March, 2006 Archive

March 27, 2006, 2:16 pm

I’m No Fool, No Siree! This Week It’s Grand Rounds For Me!

Well what on earth is Jiminy Cricket doing as my Grand Rounds mascot today?

Well first of all, our favorite NHS Blog Doctor, Dr. John Crippen is our Grand Rounds host this week.

Dr. Crippen likes the game of Cricket. Only yours truly thought Cricket was really Croquet.

Hence, the Jiminy Cricket mascot.

Dr. Crippen quite kindly posted an Emergiblog archived post this week, as this blogger was too exhausted to even hit the keyboard over the weekend.

It’s one of my favorite posts from last October.

Perhaps I shall read this particular volume of Grand Rounds with a nice spot of Earl Grey tea to get myself into that wonderful British frame of mind.

Enjoy! I know I will!

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March 23, 2006, 4:13 pm

Tangential Thoughts on a Thursday

Another Great Moment In Medicine:

All the nurses go to their rooms and every resident in the world gets a good night’s sleep!

Sorry, nursing colleagues.

I couldn’t resist.

It was my first thought when I saw the photo!

This is actually a Parke Davis ad, one of a series.

It’s a medieval hospital.

Doesn’t it seem like a lot of wasted space in the center there? How did they heat the thing?

The nurse up front looks like someone just told her she had to do mandatory overtime.

hhhhhhhhhhhhhhhhhh

There are some new links in town! Check out an new blog by ER physician Charity Doc , or soon-to-be Student Nurse Jack and Misadventurous Melissa who is a nurse colleague in southern CA. I’ve also discovered Krista at Picklecakes , also a nurse and not afraid to tell it like it is. I’ve also added to my patient blog roll call recently with Patricia at The Multiple Sclerosis Companion.

hhhhhhhhhhhhhhhhhh

I sure would love to hear the whole story about why Rich at Geek Nurse had to shut down his blog.

I was sorry to see that.

I have not worked in an ICU since 1989 and I was learning a lot from him, especially since I’ve never worked a Pedi ICU.

ddd

I love the job I have now and I wonder what I would do if given the ultimatum to shut down Emergiblog.

I know!

I’d quit and put up an online tip jar!

I could get free care in the ER!

I’d have to find a place for the homeless with wireless internet connection, a place to charge up my iPod, my cell phone, my coffee pot and have access to American Idol, BBC America and the Cartoon Network, but hey! All in the name of free speech!

In all seriousness, we miss you, Rich. Let us know “where” you are. You can’t keep a good nurse down. Especially in the blogosphere.

hhhhhhhhhhhhhhhhhh

Now that life has settled back into it’s normal routine after family health issues and lots of extra shifts, it sure is nice to catch up on all the posts I missed. I’m only a third of the way through my list of blogs (see sidebar). At least with my “live bookmark” feature on Firefox I can see who has new posts and who doesn’t.

hhhhhhhhhhhhhhhhhh

I’ve decided to give Blogger one more chance.

I’ve checked out Typepad and I actually “own” the “www.emergiblog.com” domain name over at enom.com, I just haven’t had the time to actually sit down and work with it.

I’m kind of attached to this format and changing designs is like getting a plastic surgery make-over. It would still be me but it wouldn’t “look” like me.

But one more major breakdown that affects this blog and I will become so good at html my new site will look like the Taj Mahal.

Blogger may be free, but so is half the care I give in the ER. I still have to do my best.

hhhhhhhhhhhhhhhhhh

For one shining moment, I was a Large Mammal over at the ttlb ecosystem. Now I am a Maurauding Marsupial again. Sigh. How can that be when my Techorati score is up?

Yes, I pay attention to little things like ttlb and Site Meter.

Oh well. At least having a marsupial pouch is handy for my trauma scissors….

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March 22, 2006, 4:09 pm

What I Think It Takes To Be An ER Nurse

“Mary Louise Shines”?

Yeah, and I’m Catherine Zeta Jones.

This is no real nurse. I haven’t seen her in a single recruitment ad in all the hours I’ve spent searching the internet.

Interestingly enough, she comes from New York, just like Beulah France, RN, our favorite nurse consultant when it comes to harsh toilet tissue.

So we can avert the nursing shortage and gain valuable staffing by just using Pepsodent?

“You’ll wonder where the yellow went, when you brush your teeth with Pepsodent!” I did not make that up. It’s the old ad jingle.

Never mind what year.

*****

But wait!

Now she is recruiting for…clear skin?

She would never have recruited me.

She looks like a Stepford Nurse.

She speaks in thought bubbles.

And her cap is really yukky.

Hey, I have priorities, ya know.

******************************

Ever thought about being an ER nurse?

