Shifts 97, 98, 99, 100, 101, 102

Its been pretty busy at work lately and I have been having some pretty sick patients, too, lately.  To be honest, I can't even remember everything these last several shifts and I haven't, obviously, been blogging regularly, to keep things fresh in my memory.  But I can say one night during shifts 97, 98, or 99, I literally had one patient dying in one room (he turned out to be a "Do no Resuscitate" patient, more on that in a second) and a patient continuously having seizures in the next room.  Trying to juggle two critical patients at once is no easy feat, let me tell you, especially after needing to go with the patient who was seizing to CT Scan right after you just coded your other patient.

So more about my "Do not resuscitate" patient:  He came in feeling weak, not eating over the past several days, and pain in his right leg.  He had multiple myeloma, a form of cancer, and was in his 80's.  His blood pressure upon arrival in triage was low- 80 something over 60 something.  Textbook normal is 120/80.  He actually came into the ER prior to me coming on shift and when I got there, I took him over as a patient.  His blood pressure at that time was like 113/70 something.  Better.  I kept him on continuous BP monitoring, but he was taken off of it when he went for some tests.  When he got back, fluids were ordered and a blood transfusion were ordered.  I went to get the blood and the fluids, started running the fluids and checked his BP which was now 80 something over 50 something.  Not good, going back down. I opened up the fluids to run as fast as they could and put the bed in a position called Trendelenburg, which is where we raise the bed up and then lower the head of the bed.  This ensures that while the BP is low, the brain will still get the blood flow it needs.  I checked the BP again, still not improving.  I waited a couple more minutes, checked again- now 64/46.  I went to get the ER doctor and told her his BP is still going down after fluids and Trendelenburg.  She went into the room and the patient was increasingly less responsive.  She decided to call a code so that we could intubate the patient as his oxygen saturation was tanking too.  He had a pulse but was essentially not responding to us.  The family was there and before the doctor intubated, she talked with the family, who then advised that they would not like to have the patient intubated and their wishes of no CPR were also expressed.  So basically that all meant that we would wait for him to die on his own without intervening. The patient received 2 units of blood and 1 liter of fluids and his BP was still not improving much.  He was admitted to the medical floor and I called the nurse up there to give report, but after I gave report, the patient became more unstable and my charge nurse said he would probably die on the way up, so we should just let him stay in the ER.  Sure enough, his heart rate started to slow, went down into the 40's.  Patient still had a faint pulse.  Then the patient's heart rate went to 0, and his pulse was slightly there, my charge nurse told the family they should say their goodbyes and they did.  That, for me, was the hardest part.....hearing the granddaughter say, "Goodbye, Grandpa, I love you," was all I could do from bursting out into tears.  I just held the hand of the wife until it was her turn to say goodbye.  So strange how you can be home not feeling well, decide to go to the ER, walk in, and then die later that night.  You just never know.

I've had severe cellulitus (infection) of the leg, acute respiratory failure, abdominal pain, ear infections, sore throats, broken ribs, broken knee sustained from a car accident....you name it, I've probably had it.  I like my job, I love learning.  I've been giving some medications lately that I've never given, so thats been pretty neat.  The only thing I can say I don't like is that we have a lack of tech help at work.  I wish that could change because it would certainly make my job easier and help me take better care of my patients.

I'm back at it again tomorrow.  I work Tuesday, Wednesday and Saturday this work week.  Until then...

Update: Shifts 91, 92, 93, 94, 95, 96

I worked a lot this past week, having 4 days in a row, and one day off in between the other 2 shifts, so I haven't had much time or energy to post.  But the good news is I did a few really cool/new things.  

Shift 92:

Patient came in complaining of having car battery acid getting into his eye.  The doctor ordered some anesthetic eye drops and something called a Morgan lens to irrigate the eyes.  I had to insert the lens into both eyes and the lens was connected to a liter of normal saline IV fluid, one liter for each eye.  The liter of fluid irrigated the eye through the lens.  Quite interesting.

Shift 95:

Patient came in from fire rescue who was napping and when the family went to wake him up, he just had a blank stare and was having aphasia- trouble communicating.  Doctor came to the bedside to evaluate him and decided to call a stroke alert.  A stroke alert is called overhead throughout the hospital and basically tells the lab to send someone over right away to draw blood, tells the CT department to make sure a machine is clear for the patient to have an immediate CT scan, tells any other staff in the department to come help.  A neurologist is immediately called and usually comes to see the patient within 30 minutes.  The CT scan is used to determine if the stroke was caused by hemorrhage (blood) or ischemia (a clot).  This patient's stroke was ischemia, so the decision was made by the neurologist and family to administer a medication called t-PA (tissue plasminogen activator) which is a highly potent medication used to bust up the clot.  There is a chance of the patient hemorrhaging, so its important to get a good history from the patient's family to see if they are a candidate.  It can also only be given within a 3 hour window of onset of stroke symptoms, and I read somewhere that only 3-5% of patients make it to the hospital in time to received the medication.  However, I don't know how accurate that statistic is since I've seen 3 patients get t-PA in the last couple of weeks.  To give the medication, you give 10% of the total amount, based on the patient's weight in kilograms, during the first minute.  Then you give the other 90% over one hour.  Then the patient has to stay in the ER for 30 minutes to 1 hour after the infusion for evaluation.  Then the patient goes to the ICU.  I'd like to see how his is doing now because he was still very aphasic when he left the ER.  The medicine takes a little time to work, so I am hoping there was some improvement for him.

Shift 96:

Patient comes into ER, around 8pm-ish, complaining of not being able to urinate since 11am.  We inserted a foley catheter into his bladder, but there was no urine.  We tried irrigating it, which means we take a syringe of saline and push it into a part of the catheter and its supposed to break up any clots if there are any.  Still no urine.  Doctor then ordered a bladder irrigation, which is connected to bags of fluid which continuously run into the bladder to help irrigate it.  Still no urine.  The ER doctor then called the patient's urologist who said to stop the irrigation and that he would come in.  He tried a couple of things, which didn't work, but then decided to insert a suprapubic catheter, which means above the pubic area, a hole is basically cut through the skin and a catheter is inserted into the bladder there.  It is stitched into place.  This finally worked for the patient and urine was draining into the foley bag.  I assisted the urologist the whole time, so that was cool.  I even had to run around the hospital at one point to find a bladder scanner, which is like a small ultrasound machine used to see how much fluid is in the bladder. The urologist wanted that prior to inserting the suprapubic catheter.

So thats all my interesting info for now.  I am off for 6 days, so no posting for a while.

Until then......

Been Slacking (shifts 86, 87, 88, 89, and 90)

I've been a horrible blogger lately.  Thing is, after my 2nd and 3rd shift last week, I had 4 days off and I just did nothing.  Then this week I worked 3 days, and now I have 7 days off in which I would like to also do nothing. 

At any rate, there really hasn't been much going on. Day in and day out its the same....some sick patients, a few really sick patients, and then a bunch of patients who you wonder why they actually came to the ER in the first place.  

On the day of shift 86 I worked 2pm-2am and I was sent home early at 11:30pm due to it being slow.  The next shift, shift 87, I worked 11am-11pm and at 7:30pm I was sent home due to it also being slow.  On my last shift this week, shift 90, I was called at 11am and told that they were slow and that I wouldn't need to come in until 7pm.  I was supposed to work 2pm-2am, but I worked 7pm-2am instead.  It stinks to lose the time, but I am able to use my vacation time to make up for the lost hours.  The good thing is I still have a little over a week of vacation time after using it for getting off early/going in late, so I'm not upset.  And I get to spend extra time with my family, so thats always a plus.  

The only other thing I can think of to talk about is that fact that I am probably moving to day shift.  This would begin with the next schedule that hasn't yet been posted, which is the Aug 26-Sept 22 schedule.  I haven't heard official confirmation of this yet, but it seems pretty likely to happen.  Basically, one the day nurses put in her notice and told me about it, so I went to my clinical coordinator and asked what the chances were that I could move to days.  She told me they were thinking of moving me anyway because of the fact that I am still so new and I really should have a full assignment every shift so that I can learn to organize, prioritize, and see things from beginning to end.  I agree.  Also, one of the night charge nurses has been giving me a hard time and I have recently just gotten completely fed up with her, and making a move to days would be better for my sanity.  Its busier, the techs aren't as helpful during day shift (I don't know why that is) but the days got by faster for some reason and the 2pm-2am shift just drags on forever.  I'm pretty tired of working to 2:30am-3am and getting to sleep somewhere between 3:30-4:30am on work nights.  I sleep until 11 or 12 and half my day is gone.....however, its better than night shift where I'd lose my whole day, so I won't complain. 

