end of a long day's work...

well, you force yourself to get up. you get ready and make your way into work. you survive barely all day for your 12 or 16 hour shift and hopefully get out on time. you're excited to get out, you jump in your ride and start the seemingly forever long commute home. you just want to get that hospital funk off of you and roll right into bed. sounds great right? well this girl had a different idea...
"what, dad?"

first experience off orientation as a new Murse...

well, this was quite some time ago. my wife, who was my coworker and friend at that time, was with me on that day. it was my first day off orientation, but she and others were around to give me a hand of course.

well, it was said that this one nurse [jane] had the worst luck and darkest cloud over her. anything and everything bad that could walked, pushed, or dragged though that double door would hit her bays. lucky for her i had come around.

feeling anxious nervous and confident at the same time i had started my shift. first hours of the day yielded the normal urgent non urgent ambulatory bumps and bruises, maybe an asthma here and there. then in comes a young guy by pfd medics. pale as can be, if you ask my wife, i have no skills in determining skin colors...but as white as a sheet of paper this guy was. chief complaint was severe abd pain with nausea...no vomiting yet. well, chey, slyly pointed out his paleness to me and states 'he's gonna crump on you'.

chey has many years of experience and can call out the sickies of the bunch. i've learned well to trust her instincts. we quickly setup the patient, triage, get him on the monitor and obtain bilateral access w/ iv fluids. well shortly after that does this guy do exactly was chey said he would.


take this picture and change the puke color to bright bright bright red.

projectile vomiting of the brightest blood i had ever seen and this guy was going for the record. tons of it just kept coming out of his mouth and shot at length about 4-5 feet, well past his own feet on the stretcher almost hitting the curtain.

dont you know we were singing a tune calling out for dr [John] to hightail his butt in my room. but all in all, some work went into it. this guy had a taste for coccaine, about 700 bucks a DAY he would spend and had done some serious damage. his numbers...H/H 3 and 9. impressive, but as luck would have it my last gi bleed out did these numbers.

i do believe i am getting proficient with gi bleeders and the Lord does give me good practice.

you can laugh but...

i think chest pt does work. im a huge proponent of it. many people tell me they haven't used it since their peds rotation in nursing school. well, i do use it in my practice where i may see it fit. and to my credit i did use it on a patient who came in with ?od, aspiration, and resultant respiratory arrest. severe to the point where she was consistently mid 60s on her pleth while intubated and the docs feared that ards was setting in and would take her. most everyone rolled out to do their other things and document. i sat around to help, eventually did some chest pt on her and slowly did her numbers climb. couple days later she extubated herself, went AMA and came back a couple weeks later as the same...she liked the nose candy and the street vitamin H. like i say, everyone needs a hobby.

you're here to work

ok ed nurses listen up...how often do you end up holding patients in tracking to go upstairs because no one picks up the phone or makes excuses to take the patient?

way too often for me. certain floors continually give us grief over admissions. the patients are sick or complain that they are sick and someone believes them, or must prove them wrong. either way they get admitted and this is why we are lucky enough to have jobs. i understand that getting a new patient means getting off your butt. i like to sit on my butt too. but im also a worker, and when a patient comes through our door, me and most of my crew will get up and get to work if we are not already. this is how it goes.

i see that repeat offenders will tell me that a bed is not clean, when housekeeping makes it a point to tell us its clean, and our bed tracking system says its clean. sometimes i think the floor's staff sits in the bed just to say its dirty. one day last week a specific floor continually gave us problems sending patients. bed tracking AND housekeeping supervisors both tell us that beds are clean and ready. and the floor has new excuses with every patient and every phone call. 'we changed the room number', 'that room is our only isolation room', 'that nurse is off the floor', 'we didn't know about the pt', 'the room isn't setup for that type of pt', 'we don't have the ancillary staff', 'we dont, we dont we dont'.

