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MunkiRN 6,071 Views

Joined: Jul 6, '09; Posts: 57 (32% Liked) ; Likes: 80

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  • Aug 7 '13

    So you feel like vindicated that a "mistake" was averted because you refused to draw blood from a dizzy, dyspneic patient having chest pain. Hmm.

    OP, if I am ever your patient and I suddenly develop CP, SOB and dizziness ... draw my blood from whatever access you can get. Please and thank you. And if my doc says, "oh, no EKG changes ... cancel the labs" ... or writes an idiotic order like "no blood draws from midline" ... please assist me to sign myself out AMA so that I can get a doc who has his/her stuff together.

  • Aug 6 '13

    I stare at the four LED panels in front of me, each displaying cases for every OR, listed by room. I groan inwardly, bracing myself for a busy day.

    "Canes, you ready?" asks the Medical Director. Every morning, the Medical Director and the Anesthesia Coordinator and I meet to discuss add on cases, and the movement of scheduled cases to ensure the completion of the day's schedule.

    We collaborate on which cases to move, which order add on cases should go, and discuss any unusual circumstances, such as time constraints for surgeons, specialty staff availability for difficult cases, and special requests.

    Today is conference day, which means that surgical staff and anesthesia staff meet for the first hour of the morning prior to starting cases. Because I am the charge nurse, I can't attend the surgical staff meeting. Someone has to man the ship, right?

    "Ok then, Canes. I'm off to conference. Page me if you need anything," the anesthesia coordinator sings over her shoulder as her wooden clogs click on the tile floor.

    I glance up to acknowledge her, but only see the tail of her white coat as she throws it around her shoulders like a cape.

    Ahhh...a few minutes of peace. I can get so much done now!

    No sooner had I turned my back to the glaring LED panels than a resident appears out of nowhere, tugging on the sleeve of my lab coat.

    "How's your day going?" she asks, traces of a smile dancing on her lips. She blinks rapidly and raises her eyebrows.

    "Depends on what you are holding in your hand," I reply. There is no smile dancing on my lips.

    She sighs. "Sorry to be the bearer of bad news, but I have a 65 year old woman in the ED with an incarcerated hernia. We need to get her to the OR now."

    I glance at the LED panel and search for the trauma room. Several cases had already been posted.

    Her gaze follows mine, and she reads the board with me. As if she could hear my thoughts, she turned to me and said, "It can't wait. We have to go right now. We will bump ourselves."

    "Of course," I reply. "I'll page Dr. Thomas and let her know that we need to open the room right now."

    "Thanks, Canes," she said. "I'll go ahead and bring her to the holding area, ok?"

    "Yep, that's fine," I reply.

    Running my finger down the list of staff for each room, I found the staff assigned to that room. Today, conferences were broken up by committee teams, and I didn't know which committee the staff members were on. I paged each manager, asking if Nurse X and Nurse Y were on their committee, because I needed them to start an emergency case.

    "Hey Canes. Nope, Nurse X isn't on my committee."

    "Canes, I don't have Nurse Y with me."

    "An emergency already? Sorry, Canes. Nurse X isn't here."

    My anxiety started to mount. My options were becoming more and more scant. When the phone rang, I jerked the receiver up.

    "Canes, I have Nurse X with me. But she's in a meeting," the manager says.

    "Yes, I know that. An emergency case was just posted, and I need her to start the case," I said.

    "But she's in a MEETING. She's the recorder for the meeting. Can't you find someone else?"

    I am incredulous with this response.

    "Last time I checked, patient care trumped committee meetings," I reply, with barely contained sarcas

    Nurse X checks in with me, and I fill her in on the details of the case. She is a trauma fiend, and loves the fast paced environment of a good trauma case.

    "Did you find Nurse Y?" she asks.

    "I still can't locate her," I said.

    I paged Nurse Y's manager again. Ten minutes later, the manager calls me.

    "We're in a meeting, Canes. What's up?" she said with a clipped tone.

