last 2 weeks.  Two of the three died. The thing is they were, shall we say, within my age range.  What the hell is going on here?  Why, all of a sudden are people close to my age keeling over and trying to die on a regular basis?

Am I getting old?  Am I doomed? Makes me stop and wonder...

potlucks and enemas

Three of us are sitting in the breakroom...we had a potluck that day.  So we're chowing down and one of my co workers is talking about giving someone an enema.  I start laughing. I said "Only a nurse could keep eating while hearing about an enema." Did we stop eating?  Of course not.

There is a law about polucks in the ER:

IF THOU CHOOSES TO HAVE A POTLUCK, PREPARE THYSELF FOR AN INEVITABLE SHITTY DAY.

when efforts are futile

My best friend at work retired yesterday.  It makes me really sad.  I will miss  her a lot.
                                                      ***                                              
                                                   
When you are in the military and in a war zone, you get whats called hazardous duty pay.  Yesterday we should have all have received HDP in our ER. It was that kind of day.  A day that when you walk out the door you feel like you have been run over by a truck.

My first patient was a hysterical  person by ambulance who didn't speak english.  Did her family come with?  Of course not.  When I say hysterical I mean yelling at the top of their lungs in a language nobody understood.

We have this video interpreter service we use prior to getting a live and in person interpreter.  So imagine this , you are sitting at home on a Sunday morning..the call comes in for an interpreter.   You take the job.   No big deal, routine.  You come on the screen and are faced with a 300 pound hysterical person shouting at the top of thier lungs.  Did I mention they were hard of hearing?

This might sound cruel but I wanted to slap her across the face and say "snap out of it!" like they do in the movies when someone is hysterical.

My day only got worse from there. My patient walked in, an hour later they were dead.  The person wasn't elderly. An unexpected death.

This is probably the most stressful thing that can happen in the ER.  Unexpected critical events.  When someone is coming by ambulance in critical condition, we can prepare for it.  When something happens unexpectedly in the ER, it creates chaos. Eventually the chaos settles, but it stresses everyone out.  Its so hard when you are in a code, the person is not old and you realize your efforts are futile.  They aren't going to come back no matter what you do.

Then there is the family who eventually enter the room of their dead loved one, in a state of disbelief.  They start wailing.  It makes you tear up.  More family arrive and the sounds of their grief travel through the ER.
Those are the situations that stay with you for a few days.



living forever isn’t all that great

I'm not 88 or 95 years old.  I don't know what its like to be at that age.  One thing I wonder about is why do  a lot of the very elderly put themselves through all of these complicated medical procedures?  Like being resuscitated and going through a hypothermia therapy. The risk of TPA.  Being on dialysis.  Taking a chance on a major operation.

Is it because their children want them to? Are they afraid to die? So many people are uneducated about health care.  They don't realize that they may survive the procedure but it is the recovery process that will kill them.  They will develop complications.  Just being in a hospital environment exposes them to so much risk. The chances of them making it are minimal.

I hope by the time I reach that age, we have started to deal with the fact that we can't continue to keep our very elderly alive with  medical care that will only make them suffer in the end.  I hope, but I doubt it will happen.  We want to live forever
 

wheelchair follies

This elderly confused man is picked up by medics on the street.  Here's the thing: He uses an electric wheelchair. Of course the medics can't take the wheelchair with them to the hospital....

So, what, you are asking will happen to the wheelchair?  It will be towed away like a car and
put in an impound lot.  Yeah, I'm not kidding.

I wonder if he will have to pay to get it out?  Chances are he doesn't have a van to cart his wheelchair home...now what?

the reality of being an ER nurse

One of my co workers dropped a pearl of wisdom on me this weekend.  This might surprise you, but this is what she said: "Coming here has become a lot easier since I have decided that I hate this place".

Probably sounds funny to say it was a pearl of wisdom...but it  got me to thinkin'...  The first inclination when someone says that is to say: Why do you work here if you hate it? You should move on, etc. blah blah blah.  Then I realized what she was saying:  I hate it here, I'm going  to hate it here, but I have to work here for whatever personal reason I have and I accept that it will not ever be anything different, so I accept that.

That might sound cynical and negative, but at least it is realistic. I work it in a terrible environment. It is outdated, shabby, too small, noisy.  It makes my job harder.  Every day there is a new change, from charting to equipment to any other idiotic change that comes down from above. These are going to happen and I have no control over it because basically those that make the changes don't really care what I think.  I can't make the ER over so the environment won't change anytime soon.

