Cracking the chest

I dont not even know where to start this blog. 2 nights ago a patient bled out in our trauma room because her boyfriend stabbed her 15-20 times in the chest and abdomen....and then I drive home and try to sleep and live my normal day to day life. I have not been the same.



Christmas eve: Night 1: absolutely not how I thought it was going to go. I figured okay everyone will be home with their families boy was I wrong. I ran my ass all night long. I guess there is more freedom on nights. The Emergency room was really busy but I did my job and went home to get some much needed rest...only GOD knew what was coming the next night.

Christmas: I come in...just clocked in and I run into the trauma room because we have a CPR in process and No Nurses in the room, likely because everyone had super sick patients and everyone was trying to save their lives. Patient had been down about an hour and despite many rounds of ACLS the patient died.

Sometimes I think that if I did not work nights and work with a certain doc I would be behind or miss out on seeing amazing talent and willpower to save a life. Nights are just crazy. Of course this night was extremely busy as the night before. I guess our 50plus bed ER is never a patient short but always short on staff. I ran by the trauma room to see my coworkers performing CPR, gowned and scrambling around and here we go. Here we had a 26yr old female who appears to have taken a significant beating and has been stabbed multiple times in the chest and abdomen, on scene she had a pulse....DR. Amazing cracks the chest, clamps the aorta and starts to manually massage the heart while having one of my coworkers take over he inserts a 5f cordis and everyone is on chairs pressure squeezing blood and fluids into the patient. We tried so hard...but despite the efforts the patient did not make it. Merry F'in Christmas. I felt helpless. immediatley after EMS brings in the "boyfriend" altered mental status who is covered in blood.....how do you switch and now take care of this man? I couldnt do it. Needless to say he medically checked out and is in custody. My coworkers and I could not stop talking about this event all night. Our therapy.

December 26-Sunday: hell....end of story.

I am pretty sure I am getting sick..I am not surprised.

There is no I in team...except at this hospital

Last week I had a very sick ICU patient who came in around midnight, luckily for me I knew he would be ICU early on (I then prepared him for ICU admit) it was just convincing the ER doc that the patient was "that" sick. (sarcasm) I just wonder what ever happened to the idea of team? This patient was very sick and Not one of my co-workers decided to get off their ass to help me. This patient's pressure was dropping and all I could think of was him arresting in my room. If it was not one critical change in this patient it was another. Hypoglycemia, hypotension,possible PE, renal failure and of course intense pain due to the fact this patients legs were the size of an elephants. This was the type of patient that should be 1 on 1 and I was one on one only because there were few other "really sick" patients in the ER that night. I finally get a chance to go eat my lunch...( or just took a second to noursish my being) I was in the breakroom right next to this patients room maybe 5 mins. A nurse runs in "Do you know his pressure is 50/17!?" OMG! "yes" I respond...."its been in the shitter all night and the doc wants to send him to tele and maybe try one more bolus." Nice of them to notice that I might need a hand at some point instead of sitting on their asses decorating for Christmas. The charge nurse then comes in and tells me to go take care of my patient. You have got to be kidding me...the nerve of these nurses. It is just times like this where you work so hard and try to do so much for patients...sucks when they do not notice but I almost feel as though it sucks more when your co-workers watch you run all night long and do not offer a hand. WHAT EVER HAPPENED TO TEAM? oh and I had this patient for a total of 7hours. I just love ICU holds

I almost forgot

I have been an RN for over a year now ;)

Shared Governance

My hospital is trying to gain magnet status. I find that working in the ER is extremely hard work so I've decided to join in the meeting on shared governance in hopes that it will change some part of our work environment. Yesterday we had our first bitch fest or meeting. I honestly feel like it was productive and I am trying hard to be optimistic because I do like working in the ER. There is a certain sense of accomplishment when it comes to being an ER nurse. I have also been thinking of going to days...nights are hardcore. I go into work at 7pm and we run all night long with full patients until about 4-5am. I am mentally and physically exhausted. I am willing to do anything to make myself feel more sane.

I have not blogged in a while because there is not much to talk about. I have received some interesting cases but all in all in routine. A lot of our nurses are leaving and we are now getting agency. I am just glad we will have someone else to take patients and share the load. I am tired.

Lately!

I know it's been a while since I've blogged! Things have been so hectic, especially in the emergency room. I have not seen this place so short staffed ever. I have been running my ass ragged every night. It's been a trying 2 months for me. The Er really forces you to deal with stupidity on an entirely different level. Let me explain....

