ScrappyED

Thank you!

You are so welcome Corey. I come back to that article myself occasionally after a really bad trauma to reflect and remember all the wonderful people who feel the way I do. Glad my words touched you! Kellie By the way, I'm a nerdy RN too!!

You know I can't decide if this is hilarious or sad! Right now hilarious is winning.

Have you tried talking to management or HR about how you feel? Large corporations like hospitals have to have guidelines in place to protect their business but sometimes exceptions can be made for good reasons. If I were your manager I would try everything I could to get you into a better position for your situation if you've been an asset. If you have been a good employee with a good attitude and come to work on time and don't call in all the time then they might be willing to let you change in order to keep you. If you've been a good employee and they are not willing to help you then you need to find a different organization anyway. If you've not been a great employee than I would keep that in mind for next time and start looking for a new spot! Just be careful about the facility you choose. I have a friend who worked at a SNF right out of school and was able to get a hospital job 6 months later so it is possible--just make sure that you are not hung out to dry while there! Nursing homes have bad reps for placing RN's in positions they aren't ready for yet with way to much responsibility for their experience. Hope this helps and good luck on the baby!!

In TN you can work as a "nurse tech" after one semester of nursing school (where you learn how to take VS, do bed baths and other fundamentals). I would talk with HR at your local hospital(s) and get their opinion. Actually, you may be better working as a unit secretary--no certification required--less hard on the body, and you will learn a lot that will help in school about meds and labs and things. I did both before becoming an RN and the secretary position helped more than anything!

Thanks so much!!

I wanted to start something very similar to this in our ER and am in the process of gathering info. Would you be willing to share your protocol and any other info you have? We see so many miscarriages and occasional pediatric losses in our dept and was surprised to find out there was nothing official done for these families! Most of the info I find is just for miscarriages so anything specific for older kids would be great too! Thanks!

I just started as an RN last year at the same time my husband got back from Iraq. I have an awesome ER job that I worked my tail off to get at the only Level 1 Trauma center around but... we just got word that my dh is probably going to get deployed again this summer and I am freaking out because we have three children--only two of which are just now old enough to stay home alone during the day--let alone for my 12 hour 9a-9p shift where sometimes I don't get home until 10 or 11 pm. My youngest is NOT old enough to stay home alone. I am trying not to get too worried, I guess I could work in a doctor's office for a while but man I don't want to leave the ER. I am hoping that maybe they can work with me for the year that he is gone.

I was a compulsive nail biter until age 14 then moved on to food so I feel your pain. The underlying problem is not a fake nail or real nail issue--it is the chewing desire and the anxiety. Maybe the gum idea would work--I constantly keep a pack of gum with me or sometimes mints or something. (The pt's probably appreciate the good breath too :wink2: ) Try adjusting your meds also if the anxiety is not under control. It sounds like you have a lot going on in your life right now so I would have a talk with your doctor that is prescribing your Zoloft. And get a manicure, pedicure, massage on a regular basis! They help me tremendously!!

Wow! I have seen attendings sit back and let resident MD's jump in and help us control a combative pt but never seen it in that kind of situation! I would be writing a letter of complaint to someone higher up on the nursing and medical sides for sure!!

I have a problem with allowing pt's to act like this without saying anything. It is not acceptable to be rude just because you don't feel well--and I have taught my children that too. Yes, this child could be very sick and scared and the talk should not be confrontational but firm and loving. But...you can't just tolerate it and ignore it--that leads to more of the same and him/her thinking that that is the only way to get attention. When I have confrontational pt's like that I very calmly explain to them that it is hard for me to give them the best care if they are shouting and rude to me and that I would appreciate it if they would remember that I am a person too. Then I ask them what is wrong and why they feel so angry, upset, sad etc. that they have to yell and be rude. Many times it has calmed down a pt who felt they were being ignored or treated badly themselves. Then there are the times where it doesn't help at all and nothing anyone can do about it. There are just rude, mean people out there who are very selfish/self-centered and will never be kind to "just a nurse". Those are the ones you just have to set firm boundaries with and grin and bear it. Our security helps too if they get too badly behaved!! Regardless, you can't just ignore the behavior! It doesn't do the child any good because the next person they try that with may not be as understanding or professional!