Now, lets talk about the patients.  A lot of them are shitheads. Even the nice people who are nice in the real word can be shitheads in the ER.  I deal with the dysfunctional, the addicted, the mentally ill, the ineffective copers, the stupid on a daily basis.  It is the reality of my job.  My job is thankless.

The point of all of this? Acceptance.  I work in a shitty, stressful environment.  A lot of the patients are shitheads. I have little control of change. I choose to keep working here. For years, I have wanted it to be different, stressed over the fact that it isn't different.  Stressed over the fact that it won't change.  Expected it to change. Accepting reality makes it so much easier.  Look around you.  This is it. This going to be it today, tomorrow, next week. You can leave or you can accept the reality that hits you in the face every day.  Then when something good happens it will be a pleasant surprise
.

a shitstorm

I actually ran at work yesterday. I mean move the legs full out run.

I don't run. I'm not a runner. At work.  I saunter.  I may walk fast once in a while.  Rarely. I'm not excitable.

This was one of those "Oh shit! That wasn't supposed to happen!" moments. But it did and I ran. It wasn't even our patient.  They were alive when they left the ER.

I started charge at 3 pm. Within a half an hour we had a  stroke come in.  Then a half hour after that the Oh shit! moment happened.  Then during that an MI came in.  Then here is news that there is a helicopter landing and guess what, the bed isn't ready.  Helicopter = critical patient.

Yes, folks, we got ourselves a GENUINE shitstorm happenin' here.

Six hours later I dragged my butt home.



our ER becomes the Target ER

My ER is shabby, old, falling apart, embarrassing really.  We are an inner city ER and last on the list for renovation because of that. Every other ER in the system has been redone, but then most are located in the suburbs where people have insurance and wouldn't come to a broken down ER.  Since the poor and elderly city folks don't have a choice, they still come to ours and don't expect a shiny new ER.  So the heads of the corporation don't really give a shit what our ER looks like.

So I have an idea.  We get Target to sponsor our ER.  We become the Target ER.  Target pays for the renovation.  We put a big bulls eye on the front of the ER.  The employees all dress in red scrub tops and tan pants with a target bulls eye on the pocket.  Everywhere you look there are signs that say: "This ER brought to you by Target".  Our patients are called guests...Target could advertise that they sponsor us at different events, on TV, the internet.  Its win-win for everybody.

In fact lets just extend this whole concept to all of medicine.  I mean health care has become a corporate, profit motivated environment anyway.  Lets go all the way.  Lets let corporations sponsor hospitals, clinics, every part of it.  It would save our system from economic collapse.  Companies would compete with each other to be sponsors of hospitals.

Becoming the Target ER is the only way I can think of that we will ever get a renovation.

ode to nurses

I was reading a book recently and one of the main characters was a nurse.  She worked in pediatric
oncology.  It talked about her work periodically in the book.  There was one patient she had that she grew close to who was a teenager.  He was on the floor for a while.  He was hanging in there.  Then he got pneumonia and died.  This person she grew to really care for. This family too.  It brought tears to my eyes.

It was just a book, a fictional book,  but it got me to thinking about nurses. What we do.  How much I respect and admire all of us. The nurses who work with kids with cancer, knowing they are probably going to die.  The nurses who work with quadriplegics who are adjusting to a life in which they will never walk again.  The nurses who work with the teeny tiny premies for months hoping they will make it. The nurses who stay with families while their loved ones die.  The nurses who relieve the pain of the people who are suffering terribly.  All of the nurses, day in, day out who care for the sick and vulnerable among us.  Its a tough job, but they keep going back every day to do it anyway.    

docs: put on your big boy/girl pants and change

Could it be that there is teeny tiny movement starting around the overprescribing  of pain medications that is an epidemic in this country?  In January Mayor Bloomberg (gotta love this guy) announced an initiative at the 11 public hospitals in NYC.  The VOLUNTARY initiative states that emergency departments "will not prescribe long-acting opioid painkillers, can only prescribe up to a three-day supply of opioids, and will not refill lost, stolen or destroyed prescriptions". What a concept....Read about it here.