Do not let your 3 children sleep on the Er floor! It's dirty, covered in staph and probably saturated in every bodily fluid possible.... But still you choose to ignore my requests. Do not go to the Er for a toothache.... You will wait hours. Learn to spell before you sign in and tell us " tomach paint." maybe I jaded. Every night it's something else that ties Er nurses up in non emergencies. It is so refreshing to see actual sick patients not abusing the system.

I feel for the Pt who almost drank
Himself to death because his wife died... Yes, almost bought himself a tube bit bipap will suit him for now. I feel for the patient who was assaulted, the cardiac arrest, cvas and those who legitimately need emergency care. I went into this field to benefit the lives of others, to aid the critically I'll and 90 percent of the time it's all minor care routine doctor visit patients coming to the Er. Go find a doctor. Sadly, this will never change, nurses will continue to be over worked, we will get burned out and continue to leave the field but for now we are sadistic and keep coming back..... It's a paycheck but honestly a part of me cares, a lot. I feel that I go back because I am challenged when the real sick patients come in.... I come in for them.

Public announcement -
Lately, people have been getting so mad about wait times in the Er before going to their admit rooms... It is not the nurses fault and we so not have any control over this!! I want you to go to your room too. It is frustrating to you, me and everyone sitting in the waiting room waiting for care.

ER is not what I thought it would be, ever! The trauma comes but most of the time it's unglamorous and hard work. I rarely get to pee, take my 30 minutes that are deducted from my paycheck and i care for multiple icu patients sometimes that should be one on one care. It is often scary and always exhausting but i have not given up on the field yet.

On another note, all the stress allowed me to make an impulsive decision to jump out of a plane with some friends and I loved it!!! Talk about exhilarating.

A grand Royal dose.

Last night was one of those nights....Yes, one of those nights where this new nurse felt like a complete idiot. I started the night thinking that a certain group of rooms just fell into my scope but I most definitely think I am being challenged.

The night started with an automatic ICU patient, meaning I came onto shift and someone else had this patient for the majority of the day. I usually would prefer to get someone from the start, in that way you know the patient. Luckily the majority of stuff was done and I was just waiting for a room.....Thank goodness because Mr. Altered was screaming out of the next room. I was in and out of his room every 5 minutes because he wanted to get out and walk around....He did not know why he was in the ER, or what was going on and my biggest fear was that he could possibly fall down.

I actually really enjoy it when my patients get beds in the hospital because I can get them wrapped up and sent off. Last night one of them decided to have a bowel movement while transporting, therefore, making me look like an incompetent and inconsiderate ER nurse, as they already think of ER....ICU nurses are a different breed, just as ER. Needless to say I hope I do not have to go to "that" ICU for a week. On my way down...I use my walk to gather my thought because I just have that feeling about how the night was going to go. I turn the corner back into the ER and I hear yelling. Lucky me! I have a new patient who is being intubated....ahhh. I actually do not have that much experience with intubated patients, so I was feeling okay about it but very scared. I know how time consuming ICU patients are, on top of that you are on the phone a lot with their consults (other docs) and getting more orders just to increase your load of work. I pulled myself together and went into the room. Unresponsive, agonal respirations, high BP and HR...look who just bought themself a tube. Intubations are similar to codes...sometimes they are organized and sometimes controlled chaos. Last night was a little of both. This patient did not have IV access and lucky us, no one could find anything to poke....therefore, buying herself a central line as well. High risk drips still scare me because the patient can go bad very quickly, as well as spinal taps on ventilated patients. This patient had a very high fever with really no evident signs of where the infection was coming from...Poor, poor ER nurses get exposed to everything. I would like to think the ER is helping me build a super immune system. I did indeed receive a significant amount of experience. Thankfully, I had a great experienced RN to help me most of the night. Finally, I get this patient settled only to get 2 other patients who are very sick. I thought I was going to collapse but I just kept on.

The EMS phone was ringing off the hook for a Saturday night and I knew there was even more patients being transported in.

I received another wake up call when I lost my compassion for about 0.5 seconds. I had a patient constantly on the call bell due to pain. The ER is always busy but I always find time to answer the call bells and see what my patients need. My patient wanted more pain medicine but the scary thing was her pressure was very, very low...come to find out she had a GI bleed. GI bleeds can catch up to a patient very quick and are often deceiving. I knew she was going to need a transfusion. Eventually, I was able to calm her pain, which was actually from battling cancer with Dilaudid. I mentioned to another nurse that "she was needy". Whoa, did I get a wake up call! "She is dying of cancer, do not lose your compassion. It is way to easy in the ER!". I instantly felt like an ass and felt horrible because that for one is not my attitude. Wake up call.