Anyway, that's all for now.  I am off until Wed and then I have a horrendous schedule.  Work Wed, off Thurs, work Fri, Sat, Sun, Mon, off Tues and then work Wed.  Six out of eight days working....bleh.  But the bright side of that is I will have six days off after that.  I'll keep you posted on the move to days.

Until next time......

Shifts 82, 83, 84, and 85

My shifts have been pretty uneventful lately.  Most of my patients are usually not very sick.  Most of the patients I see lately are patients that could have seen a primary doctor for their issues.  However, the only interesting thing I can talk about is tonight (shift 85), I had a patient come in that I saw during my last shift, which was on Wednesday.  She came in with stomach pain that never went away from last time she was here, only it spread up into the left side of her chest and it was a lot worse that it was before.  The pain had gotten worse in the last 3 hours.  Turns out she had ST segment elevations in her EKG, which means it was a bad heart attack. (ST elevation=bad!).  Since we cannot do cardiac catheterizations in our hospital, she had to be transferred to another hospital.  The ER doctor had ordered a nitroglycerin drip IV, and since she was on the drip, I had to go with her during the transfer (the paramedics cannot manage drips like that during transport).  It was the first time I ever transported a patient to another hospital.  We drove lights and sirens on the way to the other hospital.  It was a neat experience, but it was unfortunate for the patient, though.

That's all I have for now.  I am working three days straight- today was day one.  Stay tuned for days two and three......and then I have a nice 4 days off.

Until then.....

Shifts 79, 80 and 81

The last several shifts have been pretty uneventful.  During day shift, I have been floating, helping draw labs, give meds, assess patients, bring patients who were admitted to their rooms upstairs......things like that.  Nothing interesting to talk about.  I have one shift tomorrow, then off for one day, and then two shifts the next two days after that.

Until then.......

Shift 77 and 78

Shift 77:
Not too bad of a day.  It was pretty steady during day shift, and slowly during night shift it slowed down.  By the time I left at 2am, there were 6 patients in the ER and 4 of them were in the process of being discharged. There was no one in the waiting room and there were no fire rescues on the way, so in just a few minutes, there would only be 2 patients left.I had one really sick patient who ended up going to ICU.  When I went to bring the patient up to ICU, I noticed a family member of a patient I had last week who went to the Medical floor and now is in the ICU. I stopped in the room on my way back downstairs and found out she wasn't doing well, wasn't responding and ended up transferring to the ICU and is currently not doing well.  Breaks my heart.  I hate seeing that.  The good news is that the family member's brother who was also in the hospital for over a month is finally home.




Shift 78:
Today marks the halfway point of my first year being an ER nurse.  I started on the floor in January and as of today, I will have completed half of the shifts I will complete in a52 week time period.  I can't believe how much more I know now than I knew 6 months ago, but yet I still have so much more to learn.  We'll see where the rest of the year takes me.


Anyway, this shift started out pretty well.  It was slow actually.  During day shift, I relieved lunches and then floated.  I went on my lunch break before shift change because I knew we were going to be short on staff during night shift.  On my way back from the cafeteria, I run into the family of the patient in ICU that I keep running into.  I talked with them a few minutes in the hallway before I had to run back to clock back in.  After shift change, things started to pick up.  It got a little busy, not insane, but busy. I had a patient who had really high blood pressure that we could not get to go down.  I ended up having to give a very potent blood pressure medication that I have never given before and it finally started to go down.  Her initial blood pressures were crazy.  Something like 237/112 when textbook normal is 120/80. Way too high of a blood pressure.  Patient ended up going to ICU because of the medication she was on.  A patient on it needs to have their blood pressure monitored constantly and that just can't be done on the floors.

Other than that, nothing else interesting going on during the shift.  And now I am off for 5 days.  Five days to try to get my new house in some kind of order.  No rest for the weary.

Shift 75 and 76

Really, the two shifts seem a blur.  By that I mean, I can't exactly remember what happened which day.  I will say Saturday seemed busier, but Sunday was steady, never really slow.  On Saturday, I had a patient who was telling me he had gotten cancer.  I was talking with him and his wife for several minutes and then the patient started crying.  He hugged his wife and as he did, he grabbed for my hand and held it.  It was one of my most sweetest moments as a nurse.  Afterwards, he thanked me.  Not that I feel like I did anything, but I guess sometimes people just need to be able to be free about their feelings and let it out, and I was there for him and his wife.  I'm glad I could be.  That's why I do what I do.  

I've had some pretty sick patients the last couple of shifts. I hate that.  I hate seeing people so sick.  

To say I am exhausted would be an understatement.  Working six days in an eight day time period time period is exhausting, and I haven't even worked day five or six yet.  Between working and spending my one day off in between on moving is tiring to say the least.  But it's almost over and I will have 5 days off, thank goodness.

Until then.....

Shift 73 and 74

Shift 73:

Busy shift.  Started out pretty busy, stayed busy pretty much the whole shift.  Only one thing really interesting to talk about. I had one patient that came in with chest pain.  She presented like most of my patients with chest pain- which is while complaining of different symptoms, she was not in what appeared to be any distress.  She had the pain for five hours or so, so it would seem it was not a heart attack or anything.  The EKG tech came in to do an EKG and I went into another patient's room to give a medication and send her home.  The doctor comes into that room and says, "Gabbi, I need you urgently."  So I turn around, look at him and go out of the room.  Outside the room he says, "You know that EKG we did next door?  Well, she had a major heart attack."  I asked him if is was a STEMI (which is a bad one) and he said yes.  For STEMI patients they would get tPA (very potent clot buster) if the patient qualified to take it, and would be transferred to another hospital for a cardiac catheterization. Unfortunately, since she had waited too long, we couldn't do either of those things, so we had to give her what we could and she went to ICU.  If she came in time, it would have been my first "Cardiac Alert" call.  I don't even know what happens when that call is made.  Its not made very often.

That's all for that shift.

Shift 74:

Busy, but not as busy as the day before.  We also had an extra nurse so that made things go better than they could have.  I never had my own assignment the entire shift, but during day shift I covered some lunches for the nurses. During night shift, the charge nurse had me float, which was nice. I guess I basically floated the whole shift. I don't get to do that often on nights, or days for that matter. Also during night shift, we had the NBA Finals game on (Go Heat!!) and we ordered pizza and wings.  It wasn't slow at night, but it was ok enough where everyone was able to keep up.  We also had one ICU hold, which eventually turned into two. That means, we have ICU patients, but the ICU is full and doesn't have beds for the patients upstairs. Once there is shift change, an ICU nurse will come to the ER to take care of the patients since they really need the extra attention that we can't give them. If a patient we have turns out to be an ICU hold, we don't get an ICU nurse right away because the administration has to get staffing to handle the patient load in the hospital, so they may have to call in agency nurses.  Thats why we don't get a nurse until shift change.  Anyway, the ICU patients too up two of our rooms, so it seemed busier than it was.  Also, we had a lot of very sick people this shift.

Some interesting things:  

• We had a stroke alert.  The patient came in and besides all his other symptoms, her was unable to communicate.  Later on in the shift, he was talking to us.  That was neat to see.  
• We had a patient that came in that fell.  Turned out he had a subdural hematoma (bleeding in the space between the brain and the skull).  This is bad because the blood can collect rapidly and compress the brain tissue causing damage.  He was being transferred to another hospital because of the surgery he needed to have done and as it turned out this guy was alert, awake and talking when he came in.  While awaiting transfer, he was lethargic and unable to be aroused.  He had to be intubated before he was transported.
• I had a patient that I helped take care of that had a pressure ulcer (bed sore) on her bottom.  The nurse that was taking care of her asked me to take a picture of it because she hadn't had a chance to yet.  (We take pictures of all wounds that are present on patients to document that they were there upon arrival and not caused by the hospital).  Anyway, this was THE WORST, hands down, pressure ulcer I had ever seen.  The smell associated with bad ulcers are indescribable.  This was bad.  It was all I could do to not vomit.  Good thing I was behind the patient trying to take the picture so she couldn't see me dry heaving.

