A slow death

We have been slowly decreasing triage out front. Days past we could have up to three nurses out front but not anymore. Now days we have one sitting at the desk with two techs who run patients back. The nurse out front types the chief complaint in and places them in a bed in the back. Rarely are they triaged out front anymore. So, our illustrious Dr. Silverfox has made comments that he would like to completely close triage in the near future.

One day a few weeks ago one of the charges decided to not even recept the patients coming in the door. Just grab them and place them in any available bed. The nurse in the back was now responsible for recepting and then triaging the patient. It makes the door to bed time almost nil but is it safe?

If I'm in a cardiac room and 2 or 3 patients show up in my other rooms I won't know it because they aren't on the tracker yet. Of course nobody tells you they just placed patients in your rooms, you're suppose to know this by freaking osmosis I suppose. Of course we still have 3 or 4 charge nurses on who are sitting at the desk with their feet up and surfing the net.

The door to bed thing has gotten out of control. Of course all the upper management types are getting big bonuses and visits from the corporate hacks praising them for their great wait times.

FML.

Huge Fail

After following this case for the past 3 years, I'm disappointed to say the least in the verdict.

Where is common sense? The jury seems to have wanted all the high tech stuff like on TV programs. I'm betting they were expecting a video of Casey killing Caylee and walking into the woods with her little body. Who knows! Whatever it is that these 12 jurors were thinking it's obvious they felt that there was no evidence to prove that Casey killed her child.

Really?

I wonder who they think it is that threw this baby out like garbage? Who was driving the car that smelled like a dead body had been in it? Who partied like a rock star for 31 days after her child disappeared? Who was the pathological liar and thief in this case? Oops, her mom lied about being at work. Oops, her dad lied about an affair with some floozy.

Reasonable doubt. You can't doubt the jury on this one. Even though we as the public know a lot more about this case than they did, I'm still having a hard time wrapping my brain around the fact they didn't find her guilty on a lesser charge.

Party on, Casey. Bitch.

For What It's Worth

So, I get a text message last week from one of my co-workers that stated “Guess who they are training for relief charge?” Uh, IDK? When she texts me back all I could do was respond with LMAO, HAHAHA!

I had been off a few days and when I came back it was the talk of the department. People were pulling me into the hall closet to tell me they were going to HR and calling corporate compliance and all sorts of foolishness. Some had already spruced up their resumes and sent them out. Me, I was annoyed at the choice but after a gazillion years in nursing not surprised at all.

They picked Nurse Nasal Whiny Voice, a nurse a total of maybe 3 years. I think they must have been smoking crack or something because this 'thing' is a silly little girl. She’s always out by the ambulances hanging with the boys, or sitting at the desk slamming a new orientee and basically just being a worthless co-worker. She’s complained about everything under the sun you can imagine and has called in sick more times than I have in 20 years. She's the first to know any gossip going around and let's you know it. WTF were they thinking?

Me and my friend Double D were sitting in the shit area in the back last weekend, which some think is punishment but we think it’s great. We have our own little desk and mostly get LOL’s from nursing homes and minor stuff. We chit-chat all day long while we work and basically it’s real smooth. Nobody ever comes back there, let alone any charge nurse to see how things are going.

Around the corner comes Whiny asking us with her new super management authority type voice if we’re doing okay and is there anything she can do for us? Well ya'll know I’m old and hard of hearing so I totally kept doing what I was doing and so did Double D who is also hard of hearing. When we didn’t respond, she looked at us and repeated herself in a much louder and whinier nasal voice. I looked up slowly and told her we were fine and carried on as if she had never walked by.

We found out later she went up to the real charge nurse and said we were sitting on patients, loud and whiny enough for half the nurses station to hear. Of course, half the nurses station came and told us. That was fun, it was good times.

More to be revealed, I'm sure.

Doctor Medic

I'm sure all ED's have one of these, the paramedic who thinks he is a doctor. Thinks he is the team leader in a critical situation because he works at the big house downtown and flies on the helicopter and shit.

