To all my fellow ER nurses (and to me!). Its Emergency Nurses week and today is 'our day'.
Some days I still sit back and go wow am I really a nurse?? An ER nurse? Holy crap how did that happen! LOL. Mom says, I never think that I always knew you would be one!
Still love it. Still learning every day - sometimes several things a day! Still love being hands on with my patients making differences in their lives - at least I hope so!
xoxo
Wednesday, October 10, 2007
Tuesday - what a difference a day makes
Simply put Tuesday was a refreshing break. NOTHING compared to Monday. In fact when we left this morning there were only 3 pts in the ED. Big difference compared to Monday. And I only had a full zone of pts for like 3 hrs. After that, I only had 1 or 2. Its a blessing though cause anyone who was there Monday could not have done that again Tuesday.
And my orientee is on her own and flying high! So exciting she has been on her own for 2 weeks now and doing awesome. Pat on the back to me, pat on the back to her. I know I can only teach so much and she has to do it and that she has! It actually came full circle when the nurse who oriented me on day shift for two months complimented my orientee after picking up her pts one morning. Kinda nice to see what goes around comes around - in the good sense.
And my orientee is on her own and flying high! So exciting she has been on her own for 2 weeks now and doing awesome. Pat on the back to me, pat on the back to her. I know I can only teach so much and she has to do it and that she has! It actually came full circle when the nurse who oriented me on day shift for two months complimented my orientee after picking up her pts one morning. Kinda nice to see what goes around comes around - in the good sense.
Monday....or as we referred to it....hell day
(Long - but will give u a glimpse into some of my nights if you read it!)
This past Monday was the worst I have EVER seen my ER......plain old down right so freaking full its not even safe for the patients that are there. Why do I say that? Well when I walked in the door and took a look at our 'tracking board' that tells us who is in all the beds and who is in the waiting room..........the waiting room had more than 35 people in it. Now, keep in mind that's 35 people IN ADDITION TO the 40 people already in our beds to be seen. Also keep in mind our typical flow is around 145 pts in a 24 hrs period. Needless to say with 75 of them there at the same time.....it wasn't a good thing. The top person had been waiting something like 4 hrs.
So I put on a smile and go to get my assignment (yes I actually do try to smile!). In a situation like this there are 2 things you really don't want to be #1 the Triage nurse who has to see every pt that walks through the door and decide how sick they are or...... #2 be the nurse in T2 who brings pts back prior to having rooms and starts their work up. IV's, blood work, urine, CT scans, xrays, etc. Well guess what. I was saved from #1, but not from #2. Laughing, that's how I responded. I mean seriously if I didn't find humor in having to deal with irate pts who have been here for hours listening to me call their name only to tell them we still don't have a room but I will draw their blood, etc what else was I to do? Cry? I seriously considered it and that came in as a close second.
Only relief was that we were OVER staffed for once and I had 2 other nurses in T2 with me. Which is nice to have more than just one, cause typically that's all there is. On to the next step - evaluate the 35 pts in the waiting room........well lets see I have 5 priority 2 pts meaning they are at the top of the list to be started some abdominal pain, one chest pain, one change in level of consciousness...and it goes on. Start taking those pts and working them up. Then I lose another nurse to do conscious sedation. Bam down to 2 nurses, ok that's still better than 1. Next work up another pt. Find out the triage nurse is 45 minutes behind triaging pts cause so many are walking in the door. Bam down to 1 nurse, just me. The other nurse got lost to helping triage for about an hour....... I'm still working pts up. She's back and we are two-timing which helps us get through the list faster. But then again the faster we worked the more pts that walked in the door. Pts were being seen IN THE HALLWAY by docs cause there was no where else to take them!!!!
