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Sometimes you should be careful what you wish for.....

 

For instance, one night our ER was going down 2 nurses at 3am so I was assigned to go there for 3am -7am to cover.  Usually when they are going down 1 nurse I just go as helping hands since I have to cover any METs or Codes that may occur during that period too.  But this night they were particularly short so I was asked to take an assignment and the charge nurse would cover me if any emergencies happened elsewhere. 

 

I was given 3 beds in the observation area but only 2 were filled.  They were both going to be admitted but there were no beds in the hospital so both were holds.  Both elderly and both settled in and asleep.  A set of signs on each, a pair of assessments and a talk with one who had family and I was in the clear. 

 

I then asked the charge nurse several times to give me another patient to fill my other bed but she said no as she already had 3 of her own and didn't want to cover 3 more if I had to leave.  So, I helped others and waited and waited and waited.  And, of course, being me complained a bit as to how useless I was being.

 

Then about 5:50am the triage nurse doesn't consult with the charge nurse and puts a patient in my 3rd bed.  I go in to see what he is and find a young man in his early 30's.  She tells me he had just had a syncopal episode at work with a LOC for approx 10-15 seconds.  Kinda impressive but I'm not really expecting much.  They rarely repeat themselves for us nurses!! 

 

The tech gets an EKG, I get him on the monitor and we start chatting etc.  I'm actually starting to think like an ER nurse (scary for a critical care nurse at heart!!)  and go get a rainbow of lab tubes to get his blood while I put his IV in.  I start an 18 in his AC.  As I'm getting the last tube of blood I hear the monitor start to beep and look up.  He had this whole time been a nice NSR in the 80's with no ectopy or anything funny.  Now he's in the 40's!!  Yikes! 

 

I ask him how he's feeling and he initially says fine.  Then changes his mind and says he's a bit nauseated.  I look out and there is NO ONE to be found at the nursing desk!!  Oh shit!!!!!  I then look back at the monitor and his heart rate is now 30's and he's telling me that he is really feeling quite nauseated and not good at all.  I look again and see another nurse and barely get her attention but luckily she comes to my aid.  She gets some atropine and goes to flush my IV site and in my haste to tape the site in I had taped it too far down and we cannot get the flush syringe on the catheter.  Oh shit BIG TIME now as he is now in full blown asystole and his limbs are stiffening and he is totally out. 

 

I finally get the tape off, get the site flushed and she gets the atropine in.  Not sure if his heart restarted on it's own or with the atropine but it did restart.  Thank God!!  He then wakes and asks what happened.  The doc explains that he showed us what happened when he had the last syncopal episode and thanked him for helping in the diagnosis!!  I told him that if he really wanted to get my attention he didn't need to make his heart stop, that there were easier ways to do it!!

 

All in all he was in asystole for a total of 12.4 seconds by the monitor strip!  Needless to say he didn't tolerate it well at all.  Much more and he would have gotten some good ol' fashioned CPR.  He was close as it was.  Went to the CCU and got a temp pacer in his jugular and then a PPM the next day.  I don't think they ever found a cause.

 

But I definitely learned a lesson.........................when in the ER be careful what you ask for!!!!!

Super Pube

I get this call from a nurse on one of the floors the other night and she says "Can you come and check this super pube for me?"  I make my way up there and am wondering what I'm going to find.....................a HUGE pubic hair or a superpubic catheter!!!

"Just a nurse"

I came across this blog post on the Happy Hospitalist's blog and wanted to share it with my other nurse readers.  It's a great story.  Thanks again Happy!

http://thehappyhospitalist.blogspot.com/2009/01/just-nurse.html

Raisins on sticks

Wow, it's been awhile since I've been here.  I've been sick on/off for about 8 months now.  Had some 4 month long mystery illness that spontaneously resolved in the late summer to early fall and then recently had Lyme disease and mono at the same time.  Now just found out that I've had iron deficiency anemia for at least 6 months if not more.  Needless to say I haven't been feeling my best and since I can't give up being a mom or nurse the blog is the thing that went!!  But I'm back and am going to try and get back into the swing of blogging my nursing stories at least a few times a week.

This is actually a story that one of the cardiologists I used to work closely with told me.  The background that made it so much more funny is that he is in his early 50's and quite reserved.  He does talk and joke with the nurses but never in a way that the younger male docs would if you get my drift.  

He was in late one evening and we had a confused older lady who was continuously taking her gown off.  We were joking about how this lady just liked to be naked no matter what we tried to do.  So he pipes up with "I've got a story for you gals about older naked ladies".  Coming from him we weren't really sure what to expect.

He tells us about all the times he walks into an exam room to see a patient and it is an older lady in her 70's or 80's and she will be sitting there on the exam table naked from the waist up.  He says "I'm a cardiologist.......not a GYN who would need to do a breast exam."  We figure with him that's the punch line but oh no it gets better!

He goes on to say "yep it just takes me by surprise each time.....there they are sitting there chest bare and it's like two raisins hanging on the ends of the sticks."

Can't we all just get along

Since starting my job as a resource nurse and being all over my hospital I've seen lots of things from basically all prospectives.  I was never one that fell into that whole dept against dept thing anyway but now it annoys me even more.  Aren't we all here for the patients instead of to be against each other?

