too much...just way too much

I've been procrastinating writing this post

I don't want to write it. I want to stay positive, I don't want to whine or complain or bitch. But I can't keep this shit in.

Don't get me wrong, I love being a nurse. I think it's such a rewarding job and I wouldn't trade it for the world but.....this past week was the HARDEST week i've ever had. The hospital saw the highest patient volume in its' history. We felt it...I felt it. In the ER we have 5 patients each. So we are responsible for 5 rooms. Sometimes they are all full and sometimes you have only 2 or 3 patients. This week every room was full, every hour and every minute. There was no moment of relief.
No second to run and go pee
No second to take a deep breath
No second to think
No second to focus
Just run
run
run
and think later.

I felt like I was putting my license on the line. I could of made so many mistakes. I did make mistakes. I forgot to sign things. I didn't give my best care. I was uptight, stressed and not at all the nurse I want to be...hell...the nurse I AM.
I understand that jobs get busy and I do work in a fast paced job but this was crazy. This was too much for even the experienced nurses. Everyone was losing their shit. Swearing, lashing out, not working as a team. What could have been the solution? Call for back up! Call more nurses to help! Call more paramedics! At one time I had 5 IV lines to be started and 4 EKG's...how the hell am i supposed to get that done in the 15 minute window I have if all the people came in at the same time???? Just insane.

Then..just when i thought i couldnt take anymore...the ambulance bay opens and a cardiac arrest comes in. The guy had been without a heart beat for 20 minutes. Of course he becomes my patient. We all gown up quickly covering our faces, bodies and hands with plastic assuming this is going to get messy. The man is about 70 years old and i'm told he had begun vomiting buckets and buckets of blood at home. His wife called 911 cause she didn't know what to do. Fire rescue got there and as soon as they placed him on the stretcher he coded.
His heart stopped.

They jumped into action giving him two amps of epi and doing cpr. Unfortunately he was in what's called PEA. That means 'pulseless electrical activity'. The monitor was showing a rhythm but there was no pulse to be found. His heart could have been quivering due to meds or other unknown reasons but it wasn't actually producing a pulse. Unfortunately we cannot shock a rhythm like that. All we can do is continue cpr and hope for the best. It turns out he had Lung Cancer and the cancer was now affecting his heart as well.
I was advised that the wife would be coming around the corner any minute and my job would be to stay with her and explain all the proceedings. You DO NOT want that job.
At this point there are a million people in the room, the patient is being intubated, lines are being drawn, CPR is going on, his clothes are stripped off and its loud and crazy. The wife is asking me everything"
"why are his clothes off"?
" why are they pounding so hard on his chest?"
"why isn't he talking"?
"when will he be discharged?"
WHEN WILL HE BE DISCHARGEDDDDDDDDDDD????

THIS LADY HAD NO F---ING CLUE THAT HER HUSBAND HAD BEEN WITHOUT A HEART BEAT FOR OVER 45 MINUTES. SHE LITERALLY WAS IN COMPLETE DENIAL.

 

I had to try my best to explain everything in terms she could understand. Meanwhile I still have 4 other patients calling my name, meds that are late and people that are becoming increasingly pissed off.
The doctor looks at me from across the room basically to say "what does the wife wanna do"? Should we stop now or keep going. The wife says "my brother came back from the dead so my husband will too". Jesus. Doc says that last thing we could try is to place him on a special heart medicine drip. We both know that its been too long now without heart activity but we must try. He advises me to run and get it. I drop everything and go to the med room to get it only to find that it's not available there. I call pharmacy and they tell me they will make it. I look around for a tech to retrieve it from pharmacy but no one is around. I RUN...and i mean RUN up three flights of stairs to the pharmacy. They were mixing it up there and it still wasn't ready. I was pacing. Finally I grab it, fly down the stairs and burst back into the patients room.....only to see them pulling the sheet over his head.

It was too late.

He was gone.

I didn't run fast enough.

