those warm family get togethers

On the holidays we all feel this sort of obligation to get together with the family even if we only see them once a year, even if we can't really stand them. It is what families are supposed to do. It is what we have been brought up to do.

We are supposed to tolerate perverted Uncle Ralph on Thanksgiving or your drunk nephew Bob. The rest of the year, you wouldn't have anything to do with them, but on Thanksgiving you feel a little warm spot in your heart for them, they are family after all....

So it all starts well, the relatives arrive one by one to a festively decorated home. Hugs and kisses all around. Refreshments are offered. Everyone settles down to catch up on who has been arrested, whose teenage daughter is pregnant, who died.

Then you run out of conversation. Some people have had a few cocktails. They start getting louder. Grandma looks annoyed. Son starts getting mad at Dad. Son pops dad in the mouth and they wrestle on the floor. Obnoxious Uncle Ralph says the wrong thing and gets popped in the eye by nephew. The warm family get togethers breaks up as various family members retire to lick their wounds, vowing they will never get together with these fools again.

Dad heads to the ER where it is discovered son has broken his jaw. He is sent home with instructions to only drink liquids till he sees an oral surgeon tomorrow. Drunk Uncle Ralph has an orbital fracture. I love the holidays....

uncle, I say, uncle...

Uncle. I surrender. I give up. I am waving the white flag.

I have come to the conclusion that I, madness the nurse, cannot possibly be the nurse that my employer wants me to be. So I've decided that I won't even try.

Here is what my employer wants me to do as a nurse:

1) Always have a shit eating grin on my face.

2) When someone calls me a "fucking bitch" and threatens me, "de-escalate" the situation by trying to understand the patients point of view.

3) Do not judge anybody - happily give narcotics to that drug seeker. Welcome that frequent flyer with a "hey Bob, what can we do for you today?".

4) Never question the doctor - THEY ARE THE DOCTOR and you're not, remember that. If the doctor chooses to order 50 tests on every person, give dilaudid to heroin Harry, that is their perogative. Your job is to carry out that order, no questions asked.

5) Be okay with the fact that some of your coworkers cannot carry their share of the load and you are going to have to pick up the slack. "We"re a team".

6) Be okay with working short in a high acuity, inner city ER that doesn't have the option to close the door, or refuse patients. Your employer is trying to save money by running lean..

7) Remember to fill in the 500 blanks required on every chart for every patient you see. Expect a nastygram if you don't.

8) Accept the daily change in the electronic charting that you do and be okay with changes in things like blood administration, which used to have maybe 4 or 5 boxes to fill in, now has about 20. "We're just trying to make things better and safer".

9) Be okay with the inefficient flow of patients to inpatient rooms. Understand that housekeeping has to have at least 2 hours to clean a room and that the nurses upstairs are way busier than you are.

10) Do not complain...about anything. You knew what you were getting into when you got this job, so stop whining.

I am officially throwing the towel in.

the best thing since sliced bread

I have mentioned this before, but it bears repeating... It is the greatest invention since sliced bread. The state prescription drug monitoring program. All pharmacies in the state are required to report dispensing of any controlled drugs to this registry. It can then be accessed by any physician or pharmacist. We use it a lot in our ER.

When someone comes in with chronic pain requesting narcotics, it is almost always used. The information is always interesting. I had a patient who was prescribed 360 Vicodin tablets at one time. I kid you not. That is the kind of ridiculousness that goes on in this country. Then we wonder why we have a prescription drug problem.

This information allows a doc to directly confront a drug seeking patient with how many scripts they have received over the last couple of months and from how many doctors. I mean what can a drug seeker say? Its right there in black and white.

I wish all docs used it. If they saw in print the prescription drug problem perhaps they would rethink their own prescribing habits. Cause guess what? At the core of this prescription drug addiction epidemic is the doctor. Its time for them to take a good look in the mirror.

the blood curdling scream

Ah yes...Its time to give report on your patient. You have a room number. The patient can finally get to a more comfortable bed. If only it were that easy...sometimes it seems the floor nurses have made a science out of how to delay getting an ER patient. So here it is..the top ten strategies employed to delay taking report:

1) Nobody home: No one answers the phone...at all.

2) Limbo move: Put you on eternal hold.

3) The switcheroo: Different nurses answer the phone and transfer you to other areas where the nurse taking report supposedly is. You end up back at the desk eventually.

4) The stunner: The HUC "accidentally" hangs up on you.

5) Housekeeping reverse play: Housekeeping has not arrived, just started, cleaning the room.

6) The CTD* defense: One of the patients on the unit is crashing and all of the nurses are involved, no one is available. (* circling the drain)

7) The dodge: The nurse "just transferred a patient", "just got another patient", they will "call you back".

8) The surprise play: As you are giving report, the nurse puts you on hold to talk to the charge nurse about whether this patient is appropriate for their unit.

9) The delay: The nurse is on break, at lunch or dinner and the buddy is way too busy to take report.

10) The shift changer: It is an hour before, or an hour after shift change. The nurses are all in report, they are doing their first assessments, the patient will go to the oncoming nurse after shift change, etc etc.

If you hear a blood curdling scream echoing through the halls of the hospital its probably an ER nurse who can't give report...

from feast to famine

It was the day from hell. We knew it was coming. The last couple of days had been average. It's a holiday weekend. It was not a matter of if we would be pounded, but when. And of course who is in charge of this chaos? You guessed it.

When I took over charge things looked dire. They got worse. Everybody was running their ass off. The ER was full, the waiting room was full. The wait was 3 hours. The natives were restless.

At one point an irate patient came up to the window. They had taken an ambulance in for a very minor problem. They were triaged and put in the lobby. Two hours later they still hadn't gone back. They yelled at me and left. Moral of the story: If you take an ambulance in for a minor problem, you're going to the lobby like everyone else.

Here's the deal - the chaos went on for about 9 hours, to the point where we called in an extra doc and nurse. Two hours later the lobby was empty and so was the ER. I actually got to leave early.

That is ER in a nutshell. You go from bursting at the seams to empty all in the course of a 12 hour shift