ERnursey

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New Look
2008-01-12 04:01:00
My sister is re-designing my page, I want her to get the banner to go all the way across the page but other than that, what do you guys think?

Grand Rounds
2008-01-10 04:16:00
This weeks edition of Grand Rounds is hosted by Path Talk. Grab a cup of coffee, sit down and enjoy!

WAY TO GO MEAN MOM!
2008-01-10 03:59:00
Here is a story about a woman after my own heart. It is so good to know that there are still some people that are not afraid to be the parent.
More About: Mother

Sad but True
2008-01-09 17:52:00
One of the medical records clerks came to the ER yesterday looking for a chart. She started of by telling me that the patient had been admitted to the floor and then been sent back to the ER, which is not done. So I pull up the EMR and put the patients name in but he is not found. I tell the clerk that but she is insistent that she was an ER patient so I search by the med record number but the patient has not been in the ER. She then shows me the face sheet which says direct OBS. I ask her if that doesn't mean she was a direct admit to 23-hour observation status. "Well she had her blood drawn in the ER." I tell her that sometimes when a direct admit comes in the ER phlebotomist will draw their labs quickly on the way by to expedite tests, it does not mean they were an ER patient. "Well we can't find the chart, where do you keep your charts" I tell her we have no paper charts, it is all on the computer like it has been for the past three years. "Can I look around for it?" ...
More About: True

I'm not using my inside voice anymore
2008-01-08 05:55:00
So. It's the typical Monday. It's 2pm (1400 for us medical folks) and the ER is jammed up to the rafters. We're holding 6 admits, two of which are ICU patients (funny how the ICU nurse only can have 2 patients but the ER nurse somehow has to manage ICU patients and their other patients also.) In the hall we have 4 gurney patients and 6 patients in chairs. The PA is seeing people in the lobby and starting their lab and xray orders. We have already admitted 18 patients (between 10 am and now) and have another 8 admits pending. There are two ambulance crews standing in the hall without a hope in hell of off-loading their patients anytime soon. I'm in charge of this mad house. I have two phones on my belt that are ringing non-stop and I am one step away from 'accidentally' dropping them in the toilet. I am trying to intake one of the ambulance patients and get report on a patient that is being transferred in on one of my phones. During all this I get a call from one of ...
More About: Voice , Emergency Room , Inside

Better Management of Hospital Beds
2008-01-07 04:34:00
I was reading a back issue of Modern Healthcare when I came across a letter to the editor by Eugene Litvak et al from the program for management of Variability in Healthcare Delivery at Boston University's Health Policy Institute. (yeah, I have no idea what that is either) I was immediately captured by the letter's suggestions - unfortunately I cannot link there as you have to be a paid subscriber so let me sum it up for you. Their suggestion is that ER overcrowding is not being caused so much by the amount of hospital beds that have been closed over the last few years but rather by Poor management of the existing beds. In this letter they single out the poor scheduling of elective surgery and even did a study demonstrating that the timing of ambulance diversion is best predicted by the number of elective surgical admissions for that day, not the actual amount of ER patients. Why? Well if my hospital is any indication, the beds are given preferentially to the surgery patients ...
More About: Management , Hospital , Beds

Ah! Electricity.
2008-01-05 21:48:00
excuse the lack of posting, I've been among the 400,000 Californians without power until just a bit ago, I am very happy to be able turn on the heat, even though it's not too cold here, after a day with the house being in the upper fifties, we are all feeling quite damp and chilly. To add to my woes, I am still feeling quite crappy from the flu.In reading blogs this morning I came across this at the Happy Hospitalist. This is just the kind of thing that chaps my ass. How can juries award these morons anything? A guy that got bit while he was in someone else's yard shooting the chained up dog with a pellet guy, a woman who put her RV on cruise control and then got up to go and make herself a sandwich. Good grief.Now excuse me while I go drink a steaming cup of theraflu and become unconscious for several hours.
More About: Electricity

