Blame it on the ER

I was home Friday (I hurt myself and need surgery). After having five abdominal surgeries in six months last year I think I have a little PTSD...but enough about me. This post is about something else. As I said, I was home Friday...flipping through the channels, and what do I see, my little town on CNN...then MSNBC... Hey, maybe that is why I keep hearing helicopters overhead and sirens screaming. One of our local psych/etoh'ers decided it would be a great idea to take a few hostages at the Hillary Clinton campaign office. Well, most people know that ended with him releasing his hostages and surrendering peacefully.

Today the local paper had his 'story'. His family claims he came into the ER and wanted help for his psych problems and we sent him away since he had no insurance or money. This is absolutely NOT TRUE. But, they are making our little, non-profit hospital out to be this horrible institution that sends psych patients away without treatment. I cannot discuss this patient, of course. But, as anyone familiar with EMTALA knows, ALL patients are given a medical screening when they present to the ER. Typically psych patients are screened to make sure it's not a medical problem then we call in emergency services and they determine the appropriate dispensation of said patient. If it is a drug/etoh problem we refer them to the drug rehab and other services in the area.

This morning I worked in the ER and I can't count the number of calls we got from people letting us know how horrible we are for not treating this poor guy. Of course we transfer the calls to the nursing supervisor so she can handle it. It's terrible that the newspapers aren't more responsible in their reporting and checking facts. The hospital hasn't released a statement yet, but I hope they do. People like to point fingers when something like that happens, and right now the fingers are pointing at us...and I don't like it!

Baby G

I grew up about 20 minutes from where I live now, so I end up seeing a lot of people in the ER that I knew as a kid. Sometimes it's great, sometimes not so great. Today was one of those not so great days. Today I took care of Baby G. I had taken care of Baby G before. He was beautiful, healthy and one month old when I met him. He looked so much like my son did when he was a baby. Baby G is my sons second cousin on his fathers side (his cousins child). I couldn't recognize him today, just four months later.

He was brought in to the ER today, his head swollen to twice the size. A skull fracture, hydrocephaly, fractured ribs. I had never seen a CT that looked like his. When I realized who he was I literally felt faint. The parents deny abusing him, of course they would. Those injuries could not be caused any other way than by abuse. He ended up getting intubated and medflighted to Boston.

It's so tragic. It always is. But, knowing the family, having held this little boy in my arms just a few months ago and marveling at how much he looked like my own child...it hurts. His parents are teenagers (I changed his dad's diapers when he was a baby). I just never saw this coming. They had seemed so attentive and caring. And, now...if he survives, he will have profound brain damage. I hope they are able to determine who hurt him, and no matter the punishment, it is not enough. It breaks my heart.

Mom's heart goes Ka-chunk

My mother is the picture of health. She's 67, active, thin, but smokes. (far less than a pack a day) Well, a few weeks ago she told me that she had a problem. Every so often she can feel her heart go 'ka-chunk' then she gets dizzy, then it passes within seconds and she feels fine so she goes about her business. Apparently it had happened a few times in the past month, but she didn't want to say anything. She wanted me to tell her what it could be. Well, of course I told her she needed to see her PCP and get checked out. But, that if it did it again, go to the ER.

My mom went to her PCP. Who sent her to cardiology, who scheduled her for a stress test. My mother lives next door to me so when she got back from her stress test I went over to see how it went. She looked pretty scared. She was hooked up to a holtor monitor and said that they were going to call to schedule a diagnostic cardiac cath. When I asked what the cardiologist said she couldn't tell me. Just that there was 'something wrong' with her stress test so they hooked her up to the holtor and told her that she needed a diagnostic cath. So, I reassured her that everything would be alright. But, I'm scared. I want to know details, what exactly did they find? She didn't know and I didn't want to grill her. So, my Mom's cath is scheduled for Wednesday, and then we'll know more.

My mom told me that as a child the doctor was worried about her heart. She stood behind a machine and he could look at her heart. The nurse even brought in a mirror so she could see her heart beating too. This would have been in the 1940's-early '50's. I have never heard of such a machine. Of course, she's had a good 60 years since that test without any problems, so I just don't know.

Please, say a little prayer that my mom's cath comes out ok. And, if you don't pray, well wishes are just as good.

rant

For the most part I love the ER. Coming from the ICU I was pretty shell shocked at the frenzy of the ER sometimes. But, I've even come to love that too. Today was one of those days. I had two men with sudden onset of unilateral hemiparesis come in almost simultaneously. I had time to get one to CT and back to the dept. to receive the next one and get him to CT before I had even gotten an ER chart.