its ridiculous really. now although the er could go on divert, i can't remember the last time we did. and even when we are wall to wall patients, new ones keep rolling in and we just sit patients in a chair or stretcher and make up a name for that 'pt care area'. this is what we do. no nurse to pt ratio cap, no locked doors on the medic/ambulance bays. and the walkers and drop offs still keep rolling in. and in fact its my opinion that most of the legitimately sick patients actually do not call 911 and hitch rides from family friends or buses.

we are all hospital employees, we are hired to do a job, there are tons of sick patients to take care of, you are expected to work. this is the reality of our work, you were aware of that when you started, you should know that when you come in to work today. so...pick up the phone, and no excuses.

your crew makes or breaks your day

you get up, you get ready and make your way into work. you clock in and check your assignment. not only that you look as to who your neighbors are. well, crap... if you don't have good fun people that are workers surrounding you, your day can absolutely just suck butt sideways.


for me at least it can really set my mood and overcast my day. just the other day i had across from me a nurse who doesn't really help anyone much less her own patients. and next to me i had a nurse who cant hold an assignment unless its a super easy day. my supportive staff were my only saving grace as they were strong. helping me and others so that i [selfishly] didn't have to go and help the others. a few traumas and codes are where i did help, but on the most part i was saved from the harsh reality of what was the job. it really did poop on my day and i was not happy.

makes me think of a week or so ago, when i had excellent A Team staff to work with. and holy butt kicking did we get. but with Docs that are nice, funny, and are into patient through-put...and RNs PCAs and LPNs that just work together and get things done, while having some laughs and fun in the middle...well to me that just creates the epitome of what a job should be.

if you can't have fun at your job, its a job. no one, but no one wants just a job. when you are surrounded by people that you care for and they care for you, you just have a great day no matter what happens. and let me tell you, that day we had the philly fire department at the front of our station all day, hastes and rapid responses all day, and not one of us got a break, much less time to micturate. but this is what we do, and our bladders and stomachs may suffer for it, but its our job, our passion, and our lives....and for days like that, we love it.

i hate racism

and i hate racists


you'd think that in a time like this people would grow up and stop being small minded and self centered. the world in integrated, we are all brothers and sisters. why in this 21st century are we still fighting this battle? there are better things to argue over...AIG for one!

side by side, husband and wife

both my wife and i are nurses. i met her at my first hospital and BAM! 3 year later we were together :p

we left that hospital together and joined forces again at our current position. people ask me if its weird or difficult. honestly, i love it. she may have different opinions on that one. but i do love working with her. she is immensely smarter that i, and i can rely on her answers for quick resolutions to my confusion.

now when we have our issues to work out, it seems that at work, its work. we go in together maybe not talking, but we end up going home together conversing. at this hospital we don't have time to argue or think about arguing. we're told that it is the #2 (or 3 i dunno) facility in the U.S. for penetrating trauma. lots of fun.

now at the first er, where we met, the honeymoon phase was going on. but as that kind faded, unfortunately, we did have spats. but i do blame that on my immature mind set at the time. as you get older you realize what stupid things you've done in the past. and i've done many. we argued over stupid things like saying bye on the phone or text message. rediculous, now that im the mature and supremely fine specimen i am today.

things are definitely different now. but as good as things are now, i do see in the future that we won't be together in the workplace. we're venturing into different fields. forensics and teaching for her, and i want to fly and intubate people. juggling family, work, and each other we add school to further education and our careers. she's done a lot, im kicking my feet around a bit, but im starting to walk in a direction of worth.

i'll definitely miss working with her. her witt...she would call bs bs. find fault in the doctor's orders. questioned their thinking. she's the go to person for iv's. never nervous, always collected. she'd argue with attendings and get them to see that she's right pretty much every time. someone i would love to eminate but not be able to replicate.

counting days...