    "I have an emergency case, and I need Nurse Y. Nurse X is already preparing the room," I said.

    "Oh. Nurse Y isn't scheduled to work today," she said in a matter-of-fact way.

    "But you listed her in the trauma room," I said.

    "My mistake. Sorry about that," she said, and hung up.

    "Canes, our patient is in holding. Can we roll back now?" the resident asks me.

    "Not quite yet. I'm still looking for another staff member," I said.

    Luckily, one of the committee meetings broke early, and staff were milling around the desk looking for their assignments.

    "What's with the frown?" one of the staff asks me.

    I explain my dilemma, and bless her soul; she volunteers to start the case.

    One fire put out.

    As the morning progresses, I find that I am without a secretary. The phones are ringing off the hook. I page my manager.

    "You rang?" she said.

    "Did you give our secretary the day off?" I asked.

    "Oh, yeah. I meant to tell you that. She had to attend her son's graduation this morning," she said.

    "Did you have a replacement for her?" I asked, my voice reedy.

    "Well, originally I had planned to come to the desk to answer phones for you, but I forgot that I have back to back meetings and won't be available until two. Do you need help?"

    Softly, I close my eyes. What was I supposed to say? That she couldn't attend her meetings because she had to play secretary for me?

    "It's ok. I can get through it," I said, eyes still closed.

    The next few hours felt like a war zone. As I was assigning lunch reliefs, I posted one emergency case after another, took care of students/observers/reps asking for scrubs, contacted surgeons for availability for cases that could be moved up due to cancellations, kept Dr. Thomas in the loop with every change, handled a registration problem, fixed a computer interface problem, contacted staff/sterile supply/managers to room changes, changed staff in 3 different rooms to ensure competent matches for cases, and guided med students to rooms...the phone would NOT stop ringing.

    A surgical attending was arguing with me about his case placement, and I couldn't get a word in edgewise. I let the phone continue to ring, adamant that I would get my point across to the surgeon.

    Looking down at the phone with his face creased into an angry frown, the surgeon said, "You gonna get that?"

    Seething, I picked up the phone.

    "OR, this is Canes."

    "Uh, somebody called me from this number."

    "I'm sorry, what did you say your name was?" I asked, trying to keep the irritation out of my voice.

    "Dean. Somebody called me from this number," he said again.

    "Hey, Dean. Are you a patient?" Somewhere in the cobwebs of my mind, the name 'Dean' stuck out.

    "Yeah. I was there last month. Somebody called me. I just hit *69. Who called me?"

    We have about 500 staff members in the surgical services department. Needless to say, I had no idea who called this patient. But he was a PATIENT. He deserved my undivided attention.

    "OK, Dean, let's you and I try to figure out who might have called you."

    The surgical attending slapped the counter in front of me in frustration. Two staff members were waiting to get their assignments. Three phone lines were ringing. The pre-op nurse was gesturing to me. An anesthesiologist was talking to me as if I wasn't on the phone.

    I spent twenty minutes on the phone with Dean, only to realize that he wasn't a surgical patient. He was a dialysis patient, and wanted to know when his next appointment was booked. I knew how frustrating it must have been for Dean to be transferred to one department after the next, and I wasn't going to transfer him again. I put him on hold as I contacted the dialysis unit, and got the information he wanted. As I relayed the information to Dean, his response caught me off guard.

    "Hey, thanks, lady. Ya' know, I think the call might have come from the transplant surgeon, Dr. A. He called me yesterday and said there might be a match for me, and that I should come to the ED. What do you think? Should I call him, or do you think I should go to the dialysis unit?"

    In spite of me, tears welled up in my eyes. I looked to my right and focused on the transplant information sheet tacked onto the corkboard. Sure enough, Dean's name and information were clearly written out.

    "Yes, Dean. I see that you are booked for a kidney transplant. Come on in to the ED. We'll see you in a couple of hours," I said.

    Gently, I replaced the receiver. I stepped away from the melee at the desk and gathered myself, encouraged that I would meet Dean personally, and help him through his life changing transplant surgery.