He also had an SVT in the 150's that we got down into the 80's with some dig, then cardizem and a cardizem gtt. Even got echo in to see the patient before admission in the ER. While he was getting his echo I got the first patient to ICU just in time to get the cardiac arrest into his just vacated bed. Poor guy was well known to us, CAD, CHF, COPD, O2 dependent, DM, HTN. He was found in asystole, but the family wanted 'everything done'. He didn't make it.

Gave me a chance to check on my other rooms with the r/o dvt, viral syndrome, seizure and migraine in a patient with seizure and migraine history. Got my admitting orders for hemiparesis #2 and call admitting. Get my admitting paperwork back and a big MRSA is on the guys demographic sheet. I check the admitting orders again and don't see MRSA, so I figure it's an error that they can correct after admission.

When I brought the patient over to the ICU the receiving nurse is gowned and gloved because there is a flag on the computer that this patient has a Hx of MRSA. I'm thinking, that's nice, wonder when they were going to tell me since I have been all over this guy with my assessment, IV's, EKG's, etc. Then I go back to the ER.

The code's family was here and would like to see their father. So, I go to the family room. I know some of them from his frequent visits, I comfort them and bring them in to see their father. Some are crying, blaming themselves for not calling 911 sooner. They needed to hear me tell them it wasn't their fault. They needed me to be with them right then. But, there is a knock on the door, ICU is calling me.

I excuse myself, thinking it was a simple question, like did the carotid U/S get done, when was his last BM...whatever. No, it's that there wasn't a green sticker on the chart, as per policy, for patients who have MRSA or VRE. I explained that seemed to be more of a registration thing than something that was my responsibility, and that I was busy with a grieving family. The ICU nurse is a friend and completely understood and told me to go back to the family. End of story....no.

Next thing you know, I have the ER nurse manager out at the nurses station along with the infection control nurse. They wanted to know why CT, US, Lab, X-ray wasn't told by me that the patient had MRSA. My question is why didn't someone tell me?! Oh, it's in the computer, and supposed to be on the ER demographic sheet. Well, excuse me, but I was rather busy and didn't look at the demographic sheet. Our nurse manager KNEW how busy we were, she did order us some dry turkey on white bread sandwiches from the cafeteria since we had to work through lunch and went on diversion. (We NEVER go on diversion)

I didn't even have a chart before the patient went to CT. After that I had cardiology, er and neuro orders on him and drips to hang and titrate. Then a code...not to mention my other patients. The infectious disease nurse tried to make it sound that by me not checking the demographic sheet I put the whole hospital at risk of MRSA. Do people routinely check the demographic sheets on their patients? There has to be a better way to alert us to things like that. I'm not taking responsibility for it. Especially on a day like we had today.

And, since I'm ranting. WTF is up with 12 hr shifts and no breaks? I understand we are really busy, but if we don't have time to go to the cafeteria why must we be served turkey sandwiches, without any veggies, dry on white bread (mayo on the side) I am positive that prisoners get better food! Not only that, I don't get paid to work through my break. Luckily I have gotten smart and I pack a lunch now. Mostly portable food, fruit, a pudding, then chicken/broccoli/rice in a bowl with a cover. (I can always grab a few bites)

Bonus

I have worked at the same hospital for well over a decade. We have always gotten a 'bonus' around the holidays. Last spring we were told that our bonus would be dependent on receiving >80% press-ganey reports. I never depend on my bonus, but I found out that there are people I work with who aren't dr's and nurses that pay their heating bills for the winter with the bonus.

There is a complete multimillion dollar renovation going on for the past few years and new dr's offices, urgent care, etc. I may be cynical, but I was convinced they were over budget and wanted to balance the books by creating an unobtainable goal. How would we improve our scores with MAJOR construction and confusion just finding the main entrance of the hospital? Not to mention a loss of rooms during construction and an increase in the numbers of patients. It almost became routine to be holding admitted patients in the ER, treating ER patients in hallways. We even commandeered other departments that were closed on weekends to treat fast-track type patients. Still, we did our best, and met our goal. And, we got our bonuses.

Our Welfare State

The definitions of welfare are curious because they are in some ways opposite. One definition is Welfare-good-fortune, health, happiness, prosperity etc. Another is Welfare-a government agency that provides aid to people in need esp. people unable to work.