I know it wasn't my fault. I know he was gone already. I know all this but somewhere in the back of my mind I hold onto that little feeling that I could have done more.
The next two hours were full of reports, family members mourning and screaming and more patients demanding all of my exhausted attention. I drove home from that shift feeling defeated. I just couldn't take much more of anything. I was too tired to feel emotion and too full of emotion to be tired.

I had the next 4 days off...THANK GOD...and I didn't have a true meter of what a wreck I was until I was over at my boyfriend's house. We were watching tv and relaxing and I was starting to doze off. He asked me about my crazy week and what made it so stressful and that was it...

I COMPLETELY LOST IT. Tears came draining out of me. My shoulders shook and heaving sobs poured out of body. I was an absolute mess. I guess I was waiting for the okay from someone and the flood gates opened.I had been holding the stress and pressure in too long. The death of that man haunted me that week and I couldn't seem to let it go. I sobbed and sobbed and I'm pretty sure completely soaked his shirt with my tears. It felt so good to have someone to talk to (or cry to) and I realized that it's not a bad thing to be filled with so much emotion over my job. It makes me human. I have always said I hope to never get hardened to the likes of death or pain. I honestly don't think I ever will.

You know...someday I might need someone to save me. I pray that if that ever happens and I'm laying there in a hospital bed with my life hanging in the balance, that there will be a nurse there by my side who's just like me. Someone who's maybe a little overly emotional, bursting with passion and wearing great sneakers to get up those damn stairs quick...

 

 Emma Roberts RN

how to be successful in the ER

Qualities Required for an ER Nurse

I found this on a fellow ER blogger's page and found it not only enlightening but also a little silly :)

 

If you want to be successful in the ER :

1. You must be able to adapt quickly to change. The first 60 minutes of your shift may entail finding out about a policy update, initiating a lidocaine drip on a patient, taking a bead out of a 4 year old's nose, finding out the previous policy update was updated again, assisting in a casting, placing a catheter in a 80 year lady with dementia and unique female anatomy, being floated to ICU, being released from ICU, doing pediatric triage, and then going on a run with EMS because they are short staffed.

2. You must be able to hold your urine for 12 hours straight. See number 1 for reference.

3. You must not be a frequent crier. Tears are OK once in a while, but not on a daily basis. Seriously people......if you are that emotional, find a less stressful job.

4. A sense of humor is a must - a vital requirement. You cannot survive without it. Because sometimes it's just dang funny when a man comes in with a foreign object in his "orifice", or Dr Q slips on the freshly mopped floor and lands with his coffee spilled over his scrubs and the stool sample card he was carrying flat open on his face.

5. You must be a critical thinker. You must understand WHY you are doing what you're doing. Being genuinely surprised that your patient is hard to arouse after 30 minutes on a Versed drip makes the other nurses look at you funny and wonder where the hell you went to school (www.easynursingdegress.com?). Also, not doing a urine dip on a patient that has just been kicked in the gut by a 1 ton horse because "the doctor didn't order it" is just not acceptable.

6. You must be willing to train other nurses. How will we devlop competent nurses to cover for us on our vacation days if we don't make the effort to train them? Really - it's in your best interest to show SusieQ how to assist in a chest tube insertion, because you may want to go to NYC next month and there is noone to cover your shift on Trauma Call except a new inexperienced RN who was never trained. Next thing you know, your boss says "No!"

7. You must not mind body fluids. Blood, vomit, poop, pee - they're all part of a normal day in the ER. Sometimes you even get to have them splashed all over your clothes and in your face.

8. You must be excellent at organization and time management (refer to number 1 once again).

9. You must be able to recognize the fact that a 45 y/o obese male with a history of smoking who is experiencing chest pain needs to be seen before an 80 y/o female with complaints of "it burns when I pee." Triage is your friend - know it, own it.

10. You must be able to prioritize. It is more important for you to obtain an EKG on your 45 y/o male than it is to obtain a urine sample on your 80 y/o female. Just because the doctor ordered the UA first doesn't mean that is the order in which you perform your interventions.

