Your safety matters

It's happening more and more. Medical professionals are being hurt, attacked, even killed while providing care. We go wherever medicine takes us. Caring for others is a part of who we are.

Let's learn to care about ourselves and our safety more. You are not obligated to go into any situation that you feel is unsafe for you. You do not have to deal with the aggressive visitor that has threatened you more than once. You do not have to deal with sexual harassment from your patient. You are not at work to be subjected to physical abuse from your patients. Your safety concerns are valid. You have every right to demand a safe work environment.

If you need to utilize security then do so. If the nursing staff has to be changed because the patient only harasses a particular nurse, then make that change happen. Report threats and take threats that are reported seriously.

Furthermore, be aware of your surroundings. Know where you are in your room in relation to the door. If the situation calls for it, take a second nurse in with you as your "back up". In some hospitals, security can be used to sit with the patient, if the patient is deemed a danger to the staff (the hospital I am at currently does this).

You are important. Know that your safety is important too.

 

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Story time no.6

Sitting at the front nursing station when the door rings.

"Delivery for STICU!"

Delivery? It's one in the morning, what the hell is being delivered at one in the…

Oh.

Ohhhhhh…

THE LEECHES!

He's delivering the God forsaken leeches!

I am thoroughly grossed out. I hate leeches. I hate them with every fiber of my being. I can't touch them. I don't even want to look at them… but I need to open the box so we can put the squirmy bastards in their refrigerated tanks.

I managed to open the box. As you can see, I even managed to pick up one of the bags.

That's as far as I got.

Dude was far too squirmy and I was far too grossed out to do anything else with them. God bless our tech for being able to grab the box and take them away from me so she can put them away.

I'm a horrible charge nurse. I'll take that. I'm not touching those bastards though…

Speak up when it doesn’t feel right

You are your patient’s last line of defense.  Whether it’s meds, bedside procedures, trips off the unit, or just care in general, you are the person that can potentially save a patient.

I know, medical shows would have you believe that doctors are the saviors. Doctors are the last hope. Doctors save the world! Yeah, most of the doctors I know can’t start an IV sooo…

You are the one at the bedside for 12 hours. You are the one that has had them for three shifts straight and don’t even need report anymore. You are the one that knows that patient. You are the one that may notice something wrong.

Perhaps you come in for your shift and notice that Mr. B, who is typically trying to crawl out of the low bed and get back to his “bus”, it far too chill. His vitals have been great all day. The team doesn’t order labs for him daily anymore but the ones from two days ago look fine. In your gut you know something isn’t right. You talk to the doc, who isn’t impressed. You give it all you got and at least convince the doc to order a set of labs for now. You get those labs and anxiously wait to see if they can help you figure out why Mr. B hasn’t tried to kick you in the face tonight.

And then the lab results come back AND THEY ARE A SHIT SHOW! His WBC’s are almost 30. His H&H has dropped by 3. His BUN and creatinine are climbing. All of his electrolytes are out of wack. But once again, his vitals have been good all day.

You just saved your patient. You knew something wasn’t right, even if you couldn’t pinpoint it. By being a patient advocate you may be the reason he’s alive.

Maybe it’s less dramatic than that. Maybe they have ordered a medication for your patient that seems like it just might be contraindicated at this point. His platelets are low. His INR is going up, not down. One of the teams wants you to give heparin. You aren’t comfortable with that, especially since the primary team (or doc) purposefully stopped it because of his labs. You try and talk to the ordering provider and rather than listen he yells “just do it!“.  Do NOT just do it. Healthcare was not designed by Nike and that rarely works out. You can take another step. You can talk to the primary team or doc about a consulting team or doc restarting what they’ve stopped. So you do just that. Primary agrees with your hesitation and they talk to the consult to let them know heparin has been discontinued and why. Turns out, consult didn’t actually look at any labs before ordering it.

Looks at you walking around saving the day, like you have an “S” on your chest! You know what you are doing. You know when something isn’t quite right. You know your patient. Trust yourself and speak up when you feel like it is necessary.

Story time 5

I rarely, if EVER, read comments on social media. I know better. The amount of hatefulness in the comments is unmeasurable. However, I ran across a post on Instagram showcasing the singer Halsey's thoughts on birth control and why is should be considered health care. She even went on to list the medical conditions that birth control was able to help.

