I am slacker, what can I say?

I've been slacking on the blog lately.  Why, you ask? Winter boredom.  Winter blues. I live up here in the frozen tundra.  Last year we had unseasonably warm temperatures.  It was in the frickin' 70's on St Pats day last year.

This year it is NORMAL.  Normal means a long, cold, snowy March that is excruciating.  Every day is gray.  Every other day it snows just enough to make it annoying to drive.  Like yesterday it had snowed about an inch.  This is the time of year when it gets warm enough to melt the ice during the day, then it freezes again at night.  That inch of snow covered the ice.

Now here is a formula:  ICE + inch of snow + people = too many people coming to the ER.  Another formula:  ICE + inch of snow +  too many people coming to ER + madness the nurse (working triage and charge all in one day) =  a depressed and gnarly madness the nurse.

After 12 hours of running my butt off, today I am exhausted and my bones are feeling their age.

the bomb drops

Sometimes people have a bomb dropped on their lives in the emergency room.  Sometimes we find out things that no one expected and its really, really bad.  The doctor has to deliver some news that will change their lives forever. So the doctors breaks the news.  The nurse goes in to deal with the aftermath.

This is what nurses do. We deal with the human part of medical problems. Not only do we do the treatment necessary, we help people deal with what is happening to them. Whenever there is a threat to a persons physical self, its damn scary.  Some times its more scary than others. It is the beginning of an ordeal that could last for months, even years.  Many times they will die. We know they will die, but we don't tell them in the beginning.  No one wants to hear they are going to die on the day of the bomb drop.

We are saying to ourselves: "oh shit..this isn't good..." We feel sad, knowing what the person will go through.  We wonder what will happen to them.  We will never know. Is it better that way?

yup

triage is not for sissies

Triage. Every ER nurses nightmare.

Here's what triage is like:  Pretend you are at a carnival.  You sit at a booth.  There is a sign that says: HIT THE PERSON OVER THE HEAD, FREE OF CHARGE.  You are being paid to sit at the booth.  Being the reasonable person that you are, you assume that most people are nice enough to not hit you over the head. What surprises you is how many people are willing to hit you.  The first few times you are shocked. Then you get pissed.  I mean seriously, what is wrong with these people?  Hitting another human being over the head! The thing is, you can't leave, not if you want to get paid. You have to let them hit you.  Oh BTW, the owner of the booth wants you to have a big smile on your face while you are sitting at the booth.

There is a lot of emphasis on patient satisfaction these days. Reimbursement is starting to depend on it. So the goal is to make the patients happy. Noble goal. Triage is the gateway to the "patient experience". Triage is first contact.  It sets the tone.  Blah blah blah.  The triage staff needs to be polite, professional, etc.  More noble goals.

Reality: triage is difficult as shit. You are bombarded continually from all different directions:

patients presenting for care, sometimes all at once
ambulance phone calls
doctors phone calls
dealing with relatives, friends
you are an information desk for the whole hospital
   -looking up where patients are
   -directing everybody everywhere
dealing with unhappy people in the waiting room

People are impatient, angry, hysterical, anxious when they present to triage. They don't understand why they can't go right back.  Sometimes people act out in triage: crying, yelling, sometimes throwing themselves on the floor.  Often times there are people in back of triage in carts.  These are the people who can't be in the lobby.

Add to this the constant worry of the triage staff about putting people in the lobby who shouldn't be in the lobby.  In other words they are sick enough to go back, but there are no beds. Hopefully they'll be okay in the lobby.

In the middle of all this lies the triage nurse, trying to manage it all.  You are stressed in that role.  You are abused in that role.  You are sometimes overwhelmed in that role.  To expect nurses not to express their stress, frustration is unrealistic.  We who work triage are human. We are expected to be superhuman and do all of this with a continual smile.  Its not possible.

Whats the solution?

1) Eliminate as many phone calls as possible:
          -maybe ambulance calls can be handle in the main ER
          -put and end to doctors calling in about their patients
2) Have a  desk/person to field questions at the triage desk about directions, information, dealing with families.
3) Be realistic with patients about wait times.
4) Don't keep people in the ER for 4-5 hours at a time, backing up the waiting room.

nurse dodges bullet

Think you have a hard job as a nurse? On Chicago's south side, where the murder rate is out of control, home health nurses  have you beat.  Due to the danger of the neighborhood, they have to be accompanied by an armed guard as they go to care for their patients.  The armed guard is often a retired police officer.  They travel in a car together with a police radio.  If there is trouble in a particular area they either reroute or may decide not to go at all.

I wouldn't have the guts that they have.  Read their story here.