    I'm so glad I picked up the phone.

  • Jul 1 '13

    Quote from HM-8404
    I am not a nurse yet....
    This is where the problem started. Your other experience is great, but until you've worked as a nurse independently with a license to worry about, the dynamics of a floor and the management will elude you. Articles like this will not make sense.

  • Apr 12 '13

    Quote from PrayeRNurse
    So we as nurses need to work on States regulating MA's.
    You know, it's really no wonder this country is going to hell in a handbasket, with thinking like this. The solution to your problem is to sic the government on someone else, to take away their job by regulating it out of existence? Who else's job would you like to use the power of overbearing government to destroy?

  • Apr 5 '13

    A gaunt, elderly gentleman in bib overalls appeared in front of the ancient farmhouse, smoking an unfiltered cigarette and watching me closely as I pulled off the road into the dusty driveway. Next to him stood a dark-haired woman who seemed at first glance to be young enough to be his granddaughter, but whose face, upon closer inspection, was almost as weathered as his.

    The two greeted me warmly, if a bit cautiously, as I stepped onto the porch. As I've done many times in my career, I had come to evaluate a prospective resident for a move to my assisted-living facility, and once again felt the awkwardness of the situation for all concerned. No one makes these decisions lightly, I knew, and once again I was impressed with the dignity I saw on display as I was invited into their home.

    His name was Rowland, but he'd been known as Roy since his teen years because, as he explained to me, he thought his name was "too frou-frou for a farm boy". At ninety-five, he was the sole survivor of six siblings, and his flat Nebraska accent could still be heard in his voice despite his having lived on the West Coast since the end of World War II. He proudly showed me around his living room, where hung pictures of his family of origin and his own children, all of whom were now in their sixties and seventies. But it was when he spoke of his wife that his craggy face broke out in sunbeams......Laura, her name had been. They'd been married for sixty-five years when she turned from her cooking to greet him one sunny summer morning, had a massive stroke, and was dead before she came to rest on the linoleum floor. But to hear him tell it, she was very much alive in his heart.

    Then, he asked me to take a walk around the small grass-seed farm, where the crop was just about to be harvested. As he puffed on his cigarette, he talked seriously of his declining body and mind and his impending move, and I found myself filled with fierce admiration for this "farm boy", who was facing yet another in a long series of indignities that his renal failure and macular degeneration had foisted upon him.

    "I don't want to leave this farm," he told me matter-of-factly. "It's the only place I've ever lived at since I got out of the Army. It's where Laura and I made our family---Sue still lives here, you know. She takes care of me. Or thinks she does." A wry grin and a wink followed this statement. "But, I've decided that I'm going to make the best of things, no matter what. So, you think this place of yours will put up with ol' Roy?"

    Well, we certainly did 'put up' with him, and he became one of our favorite residents. He was quiet and somewhat reserved for a time after move-in, but he eventually made some friends and could often be seen on our porch, smoking and chatting as genially as he had that day on the farm. He was always respectful toward the staff, and to my knowledge he never once complained about his changed circumstances. The closest he ever came to admitting his sadness was about a year after he'd moved, when during a care conference with him and his daughter I asked him how he liked living with us.

    "It ain't the farm," said Roy frankly, "but it ain't half bad."

    Sadly, this past year we've watched "Ol' Roy" dwindle slowly but inexorably. Now ninety-seven, he knew his journey was drawing to a close as his renal function continued to decline, and though dialysis was obviously needed, he refused: "I'm an old man and I'm tired. I'm ready to go find my Laura."

    Last Sunday, his daughter Sue took him out of the facility for Easter dinner at the farm. She helped him up the stairs to the main house, turned for just a moment to unlock the front door......and in that instant, he fell backwards, hitting his head on the first step and tumbling down the rest of the way.

    He never regained consciousness.