I read the comments.

For the most part the comments were full of women in support of her tweets and sharing stories of their own on how birth control has helped them.

But it wasn't all support. Oh no. There were a few in the comments that wanted the world to know that we, THE ENTIRE FEMALE POPULATION, were stupid for not just taking care of our reproductive issues the "natural way".

Yep. That's the fix. Change your diet and drink a special tea and that'll handle that severe endometriosis and those ovarian cysts you're dealing with.

But there was one lovely person in the comments that couldn't just be happy with condemning your use of meds. Oh no, Cassy_chevy had to condemn YOU!


Awesome. Let's bash any and every person that decides to have a different opinion.

So there you have it ladies. YOU have no idea what YOU are doing with YOUR body.

The toxic work team

“Nurses eat their young!”

Have you ever heard that before? To my new nurses out there, you may not have heard it yet but you will. To my experienced nurses, you’ve probably heard and experienced this first hand.

What exactly does that statement mean? How is that statement meant to be taken?

Honestly, to me, when I hear that statement I instantly hear “no one treats nurses worse than other nurses.” That mentality is what leads to a toxic team.

My current coworkers are amazing, I cannot say that about a previous place of employment, however. It was the true definition of a “toxic team”. The older or more experienced nurses there took pride in “eating their young”.  At that time I worked with a team that spent more time criticizing my every move and looking for mistakes than teaching me what I need to know as an inexperienced ICU nurse. There was a nurse that took PRIDE in the fact that other nurses were afraid to give them bedside report! It did not matter what you did. You could have coded a patient 3 times that shift, just come back from a repeat head CT, after emergent OR. This team member would question you on why the room is messy or why the 1900/0700 (depending on the shift) med was not given. img_1898Really? REALLY? I JUST SPENT 12 HOURS TRYING TO KEEP THIS PERSON ALIVE AND YOU ARE WORRIED ABOUT A TYLENOL NOT BEING GIVEN?

I asked other coworkers why this person was like that, and that’s the first time I heard “nurses eat their young”. Not only was this the answer but it was also given with a “justification”. Nurses that believe in this motto try to explain it as giving you, a nurse, a “real world experience”. They want to “break you in”. They want you to understand that the “NCLEX” world isn’t real. They want to toughen you up and make you a “better” nurse. They have countless reasons for why they are a bitch. It is NOT ok! There are plenty of ways to help a nurse develop and constantly being toxic is not one of them

I finally got sick of the crap so I went to my nurse manager. Her response? “Give them the same crap back. Stand your ground.” Not what I expected her to say but exactly what I needed to hear.  I did just that. Whenever this team member started with their shit I shut it down. Quickly. It did take a few times but ultimately this young nurse did not get eaten.

If you are a senior nurse please take a moment to remember a few things: There are ways to ask questions during report about an uncompleted task without being accusatory. There are positive ways of giving feedback to a nurse that may be lacking knowledge in an area. There are positive ways to help the “baby nurse” to transition from the NCLEX world to the real nursing world (and it is a big transition). Basically, there are ways to address issues where a nurse may not be up to par without being an asshole about it.

If you are the baby nurse please understand that you do not have to accept this toxic behavior. You can speak up, and you should. You don’t have to be confrontational. If you are not comfortable speaking to that nurse directly, address it with your nurse manager. If your manager chooses not to address the behavior then just know you are *probably* working on a shitty unit and you should *probably* start looking for a better place of employment.

Hello nightshift, goodbye normality

I am a nightshift nurse. I have been my entire nursing career. It’s what I am used to and it’s been great for me. Key word: been. I used to love being a nighshifter. You couldn’t get me to work a dayshift if you paid me extra. 

That’s changed. I’m old now. I’ve been a nurse for 7 years, that’s like 21 years in human time. Nursing ages you, quickly. I’m tired. I’m always tired. That’s the problem with nightshift, it goes against your natural rhythms. I’m not supposed to be up wiping ass at 0241 in the morning and yet here I am doing just that. I can’t just have one shift off in between nights anymore either. It’s impossible for me to get anything done because I’m so exhausted that I sleep the whole day away. I’m lucky I live in a house and not apartment because I cannot tell you how many times I have been up cooking and cleaning at like, 2330 at night as if it’s normal. When I have a stretch of days off, I fall back into a normal rhythm, up during the day and down by 2200-ish. That first shift back after a stretch off is BRUTAL. It’s getting harder and harder to adjust back to the nightshift life. I think I may be reaching the end of this “nightshift nursing” thing. Then again, my mouth is far too vulgar for dayshift so… 

Story time no.4

I’m driving home from another night shift of shenanigans but what’s new. 

