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.

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.

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.

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....

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.

Nurse saves Jimmy Kimmels baby's life

If we ever have any doubt that we make a difference, think of this.  Nurses are heroes 24/7. We are the backbone of the healthcare system. Without us, it would collapse. People would die. Never let anyone treat with anything but complete respect.

Welcome to the hellhole

Emergency rooms are not what they used to be. Gone are the days of lacerations, sprained ankles, appys, replaced by people with complex medical histories who are now septic, have had MI's, strokes, etc. In other words our patients are train wrecks.

Add to that the frequent flyer nutbags, drunks, overdoses.  Throw in an explosion of the mentally ill, especially adolescents, you have a picture of the modern day ER. In other words everybody gets an IV, meds, 25 lab tests, a UA, at least one xray and probably a CT.  You may be the lucky winner of the numerous MRI's and CT heart angios we are now doing out of the ER.

You can expect to wait most days a minimum of 2 hours. You can expect at least one of the numerous mental patient who have been sitting in ER for 1-4 days to get out of control, possibly needing to be restrained, during your stay in the ER.

Woder where your nurse is? She or he are spending most of their time charting about things that have nothing to do with why you are here, but but are required anyway.

Yes your ER  has become a mecca for the chronically ill, the elderly, the mentally ill and hood rats from the neighborhood. You can expect to meet them in the crowded waiting room. Throw in a few smelly homeless people, jittery drug seekers, moaning drama queens and you get the idea. You will hear languages from all over the world. It's a United Nations out there. We take everybody.  We can't turn anyone away.

Womens march

I went to the women's march today and it was really fun!

I gotta say, it was a good day

So I picked up an extra shift today. God knows why. I never do that. The shift was 8 hours. I typically work 12 hour shifts, so 8 is a piece of cake. I was thinking when I got home and didn't feel like I had been hit by a truck, that this what it feels to work at a normal job. You work a reasonable amount of hours and aren't completely exhausted when you get home.

What a concept.

Besides that, there is a minor hear wave going on here. It was 43 today.

Life is good on the frozen tundra today.

Welcome to my world, won't you come on in...

Go ahead. Click on the arrow. Its OK. You can trust me. You know that...OK did youdo it? Does it make the hair on the back of your neck stand up? 

Welcome to my world. At least once a shift someone is doing something similar to this. They are screaming so loud that it can be heard throughout the emergency department. Last
week it was someone who doesn't like white people screaming about their dislike, followed by yelling for their mother. Now mind you this is a grown adult. 

It's just another day......lalalala....

Mondays are shit shows

It's sleepy time here at the madness blog. I have taken 50 mg of melatonin. As I drift off to sleep, I will be thinking of the guaranteed shit show that Mondays always are....

ER nurse returns to scene of crime

So I'm back. Yes, in the waning days of my crazy career as your friendly neighborhood ER nurse, I have decided to the blog the shit out of these last months.  Yes, my dear readers, yours truly will be leaving the ER within this next year. I have already told everybody in order to force myself to actually do it.

When I do leave the Hortenz W. Snagglepuss ER (YES our ER will be named after some fool who threw some money at the hospital in order to be memorialized on our ghetto ER), no doubt the ER will implode behind me.  

So let the re- blogging adventure commence. Are you still out there in the blogger universe? Come back to me, you deviants...

Before I restart, A BIT OF A DISCLAIMER:  Everything on this blog is true. I have not changed a word of what happened. In fact, I plan to quote patients verbatim. I will probably use real names.  In fact here is my name: Nancy Nussbomb.  I work at the world famous Bob's We're #1 In Rectal Surgery We Are Certified In Everything Some Shit You Never Heard Of We Have Electromagnetic Status (a super-duper nursing certification that leaves magnet status in the dust) Hospital. We are located in downtown Des Moines. That's a picture of me over to the side.

HIPAA be damned! Come at me bro!

2017 won't be so bad....hopefully

My jewelry on etsy

Unwritten rules of the ER

1) If you come in on a backboard you will have to go to the bathroom within minutes of arrival.
2) If you come in with a probable broken hip you will have to to the bathroom immediately on arrival.
3) If you order food you will be too busy to eat it.
4) Xrays that were done in a nursing home of that broken hip will never come with the patient to the hospital. They will have to be done again.
5) If your patient overdosed on pills and you have to do a gastric lavage, they will always have eaten a disgusting meal before they took the pills.
6) If you get a loud, obnoxious drunk, detox will be full.
7) If one person comes up to the triage window to ask how much longer it will be, it will have a domino effect and everybody in the waiting room will come up there too.
8) If your pro football team is any good at all, you will slow down during the games.
9) If you wear any kind of new uniform or shoes someone will bleed, vomit or pee on them.
10) If you are the charge nurse and go to the bathroom, your phone will ring.
11) If you are having a horrible, busy day, at least one of your frequent flyers will show up. (Its like they have radar or something)
12) If you have a patient who is crashing, ICU tell you they have to transfer a patient to take yours.
13) Its true that when the moon is full, or there is a change in barometric pressure, the weirdos come out of the woodwork.
14) At some point in your time in ER, an embarrassing relative, old boyfriend, hated friend will come in while you're working.
15) When you are really, really busy, one of the following things will happen: the computer will go down, the tube system will go down, a lab machine will go down,
the hospital down the street will go on divert.