Case in point: We get a full code from the jail, found down and non-responsive. Even thought the auto pulse is on, he's in ankle cuffs and one arm is cuffed. I walked in to help because my rooms were full of boring crap and I like to look at young, buff cop types. Yep, breaks up the day.

In comes the sweet doctor with 5 kids who looks 16. She's so way over the top cool, I could only hope to be her. Right away Dr. Medic starts telling her we gotta get this King tube out, we gotta get an EJ line going, directs a younger less experienced nurse to pull up some Epi (given 1 min prior while unloading) and generally just turns the room into chaos. I left the room to sit at the desk and watch the very fine behinds of the cops at this point.

Dude ending up being a huge head bleed and the king tube was the least of his problems.

Another day, family pulls up to triage with a lady in the car who they say isn't breathing right. Um, no she is in full arrest. We pull her out, toss her onto a stretcher and tube her right there. CPR continues off and on for a while, getting a pulse back at times. Super Dr. Medic keeps checking in the room to see if I have my drips maxed out. Ummhmm. Big Doctor B comes in and says lets just try some Vasopressin. Granted, the codes been off and on for 30 minutes. Whatever. It's almost time for me to leave and whatever gets me though to 7P with an alive patient is good for me. But oh no! Dr. Medic starts in with Big Dr. B on protocols and what the studies have shown on giving Vasopressin this late in the game. Oops, too late, I already had slammed it in. Big Dr. B is super passive-aggressive and just kept nodding at Dr. Medic. All was good, I left the place not having to deal with the princess on the night shift who wants it all wrapped up with a bow for her.

I wouldn't care all so much if Dr. Medic would just do the skut work once in a while. You know, like do an EKG for me, put the IV in and take the patient to CT on a monitor. It would also be nice if he'd shut his pie hole about how great he is and how many lives he saved being so wonderful and all.

Fibro My Ass

I would rather chew on tin foil than to have another fibromyalgia patient to deal with.

Thus, I went shopping last week for a cute pair of sandals with a decent heel to wear with jeans. I walk into the store and eye the Dansko section, which has a whole bunch of really cute shoes. I pick out a couple of pairs and sit down to try on, when the sales guy tells me, "I've sold 20 pairs of these in the past two weeks to women with fibromyalgia."

My head suddenly started to spin. There was no way I was buying anything from this smirking little fucker in his 20's.

I then went home and ordered the shoes from Zappos.

Hood Time

So I felt like I was working in the hood a few weeks ago. We aren't a trauma center, so when one does come in it's through the front door.

As fate would have it, I was out in triage minding my own business with the coughs, colds, flu symptoms and flank pain. I hear some yelling, and turn to see this really skinny chick wearing daisy dukes grabbing a wheelchair and shrieking that she's bringing a head injury in. Okay, but where is the car? Oh, my bad, I'm not up on the hood ways anymore. She's parked way across the parking lot where we see her and a gentleman tossing a dude into the chair. She runs across the parking lot with the patient bouncing all over the place.

After parking him in front of me, she states she doesn't know him, that he was working on her roof and something heavy fell on his head. The fact that half his skull looks fractured and the right side of his face and head are swelling in front of my eyes causes me to pause. He can barely eek out his name and off we go to our equivalent of a critical room.

Of course he gets choppered out with 10 skull fractures, 2 sub-arachnoid bleeds, a sub-dural hematoma and a drug screen that lit up the evening sky.

So, all you real hood nurses, do you really think something fell on his head?

Like, hahahahahaha.

HHS

You know, hysterical hispanic syndrome. One pulled up today, almost drove straight through the double glass doors and comes running in with a child in their arms saying he's dying, somethings wrong. I get a look at the kid and he's a little pale, he's breathing and he's warm and dry. Kid proceeds to ralph all over the place and is looking around, he himself a little hysterical because of the parents and all the entourage who rode along. So to be nice, I take the kid back and get him all warm and cozy in a pedi bed with a blanky. The other 15 relatives all start the camp out/vigil in the waiting room which is now bursting at the seams.

