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stephen1219 has 1 years experience.

stephen1219's Latest Activity

  1. stephen1219

    When you're on a date... and run into a previous patient

    Well just to add some more humor.... I didn't see the date again either.... such is life! hahaha
  2. It was my day off. I met my date for "coffee or drinks" at an eclectic little side shop downtown. The conversation was stimulating and not the typical first date interrogations I've experienced in the past. We talked for an hour and then left the coffee shop to go for a walk at the nearby park... And that's when it happened. A tall man in a dark blue suit approached me and asked: "excuse me, you look familiar do I know you?" I told the man we didn't know each other but I introduced myself and my date. When he heard my name, he said "Oh, now I remember, you were the nurse that helped me when I had my heart attack" Bam. Zing. Ring-a-ding-ding. I suddenly remembered him... and you know what else... I seemed like a hero to my date. A hero. Knocked it out of the park. We only had a very brief less than 1-hour interaction as he came into the ER and we rushed him as quickly as we could to the cath lab. There were probably 8 people in the room doing various things (lines, labs, EKG, monitor, pads, shaving, consents, etc.) I remember while I was working on him, I did my best to stay at the head of the bed and explain everything that was going on and what to expect going forward. There wasn't a social worker on shift so I had to also call his extended family which was one of his biggest concerns. We gave him the meds, cardiology was finally ready for him and then just like that he was gone. I didn't think I would ever see him again, especially since I live in a big city. However, I was pleasantly surprised to meet him again. It was perfect timing actually. I was trying to explain that nurses do a lot more than just give pills and follow doctors orders when he approached me. He shook my hand, told me that they "put a few stents in", he stayed a couple of nights and then he was discharged home. And then he thanked me and walked away. My date asked me if I paid the man to say those things. I told her I wasn't above doing that... But it was genuine interaction. I'm not sure she believed me. Experiences like this are so refreshing and rare. I think we as nurses tend to cling to the negative experiences and interactions. Just the last shift I worked, I was called every name in the book while taking care of a very intoxicated patient. Every day there's a nurse out there taking some kind of undeserved abuse from a patient. And while the importance of nursing and the impact on people's lives was drilled into our heads (or at least my head) in nursing school, I forget every now and then. And it's nice to be reminded. I should remember the woman who stopped me at Target and told me I worked with her father when he had his stroke. (He's apparently still smoking and was currently at the casino according to the daughter). I should be grateful that a future chef in culinary school who cut himself on two different occasions and needed stitches remembers me and is excited to have "the fanny pack nurse" again. Because they are proof of this positive impact that nursing can provide. And this is why I became a nurse. I doubt I'll see that patient again, but I've been wrong before. However, I do think I'll see my date again... But I've also... been wrong before...
  3. stephen1219

    That's not a bad nurse

    A friend of mine dislocated her shoulder and ended up in the emergency room. Because the emergency room is normally a hot mess express, she ended up having to wait over an hour and a half to be roomed. When she finally saw a doctor, he told her she was going to get some pain medicine through an IV before he popped it back into place. Everything turned out fine and she was discharged within an hour. And then she proceeded to call me (because I'm an ER nurse) and tell me how awful her nurse was. "She missed my IV the first time and she had to poke me again. It was awful". I told her "That's not a bad nurse". This isn't the first time I've heard something like this. Many people and patients tell me their "horror stories" about emergency, urgent care, or office visits. And when I ask for any more details besides them missing one or two IV starts, they usually don't have anything more to add. And that's when I get frustrated. If you sat in a pool of your own diarrhea for 50 minutes you had a bad nurse. If you were poked six times for an IV before an ultrasound IV expert was called, you had a bad nurse. If you were given 10mg Haldol and 2 mg Lorazepam by accident because your nurse didn't double check the order and realize the doctor put the emergent psychiatric "go to sleep cocktail" on the wrong patient, and you woke up with a tube down your throat... you had a bad nurse. If you were discharged home and developed a nasty rash on your arm that spread into a wicked skin infection that needed to be treated aggressively with antibiotics because your nurse didn't wash their hands and follow isolation protocols after touching an XDR patient... you had a bad nurse. If you were there for a chin laceration repair and could ambulate without difficulty and the nurse told you it was hospital policy that everyone had to use a urinal or bedpan only... you had a horrible nurse. If you were not updated with changes in status or progress every hour or so because your nurse was in the locker room exchanging saliva with the pharmacist... you had a bad nurse. If you noticed your left arm was rapidly swelling around your IV site that has Phenergan infusing and you called your nurse in to reassess and they said "meh, it's fine" and walk out... you had a bad nurse. If you had a horrible burn from a kitchen fire and your nurse walks in singing "This girl is on FIRREEE, FIREEE, FIREEE".... You had a bad nurse.... But you kind of have to appreciate the irony. A bad nurse is someone who diverts narcotics and sells it on the black market for extra cash. A bad nurse only goes into your room to watch the game on the television. A bad nurse doesn't advocate for you or questions things when they're wrong. A bad nurse doesn't clean up their mess and leaves a "sharps and needles minefield" in your stretcher. I remember being a new nurse and I missed a lot of IV starts. I still miss now, I'm not perfect. And there's no question clinical skills are important in nursing. But to categorize the entire experience with a nurse based on one or two pokes is crazy to me. If I have a nurse that is attentive to my needs, empathetic, smart, and considerate, they could poke me twice and I'd be fine with it. Because that's not a bad nurse
  4. stephen1219