All ER nurses are just fantastic Wow Jennyw, what a night. That definitely tops my worst so far! :bowingpur

Thanks so much for sharing your experience and your advice. I have never had to deal with a miscarriage and have had four wonderful children. So I have always felt very awkward and inadequate when dealing with pt's who are miscarrying. Thank goodness that I have not said much more than "I'm so sorry" because I didn't know what to say but hearing your advice will definitely help in the future. :icon_hug:

What an awesome recap of our "normal" workday! I love it!!! And to the question about do we love it....it really is a love/hate relationship. I can't imagine being anywhere else more than for the occasional float--but when my shift is over (or an hour past "over") you may see smoke rising in my footprints Especially the other night when I got to open a third fast-track in the EMS hall! We normally only have the one regular area, our back-up CDU had already opened a second one. Lucky me got to create my own zone, Yay! I had 5 chairs and two stretchers (only 2 left in the whole ED) lined up with taped up scraps of paper on the wall with "bed" #'s on them. Two hours before I was supposed to leave. I think we decided someone posted a neon sign up on the interstate that read "Free drugs at the ER" or something that night! OHH, and one bed with a mom and child in it ended up having a nice twin set of scabies. So my other pt's in my own little fast track mutinied about the bathroom back there and refused to do anything until housekeeping came and disinfected. Not to mention the fact that now I was down to only one stretcher!! Yeah, I love my job, again==closet ADHD I think! :hpygrp:

Do you WORK in an ER?? I find it hard to believe that you do. We all have infinite compassion for those who truly need to be there--otherwise we wouldn't do it! It is the ones who come in via ambulance for knee pain that they've had for literally one year and take up room and resources that the child in the lobby having an asthma attack, the little old lady with an acute GI Bleed needs and the gentleman with a STEMI need. And, we the tax payers are paying for that EMS ride.

#51 The number of times you come out of the room and up to the desk to ask when your loved one is going to go upstairs is exponentially related to the time it will take to get you there. #52 Please eat before you come to the ER so that I don't have to listen to you whine about "starving to death!" because you haven't been allowed to eat in a whole afternoon. #53 Please ask to pee before I get you hooked up to the 30 wires and BP cuff and O2 sat monitor, IV tubing and side rails up x 2. #54 Men, learn to pee lying down for goodness sake. I am NOT going to compromise your spinal immobilization "just this once" and let you sit up and pee on the side of the bed. My son could do it from the first day he was born (I have pictures to prove it) so don't blame it on Gravity!!!

We have a nursing progam in TN that will not admit anyone who is overweight. It also said in my nursing school handbook that you must be able to function within the tight spaces common in hospital rooms in order to fulfill graduation requirements. I often wondered how they got around someone filing a discrimination lawsuit. While I feel for your friend, when we have a patient crashing there are 10-20 people in that one room trying to save that patient--it is very hard for even the skinny nurses to perform their tasks and we have a few really big ER rooms). I am somewhat overweight but nowhere near 450 lbs and have a hard time getting around in some rooms even when it's just me and the pt and family! I would wonder if your friend will be able to efficiently do her job? I hope so for her sake! Of course she doesn't have to work in a hospital :-) Tell her that if she wants it bad enough to stick with it and don't let one instructor determine her life's course. Good luck!