Anyway, that's all for now.  Overall, it was a good shift.  Tomorrow I have two more days back to back, then a day off (which I am moving, so I will be exhausted).  Until then......

Shift 72

Whoa.  What a shift.  Busy, busy, busy.  Started out steady, and got busier as the hours went by.  And it never stopped.  Around 1:15am, it was nearing the end of my shift, my charge nurse went on break because once I left, it was only going to be her and the 2 night nurses (we were short 1 nurse once again).  Fire rescue calls on the radio that they are on the way with a patient.  Fire rescue #2 calls on the radio.  Then, fire rescue # 3 calls on the radio that they, too, are on the way.  I was the only nurse with rooms open and I also had one patient to discharge to go home, so it made sense that I would get all 3 rescues because why give the other nurses more patients when I have hardly any and they have 4 each already.  Well, they all came within a 5 minute time frame, and the very last one that came in was a code.  That means, everyone had to drop what they're doing to come help in the code.  Meanwhile, my charge nurse is on break, and me and one of the other nurses are new ER nurses, so I started freaking out internally - ha.  However, all went well as far as handling the code, but unfortunately, the person didn't make it.  It took me until nearly 4am to catch up on my other fire rescue patients, finish the paperwork for the patient that didn't make it, and discharge one of the my patients.  It was so busy that while I normally take a break during night shift when things slow down a little, it was so busy and I didn't even get a break.  My charge nurse came back from break and wanted me to take my break, because technically, we have to take a break no matter what, but there was no way I could take one at that point, I was trying to play catch up as it was.  But its alright, I won't get into trouble for it, and if I do, not much trouble.

Anyway, I survived the shift and it was nice that I had 6 days off to follow a hectic shift like that (even though at this point, I have only 1 day left off).  I guess its the price to pay for several slow nights.

Well, thats all for now, until Wednesday.  Then I have 2 days on, 1 day off, 2 days on, 1 day off, and then 2 more days on.  It will be a busy 8 days. At then end of that crazy 8 days, I will have officially completed my first half a year as an ER nurse.  Very cool.

Until then.....

Shift 69, 70 and 71

Overall, nothing interesting the last three shifts.  A little busy during the day shift but slows down during the night shift.  Nothing to really talk about.  I know that may sound strange being that I work in an emergency room, but really a lot of the people that come in aren't seriously sick.  Anyway, I have to work today and then I am off for 6 days, which I am really looking forward to.  

Until next time.....

Shift 68

When I first got in, things weren't busy but it was slow either.  Our fast track area hadn't been opened yet.  Usually, it opens at 11am, but if its slow enough, they keep it closed and have the extra nurse and either the PA (physician's assistant) or NP (nurse practitioner) stay in the back.  It did pick up a little bit and they opened up the fast track area.  But after that point, there was never a time where all the rooms were filled.  After shift change it really slowed down.  I never had more than 2 patients at a time, and I had 4 rooms I was assigned to.  There was a lot of sitting around.  I even completed 4 out of 6 online courses that I needed to complete that are due yearly. It was definitely a nice change.  Too bad we were short a nurse, because I surely would have went home at like 10pm and even though that means less money, I am never opposed to going home early because going home early means getting to bed at reasonable hour and getting up at a reasonable hour as well.  At any rate, it was unusually slow, thats for sure.  Even the fire rescues were slow......I think we had 3 or 4 my whole shift.  When I left, there was one patient in the ER and there was a fire rescue that just walked in the door with patient #2.  There was one more rescue calling in on the way, but that was it.  Two patients and one on the way.  In the whole ER.  Slow. (and those fire rescues when I was leaving weren't counted in the 3 or 4 from the entire shift, since I was technically clocked out, but still, a total of 5 or 6 is not much in a 12 hour time span).

It made the time go by slowly, but I do enjoy a slow shift like this every now and then.  It was nice.

Obviously, there was nothing interesting to report this shift.  I did hear the day before I missed a trauma (my day off).  Apparently, someone was stabbed, but the fire rescue didn't think it was that deep or serious, and brought them to my hospital.  After stitching up the wound, inside and outside, the bleeding could not be controlled, so fire rescue was called to take the patient to a trauma hospital.  Crazy.  I haven't witnessed this yet, but every once in a while, things like this happen.

Well, thats all for now.  Until Saturday......

Shift 65, 66 and 67

Shift 65 and 66:

These were last week and I forgot to blog then.  Now, I can honestly say I can't remember exactly what happened then, but I know one of the days was a little busy.  Nothing interesting happened, that I can say.

Shift 67:

Yesterday's shift.  Was pretty busy when I first got in.  I was called in early due to a nurse having to leave during her shift.  I had a full assignment and thought at one point I'd pull my hair out there was so much going on and so much to do.  Finally, it started to slow down and stayed pretty nice the rest of the night.  We had a lot of fire rescue calls during the night shift, but even with all those calls, we never had all the rooms full at one time.  I never really had anything super interesting going on, but all of my patients yesterday were admitted.  I never once discharged any of them. We have these things that are called "Core Measures" and when someone comes in with a stroke/TIA, chest pain/MI, pneumonia, congestive heart failure......we have to use these core measures to ensure the patients get the best treatment.  Its not just my hospital; hospitals all over use these.  Anyway, I had to use the stroke, chest pain and congestive heart failure core measures on my patients yesterday.  It can be a little time consuming.  Two of my patients went to ICU.  I can go weeks without an ICU patient.  And the only really interesting thing that I did yesterday was give a patient a medicine called Atropine, which is used to increase the heart rate.  Normal heart rate is 60-100 beats per minute (bpm).  Her heart rate was in the 40's and kept dipping down into the high 30's.  Usually we don't do anything in the 50's or high 40's, but once you start dipping below that, it gets dangerous.  Once I gave her the atropine, her heart rate went into the 80's.  Eventually it started going lower again, but pretty much maintained itself in the 60's.

Well, I'm back at it again tomorrow, then I have two days off and then back at it for the weekend.  I have 5 more shifts until I have a nice 6 day off stretch.  Until then.........

Shift 63 and 64

Shift 63:
Nothing to report as I had to call in sick.  Been fighting a stomach bug of sorts- fever, body aches, headaches and stomach junk. Been sick since Thursday and even with Thursday and Friday off, I still wasn't feeling better so I called in sick.  I hate doing that but what can I do?

Shift 64:
Oh how badly I wanted to call in again today, but I really didn't want to call in two days in a row.  So I went in.  It was a slow day all during day shift.  I literally sat around most of the day.  About 2 hours before shift change, I went into triage.  Then at shift change I had to take an assignment.  My charge nurse felt bad about that, knowing that I didn't feel well, but we were really short staffed.  I had three rooms until 11pm and then I had 4 rooms assigned to me. I had everything from back pain, to pink eye, to hip fracture, to chest pain, to shortness of breath, to pain in the esophagus. I struggled through my shift but I made it.  Nothing really interesting or fascinating to report.

For now, two days off, where I will hopefully be feeling better, and then back to two shifts back to back on Wednesday and Thursday.  Until then......

Shift 61 and 62

Shift 61:

Not a bad shift.  Nothing really interesting to report.  Things seem to be getting easier and easier for me and I am getting less stressed.  I realize how much I enjoy working with the night crew.  I work 5 hours with the day crew and the other 7 are with the night crew.  The night people are fun and there are more times when there is down time with nights than with days.  I would totally want to work day shift for the hours if it wasn't for the fact that I would no longer work with the night crew.

Shift 62:

Today, I think its possible we are the only ER open.  Fire rescue after fire rescue, walk in after walk in.  Non stop ALL day, even into the night shift.  It slowed down, but it did not stop.  When I left my last shift, there were 3 patients in the ER.  Tonight when I left, we still had all the rooms filled and just one hallway patient (we have 10 possible hallways beds available on top of the rooms we have).  It was crazy.  Nothing interesting to talk about.  Glad I have 2 days off before having to do it all again.  I'm dreading the next 4 shifts because we are extremly short staffed on nights all 4 of those shifts.  I am hoping and praying that changes by then.  We shall see. 

For now, I have 2 days off and I am going to enjoy them. Until then :)

Shift 58, 59 and 60

Sigh.  Even with 4 days off, I am still struggling to write my blog.  So here goes- short and sweet.

