Sunday, July 30, 2017

ER nurses have become psych nurses.

I feel like I work in a psych ward these days. It's psych all day, every day.  These days it is not unusual for psych patients to stay 2-5 days in the ER.  No beds.  Not a day goes by that one of these patients gets out of control.  Some people yell for hours. They sometimes scare the other patients.  Half of all the patients are sometimes psych patients.

The number of adolescent psych patients has exploded in the last few years. Why is that? What has happened in our society to cause more kids to be unable to cope? Is it just increased awareness?

It feels like the vast majority of patients are people with chronic problems.  The people who have 2 or 3 diagnosis' and are on multiple meds.  We don't get many people who are just having a crisis in life.

The latest psychiatric diagnosis de jour is PTSD.  What used to be only heard of with veterans has now spread out to the general population as a diagnosis.

Want to get admitted for psych? Here are the magic word "I am suicidal". Gets you in 90% of the time. It's part of the reason for overcrowding.

No one seems to care about the ongoing mental health crisis in hospitals.  Psych patients aren't profitable.  So it goes on and on, getting worse by the day. Staff are getting hurt.  ER nurses have become psych nurses. The patients are the ones who are suffering.

Tuesday, June 06, 2017

How nurses cope with being a nurse

Nurses carry around so many stories. A lot of them are tragic. They are stories of suffering, loneliness, death, pain. A nurses career is a lifetime of those stories.

If you want to continue to be a nurse, you have to learn to cope with having to take in all of these experiences. You learn to put them in a box. It reminds me of what a soldier does after a war. They put the war in a box in order to go on with life. The box may never be opened.

Nurses talk to each other about being a nurse. Mostly we complain to other nurses about how hard nursing is.  We laugh about the absurdity of things that happen. We rarely talk about feelings. That is taboo.

We are the strong ones.  That's what we tell ourselves. It almost becomes a badge of honor to be able to handle anything without falling apart. We fear looking weak.  If we let our feelings come forward, we might fall apart.

So we carry around all these stories every day for years. They are a heavy burden. They weigh on us. They make us grow weary.  We grow exhausted with hearing the tears, anger, cries, shouts, that go along with the stories. So we invent the imaginary box in our mind. We put all of it in there.  We close the box tightly on the way home from work.  No one outside of other nurses would understand what's in the box.

Every once in a while something refuses to go in the box. We carry that story around for a while. These things are too big to fit in the box. Time makes the story grow smaller and it then goes in the box with the other stories. Those kind of stories leave a little mark on our soul. We are only human after all.

Monday, May 22, 2017

Measles outbreak in Minnesota

There is a measles outbreak in Minneapolis, Minnesota. There are now 66 cases.  The vast majority have been in the local Somali community.  Vaccination rates in 2-3 year olds has fallen to 41% in recent years.

About 8 years local Somalis started to notice increasing numbers of their children were in special needs classes in school, many diagnosed with autism.  It caused alarm in the community.   Those who oppose vaccinations starting giving talks in the community proposing a connection between the MMR vaccine and the rates of autism.  Mother's stopped having their children vaccinated or they were waiting later to vaccinate to see if their child would develop normally.

Immigrant communities are often isolated due to language barriers. It is natural to live in communities together when you share a culture and language and are in a new, often scary  place.  In Minneapolis, many  Somalis live in a few high density high rises. It is a nightmare scenario for an epidemic: people living in very close proximity to each other sharing elevators, laundry rooms, children playing with each other. Everyone shops at nearby stores, goes to cafes in the neighborhood. People who can't speak English get their news from within the community. Word travels fast among mothers when children are being adversely affected.

Add to this the fact that Minnesota requires vaccinations for school age children, but parents are allowed to "opt out" if they have philosophical objections. All  of these elements have led to the current outbreak. Health officials are scrambling to get it under control.