He was able to answer our questions for the first few minutes and it looked like it was going to be a "routine" trauma where we stop the arterial bleed, set the fracture then scan the pt from head to toe to make sure there are no hidden internal traumas. About 5 minutes into our routine the guy's heart stopped and we attempted resuscitation for over half an hour. We tried everything in our power including cracking open his chest and doing cardiac defibrillation and cardiac massage (where the attending MD actually puts his hand into the pt's chest and manually "pumps" the heart). When the MD eventually "called it" the nursing student I had been precepting all weekend lost it and ran away crying. It is a sad process after such a lengthy code to clean up the trauma bay. There is debris everywhere, most of it covered in blood and sometimes other bodily fluids. There are bloody footprints where the 20+ members of the trauma team weave around the pt and each other in the frantic dance of pitting life against death. There are usually various bloody, metallic instruments lying around from cracking the chest, clamping off arteries, inserting the breathing tube and various other life-saving procedures-looking like some medieval torture chamber toolbox has been upended and abandoned . Pieces of paper and plastic that once enclosed precious sterile instrumentation, blood products and medicines litter the counter-tops, the floors, the code cart, the stretcher surfaces and the respiratory arrest airway boxes. Blood-soaked clothing torn in the wreck or cut off by us lay in a few piles on the floor. Since this patient will be a case for the Medical Examiner there are several plastic tubes of varying sizes protruding from the patient that we are not allowed to remove. The breathing tube spills bubbles from the gasses that begin to form immediately postmortem giving the illusion that something of this patient's life is still possible to retrieve. Like so many other times after a pt death I catch myself looking closely at the body for signs of spontaneous respirations-something my brain knows that by man's understanding just isn't going to happen-wondering if I may yet witness a miracle. Everyone not considered directly responsible for the patient's care starts to file out, some quietly talking to one another, some silently shaking their heads, some already laughing about something silly that happened during the mad rush in the way only people who routinely face these kinds of things can do. Now the feeling in the room has changed. The pace slows, your internal focus relaxes and can broaden again to more than the immediate moment and the immediate task at hand. Each team member, in their own way, processes the events of the past 45 minutes or so. Some wonder if they could have done something differently, performed a skill better or faster, called for an intervention sooner. Some put it behind them and move on mentally as fast as they do so physically. Some are angry, some sad, some businesslike in their tasks after the death. The small crew that is left begin cleaning the bay and bundling up the pt, cleaning the face off as well as possible so that if the family wants to see him they aren't any further traumatized than necessary. One of the Residents that is left begins to quietly sew up the chest as we work around him. Another Resident sits at the trauma desk for this bay, trying to reduce that 45 minutes of chaos into the impartial medical charting required by law. She looks up occasionally and asks for the time that something happened, the size of a tube or the name of someone who intervened in one way or another. One of the other nurses sits in another corner and finishes the detailed charting that we are required to do-referencing the frantic notes chicken-scratched during the code. . About half-way through our vigil word comes that family has arrived. It is the moment we all dread. From a receipt in his wallet we knew that approximately an hour ago this man had just finished a trip to the grocery store. Now we have to go inform his family that their husband, their father, their son isn't going to make it back home from this trip. That receipt, found after the patient had passed away while logging his belongings, got to me more than anything else. I suppose it became a symbol that this man was not just another day at work but a fellow human and was a blaring siren screaming how fragile life really is. You almost don't want to find things like this that humanize your patient because it makes the job harder once they become more real. But then you are glad, in a way, that you do discover that your emotions still function and that you haven't become totally disconnected from what most of our non-ER friends think and feel about human life. The resident, my charge nurse, our patient representative, the chaplain and myself walk into the small room where four scared people have gathered to wait on word of their loved one. The chaplain is the last person to enter the room. What I notice first are their eyes, already showing signs of being a little overwhelmed by the situation and the number of us coming to talk with them, begin to widen in dismay at the sight of the chaplain in his familiar black shirt and white collar. Two of them, our patient's older children, put their hands to their mouths. The woman who is our patient's wife, says "It's bad isn't it?" and the resident in a calm, quiet and compassionate voice begins to tell them the story. He does a wonderful job, where others have bungled it badly, and we give the family time to absorb the first impact from the blow of his words. Eventually, we lead them to the patient, skin already starting to mottle in places but also still bleeding from the facial laceration. This was disturbing-I had not seen this happen as badly before and, of course, the family did not understand at all. Like I had done earlier they sought for other signs of life, saying over and over that this wasn't real and couldn't have happened. One by one they leave to begin "taking care of the details" as those in the business of death like to call it. They will have to decide on where the patient's body will spend his last days above ground, what clothes he will be buried in, what kind of casket he will have. They will have to endure calls from the local police department about the wreck, the county forensic office about the autopsy, friends and family calling to give their condolences. Things that moments earlier had never even entered their minds. As is my duty, I hand them a small card with the name and number of the Medical Director of the forensic center as they are leaving, feeling like this just wasn't enough to hand a family as they leave the hospital without their father and husband. The charge nurse comes up to me and tells me I did a great job during the code and while meeting the family. I thank her and then the tears begin to well up. I push them and the thoughts of what just happened to a back corner of my mind and walk back to the scene to continue my part of the job. Thankfully, the trauma bays spend the majority of their time empty and are many times a haven for those of us who may need to get away from the rest of the craziness in the main ER. It is different right after we have lost a patient-especially one that came in awake and was relatively young and died so unexpectedly. The bays seem not just empty then but desolate. They truly remind you of the proverbial "war-zone"for a short time until all traces of the tragedy are bleached, mopped and taken off in the trash. Then within minutes, in a somewhat surreal fashion, everything looks normal again and you can almost believe it was just a dream. As I got home last night and crawled into bed beside my husband I hugged him extra hard and thanked God that we had at least one more night together. I had already peeked in on the kids to make sure they too were still on this side of life. I can almost feel my skin toughen just a little as I wake up today to face the new day. I have survived the trauma after the trauma and will go back for more. Kellie G., RN

