Wednesday, September 26, 2007

The things we do...

OK, our management has finally decided that there has been a big issue since we have moved into our new ER, namely nurses are disappearing faster than than free food left in the break room. And not just the new nurses either. Nurses that have worked 10+ and 20+ years in our ER have and are leaving. Some of the reasons I have posted in previous blogs.

Which brings us to their solution. Let's pay incentive. They are offering 6.25 extra an hour for each additional shift picked up along with a 500 bonus if you work 60 extra hours in a 6 week period. Oh, they get us where it hurts! They know most nurses will not turn down an incentive like that. So for 6 weeks, we might be fully staffed, although it will be with tired, overworked, grumpy nurses. And the clincher is that you will lose everything if you call in even 1 day. So our call ins will go down as well.

But I have been doing the math here, pretaxes, I will only make an extra 875, and the OT. Now my OT is pretty good, but I would rather make it in a less stressful department, i.e in my old unit. There they pay 75 for a 8 hour or less shift and 125 for a 8 hour or more shift, straight up, this averages to somewhere around 10 more an hour. Now they are not offering the 500 dollar incentive for 60 hours in 6 weeks, but as for straight up overtime, you can not beat it. I have 2 and only 2 patients, the same 2 patients all night long. And these patients are either intubated, recovering from open heart surgery or both, so they do not whine very much and are very appreciative. It is a strictly nurses run unit at night, we have a practitioner that handles all of the problems that we cant (which are few and far between, we are expected to be able to handle pretty much anything), she calls the MD if she cant handle it. We can eat at the nurses desk. we have the radio playing in the background. We surf the web when we are not busy. We carry morphine and syringes in our pockets with out "the joint" Nazis making a scene, We have techs that stock and check off crash carts and do all of those non patient care things that we are required to do in the ER, every last one of our patients is truly sick, it is heaven.

BUT.... i am a trauma junkie. I love it. There is no rush like the rush you get from a GSW or bringing back a car crash victim that has coded on scene, or a full arrest that actually makes it, not just a rhythm, but with full function. Or a stroke that get tPa'd and you start seeing them regain what they had lost a few hours before. A heart attack that survives because they get to the cath lab in less than 20 minutes and the blockage is removed. I like never knowing what is going to come through the door next.

I love my people in the ER, quirkiness reigns. Not just anyone can work there. It is also the only place I have seen where the docs and nurses work like a true team. Even in my small unit with 4 docs, it just isn't the same. Our ER docs have our backs, and we have theirs. We hang out after work, we know each others families, we celebrate birthdays, life and death. We drown our weekend sorrows on Monday mornings in margaritas with each other at 0700. We laugh over the stupidity of patients and each other and cry over the defeats. We tell dirty jokes, are inappropriate, and the lot of us could be the poster children for sexual harassment and how not to be politically correct.

I guess i am pulling my extras in the ER the next few weeks. Single parent with Christmas just around the corner, can't look a gift horse in the mouth. I just wish management would come up with a longer lasting plan, ie hire more people, more support staff, and slow down the flow. Wait for my bed to be clean and dry before you throw a 21 year old on it whose "emergency" is a cut left pinkie toe. Waiting 10 more minutes so I can chart, pee, or drink something will not make this guy die. I will probably be shooting myself in the foot come next month, but oh well, I start next week on my extras. Pray for me.

Tuesday, September 25, 2007

Weekends Suck

My weekend seemed to have "theme nights" all weekend long. I worked with the same doc all weekend and he is one of my favorites, so that is probably the only reason I did not sign myself in under Sunday night's theme. On Friday night, we were like trauma central. 8 level 2s, 4 level 1s, including 2 peds, 2 trauma arrests, including 1 ped. That is my kinda ER night, we were humping all night long, but I actually felt I did some good in the world. We also had 1 heart alert (our jargon for a heart attack that needs to go to the cath lab), a stroke alert, 2 full arrests and a head bleed that turned into a full arrest. I also think there was 4 intubations. For the first time in a long time I felt like I was doing true emergency medicine and not free clinic work.

Then on to Saturday night. That was the march of the vaginas night. And, of course, all of the male nurses in my department were on my end, so I ended up being tootie girl all night. I think I did 9-10 pelvics with the doc that shift. I felt like I needed some kinda symbol like batman, except it would be a kinda inverted leg symbol for them to flash when they needed me and I would come with speculum and swabs in hand, rolling the pelvic cart. I have a theory about pelvics and the weekend that has to do with a long, wild night on the town, followed by regret and fear, and winding up in the ER, because 2-4 am is consistently tootie hour. You can bet on any given night between those hours, there will be at least 1\3 of the patients out there females complaining of lower abdominal pain and\or vaginal bleeding.

Sunday night, this was, the loony bin let everyone out with weekend passes and they wound up in our ER. Over half of the patients on our end that night were psych evals, and every single patient I had was a psych eval, save 2 traumas. And these were not run of the mill psych evals either. These were scary crazies. 1 one mine had beat up 5 cops, while in handcuffs, sprayed 4 times with pepper spray and tasered 5 times, I am not exaggerating one bit. I also think I forgot to mention that he was about 6' 5 and weighed no less than 350. the only good thing about this guy, was he seemed to like the nurses, so he ended up not being too bad, until he would catch sight of the security guard that was posted at his room, then he would go ballistic again. the worst thing about our new ER and psych patients is that we no longer have a psych eval room, so we have to pull everything out of the room before putting the patient in it. This gets tiresome, and crowded when over half of the patients are there for psych evals and so your hallway is full of stuff from all of the rooms. The other bad thing was I had an attempted suicide placed in a room that was not visible from the nursing desk, so until she went upstairs, I practically had to hang out right by her room, so nothing could happen. I am so glad the weekend is over!!!

Wednesday, September 19, 2007

Selected pics that remind me of some of my favorite bloggers

ERNursey, letting you know all ER nurses feel how you do.....

Scalpel, for your cat fetishes and your bucking the system personality.....

The Docs over at MDOD, to counteract the antidarwiniasm of medicine....

Whitecoat rants- maybe your ED of the future could include this for pain management....

Monkeygirl, cause she loves her Pirates....

CharityDoc, here's hoping you stop procrastinating and start back blogging.....

Nurse K, this just reminded me of the Speaker, and we all know how tight yall are.....

And I am probably going to hell for this one, but it was so funny I couldn't resist it.

Lawyer Bloopers

Here are some attorney bloopers that put the chart bloopers to shame...

These are from a book called Disorder in the American Courts, and are things people actually said in court, word for word, taken down and now published by court reporters that had the torment of staying calm while these exchanges were actually taking place.

ATTORNEY: What was the first thing your husband said to you that morning?
WITNESS: He said, "Where am I, Cathy?"
ATTORNEY: And why did that upset you?
WITNESS: My name is Susan!
ATTORNEY: What gear were you in at the moment of the impact?
WITNESS: Gucci sweats and Reeboks.
ATTORNEY: Are you sexually active?
WITNESS: No, I just lie there.
ATTORNEY: This myasthenia gravis, does it affect your memory at all?
ATTORNEY: And in what ways does it affect your memory?
WITNESS: I forget.
ATTORNEY: You forget? Can you give us an example of something you forgot?
ATTORNEY: Do you know if your daughter has ever been involved in voodoo?
WITNESS: We both do.
WITNESS: Yes, voodoo.
ATTORNEY: Now doctor, isn't it true that when a person dies in his sleep, he doesn't know about it until the next morning?
WITNESS: Did you actually pass the bar exam?
ATTORNEY: The youngest son, the twenty-year-old, how old is he?
WITNESS: Uh, he's twenty.
ATTORNEY: Were you present when your picture was taken?
WITNESS: Are you shitt'in me?
ATTORNEY: So the date of conception (of the baby) was August 8th?
ATTORNEY: And what were you doing at that time?
WITNESS: Uh.... I was gett'in laid!
ATTORNEY: She had three children, right?
ATTORNEY: How many were boys?
ATTORNEY: Were there any girls?
WITNESS: Are you shitt'in me? Your Honor, I think I need a different attorney. Can I get a new attorney?
ATTORNEY: How was your first marriage terminated?
WITNESS: By death.
ATTORNEY: And by whose death was it terminated?
WITNESS: Now whose death do you suppose terminated it?
ATTORNEY: Can you describe the individual?
WITNESS: He was about medium height and had a beard.
ATTORNEY: Was this a male or a female?
ATTORNEY: Is your appearance here this morning pursuant to a deposition notice which I sent to your attorney?
WITNESS: No, this is how I dress when I go to work.
ATTORNEY: Doctor, how many of your autopsies have you performed on dead people?WITNESS: All my autopsies are performed on dead people. Would you like to rephrase that?_________________________________________
ATTORNEY: ALL your responses MUST be oral, OK? What school did you go to?
ATTORNEY: Do you recall the time that you examined the body?
WITNESS: The autopsy started around 8:30 p.m.
ATTORNEY: And Mr. Denton was dead at the time?
WITNESS: No, he was sitting on the table wondering why I was doing an autopsy on him!____________________________________________
ATTORNEY: Are you qualified to give a urine sample?
WITNESS: Huh....are you qualified to ask that question?______________________________________
And the best for last:

ATTORNEY: Doctor, before you performed the autopsy, did you check for a pulse?
ATTORNEY: Did you check for blood pressure?
ATTORNEY: Did you check for breathing?
ATTORNEY: So, then it is possible that the patient was alive when you began the autopsy?WITNESS: No.
ATTORNEY: How can you be so sure, Doctor?
WITNESS: Because his brain was sitting on my desk in a jar.
ATTORNEY: I see, but could the patient have still been alive, nevertheless?
WITNESS: Yes, it is possible that he could have been alive and practicing law

Layperson CPR

I used to think that the more people who knew CPR, the better off we would be as a population, until last night. Had a call from EMS that stated they were bringing in a patient that had received bystander CPR, patient had a oulse and had in fact never appeared to lose one, vital signs were stable. Pt was complaining of chest pain. Apparently, Papa had passed out drunk in the floor, and Mama and son, got scared and immediately started into CPR, WITHOUT FIRST FEELING FOR A PULSE. So as they were going to town on chest compressions (they had to be doing very adequately, the patient had 3 cracked ribs), the patient awakens from his drunken stupor and starts swinging. Ems arrives to see the son on the dad doing chest compressions, and about 30 seconds later, the dad startwildly cussing snd swinging. Only injuries noted was a very bruised sternum that extended to the left side and 3 cracked ribs. And we could not get the family to understand that they in fact DID NOT save their dad's lofe. They were bragging to everyone that once CPR started, the dad awakened quickly, hmmm, wonder why?

Tuesday, September 18, 2007

I Love This Game!

This is one of the things i love about college football, especially in my favorite conference, the SEC. You have Kentucky and South Carolina with undefeated records right now, these two teams are usually near the bottom of the East(although granted the gamecocks now have the one of the best coaches ever in college football so they were expected to improve), with Vanderbilt having a winning record at 2-1. The "powerhouses" of the east, Tennessee and Georgia both have losing conference records(0-1), while Tennessee just has a losing record(2-1)and has fallen out of the top 25(oh it kills me so....). Florida is sitting at the top, which even though they won the BCS last year, it was not believed that their offense or defense would hold up this year.

Now onto the West. Alabama which was not even ranked preseason, is top of the conference, with LSU right behind. (Al has played more conference games than LSU presently). LSU has arguably the best team in college football this year. Mississippi State beat Auburn, who was previously ranked fairly high in the polls. Arkansas and Auburn both have shown disappointments. About the only team who has not surprised anyone, as of yet, is Mississippi.

Unless you have lived in the South, I do not believe anyone truly understands the deep significance it plays in our lives. ERs and stores are ghost towns, college towns populations quadruple, RV's park outside of stadiums, long road trips are planned to away games, weddings and other important things are scheduled around ball games. Teams can go all season long losing and as long as they beat their rivals, the season is salvaged (Alabama and Auburn, Tennessee and Florida, Mississippi state and Mississippi, etc) or vice versa, you can win all year long and if you do not beat your rival, all those other wins are insignificant. Everyone replays all of the games the next day in great detail, everyone becomes a football expert. Bragging rights are held all year long to the winner. It is the strongest conference hands down,our weakest teams can hang with any team in any other conference and can beat most, maybe not the conference champs, but usually the second or third teams. There are no easy conference games for anyone.

How can anyone not love college football?

Monday, September 17, 2007

Never Expected This...

Had an unresponsive drunk 18 year old brought in frantically by his parents. We are cutting of his clothes, putting him on the monitor starting IVs, cathing him etc, all the stuff we do in this situation. Sats and vital signs are fine, but this guy is not responding. Not with the 14 gauge IV stick, not even with the Foley insertion. The ICU nurse in me kicks in and I start doing all of the mean things to elicit a response. Now you should know that I am the nurse that people come to get when they have an unresponsive patient because I can usually make ANYONE respond to pain. I am very vigorous at eliciting response to painful stimuli. Quotes one nurse I work with, "If I am ever brought in unresponsive, don't let bohica near my room". Now before you go thinking I am some kind of sadist that gets off on people's pain, this is so not true. I am trying my hardest to truly assess a patients neuro status. I don't just jump right in with the vigorous sternal rubs and nipple twists, but do get there if nothing else elicits a response and if those do not work, I will do nail bed rolls. Back to the story. So this guy does not even flinch on Foley insertion, which tells me 1. he is not faking 2. he is really close to comatose. Now I am not wanting to intubate this patient if at all possible so I give him a sternal rub and I get a little twitch of the mouth. I proceed to do a nipple twist, and what does this drunk guy do? He smiles, rolls his eyes,moans and has experienced a sudden rush of blood flow to a certain medial lower organ. The doc and I had to run out of the room and died in a fit of laughter.