Out of the multitude of tests that we run in ER, urine dip is probably one of the simplest ones. Well, at least I think so. However, some of my patients wouldn't agree.
It seems like everyone who presents to ER gets a urine dip done. Some end up with their pee being sent for C&S as well. I have to ask my patients for a urine sample so often that I have my own little speech that I usually stick to: "Whenever you feel like you can pee, we'll need you to give us a urine sample." [Hands over a container and a biohazard ziplock bag to the patient.] "Just put it in the bag when you're done."
Simple, right? Unscrew the lid. Pee in the container. Put the lid back on. Put the container in the bag. Hand it back to the nurse. Even if I tried, I don't think I would be able to come up with things that people do when asked to provide a urine sample.
An elderly man once returned from the washroom with the biohazard bag in hand. "I've got my urine sample," he says as he hands it over. I spent the next five minutes trying not to spill any of his urine on myself while pouring it into a container. He peed right in the bag. Good thing it had a zip lock on it...
Another time, a young girl handed me her sample only for me to realize that she somehow (and to this day I keep trying not to even try to imagine how) managed to shit in the container, the diameter of which is about 1 1/2 inches, instead of peeing in it (mind you, I didn't give her a hat or anything). I had to tell her to throw that (literally) shit out and go back to the washroom.
I won't even tell you how many times people tried to pass tap water for their urine. These are usually patients that we run urine tox screens on. Right... I've seen enough pee in my nursing career to be able to tell it apart from water, you smart ass. Go try again.
After all these years of asking people to provide urine samples, it makes me think that it might be helpful to come up with some sort of an illustrated step-by-step instruction sheet. No words, just pictures. Multicultural-friendly. Like those Ikea instructions you get with your $15 put-it-together-yourself side tables.
Sunday 31 March 2013
Friday 29 March 2013
Triage, or the things you learn about humanity
I had a pleasure of triaging this 22-year old guy last night who stuck a tab of Tylenol in his right ear and (surprise surprise) couldn't get it out. I didn't even bother exploring his reasoning behind what he did. It was well into my night shift. I was tired. I already saw enough stupidity for one night. But I did ask how long has the pill been stuck in his ear canal. "Twelve hours," he said. Then he paused, thought about it for a second and said: "No, more like eleven."
Thanks for clarifying the exact time you did something that no normal person after the age of six would do. Thank you, because it definitely made you look less like an idiot.
Thanks for clarifying the exact time you did something that no normal person after the age of six would do. Thank you, because it definitely made you look less like an idiot.
Wednesday 27 March 2013
12 Hours in Hell, or Why Didn't I Call In Sick This Morning
A shift from hell in my understanding goes something like this:
In 12 hours you look after:
- two intubated patients, one of whom ends up in the ICU and the other transfered to another hospital for an urgent neuro surgery (of course, you are the one who has to go with the patient, RT, MD, and two paramedics bouncing all over the seat at every bump in the back of an ambulance).
- two patients with COPD exacerbation in severe enough respiratory distress to need BiPAP.
- a patient in atrial fibrillation who needs to be cardioverted (while all hell is breaking loose with your other patients).
- a patient waiting for a step down bed for 17 hours because there are no available beds in the hospital, who needs hourly blood glucose checks and Q4H blood work.
- a patient having two seizures even after being loaded with Dilantin.
- a code STEMI patient who gets rushed to the cath lab.
- a violent drunk patient who needs to be put in four-point restraints by security and slammed with vitamins A and H (Ativan and Haldol).
Add to all this the fact that I only got four hours of sleep the night before and you get a true shift from hell. On the bright side though, I finally got a chance to hear firsthand how loud ambulance sirens sound inside the truck. In case you ever wondered, not loud at all. It took me a minute to realize that it was us and not some other ambulance truck behind us. One more thing off my "want to know" list.
In 12 hours you look after:
- two intubated patients, one of whom ends up in the ICU and the other transfered to another hospital for an urgent neuro surgery (of course, you are the one who has to go with the patient, RT, MD, and two paramedics bouncing all over the seat at every bump in the back of an ambulance).
- two patients with COPD exacerbation in severe enough respiratory distress to need BiPAP.
- a patient in atrial fibrillation who needs to be cardioverted (while all hell is breaking loose with your other patients).
- a patient waiting for a step down bed for 17 hours because there are no available beds in the hospital, who needs hourly blood glucose checks and Q4H blood work.
- a patient having two seizures even after being loaded with Dilantin.
- a code STEMI patient who gets rushed to the cath lab.
- a violent drunk patient who needs to be put in four-point restraints by security and slammed with vitamins A and H (Ativan and Haldol).