Eye-yeee, eye-yeee, eye yeeeeeeeeeeeee.....

Wait Times

I don't know about your ED, but in mine we're all about getting patients back to their rooms as fast as greased lightening. We advertise wait times on bill boards and there is even a triage app for the lay public. They can input their symptoms and get an idea if they need to come in or not (Hahaha, like that will stop them). I had one lady who was directing me what to type while I was triaging her baby daddy's abdominal pain. Really, you don't think I've seen like 9 million abdominal pains, sweetie?

So, this don't stop, go straight back to a bed has me worried. For instance, that's all fine and dandy when we're half empty like at 0700 on Sunday mornings, but by 1100 we're hopping. My job as the triage nurse during these hours is to look in my computer at what the initial complaint is that the meeter greeter typed in upon arrival, and assign a bed based on that. Now, me being old-fashioned, I like to at least eyeball them so I sit at the entry desk. But, some of the other nurses will just sit in their triage room, see the complaint and assign a bed. The meeter greeter then walks them back for the nurse in the back to triage. Next, the scribe signs up the doctor they are working with and this is what they call door to Doc time and the corporate hacks are all shitting diamonds and gold over these great wait times. In the meantime, the patient may have stated they have a cough but really, they are in fulminating pulmonary edema and nobody sees them until that nurse first realizes she has a patient in the room and second goes in there, which could be a while.

When the back is full, we start doing the triage out front and I've had the charge nurses send out a medic to snatch the patient right out of their triage chair and take them to the back, not triaged. How is that triage? A triage takes a couple of minutes. The nurses who are in the back that day are hating life. The doctors hate it because their paycheck is based on their door to doc times. When the place is bursting at the seams, the docs get behind because you know, they're running a code or something equally important. But hey, the times still look good because the scribes are signing up their docs, but they really aren't seen for hours.

In my opinion, it seems that this is a disaster waiting to happen. The way I understand ESI, if you're a level 2, you go straight back to a room where a nurse right away starts doing stuff and the doctor comes in and stuff happens to help you. If you're a level 4 with the sniffles, you're just as important as that gasping COPD'er because you know it's all about customer service.

Another new rule is over 80 and under 1 go straight back, no questions asked. So, I had an 84 yr old female who was a level 4 and a 52 yr old chest pain with HTN. The 84 yr old got the very last bed in the department, while my chest pain guy went to a hall bed with no monitoring equipment. Seriously, I'm very concerned.

When the balls hit the walls, the charge then takes over bed placement. Good for me, sometimes bad for the meeter greeter walking them back to dirty rooms. Since the charge never leaves CentCom (or their chair), they really don't know if the bed vacated 2 seconds ago is clean, they just assign the next one to it and here comes Nancy Upscale from the Burbs and oh my god, she sees a slaughterhouse in the room she's assigned to. So, I say to the charges how is this customer service when our er, customers, see such mayhem? I was told it doesn't matter, all that matters is the time they sign in to the time they are placed in a bed. They all said that corporate doesn't care about that, yet. When they do, then they will address it.

I've been scouring the net for any studies done on this wait time phenomenon. So far, nothing that shows outcomes medically. All they talk about is patient satisfaction like the ED is McWendyKing or something. They even installed a patient satisfaction survey at a couple of kiosks around the department.

Just shoot me now.

Dusting the Lady Bits

When I walk in late and see my assignment is Bush Gardens for the day, part of me is pissed off and part of me is relieved. Usually it's an easy shift task wise, but mentally it drains and by noon I'm hatin' on anybody with a vagina. I'm usually hating on the baby daddy's too just because they feed into the drama and make my life miserable by bothering me every 5 minutes for blankets, socks, ice. She's hungry and hasn't had lunch, can I bring her in some french fries? When is she going for her ultrasound? She's having pain again and needs more of that D medicine. You name it, it's the same thing over and over.