My Name is ERnursey and I am a 20 Questions Addict
2008-01-03 23:45:00
The kids put a 20 Questions game in my stocking. In a short week I have become hopelessly addicted to the stupid thing. I mean, how can a small, electronic hand-held game read my mind for crying out loud. It is uncanny in it's ability to guess whatever obscure item I am thinking of in 2o questions, sometimes it has to use 25 but in probably 100 attempts it has only missed two or three times. So I will pick it up and play it a couple times and then set it down and walk away, then pretty soon I'll think of something and think "Oh, I bet it won't guess this one." I'm pathetic.
More About: Addict

Crayzee!!!! (Shamelessly stolen from Nurse Kelly)
2008-01-03 04:38:00
Ok, how crazy do you have to be for a law firm to fire you, despite having endless money? I guess Britney Spears knows because, despite her millions of dollars, her law firm has decided to no longer represent her in her custody battle. Giving up and endless supply of billable hours? She must be nuttier that we have all heard. It's pretty sad for those poor kids. Being a millionaire does not mean you aren't white trash.
More About: Stolen , Kelly , Nurse , Mele

Great, now I'm an ad
2008-01-02 21:38:00
Found this while perusing my stat counter - now I'm being used for advertising, not sure what I think about that. (look down at the bottom of the ad.)
More About: Great

Grand Rounds
2008-01-01 17:45:00
Grand Rounds is hosted this week at Other Things Amanzi with a theme of new beginnings - appropriate for the New Year.
More About: Grand

Flu
2008-01-01 17:26:00
Happy 2008, to celebrate I believe I will have the flu, teach me to forget to get my flu shot. I started having chills and back pain during the night - I know something is off when I am putting the 6th blanket on my bed and still shivering. This morning I have a lovely temp of 102.3 along with sore throat, cough and myalgia, how convenient that it is my day off. Tylenol and fluids here I come.On the good side, ERson has been in touch to give me his come home date, which will be sooner than he had thought. Happiness.

Happy New Year
2008-01-01 05:27:00
Happy New Year everyone.Can it really be eight years ago that we were anticipating the new millennium and expecting the end of life as we knew it because all the computers in the world were going to crash at midnight? That seems rather silly now, doesn't it. But how is that eight years are gone, in the blink of an eye?I am grateful that another year has passed and we are all healthy, have a warm home and plenty to eat. I am grateful for my family - we have our quirks but none of us are too nutty, no one has ever been in jail, homeless, drug or alcohol addicted or institutionalized. I am grateful for my children, although granted they are meeting the definition of children less and less . I am grateful that I have a job I enjoy that allows me to live a comfortable life and will hopefully provide enough overtime in the next few months to pay off the Christmas Visa bill :-(I am especially grateful that ERson will be returning to the United States soon, it has been a long, difficu...
More About: Happy , Happy New Year

Don't try to rob Santa -fool!
2007-12-31 17:13:00
Via Law dog is a story about why it's not a good idea to try and rob Santa . Go Rednecks!
More About: Fool

Pond Scum
2007-12-31 16:35:00
The lawyer in this story is lower than pond scum. Hopefully the local Bar Association will take care of him.H/T William
More About: Pond , Scum

Kendra's Law
2007-12-30 18:36:00
This all sounds good but since we can't get local governments to fund any inpatient beds or outpatient treatment I can't see it working here without some big changes.Many years ago I worked a community that had a huge psychiatric facility, in it's heyday there were over 1500 beds. The patients there were made to function at their highest ability, they ran a farm and a dairy, worked in the kitchens or laundry - generally lead a productive life. But then the government decided it was illegal to make patients work. Now inpatient mental health patients sit around all day, watching TV and smoking. And once a day or less they have some form of therapy, usually not even with a psychiatrist. The focus is on medicating their symptoms, not teaching them how to deal with life. And that huge hospital? All those beds have been closed by the government, it sits empty now, the farm and dairy closed. And all of the 1500 inpatients? The older ones went to nursing homes, a few went to half-...