The other night I spent 7 of my 10 hour shift working in the ER due to them being so short staffed and so busy.  The only dinner they got was the tray of day old sandwiches, chips and coffee I got them from the cafeteria as no one had a chance to go to the bathroom never mind get food.  As I'm in the cafeteria I hear a tele nurse say something to the effect of "the ER needs to quit whining."  

I so wanted to say something to defend them as I knew firsthand how busy they were.    Ambulance after ambulance pulling up, multiple stabbings, chest pains, an acute MI, etc, etc.  But then I got to thinking of the nights that the tele floor gets 6 admissions from the ER in an 8 hour shift and they bring them up one after another without enough time to get the first one settled in and the next one is arriving.  I've been up on the tele floor helping them when this happens and overheard the ER later saying something about the tele floor nurses whining too.  

And it's certainly not just the tele floor...ICU was giving the ER a hard time the last night I worked too.  It's all around.  Basically on every floor.  No one understands what the other floors go through.  The floors don't understand that the ER cannot refuse ambulances and have to find room for them when they arrive.  And the ER doesn't understand that the floors have 6-9 patients apiece that includes confused, busy, rude, heavy, etc patients and their family members.

So, again I ask..........aren't we all here for the patient?  And can we all not just get along?

Why I couldn't be an ER nurse

I've been spending a lot of time down in the ED since starting my new job.  I like it in small chunks but couldn't do it full time.  Not that there aren't bad things that happen in nursing all over but the things I've seen in the ED seem to just top them for me.  Although I guess L&D would have worse but luckily I don't have to go there!!

A week or so ago I was down there about 2 am when a MVA came in.  It involved a woman in her early 30's and her 3 yo son.  The boy wasn't hurt too bad at all....just a few minor scratches.  The mom was fully boarded and collared.  And FREAKING out.  At first I thought that she was freaking because she and her little one had been in the accident as I would be.  I mean they would have to tie me down to keep me away from making sure my kid was ok you know!!

Well, turns out she was freaking because she was drunk.  Her BAL was .20!  Our legal limit here is .08.  And that was just the beginning.  Her DAILY meds included ativan, vicodin and percocet.  Yup, on top of the alcohol.  Wait it gets worse........

The carseat was improperly installed and had come loose in the accident so it was by the Grace of God that kid wasn't hurt more.  Think I'm done............

Her license had recently been suspended too!!

OMGosh!   I'm not sure if I could have taken care of her.  I know in nursing we aren't supposed to be judgmental and usually I'm pretty good about that.  But I was really struggling with it in this case.  The ED is definitely not for me!!

P.S.  Wondering how bad mom was hurt?  She fractured her lower back where the lumbar and thoracic vertebra meet.  And the kiddo went home with Dad who wasn't married to mom anymore.

I've been listed!

I got an email the other day that my blog has been listed on a top 100 list!!

Lots of others that I read are on it too.  You can check it out at rncentral.

Thanks for reading me!!

My first month

I've just about finished my first month in my new job as a MET/resource nurse.  I really love my new job!!  It's great for someone who is social and loves action.

The first two weeks were fairly mellow but now that staff knows we are here (I work three 12 hour night shifts and my partner works four 10 hour night shifts) we are being called upon much more often.

My first week started with a bang in that I transferred two patients to my old floor (CCU) on my first night!  But then the second night I had not one page!!  Then the third night I helped in the ED with a code on a 40 yo that we pulled through who died a few days later in the ICU.  In my down time (which there was a lot of this week) I mentored the new GNs and introduced myself and my position to the staff.

My second week started out with 4 Code Mr. Greens (extremely agitated patient) in the same 12 hour shift!!  Not my cup of tea!  But then had a trauma code, several METs and a BAT (stroke).  

The last two weeks things have really picked up and I have had quite a few more METs and just clinical calls in general.  The hospitalists are getting to know my partner and I better and are giving us more leeway in judgment calls which is nice.  The staff is excited to have us around and the ADNs are glad to have another set of hands in the hospital to help them too.

All in all the position is working out great!  I'm quite happy with it so far. :0)

What is your blog film rated?

I found this on another blog and figured I'd try it.  I wasn't sure what mine would come back as since sometimes I tend to rant!!  But it bases it purely on the words used.

Here is my rating:

Created by OnePlusYou - Online Dating

It's only issue was with my usage of the word pain.........interesting!

An interesting shirt

 
Tonight I had to go to our locked inpatient psych unit to relieve them for break since there is only 2 RNs there at night.  I've done it before and it has always gone well with all the patients sleeping the whole time I'm there.

 

Tonight 3 patients were still awake when I got there at 12:30 am.  They were conversing quietly at a table in the common area.  I just sat at the nurse's desk while 1 RN when to break.  All was fine.  Then 1 patient gets up and I happen to notice his shirt.  It was a black tee shirt and on the back it said "Caution does not play well with others"!!!  And the not was underlined!! 

 

I about fell out of my chair and had a really hard time not laughing!!!  To see a psych patient with that shirt on just seemed hysterical to me!  Maybe I'm the only one though.....I'm not sure!