I explain why I need to straight cath when they're bleeding and the crying starts with their legs clamping shut tight. Color me unimpressed, the straight caths I use are pediatric size. I want to literally run when I see a 20 something female come in by BLS and she's acting the fool in front of the charge nurse desk. I know that beatch is gonna be mine in a minute. Yeah, and then 5 minutes later a bunch of her family shows up. Like, they couldn't just drive her in themselves? I guess that would defeat the whole purpose in their attention seeking game, right?

I have to say a lot of the work-ups are positive for early pregnancy with the resulting glee in their voices, "I can now apply for medicaid!"

I wish I understood this dog and pony show.

When tattoos go wrong and other nonsense

I should have know that I'd drawn the short stick in triage when the other nurse told me she took the 2 yr old screamer. I picked up the chart and it said "got bad tattoo last night and foot is hurting." Okay sister put it up here, let me look at it. I unwrapped it and Geezus, Mary and Joseph, her left foot was gigantic. She said that her friends boyfriend, who had just gotten out of prison, did the tattoo last night and now she couldn't walk. No shit. Her foot was as big as her head and red with a huge streak going up her leg. And, she was 2 weeks postpartum.

Not to be outdone, dude comes in and tells me he has a lump on his rectum that is killing him with pain. He claims that he had "accidentally" sat on his dogs bone, the biggest one that they sell on Fosters and Smith, and it got stuck somehow. When he tried to pull it out, it ripped part of his rectum with it. Come on dude, really?

A yuppy mother type brought her 15 yr-old in to be checked, mother states that the daughter told her she had gotten raped the day before. The mother states that she knows the girl was raped because she checks her all the time to make sure she is still a virgin. Yeah, that's the ticket, mommy. Your kid is a virgin and I'm Mother Theresa. I don't know about you, but I guess I was a bad mother because I never did this to my teen daughter when she was in high school.

I just love triage. Really, no really.

Hello Bad Girls

It's time for ACLS again and this video will help you study. That is if you can stop starring at Barry's very tight white pants.

Little Miss Snark

Okay, who heated up last nights fish in the microwave? Now the whole place smells like Bush Gardens is hosting a chlamydia clinic.

And while I'm at it, next time the sign on the bathroom door says OUT OF ORDER, don't go in there and see a man about a dog. Thanks to you, nobody can eat in the break room until they call the plumber, and that won't be until Monday.

And bitch please, quit wearing that nasty perfume to work. You really think that shit smells good to sick people, let alone your co-workers who have to put up with it?

Bleh: It's one of those days.

Spider Bites and Head Lice and Diarrhea, oh my!

You would think that Super Bowl Sunday after 1600 hours would be slow in the ED.

After a sort of slow day in triage and spending some time restocking stuff that hadn't been replaced since the Reagan administration, I wandered back to the main to hang out and goof off a bit, something that never happens in the suck-you-dry-and- write-you-up ED. Mid laugh, the charge tells me that the medic called and said that 6 adults from a group home had just checked in with n/v/d. I laughed, right, that's hysterical. I turned around and glanced at the tracker and yep, there were 6 new names up on the board each with a number next to them 1/6, 2/6 etc. Me and the other triage nurse get to work getting them triaged and back to the fast track area that has 10 beds in little cubes all next to each other. I actually felt bad for the fast track nurses for a minute.

The sixer done, I take a minute to run to the potty and when I return the medic tells me that he put 2 kids in my room with head lice. I peek in and sure 'nuff, there's 2 pre-teens sitting in there with long bushy hair, one of them in my chair. It wasn't that big of a deal, but when the mom pulled out a ziploc baggie with lice she'd captured I was like what the hell is wrong with people?

Topping off the day was Spider Bite boy. He couldn't even walk, his knee was so red and swollen. So were both his thighs. He proudly showed me all the "bites" like they were badges of honor. Yeah, dude, you're more than likely going to get a work note.

Finally, it's 1855 and in comes a guy in his mid 60's complaining of vomiting x 1 with weakness. I wheel him in and get a set of vitals which suck. His color isn't too great, either. He's there less than 30 seconds and comments that he'd feel better if his indigestion would just go away. Crap. Why didn't you say so? I call to the back for a bed and tell them I'm coming now. We get an EKG and he's having a STEMI.