Lets just say I'm all excited at 11 pm that I should be getting a zone and have my 3 or 4 pts and be in my own little world. Just kidding, we are still overstaffed. I need to do a conscious sedation on a pediatric pt with a broken wrist. Grand, exposure to radiation for me and small hot cramped room with a crabby ass orthopaedist. Just a topper for the night. Rounding up the papers, the cast cart, the portable xray machine, etc. So I can be ready. Then I get told you can go back to T2, the other nurse can do the sedation and we have an agency nurse coming down from one of the floors to cover the other nurse. SERIOUSLY? Back to T2....that's like totally not nice!! But ok, off I go. Back to T2 only like 20 pts in the waiting room, ok we are making progress. Phone rings, Beth the agency nurse isn't coming down from the floor and the other nurse started the sedation so now we need you to cover Peds. O Lord.....peds, me?? NOT a good combo. Last time I had to start 2 IV's on kids 3 y.o. and 6 y.o.. Did not make me happy at all. The good news is there is only 1 kid (Other than the one who was being sedated) and there could have been 4 more. The bad news, its a 7 week old baby.....who needs blood and a straight cath for urine. Just my damn luck. Can I take the conscious sedation back with the crabby ortho guy and give this to the other nurse? Nope sure cant. So I call charge cause I have never cathed a baby girl and I don't like to stick peds pts. I tried and felt a very small but good vein, stuck her....nothing. But the other girl had trouble too so I don't feel so bad! Blood and urine, done. Other nurse done with sedation, so I am back to T2 around 1230.
Sit down review the computer to see who to start first....call charge and confirm she really does want me in T2. She says no, actually I want you to float and take pts upstairs. Ok done. 1245 went to main nurses stations asked if anyone needed help. Told the nurse for room 2 I would take her pt upstairs when transport got there. Walk to main 2 ask if anyone there needs help. Start an IV medicate a pt. 130 am - Go back to main 1 see charge nurse.....get told I'm picking up a zone of pts because that nurse just tripped and fell and now needs to be seen. LOL. seriously how many more times can we change what I'm doing?? Laughed and went with the flow. Fortunately she wasn't hurt and I only inherited 2 pts in a zone that was closing. Stayed there for 1.25 hrs.
3 am pick up a zone with 3 pts. Be happy, that's all I have to worry about. 1 demented little old lady, one lady with sob chronic probs and one belly pain we are ruling out gall bladder and appendicitis on. Happiness is......till the box goes off that tells us an ambo is coming in. I can hear the alert noise but nothing after that. Finish doing my work. Medicating a pt. Get a call from the doc, we are moving your pt from room 7 and putting an ambo pt in there. But wait, where the hell did my other pt go cause she needed a rash of things.....can someone tell me where she is??..... Finish medicating several minutes later. Go to gret the new pt - realize she hasn't been triaged. Notice the EMS guy being an asshole, so I give him the same courtesy. O except this lady was having trouble breathing and this asshole couldn't bother to at least put her on some oxygen once they switcher her bed? Are you kidding me.........jerk. Realize this is the mom of a CCU nurse here, woa gotta love that.......watch your steps. I think I'm a good nurse and I do things like I should but a little extra attention to details doesn't hurt things.
645 New nurse asking 'who has B zone'. O thank God ......and I turned it all over. Except at 708 CCU called to get report on one of the pts. Can I give them reports since I'm still there and the new nurse doesn't know about the pt? Of course I can. I would want someone to do it for me......if only they new the night we had.
Home, in bed and asleep as fast as I could get. And to think I had to go back on Tuesday.
This past Monday was the worst I have EVER seen my ER......plain old down right so freaking full its not even safe for the patients that are there. Why do I say that? Well when I walked in the door and took a look at our 'tracking board' that tells us who is in all the beds and who is in the waiting room..........the waiting room had more than 35 people in it. Now, keep in mind that's 35 people IN ADDITION TO the 40 people already in our beds to be seen. Also keep in mind our typical flow is around 145 pts in a 24 hrs period. Needless to say with 75 of them there at the same time.....it wasn't a good thing. The top person had been waiting something like 4 hrs.
So I put on a smile and go to get my assignment (yes I actually do try to smile!). In a situation like this there are 2 things you really don't want to be #1 the Triage nurse who has to see every pt that walks through the door and decide how sick they are or...... #2 be the nurse in T2 who brings pts back prior to having rooms and starts their work up. IV's, blood work, urine, CT scans, xrays, etc. Well guess what. I was saved from #1, but not from #2. Laughing, that's how I responded. I mean seriously if I didn't find humor in having to deal with irate pts who have been here for hours listening to me call their name only to tell them we still don't have a room but I will draw their blood, etc what else was I to do? Cry? I seriously considered it and that came in as a close second.