Wow, I am humbled by all of your kind comments. I almost didn't post this story because I never have started a thread before and am relatively new to the field. Boy am I glad that I did--thank you so much for making me feel welcome and understood! By the way...I wouldn't even know how to get started on getting published in a magazine but the idea is intriguing :) Again, many thanks!

If the wait is really long out in triage and we have lots of open rooms our ER does bring them back but each nurse brings back only one pt at a time as they can handle it. If the wait is very long and we don't have several open rooms we send a second nurse out to do a "second triage". This nurse has to take down info manually and then walk back to a free computer to enter the info but at least the patients are triaged more quickly. It is dangerous and irresponsible to fill up all your rooms with unknown acuity pts if their nurse doesn't even have time to assess them first. What if the pt codes in a room by themselves, door shut (because of HIPPA), not hooked up to a monitor (lack of enough techs) and no family (they dropped them off at the door and ran)? Not to mention the fact that just when you fill up all your available rooms with nurses who don't have the time yet to take care of the pt is when the back door becomes flooded with ambulances. We only bring back patients immediately if we have several open rooms and several extra "floating" nurses who don't have traumas currently. Sometimes our flow-co/charge nurse will bring back a pt or two and triage them for us. Maybe suggest that to your manager

After several days of working regular ER zones and one of doing triage I worked as one of the trauma response nurses yesterday. My first patient was from a head-on MVA. He came in with a serious facial laceration that had hit an artery and with a left leg fracture obvious to all by the right angle his lower leg made to the upper. He was able to answer our questions for the first few minutes and it looked like it was going to be a "routine" trauma where we stop the arterial bleed, set the fracture then scan the pt from head to toe to make sure there are no hidden internal traumas. About 5 minutes into our routine the guy's heart stopped and we attempted resuscitation for over half an hour. We tried everything in our power including cracking open his chest and doing cardiac defibrillation and cardiac massage (where the attending MD actually puts his hand into the pt's chest and manually "pumps" the heart). When the MD eventually "called it" the nursing student I had been precepting all weekend lost it and ran away crying. It is a sad process after such a lengthy code to clean up the trauma bay. There is debris everywhere, most of it covered in blood and sometimes other bodily fluids. There are bloody footprints where the 20+ members of the trauma team weave around the pt and each other in the frantic dance of pitting life against death. There are usually various bloody, metallic instruments lying around from cracking the chest, clamping off arteries, inserting the breathing tube and various other life-saving procedures-looking like some medieval torture chamber toolbox has been upended and abandoned . Pieces of paper and plastic that once enclosed precious sterile instrumentation, blood products and medicines litter the counter-tops, the floors, the code cart, the stretcher surfaces and the respiratory arrest airway boxes. Blood-soaked clothing torn in the wreck or cut off by us lay in a few piles on the floor. Since this patient will be a case for the Medical Examiner there are multiple plastic tubes of varying sizes protruding from the patient that we are not allowed to remove. The breathing tube bubbles from the gasses that begin to form immediately postmortem giving the illusion that something of this patient's life is still possible to retrieve. Like so many other times after a pt death I catch myself looking closely at the body for signs of spontaneous respirations-something my brain knows that by man's understanding just isn't going to happen-wondering if I may yet witness a miracle. Everyone not considered directly responsible for the patient's care starts to file out, some quietly talking to one another, some silently shaking their heads, some already laughing about something silly that happened during the mad rush in the way only people who routinely face these kinds of things can do. Now the feeling in the room has changed. The pace slows, your internal focus relaxes and can broaden again to more than the immediate moment and the immediate task at hand. Each team member, in their own way, processes the events of the past 45 minutes or so. Some wonder if they could have done something differently, performed a skill better or faster, called for an intervention sooner. Some put it behind them and move on mentally as fast as they do so physically. Some are angry, some sad, some businesslike in their tasks after the death. The small crew that is left begin cleaning the