Add to all this the fact that I only got four hours of sleep the night before and you get a true shift from hell. On the bright side though, I finally got a chance to hear firsthand how loud ambulance sirens sound inside the truck. In case you ever wondered, not loud at all. It took me a minute to realize that it was us and not some other ambulance truck behind us. One more thing off my "want to know" list.
Wednesday 20 March 2013
The tales from down under
One of the joys of my job is chaperoning docs during pelvic exams. Majority of the docs in our department are men, so whenever they have the pleasure of performing a pelvic or rectal exam on a female patient, they ask one of the female nurses to be present during the procedure. Just in case. Doing the job that we do, we all need to cover our behinds.
Just last night when I was the charge nurse (which means I wasn't even assigned to an area in the department) I had to assist with three pelvics. I hate pelvics. First, I find it awkward just standing there doing nothing while the woman on the stretcher with her legs spread wide is looking at me with agony of discomfort and embarrassment in her eyes. Second, the smell that sometimes comes from those vaginas makes me cringe. If you've never smelled a tampon that was "lost" in a vagina for a few days, pray that you'll never get a chance to. Third, depending on the doc doing the pelvic, the experience can reach more than an expected level of awkwardness. I was the lucky witness to the following once:
We're in a middle of a pelvic exam. The doc takes somewhat longer than usual time fumbling around in between the woman's thighs with a speculum and then his fingers. Finally he says: "I haven't said it in ten years, but I can't seem to find your cervix... And I have long fingers."
It took all the willpower I could muster for me not to burst our laughing. The woman on the stretcher just looked at the doc with exasperation and a silent prayer in her eyes for the torture of a stranger man poking around her privates to be over.
I will also forever thank my lucky starts for letting me be present during a pelvic exam where one of the docs would diagnose vaginitis by smelling his fingers after pulling them out of a woman's vagina.
At the end of the day, pelvic exams are sometimes fun. Most of the time though, they are boring and take up a lot of the time that I could've spent on giving people pain meds, drawing their blood, and assessing new patients. But the docs need to cover their asses. It just makes me wonder why is it that no male nurses/docs need to chaperone me when I insert foley catheters into patients' penises?..
Just last night when I was the charge nurse (which means I wasn't even assigned to an area in the department) I had to assist with three pelvics. I hate pelvics. First, I find it awkward just standing there doing nothing while the woman on the stretcher with her legs spread wide is looking at me with agony of discomfort and embarrassment in her eyes. Second, the smell that sometimes comes from those vaginas makes me cringe. If you've never smelled a tampon that was "lost" in a vagina for a few days, pray that you'll never get a chance to. Third, depending on the doc doing the pelvic, the experience can reach more than an expected level of awkwardness. I was the lucky witness to the following once:
We're in a middle of a pelvic exam. The doc takes somewhat longer than usual time fumbling around in between the woman's thighs with a speculum and then his fingers. Finally he says: "I haven't said it in ten years, but I can't seem to find your cervix... And I have long fingers."
It took all the willpower I could muster for me not to burst our laughing. The woman on the stretcher just looked at the doc with exasperation and a silent prayer in her eyes for the torture of a stranger man poking around her privates to be over.
I will also forever thank my lucky starts for letting me be present during a pelvic exam where one of the docs would diagnose vaginitis by smelling his fingers after pulling them out of a woman's vagina.
At the end of the day, pelvic exams are sometimes fun. Most of the time though, they are boring and take up a lot of the time that I could've spent on giving people pain meds, drawing their blood, and assessing new patients. But the docs need to cover their asses. It just makes me wonder why is it that no male nurses/docs need to chaperone me when I insert foley catheters into patients' penises?..
Monday 18 March 2013
Night shift worker blues
Nothing takes the stress and pain of a long Monday shift away like a nice glass of a spicy Caesar. Well, maybe a frosty pint of beer. Or a glass of delicious mellow red wine. To be honest, after a shift from hell, anything containing some amount of EtOH will do. Well, almost anything. I've seen enough patients drunk on hand sanitizer, mouth wash and cooking wine to know that drinking these things makes you smell awful and eventually turns you into a walking (and sometimes, although rarely, talking) bag of flesh reeking of urine/feces/BO/sweat/dirty feet/you name it.
