Monthly Archives: September 2007

New Feature: Chief Complaints!

Everyday, I like to browse the list of patients waiting to be triaged. The way the ED works, patients walk in and first meet the “Expeditor.” They tell the Expiditor what’s wrong with them and then proceed to the waiting area where they wait anywhere from 1 minute to 12 hours.

The triage nurse browses the list of chief complaints and chooses the sickest patients first. This is why we sometimes have 20 patients with “Chest Pain” waiting because they know those are the magic words. There is a poster in the waiting room, “If you are having chest pain, please tell the nurse.” Patients watch another patient with actual chest pain ushered into the ER and soon, everyone has chest pain. The nurse brings them in and “chest pain” turns into a stomach ache they’ve had for 3 months. I feel for them though – If I had been waiting 12 hours, I might develop chest pains too.

Then there are patients who stick to their actual, awesome chief complaints. From now on, whenever I post, I will give a sampling of great chief complaints collected over the past few days/weeks.

This past week? Not exceptional. But, I guarantee there are occasionally some REALLY good ones. Keep checking in.

1. “Fungus and itching x 1 year” : Where? I guess the expeditor didn’t care.
2. “Q-tip stuck in left ear”
3. “Krazy Glue in left eye” (this patient had been waiting 8 hours last time I checked)
4. “Genital problems”: this is obviously my favorite.

Recipes!

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Here is a good recipe for imagining my place of work:

Step 1: Climb out onto the nearest crowded subway platform in New York City (preferably in one of the outer boroughs.)
Step 2: Grab everyone on the platform and bring them to my hospital.
Step 3: Give each individual an official employee ID tag – Randomly assign jobs: doctors, nurses, housekeeping, central sterile supply, clerks, BioMed, Respiratory therapists, HIV counselors, physician’s assistants, lab technicians, blood bank technicians, hospital police, and EMT’s.
Step 4: For extra flavor, head up to Riker’s Island prison and get about 15 prisoners. Make sure to grab 2 corrections officers PER prisoner
Step 5: Stick them in the ED as well.
Step 6: Don’t forget this very important step! Go grab a few of the absolute most psychotic homeless people you can and throw them in for fun.
Step 7: Finally, find another subway platform and gather at least 200 people.
Step 8: Place them in hospital gowns. The percentage of actually-sick people you grab will probably be similar to the percentage of actually-sick people in our ED (read: a very small % of our patients qualify as truly needing “emergency” care)
Step 9: Before proceeding with your batter, Make sure to break at least 1/4 of all the equipment in the ER. It is particularly important to break a large number of stretchers so that the mattresses no longer sticks to the bed frame. In this manner, the majority of your patients can gradually slide off the end of their bed during your shift.
Step 10: Scatter overflowing urinals throughout the environment.
Step 11: Now stir vigorously.

I’m a nurse?

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I became a Registered Professional Nurse on 7/16/07. That’s a pretty big deal.

I’ve been working as an ER nurse since 7/23 and it has been quite the whirlwind since.

A lot of nurses have told me, “Oh, nursing school is the hard part -after that, being a nurse is easy.” I have NO idea what they’re talking about.

Nursing school was a breeze. Sure there was the occasional difficult pharm test, but all in all, nursing school required minimal effort. I probably attended 30% of my classes at most. I spent most of my time sitting in Washington Square Park drinking smoothies and admiring the dogs in the dog run. If I was running late to class, I would just scratch the whole day, go to the park, and then study in the library during the evening. Sometimes I would take 3 or 4 days off just to wallow in my apartment and read Harry Potter. Sure, I had some very, very long nights cramming before my exams, but the only person I had to let down was myself if I didn’t do well. And I don’t mean to plump out my feathers here . . . actually, I do . . . but I did very, very well in nursing school. Honors and everything.

BEING A NURSE? That’s a whole different story. I have a patient who is mistriaged to my low-acuity area of the ER while they are actually having an acute MI? That patient is really relying on me to: a) notice they are having a heart attack, and b) figure out what the fuck I’m supposed to do. By the way, that was my first day on the floor.

A guy who can’t breath well is relying on me to help him out. 103 year old ladies passed out in bed and unresponsive? Yeah, she wants my help too. Guy who woke up after lying in an ally for 12 hours after being assaulted? He wants me to act appropriately if he is bleeding internally. Guy with an allergy to penicillin? It’s pretty important that I not only notice his allergy on the chart but ALSO manage NOT to give him penicillin. All of these are situations I have faced in my few weeks as a nurse and I have to say, this sort of stress is WAY more real than bullshit nursing school stress.

I want to be a really good nurse. That’s the goal.
I want to assess my patients flawlessly, react with all the appropriate interventions, slide in an IV while the patient smiles serenely and asks, “That was it? It’s already over?”
I want to communicate with doctors intelligently and have them raise their eyebrows at my sheer nursing genius.
I want to react to everyone calmly and pleasantly, including patients, psychotic family members, and psychotic collegues.
I want to leave my shift feeling like I have completed every task, documented perfectly and still made every patient just a little more comfortable.
I want to stop caring that the other nurses think I’m a little weird – I did a good job and advocated for my patients – that’s all that matters.
I basically want others to be in awe of my skills. My many skills.
I would like to be a super nurse.

Right now, I’m lucky if I make it through the day without spilling a mislabeled urine cup on myself or exploding a patient’s vein with my IV ineptitude. I’m thrilled when I leave feeling like I have completed even 1/10th of my assignment. I celebrate each time I manage to NOT drop an entire cup of medicine on the floor. I approached a resident the other day to present my short-of-breath patient and ask for help. When the doctor asked, “What’s the patient’s name and how old is he?”, I just stammered and stared at my paper realizing I knew neither piece of information. On the up side, I managed to help my patient breath again.

I’ve got a really long way to go.