I personally don't think welfare is what the people who envisioned it thought it would be. For one...just in the definition-'unable to work'. I'd say the majority of people I see who are on welfare are capable of working. More than capable of working, they chose not to. Then, because they can gain greater 'prosperity', they do what they can to get it, it's almost a job to them. Have a few more babies...get a little more $$$.

And, in my opinion, there is no way that government welfare can lead to 'good-fortune, health and happiness'. I believe that part of being a happy person is being a productive person. I think that there is more to being a productive person than having children that you can't support without the means of 'welfare'.

People who chose a life on welfare are almost choosing NOT to live. The money they do get is not enough to support themselves and their children. How discouraging it must be to try to have any quality of life for your child or yourself on the pittance that welfare pays. Welfare seems like a viscous cycle of degradation that is perpetuated in future generations. People who want a better life nearly have to claw their way out of the whirlpool of welfare dragging them down, cause I think welfare is self perpetuating. I don't think they really try to help people get off welfare. I have so much respect for people who use welfare for what it is meant for....to help in times of need, then to get back on their feet. I have an equal amount of disrespect for people who see welfare as a career. Especially people who have at least $40 manicures, starbucks coffee, cell phones, chunky hi-lights and kids without shoes that fit, and 'no money' to get OTC tylenol for their childs mild fever.

I could go on, but I may save that for another time....

Least favorite EMS radio reports

Feel free to add your own...

-Patient was unresponsive on EMS arrival, but is combative in the back of the ambulance after 2mg of Narcan.....and I think they have been incontinent....

-This is EMS III, Status 2 traffic, approximately 3-5 out with MVC patient and their left foot.....

-Patient is well known to us, hospice patient with end stage CA, on arrival patient in respiratory arrest, family begged us to 'do something' patient has ETT now, no spontaneous respirations.....

-(from a 1st responder) Patient A&O x3, unresponsive to painful stimuli.......huh?

Who's in charge?

I got this by email from my brother. I think it's funny. (sorry to all who are in charge and aren't assholes, one bad one gives everyone a bad name)

All the organs of the body were having a meeting, trying to decide who
was the one in charge.

"I should be in charge," said the brain, "because I run all the body's
systems, so without me nothing would happen."

"I should be in charge," said the blood, "because I circulate oxygen all
over, so without me you'd all waste away."

"I should be in charge," said the stomach, "because I process food and
give all of you energy."

"I should be in charge," said the legs, "because I carry the body
wherever it needs to go."

"I should be in charge," said the eyes, "because I allow the body to see
where it goes."

"I should be in charge," said the rectum, "because I'm responsible for
waste removal."

All the other body parts laughed at the rectum and insulted him, so in a
huff, he shut down tight.
Within a few days, the brain had a terrible headache, the stomach was
bloated, the legs got wobbly, the eyes got watery, and the blood was
toxic. They all decided that the rectum should be the boss.

The Moral of the story? Even though the others do all the work, the
asshole is usually in charge.

Milk and Molasses Enema-STAT!!!

A friend of mine had to call and vent about a shift recently. My days off are sacred, and I really don't like hearing about bad things that happen at work, it messes up my feng shui, screws with my chi, fluffs my aura! But, since she is like my little sister, I let her proceed.

She was on the cardiac assignment and among her patients was a patient being admitted to the floor..he had a few complaints but one of them was he was chock FOS. Another patient was pretty unstable...being put on a neo gtt, etc. The admitting dr wanted patient A's enema given before they went to the floor. What tha.....? Are you kidding me, lets delay the admission to give a milk and molasses enema? Sounds like he is literally shitting on the ER. (or has a crush on the floor nurse) Well, my friend told him, 'No....can't do the enema, I'm busy in another room.' the admitting dr. called the nursing supervisor to complain he felt she was too good to do an enema!!! Huh...wha? And, after hearing the facts...the supervisor still wanted to know what my friend could have done better to make sure that all of her patients had their needs met. As an old nurse I used to work with used to say....why not shove a broom up my ass and I can sweep the floors at the same time!

I know I read in nsg school that the old time nurses tended the wood stoves and cleaned and swept the floors and gave a head to toe bath TID....but they didn't have neo gtts to start and titrate. OR milk and mollasses enemas, STAT!

Press-Ganey survey answers that make me smile

-In answer to nursing-attention to your needs-It took 2 hours to get a cup of coffee for a patient with abdominal pain.....when I work for Starbucks I will worry about that one.