11. You must be a cold, hard bitch. Oh wait - no....that's just me.

12. You must bitch endlessly about how unreal medical shows are, but secretly watch them at home cuddled up in a blankie with a cup of hot chocolate while yelling "You don't shock asystole asshole!"

13. You must be willing to keep up on your education and be aware of current practice. Stating "Well, Abby did it last night on GREYS ANATOMY" doesn't go over very well with the Chief of Nursing. See number 12. Another tip - People magazine does not contain any CEU's.

14. You must not screw around with your coworkers. Paramedics, police, firefighters - go for it. But another ER nurse or doc? Not a good decision. First, you're mushy mushy kissy kissy in the hallways, making people want to throw up. Then, when things go south (they always do), it becomes difficult to take care of that patient seeking treatment for syphillis without popping a comment off to Big Bob RN about how you're surprised he's not laying on the stretcher - as much as he fooled around on you.

15. You must be able to handle people yelling, screaming, cussing, and spitting at you without taking it personally. Review number 3.

and last, but certainly not least............

16. You must be able to find rewards in the little things - the smile of a child after they've been sewn up and get to choose a sticker, the reassuring beep of the cardiac monitor after you've resuscitated someone, the way the closet at the end of the hall is soundproof so no one will hear you scream when you are losing your mind.

 

______________________________________________________________________________

 

I think being able to find the humor in my job is essential. It gets hard, real hard and being able to chuckle about things makes it all okay in the end. I know sometimes things are gross or disturbing but sometimes things are also amazing and unbelieveable.

 

It's the miracles that make everything else worth it.

 

Here's to one of the best jobs around...cheers :)

 

EMMA ROBERTS ER RN

PRE JUDGE

Patient Advocacy

We judge, form opinions and often times stereotype certain "types" of people. I admit that I too have been one of those people. We try and try to remain open minded and judgement free but more often than we'd like to admit to, we label people as "different" and ultimately relinquish full respect. This is no different in the medical field. The problem, however, is that this lack of respect could mean the difference between sickness and health and horrifyingly enough... between living and dying. We CANNOT and must not look at anyone in any way other than that of a sacred human life.

I found myself dealing with this situation first hand the other day.

The situation: At my hospital we have a unit devoted solely to pregnant woman who are addicted to drugs. These woman apply to be in the program and once accepted, succumb to intense detox in order to get healthy for their unborn child. There are woman from all walks of life, some homeless, some lawyers and even some doctors and nurses. This program is a safe place to go to start fresh and try to salvage the health of their baby and themselves. These woman should be rewarded and praised for checking into this program...right? You'd think so. Unfortunately they are pegged as "druggies" by many and treated with less than hospitable practice.
I was working and recieved a call from the unit upstairs. They stated that a woman from the unit needed to be seen in the Emergency Room because she has been screaming and moaning for about 3 hours. She states her abdomen is killing her and the pain is unrelenting. The reason they needed to bring her down to us is that this specialized unit is not a medical floor. It is a detox yes, but they do not have the capabilities to treat acutely sick patients. We have doctors, nurses and an abundance of tests and medications so many times patients from other floors are sent to us. We work fast and hard and are able to diagnose serious illness at a rapid pace. This young lady was brought down a few minutes later by wheelchair and I swear to you I could hear her when she was still in the elevator. The screaming, moaning and crying was deafening. She was not going to be my patient but I put her in a room and began to get her information and story. Well... that was my plan except for the fact that she would not speak, only scream. I tried to understand what she was saying but the only information I could determine was that her right lower quadrant was in excruciating pain. I read thru some paperwork the unit had given me and got a greater picture of what we were dealing with. It was amazing having a chart to go through, a day by day account of the patients' history. In the ER we NEVER know what has happened before, we NEVER know what meds they are really taking and we certainly NEVER know what is going wrong now. It is our job to find the cause, diagnose it and FIX it before things go horribly wrong. So...I read.

She had been in jail for a short time
She is 28
She was addicted to pain killers
She hadn't done a drug since aug 10th
She had been in the unit since Aug 12th
She was 6 months pregnant.