Guess who didn't get home in time for Big Love?

Just a small sampling of my day:

Stupid #1: Per wife: He's had n/v for an hour. It won't stop. He always gets an IV and medicines for this. He has chronic UTI's since childhoold d/t some congenital thing.
Rachedy: That emesis looks like pure water, has he been drinking water?
Stupid #1: Yes, he has, his throat is dry!! He needs to be admitted, we don't have insurance and no money to buy antibiotics!
Rachedy: He's being discharged, there is no indication to be admitted.
Stupid #1: WHAT? We always get admitted. We're leaving this dump and going to the big house downtown where they always admit him and give him medications for his pain and nausea.
Rachedy: Bub-bye.

Stupid #2: I have mucus in my throat and I can't stop coughing, I'm wheezing. I had a UTI last month and an ear infection. When I cough I have chest pain.
Rachedy: I see, do you have asthma? Right now your lungs are clear.
Stupid #2: Yes! I'm sick, I don't want to be blown off, I know how this works, I'm a nursing student at the technical school.
Rachedy: Okay, but all your tests are negative. Your urine is clean. Your ears are clean, they are discharging you.
Stupid #2: I want to talk to the manager!
Rachedy: Okay, but I have to put you in the hall, I'm sorry. The manager will be with you shortly (when they get back from a meeting and lunch and afternoon break and then another meeting followed by the ice cream social that none of us have time to attend.

Watching the look on her face while pushing her into the hall while the code is rolling into her room: Priceless.

Meet the New Boss

It's been a few months since all the old doctors were fired, er, replaced by a new physicians group. Needless to say, I miss Dr. Crotchety. I miss Dr. DoNothing who only ordered Motrin and a Sierra Mist for every complaint except a head bleed or STEMI.

The new director, Dr. Silverfox, thinks he's the Sultan of the ER. His shenanigans even have the biggest ho's I work with complaining. He'll walk by you and reach out and touch your back or comment on your make-up or hair, make comments like, "Thanks for bringing me coffee this morning." Ugh, he's so disgusting.

One newly graduated doctor who is on staff has a bad habit of peeing in the staff toilet and not flushing. All the red bull he drinks makes for a huge pot of frothy yellow piss that stinks. I hate him because he does a full-court press work-up on everybody, bar none.

I prefer to spend my time in triage these days. At least I know what I'm dealing with out there.

Got a box of T-Shirts?

The usual suspects shuffled in and out of my triage room with the sniffles, cough,
aches, some worse than others. One lady who reeked of menthol cigarettes and had a nose that sounded like it was full of rotting grits whipped out an old white, now grayish tinged stained tee shirt in a size 3x and blew a huge honker into it while I was typing her up. She then stuffed it back into her backpack.

Really, skank? Having been sick myself all week, I seriously had to excuse myself before I threw up all over my keyboard.

Sick

I'm not one to get sick with stomach stuff but this week has been a week from hell with vomiting and some diarrhea. After vomiting every 15 minutes the entire night on Sunday, it briefly crossed my mind how I was going to get to the ED. Scratch that, I would never go to the ED for N/V/D. I mean, really, I'm not elderly and I'm not under the age of 5. Besides, I don't want to be laughed at by all my co-workers.

What I don't get is how these people manage to even get off the couch to come in. I could barely walk down the stairs, let alone go back up them until night time. So, I did the sip thing, took some Zofran/Immodium and tried to ride it out. It's now Tuesday night and I still feel sick. WTF?

Making it worse was one of my crowns starting hurting like a real bitch and I had to drag my sick ass out to the dentist today. After some adjusting to my ever increasing mouth full of porcelain, I came home and tried to eat a little something. No go. Seriously, I can't eat anything without getting this over whelming urge to hurl. Then, to top it off, the cat has diarrhea. Nice.

I've got one more day off then it's back on Thursday. I might just have to call in, even though every time I have called in, it's the same excuse of N/V. All lies, maybe I better come up with a better excuse.