Ever wonder if you “have what it takes”?

I didn’t think I did until one slow day in ICU I floated down to a tiny, three-bed ER and fell in love with a whole new world.So here is my own, personal subjective take on what it takes to be an ER nurse:

  • A Strong Personality
    • Timid, fragile….no place for that in the ER. Things will get tense and tempers will fly.
    • Do you cry if someone says “Boo!” in the wrong way? If you are a “Sensitive Sam”, you will have a hard time. I know. I was a “Sensitive Sam”. Then I got older. Now I can say “Boo”! right back and then some.
    • Alternatively, if you are the type to hold a grudge, the ER is not for you.
    • That doesn’t mean you have to be a loud, boisterous person. Two of the best nurses I ever worked with were extremely quiet. They didn’t say much, but they were the epitome of efficiency and their patients were in superb hands.
  • An Assertive Personality
    • All nurses are patient advocates, but in the ER you do not often have the luxury of time.
      • Occasionally you will find that decisions are being reached (as in admit vs. return home) that you, as the nurse, can influence.
      • If you feel a decision is being reached that is not in your patient’s best interest (weak while ambulating and lives alone, for example), you must speak up. Can you do that?
    • The easiest doctors you will ever deal with will be the ER docs. There is a sense of teamwork and communication between the docs and nurses that is really unique to the ER.
      • You will be dealing with specialists from every department: surgeons, eye specialists, hospitalists, cardiologists, neuro docs, etc.
      • They don’t always know the policies of the ER.
        • sometimes they will make it quite clear that they could not care less about the policies of the department.
        • It will, occasionally, be up to you to assert that you cannot carry out a specific order because or ask them if an order can be done after admission to free up an ER bed. Are you willing to do that?
  • Energetic
    • If your idea of aerobic exercise is to click the remote twice in a row, you need not apply to the ER.
      • You will move. There will be shifts when you never stop moving. You need to be willing to walk in that door with roller skates on and well oiled to boot.
      • You have to be willing to put in the energy that the job requires. Can you do that?
  • Stamina
    • Energy is a willingness to work. Stamina is the ability to work.
    • You will never know what you will be dealing with on any given shift
    • You have to be able to go the distance – finish the shift giving 100%.
      • Often without breaks, sometimes without dinner.
      • Maybe even after your scheduled shift is over. Can you handle it physically?
  • The Ability to Prioritize
    • You have four patients, two cardiacs, one going to the cath lab, one GI Bleeder (stated at triage) and a patient with an ingrown toenail. Who ya gonna call?
      • Sorry, the Ghostbusters are busy – you make the decisions.
        • What orders go first on which patients?
        • You can always ask your co-workers for help, but you need to know what you want them to do! Can you make decisions on the fly?
        • Can you handle more than one crises at a time? Are you willing to take the chance that you will have to? Does the idea exhilarate you or make you nauseated?
  • The Ability to be Flexible
    • When your co-workers get overloaded (see above), are you able to see beyond your assignment and help prioritize their care?
    • When your rooms are empty, are you willing to discharge, start IVs, medicate your colleague’s patients? Are you willing to ask them if they would like your help?
    • Someone calls in sick. Are you willing to pitch in and help cover for them?
    • Your co-worker is having a bad day….sorta bitchy. Are you willing to cut them some slack?
    • The doc wants to add some tests to the patient, increasing your already heavy workload. Can you take it in stride?
  • Attitude
    • You must have a positive attitude.
      • No one wants to be around constant bitching or fault-finding.
      • That can drag down the morale in an ER faster than an unsuccessful code
      • Can you put on a positive front even when you are not feeling it?
    • Then, again, there is a time and a place for ventilating. The nurse’s station or the patient’s room is not it. Can you wait to complain until it’s appropriate?
    • Your patients already feel bad. They are sick, they are angry, they are tired, they are impatient. Can you smile and be upbeat when everyone around you is not?
    • Can you see your patient as an individual and empathize, not just see them as the “abdominal pain in the back room”?
*****

And now the controversial statement:

I do not believe that a nurse should begin their ER career as a new graduate. It is imperative that she/he gain the skills of prioritizing and assessment/evaluation on at least a monitored unit.

The “feeling in your gut that something isn’t right” comes from your experience outside the ER. You need to have enough experience to have developed that sixth sense.

You should be comfortable with drips,coding and defibrillating (basically, Critical Care) well before coming to the ER. The other stuff is just clinical and can be picked up quickly.

You have to be able to carry your own weight.

There are always exceptions, I have worked with nurses who are barely out of school who were made to work ER. But they are few and far between.

If you were meant for the ER you will love every minute. If you were not meant for it, you will know almost immediately.

I think it may be in our genes…….

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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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