I have recently made a conscious decision to start drinking more water throughout the work night. I did not make the conscious decision to pee before leaving work 😒.

So here I am, at the rest stop (because my commute is 1 hr 15 mins and 75 miles one way) peeing in a fly ridden restroom. That’s not what bothers me. I just saw a woman walk out of a stall, walk past the sink without washing her hands, and just walk right on out of the bathroom. 


So, you’re just not going to wash your hands? No? Oh, ok. 

I walk out behind her to see her at the vending machine getting a bag of chips, because nothing tastes quite as delicious as Doritos and bacteria… 

Story time no. 3

You ever have a patient situation hit you hard? It’s happening to me tonight. 

We have a patient going down to OR for organ harvesting. The patient had a severe fall with non survivable injuries. The family had the heart, the soul, the strength to say yes to organ donation despite the sudden death of their loved one. 

It’s hard to watch. It’s hard to see the children say their last goodbye’s. It’s hard to see their tears. It’s hard to listen to them thanking us profusely when we should be thanking them. It’s hard knowing that this is the last time they will see their loved one, connected to IV’s and intubated. It’s just painful. 

I know that this patient will bless someone else’s life. They aren’t dying in vain. I just wish they weren’t dying at all… 

The end isn’t always the end

I learned a lesson not too long ago. The end is not always the end. I got to see this first hand more than once.

A few months ago we had a trauma, pedestrian-vs-motor vehicle, that came to our unit with severe head trauma. The patient had a head bleed along with swelling. The CT scans did not look good. The MRI didn’t look any better. The patient and family were refugees from a war torn country, they spoke little English. The team began having “the talk” with his family. You know that talk, the one where they are pushing for the DNR because the patient is not expected to have any quality of life. Yeah, that talk.

The family would have none of it. We managed to stabilize the patient. They got the standard trach/peg combo. The doctors continued to speak with the family about the quality of life and the family continued to hold out hope. The patient ultimately managed to be transferred out of the hospital into a long term care facility. We were pretty much under the impression that they would just waste away in a nursing home, with no improvement in neuro status.

The patient came back to visit us, along with the family. The patient still has noticeable deficits but was able to fully communicate and even thanked us for our care. We had given up but they didn’t.

dont give up

More recently, our unit had a very sick vascular patient that coded during their surgery. The OR team got them back and immediately brought them to our unit (STICU). They coded again, the second code was worked for an extended period of time and then the team called it. They died. And then they decided death wasn’t really for them and their heart started beating again… spontaneously… after the code was called… while the team were having a moment of silence for the patient.

The medical team spoke with the family and let them know that even though the heart is beating, the patient has been “down” for an extended period of time and neurologically there is probably nothing there. The family decides it’s in the patient’s best interest to make the patient a DNR. The family begins saying their goodbyes and leave in expectation that the patient would probably code again within the next few days. Everyone is pretty much preparing for this patient’s end of life…

gointothelight

Except the patient…

That night, they opened their eyes to painful stimuli. Then it turned into opening eyes to name but no purposeful movement by the next day. By the third day or so they just woke the fuck up and tried to self extubate! All of us were pretty much like:

heart attack

They were completely alert, oriented, and by the end of the shift able to write questions on a piece of paper. Needless to say we were all kinds of confused, surprised, and impressed. We ended up nicknaming the patient “Lazarus”. Are we going to Hell? Yes. We are all well aware. I have a time share there.

The patient had a rough course. They were intubated, extubated, and reintubated multiple times before finally being trached and pegged. However, as I am typing this they are alive and are being prepped for long term acute care out on the floor. That’s right, the patient that we basically pronounced dead is instead going to LTACH soon.

These moments have taught me that it is not over until the patient decides it’s over. It has also taught me that maybe I shouldn’t give up so easily. My miracle patients are showing me there are still some things that we in medicine don’t understand. We don’t know it all. I am glad for that.