November, 2005 Archive

November 3, 2005, 12:02 am

Do Your Patriotic Duty and VOTE…for Emergiblog!

Oh wow! I actually made the list of nominees for Nurse Blogger of the Month over at Mediblogopathy!

I would love it if you checked out the contest and voted for Emergiblog!

The great thing is that in checking out the other blogs, I’ve found a few I didn’t even know existed! I suspect that the links in the Blog Roll Call will be expanding in the next few days!

Thanks for checking out Emergiblog! What can I say, but NURSES ROCK!

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November 2, 2005, 1:50 pm

Sister, Can You Spare Some Advice?

Oh yeah. We know ’em. Hopefully we know more than one!
But don’t think you’re gonna find out who it is by calling the emergency department!

We don’t give advice over the phone.

The secretary has informed you that we don’t have an advice nurse in the department. They have told you that we are not allowed to give advice over the phone. They may have even mentioned that the unit was very busy and no nurse was available.

But you insist on speaking to a nurse. And, after all, “Customer Service” is our middle name and so you are asked to wait and are placed on hold.

A person calls an emergency room for advice for many reasons:

  • They are injured and are from out-of-town.
  • Their doctors never returned their call.
  • They aren’t sure if they are sick enough to require a visit.
  • Their relative is very ill and they are worried.
  • They have a question about a medication.

They usually want help with one or more of three symptoms:

  • Pain
  • Fever
  • Vomiting

I can’t give advice on any of them.

But I don’t mind taking the calls because even though I can’t give advice, I can listen

I can also ask questions to get the gist of how severe an illness may be. I tell callers that while I can’t actually give advice I’d be happy to listen and perhaps direct them to someone who can help.

  • I can tell them:
    • That their regular doctor has someone on call 24 hours a day and that they can call the doctor even though it is the middle of the night.
      • I once had a caller who was adamant that they could not get through to the answering service after trying for hours. I knew we were getting through okay, so I called the answering service and had them call the patient.
      • Hey Docs! Call your patients. I often hear that a message has been left for you, but they never heard back.
    • If it is a pediatric patient, there is a local pediatric advice line open 24 hours.
    • Any questions on medicine I can refer to the local 24-hour pharmacy.
  • I let them know that while I can’t make the decision of whether or not to be seen, we are open 24/7 and are happy to see them should they decide to utilize the ER (which usually earns me a dirty look from the ER doc on duty…)
  • I can tell them to hang up and dial 911 immediately.

Every now and then, the call is a definite life-threatening emergency. It’s because of those rare times that I don’t mind taking an “advice call”. First of all, I’ve learned how to “give advice” without really “giving advice”. All the patient really wants is someone who will hear and validate their concerns, which can all be done by listening and letting them know that we are there should they need to come in.

It’s funny. All of the above can be done, and in my facility are usually done by our unit clerks whenever possible.

But sometimes, it’s just got to be the nurse.

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November 1, 2005, 1:39 pm

Back in the Old Days….

Grand Rounds 2.06 is up over at Kidney Notes
this week and I’m going to be spending a good part of tomorrow morning with a cup of coffee reading the posts. Looks like a fantastic group of topics again this week. Check out the crocheted GI tract (I’m serious!).

If you are old enough to remember the people in this photo, well…’re old. Is there anyone who didn’t watch “General Hospital” at one point or another? I’m not sure who this hapless student nurse in the ugly blue cap is, but the guy on the right is “Steve Hardy, MD”, CEO of the hospital and on duty in the emergency department 24 hours a day, seven days a week. He also did surgery on a few occasions and was the first TV doc I knew who defibrillated a patient in asystole waaaaaay back when I first knew what that meant. The nurse on the right is “Jesse”.
Never knew her last name. Head nurse of the ER and this photo is the only time she was ever caught smiling. I’m so old that I remember when old-lady-nurse “Lucille” was an ER nurse that constantly picked on “Student Nurse McGillis” who obviously never rotated to any other department in the hospital but the ER. Probably graduated in the hallway. I used to pray that I would never have to work with a nurse like Lucille and thought that all nursing instructors were there to make you feel like a piece of dirt. Luckily, my real-life experience was not like that; I felt like a piece of lint in nursing school.

That reminds me of the time during the last quarter of our last year of school (when “Grease” was the word and “Star Wars” was new…) a bunch of us decided to play “hooky” from clinicals on this particular Thursday and go down to Santa Cruz for the day.. Never mind that most of us were from the same clinical group, we all “caught a bug” at the same time and called in sick. Had a great day, but I got so badly sunburned I made a lobster look like an albino. The next morning I was in so much pain I couldn’t even put a bra on (trust me, no one would have noticed) and I walked like Lucy Ricardo in the episode where she fell asleep in the sun and had to wear the scratchy designer suit in the fashion show. Anyway, there was no way I could miss another clinical so in I waddled. My instructor (Claudia, bless her heart), with a barely straight face, asked me if my “flu” was better. Of course, we hadn’t fooled her for a minute. There were no repercussions; she probably figured I was suffering enough.

The next rotation nearly caused me to quit nursing all together. We were rotating through intensive care and all of a sudden I went into panic mode. I realized I had no clue what I was doing. I thought I was going to kill someone in my ignorance. The fear came out of nowhere and was as intense as anything I’ve ever felt in my life. These patients were sick and I was just a stupid, clueless 20-year-old who was going to be let loose on the public in six weeks.
At least that is what was going through my mind at the time. Then one morning I was assigned a patient on a ventilator. I walked into the room, took one look at this prostrate human being with tubes in every orifice and in orifices made just for the tubes and I snapped. I got numb and said to myself, “I’m quitting. Now. I don’t want any part of this. Ever.” I turned around, told the staff nurse and my instructor that I was ill, picked up my stuff and walked out of the hospital.

My plan was to drive by the college and turn in my resignation/drop my classes right then. Just thinking about dropping out took about five tons of pressure off my back. Instead, I felt so spent that I went home first, I told my mom what my plans were. By the way, it never occurred to me to tell my instructor how I was feeling.

Thank God for moms. She went ballistic. Told me I had only six weeks to go and was crazy to drop out now and if I wanted to be a secretary later that was fine but at least get the degree and how could I possibly even remotely think of wasting all that time and effort just now before it was time to graduate, etc, etc. And for pete’s sake don’t make any decisions until after the weekend when you’ve thought about it!

I went back to lecture that Monday, but only to do what my mom suggested: to finish the degree. Then a miracle happened. The next Thursday my instructor met me to give me my assignment, which was to observe the ICU nurse as she cared for her patient. I didn’t have to do any procedures unless I wanted to. And she paired me up with an absolute angel of a staff nurse. By the end of the day I was measuring MAPs and suctioning an ET tube and understanding arterial lines and hanging IVs.

That instructors name was Pat and she knew exactly what was going on. I never told Pat that I was scared or anxious or ready to quit. I never told anyone but my mom. Pat had sensed what I needed and put me right where I needed to be with the exact person I needed to be with.

I graduated, obviously! And after a three month stint on a med-surg unit, guess where I ended up wanting to work. Yep, critical care! Go figure…..

(Blogging is a funny thing. I had no idea that I would end up with this post when I started.
Must be because I am reading lots of blogs of nursing students and they are bringing back memories I had long forgotten. Back to ER musings tomorrow….)

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About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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