bay and bundling up the pt, cleaning the face off as well as possible so that if the family wants to see him they aren't any further traumatized than necessary. One of the Residents that is left begins to quietly sew up the chest as we work around him. Another Resident sits at the trauma desk for this bay, trying to reduce that 45 minutes of chaos into the impartial medical charting required by law. She looks up occasionally and asks for the time that something happened, the size of a tube or the name of someone who intervened in one way or another. One of the other nurses sits in another corner and finishes the detailed charting that we are required to do-referencing the frantic notes chicken-scratched during the code. . About half-way through our vigil word comes that family has arrived. It is the moment we all dread. From a receipt in his wallet we knew that approximately an hour ago this man had just finished a trip to the grocery store. Now we have to go inform his family that their husband, their father, their son isn't going to make it back home now. That receipt, found after the patient had passed away while logging his belongings, got to me more than anything else yesterday. I suppose it became a symbol that this man was not just another day at work but a fellow human and was a blaring siren screaming how fragile life really is. You almost don't want to find things like this that humanize your patient because it makes the job harder once they become more real. But then you are glad, in a way, that you do discover that your emotions still function and that you haven't become totally disconnected to what most of our non-ER friends think and feel about human life. The resident, my charge nurse, our patient representative, the chaplain and myself walk into the small room where four scared people have gathered to wait on word of their loved one. The chaplain is the last person to enter the room. What I notice first are their eyes, already showing signs of being a little overwhelmed by the situation and the number of us coming to talk with them, begin to widen in dismay at the sight of the chaplain in his familiar black shirt and white collar. Two of them, our patient's older children, put their hands to their mouths. The woman who is our patient's wife, says "It's bad isn't it?" and the resident in a calm, quiet and compassionate voice begins to tell them the story. He does a wonderful job, where others have bungled it badly, and we give the family time to absorb the first impact from the blow of his words. Eventually, we lead them to the patient, skin already starting to mottle in places but also still bleeding from the facial laceration. This was disturbing-I had not seen this happen as badly before and, of course, the family did not understand at all. Like I had done earlier they sought for other signs of life, saying over and over that this wasn't real and couldn't have happened. One by one they leave to begin "taking care of the details" as those in the business of death like to call it. They will have to decide on where the patient's body will spend his last days above ground, what clothes he will be buried in, what kind of casket he will have. They will have to endure calls from the local police department about the wreck, the county forensic office about the autopsy, friends and family calling to give their condolences. Things that moments earlier had never even entered their minds. As is my duty, I hand them a small card with the name and number of the Medical Director of the forensic center as they are leaving, feeling like this just wasn't enough to hand a family as they leave the hospital without their father and husband. The charge nurse comes up to me and tells me I did a great job during the code and while meeting the family. I thank her and then the tears begin to well up. I push them and the thoughts of what just happened to a back corner of my mind and walk back to the scene to continue my part of the job. Thankfully, the trauma bays spend the majority of their time empty and are many times a haven for those of us who may need to get away from the rest of the craziness in the main ER. It is different right after we have lost a patient-especially one that came in awake and was relatively young and died so unexpectedly. The bays seem not just empty then but desolate. They truly remind you of the proverbial "war-zone"for a short time until all traces of the tragedy are bleached, mopped and taken off in the trash. Then within minutes, in a somewhat surreal fashion, everything looks normal again and you can almost believe it was just a dream. As I got home last night and crawled into bed beside my husband I hugged him extra hard and thanked God that we had at least one more night together. I had already peeked in on the kids to make sure they too were still on this side of life. I can almost feel my skin toughen just a little as I wake up today to face the new day. I have survived the trauma after the trauma and will go back for more.