It is important to know others have no idea what you are dealing with outside of their room. The ER will not take that toll on me. One of the other patients family was getting angry at me last night because I was not in their room very often. I agree their family member was very sick but the patient next door was dying...ventilated, tapped, and drips galore. It is very difficult to get others to understand that Yes, you are sick and in the ER but sometimes there are others who are still "sicker". I wish there was more staff so that the patients could get more thorough care. I often go home feeling inadequate when I feel like the bare minimum was done. I always want to do more. I get so frustrated when patients come in by EMS or as a walk in and expect a ER mini mart. We are trying to save lives here people and if you are that sick...you will be NPO! It is so sad how the ER is abused and unfortunately will not improve anytime soon. We sure deal with a lot of bullshit, so I guess I can appreciate a night with real emergencies.

I am Thankful that I work with experienced nurses who are willing to help but I am so scared to one day not have that help. I have now been on the floor taking care of patients for 5 months....supposedly in 7 more months I will be competent. I feel like a wild animal who only eats when time allows, meaning it just might be my last meal...that came at 4am! 10 hours after I had already been running around the ER with my head "almost" falling off. I had to admit to my coworkers before shift change that I lack a poker face, which was evident all night long. "You got your ass handed to you last night" and "you were running all night" were some of the comments. Well....at least I was not the only one thinking that. Last night was my grand royal dose of ER. OUCH




Found this pic amusing...

A few nights in...

I am officially a night nurse! Here I am Wednesday night, actually my birthday is in one hour....and I am pretty awake. I work tomorrow night on my bday and the only gift I'd like from the hospital is a dose of trauma patients or an easy night. I did get a card in the mail which allows me to have one free meal in the cafeteria, not to exceed six dollars. Too bad its closed at night.

My first two nights in the ER went pretty decent, besides the frequent coffee breaks, dropping instruments, and failing to speak correctly after 3am. I like nights...the staff is fun and the atmosphere a lot more laid back. Monday night was of course hectic because Mondays are always hell...always. I am pretty sure as long as I keep my caffeine levels at a high rate I can make it through. I do find it very hard to sleep during the day, but hopefully will make up for it tonight and hopefully napping before work tomorrow night.

My night started off with 3 new patients, which is also called being "Slammed." One of them really pissed me off. Why do people all of a sudden become helpless once in a hospital...if you get around at home and are not here for a hip pain, head trauma, knee pain, SOB, leg pain, or a foot injury then why cant you help me get you into a wheelchair...or why does your family just sit there and watch me struggle. You were dead weight and my back has been killing me ever since. UGHH. I think it is important for patients to be nice...if you are nice, I will be the best nurse you have ever had....this includes your family too. Do not forget your manners and etiquette at triage and one last thing....Mr. Family, Stop pacing outside the room, up and down the halls and glaring at the nurses. 1: your family member will not be discharged any quicker and 2: you make me want to call security. I am very sorry that you thought this was burger king and you would be in and out like some kind of drive through ER. Some patients make me giggle...one was here for "bomiting." Someone call the police. I was also exposed to the doctors love of 4 am doughnuts...note to self- Do not give in again.

I had a patient who had a stroke years ago and all this time his beautiful wife has stood by his side, loving him, cleaning him, caring for him, helping him communicate (he had a trach) and crushing his medication into his PEG tube. This man was alive because of her love and support. It was refreshing to see. Unfortunately, like millions of other people this man was uninsured....I just wonder if he had possibly been insured and taken medication if his stroke could have been prevented. It is truely couples like this that take marriage seriously and uphold their vows....for better or for worse, for sickness and in health. It was an eye opener.

Lately...in the Emergency Room.

Lately, I have had a lack of interest in posting about work or anything for that matter. Call me cynical but already after 4.5 months I find myself wanting better pay and more staff. Tomorrow night I start working nights! I am excited, anxious and irritated all at the same time. I am doing this for 1: more money 2: the experience and 3: I am basically a scab and do not have much of a choice. I am just about to be on my own at work...whoa its really gone by quickly. A few weeks back I had a few patients tell me I was a great nurse and had great bedside manner, unfortunately they are not all that nice. I'd love to think I make a difference and when I do go home I usually think "I made it and no one died on my watch today." Sad. This job brings enormous responsibility, stress and demands. I guess I have to keep the fact in my mind that if the nurse messes up the patient dies...no big deal, right? I look forward to bringing in some night nursing stories and experience to this blog. For now I am too busy trying to work on adjusting my body in 2 days to work 12 hours all night long and save lives.