    I Was Your Nurse Today

    Thank you for your kind words. My hospital held several 'debrief' sessions regarding this incident in an effort to check in with the staff. In the past, I had never participated but I found talking and writing down my feelings truly helped... as corny as that sounds. If the time comes when you are in this situation, I hope you can find a way to 'debrief' as well.
  5. stephen1219

    I Was Your Nurse Today

    Zak, I was your nurse today From the second they brought you back from the waiting room I knew you were in trouble. Your face was blue and dusky. Your body was mottled. Your breathing was shallow and raspy. Your words were unintelligible. It was hard to get access because your body was cold and clamping down. There were many people in your room. Doctors, nurses, respiratory therapists, paramedics, social workers, your family. I talked to your wife and told her we had to put a tube down your throat to help you breathe. I told her we were giving you antibiotics, blood pressure medications, and more fluid. She told me to save you. Your wife is a friend of mine, of the entire department. When your heart stopped beating we put pads on you and started pushing on your chest. We shocked you twice. We called more doctors. We gave you more medications. We put a bigger tube in your right groin. We brought your wife to the head of your bed. We kept pushing on your heart. I jumped up and started pushing, wanting to believe that I could make a difference, that I could jump start your heart again. We called more doctors. We grabbed more people, more equipment, more medications. We kept working. We didn't want to stop, we were never going to stop. I wonder if you heard your wife say to you "you can't leave me, don't leave me". I wonder if you heard her begging us to save you and felt us work harder and harder. I wonder if you knew how much your wife and mom and dad and sister loved you. I wonder if you heard their words and felt their love. I was still your nurse when your wife told us to stop after 40 minutes of coding. Everyone left the room except your family. I brought chairs in and my heart broke while I listened to your wife tell you she will always love you and your children that you never got to have. I walked out of the ED and yelled because I couldn't believe someone so young and healthy could deteriorate so quickly. I thought about my brother who nearly died in a motorcycle crash. I was your nurse today. I couldn't bring myself to look at your wife's face when I had to go into your room to draw more blood cultures. She was sprawled over your body making a chilling cry I'll never forget. I stepped out and saw my hardened ER family of co-workers who've seen it all hugging each other and crying. I had to comfort the ED attending who just arrived for a night shift to discover the patient he sent home yesterday had returned today and died. I was your nurse today. I helped steady your wife's hand while she signed for the autopsy report. I asked if she wanted me to remove your 2 year and three month wedding ring off your cold lifeless fingers. She wanted to do it. I listened to the cries of your family. My co-workers complimented me on my good work when deep inside I felt like all I did was watch a healthy man die before my eyes. I re-lived the entire course of events numerous times because the person charting didn't do a great job. I was your nurse today. I'm sorry we couldn't save you. Your face is etched into my memories. I don't think I'll ever forget it. I wish I knew you before. It's clear you were well liked and loved. I was your nurse today.
  6. These are my ramblings when I get the question "what's the craziest thing you've seen in the ED?" I always respond differently because I never know how to answer this question. Sometimes, there's a very specific example in mind. Other times, it's that people keep coming back to work. When people find out I work in an emergency department, they always ask me what is the craziest thing you've seen?” I always laugh at this question because I think it's ridiculous. I could tell them about the person with a chainsaw accident to the face. Or the woman who was so convinced that she had parasites living in her hair she picked away at her head until she dug almost completely to the skull. I could tell them about the man in the psych ward who referred to my Adam's apple as a tea kettle ******** (the nicest of names he called me) who ended up in 4 point restraints. Or the person who fell from a 10ft ladder and had every bone in his face smashed after the window he was replacing toppled over. Or the female on suicide watch after her husband suffered a cervical spinal injury 4 months ago and told me I haven't cried since the accident”. Or my favorites, the people who have tattoos all over their body but cringe when I come toward them with IV supplies. I could tell them about the screaming, the yelling, the spitting, the crying. The unusual anatomies, the mental health breakdowns, the social work nightmares. After everything we see working in the ED, it's hard to sum up a single craziest moment”. Maybe the craziest thing is we don't talk about it. I've been in numerous high stress codes and sometimes we get the patient back and sometimes we don't. Either way, we go right back to business after the code because there's always more people in the waiting room. It's not that we don't want to talk, but sometimes we don't have time to have a debriefing. And sometimes we really don't want to talk about it…. because then we have to really think about it… which can be terrible. Or maybe the craziest thing… it's that we keep coming back. And that we enjoy it. At least I do. What are your thoughts?
  7. stephen1219