-Under arrival-comfort of waiting area-The waiting area was very UNcomfortable-there were people coughing and getting sick almost everywhere! (welcome to my life)

-Under courtesy of the nurses-Nurse rudely told me to move my car from the ambulance bay when I was dropping off my wife. (Unless you are in a big truck with lights on top and a stretcher in the back...yes, I'll ask you to move your car)

-The patient with the POOR waiting time in the treatment area before they were seen by the dr, when time of registration to, time to room, to time to dr. was 17 minutes. For something not life threatening a waiting time like that is not POOR. The world doesn't revolve around you and though it may seem 'quiet' you don't know what is in the other rooms and most likely you weren't the 'only patient' we had!

-Nurses-attention to your needs-The nurses were just standing around talking at the nursing station. I won't say this never happens, but sometimes when people think we are just 'talking' we are actually communicating about our patients, what we need to do, what we have done, who needs to be consulted, how someone is getting to CT, whether there will be a room for the newly admitted patient on the floors or do we hold them in the ER, And can the guy with the abdominal pain have some coffee...he's been asking for 2 hours now.

Don't take this personally, but....

In catching up on some of my favorite medical/er blogs I have seen a lot of posts by patients who seem offended by the cynicism they see on the medical blogs. I understand how disturbing it is to hear people who are in the profession of caring saying seemingly derogatory things about the patients they are caring for. But, truthfully, nursing is at once one of the most rewarding and degrading, thankless jobs I have ever had or could imagine. I wouldn't change my job for the world, I love it.

If you are a patient, please, don't take the things you read in medical blogs personally. Try to understand that no matter our personal feelings about a few frustrating patients, most medical providers maintain a professional attitude with the patients. Blogs are sometimes our ways to vent about the frustrating part of our lifes work, just like anyone else can have complaints about their jobs.

People in the medical field seem to appreciate a darker sort of humor that other's don't appreciate either. I can't count the number of times I've inadvertently 'grossed out' people at dinner. It doesn't always occur to me that the stories will bother some people, while at work we will talk about a nasty chainsaw injury while eating cafeteria lasagna. (which can sometimes look worse than a nasty chainsaw injury )

Self service ER?

http://www.msnbc.msn.com/id/20761116/wid/11915773?GT1=10412

An ER in Texas has set up self serve kiosks for check in. I don't know about Texas, but in NH a medically trained professional has to be the first person to see you on arrival in the ER. Patients in this article feel that the kiosks are a little 'impersonal'. I can see now the people who will choose a complaint that is a bit more serious than their back or dental pain so they can move ahead in the que. What are we coming to?

255kg + w/c= pain in my back

I had a 255kg guy sign in yesterday with leg pain. His legs were probably protesting the 500+ lbs they were forced to carry around! Well, after pushing his w/c to a room I realized that I couldn't stand up straight or take a breath. I was in so much pain I broke out in a sweat and started crying. I am not a baby, I was in excruciating pain :( I was forced to sign in to be treated as a patient in my own ER.

I'm feeling a lot better today, but it still feels like I have a charlie horse in my side. I can't lift my arms or twist my torso without increased pain. I'm out of work now til monday. Kinda pisses me off that people can allow themselves to get so freaking big...seriously, isn't he the size of two refrigerators? Then I hurt myself trying to help them! There oughta be a law.

A friend of mine let me know what I missed today. 0730, someone had fallen from a second story window sometime in the night and was discovered come morning...skull fractures, pneumocephalus, hypothermic. Later someone was thrown from a horse...c6 fx. Then a nice cardiac arrest that they got back but ? hypoxic brain injury. Then a stellar citizen with a BAL of 495. ER waiting room bursting at the seams. Another day in paradise that I missed due to the incredible 255kg man.

Self injecting insulin?

There was a sick call at work the other day and I decided to work 11a-7p. I could tell from the minute I walked in that it was one of 'those days'. Security sitting in the hall 'guarding' someone, people moving with purpose, flags up on a lot of charts, charts in the 'right rack' where we put people who have been triaged back to the waiting room since all the ER rooms are full....the only things missing were the police and victims inc. Before too long they were in attendance too.

Since it wasn't my usual day to work I was put on the trauma assignment (my least favorite assignment...give me a nice clean MI (not inferior) any day) A friend of mine was on my usual assignment, cardiac. And she looked pretty busy with an admission and young diabetic who kept going hypoglycemic even with a D10 gtt and a few amps of dextrose. It wasn't really the time to hear the paramedics calling in with a guy who fell off his roof and was in respiratory arrest.