Me too with the "huh?". We don't put blood on a pump in the ED and even if we did, priming the line with saline doesn't take but a few extra seconds. you run the saline through, mainly to make sure the IV is going to hold up and to minimize loss of the RBC's. For those of you who run blood on a pump--do you have the twin sets that allow saline flushes or do you have to do a piggyback setup? Either way you could turn the pump to "999" and run the blood into the tubing very quickly.:)

Never heard of such! Anyway, try priming very slowly. You could also try pinching off the lower part of the tubing while the larger drip chamber on the bottom of the blood tubing is filling up and has plenty of blood in it before letting the blood flow into the rest of the tubing. Good luck!

I see that our new employees are very lucky! I'm in a Level 1 Trauma center and we hire one new grad each year. She/he gets a minimum of three months orientation--longer if needed. Experienced nurses who have never worked in an ER get about a month but they are never "kicked out" if they don't feel competent. Nurses who have worked other ER's get a couple of weeks unless their skills are way below par. Boy was I scared when I was left "alone" that first day:( but I made it! I wonder if the increasing times of orientation are due to liability costs or to high turn-over these days (or both). HHhhmmm. Scrappy :prdmltywf: :prdnrs:

I love the ER and can't imagine being anywhere else long-term. I have worked on critical care areas and on floors--and I have sometimes worked just as hard, physically and mentally, there as in the ER. I have great respect for many of the nurses who work those units. They have good nurses and bad ones just as we do in the ER but, I have never worked in a hospital area that is as consistently demanding, in all respects, as the ER. I'm sorry if you don't agree but I know for a fact that it takes a certain rare kind of person, who can hold up under the near-constant stress that we undergo on a daily basis and not only keep coming back but actually thrive under these conditions. The ability to keep calm and be able to think and react effectively under the gun is a valuable trait that is both rare in humankind and yet necessary to be successful in the ER. Those of us who work there and love it have every right to be proud and swagger just a little. In the end though, I try very hard to live by the words on a poster that was on the wall of my nursing school: It is not necessary to put others down to move yourself up the ladder of success in life. I.E. we can pat ourselves on the back, and have a right to!, without downing other nurses in the process. We all need to support one another in becoming better nurses, better people--instead of bickering. Just my two cents... Here's to all hard-working nurses!!! May the new year bring us all clean, smiling patients, grateful family members, pleasant, intelligent doctors, fast support services and an endless supply of big-girl panties for the days that doesn't happen! Oh, and no scabies!!:hpygrp: Scrappy :prdnrs: :prdmltywf: