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Observation and rant about the observed.

So, on my way home from work I stopped at a gas station to get a snack for my ride home. There was 3 or 4 ppl ahead of me. The lady that I was directly behind had her daughter with her, whom was not just over weight or obese for her age, but morbidly obese at the ripe ol' age of 8 or 9. The girl had a bag of chips in her hand and picked up one of the red-hot sausages and said, "Mama, can I get this, too?" The lady replied with a yes. Then the girl asked what all she was allowed to have. And I shit you not that the mother said, "Girl you got ten dollars, just spend it." So now the girl could have had a lesson in money management and savings but mom taught her instead to blow the wad. 

So, the girl is going around the convenient store just picking up shit from the shelves (a yoohoo, chips, two redhots,) and makes her way to the 3-day-old cold sandwich/lunchable section and the mother turns around to me and tells me to go ahead of her and in the same breath tells her daughter not to get any of the stuff from there because they're really expensive. So great, the most healthy choice the child was gonna make (albeit, not too healthy b/c we are at a Cirle K) and mom discourages it b/c it's to expensive to get and tells her to get a whole bunch of cheap stuff vs a few cheap items and one more expensive more quality item. 

FANTASTIC! Way to go lady! You had a chance to educate your child in finances and health (kind of--a ham and cheese sandwich is better than two Snickers) and help her to not be as broke as you are but instead you helped ensure she'll continue to be broke like you, and be on welfare all her life, and you've helped her to get diabetes, high blood pressure, high cholesterol in her future so she can come in to the hospital once a month and be disabled by the time she's 40 y/o and be a complete drain on our society. I give you mad props...not. SMH. 

Pet Peeves

So, I recently moved from a rural ER to a pretty fucking huge level 2 trauma center ER.  Yeah, I like it.  It's a lot to take in, but I like it.  But in moving to this new facility, I found some things are just universal; or at least they are in my southern redneck of the woods.  And this is where I'm gonna let it out. My biggest pet peeves... for the moment.  The first two run neck and neck for top pet peeves, one just takes the cake.

My number one pet peeve is when people tell me that something has been going on for a minute.  No fucktard, I need a real fucking time frame.  Nowhere in my electronic charting system can I chart "1 minute" as a time frame.  I'm not asking you how long this has been going on out of the need to pass the time or because I'm making small talk.  Do I really look that "nice" to you?  I really fucking need to know how long you've been having that CP, AMS, abd pain, cellulitis, abscess, cough or green shit coming out of your twat. Just fucking tell me.  An hour, a day, a week, a month?  What is so damn hard about that?

And the runner up for my biggest pet peeve is improper communication of the 0 to 10 pain scale from the patient to me, the RN.  For instance, when I ask a patient what their pain scale is from 0 to 10; with 0 being no pain and 10 being the worst pain ever possible in human existence.  "100 out of 10" is NOT an appropriate response because 10 is the highest number possible.  You can't put your stereo on 20 out of 10 volume because the dial only fucking goes to TEN!!  Or let's say I go to reassess the pain after giving 4mg of Dilaudid and I ask the patient if the medicine helped any and the patient states that it did (a lot) and then rates their pain as 9/10 when that was their pain rating prior to administration of the fucking med.  So now I'm confused, did it help or not.  Oh, you're probably not high enough to think it's "helping" your pain.  Which leads me to me next pet peeve.

When did our society come to believe that in order for pain relief to be affective one must have a head rush?  And I'm not just talking about the frequent flyer sicklers.  Even patients that have a legitimate reason to c/o pain, don't even want to try some Motrin or Tylenol or Toradol.  If it doesn't give them a fucking high, they think that it doesn't work and won't try it.  I seriously wish that we had a drug that could induce mild vertigo and no other mind altering effects and put it in the toradol or the IV tylenol.  I bet people would want it then because they'd be thinking they were high and getting pain relieving measures.

Another thing that irritates me is when we've just put an ETT in a pt, dropped an OG and a foley and started the propofol drip and in walks the family and screaming at me because her feet are fucking cold and she has no socks on.  Well, you know, them cold feet are kinda the last thing on my list when I have three other patients and this NOW critical ICU patient on a vent and I'm trying to chart everything that just went down in the last 45 minutes for no reason at all other than the MD wanted to intubate your loved one that was brady and responding to atropine swimmingly (no SOB or resp distress).  I kinda have to keep increasing the MJ juice out of our defined parameters because your loved one opens her eyes to look across the room when I call her name and she's supposed to be sedated, but instead she's bucking on me and trying to pull out all these tubes so now I'm restraining her ass.  Yeah, get your head outta your ass and go sit the fuck down.  Her cold feet will keep as long as we can keep her heart beating.  Not that I don't realize that your traumatized from this event too, but I don't have time for it.

Yeah, so those are the top 4 pet peeves I can think of right now.  What's yours?

You know... Nutt'in

I walk into the Pts room. "Hi, Frequent Flyer, I'm Bitchy Nurse. What brought you in to see us today? Oh I see on your sign-in sheet. You're having low back pain? Any N/V? Any blood in your pee? Any pain when you pee? Any vaginal discharge or itching?" *tongue pop* "Well my back be'en painen me for two days on my lef' side. Naw, I ain't been having no trouble goin' to duh bafroom. But *pause* it be feelin' like I be nutt'in on mysef." *head cocked sideways* "Uhm, I'm sorry, what was that?" "I be feelin like I be nutt'in on mysef." *I clear my throat* I'm sorry sweety I'm partially deaf and real hard of hearin'. What'd you say?" "Well you know when you be hav'n sexxx and you be nutt'in? Well, I be feelin' like dat all duh time." "So, what I am hearing is that you have no urinary symptoms but you constantly feel like you are at the point of or are about to reach orgasm. Even when you are not in the act of sexual intercourse. Is that right?" *Smile* "Yeah, like I be nutt'in mysef." "OK, let me get this typed up in the computer and Dr. Laughs at all his Pts stupidity will be right with you." *I had a straight face the entire time*. I walk out of the room, shut the door behind me because I'm about to crack up. I make it to the med room, shut the door and laughed so hard I was almost inconttinent on myelf.

Frustration...

So, over the last few months I've noticed that I've become more and more bitchy at work. And not my typical "bold like a lion" self. More like mean like a snake. And it's not the patients. It's the freaking cynical people I work with. Not all of them, granted. But some of them just are always so negative. It only takes one bad apple to spoil the bunch, right? Well, I'm easily spoiled. I get stressed out and instead of those in charge giving me a word of encouragement they go bad mouth me to my peers. Then they have enough nerve to ask me why people in this ER can't get along and why we're all back stabbing...Well dur....You set the bar because you're the CHARGE NURSE. If you're playing high-school games, you can expect the rest of the staff too...

I admit, I am easy to pull down. In some ways I am a leader. Unfortunately, in others I am a follower. And if I'm surrounded by negativity and trash talking it's very easy to pull me down to that level. On the same hand, if I'm surrounded by positive attitudes and people so happy to be be doing what they're doing, it can be pulled to a higher level. I recognize that since I am now a nurse, it's partly my responsibility to set the standard, and not just the standard of care. But a standard of professionalism and attitude. I don't want to be a follower of the negative. I want to be a leader of positive!

So I am truly working on this. It's just hard to change a mind-set that has been with me for 30 years. But I can think of two specific instances in the last three weeks that I have shut my mouth and just smiled while another peer unloaded on me. Usually I would have let my mouth say stuff that would make Satan blush in order to tell the other person off. However, I didn't. Even though those people deserved what I had to say. Why? Because now I must help to set the bar.

I'm just so frustrated. I don't like dreading going to work. I don't like counting the minutes until I can go home. I just hope that I can and do change my own personal frame of mind. I hope I can become impossible to drag down and easy to pull up.

If you are the praying kind, keep me and my attitude in your prayers. Please.

That is all.

OMG...

So, this episode has absolutely NOTHING to do with the ER. But it does have to do with death, grief and mourning.

Today, on this miserable, rainy, wet, cold and dreary day...I have turned thirty. Yep that's right, folks, my twenties have died. They were having SOB and went into respiratory distress yesterday, along with all the idiot chief complaints I saw sign in yesterday at the front desk of the ER. Recepted every stupid complaint into the computer myself, while my poor twenties were in respiratory distress. Well, as you can imagine without action and treatment, my twenties coded on me sometime in the night during my sleep. Well when I woke up this morning, I attempted to resuscitate them, but I have just called the code. They are dead. Luckily for me since the code didn't happen at the hospital, I have no paperwork to fill out, except my recollection of the events in this blog.

So now, I guess I'm officially in mourning. Man I had a lot happen in that decade of life known as my twenties. I became a drug addict in that decade. I snorted so much crap up my nose, it's amazing that my nose didn't protest and run away from me. Doesn't work the best for breathing now, but for some strange reason allows me have heightened sense of smell. How lucky for me in the healthcare industry that I still get to smell every putrid stench that comes along and makes me gag.

It was in this same decade of life that God spoke to me and saved me AND delivered me of the addiction I speak of above. June 5, 2004 I was reborn and put down the straw. PRAISE GOD! Life clean is so much better and more rewarding. Without God, I would be dead. I would be taking the ol' 6-feet under, dirt nap. But instead, God saw fit to keep me alive and use me for his purposes.

In my twenties I was given the gift of motherhood and bringing life into this world. How that child taught me love. I had used the word "love" in my vocabulary my whole life, but I did not know it's true meaning until I felt her move inside of me. Wow, my use of the word "love" prior to that wasn't even close. Then when she was born, the word grew even more. To know why the mother lion or bear or elephant or *insert wildly violent mother protector here* is so vicious in regards to her offspring, is truly amazing. The love and need to protect my Angel sprang forth from my DNA. I can't even describe it.

In my twenties, I found what God has called me to do with this life of mine. Found out what my purpose is. He called me to be a nurse. He showed me through my child. You see, my Angel was born with a very RARE disease. So rare that they have yet to isolate the gene/chromosome(s) responsible for this disease. So rare, that she is only the fourth known child in the world to have this condition. So rare that she has a case study, all to herself in a peer reviewed medical journal published and read throughout the GLOBE. So rare that she and her symptoms are in a database in the UK, all by herself, so that doctors can compare their pts symptoms to hers and thousands of others, in hopes of finding other babies like her. She was severely handicapped. And I kinda became a nurse before I knew I wanted to be a nurse. She required almost round the clock care. And until we got in-home nursing, I did it all. All of her meds, G-tube feedings, PT, OT, etc. I was just taking care of my baby, I didn't know that was nursing. Then, I finally asked enough questions to the nurses that helped to care for her that they said, "Why don't you just go to nursing school and find out." After 10 or so of them said the same thing, I figured maybe God wanted me to be a nurse. I realized how much I want to take care of people. I want to take care of the people that society has cast to the side and deemed unimportant. I want your "drug-seekers" and "crazies". I want your helpless. I want your worthless. I your poor in health. I want your poor in spirit. I want the pt that is so ornery and crotchety and has nothing nice to say. I want them all. And I want to shower them with excellent nursing care and I want to shower them with LOVE.

On a side note, I may be a smart-ass. And I may rant about the ER and some of the situations I find there. But I absolutely wouldn't trade it for the world. I get to help people on a level that I don't think I could anywhere else. Don't mistake my venting for lack of passion.

I met my husband in my twenties. When I had finally decided to give up on finding a man that would have any interest in a single mom with a severely handicapped child, I got a flat tire and pulled into a gas station and met the man that is now my husband. That man and my Angel fell for each-other so quickly, it was frightening. What if it didn't work out? My little Angel would suffer the loss, too; not just me. But thankfully, that wasn't the case. Unfortunately, it was Me and That man that would suffer the loss of her.

In the same decade that I was given the gift of love and life, I was given the terrible heart ache of death and grief. In my twenties, my gift from God was taken home to be with our Lord and Saviour. My little Angel died at the age of not even 2 years old. That grief will be with me until the day I die and I get to be with my Saviour and see him holding my own little Angel. The grief of one's child dying (spelling?) before you is unimaginable. I mean, we are supposed to die BEFORE our children. It's something that our DNA has not really coded for. That man wanted to adopt my little Angel, but alas, we didn't have enough time. But it was put on her death certificate with That man as her father.

In my twenties, I became a wife. Still sounds kinda odd. Wife. Sounds so adult. Me an *adult*. heh. The question is, when will I actually FEEL like an adult?