Shift 58

Not too busy and nothing interesting to talk about.  It was my first shift of three in a row and I worked with two awesome charge nurses.

Shift 59

Today was also not too busy of a day.  But we did have a couple of interesting patients in the ER today. One was a young man who came in (wasn't my patient) and turned out one of his lungs were deflated.  He needed a chest tube put in to "reinflate" his lung.  I got to watch.  It was my second time ever watching this done and the first time in the ER. Second patient was brought in by family members who asked one of the staff workers in the parking lot where the ER entrance was and if there was a quicker way to get in.  Behind them was another family member running up with a limp, unresponsive 3 year old.  They quickly came in through the side door, wheeled a patient out of one of the rooms, and moved her onto a bed and into the room.  Patient started seizing and vomiting.  Apparently, she was asleep and vomited, family member went into check on her, and she was not waking up.  She was breathing and had a pulse, but was responsive.  We took her to cat scan, and then when she returned the ER doc made the decision to intubate her in order to protect her airway because she had seized again and had also vomited.  We do not have a peds unit in our hospital so we had to transfer her to another hospital.  That was pretty much the extent of our care for her.  And that was pretty much it for my shift.

Shift 60

I don't know what happened, but when I got in, it was already going crazy.  It was so busy.  My charge nurse had me go up front to triage to relieve someone for their lunch break, and that person never came back.  So I stayed up there from 2 until 7pm when it was shift change.  At one point, we had myself and another nurse up front triaging patients because we got backed up.  In the back, we had fire rescue after fire rescue bringing in patients.  Finally after shift change it started to slow down and was never really bad after that.  I don't even think we had any fire rescues come in after 8pm until I left at 2am.  When I left at 2am, there were only 3 or 4 patients in the ER.  Nothing really interesting happened this shift.

I work again tomorrow, so stay tuned for more soon.

Shift 56 and 57

Shift 56:

The shift started out with me walking in the door, past my director's office, who ended up stopping me and telling me that he resigned that morning.  His last day in the beginning of June.  His assistant/clinical coordinator had already gave her notice as she and her family were moving back home to another state.  Her last day is mid-June.  So, there will be a lot of changes coming in June.  I'm not sure if I should be afraid or excited.  The new people could be amazing, or they could be terrible.  Actually, I think some of our current nurses are interviewing for the assistant/clinical coordinator position, so that will be nice the person who is hired is one of them.

Anyway, today was very busy.  We had an extra nurse on the floor, so that was helpful.  I had two patients during this shift that had to be admitted to ICU.  The first patient I had before shift change.  Another nurse on the floor had a patient that needed to go to ICU as well, and ICU happened to be full.  So an ICU nurse came down and took care of the patients in our ER.  I started taking care of the patient who would become my second ICU patient when one of the ICU patients that were being taken care of in our ER was downgraded from ICU status and was able to go to one of the other floors.  I waited for the admitting doctor to call back to admit my second ICU patient, and it was nearing the end of my shift.  I was hoping to get out at 2, but unfortunately, the charge nurse who was working rarely lets me out right at 2.  At 2:15 the doctor calls, and I had to take orders. By the time that was done, I had to give that patient some stat meds.  That took a little time, and by that time, my other 2 patients were up for discharge.  I had to spend a little time discharging them, and then it was time to give report to the ICU nurse on my ICU patient (we give a report about the patients to the nurses to catch them up to speed about what is going on), but the nurse was busy at the moment.  Then I realized I had to fill out some more paperwork about the patient, and I had to do a screen for admissions in the computer that usually I don't have to do but this particular charge nurse makes us nurses do it.  By that time, it was 3:40am and I was finally able to walk out.   If only I had left at 2, I would have avoided all that mess.  But at least I didn't have to work the next day, and I had 2 days off, and I got some overtime so I guess I can't complain.  Even though it was a busy day, I seem to be handling the stress better.  I've noticed this with some of the busy days we've been having lately.  That's a good thing.  I'm getting closer to the halfway mark of my first year and I have learned and grown so much, but there's still a long way to go.  

Shift 57:

Today was a relatively slower day.  It wasn't "slow", but definitely better than the other day.  It stayed pretty steady most of the day, but nothing stressful.  After shift change, I was floating, and it started slowing down pretty well.  At midnight, my charge nurse asked if I wanted to go home, and I said yes since today was Mother's Day and I didn't want to have to sleep in too long like I would if I got out around 2.  It was a good shift.  I actually looked forward to going into work this shift.  Maybe it was because of who was going to be charge nurse for the night shift, but regardless, I am feeling better and better about going to work. I really just think I am still trying to adjust to not being off whenever I want to be and with not being able to be with my kids and family like I used to be when I was a stay at home mom.  In time I will feel better about that.  I am slowly adjusting.  I was off for 9 years and its going to take time to get used to not having the same freedoms I had before.  But the good thing is I only work 3 days a week, so I still have a lot more freedom that a lot of working people.  And I get to help people in the process.

I have three days back to back this week, so I am going to be exhausted.  I will write when I can, but it might be Wednesday after the third shift.  Then I have a wonderful 4 days off, including my first full weekend off in a month!  I am so looking forward to that.  Until then......

Shift 54 and 55

Shift 54:

The shift started out good.  It wasn't busy, but not super slow.  Around 11/11:30pm it started picking up and got really busy.  At that time of the night, we only have 1 doctor, so he started getting really backed up.  He finally asked if the charge nurse could call the doctor who is the head doctor (I believe he is the "medical director" of the ER) and ask him to come in. At 1 or 2am he came in to help.  We had every bed filled, and 4 or 5 hallway beds full as well.  The nurses were working together as an amazing team......I never once felt stressed.  We were all helping each other.  However, I didn't leave until nearly 4am (yikes!  I work 2pm to 2am).  I had a patient that came in with shortness of breath- a young girl, I think about 28 or 29.  We hooked her up to the monitor and her heart was beating a little fast, what we call sinus tachycardia, which is 100-150 beats per minute.  She was around 110 or so.  Then, a tech was in the room with her and she said she didn't feel well all of a sudden, and her heart rate went crazy- 250!!! We call that SVT- supraventricular tachycardia, which is from 150 to 300 beats per minute.   The doctor and I went in there, and he had her bear down as if she were having a bowel movement (what we call a vagal maneuver- the bearing down stimulates the vagus nerve, which slows down the heartrate).  Her heart responded and then she went back to sinus tach.  A little later, she went to have a CT.  When she was being rolled back into her room, she didn't look too good, so I told the tech to hurry and get her back on the monitor, and sure enough, she was at 225 beats per minute again.  I told the doctor to come because she was in SVT again and that the vagal maneuver wasn't working. At that point, he said we needed to give her adenosine, which is  a medicine that slows that heart down, and sometimes so much so it may nearly come to a complete stop, so whenever you administer this medication, you must attach defibrillator pads to the patient (some machines have sticky pads that you just stick on, and some machines have actual paddles- we have the pads in our ER). I went to get the meds, a tech went to get the defibrillator.  Then I administered one dose of adenosine and it did not convert her heart rhythm to sinus tach.  It barely did anything to her heart.  I then administered a second dose of adenosine.  Still nothing.  Barely any change.  The doctor then decided we'd try cardizem, which is in a class of medications called Calcium Channel Blockers.  Essentially, they block calcium from entering the heart cells and blood vessels, therefore causing a relaxation effect and widening of the blood vessels and also relaxation of the heart muscle.  This lowers blood pressure and slows down the heart rate.  I gave her some cardizem in her IV and it finally converted her heartrate back down to 130.  I gave her some more a little while later as well, but her heartrate still lingered at 130.  At that point, it was time for me to go home.  When I came in the next day (shift 55), I was thinking about stopping to see her in her room.  She had been really scared the night before, and was crying because she didn't want to die and she really thought she was.  She wanted to call her mom in another state but was debating it because she didn't want her mom to worry, but at the same time she thought if she was dying, she wanted to talk to her mom again.  I comforted her, told her she should call her mom, but to remain calm and just tell her mom she wasn't feeling well and was at the hospital.  I also reassured her that she was in the right place to be sick and that we'd do all that we could to help her get better.  Anyway, I wanted to see how she was doing, and lo and behold, she was still in her room in the ER.  Apparently, she was going to be admitted to ICU, but there were no ICU beds available, so she had to stay down in the ICU (its what we call an ICU hold) and an ICU nurse usually comes to take care of that patient.  The nurse who took over for me when I went home the night before is an ICU nurse, she just floats to the ER to help sometimes, so she took over that patient's care until shift change.  Then another ICU nurse took over.  By the time I came in, the cardiologist had just downgraded her to telemetry, which is a little more acute (sick) than just a medical-surgical floor, and these patients have to be on a cardiac monitor 24/7.  She was actually just getting ready to go up to her room.  I was glad she was doing better and her heartrate was beating in the 70-80 range, which is awesome!  Anyway, that was my exciting experience of the night, my exciting new experience, however, it was unfortunate for the patient.  But I am glad I got to be her nurse to be there for her when she needed someone.  I hope I helped her feel as though  she was taken care of, and taken care of well for that matter. And most of all, I am glad she is doing better.