Only relief was that we were OVER staffed for once and I had 2 other nurses in T2 with me. Which is nice to have more than just one, cause typically that's all there is. On to the next step - evaluate the 35 pts in the waiting room........well lets see I have 5 priority 2 pts meaning they are at the top of the list to be started some abdominal pain, one chest pain, one change in level of consciousness...and it goes on. Start taking those pts and working them up. Then I lose another nurse to do conscious sedation. Bam down to 2 nurses, ok that's still better than 1. Next work up another pt. Find out the triage nurse is 45 minutes behind triaging pts cause so many are walking in the door. Bam down to 1 nurse, just me. The other nurse got lost to helping triage for about an hour....... I'm still working pts up. She's back and we are two-timing which helps us get through the list faster. But then again the faster we worked the more pts that walked in the door. Pts were being seen IN THE HALLWAY by docs cause there was no where else to take them!!!!
Lets just say I'm all excited at 11 pm that I should be getting a zone and have my 3 or 4 pts and be in my own little world. Just kidding, we are still overstaffed. I need to do a conscious sedation on a pediatric pt with a broken wrist. Grand, exposure to radiation for me and small hot cramped room with a crabby ass orthopaedist. Just a topper for the night. Rounding up the papers, the cast cart, the portable xray machine, etc. So I can be ready. Then I get told you can go back to T2, the other nurse can do the sedation and we have an agency nurse coming down from one of the floors to cover the other nurse. SERIOUSLY? Back to T2....that's like totally not nice!! But ok, off I go. Back to T2 only like 20 pts in the waiting room, ok we are making progress. Phone rings, Beth the agency nurse isn't coming down from the floor and the other nurse started the sedation so now we need you to cover Peds. O Lord.....peds, me?? NOT a good combo. Last time I had to start 2 IV's on kids 3 y.o. and 6 y.o.. Did not make me happy at all. The good news is there is only 1 kid (Other than the one who was being sedated) and there could have been 4 more. The bad news, its a 7 week old baby.....who needs blood and a straight cath for urine. Just my damn luck. Can I take the conscious sedation back with the crabby ortho guy and give this to the other nurse? Nope sure cant. So I call charge cause I have never cathed a baby girl and I don't like to stick peds pts. I tried and felt a very small but good vein, stuck her....nothing. But the other girl had trouble too so I don't feel so bad! Blood and urine, done. Other nurse done with sedation, so I am back to T2 around 1230.
Sit down review the computer to see who to start first....call charge and confirm she really does want me in T2. She says no, actually I want you to float and take pts upstairs. Ok done. 1245 went to main nurses stations asked if anyone needed help. Told the nurse for room 2 I would take her pt upstairs when transport got there. Walk to main 2 ask if anyone there needs help. Start an IV medicate a pt. 130 am - Go back to main 1 see charge nurse.....get told I'm picking up a zone of pts because that nurse just tripped and fell and now needs to be seen. LOL. seriously how many more times can we change what I'm doing?? Laughed and went with the flow. Fortunately she wasn't hurt and I only inherited 2 pts in a zone that was closing. Stayed there for 1.25 hrs.
3 am pick up a zone with 3 pts. Be happy, that's all I have to worry about. 1 demented little old lady, one lady with sob chronic probs and one belly pain we are ruling out gall bladder and appendicitis on. Happiness is......till the box goes off that tells us an ambo is coming in. I can hear the alert noise but nothing after that. Finish doing my work. Medicating a pt. Get a call from the doc, we are moving your pt from room 7 and putting an ambo pt in there. But wait, where the hell did my other pt go cause she needed a rash of things.....can someone tell me where she is??..... Finish medicating several minutes later. Go to gret the new pt - realize she hasn't been triaged. Notice the EMS guy being an asshole, so I give him the same courtesy. O except this lady was having trouble breathing and this asshole couldn't bother to at least put her on some oxygen once they switcher her bed? Are you kidding me.........jerk. Realize this is the mom of a CCU nurse here, woa gotta love that.......watch your steps. I think I'm a good nurse and I do things like I should but a little extra attention to details doesn't hurt things.
645 New nurse asking 'who has B zone'. O thank God ......and I turned it all over. Except at 708 CCU called to get report on one of the pts. Can I give them reports since I'm still there and the new nurse doesn't know about the pt? Of course I can. I would want someone to do it for me......if only they new the night we had.
Home, in bed and asleep as fast as I could get. And to think I had to go back on Tuesday.
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