Reading this ultimately squashed my first "judged" theory. I had assumed she was going through withdrawls. I had assumed she was seeking her next high. I had assumed she was less of a human than me. I assumed wrong.

I went to find the doctor. Usually I feel very comfortable talking with the doctors but there happened to be a new doctor working. I didn't know her and wasn't sure how she operated. I ran to the doctor and physicians assistant and told them that they should check on her STAT. I didn't like the way she was moving around the bed. She couldn't sit still and the color was draining from her face. She was diaphoretic (sweating) and would have moments of such intense pain that she would freeze up and stare off into the distance. The doctor and PA asked who was in the room and I told them...then they continued their conversation. I mentioned again that I felt like she needed meds as soon as possible only to recieve the same response. I acted on the patients behalf. I directed the paramedic to begin drawing blood and to send it STAT to the lab and then I began monitoring her vitals and entering as much information as possible into her file. Keep in mind the entire time during this process the patient is screeching and screaming at the top of her lungs.So much so that other patients were walking by to see what all the commotion was about. The doctor stops by, peeks in and walks back to the desk. I wait for the meds to pop up. They don't. I wait some more. They never appear. I walk over to the desk and said "I really feel that we need to medicate her. She has thrown up several times and there is obviously something really wrong." I heard a few whispers...."she is probably detoxing, she probably wants morphine, no one screams that loud when they are really in pain". I stood there right next to the doctor until it became annoyingly apparent that I wasn't going anywhere and I saw her finally write the medication order. I then  ran to get it and had it in my patient within the next 2 minutes. This woman had now become MY patient. Not because I was told to take her but because I knew that someone had to advocate for her. Someone had to be her voice because I know if that were me I would want someone with a little compassion to give a damn about me. Little by little tests were done and meds were given. Watching this woman broke my heart. Yes she used to do drugs, and you know what? She'll probably do them after she gets out of the hospital. But who the hell am I in the grand scheme of life to decide who needs to feel pain and who doesn't. Who should suffer and who shouldn't?
Labs come back: she has a white blood cell (infection) count of over 17,000. This is high. Something is wrong~! I knew it. An MRI of her abdomen is ordered to rule out appendicitis or gallstones. The MRI technician is called at home to come in. She arrives and I watch her interact with my patient. She is tired and abrasive and is mad that my patient won't lay still for her. Are you kidding me? The MRI tech keeps saying to her..."lay still, stop moving, ugh, geez, sit still". I put my face close to hers and whisper " I know you're in pain, i want to help you but i need you to do your best to lay still so we can get a clear picture of what's going on. We are going to get you feeling better soon. Can you do that for me?" She nods and muffles a yes. The MRI shows exactly what i knew all along. Appendicitis. She needs surgery STAT to save not only her life but the life of the baby as well. This is very dangerous and if it ruptures can be fatal.  I know how bad this hurts because mine ruptured years ago. If someone would have told me to be quiet or lay still or that I couldn't have any medicine I think I would have found the nearest highway to play in. The pain is unrelenting and unforgiving.

Seeing the doctors face as she looked at the MRI result was priceless. I knew as I watched her writing her final diagnosis of Acute Appendicitis that the lesson was learned.
And seeing her read the final lab result : NEGATIVE DRUG SCREEN was even better.
This young lady wasn't seeking drugs: she was seeking help. And where else should she have gone to other than a hospital? And who else should she have trusted with her life other than a doctor?

Apparently... a nurse.

Moments like this make me proud to have RN after my name.
People often say... "how do you deal with it, the stress, the blood, the sadness?" I never really have a good answer but I guess I don't really need one. You know the quote " do unto others as they would do unto you"? I hope that someday if I'm laying in a hospital bed that I can look up and know deep down that the person standing over me will take good care of me. They will not decide what medicine to give me based on what kind of car I pulled up in, or what color my skin is...or if I have insurance or not. They will care for me because I am a human being and I have a right to life. And NO ONE is above that.

Proud,
Emma Roberts RN