Shift 55:

Relatively slow day. At one point, we almost had an empty ER.  We had about 5 patients and they were all just waiting to go upstairs (they were already seen, treated and admitted).  We sent 2 nurses and 1 tech home early.  Then around 5pm or so, we started picking up a bit and it lasted until 9:30pm or so.  Then it slowed down again.  I probably would have been able to go home early, except for the fact that there were only 2 nurses who came in at 7pm, so when I left, there would only be 2 nurses left on the floor.  

Shift 56 is Wednesday, and then I am off again for 2 days.  Until then.....

Shift 53

It was a steady day.  Busy but not terrible.  A good busy, as I like to call it, where its slow enough where I can keep caught up with my patients but not too busy where I am going crazy.  We were staffed well, so it was a good day.  I had received a 3 room assignment when I got in, and then at shift change I got a new 3 room assignment.  Nothing interesting or anything.    Oh well, I forgot, as soon as I clocked in I heard the code alarm go off.  Fire rescue came in with a code, but really it was pretty uneventful because the doctor called it just as soon as the patient was in the room.  Fire rescue had already worked the code in the field for 45 minutes, so there was really nothing more we were going to be able to do.  Sad, but true.

And that's all folks.

Shift 54 and 55 this weekend......stay tuned.

Shift 52

The day before shift 52, I had the migraine of all migraines.  Hadn't had one so bad in a REALLY long time.  Before bed, I took 2 fioricets (migraine meds) and went to bed.

The brunt of the migraine had subsided, but I still felt the pressure in my head, I was still sensitive to light, and I still felt a little foggy.  I went into work at 2pm and thank goodness it was slow.  It was an uneventful day.  I had a 4 room assignment from 2p until 7p when the shift changed.  Then I went to triage.  I had asked the charge nurse if there was any possibility I could go home early and she told me she would try.  We had 5 nurses on the floor, plus the charge nurse, but we only had one tech, so I guess she was going to see how it went.  I went on my break at 10:30pm which really wasn't a big deal because I don't really like to go early, and it seems to make time go by better if I have less time left after my break.  I get back from break, ran up to one of the floors with the ER doc for a code (we don't usually do this, I just wanted to see it on the floor) and then I get back to triage.  At that point its 11:15pm and about a half an hour later, the nurse who relieved me for my break came to relieve me to go home.  So I left at 11:45pm which was nice.  But it was a really good day over all.  Just wish I hadn't been trying to recover from this migraine.  I still am trying.

Shift 53 is Thursday.  Stay tuned until then.

Shift 50 and 51

Shift 50:

Started out slow, we kept our fast track area closed.  I actually came in at 11am to work for my friend because she needed to come in later (she had something to do in the morning, so she came in for me at 2pm).  Around 3pm, the ICU called and asked if they could send one of us up to their unit to help them.  My charge nurse came and told me that I was to go up and help, that my director wanted me to be the one.  Not exactly sure why, perhaps he thought it was good for me to get the experience and to see how things work in the ICU.  Whatever the reason, I was glad to go.  But I am freaked out by all the machines and meds in the ICU- I won't lie.  I would get used to it if I ever worked there, I'm sure, but from the outside, looking in, its scary.  Anyway, I helped pass meds to a patient, and I checked some blood sugars, I ran a patient's belongings to another floor (the pt was in ICU and got transferred), and I helped answer phones, and I helped with a couple of minor things with the patients.  I was there for about 2 hours and then had to go back to the ER because they had a critical patient and needed me back to help with other patients.  Overall it was a pretty uneventful shift, but it was a little busy for a while.

Shift 51:

When I came in, I took over a 4 room assignment (which is a normal assignment, and this particular assignment has the possibility of having a maximum of 8 patients if you have all the hallway beds filled).  I only had 5 patients maximum at one time, however.  It was a steady busy, a good busy, where it wasn't too crazy that I felt like I was insane at any one time, or too slow where time was going by too slow.  I went on break right before shift change and when I got back, I finished some things up and it was shift change time.  At that point, my charge nurse sent me to triage, which I like to do sometimes at night.  However, it started getting crazy.  Not insane or anything, but there was a couple of hours where I had 4 to 5 patients waiting at all times while I was actively triaging a patient.  I'd get done with 1 and 1 or 2 more would walk in.  Finally, I got caught up and at that point, I only had 1 or 2 more patients come in the rest of my shift.  Also pretty uneventful tonight.  

I have to say, the way I feel about work is somewhat bipolar.  I like the people I work with (well, like 95% of them anyway), I think at times we have a lot of fun.  I have no problems talking to the doctors.  I like helping the patients, but for some reason, I always dislike "going into" work.  Once I'm there, I'm fine, its just the time leading up to it.  I think the most of it is me missing my kids.  Its hard to go back to work after 9 years staying at home. And its hard because the kids have a hard time with my being gone sometimes, too.  But I really do like my job most of the time.  One weird thing I've noticed is that my stomach is usually upset on the days I go to work, so I'm guessing its not a coincidence.  It gets better once I'm at work for a little bit, but its just weird it does this on work days. Hopefully, that will go away.

On another note, I forgot to mention back in shift 47 was something that really made my day and was another reminder why I do what I do.  I had a patient I was taking care of and had to give him a few medicines he had never had before because his heart was in what is called Atrial Fibrillation, where the atria of the heart beat irregularly and rapidly.  Anyway, I always tell my patients what I am giving them and I ask if they know about the medication, and then I explain what it is, what it does, and side effects.  My patient and his wife were so appreciative and grateful that I did that.  They, mostly the wife, kept complimenting me on what a good job I was doing and what a good nurse I was.  Not that I do this for the recognition, but sometimes you don't know that the patients felt like they were taken care of unless they say so.  It really made my day in a time of craziness. They told me they were going to call the comment line that our hospital has and they wanted to make sure I got recognition.  That was sweet.  I don't know if they actually called or not, but I am glad they felt like they were taken care of.  One time while the wife was telling me that I explain things very well, another patient who was in a hallway bed right in front of their room (and was listening to everything) said that she agreed, I explained things well.  This is why I do what I do.  That makes it all worth it.  

Another shift tomorrow, then off for 3 days.  Until then........

Shift 46, 47, 48, and 49

Sorry, with three straight days of work in a row, and then one day off before I work one more day, I didn't have much time for blogging.  So, I saved it for after today.  

Shift 46:

Not so bad when I first got in, but started picking up pretty good.  I ended up taking 4 hallway patients within a couple of hours before shift change because the day nurses were overloaded.  Then at shift change, I went to relieve the 11am nurse for her lunch break and then I took my lunch break and went to triage.  Pretty uneventful day overall.  It did finally start to slow down and it was a pretty decent night part of my shift.  

Shift 47:

Again, not bad when I first get there, but then the flood gates opened!  I'm not even exaggerating when I say that we literally had 3 fire rescues walk in the door at the exact same time.  There was a line where they check in (I've never seen that before!!).  And then while they were lined up, there was another fire rescue calling on the radio.  We had patients waiting by the ton in the waiting room.  It was so bad we had 4 nurses on the floor yet we had to call for another nurse to come in, and she came at 4:30pm to help, and we had to call our director, who also came in to help.  It was insane.  At shift change, the nurse who came in at 4:30pm covered my patients for my lunch break and I went.  When I got back, she left, and it was somewhere around 8 or 8:30pm by that point (I didn't go right at shift change and then while on my break, I had to take a call from a doctor, so I got a few extra minutes on my break).  When I got back., things finally started to slow down.  Patients got discharged or admitted so rooms opened up, and we didn't have as many people coming in as fast as they did, so we were catching up.  By 12:30am, I no longer had patients in any of my rooms.  Other than being busy, it was really an uneventful day otherwise.