    His injuries were "catastrophic", according to the attending physician who spoke with Sue, who then related the story to me over the phone on Monday morning. Roy had not only a severe brain bleed but a ruptured spleen, which was inoperable given the grave nature of his condition. We talked about bringing him back to the facility with hospice, where he'd be in familiar surroundings with familiar people who were only too willing to be with him and keep him comfortable, but a greater force than ourselves made the decision for us before we could get him out of the hospital.

    Naturally, Sue feels terrible about the circumstances of Roy's death, even though she couldn't have anticipated or prevented the accident. And all of us who worked with him and cared for him are shocked and revolted at the thought of how he must have felt as he fell down those steps; I think we all had hopes that he would go to sleep one night, and simply forget to wake up again.

    But now there are nights when I myself drift off to sleep, and I can almost smell the freshness of newly harvested rye grass and hear the roar of farm machinery as a tall young farmer in biballs puts a brown hand to the gearshift. And somewhere, the voice of a woman named Laura floats across the green fields, calling him to supper.

  • Mar 23 '13

    Not a nurse, yet! But, in all of clinicals I have seen everyone on a first name basis. As I student I call the nurses Miss or Mr first name, out of respect, even if they are younger than me. In my mind they are elder in experience, ya know?

  • Mar 23 '13

    It never hurts to just ask. I myself prefer "Goddess" .

  • Mar 20 '13

    Two mornings ago I received a distraught phone call from my mother telling me that my dad, who is suffering with end stage COPD, spine compression fractures, and a distinct lack of proper narcotic metabolism, became flighty, picky and squirrelly to such a point that he was assigned a sitter.

    Look, I've been around. I know what can be said about sitters. I know that for every one that understands the amount of sheer effort and work that goes into trying to keep someone in bed, calm and intact, there are several more misguided individuals that think sitting is easy, requires little effort and even less work.

    Obviously those individuals need to meet my dad when he is blitzed out of his brain on Fentanyl and Vicodin. Let's just say that when my family decides to lose it, we don't just misplace our minds, we straight up blast them into orbit never to be seen or heard from again.

    Maybe it's the southern mentality: go big or go home.

    We pride ourselves on hearing the blankets whisper, seeing shadows slip through the walls, and having full out conversations with no one physical. We sing with gossamer birds, swat at oily, ethereal spiders, undress, and boot scoot boogie down the hall, crumpled spine and inability to breathe be damned. We talk back at the television (even though it's off), recite bits of poetry, and try to lick our meatloaf. We load pills in the end of water straws and attempt to "tranq" the "elephants" in our room. And yes, the nurse would just so happen to be the elephant in question. Perhaps wearing grey scrubs in the presence of one no longer operating on this plane of reality was a mistake. Just sayin'.

    But regardless of all the insanity, of the wandering, flitting hands that pluck at skin tears, scrape at desperately needed picc lines, and fidget with the oxygen in his nose, and never, ever rest, he is safe, cared for, and, although gently, patiently re-oriented again and again, he is even kept company in his joyful delusions.

    I went to see him the other night only to walk up to the room to hear him murmuring, "The you hear them?"

    "Yes, sir. I think they are canaries. Let's lay still and see if they come back to sing to you."


    And there he was, staring at the upper corner of the ceiling as if watching a menagerie in the zoo, rapt, still, his hands resting lightly on his bedding. The sitter, Margaret, greeted me and explained everything he had been up to in a hushed whisper.

    After all, we were waiting for the canaries to return.

    And then last night, a half mad, partially naked Humpty Dumpty decided to have a great fall.

    It would seem that someone decided to tap into their inner ninja and attempt to vault the bed rails and make a beeline for the room exit. The gown was apparently trying to rat him out, so it was discarded for the sake of security (thankfully, he didn't manage to totally disrobe).

    Mission impossible music may or not have been involved.

    The sitter only looked away for a second. And you know what? I totally believe her. I've seen my dad move when properly motivated.

    But it is not because of any "blame" issues regarding his escape attempt that she caught my attention. No.

    It is because she was fast behind him, and when his foot caught and his burst of strength gave, she swiftly, skillfully guided him safely to the floor, cushioning his head on the soft toe of her shoe.

