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!