Shift 48:

Seems to be a pattern.....not so bad when I first get there.  Even our fast track area was closed.  But it started to pick up for sure.  I had 3 rooms when I first got in, and at shift change I ended up getting 1 more (we had less nurses to split the rooms at night).  At one point (after shift change) I had 8 patients!  Thank goodness we had the fast track area closed because that nurse was able to float to help.  It was steady all night.  When I left, I had just discharged 2 of my 4 patients, and 2 more came in.  The charge nurse had to take my patients because we only had 2 other nurses working that night.  It was crazy.  

I did have one pretty interesting patient-  the patient was having a severe allergic reaction to cleaner fumes that were sprayed in the bathroom.  Patient went in right after the bathroom was cleaned to take a shower and started having trouble breathing, was coughing and headed right over to the ER.  Good thing.  When he got there, he was having trouble breathing, his throat was swelling, his eyes were swelling, his eyes were watering like crazy.  His oxygen saturation was at 94% in the waiting room, and then went down to 92% in his room in the ER.  We gave him Epinephrine, Benadryl and a steroid to help decrease the swelling, and we put him on oxygen.  Within minutes, his lungs were fully moving air again and his oxygen saturation was back up to 100%.  Scary for him I am sure.

Long day (or 2 days I should say), and when I got home, my head pounded, my feet ached (they still do!) and I was exhausted.  One day off and then I have to work again (thank goodness its only for one day, then I have two off).

Shift 49:

When I got it in, it was busy, but not crazy.  It stayed steady all day.  Around shift change, it started slowing down. It really was a decent night, but we had a ton of fire rescues coming in constantly throughout the night.  Not much to really say about tonight, except I had one patient who came in from a nursing home who just had a foley catheter put in earlier yesterday and there was no urine draining from it. So, the nursing home sends him to us.  First, I tried flushing it, which means I just disconnect the tube from the bag and take a big syringe with sterile water and flush it in.  Nothing drained out.  Next I tried deflating the balloon on the foley- at the very tip of the cath, there is balloon that is inflated once the cath is fully in to keep the cath from coming out.  This is how is stays in.  So I deflated the balloon, pushed the cath in further, and then reinflated it, and voila!  The urine started to drain.  Seems like the nursing home could have saved time (and this guy's insurance money, and fire rescue resources) by troubleshooting the problem first.

Anyway, I am going to enjoy my 2 days off, especially with this surprise cool front that came through.  Its 1pm and its 72 out.  I just love it!!!  

Shift 43, 44, and 45

Shift 43:

Not much to say about today. At the 7pm shift change we had a charge nurse AND 4 nurses come in (usually its a charge nurse and 3 nurses). We got slow, and the charge nurse closed our fast track area at 9 or 9:30pm and sent that nurse home. At 12am, we were still slow and I had thought for sure they'd send me home early by now, but nothing was mentioned, so I asked the charge nurse if I could go. She said yes and I was out of there by 12:15am. Nice. It doesn't happen often, so I will take it when I can get it.

Shift 44:

Paid for going home early the other day today! It was a busy day!! It was actually ok when I first walked in the door, but soon went downhill fast. I can't even remember how many fire rescues came in, there were so many! I had a pretty sick patient come in about two hours before I was supposed to go home. She had a hysterectomy about 3 weeks before and about 45 minutes before she came in, she started bleeding badly. While en route via fire rescue, the paramedics told me her blood pressure kept going lower and lower. When she arrived, her systolic blood pressure was in the 80's which is not good. She was still talking and conscious, but she was very weak and very pale. We gave her fluids, ran some labs, and I put her bed in a position to keep the blood flowing to her brain since her blood pressure was so low. We also gave her a unit of blood. Unfortunately, she had to be transferred to a hospital that treats OB/GYN since she had a GYN surgery and that was what was causing the bleeding. I didn't get out until nearly 4am (I get out at 2am!!), and we stayed busy the whole night. Even when I left at 4am, I think all the rooms were still filled. Thats not a normal thing for the night shift, and when I left, there was only the charge nurse and 2 nurses on the floor, so the 2 nurses that were left had to split the whole ER. Yikes! (Although I had 2 patients when I left, and the charge nurse actually took those 2 patients, so the other 2 nurses split what was left).

Shift 45:

Better day, but busy for a while. Then it slowed down a bit until about shift change and then it picked up again. At shift change, I got to go to triage, which was nice. After I triaged the 5 or 6 patients that were waiting when I first got out there, I caught up and it stayed slow (at least out in the waiting room). At times, a couple of patients would come in a at a time, but no more than 2 or 3. Most of the time, only one patient would come in at a time, and there would be times where no one came in for a while. That was a nice break for me.

It still amazes me, I don't know why, the things people come into the ER for. I mean, I get the whole not having insurance thing- I didn't have insurance for 9 years. But people just come in for things that are not emergencies. For instance- in triage the other night I had a patient come in for his knee that has been hurting him- FOR TWO YEARS!! And he wanted to find out what was going on with it. On top of that, he had come in earlier in the day, signed in, waited to be triaged and then left before he could be taken back. So, it apparently wasn't that much of an emergency if he left. Believe me, I know I may sound harsh here, but when my patients are sick, I am caring. Even if they aren't sick, like this guy for instance, I am still caring- outwardly. Inwardly, I may shake my head a little :), but I never let them know. I'm always nice, I always smile, but sometimes I do have to wonder about these people.

I'm back on Thursday and I have a tough schedule ahead of me. I work Thursday, Friday, Saturday, off Sunday and then back Monday. And on top of that, Saturday night we will be very short staffed, so I am praying for a very slow night Saturday. Stay tuned.....

Shift 42

was non-existent. I was feeling horribly, with stomach issues, and there was no way I was going to be able to work for 12 hours. It was a good thing, too, because as soon as the stomach issues ceased, my head started hurting terribly. I'm back to work on Tuesday, so stay tuned until then.

Shift 41

Not too bad of a day- wasn't slow and wasn't busy. It was a nice shift. I actually got a room assignment around 3pm and had that assignment the rest of the shift. I got to take my break late- around 10pm, which is fine for me, because the later, the better. I hate taking my breaks when I haven't even worked half my shift yet. Time goes by a lot faster when I take my break later.

Around 11:30pm, we were down to about 2 or 3 patients in the entire ER, and I was going to ask to go home early. I hadn't had the chance yet because the charge nurse was busy, but then unfortunately it started picking up. It didn't get crazy busy or anything, but we had a steady flow of patients coming in for a while. I ended up staying my entire shift. I am very exhausted and I have one more shift tomorrow to get through and then I will have 5 days off. So happy about that, and so looking forward to spending some time with my babies (they're on Spring Break right now).

Nothing really excited to report about my patients today. Here's to hoping I have another great shift tomorrow!

Shift 40

The shift started off ok. Busier than the day before but by no means crazy. I covered for one lunch and basically just floated and helped for the first five hours. Then came change of shift. I picked up a 3 room assignment and the patients started coming in. I never had more than 4 patients at a time, but I kept hearing the tech ask the charge nurse for rooms and I kept hearing fire rescue call us on the radio. It was steady until 12am. Busy, busy. At one point I got three patients at one time. Luckily, they were all pretty minor cases- 2 sick with upper respiratory infections and the other had a strained muscle. But at one point I had two patients that both needed a lot of meds, both patients needed my time for different reasons. One of the two patients I was worried about because she came into the ER via fire rescue in respiratory distress, and you just never know how that's going to turn out. We were short a tech because another floor needed him, so while we had a good staff of nurses, we were short somewhere else. That always seems to be the case. Either that or we have too much help on a day that turns out to be slow and not enough help on a day that turns out to be busy.

My respiratory distress patient turned out ok, although she had to be admitted for sure. There was a time where she started yelling, "Help, Help!" So I ran into her room thinking she couldn't breathe. It turned out she had a terrible cramp in her leg and she begged me to rub it. So I did. I rubbed her leg for a good 10 minutes, all the while thinking to myself how I have other patients to take care of, yadda yadda. But then after a little bit it dawned on me, that really I was actually, FINALLY doing real nursing care. That is what nursing is all about- helping our patients feel better, feel more comfortable, giving them care that makes them feel like they are the only patient we're treating, because in actuality, for the moments we are with the patients, they are our only patient. The only patient that matters. And thats how we should treat each and every one of our patients. But it made me feel like for once, I made a little bit of a difference. I helped someone feel better, even if just for a moment. And when she yelled for a second time later on, because her other leg cramped up, I rubbed that leg, too, just as if I didn't have anything else to do in that moment- even if I really had a million other things to do.

And thank you to Mrs. X for helping me remember what my job is really all about, and why I wanted to be a nurse in the first place.

(stay tuned for more, as I have 2 more shifts in the next 2 days, bleh, but then a glorious 5 days off to follow)

Shift 39

Well, I officially reached the quarter way mark through my first year as an ER nurse.

And I lived to tell about it :)

Today was pretty uneventful. It was slow at first, slow enough to cut a couple of techs during day shift and to cut the two nurses who leave at 11pm by like 8pm. Of course, it got a little busier once they went home, but it was not too crazy. Nothing really interesting to report except that there was almost a fight between a patient of mine and another patient. My patient was agitated and loudly expressing his agitation when the patient across the hall told him to "shut up!" That didn't go over too well, but thankfully a tech and I were able to talk my patient back to his room.

And that's all for now. Stay tuned for shift 40 tomorrow!

Shift 37 and 38

Shift 37:

Not too bad of a day, we had a lot of staff as far as both nurses and techs. I took my break around 8:30pm, and then when I got back I had a few minutes until I had to go to a training class for the new fancy phones we're going to start using in a week. Then I got back and it was still pretty nice for the rest of the night. No real interesting patients, nothing special to report.

Shift 38:

I wake up at 11:15am to the sound of my alarm. Not 2 minutes later, my phone rings and its work asking if I could come in early- they are slammed and haven't even started doing lunches yet.

Here's how it normally goes. There are two nurses at 7am, one at 9am, and one or two that come in at 11am. Usually, by the time I get in, the 7am nurses have already gone to lunch. Occasionally, the 9am nurse has gone too, but mostly I start off relieving them for lunch. Today we only had one 11am nurse. So I get there and one of the 7am nurses is at lunch, the charge nurse was covering for her. I relieved the other 7am nurse for her lunch, and then once she got back, there were a ton of patients that needed to be transported to the floors but we were short on tech staff, so I helped out there. I had to help everyone do many things because it was just one of those days. Then, at one point, I had to help cover for triage because the triage nurse had to go to the phone class I went to the night before. Patients just kept coming in through the waiting room, and fire rescues just kept bringing patients by ambulance. It was definitely a crazy day. To top it off, the 9am never got her lunch until 6:30pm. I relieved her, just as she was getting not one, but TWO fire rescue patients, one of which happened to be a relative of a very important hospital person- talk about stress. The nurse I covered for came back just as it was time for shift change, and the poor 11am nurse still hadn't had her lunch break yet. I think she finally went at like 8:30pm or so. One of the night nurses didn't make it in due to car trouble, so we all had full assignments and it was busy at the same time. I think it finally slowed down around 10ish. I finally went to lunch around 10:30pm- or was it 11:30pm??- I can't even remember at this point. When I got back, I didn't have any more patients, and I basically just caught up on my paperwork, and helped triage a couple of patients, and stayed until my charge nurse came back from her break, and then I went home. I was supposed to leave at 12:30am since I came in early, and I think I left around 1:15am. It was a LOOONGGG day and one where everyone really was stressed out about. One of the 7am nurses didn't leave until like 9pm I think. It was crazy. Still not as bad as the one day we had a few weeks ago, but I would say a close second, or third. It was bad. No real interesting patients or anything, but I will say I have seen several patients come into the ER with REALLY high blood sugars during the last two shifts. I mean 3 patients in 2 days with sugars over 500?? It happens sometimes, I suppose.

I'd love to get to the point where I don't feel as stressed as I do sometimes. I mean, I guess we all feel that way on days like today. I know the other nurse was so happy when I was there and when I asked her if we were busy, she said "SO busy!!" I really like my job, I just hate the stressed feeling that comes with it at times.

On a side note, one more shift and I will be a quarter of the way done with my first year as an ER nurse. How time flies!

Shift 35 and 36

Shift 35:

Today was much busier than the last few shifts. When I came in at 2pm, no one had gone to lunch yet, and usually at least 2 of the nurses do by the time I get in. So basically all I did from 2 to 7 was relieve lunches and help the nurses catch up prior to going to lunch and coming back from lunch. Then at shift change I got 3 rooms, which at the time meant I had 6 patients since my rooms also had hallway beds. But around 9:30 or 10pm it started slowing down. I hadn't had my lunch break yet, but as it was dying down, I got a patient from fire rescue that is normally a patient that is with it, but was confused and not responding at all to our questions and commands, etc. She was awake and constantly trying to get out of her bed. It took me, the security guard and two techs to hold her to get an IV started, and the security guard had to sit with her the entire time she was in the ER. I gave her some meds to try to calm her down and help her sleep, and actually gave her a couple of doses. It wasn't working. I went to lunch and another nurse was going to give her more meds if they were ordered while I was at lunch. When I came back, more doses of the meds were ordered and we finally got her to stop trying to climb out of bed and she actually fell asleep. There was one point where she woke up and was scratching at me, and she actually scratched my neck a little, but I just calmed her down and talked her into going to sleep. Eventually, we got her transferred to the floor, and later on, I had to run something upstairs to her floor, and saw her bed literally sitting in the middle of the nurse's station, so that they could keep a close eye on her in case she tried to get out of bed again. Crazy. That's about the jist of my day today.

Shift 36:

Not so bad today- actually kind of slow when I get in. All lunches were done and we had our fast track area closed (not enough patients to have to open it as of then), and we had an extra nurse floating and then me. It did start to pick up some towards 4/4:30 and we opened up fast track. At shift change, I was assigned 3 rooms again, and it was pretty much a non eventful night, for me at least. We actually had 2 patients who needed to go to ICU, but they were full, so we had to hold them in our ER. That means they stay there until a room opens in ICU, which could take days, worst case scenario. Two nurses and I basically covered the ER while one nurse took just the 2 patients (since they're critical, they need more attention and in the ICU its one nurse to two patients). One of the ICU patients ended up dying while in the ER (that patient was a patient who did not want to be resuscitated, so there was no code of anything). And then an ICU room ended up opening up around 10:30/10:45, so the nurse got the patient ready to go upstairs. We had slowed down a lot, and I was told that when that nurse brought the patient upstairs and returned, I would go home, so I ended up leaving at midnight. I like leaving early, but it does stink to miss out on the money.

So that's that. I work again tomorrow and Tuesday, so stay tuned for more updates soon.

Shifts 32, 33, and 34

Shift 32:

Slowest day I have ever seen in the ER since I've been there. By 9pm, with only 6 patients in the entire ER, and 3 night nurses, 1 charge nurse, me and a nurse that leaves at 11pm, the charge nurse decided to let the 11pm nurse and I go home early. At 9pm no less. Not much to report today, obviously.

Shift 33:

A little busier today, at least when I get there. Then it started to even out a little, so I thought it would probably be a decent night. We had a charge nurse and 4 night nurses coming in, plus me there until 2am. I thought for sure I would be cut early tonight, I might have even bet the farm on it. One of the techs "forgot" she was scheduled to work (convenient, especially on a Saturday, especially on St. Patrick's Day). So we had only one tech to help with all the lab draws, specimen collections, transporting of patients to the floors, etc. etc. At shift change, I went to triage and was there the rest of the night. Patients just kept coming in. And coming in in groups, not just one at a time. Nothing exciting or new today, just busy. I felt so bad for the ER doc, who after 11, is there alone. (We have a dr that comes in at 7am to 7pm, a dr that comes in at 10am to 10pm, and a PA or NP that comes in 11a to 11p, and we have a dr that comes in 7p to 7a.) He had patients stacked to see him when I left.

Shift 34:

I come into work and it was a "slower" day. It wasn't dead by any means, but it was slow enough that they never even opened up our fast track area at 11a. So we had three nurses on the floor, plus me and another nurse floating. It was a nice day and I definitely felt like I needed it. Then shift change came around, and it was still a little on the slow side until about 9 or 10. They let the nurse who leaves at 11p go home early, and then it seemed to start picking up. Once all the rooms filled up, they stayed filled. When I went home at 2:45a it was still full. Don't people sleep around here?

