November 2, 2010, 2:55 pm

Don’t Speak, I’m Passing Meds

Oh, to have my own desk in the ER!

A place to think, to write without getting my chair jostled or my elbow knocked or my charts shifted.

Most of my ERs have been short on desk space. Chairs are at a premium. If you are charting and you get up to answer a call light, by the time you get back your charts are stacked and shoved to one side with someone else’s derriere warming the seat cushion.

Imagine a U-shaped “nursing” station. The EDMD desk takes up 33%. The unit secretary takes up about 33% This leaves the remaining 34% to divide between 3 – 4 nurses at any given time. And an ER tech. And any primary docs that show up.

It gets pretty cozy in there.

The NP/PA gets to have the little desk around the corner. The one with the computer. Not that I’m jealous.

Or anything.

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

Medication rooms have become sacred locations.

One is not to speak while engaged in the preparation of medication.

One is not to speak to anyone engaged in the preparation of medication.

It’s for safety. It helps prevent medication errors.

Signs are posted.

Do not disturb.

Silence is golden.

*****

It’s a great policy, given the hectic atmosphere of an ER. Having quiet, uninterrupted time to focus on medications is a godsend.

In the med room.

So why are they saying we should prepare/draw up the medication at the bedside?

Have you ever heard what goes on at the bedside?

It’s something like this:

“Hello, Mrs. Jackson! I have medication here for your pain and something for your nausea.”

“What are you giving her?”

“She wants water.”

“It’s cold in here!”

“Can I have a blanket,too?”

“Are you calling her primary doctor? Is he coming in? When will he be here? What do you mean he isn’t on the way?”

The patient hasn’t even spoken yet.

“I’ll be giving you some Zofran for nausea and some Dilaudid for pain control. Do you have any allergies?”

“Zofran never works.”

“OMG, they are giving you Dilaudid? Grandma had hallucinations on that!”

“Are you sure you aren’t allergic to that? Wasn’t it something with a “d”?”

“She has a high threshold for pain medications, she’ll need more.”

The patient informs me that she has no allergies.

“What level is your pain right now?”

“It’s a 10. It’s more than a ten! Tell ’em it’s a 10, Betty!”

“Oh Betty, tell the truth, it’s much more than a four!”

“Be careful, Betty, you don’t want to get addicted!”

“Grandma hallucinated on that stuff!”

The patient has informed me her pain level is at a 4/10. I turn to draw up the medication.

“How long is she going to be here?”

“What’s wrong with her?”

“Can we use a cell phone in here?”

“Ooops, there goes my cell phone!”

“NO BABY, I CAN’T TALK NOW, MY AUNT BETTY IS IN THE ER AND I HAVE TO BE QUIET, COS SHE IS LIKE, IN PAIN, AND SHIT, AND THEY ARE GIVING STUFF THAT WILL MAKE HER HALLUCINATE LIKE GRANDMA! NO…BUT….THAT AIN’T WHAT I SAID….WELL F*** YOU, TOO!

“Jolene, take that outside right now!”

“Oh man, we are going to be here that long? I was hoping to get home before the game starts.”

“Will she be admitted?”

“We can’t take her home.”

And yadda, yadda, yadda; ad infinitum.

*****

The bedside in an ER is not a place of peace and quiet; ERs can be chaotic places.

It is our duty to maintain patient safety in medication administration in all scenarios.

But if it has been shown that preparing medications in a quiet environment without distractions results in fewer medication errors, doesn’t it make sense that the majority of this preparation should be done in the quietest, least distracting location?

Like the med room.

Instead of at the bedside?

October 28, 2010, 2:56 pm

Change of Shift: Vol. 5, Number 9

Welcome to Change of Shift!

After a Vegas-induced vacation, our nursing blog carnival is back!

There has been lots of activity in the blogosphere over the last four weeks, so let’s get right to the heart of it!

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

Editor’s Pick of the Week:

When is “nothing” the ultimate “something”? Suzanne Gordon has the answer in Nursing and the Perils of Success. And then check out her post on Teresa Brown’s New Book Critical Care for words in support of the bedside nurse.

*****

When a parent is also a health care provider, it isn’t easy to separate the two roles. Laura at Adventures in Juggling knows both sides. Read her story in Boundaries.

Whoa – this post is so chock-full of topics, I plan to write three posts just based on it! Katie Morales at NursesNetwork.net gives us her Initial Observations on the Future of Nursing after viewing the IOM Brief on the Future of Nursing webcast. You have to read this!!!

Sometimes new nurses need some “tough love” to encourage their growth. But where is the line between that and “eating our young”? Wanderer takes this on in Culture of Coddling vs. Eating Young at Lost on the Floor.

