Thursday, March 29, 2012

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!

Sunday, March 25, 2012

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.

Monday, March 19, 2012

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. :)

Wednesday, March 14, 2012

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.

Friday, March 9, 2012

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!

Wednesday, March 7, 2012

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.
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.

Monday, March 5, 2012

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.


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!

Sunday, March 4, 2012

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!

Thursday, March 1, 2012

Today was a day of firsts.

I had my first code, meaning, it was my patient that was coded. The patient came in from fire rescue, already coding. He was down too long. There wasn't anything we could of done. Unfortunately, he was gone before he got to us. We tried for a while anyway, but nothing we did or would have done would have helped. I didn't do much in my code, there was so many people doing things anyway.

About an hour to an hour and a half later, we had a second code come in. (Another first- 2 codes in one day. If you remember, since I've started working in the ER, there have only been 2 other codes total, and here 2 in one day). In this code I did a lot more since he wasn't my patient. I pushed a whole bunch of meds. I did chest compressions. Unfortunately this patient, too, was gone before he came in, but we worked on him for a little while still.

One patient was in his 70s the other was in his 40s, but with both patients, I was surprised at my lack of emotion. I'm not sure if I should be bothered by this, or if I've just already found a way to compartmentalize my emotions and not let them get to me, or if perhaps none of my code cases have been personal enough yet.

I'm not sure.

Something off topic- last shift, we only had 2 techs, and because we were short handed, and I am typically a floater (meaning, I help wherever help is needed), I had to help transport patients from the ER to the floor where they had been admitted to. While I was bringing a couple of patients there, I took notice of the floors where I had once been a student. I remembered how much I disliked those floors. And I realized how happy I am to be where I am. While I may be stressed with my job at times, maybe even a lot of the time, its better than being stressed AND hating my job. I really like my job. It's interesting and I learn a lot. And with each day I realize how much I do know. And I'm amazed.

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