What is the answer to preventing this in the future? It's a tough one.  Education first and foremost. Factual information for the community.  There has been no decrease in autism since vaccination rates have decreased. The rate of autism for the Somali population is not higher than that of the rest of the community.  Measles can kill.  Perhaps take away the opt out of vaccination rule. No vaccination, no school. Your child will have to be home schooled.

Most of all, the health departments need to hire members of the local community to educate immigrant populations about health care.  They need someone who looks like them, knows their community, someone they can trust, to advocate and educate them.

Monday, May 08, 2017

One flew over the cuckoo nest/ another day with a violent psych patient

There is a dent in the wall in one of our rooms. It was put there by somebody's fist of course. A mental health patient who just couldn't cozy up to the idea of being admitted.

So they went berserk. Wasn't my patient. I was in another room doing something while this was going on. Honestly it's like a horror movie in our ER sometimes.  The yelling, cursing, the gnashing of teeth.  The sound of someone being taken down, restrained and sedated.

The nurse is the giver of the shot in this situation. We are the one running to get the B52 (benadryl, haldol, ativan).  You hope they can hold the person still long enough to hit the target.

Well now you've gone and done it Henrietta. Because of you I have to do the charting from hell.  The every 15 minute restraint charting.  May a bird fly up your nose for that.

It takes about a half an hour for you to stop yelling at the top of your lungs, pushing against the restraints. Finally we all have some peace, your screaming still ringing in my ears.  Please stay quiet at least til the end of my shift....

Wednesday, May 03, 2017

An ode to the nurse who saved Jimmy Kimmels baby

This past Monday a nurse at children's hospital Los angels  noticed that comedian Jimmy Kimmels newborn baby had a murmur and was cyanotic and brought it to the newborn intensive care unit for further evaluation. That triggered a rush of activity that lead to a diagnosis of a congenital heart defect and heart valve problem and surgery to save the baby's life.

Here's what the public doesn't understand: Nurses do this every day.  We save lives. We are there twenty four hours a day, 7 days a week watching over your loved ones. We are the ones who notice trouble on the horizon. We trigger the alarm that leads to intervention to often save your life.  Our years of experience can make the difference between life and death.

I'm going to talk us up now. The truth is, nurses are the backbone of the healthcare system. We are the reason it has not collapsed completely.  We hold it up. We hold it up as it gets increasingly complicated, more demanding, all consuming for those working in it.

The public has no idea what we really do. They still see us in the old white uniform, nurse cap era. We are the comforters, the soothers, the bed pan carriers, food tray passers, bed makers.  Those days have been gone for a long time.

Today we manage complex patients in the intensive care unit who would die without all the sophisticated technology around them, keeping them alive.  Who is managing all that? The nurse. We keep tiny premature babies alive in the newborn intensive care unit.  We manage your cardiac arrest in the emergency room, your life threatening gunshot wound. We deal with an overwhelmed mental health system, often dealing with violent patients. We make sure the condition you were admitted with doesn't worsen, that surgery you had doesn't have complications. Out of the hospital, we try very hard to keep you out of the hospital in clinics. We care for your mom and dad in nursing homes.  

My job is overwhelming. It changes daily. It gets harder daily. People like you demand more of me daily. I am emotionally, mentally, physically exhausted when I go home a lot of the time. Many people go to school to be a nurse, start a job, then quit because it is too hard. It is, but fortunately many choose to stay.

I could not do this job without the many colleagues who I work with: LPNS, nursing assistants, EMTS,  admitting departments, dietary departments, housekeeping, pharmacies, radiology, etc., too numerous to name.  Lastly, without the physicians, nurse practicioners, physician assistants who answer the alarm I trigger, none of this would make any difference.

My job is complicated. I've made that clear. Probably the most important thing I do is not very complicated, I comfort you, reassure you, sometimes hold your hand, tell you everything will be all right. I  stand there with your wife, husband, children, friend, or by myself, just a presence, so you won't be alone. Out of all the things I do in this complicated medical world, that's my most important job.