my first experience with life...as an rn

i graduated and passed my boards. prior to that i was recruited to the ed as a tech. i left house orderly position to focus on the er's needs. far more exciting and easily kept me awake at the hours i was working. so when i got my license they were ready with a contract for me. now Jane, from my first experience with death, became my preceptor in my new professional career. and how knowledgeable she was. she taught me alot

well, after i got used to the mumbo jumbo bumps and scrapes. i had finally gotten my first acute patient. female, 30s SOB all day, using nebulizers and mdi albuterol at home without any relief. now cyanotic, diaphoretic, lethargic, hypertensive, tachycardic, tachypneic, spo2 high 70's and looked to be knocking on that door. well, panic mode set it for a brief moment, then kick a** mode took place and stayed.

ok, ok. it was just an asthma attack. but damn did that girl look like she was gonna die to me, and she very well may have without intervention. and that's what i realized. on the broad spectrum of things, it was my intervention that helped turn that woman's condition around and ultimately in no apparent distress, walk out of the er....against medical advice!

the neighborhood we served was not the cleanest, and drug addicts and seekers were many. Jauncey was obviously no different. even though she did a 180, because of the severity of her original condition, she was to be admitted for observation and maintenance. but she had to get to the methadone clinic before it closed, so....

my first experience with death

flashback to 2002, i was a house orderly at a local hospital. i had to service all needs for the hospital from 7pm to 330am. so many times did i get paged to the er. and always a quick response. i loved it down there. always something to do, i was new and eager to learn and help. as the orderly i was responsible for delivering off hours food, transport, ekg's, running various items where needed, medical records, and cpr in the event of a code.

my first code was pretty much in my first week still in orientation with a preceptor. my shift was just about over, i was paged and ran down to the er. i saw what was going on, announced my presence and stepped up. i remember cracking a few ribs on this person's hard barrel-shaped chest. three or four times we got a rhythm with a pulse, and ultimately did that patient pass. i was devastated. this wasn't supposed to happen. i respond, i step up, i compress, i help, i save. that's what was advertised to me, "help save lives".

i'd never seen a dead body, much less touched one. the others stopped what they were doing, cleaned up a few things and left myself and the primary nurse in the room. i stepped out and sat on the floor against the wall. Jane came up to me and saw my face and read my mind. her words in verbatim were "when something like this happens, we act quickly and do what we can. but ultimately if it is their time, it is their time. just know that we did everything possible to prevent this from happening. when you get home, you should think about whether this is something you want to and can do. and if it is, we'd be glad to have your help."

the next day i was early for my shift.

you have what it takes

its noted that it does take a special person to do what we do in the medical/nursing field. patients and their family members on many occasions tell me that they could never do what i do. it really is something special for myself to be able to take a person fighting the battle of their life, and turn them around; sometimes watching them get discharged and walk out of the ED.



its a little embarrassing to say that the reason i became a nurse was to make loads of money and work only 3 days a week at that. i would hang out with a friend and his dad would always be home to hang with us and take us places. i had come to find out that he was a nurse. he in fact did have a lot of nice things, a beautiful house, nice cars, and time to enjoy them.

that was it i knew what i was going to do. yea, there's the stigma of a nurse being a woman, but that didn't stop me. in fact, since being in the field i've seen that male nurses are highly regarded. my wife, also a nurse, makes it a point to state that because i have a penis, i have it easier. in short, i do believe she's right.

you women can be very petty. what is it about a woman proving herself against other women? now not all women, but when i came to the hospital i currently am at, i saw so much hostility amongst the females and the (attempt for political correct-ness) homosexual males. now not all were like this, but damn sure were there a good handful. and to be perfectly honest this did create a reputation for the facility i am now in. i have my reasons for pursuing it irregardless of this, i wanted to get my butt whooped and test my limits.

i do believe that this sole factor makes it super hard on anyone trying to make it in this field. you have new nurses, students, and old nurses new to the facility that find them having to prove themselves to a few snooty nurses that have far less experience than themselves. you also have residents that are themselves learning as we do everyday.

the other day a coworker whom i actually like, nicknamed a resident '[Jane] the Retard' and proceeded to laugh about it. of course none of us thought it was funny, and i voiced that opinion. well, its that attitude that creates such a hard learning environment. yes they are doctors, md's and do's...but they are still learning. they graduate, pass and get credentialed, then come to learn and play.