When the ambulance arrived it was obvious how severely injured this poor guy was. He was intubated and still, not the stillness of succs either. He was brought to a cardiac room briefly while CT was called, a dopamine drip was hung since he was hypotensive despite two large bore IV's w/o. During this I answered a call in the hypoglycemics room, she wanted something for pain....ummm, ok. I'll let your nurse know when she is done trying to save the guys life in exam #7.

CT revealed a C2 fracture with splaying. It just confirmed what we new....it wasn't good. We are a small, community hospital, and before the patient had even arrived we had called lifeflight to take him to a larger hospital, they were still 10-20 minutes out. As we don't even have a helipad the medics had to package the patient up to bring him to the small airport up the street that almost looks like farmer John's cows must be in the lower pasture this week.

My friend went in to check on her hypoglycemic patient and found an insulin syringe uncapped in the patients bed. The patient said that it must have fallen out of her purse, but my friend suspected that she had self injected insulin and that was why her glucose kept dropping. She lost it on the patient and they searched her things and found some oxycontin and a few other drugs, but not insulin that I know of.

This girl is known to us as someone whose baby came in with bilateral burns to her hands and who will have a 'seizure' when she doesn't get meds she asks for in the ER. So, I don't doubt that she would self inject insulin. The question is has she now crossed the line from drug seeking dirt bag to someone who should be IEA'd and lose custody of her child? She had already been reported to DCYF for the previous visit.

I know that I'm glad I wasn't in my usual assignment that day!

Do it yourself 'time release' pills

A guy signed into the ER today with complaints of abdominal pain, nausea and vomiting. During the triage he revealed that he was going on a boat trip and decided to put his pills into a plastic bag and swallow it to make his pills 'time release'. The pills he swallowed included oxycontin and methadone. He really is a darwin award candidate!

The Ibuprofen and Tylenol Miracle Cure!

Mr. D has been coming to the ER by ambulance with 10/10 chest pain for weeks. States he has had a triple-bypass (with no scar), and loves his narcotics. Every visit his EKG's and enzymes are totally normal, but he has been getting narcs galore then signs out AMA when we suggest he be admitted for evaluation by a cardiologist since his chest pain is not responsive to any treatment.

Yesterday he came in again, reeking of cigarette smoke and alcohol. EKG-normal, VS-normal, Labs-drawn. The ER doc decided that there would be no narcs this visit, and told the patient. I brought him some tylenol and ibuprofen for his 10/10 chest pain. Poor guy was in so much pain he couldn't even lift his arms to hold the cup.

Miraculously, within five minutes, he was able to get off the stretcher, pull off his leads, rip out his IV, and get dressed. I had to chase him as he was leaving to try to get him to sign his AMA form, which he refused. He was in a hurry to get to a 'Hospital that can help me'.

As far as I'm concerned we did help him! After all, before the tyleprofen he couldn't even lift his arms. :)

Holding Patients

The hospital where I work is undergoing renovations, and has been in the 13 years I have been there. We have a higher patient volume and fewer rooms. Many times over the past several months the ER has had to hold patients that have been admitted. A month ago we were holding so many patients that we only had four beds to see ER patients in one morning!

We don't get help from the floors with these patients. A nurse for holding patients would be wonderful, help to put orders in would be nice too. We will have patients with med/surg, tele or ICU admissions along with the usual ER patients. Sometimes admitted patients will have orders missed and it is really difficult to provide the support and education to the patients and their families that they need while trying to take care of ER patients too.

I got a call today to ask for help with holding patients tomorrow. It's my day off but I'm going in. Hopefully there will be some discharges on the floors and we can have our ER back!

Rx for the RN

I have had a Rx on my fridge underneath a magnet my mother gave me of an angel-nurse. The prescription is for Bitchstop-maximum dose-repeat for infinity. This prescription was given to me on a particularly hellacious day in the ER by one of my favorite MD's.

Today I received a new Rx from another physician. We were discussing Napoleon, of all people, and I jokingly observed how much he and le petit caporal had in common. To which he replied-'Kiss my ass!' I promptly asked him if that was an order-and if so to write it as such. Now I have a prescription for 'Kiss my ass-STAT-QD-PRN' under my angel-nurse magnet too.

I'm pretty sure this is a class A substance and may be extremely addictive.

Head on -vs- Grampas Dementia

Not long before my shift ended yesterday I heard a tone out for one of the neighboring towns ambulance crew for a head on collision. I think their ambulance is mostly EMT's so as I expected our medics were toned shortly after.