In my decade of twenties I actually got into nursing school. I am still in RN school, so I didn't finish my twenties as a registered nurse, but as a student nurse. The RN will come with the 30's. I absolutely hate nursing school. The stress of nursing school ranks up there with the stress of one's child dying (I didn't say grief, I said stress, there are many mental aspects of death). And that says a lot. I count the days until my graduation. Honestly, I don't recommend nursing school to anyone. I must be a glutton for punishment, or something, to continue on with this thing that I call Hell.

In my decade of twenties I've learned to care a little less of what people think about me than I did in my previous decade. Hopefully by the time I reach my 40's I won't care AT ALL.

In my decade of twenties I also completed a half-marathon at Disney (less than two weeks before my 30's).

My husband and me moved to the most awesome neighborhood in my twenties. Might seem small but we have some really swell neighbors. I haven't lived in a neighborhood that was involved with one another since my early childhood. It's nice to open up the door and holler, like a red-neck, across the street to my neighbor.

In my twenties, and through nursing school, I met one a person that is so dear to my heart. I only have 4-5 people that I would call "friends for life". And she is one of them. The friendship seemed so unlikely. Still does. She's so chill and laid back. Shows up at the last minute for everything. She's kind of preppy, hoity-toity. Blonde, thin and cute. Basically she's the anti-Me. I'm a neurotic spaz. High-strung. Show up early to just about everything. I am so not preppy and very hick-ish. Not blonde, not thin and not cute. Somehow, she gets me. She's about the only one in nursing school that has not talked about me behind my back and when I start having one of my spaztastic freak attacks she will tell me to shut up and chill-out. I am grateful for her. She has been added to my friends for life. After all, she did put me as one of her "Friends & Family out of network contacts" with Verizon. lol. ;-)

In your 30's, you're supposed to be a grown up, right? Guess I gotta do it some time. Some of the best moments of my life thus far where in my twenties and it is sad to leave them behind. It is for that reason that I feel like my youth is gone. For that reason, I say that my twenties have died. So, join me in mourning for my twenties and have a beer (Dos Equis Lager my fav), a glass of your favorite wine (for me it's Mascatto), or you favorite liquor drink (The House Margarita from Ted's Montana Grill made with Bombay Gin instead of Tequila is what I recommend), or whatever you so choose and say "Goodbye" to my twenties.

That is all.

Hospital Overflow...sacrificing patient safety.

So, I was supposed to report to work on Jan. 1, 2011 and work from 3p to 3a. I called the ER at 14:00 and they said not to come in until 7p unless contacted otherwise because we were slow. At 17:30 they called me in b/c apparantly shit had officially hit the fan. I get to work and they float me to our "admit unit" (take ER pts and do the admission assessment on them then send them to appropriate floor). But since our hospital has a maximum capacity of 196 pts and we have a census of about 220 pts, the ER is holding. So, that means the admit unit becomes its own little island of med-surg fun! AND to my luck, I get to float down there...Can you hear the sarcasm in my voice?

Well, I wasn't the only one not pleased with the situation. The RN in the admit unit tonight is an ER nurse that agreed to work in the admit unit to pick up some extra shifts. She was trained on how to do the admission assessment, not be a floor nurse. Well, what do ya know? She's one tonight. With no training on our company's eMAR (ER uses different eMAR) AND she gets to have a 6:1 ratio of patients, with only one of her. All night I have literally been waiting for her to pop a gasket...

Then on my end, the person that was "unit secretary" for our "unit" didn't do the work they were supposed to and failed to tell me. So around 1 am I realized a butt-load of orders weren't entered and the chart will have my name on it, not theirs...Oh, and there's not tech/secretary to cover the unit from 3am to 7am, so I will be working until 7am. Hence the reason I am still here. But luckily not all is lost as I have access to my blog. However, the one night of the year I forget to bring my charger I can use my phone. So, now I have a $500.00 paper weight shaped like an iPhone 4...hmmm.

I'm just curious as to whether anyone else's hospital does this? with the holds? Is this being done here because I work for the one of the world's largest hospital companies in the world and they are so focused on the numbers/times/metrics of it all and have forfeited patient safety for their numbers to look good on paper? I mean this nurse hasn't worked a med-surg floor for 3o years. She's been in the ER since the mid 80's. And in our ER, the RN's have no more than 4 pts at a time, and here she has six.

And did I mention that I'm still HERE?!?! At the fricken' hospital. I'm gonna sound lovely to sing with my worship team in the morning at church...

That is all, for now.