Medication reconciliation
2007-12-29 02:48:00
The Happy Hospitalist has a great post on all the pitfalls and perils of the medication reconciliation process - go check it out. And here is the greatest paragraph ever written:'For the amount of time a nurse spends hunting down this information, you could hire two or more full time medication reconciliation clerks in the ER who do nothing but gather information. They do it right the first time and the benefits extrapolate down line to the entire hospital system in terms of job satisfaction, patient safety. Putting ER nurses in control of a clerical job with high job dissatisfaction is a losing effort. And that losing effort results in bad information being extrapolated downline through the entire hospital system. It leads to medication errors. Over and over again. It starts with poor information from the patient and extends down the tree of data entry. Just as I did not go to school for 11 years to data gather a list of meds, neither did the nurse.'
More About: Medication , Reconciliation

Nursing practice
2007-12-28 17:11:00
This post by Scalpel has opened quite a can of worms.A couple of the comments really have my back up.As a nurse I am bound by law, hospital policy, ethics and my states Nurse Practice Act. I am responsible for my own practice just as the doctor is responsible for his. I don't blindly do what the doctor orders. I need to know if the order is appropriate, safe for the patient and within my scope of practice. The physician is not my boss and he cannot fire me any more than I can fire him. We work together collaboratively to provide safe, high quality care for the patient. We are a team - although I have certainly worked with some MD's who don't seem to grasp that concept. I have seen some orders that were blatantly wrong or unsafe and had I carried them out without question would have caused harm to the patient. For instance when the doctor wasn't watching where his mouse clicked and ordered 10mg Norcuron IM for my patient when he really meant Norco. Big difference between...
More About: Nursing

Thoughts on Product Liability
2007-12-28 00:25:00
My adorable daughter received a video game for Christmas called 'Dance, Dance, Revolution.' Basically it involves a plastic mat that goes on the floor with four places you step: up, down, right and left. Arrows scroll up the TV screen and you have to step on the corresponding arrow on the pad at just the right time. Sounds fun right?Well, it is Christmas morning and we open up the package and pull out the directions. As we start reading we realize that the directions are not actually directions but THREE PAGES of warnings. Yes, three pages. Good God. Don't use in the rain, don't use next to a window, don't use if it is wet, don't use wearing socks, don't use if you have heart problems, are pregnant, have seizures and so on and so on. I HAVE NEVER SEEN SOMETHING SO RIDICULOUS.Part of the problem is the courts. How about the person who made millions of dollars in a lawsuit because she put a container of coffee between her legs while wearing short and got burned. Duh. H...
More About: Product , Thoughts

Where DO the Morbidly Obese Go When They Die?
2007-12-26 17:48:00
Oh dear, this is bad. File under thing I never thought of, and hope to forget soon.
More About: Obese

Poems for a Modern Christmas
2007-12-26 17:17:00
As we are enjoying the holidays, let's spend a moment thinking about all the courageous men and women who are far away from home.Here is a wonderful Christmas poemThis was the first Christmas at our house where we weren't all here. It was heart-breaking. I had hoped he would at least be able to call home but I guess armed conflict doesn't pause for Christian holiday celebrations. His tour has about 1 month to go and then he will be back in the US for several months. This will probably be the longest few weeks in history.For all of you that had a wonderful holiday surrounded by your loved ones and enjoying excessive food, drink and piles of presents - give thanks to all our armed services members, past and present, that willing sacrifice to ensure that our country remains free. Send a box to a serviceman or contact your local base and find out what you can do to help the family members left behind.A SOLDIER'S CHRISTMAS T'WAS THE NIGHT BEFORE CHRISTMAS,HE LIVED ALL ALONE,IN ...
More About: Poems , Modern

Oh It's Gonna Be a Bad Day
2007-12-24 03:56:00
My shift starts at 0700. At 0703 I get my first patient, a 4o year old female with no medical history who has a 1 day history of epigastric pain, nausea and vomiting. The triage nurse was sharp and noticed that the lady was also pale and sweaty, could be possibly from gastroenteritis but she brought her straight back to the cardiac room anyway where we immediately did an EKG.The EKG didn't show any acute ST elevation but she did have some ST depression in her inferior and septal leads. The doctor orders cardiac labs, aspirin and nitro.It is now 0710 (when it comes to cardiac-we are a well oiled machine) I give her 4 baby aspirin to chew while a colleague establishes an IV with saline running TKO. At 0711 I give her one nitro under her tongue after educating her on the medication and why we are giving it. At 0712 she says those words that strikes fear into every nurses heart:"Oh.....I don't feel very well." At the same moment the red alert alarm goes off on the cardiac monito...
More About: Gonna