In Washington state, a health care system has placed limits on how painkillers are prescribed.  Doctors are told " abide by the guidelines or face the consequences".  The states also now requires patients who are on high does of pain killers with little improvement to be referred to pain clinics.   Read the article by Kevin Pho MD here.

Here's the thing: This is really great.  Finally someone is paying attention and putting the responsibility for the epidemic where it lies: doctors.   The thing is, what politicians don't recognize is that health care has become a business, like any other business.  What is a business' goal?  Make money, stay afloat.  How do you do that? By making the customer/patient happy, so they will come back.   Lots of patients are made happy by getting that almighty narc script. Hospitals are even being paid more or less based on patient satisfaction, and therein lies the dilemma.  

Doctors fear patient complaints, poor satisfaction scores.   So what. The only people who will stop this epidemic will be doctors.  They are going to have to stand up as a group and say no.  They are going to have to stop whining about losing control of their practice, blah blah blah. 
They are going to have to put on thier big boy/girl pants and take responsibility for, change a culture, that they have created. 



Its official: I’m going insane

OK its official.  I am going insane...

Every year we have to go through a "which frickin' waste basket do you put the moutain of waste we generate doing patient care?" education session.   Is it that red one, the pink polka dotted one, or the evil BLACK one? As of now, there are 8, count 'em 8, different plastic garbage containers with various names.  

I am sorry, perhaps I am a complete moron, but I can't keep track of what goes where. Its too much for my feeble little brain to comprehend...or maybe it is INSANITY to think we can remember.  Ya think?

Well, I'm doing the education online and actually reading it...not skipping to the end hoping to pass the test.  I come across a piece of information I had not known, may have skipped, subconsciously blocked out in an effort not to spontaneously combust:  The little chloraprep thingies we use to clean skin before IV insertion are considered HAZARDOUS WASTE.  OK...let me get this straight...the thing that I use 20 times a shift is hazardous waste.

Those little 1 1/2" x 1/2" cylinder thingies are hazardous waste...meaning they have to be put in a ziplock bag and into the EVIL BLACK plastic container that are only in certain areas of the ER?  You are kidding right? So I need to hold this EVIL cylinder, which by the way I have just applied to the patients skin, two feet in front of me as I go to search for a ziplock bag and then place it in the EVIL BLACK plastic container?

Now, take the amount of nurses who work in a day x amount of IVs they start and you will have many ziplocked EVIL cylinders to be disposed of.  We are gonna need a way bigger EVIL BLACK container.
In other words, it ain't gonna happen.

Here's the thing about all of this: The disposable system is very complex but its okay for us to waste narcotics galore down the sink, into the sewer, whose contents go to the water plant to be "purified" and straight into your kitchen...

Has Crayzee Central closed for good?

What is the point of going on I ask you? What is really the ('sniff) point? All of the bloggers I started with or joined along the way have died a slow agonizing death...

RIP:

Emergiblog (the mother of all ER nurse blogs)
Nurse Ratcheds Place
Weird Nursing Tales
You Can't Fix Stupid
Etc Etc Etc

And now worst of all, Crass Pollination has died.  Is the world coming to an end? First she moves to Montana (why would anyone do that?), then the blog dies. What the hell happened in Montana?  Was it all the perverts who took over the forum? Who has Nurse K and what have they done with her?

Its hard to go on....I know how hard it is to keep the blog going.  Its a been there, done that, blah blah blah situation.  Whats the point? Who really cares?  Whats it all about (Alfie)?

The only thing keeping me going are

New Nurse in the Hood

White Coat

If they quit, I stick a knife in the blog....

Duh….

Here is a word to the unwise:

If you have to have security escort you out because you refuse to leave, you probably aren't going
to get a free cab ride home from us, so don't ask...Duh

If you are discharged and refuse to leave the lobby, security comes, and you comment: "This happens every time, I have to be escorted out by security", maybe its a sign you should try another hospital...Duh

If you didn't get it at the other hospital, you ain't gettin' it here....Duh


hey, I’ll do that for 50 bucks

As a nurse in the ER, you don't think much about cost.  That is, how much what we do costs.  It is only when you or your family go to the ER for something and get the bill, that you realize just how riduculously expensive it all is.

Case in point:  My friend developed a bad cellulitis.  So they went to the ER.  Even though, the cellulitis was already bad, they chose to give here antibiotics and send her home.  Of course, it got worse.  Way worse.  So back she went to the ER.  Mind you, she had called her doctor, but they said they didn't handle something like that is in the office.