Whole wheat breakfast muffins.

Another topic: I made the best muffins yesterday. Whole wheat berry, banana and walnut.

• 1.5 cups whole wheat flour
• 1/4 cup Agave
• 1/2 cup sugar in the raw
• 1/2 tsp. ground cinnamon
• 2 tsp. baking powder
• 2 mashed bananas
• 3 eggs
  
• 1 tsp. vanilla extract
• 1/4 cup olive oil
  
• 1 cup fresh blueberries
• 1 cup blackberries

Cook at 350 for about 20 mins.

Recovering...still

Well I worked 2 days on, one afternoon and then another 12 hour shift. Today is my second day off in a row and I am still recovering. Mentally exhausted and just have zero energy in my self container. So as I sit here sipping my much needed coconut coffee I am just amazed and overwhelmed at the same time. The last day I worked I learned so much. Let me begin:
My day started with a doctor letting a women go home who was in bigemeny, not to mention 7 months pregnant, this was my first experience with feeling very uncomfortable about the situation but feelings aside, often it is hard to separate ethics and advocacy. My day was fairly steady but was full of MVA trauma, central lines, moderate sedation, psych patients who are assaulting staff and a pt who presented on levophed. AHHH... "You are telling me this one has a clot in his neck?" The orders were 2 pages long. Another first...dealing with a very, very sick ICU hold. I did it though!!! Sadly, I was unable to see one patient for over 30 minutes, thankfully it was shift change and I could pass it on. I am realizing how little time I actually spend with the patients and it is often scary. I wish we had more staff overall because the patients suffer. I am not super nurse....I am an intern.

So true-Fake Seizure in the ER

http://www.youtube.com/watch?v=_m64cy1MMPg

Haha...you must have a sense of humor.

By the way

Twelve hour shifts, which many nurses do including (me), prove that nurses really are masochists. We take a stressful job and make it even more stressful by extending it past a normal work day. People fought like hell to get the 8 hour day.
We tell ourselves: "Oh, I will have more days off if I work twelves..". haha and I have learned yes, we have more days off, but part of that time is recovering from choosing to work the twelves. OUCHY. I need a vacation.

Controlled chaos?

Where to start. First off the ER is stressful (hello major realization) and this is everyday. I am still considered an Intern but I am sure this will not last much longer. I have been on the floor full time for 2 months. I wonder Is my patient going to die on me today? What do I have to do right now...priorities. Time management (grab all my meds and do what I can when I am in the room all at once). Charge nurse yelling and wants them out now...room or discharge. Call report now? Who do I need to see first? Crap, where are my techs? What drugs do the patients need and why? When will I have time to chart? Oh God I hope I do not forget anything. Self Prayers to get the lines and labs on the patients first time. Please do not mix these patients up, control, and again...crap I have to pee. When can I pull away to pee and eat? Oh shit..its a pedi patient (what do I do and how to handle the parents). Well...used all my saline and tubing...run to supply, hope this baby can handle a 22g because it has a temp and 24's keep slipping out, explaining foleys and becoming speedy foley queen, pt has a heartrate of 18-push atropine connect to crash cart, run next door...pt NEED water and now they want ice, next room chest pain protocol (crap has it been 10 mins?)And then daily....holy crap can I really do this? Is this for me because I am about to have a mental break down and pull all of my hair out. I had heard about tough skin...mine came quick, really quick. Just finished compressions and enjoyed my much needed lunch, so Hard shell-check, already in place. I get home and realize, yes I can.

So how do I better describe controlled chaos and why is it called this anyways? Chaos is Chaos, especially when EMS is bringing in patients who are practically a walking triple A., torn aorta or stemi. Hello....where are we putting these people? Day in and day out I am exhausted. I keep hearing it will get better and I will get used to it, really? So I get up and try to put on my game face, 2 cups of coffee later I am ready to go. The best part is each day it is something different and I just hope I can care for my patients and do my best. I do know I could never be a floor nurse. My concerns are not bowel movements, one point off sodium labs, diet orders and Q6 medications. I need the rush! I need trauma but man.....I would kill for a relaxing day or 3 in a row.

"Clean" cleanse. Inspired by Dr. Junger

I am learning how to get past the cravings on day 6 but it is not without difficulty.