Just before that I had a patient triaged into trauma. 90 year old guy with a history of dementia, lived with his family and had gotten up several times the night before and tried to make his bed because he thought it was morning. I worked in a nursing home as a CNA years ago and we called that 'Sundowning' then. Grampa was a little more disoriented throughout the day and at 1800 on a Tuesday night it was an emergency.

I went into the trauma room and found a very pleasant gentleman sitting and reading the evening paper with his son and daughter in law. He was A&O x3, but some labs and a CT were ordered 'just to be on the safe side'. One of the medics joked that 'the families vacation must start tomorrow and they want Grampa in the hospital for a few days'. It wouldn't be the first time. I was pretty sure the tests would be unremarkable and the patient would be sent home to follow up with his PCP.

The night shift was just arriving as the ambulances started pulling up from the head-on. Apparently a young lady in a SUV was on the cell phone and crossed the center line striking another car head on at the top of a hill, dragging the other car 60 feet back down the hill.

We had four patients with multiple fractures and one with head trauma, as well as a person not involved in the MVA who had an asthma attack come in all at once. In the middle of this Grampa's son, who is one curtain over from a girl who is boarded and collared and screaming in fright and pain despite 10mg MSO4 and 100mg Fentanyl, lets us know that Grandpa hasn't had dinner yet.

I'm sorry, excuse me? I'm no longer surprised about what some people will consider emergencies, but it never ceases to amaze me when people will be oblivious to the actual emergencies around them and expect us to interrupt what we are doing to tend to them.

Sucking Pond Water

Every so often we plan a potluck buffet on our weekends on in the ER. It seems that every time we do this we have a hellacious day and we don't even get a chance to take a break anyway. Well, this weekend was no different. It started busy and got busier. At one point we were on diversion, but that didn't stop the codes coming in.

I had several admissions but the floors were trying to hold off on taking them, not for the patients sakes, but for the nurses who were busy too. We fax report to the floors and give them 20 minutes before we bring the patients up. Which is a lot more than the report we get from ambulances who are '3-5 minutes out with patient having crushing chest pain, hypotension, ekg showing ST elevation and runs of V-tach'. Well, everytime I brought a patient upstairs yesterday not only was the bed not turned down, but the nurses were not coming to accept the patient, and giving me a hard time about having to take the patient. Meanwhile down in the ER I am getting other patients put into the rooms where my admissions just left.

The LNA on Tele had the nerve to say to me, 'OH, you ER people always act like you are so busy.' This was 4pm, I had been working since 0630 and we hadn't even had lunch. So, I asked her....'Have you guys had lunch, cause we haven't.' She came right out and called me a liar, and said she had seen us all in the cafeteria. I told her she was hallucinating. God, that pisses me off. My feet still hurt today, we never did get lunch and I don't get paid for working through lunch because 'state law says they have to give us a break so we can't pay you for it' even though we work through it pretty often!

Working in the ER

I have always wanted to be a nurse, since I was a child. Before I could read I would sit with the encyclopedia open to the pages with the transparencies of the anatomy of man. Turning one page would remove the skin and show all the muscles, under that the internal organs, and the last page was the bones. I had my little nurses bag with a plastic stethoscope, syringes, hammer for reflexes, etc when I was a kid. And when I was older I was a candy striper, CNA, LPN, now an RN. Nursing is all I have ever wanted to do.

I recently reflected on what my nursing career is compared to what I expected it to be. In nursing school my ICU rotation felt like coming home. I loved the atmosphere of the ICU, the monitors, ventilators, different meds and opportunities to learn. I started in med/surg. I think all nurses should start in med/surg or tele. There you really learn to prioritize, see a variety of things, hone your assessment skills, etc.

Working in the ICU was great. I became really interested in cardiology and imagined one day working in a cardiology unit with patients after bypass. I floated over to the ER a few times and was surprised to love that too. I think it was the variety of cases you could see. The almost instant gratification of helping someone who is critically hurt or ill. The nurses, medics, doctors and physician assistants were a team.

One time when I floated to the ER the medics brought in a patient that was in V-Tach. The ER staff worked like a machine. Everyone assuming a different task, few words passed but things were done very efficiently. It was like it was almost choreographed. When the patient was stabilized and moved to the ICU I was amazed at how they continued to care for all the other people that were in the ER that day. I wanted to be a part of that. And, eventually I got a job in the ER. I have worked there a few years now and it is the hardest and best job I have ever had. Many days are a challenge and almost every day is a reward.

This is my blog about my life in the ER.