A lot of my friends (mostly the ones that are not nurses and don't do shift work) look at me funny when I tell them that I often have a glass of wine after a night shift. Sure, for most people, drinking at 8 AM is completely unacceptable and probably warrants a visit to AA or a check in into a detox program. Well, not if you work shifts, my friends. When I work nights, having a glass of red at 8 AM for me is the same as you having a drink at 8 PM. I have my wine, take the edge off a long and most often than not busy shift, and then head to bed only to wake up at 5 PM for another night shift... Which brings me to another point of deep frustration: I hate hate hate that there are no bars or pubs open in the morning to cater to shift workers. So many times, my colleagues and I wanted to celebrate the end of the stretch of night shifts by going out for a cold pint of beer after work. But we have to settle for breakfast and coffee. And, since it's not nearly as fun as beer, we've never actually done it. Given how many shift workers are out there it amazes and frustrates me how unaccommodating the world is to us. Don't even get me started on fire alarm testing, balcony repair work, and general water shut down in my building from the hours of 9 to 5. Don't even...
Anyway... One blog post/rant and two Caesars later I feel better. The tension headache is gone. There is only a dull ache in my feet. And my upper back is surprisingly quiet. I think I'll go have dinner now. Yes, it's 9:40 PM. Yes, it's late. But I've just worked a 12 hour shift and just got home an hour ago. I make my own rules about what's acceptable and what's not. I work shifts.
A lot of my friends (mostly the ones that are not nurses and don't do shift work) look at me funny when I tell them that I often have a glass of wine after a night shift. Sure, for most people, drinking at 8 AM is completely unacceptable and probably warrants a visit to AA or a check in into a detox program. Well, not if you work shifts, my friends. When I work nights, having a glass of red at 8 AM for me is the same as you having a drink at 8 PM. I have my wine, take the edge off a long and most often than not busy shift, and then head to bed only to wake up at 5 PM for another night shift... Which brings me to another point of deep frustration: I hate hate hate that there are no bars or pubs open in the morning to cater to shift workers. So many times, my colleagues and I wanted to celebrate the end of the stretch of night shifts by going out for a cold pint of beer after work. But we have to settle for breakfast and coffee. And, since it's not nearly as fun as beer, we've never actually done it. Given how many shift workers are out there it amazes and frustrates me how unaccommodating the world is to us. Don't even get me started on fire alarm testing, balcony repair work, and general water shut down in my building from the hours of 9 to 5. Don't even...
Anyway... One blog post/rant and two Caesars later I feel better. The tension headache is gone. There is only a dull ache in my feet. And my upper back is surprisingly quiet. I think I'll go have dinner now. Yes, it's 9:40 PM. Yes, it's late. But I've just worked a 12 hour shift and just got home an hour ago. I make my own rules about what's acceptable and what's not. I work shifts.
Saturday 16 March 2013
435 pounds of why is this patient here?
My shift today started with me coming in to a 435 lb patient sleeping in a hospital bed that nurses had to borrow from one of the units upstairs. She was simply too big to fit onto one of our gurneys. There was nothing about this patient's presentation to grant a resuscitation bed but given how heavy (both physically and in terms of workload) this patient was, she was assigned a spot in the resuscitation room. Out of all the areas in our ER, resuscitation room has the smallest nurse to patient ratio. It's usually one to two patients per nurse.
This woman has been recently discharged from our hospital after being admitted for a whooping two and a half years. She hasn't spent even two weeks in the nursing home when the staff there decided they could not cope with her care and jumped on an opportunity to send her back to us. Their reason for calling 911 was that the patient had a decreased level of consciousness. She did not. True; she wasn't as active as some other people might be, and spent most of her time in the bed snoozing. True; she had sleep apnea and stopped breathing for a few seconds here and there, but then again, it didn't come as a shock given her weight. But there was absolutely no change in her baseline presentation to grant a visit to ER, let alone being admitted to the hospital.
Couple of hours into my shift (and after a great amount of collaboration between clinical nurse specialists, physicians, social workers, and ER management) it was decided that this patient was going to go back to the nursing home since her medical condition did not change since her discharge a couple of weeks ago.
Never before did I get so much pleasure out of calling a nursing home to inform them that we were sending their patient back. Mind you, I do understand how much it takes to take care of patients like Ms. K. This is one of the reasons I would never work in a nursing home or any other long term care setting. I just don't have what it takes to do that kind of nursing. But it frustrates me to no end when nursing homes literally dump their patients on ERs as soon as they feel overwhelmed and tired of taking care of them. That's not what ERs are there for. We are not there to give long term care RNs, RPNs, and MDs a break.
When two EMS crews arrived with the bariatric stretcher in tow I paged for all the available staff to come to resuscitation bay 3. Did I mention that we don't have ceiling or any other sort of lifts in our ER? It took six nurses and three paramedics to transfer Ms. K onto the EMS stretcher. As soon as they rolled through the sliding doors of the ER and out into the crisp winter morning air I felt lighter. About 400 lb so. I could go back to taking care of patients who actually required emergency care. Well, some of them did. Majority just didn't feel like waiting in line at a walk in clinic.