    All About The Tubes... Reflections Of A New ER Nurse

    Reminds me of a quote from my nursing school instructor. If you're having trouble finding it, "stop and remind yourself that they have to pee somewhere down there". AGE87 this isn't meant to frighten. It's one of those "be comfortable being uncomfortable for awhile"
  8. I blame nursing school for beating the "reflection dead horse". However, on this particular day where I needed to straight cath an 88 yo woman, I found myself with all kinds of new reflections. As a brand spanking new nurse in the ED, I feel that every day is trial by fire as I make tiny mistakes everyday. For example: 1) changing IV maintenance bags from the pole and forgetting to clamp resulting in fluids pouring all over me, 2) starting IV's and forgetting to apply distal pressure leading to a bloodbath, 3) removing an IO for the first time, accidentally scraping my hand with the needle (not sure it happened but I was required to check in), and being admitted to the ED as a patient for needle stick precautions. It's frustrating. It's embarrassing. It's overwhelming and terrible at times. But I keep coming back. And I never make the same mistake twice. Usually. My patient was being worked up after having three GLF. I had already made another mistake earlier in the day with her IV. I succeeded in putting an 18g IV in her RAC. I drew her labs and left the room to send them. Yet when I returned, the catheter was hanging out. The patient was alert and oriented x4 and her neighbor was in the room. Both denied messing with the IV. Regretting my decision not to stat lock, I put in another line (without a bloodbath). We also needed a urine specimen. Since she was incontinent and the likelihood of acquiring a midstream uncontaminated sample was low, the only option was to straight cath. I found my preceptor and she agreed to assist with the procedure. Since the patient expressed her urgent need to go, my preceptor suggested using a bigger 14fr because it would drain faster. I washed my hands. I set up my sterile field. I had my life reflections. I was ready to go. The opening was visible and I cleaned enough to make 'Monica' from Friends proud. And then I inserted the tube. Nothing. I start to inch the tube farther and farther in. I'm starting to get concerned when it's taking longer than usual. My patient is calmly watching basketball on the TV. She denies any pain. I keep advancing. It's in as far as a male. Still no drainage. I'm thinking it has to be in the bladder curled up. I wonder can it possibly be in the ureter? She would have to be yelling right? She suddenly yells something and I look up. She's mad at the TV and still denies pain. There's nowhere left for my tube to go and I look at my preceptor. She shrugs and says it's in the vagina. We leave the tube in. I repeat the setup and I'm all ready to go again. I assess the area and..... there's nowhere to go. I feel ridiculous telling my preceptor that but I do. We turn on the overhead light. She points to an area and I try to access it and the tube curls right back. My preceptor opens another kit (she doesn't have life reflections) and we open the site as wide as possible. We see another hole that we both agree is, quite clearly, the vagina. I remove the first tube, my preceptor repeats the cleaning, and inserts the smaller tube and urine streams out. Apparently, big tubes aren't always the best tubes. At the end of the day, I felt pretty defeated. I apologized several times to my patient for my mistakes and she only laughed. She told me I had done a wonderful job simply by listening throughout the day. She told me she felt comfortable and safe under my care. In fact, she told me that several times before she was discharged home. Now, I'm not one who 'fishes for compliments'. However, it made me realize how much I undervalued the non-technical skills I had performed. It's interesting because it's not 'doing the skills' that bring me back to the ED. The humor, the wit, the stories, the empathy, the being able to turn one of someone's worst day into something manageable,... those are what brings me back. Hope you think about that the next time you shove a tube up someone.
  9. stephen1219

    New grad ER nurse

    Hello all, I know there are other forums about this but I thought I'd get a more recent perspective. I landed a good job in the ER with a 4 month residency for new grads. It starts later this month and I was wondering what are things I can do to best prepare for this (labs, meds, procedures, etc). Im very grateful for your help in the past and I look forward to hearing your insights