Tuesday, February 10, 2015

The ER kicked my butt.

I doesn't happen often. 

Yesterday, the ER won. 

I am good at my job.  Much of that arises from a time when I wasn't very good at my job.  Not being very good at your job when someone's life or health depends on your proficiency is a very stressful situation.  That stress leads you to work hard on getting better or it burns you out.  I worked hard and got better and my stress level at work decreased to an acceptable level. 


And that is the nature of the emergency room.  You never know what is going to happen. 

Yesterday started off well enough.  I was busy, but nothing too bad.  Then a DKA arrived.  For those who don't know, these are somewhat personal for me.  These are possibly life threatening emergencies and they deserve as much of your attention as you can spare if you are the nurse.  While I was getting that all settled in, my sepsis arrived.  Systemic infection that can be life threatening.  Good times.  Dehydrated to the point that I couldn't find an IV site.  Luckily, my co-worker came to my aid with an ultrasound, just in time for them to tell me about the STEMI that was arriving into my other room.  Everything else stops for the STEMI.  This is an evolving heart attack.  Time is tissue.  We had a lot of work to do to get this guy to the cath lab within the window.  Again, without a couple of co-workers, this could have gone badly.  Even with all the help, I was starting to get a bit overwhelmed. 

We get the STEMI out and up.  I walk back over to my sepsis, to try to get back up to speed with where I was and what needed to done.  They tell me there is now a code stroke coming into the room where the STEMI just left.  It isn't even clean yet.  Oh yeah, I have another room with another patient I haven't even mentioned. 

This is the point where I realized something has to give. 

Mind you, this happened on a good day, in a good hospital.  At the morning meeting they informed us that we were 'upstaffed' today.  And even though we had an extra nurse, my charge wasn't going to send anyone home  just in case. 

So, working in my favor was an extra ED nurse, a charge nurse that was good at recognizing and fixing problems as they crop up, and a pretty well run hospital.  Without any one of these things, this could have been a lot worse.  It reminded me of other places and other times when I was not so fortunate.  Sometimes these things happen when you are down a nurse, with a green charge in a place that cares more about saving money.  I've been there too. 

I'm tired.  I need a break from all of this.  Is it weird that I am looking for a more sane work environment in a prison?  Probably.

I am pretty sure though, that I won't have to do urinary catheters on 2 year old kids and CPR on 90 year old people.  I guess I will see. 

Yesterday, everything worked out thanks largely to my coworkers.  We got everything settled and I even got sent of to lunch.  Then I returned to the new patient that wouldn't stop pooping on himself.  Some days.

And on this day I broke a little.  As I have before.  When I got home my family put me back together again, like they do.  I will go back again later in the week and try again. 

It's time for a change.

I'm ready.


  1. Yup, that's why I'm extending my contract in AZ where I have usually only have 3 patients and help, if needed. Even with that ratio though, I've had plenty of days just like you described, for the past 17 years............I just tell myself I'm doing the best I can, and it's not my fault if a patient has a bad outcome. Brutal, but true. If I tell the charge RN things are ridiculous, ask for help, and none arrives, then I've done the best I can. That said, it doesn't change the desperate feeling you have at the time.

  2. Yeah. I try not to talk about the really bad days unless I am talking to someone who can understand what you mean there. Some days you do the best you can and that just isn't enough. This is one of the big reasons I am looking to try something new for a while. I could continue as an ER nurse, but the pain/gain scale is too often tilted in the wrong direction.

  3. I've always wished a hospital CEO would be my patient when I'm getting slaughtered like that. You know, nice and septic, maybe covered in his own feces, etc. Then he/she could see how bad it is when we don't have ancillary help (techs, float nurses, etc), and how bad the care can get. It's so frustrating. All it takes is a tech around that can start an IV, assist a patient to the bathroom, draw some blood cultures, whatever. Just one less task and usually you can keep up, but apparently a $15/hr tech job just breaks the CEO's proverbial back...........and who suffers? The burned out ER Nurse and more importantly, the patient.

  4. I've considered going back to ICU, where you only have 2 patients, but I'm just not into it anymore. The entire reason for me travelling was to pay my house off so I could QUIT healthcare. I've come to terms with it a bit lately, and maybe more accepting, but no doubt I'm very tired of it.

  5. Reading this post gave me mixed emotions. I wanted to jump in there and help with your patients, but it also made me really, really grateful for my non-clinical job. :)

  6. Every ER nurse has a memory of times like this. Times when it was too much and you were just overwhelmed. Some stories, like this one, have happy endings. Some don't.