*****

Nurses view their patients holistically, so this post by Mona at The Tangled Neuron is perfect for nurses with patients (and families) dealing with Alzheimer’s. Mona looks at Nondrug Treatments for Alzheimer’s: A New Systematic Review.

Heather Kelly, of The Blog of the Interdisciplinary Nursing Quality Research Initiative (INQRI), introduces Guest Blogger: INQRI Grantee Susan Letvak. Ms. Letvak supports the Initiative on the Future of Nurse, but notes a very important omission.

And now for a little ER gallows humor! Take your Monster Mash home, Boris! Nurse Me is in da house with The Deathbed Crash!

The Millionaire Nurse Blog has a new contributor! Say hi to Julie, charge nurse of a 22 bed CCU/ICU in Florida with a huge interest in personal finance! Check out her post on Five Tips to Establish Credit. Welcome, Julie! : )

*****

Toronto Emerg at Those Emergency Blues submits a chilling look at a Death in the Waiting Room, followed by an equally horrific description of a Code. I’m sitting here trying to get my breath back – I don’t think I took a breath reading either post.

Rita at Supporting Safer Healthcare knows that nurses are the backbone of hospice care, and shares some information about The Comfort of Hospice.

When you absolutely know something is wrong….a scary, inspiring story by one very courageous, persistent nurse. Check out Maha’s tale of Going Beyond Scope of Practice at Call Bells Make Me Nervous.

Over at Off the Charts, look at Finding a Job as a Nurse in a Digital Age – and Keeping It. Great links on the topic, including a link to Will at Drawing on Experience!

*****

The Great Pumpkin has visited Hotel Rehab a bit early this year! Rehab RN notes his arrival in A Little Early Halloween Antics…

Sean Dent pens his own blog at My Strong Medicine, and he also blogs for Scrubs – The Leading Nurse Lifestyle Magazine. From his personal blog, a call to respect in Role Clarification and from Scrubs, Male Nurse Introductory Course 101.

Chris at The Man-Nurse Diaries delivers an Ode to Certified Nurse’s Aides, the unsung heroes of long-term care.

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

This was truly a fantastic edition – many thanks to all who contributed!

The next Change of Shift will be here on November 11th. Submissions can be sent via my contact button or Blog Carnival.

I’m looking forward to your submissions!

October 27, 2010, 4:23 pm

It’s Not Good

Have coffee! Time to blog!

Seriously, there is actually coffee in that cup! 32,160 cups!

A Guinness World Record.

Brewed on site at BlogWorld/New Media Expo 10, by the folks at Gourmet Gift Baskets.

I think it represents about 6 months of my yearly consumption.

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

I’m putting Change of Shift together tonight, so if you have any last minute submissions, I’m “standing by” to take your order!

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

I am having a crisis.

I’m not sure if it’s an ethical crisis, a moral crisis, or an I’m-just-too-full-of-myself crisis.

But is is getting harder and harder to be an ER nurse.

*****

I can’t detach.

I mean, it’s no skin off my nose if a patient with no discernible pathology calls 911 for the tenth time in four weeks and requests transport from the other end of the county. For narcotics.

It’s no skin off my nose if a patient that has been to five other emergency departments up and down the state in the last 48 hours presents to us. For narcotics.

It’s no skin off my nose if I a patient shows up so medicated they can’t walk straight. For narcotics.

I mean, really.

I should just assess ’em, push ’em, vital ’em and street ’em.

Right?

*****

So why does it bother me? I get angry. Angry at the audacity of the abuse of the system in general, angry by the feeling I’m being manipulated, angry at the willingness to order narcotics on demand.

And tired of having to pretend that it’s all good.

It’s not good.

I’m not helping anyone.

I’m certainly not therapeutic in any way.

And I’m not stupid.

I’m aiding and perpetuating addictions.

On a daily basis.

*****

There was a time I could smile and pretend that I didn’t see the holes in the stories or the flat out lies I would catch in the course of a conversation.

Pretend that I believed a patient could not remember the name of that….”oh dear what is it called….Daludad…Dileded…oh yes! Dilaudid! That’s it!”

Pretend that patients weren’t drug seeking, knowing they knew I knew.

*****

Getting patients out of pain is one of the most rewarding aspects of emergency nursing. It’s as close as you can get to instant gratification – you medicate, the patient gets relief.

That isn’t what I’m talking about.

I’m talking obvious, blatant, in-your-face drug seeking that is becoming more obvious, more blatant and more in-your-face every day.

But the narcotics still flow.

And it’s getting harder and harder to be a part of that.

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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