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...

dangerous nurse staffing is gonna kill your dad

In the past year legislation has been introduced nationally regarding nurse patio ratios.  This will be a long time coming if it ever happens at all.

Our ER staffs by volumes.  We have, for the most part, good staffing.  During the day shift it sucks.  We desperately need another nurse.  Something bad is going to happen.

When we get a critical patient it requires two nurses as a norm.  In the early morning hours we have 14 beds open, we have 3 nurses on.  Most of the time the 14 beds are full.  When that critical patient comes, that leaves 1 nurse to take care of 13 patients.  Often times the charge nurse is out in triage helping the one nurse out there because it is so busy.

Later on another nurse comes on the side with 14 beds. So now when we have a critical patient, there are 2 nurses to manage 14 patients.  It is not until 3 pm that the staffing becomes adequate.

I work in a hospital that specializes in cardiac care, stroke care.  The patients we see in our ER are complex.  They are not your in/out laceration, ankle sprain type patient.  Add to this an order happy medical staff and you get the picture.

It is commonplace in the ER to have 2 critical patients in the ER at the same time.  This ties up 4 nurses in a 35 bed emergency department.  Good luck to the rest of the nurses caring for those other patients.

This is a dangerous situation.  To think that our management expects 1 nurse to monitor 13 patients when there is a critical patient during a period of the day is crazy.  Or to expect 2 nurses to manage 7 patients each during another part of the day, is ridiculous and dangerous.  It is an accident waiting to happen.  That accident is coming any day now.

Now add this scenario onto the drive for patient satisfaction.  How satisfied do you think those other 13 patients are when they have 1 nurse to care for them?

exit stage left

People don't make sense.  You wait 2 hours in the waiting room, are finally brought back. It is busy, you don't get an xray ordered for about an hour.  You are up to go over there.  You dramatically announce that "I am leaving, I've been here 3 hours"  blah blah blah.

What kind of sense does that make? You are about to get what you came for.  Now you are being a martyr. By the way, did I mention that you had to be put in a wheelchair on arrival due to your pain.  You were brought to the room in a wheelchair.  There you are though, snagglepuss (heavens to Murgatroyd) , exit stage left, walking out just fine. Interesting...

ER patients kind of remind me of snagglepuss.  

you rat faced embicele

When the tide turns in the ER, it can be an ugly thing. You know the patient is kind of a wacko, but you go along with all their aches and pains in an effort to just get the visit over with in the least stressful way possible for everyone concerned. So everything is honky-dorry and you are the patients new best friend, la dee dah. You are the most wonderful nurse who ever lived. And then it happens......something does not go the way the patients way and BOOM!!! New patient....a transformation from sweet, polite, best friends to THE PATIENT FROM HELL!!! The transformation is instantaneous and usually involves shouting, dramatic announcements: I"M LEAVING!!! Okay....hey I thought we were friends...

A patient comes in with some kind of cellulitis/fungus ( there's fungus amongus) thing on their feet. Oh by the way I have carbuncles (abscess like things that drain nasty goop) on my head, and I have an open sore with VRE (organism resistant to some antibiotics) on my derriere. Oh and by the way, I tip the scales at 350. The patients takes their shoes off and the bottom of her feet are black. And I am thinking to myself ICK!!! (You know that feeling you get when you are emptying a commode full of doo-doo). It just sends a shiver up my spine. In the end, said patient was going to be admitted and everything was copacetic. So, being the nice nurse that I am, I offer the patient something to eat (she's gotta keep her strength up after all). She chows down and in comes Miss Resident to do a history and physical. Miss Resident says to pleasant patient "Hey dude, there you are chowing down on a sandwich. I thought you were hurlin' so much, you were blowin' chunks all day!" (Or something to that effect) "I guess you can blow this pop stand and make tracks back to yo' crib after all".

This is when pleasant patient turns a bright shade of red, steam comes out of their ears and shouts: "I knew you weren't going to admit me, you rat faced imbecile" (or something to that effect). "Chill out, fool, let me get with the ER doc" says Miss Resident. "I'm out" says pleasant patient. (Cue dramatic exit music). Moral of the story: When someone seems too polite, too sweet, thinks you are the best nurse who ever lived, calls you ma'am, be afraid be very afraid and look for THE TIDE TO TURN....

march-december romance

I must say this has happened to me a few times over the years..