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.........