This woman has been recently discharged from our hospital after being admitted for a whooping two and a half years. She hasn't spent even two weeks in the nursing home when the staff there decided they could not cope with her care and jumped on an opportunity to send her back to us. Their reason for calling 911 was that the patient had a decreased level of consciousness. She did not. True; she wasn't as active as some other people might be, and spent most of her time in the bed snoozing. True; she had sleep apnea and stopped breathing for a few seconds here and there, but then again, it didn't come as a shock given her weight. But there was absolutely no change in her baseline presentation to grant a visit to ER, let alone being admitted to the hospital.
Couple of hours into my shift (and after a great amount of collaboration between clinical nurse specialists, physicians, social workers, and ER management) it was decided that this patient was going to go back to the nursing home since her medical condition did not change since her discharge a couple of weeks ago.
Never before did I get so much pleasure out of calling a nursing home to inform them that we were sending their patient back. Mind you, I do understand how much it takes to take care of patients like Ms. K. This is one of the reasons I would never work in a nursing home or any other long term care setting. I just don't have what it takes to do that kind of nursing. But it frustrates me to no end when nursing homes literally dump their patients on ERs as soon as they feel overwhelmed and tired of taking care of them. That's not what ERs are there for. We are not there to give long term care RNs, RPNs, and MDs a break.
When two EMS crews arrived with the bariatric stretcher in tow I paged for all the available staff to come to resuscitation bay 3. Did I mention that we don't have ceiling or any other sort of lifts in our ER? It took six nurses and three paramedics to transfer Ms. K onto the EMS stretcher. As soon as they rolled through the sliding doors of the ER and out into the crisp winter morning air I felt lighter. About 400 lb so. I could go back to taking care of patients who actually required emergency care. Well, some of them did. Majority just didn't feel like waiting in line at a walk in clinic.
Friday 15 March 2013
By way of introduction
In a few months I will celebrate five years since I went into emergency nursing. I was fresh out of school, full of ambition and passion for the profession. I didn't listen to my classmates and teachers when they told me that I needed experience elsewhere before going to work in an ER. I knew that I wanted to be an emergency nurse and I followed my dream, so to speak. Five years have gone by and even on the worst of the shifts I do not wish I chose to work on any other unit. I love how unpredictable and fast-paced my job is. I enjoy the challenges and feel amazing solving problems that at first seem too overwhelming to wrap my head around. I live for an occasional adrenaline rush of a "true" emergency. I'm friends with my colleagues because we have so much in common. And it makes me feel amazing when I know that I have made a difference.
All these wonderful big words aside, I'm not going to lie - I sometimes hate my job. There are days when I just can't help feeling burnt out and disenchanted with the whole nursing profession. These are the days when I literally limp home at night: tired, bloated, under-slept, yelled- and sworn-at at work by drunk smelly people. Or treated like a waitress or a personal assistant by VIP patients and their family members. Or talked down to and disrespected by MDs. Or having gone above and beyond for my patients only for the physician to receive a thank you card and a $100 bottle of vintage wine in the end. There are so many things that can bring you down and make you seriously consider if the choice you made all those years ago was the right one... And yet I keep setting my alarm for 5 AM and showing up at 7 to get report. My back and my feet are starting to really hate me, but I do.
These are my stories - the good and the bad and most of them something in between. And just to cover my ass, all the names and ages and identifying characteristics will be changed to protect patients' confidentiality. Maybe some of the stories never even happened. And maybe I'm not even a nurse. Who knows?
All these wonderful big words aside, I'm not going to lie - I sometimes hate my job. There are days when I just can't help feeling burnt out and disenchanted with the whole nursing profession. These are the days when I literally limp home at night: tired, bloated, under-slept, yelled- and sworn-at at work by drunk smelly people. Or treated like a waitress or a personal assistant by VIP patients and their family members. Or talked down to and disrespected by MDs. Or having gone above and beyond for my patients only for the physician to receive a thank you card and a $100 bottle of vintage wine in the end. There are so many things that can bring you down and make you seriously consider if the choice you made all those years ago was the right one... And yet I keep setting my alarm for 5 AM and showing up at 7 to get report. My back and my feet are starting to really hate me, but I do.
These are my stories - the good and the bad and most of them something in between. And just to cover my ass, all the names and ages and identifying characteristics will be changed to protect patients' confidentiality. Maybe some of the stories never even happened. And maybe I'm not even a nurse. Who knows?
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