Christmas, or In which all the sad and lonely people come to the ER
2007-12-23 05:45:00
I often wish I had been an adult during the 40's and 50's. Life was simpler then in many ways. Mom's didn't have to work so that the family could barely scrape by instead of being homeless. Kid's got kicked outside in the morning when they didn't have school and they played all day outside, riding bikes, skating, climbing trees and so on. An obese kid was a rarity then. Grandma and Grandpa lived in the spare bedroom not a condo in Florida or, even worse, a nursing home. The Aunts, Uncles and cousins lived in the same town so cousins grew up together, the whole family got together on Sunday after church for Sunday dinner. Sigh.Now, families are fractured - spread all over the earth. Mom and dad both work, the kids are alone after school doing God knows what and getting into all kinds of trouble. The elder relatives live far away and when they can't take care of themselves are shuffled of into a nursing home.That makes this time of year a busy one for the ER. In additi...
More About: Christmas , People , Lonely

Killer Colds
2007-12-21 02:29:00
First killer Staph and now this. The virus that causes the common cold is mutating into a super-cold.
More About: Killer

Exhausted!
2007-12-20 03:10:00
Christmas shopping ugh! Exhaust ed. Every year I wait until the last minute, why oh why do I do this to myself? My feet are roughly twice the size they were this morning when I left. I am on my second BIG drink and am just now starting to unwind. HO HO HO. Hah! More like Bah, HUMBUG!

Grand Rounds
2007-12-18 05:32:00
Grand Rounds is in Haiku this week! Check out this weeks edition at Trick Cycling for Beginners.I'm actually rather jealous, Haiku completely defeats me. I would agonize for hours before coming up with one lame Haiku in high school english. The amount of imagination to come up with enough for a whole edition of Grand Rounds is unbelievable. Lovely job.
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Cranky Prof RULES!
2007-12-18 05:06:00
This woman is lost on academia, she obviously was an ER nurse in another life. If I only possessed her eloquence, sigh.
More About: Prof , Rules , Cran

Helpful Hints
2007-12-18 04:51:00
As I was washing out the 6" gaping laceration on the back of my patients thigh just under his buttock I wondered to myself why anyone thinks they can out-run a police dog. I would have asked him but he didn't seem to be in the mood to chat as he was otherwise occupied with his pepper-sprayed face, his 3 sets of taser darts and the fact that he was shackled and hog-tied.I've met police dogs, they are most often German Shepard's who come specially equipped with strong muscular legs and great big, shiny white teeth. I've seen them at work both in exhibitions and on Cops, a show I'm ashamed to admit I'm secretly addicted to, and I wouldn't want to be running with one of those dogs on my heels. As an ER nurse, I've seen the runner more than once and each and every one of them are well chewed when they arrive although this guy helped inflict his own laceration because he was so hyped up on meth he just kept running with the dogs teeth sunk into his leg.So, my helpful hint for t...
More About: Hints

How to Get Tasered in the ER
2007-12-17 04:52:00
It didn't start out well, a major drama alert in the waiting room as the patient who had come in for back pain (it was his 13th visit for the same complaint in the last three months) decided he had waited too long and threw himself on the floor and faked a seizure. He had spent the previous hour moaning and crying and carrying on so bad that several elderly patients, who were truly ill, had offered to wait longer so he could go back first and then thought the ER staff were heartless assholes because their generous offer was refused. I'm sorry, but HIPPA prevents me from telling your that he is here in this ER at least once a week with a 'pain' complaint and when he isn't here he is at one of the other four hospitals in town. We've intubated him twice because he takes narcotics handfuls at a time to get high and sometimes over-estimates his dose. He's been told he will not get any further narcotics from our ER but he always tries.So after the fake seizure we took him back b...

More on Frequent Flyers
2007-12-15 03:02:00
The Happy Hospitalist has encounters frequent fliers also, read his post on how 5% of the patients consume 50% of our resources.
More About: Flyers