who are you, oh almighty nurse with er, icu, research, etc experience of so many years to call another a retard? were you so bright and perfect in intellect and hands on skill upon your first years of nursing? fresh from your boards were you able to assist clipping a dieulafoy's lesion on an active bleeder? did you differentiate the need for indepth liver function testing and ammonia studies for an unresponsive hypoglycemia pt with unknown incidental renal/liver pathology within you first months in the field?

i am honored and ashamed to work among these attitudes at the same time. yes, a number of the attitudes are seasoned and very appropriate with their skill. but so many times do i see the inappropriate side in regards to professionalism.

now also realize that i am not the silver dollar among the nickles. i am no super professional. i love the friendly environment that overcomes the hostility in my workplace. i have great rapport with most all, even the attitudes. and again, beccause of my penis it is easier for me than the likes of my wife. but we laugh, we joke, we are hilariously innapropriate at times, but when it gets down to it and the time demands it, we are a kick a** team, in a suck a** world.

shower time

couple weeks ago i went to help a trauma patient in distress. i didn't know what to expect, i just went over. before i realized she had her hand over her mouth i was head to toe in vomit....soaked. first time using the shower in the locker room. it has cold water but i didn't care.

do you ever get used to the gi bleed smell

i think i just might be. i have a strong stomach and head. but initially i would wince....now after a few years of this im starting to realize it doesn't phase me as much....interesting

nice for a change

so, not always is there a bad experience. the other day i actually had not one nasty patient. everyone of mine was polite, quiet, and nice...regardless of their condition. of course one was intubated, but again, as she awoke while intubated she was cooperative, calm, and collected. much more than i can say about some... this is truly a blessing

its a simple concept

there is a waiting room, where you wait. then you get in the treatment area, where you wait to be treated. this happens in the er, it happens in a clinic, it happens in your doctors office. its not that hard to get. and no, we dont have 50 doctors in the er, waiting for you to come through the door, and all attack your problems at once, especially when you're here for back pain from a car accident in '98 that you've run out of percocet for.

can you get this straight?

DYE Ah REE AH. NOT direars
you VOMITED, not vomicked

my arm hurts

so i'm working in the er, patient is moaning and groaning in front of myself and the physician... "my arm is killing me, and i can't move it at all" i go to assist him in removing his shirt, "sit up" i said. as i pull up his shirt he lifts both arms in a fluid like motion to assist me removing his shirt. he got a nice stare from myself and the md, and a prompt discharge

um...

so, i graduated in '04 and passed the rn boards that same year. well, i am now precepting students as most staff nurses do and i can see where i once was. the young nurse out to save everyone and help in any which way i can. wait, i still do that...to a degree. but i've become that which that i knew i never would be....jaded. and you know what did it? the drug seekers, they jobless that refuse to get a job, the healthcare abusers, the meal seekers, and the patients that just want to waste your time, get discharged and them go directly to triage to do it again! i only wish i had such time. it must be fun for them. frustrating for me!

im on shift yesterday and i had a student. very nice, very bright young girl about to graduate. and im trying to sit on my butt and work on my decubitus ulcer. and every second she's asking me to help with this that and the other. don't get me wrong, im a worker, i am a runner. but sometimes....you just want to have a sore butt, you know? and im not knocking the student either, she helped me immensly that day as did my coworkers with my critical patients.

also, since this is my first blog, you'll hear stories from present past and the unforseen future, in no particular order. if you don't like, please feel free to pretend you do like.

first of many...

well, you must know that i am a nurse. i work and have worked for a number of hospitals and facilities, and have interacted with many people...and this will be my venting point. i do 12-16 hour shifts in an horrible world where people shoot each other, shoot themselves, and poop on themselves. you, my friends, will hear the stories of work and life, good and bad. and if you can/will, share your own.... so you know, all names will be changed to either John, Jane, Jimmie, or Jauncey :P