I don't care if you can't chunk a deuce/you're inability to defecate is not my problem

Sometimes the ER smells like a pig pen. Literally. Shit is running off of carts and on to the floor.

Speaking of poop, why does anyone ever come into the ER with constipation? ATTENTION ALL CITIZENS OF THE US:

*****CONSTIPATION IS NOT AN EMERGENCY. I REPEAT. CONSTIPATION IS NOT AN EMERGENCY. THAT IS ALL. GO ABOUT YOUR BUSINESS.*****

If you come into the ER with constipation, you will be viewed as the frickin' idiot that you are. I don't care if you are 102, the fact that you haven't had a bowel movement in 3 days is not an emergency. While we're at it, why is it that old people are obsessed with having bowel movements? Its like if they don't have a daily poop, its a crisis...

By the way, I don't believe you when you say you haven't crapped in 2 weeks. Don't believe you. Sorry. You wouldn't be able to eat, drink. Go home.

Attention all ER docs: IF YOU ORDER AN ENEMA, ESPESCIALLY A TAP WATER ENEMA, YOU WILL BECOME A HATED FIGURE. THAT IS ALL. GO ABOUT YOUR BUSINESS.

When I see a constipation coming my way, I run for the med room, staff lounge, bathroom, pop machine, develop a sudden interest in my patients personal life.

Don't come to the ER for constipation. The ER staff will hate you. And while I am at it, don't bring in granny or grandpa either. Have you ever tried to give an enema to an 85 year old? Its a recipe for diaster for all concerned. Now we hate you and your whole family.

Nina Pham, nurse who contracted ebola, settles lawsuit

Nina Pham, the nurse who contracted ebola treating the first patient with ebola in the United States, Thomas Duncan, has settled a lawsuit with Texas Health Presbyterian Hospital.  The basis of her lawsuit was that the hospital did not have the protocols in place, or equipment needed, to care for such a patient leading to her contracting the virus.

She felt her privacy was violated with publicity in the press about her situation. At one point a doctor came into her room with a camera to talk to her. That film was later released to the press. I wonder if the hospital had to deal with any HIPAA violations around that issue?

She continues to suffer from physical symptoms since her illness. One of the reasons for the lawsuit was concern about possibly needing care for the rest of her life.

It's interesting that this lawsuit was filed 2 years ago and just came to trial a week ago.  The hospital, instead of settling with her two years ago, chose to go to trial, then quickly changed their mind when they realized the bad publicity that would result.  The settlement was not disclosed. Hopefully she got millions.  Texas Presbyterian Health Hospital threw her and the other nurse Amber Vinson, under the bus, in their scramble to save their own asses.

There are spiders crawling around your bed with you

Apparently throughout America there are spiders sleeping in our beds on a nightly basis.

It seems people figure any bite or sore with an unknown origin is automatically a spider bite and requires a trip to the local emergency room.  I wish I had a nickel  for every person who showed me a bite and  said "I think it's a spider bite".  I'd be a rich woman.

Don't even try to challenge that maybe this isn't a spider bite. The patient is always confident that this is indeed a spider bite and you are foolish to think otherwise. Their auntie told them so.

Out of the thousands of different kinds of spiders in the world, very few would bite humans, and even fewer of them are harmful. They are just trying to get through their day as a spider. Thinking about having to spin that damn web, whether any juicy insects will get caught today..

Have you ever heard that you are never more than 6 feet away from a spider?  There is one on the other side of your husband right now and they are sizing you up for dinner right now....

The most likely to score a percocet script drug seeker

Is it just me or is everyday just an endless parade of drug seekers?  In all their different forms.

Maybe instead of betting on the drunks alcohol level, we should bet on which drug seeker makes a score.

Here is a synopsis of the "Most likely to score a percocet script drug seeker".

1) White

2) Woman

3) Dressed normal (no cleavage, short shorts)

4)  Educated

5) Apologetic

6) Polite

7) Accompanied by concerned male (preferably husband) version of 1,3,4

Other factors:

1) Is doctor in bad mood?

2) Is doctor busy?

3) Is doctor tired?


And there you have it folks, "the most likely to score percocet drug seeker" in a nutshell.

STD rates are soaring

Q

I started as a nurse in 1985. It was at the height of AIDS hysteria. Back then we would wear a space suit into rooms of patients with AIDS:  gowns, goves, masks. Everyone was scared to death. Nurses quit nursing because of the fear. It was an awful time. Taking care of patients dying of AIDS was brutal, watching mostly young men suffer was awful.

Then as time went on and we became more educated, things changed. At this point it is a rare occurrence to care for someone with AIDS. We still see people with HIV but it has become a chronic illness, rather than a death sentence, with treatment.

Why the change? People stopped having unprotected sex. Now we seem to have entered an era when this generation, who never saw the devastation of the AIDS epidemic, are having unprotected sex once again. STD rates are soaring.

Last year there were 1.5 million cases of chlamydia.  Two thirds of the cases were women aged 15 to 24. Chlamydia can go undetected causing infertility. There were over almost 400,000 cases of gonorrhea last year. The majority were men who have sex with men. The problem is gonorrhea has become harder to treat because antibiotics are becoming resistant. Syphilis cases are also increasing.

Bottom line? People aren't using condoms. They are not being educated. Another problem is health clinics are being closed. Planned parenthood funding is being cut. Funding for clinics and education must be a priority. Education should start in the emergency room. I wish we could have a supply of condoms.