It's been a while.....

to say the least.

I left my old ER job for the "greener grass" of an Ambulatory Surgery department back in October.  After some run around getting into the department, which should have been my first warning sign, I took the only position they had open- a part time position.  It was a 3-day a week job, Mondays-Fridays, no weekends, no holidays.  I was in at 6am or 7am and out by 3:30 or 4 the latest.  Pretty awesome schedule, I could pick the kids up from school every day, have the weekends off with them, go to basketball practices, games, etc. It was the dream hours.  I wanted to get my foot in the door so when a full time position opened up, I would be first in line. The schedule was less than ideal for a part timer, however.  I never knew which days I would work until a day or two before.  Since I only worked 3 days a week, I only worked on the busiest days, and in a outpatient surgical department, that all depends on the surgeries on the schedule.  Also, as a part timer, I was always the first to go home when it was slow, or not come in at all.

A full time position opened up pretty quickly, but nothing was mentioned to me regarding it.  A person had gotten fired, so I was expecting a position to open, and I kept my eyes opened on the website for a job posting and withing a few days, there it was.  So, I asked about it and if I would be getting the position, and once again I was given the run around.

Just about that time, I had received a call from an ER, a very, very big ER, level I Trauma Center ER, asking me to come in for an interview.  Initially, I had applied for a per diem position to help supplement my days off in the Ambulatory department. I went in the next day, met with the nurse manager, and after we were done, she checked to see if anyone was available to do a peer interview with me, which they were.  So then, I had a peer interview, and then took a tour.  I spent a total of 3 hours there, the longest I have ever spent for an interview process. I had a good feeling, but I've had those before, and I was still unsure of what I wanted to do.  I knew I wanted out of my new department, and out of my hospital.  My overall experience there had been less than stellar, and I knew it was time to move on, but I didn't want to jump into the first thing that popped up.  Plus, the only full time positions they had available was on night shift.  Gulp.  I had never worked full nights before. At my old ER, I started working the 2pm-2am shift, then did 1pm-1am, then moved to day shift 7am-7pm. Well, the very next day, the hospital called me with an offer that literally made me cry- partially with happiness, partially with confusion and frustration.  The offer was too good to turn down, I'd have been an idiot to do so.  But I didn't want to give up my awesome hours and no weekends, even though I knew it just wasn't going to work.  I wasn't meshing with the people there, either, so even if I got full time, I felt like a fish out of water.  I missed my old ER team something fierce. 

I took the weekend to think about it (as the offer came on a Friday) and accepted the offer on Monday morning.  The pay was good, I could put my name down on a waiting list for days that should move pretty quickly, and I would get tons of experience that I may never get anywhere else. 

I started my new (mis)adventure on January 16th.  I did a bunch of hospital orientation, nursing orientation and computer orientation classes.  Then, last week I started in the ER, with my first day being in triage.  I've been on the floor with someone 2 other days as well.  It is quite a change from how things were at my old place.  We have 64 beds and probably about half that many in hallway beds while my old hospital had 23 with only room for about 7 or 8 hallway patients. I left the ER the other day and we had 90 something patients roomed.  My old ER usually saw that many in one day.  I had never seen so many people waiting in the waiting room before, or for so long, and especially at my old hospital. 

At any rate, I thought with the start of a new year and a new job, maybe now would be a good time to restart my blog and share my journey as a ER nurse navigating her way through life in the one of the busiest ERs around. At night.

I'm going to need A LOT of coffee......

So, welcome back!

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.