Anyway, I had a couple of sad stories today. A patient who came in (wasn't my patient, but I helped with him) who had taken all of the medications he had in his house because he was depressed. I had a patient who came in who had a brief 5 minutes of numbness on one side of his body and trouble speaking, and then he was back to normal. He said this has happened before, but was told he had Bells Palsy. So the ER doc really didn't think it was a stroke, but thought possibly it could be a ministroke. Patient was scheduled to have an MRI the next day, so the doc thought the patient would probably be going home after he had a cat scan. Turns out, patient had a brain tumor. I had another patient who was brought in by their mom. Mom thought the patient had been sexually assaulted. Ugh. That, I hated. I tried hard not to cry when mom was telling the NP why she was there with her child. I have children and I can only imagine how the mom must feel. Another patient came in, again not mine, but was 100 years old complaining of nausea and vomiting. I can't even tell you how many people come in with that complaint. Well it turns out, she was having a heart attack, and not just any old heart attack, but the really really bad kind. The kind where the artery is completely blocked, and in this type of heart attack, treatment entails either emergency surgery to open up the artery, or a medicine is used to help break up the clot. In all of the chest pain patients I have seen come in so far, none of them either even had a heart attack at all, or the few that I've seen that really did have a heart attack to some extent was not the type to be treated like this. I ended up leaving while they were still treating the patient, so I am not sure what happened after I left. Unfortunately, we don't have the capacity to treat the bad heart attacks at my hospital, so the patients get transferred to another hospital that does.

That's all for now. Two more shifts this week, then I have three days off. And a 10 year anniversary to celebrate during those days off. :)

Shift 31

The only real thing to talk about is the fact that I administered medication today to a patient who needed to undergo moderate sedation. She dislocated her elbow and in order to put it back-a process called reduction- she would be moderately sedated, so she didn't feel pain, and was virtually unconscious for a few minutes yet was able to maintain her own airway. It was pretty cool, I must say. Of course,I was not alone. There were two doctors, the respiratory therapist, my charge nurse and another nurse who was just watching.

Other than that, not much else to report. Friday is my next shift, and hopefully it will be the start of a great weekend. One can hope, especially since I have to work ALL weekend.

Shift 30

Not much interesting to report, except for the fact that I had a code tonight. Oh and a patient who we had to call a "stroke alert" for, which means its possible she was having a stroke, and we alert the whole hospital so a team will come and/or know what to do. For instance, the lab sends someone to draw the labs, CT will know to keep a machine open because this patient needs a CT scan right away and they send a tech to come get the patient, etc etc. It turned out that she did not have a stroke. Otherwise, it was a pretty ok day.

I'm tired, so I am going to hit the hay. I'm off until Tuesday, so I am going to enjoy some time with my babies this weekend and a date night on Saturday with my husband!

Sometimes

things just don't make sense.

Take for instance a patient I had who came in via fire rescue because he was eating take out food at home when he bit down on something hard and cut his mouth. It bled, apparently, but when I saw it is just looked like a blister. The doctor also thought the same thing.

But really. Was it necessary to call fire rescue to bring you to the hospital?

I know that may sound harsh or unsympathetic, but the guy was really fine. He was discharged within an hour of his arrival.

When I took the report from the paramedics on the patient, and they told me why he was there, I just looked at them with eyes that said, "Really?" and they just shook their heads. I just do't get people.

One more example- a man brings in his 14 year old son for a headache. Ok, I get it. Your kid is in pain. I've had a really bad headache before where I contemplated a visit to the ER. So as I am asking the patient the usual "When did this start? Any other symptoms-nausea, vomiting, sensitivity to light or noise?", he tells me that there are no other symptoms, and that the headache started 10 minutes ago.

(*scratches head)

Really? 10 minutes. Sheesh.

Shift 29

Today was a crazy day. Busiest I have ever seen it. It had been going on for well before I came on shift at 2pm. When I walked in, the waiting room was full of patients- of all things- waiting. All available beds were full. We ended up opening up 3 beds in our satellite area thats hardly ever used and when it is, its used for overflow ICU patients. Never in my short time there I had seen it being used for overflow ER patients, and today I did. I was sent to the satellite to open it up as an extension of our fast track area, where we see lighter load patients there for things like cuts, sprains, breaks, etc, where they can get in and out and turnover is quick. I worked down there until around 7pm when we had to close the satellite so that our ICU can set up to use the area for their patients because they were also overflowing, or at least anticipated themselves to be.

I was then sent to take an assignment to relieve a nurse that came in at 7am. Usually, I float because we have a charge nurse and 3 night nurses who come in, so they all take assignments and I float to help them keep up, or I go to triage. This shift, however, we had just the charge nurse and 2 other nurse coming in, so we were shorthanded on the worst of all nights.

So I was given rooms 5, 6, 7, and 8, which were all full, and then with those rooms we also have hallway beds, so I also had 5a, 6a, 7a, and 8a. This was the most patients I have ever had at once. The other 2 nurses never had as many as me. The most either one of them could have had, just because of how our ER is designed, is one nurse with 4 rooms and 2 possible hallway beds, or the other nurse with 5 rooms and 2 possible hallway beds. I think the one nurse had 4 rooms and 1 hallway bed, and the other nurse had 5 rooms and 1 hallway bed. So here I am with 8 patients, sinking, literally, and the others had 5 or 6 patients.

I cannot even begin to tell you how behind I was and how stressed I was about it. I cried twice. I tried not to but I really just was beside myself. Now granted, I wasn't hysterical or anything, I just had eyes that welled up with tears in frustration- both at the situation and at myself for not being able to keep up and for also letting it get to me. The day charge nurse asked me to help her with something and when were we in the room (not a patient's room) is where I cried the second time. I vented to her and she was so nice, she listened and told me that I was not the only one who cried today, that several other nurses did, too, including herself, and they were seasoned, experienced nurses, so she told me not to feel bad. It was a rough, hard day.

And I am glad its over. But I am also thankful for the people that I was working with because they were all very helpful and it could have gone a lot worse if a person or 2 were there to work instead. For the most part, everyone I work with are great people, but there are a couple who are not quite as nice or easy to get along with.

For now, I am going to thoroughly enjoy my day off.

Shift 28

Not a fun day. I went in thinking things were going to run smoothly today because we had an extra nurse to float.

Not so.

We were pretty busy but totally manageable. Until the computers went down that is. Not just the ER, not just the whole hospital, but apparently other hospitals that are part of our corporation. Talk about a mess. Three or four hours we went with no computers. And yes, once upon a time we had all paper charting, but at least then, you knew how to chart everything, how to see if there are new orders on your patients, how to get lab results, radiology results, etc. Let's just say every nurse I talked to today was also feeling just as lost as I was. At one point, I was wondering how I was going to make it another 7 hours like that. Then, thankfully, the computers came back up. I'm just glad that I was not the only one lost and frustrated. I hope to never have that situation happen again.

Other than that, my shift was pretty uneventful. I did hold the head of a 1 year old still while she had to get 10 stitches in her forehead. I tried hard not to cry. After the computers being down, and having trouble pulling a med for a patient because of the computer issue, then dealing with my charge nurse who seemed to be in a bad mood and then holding this poor kid who was screaming while her mom was crying too, I was just about to lose it. Too many emotions. But I held it together.

Somehow.

And now, if you'll excuse me, I am going to go climb in my bed and sleep after the longest day ever.

Good night!

Shift 27

Today I was called to see if I could come in early to help. I was tired, actually trying to nap for a bit when they called, but I figured if I went in early, I can get out early and go to bed earlier than if I get out at 2:30am. I assumed it would be terribly busy when I got in since they had called me in, but it really wasn't too bad at all. I floated for the "day" part of my shift, where I work with all the day staff. I went to lunch and when I came back, night shift was on and I ended up in triage for the rest of my shift. My shift was pretty uneventful except for yet another code, and a psych patient who I thought was going to attack me when I walked her to the restroom. She actually grabbed my face and I quickly removed her hand and gave her a stern warning not to put her hands on me again.

Overall, I am really liking my job. I am appreciating more and more the ER as compared to the rest of the floors of the hospital. I am continuing to learn and grow as a nurse.

Now I am off to bed. Only 11 hours until shift 27 begins!