Monday, October 8, 2007


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

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)


girlvet said...

Been there, done that. Didn't know they had MRSA til I called report. It isn't always obvious on the chart. All we can do is the best we can.

ERnursey said...

Um, it is ILLEGAL to not pay you for working thru your breaks. Call the department of labor or your union if ya got one.

Mudme said...

We don't have a union. My nurse manager says we can take a break if we want...but then my patients don't get taken care of. Luckily those days don't happen too often.