    Because of her knowledge, her quick thinking, fast reflexes and sure hands, I am not writing a grieved announcement of my dad's need for a crani or an intermedullary rodding of a femur.

    Because of her, I get to watch him listen to the sweet chatter of the blankets and blow bubbles in his soda.

    And although that may sound like the strangest thing you have ever heard, I could not, ever, be more grateful.

    It may not be much, but thank you.

    Thank you.

    Thank you for giving him the same dedication you would give your own loved one. Thank you for never yelling, never losing your cool. Thank you for laughing with me because crying is not something built into my coping mechanism. Thank you for not laughing at him. Thank you for speaking calmly with my hysterical mother when I could not be reached.

    Above all, thank you for "doing nothing".

    Most sincerely,


  • Mar 20 '13

    I am currently in the second semester of a FNP program and DO YOUR SELF A FAVOR AND GET 1-2 YEARS OF EXPIRENCE FIRST!!! Those of us with a few year under our belt just seem to get the concepts better and know the meds faster. There are a handful of people who jumped right in after nursing school and they are struggling bigtime. Just knowing the generic and trade names, or how to care for a GI bleed patient in the hospital, or knowing what a patient in DKA smells and acts like makes grad school so much easier. The few years you spend just working as a nurse with save you hours and hours of agonizing study time in the future.

  • Mar 19 '13

    Schooldistrictnurse, RN, BSN, NCSN!!!!
    I passed the national certification exam!

  • Mar 19 '13

    I'll call the shots as I see them:

    "If you're smart enough to be a nurse you should not need direction like this. And if you have traveled before you should also be MUCH more resourceful than this." = Rude. There's a way to say things in person, and there's a way to say things online. If a person talks to another person in real life (not online) my take would be that to talk this way is to be a bully. There are respectful ways to convey your thoughts and those two sentences lack respect.

    As for Craigslist. I'm not a traveler but I've moved about a lot. My base is NH where I own two houses but there is little work here. My last job was in Boston and like LA Boston is expensive, maybe not as much so but close. I wrote a housing wanted ad and explained that I was a nurse and found a room in a lovely house owned by a Tufts University Librarian.

    Though I didn't like the idea of renting a room, the huge monthly rents at the cheapest apartment made that a good deal since it was about 1/2 or less of what I'd pay for even the smallest apartment. The house is lovely, I had the upstairs pretty much by myself with a study/den and she had a wonderful kitchen. And most important, it took me only 7 minutes to get to work in the morning--in Boston that is a rarity and worth a lot on its own. Sure a person needs to be careful anyplace, not just in LA or Boston but it was easy enough to check that she worked for Tufts. I've found other places on Craigslist also in the past. Yes, one has to sift through some crap sometimes but as previously stated traveling nurses are a "cut above," and many who rent know this. One of my places is a triplex so I'm a landlord and I know this...

  • Mar 19 '13

    I laughed out loud at the medic student comment.

    Too bad so many brown crayons had to discourage your quality humor. Please keep writing the way you do for those of us who are a little brighter than brown...

  • Mar 19 '13

    Quote from usalsfyre
    Or you were never truly infected. The hyperbole here is almost intolerable.

    As part of a risk management team, this attitude is what drives me up the wall. YOU allowed yourself to be distracted. YOU got in a hurry and didn't take the extra couple of seconds to protect yourself. Making excuses like this will lead you down the road to another incident. Take responsibility for your own safety. It's no one else's fault and your responsibility to use the tools provided.
    That moment when you realize your sarcasm is so sarcastic, other people don't realize you were just joking... Great story! This made me laugh hard

  • Mar 19 '13

    Love your writing, I would totally buy the eBook version of your, "Tales of an Emergency Room Nurse: As Told By the Bedside" lol

  • Mar 19 '13

    Quote from smoup
    Some people need to chill out and learn how to read sarcasm and jokes.

    OP, love your writing style, hyperbole and jokes included!
    ^I second this...I even got the visuals that Altea described lol!