She was seen by a NP.  She ended up having and I and D (incision and drainage).  She got an an IV antibiotic. Probably should have got all this on the first visit, but whatever....

So here's the point of all this: The I and D cost over 1,000 dollars.  Now mind you, here is what happens in an I and D:

1) Area is numbed up.
2) An incision is made by a scalpel and pus is squeezed out.
3) Iodoform guaze is put in hole that is left.
4) Dressing is applied.

Time this takes: about 5 minutes.

So a five minute procedure that uses a bottle of numbing med, a syringe and needle, and I and D tray, sterile gloves, idoform gauze, a dressing costs 1,000 dollars.  Okay......

Next time, I'll do it for her and I'll only charge her 50 dollars.  I mean seriously folks, this is not rocket science.  You could train a ten year old to do this.  Numbing up an area is simple, similar to injecting for a dog bite where there is concern about rabies.  I've done that a few times. I think I could make an incision and squeeze.  I also think I could put gauze in a hole, having done so back in my med surg days.  Honestly, can someone tell me why this costs 1,000 dollars?

Oh by the way....that 1,000 dollars is only part of the bill - it is called a "minor surgical procedure".  Then they are the other charges adding up to a few thousand dollars.  Then we wonder why medical care costs so much...

doctors are wimps

I've been neglecting the blog, I know.  Its the weather. Its still winter here and I can't stand it anymore.

Anyway...
There is a horrible prescription pain med problem in this country.  One we don't want to face. Its an epidemic. Its an epidemic doctors in particular, don't want to face. Their part in it is shameful.

I'll give you an example of how completely out of control this problem has become.  There was a man who
 came in who had someone managed to get over 800 tablets of pain meds  (two different kinds) in 2 months. 800 tablets! Thats insane.

Thats just one person. Imagine the millions of pills people get each month in this country. Why does this keep going on? Because doctors are a bunch of fucking wimps who can't say no. Its easier to say yes and pass it along to the next person.  I don't know how they sleep at night.

I can hear all the doctors say:  Patients expect his. We'll get complaints. Blah blah blah. Doctors have created this epidemic and they are responsible for stopping it.

it ain’t rocket science

Good luck to hospitals in the almighty patient satisfaction sweepstakes. They are approaching it all wrong.  They are approaching it from the top down, instead of the bottom up.

I am currently on a committee addressing this.  I sat for an hour and a half at the last meeting listening to a "performance improvement specialist" talk about what we say to patients.  What do we say to them when they present at the window?  Do we say: Can I help you? What can I help you with? How do we acknowledge them?  I mean seriously....

It seems the triage area is a place where people don't "feel welcome".  Could that be because the staff appears stressed out? THEY ARE STRESSED OUT.  Here is a list of what the two nurses at the triage desk deal with:

1) Answer phones:
     - from ambulances coming in, place those ambulances in the ER (if there is a bed available)
     -from idiot doctors offices, nursing homes, therapists, etc. who call to tell us their patients are coming in.
WE DON'T CARE.  We will deal with them when they get here.
     -calls from information desk about patients they can't find
     -random other calls

2) Let people in the door to main ER a thousand times a day. Deal with frantic relatives.

3) Give directions to people to inpatient rooms,  the cafeteria, coffee shop, pop machine, admitting, etc. etc. etc.

4)  Deal with people who have to be transferred to labor and delivery.

5)  Go outside to help people out of cars.

6)  Check people in.

7) Triage people.  WOW, yes we actually have to do this in the middle of everything else.

8) Take people to rooms.

All of this is really great, especially when there are 10 people at the window, 20 people in the lobby.

In the middle of all this we are expected to smile like a frickin' idiot.  Let me ask you, could you smile like a frickin' idiot in the middle of all this?  I don't think so.

Here is what will help patient satisfaction in triage:

WE NEED HELP!!  

No doctor office, etc. calls

Security handles traffic in and out.

Charge nurse gets ambulance calls.

Come up with the money to have someone at the desk which allows nurses to actually TRIAGE (what a concept).

If you take some of the  stressors in triage away, staff will be happier, less stressed and they will be able to welcome patients as they should.  Patient satisfaction improves. This ain't rocket science folks.

Here's a clue: Maybe you could ask the staff who works in triage what they see could help the situation.  What a radical idea.