Floor nurses are NURSES, right?

I mean, they were when I worked on the floor. I'm just wondering, because lately, we're getting a lot of complaints about "unfinished business" after transferring a patient to the floor.

I'm not talking about sending up an unstable patient. I'm talking about busting ass on a patient who is going to a regular med/surg floor. Listen: you have most of the same training I do. You're certainly able to give meds, and put in a Foley, and page the covering resident for order clarification. Actually, you're MORE able to do those things, because your patient load gets capped off after about 6 patients. Mine doesn't; ambulances keep coming in. Also, I can have ICU and tele patients in my care, and unless you work in those units, you don't. Also, my patients are all more unstable than yours due to the nature of the emergency department. Here are my requests:

Don't complain to the nursing supervisor that a Foley wasn't placed on your patient in the ER, especially since the admitting doc was the one who ordered it six minutes before the patient went upstairs. We both were taught how to do this in nursing school. I know you haven't forgotten.

Don't call me complaining that the patient is "unstable" just because he has a blood pressure of 180/90 on arriving on your unit. His pulse is 78. He is asymptomatic. He has a history of hypertension. He's being admitted because his private doctor wants his hypertension under control. If his pressure had gone down in the ER, we would have DISCHARGED HIM. Call the covering resident and get some admitting orders. What, you can't give metoprolol or labetolol on your floor? You DO medicate your patients, do you not? I don't get excited about a BP of 180/90. I need at least 220/110 to start getting my panties in a bunch.

Look, I'll happily START a blood transfusion on your patient before he comes up. But once I've established that there is no transfusion reaction, the dude is coming up to you. I am not keeping him in an uncomfortable ED stretcher for two to four more hours just because you don't want to document the end of the transfusion. Also, I need the space for other patients who are coming in.

And speaking of which, if I call you and ask if a patient's bed is clean, and you tell me that the ROOM is clean and ready, but that there is no actual BED in it for some reason, don't get all pissy with me when I send the patient up in a stretcher to lie in that spot till YOU get building services to send a bed. If he can lie in a stretcher downstairs, he can lie in a stretcher upstairs, and don't threaten me with calling the nursing supervisor—I already called her and told her what I was doing. You won't get any sympathy from her. I need the damn space.

Seriously, folks, I'm busy. I have things to do.

Overheard in the ED

I was attempting to place an IV in a patient who was a hard stick. I had missed the first try and was giving it another go.

Pt: you know if you miss this one you're going to have to give me oral.

Me: What!?

Pt: you know, oral medications. Instead of IV.

This has nothing to do with nursing

but I just happened to notice that typing on an iPad is a lot like playing a fretless bass. You just hope your fingers are in the right place and fly along.

Perhaps we should call Surgery...

...this looks like a deep one...

Why is it

that people take the advice of the Internet over that of their own doctor?
I had to talk at least three people off the edge of hysteria yesterday for their uncomfortable but mostly benign conditions. One woman with a fever and rash was convinced she had some rare tropical disease despite the fact that her own doctor, whom she had gone to see twice in the last three days, told her she had a virus. Not Lyme disease. Not yellow fever. And no, not even strep. Stay home, drink lots of fluids, take Benadryl when you're itchy and Tylenol or Motrin for your fever. It will go away by itself in about a week.

Also, why is it that people can't seem to stand being sick, even a little bit? One man who had been seen in our ED for chest pain and diagnosed with pneumonia came back a day later because he wasn't feeling better. Not feeling worse; just not feeling any better. He had been given a prescription for a Z-pak (at least he was taking the meds; I can't tell you how many people don't take the medications that are prescribed for them and then complain they're still sick). I explained to him that pneumonia doesn't
go away in a day and than he would continue to feel pretty bad for about a week but that he would get a little better every day. His vital signs were all normal.

Also, why is it that some people think that if your child has a fever, and you give one dose of Motrin and the fever goes away but then it comes back six hours later OMG ITS AN EMERGENCY OMG IT CAME BACK! I have seen so many hysterical parents insisting that their kid must be seriously ill as the kid is sitting on my lap, smiling, drooling, and chewing on my stethoscope.

These are things I wonder every day...

Another Rule of the ER

If you call me in triage to ask if I think you need to come in for your knee pain, and then complain about how the last time you came in for the same thing it cost you $700 (and we "hardly did nothing" for you), you probably don't need to come in for your knee pain.

Haiti Happy Endings

No, that's not anything dirty--at least I hope not!

Even though there were a lot of sad stories, there were some funny and happy ones too!

We had an old dude in the ICU recovering from tetanus; he got better and went home. I knew he was better when he could open his big toothless mouth all the way to take the pills I was giving him. Did you know that metronidazole and not penicillin is the treatment of choice now for tetanus (in addition to the immunoglobulins and Valium, of course)? I didn't--I found out when I looked it up on my iPhone. Thanks, MedScape!!



We also had a young mother recover from heart failure secondary to postpartum cardiomyopathy who went home! (We saw three cases in two weeks; she was the only one who made it.) The doctor explained to her that God meant for her to have only one beautiful baby, and that to have another one might mean her death. We took her straight to the gyn clinic for an IUD. Here she is with her cutie patootie baby!











One young girl came in seizing, and when she wasn't seizing, she was unresponsive. We were sure this was another case for palliation, but we treated her for cerebral malaria, gave her fluids and meds, and three days later, she went home!





Another 19-year-old girl came in with horrible TB empyema. We gave her a chest tube and drained about 2 liters of pus and blood from her chest. Her 02 sat would not budge from 62% on room air for days, but after two weeks of antibiotics and TB meds, the chest tube came out and she actually went home to follow up with her local TB clinic! I don't have a picture of her, though. What I do have is a picture of me committing what would be a hideous crime in the US. We only had one suction cannister, and had two people (this girl and a young man who had been shot in the chest) with chest tubes. What to do with the cannister when it got full? Empty it out, of course--in the SEWER:


Yum! 1 liter pus and blood, coming up! (note my sexy outfit!






Glug glug, down the sewer in front of the ED. Mmmmmm. Good to the last drop!











And lastly, kids and babies! Haitian kids and babies are the cutest in the world. I became friends with three little siblings who lived in a tent near the lab; I think their mom works for the hospital and so they stay there. They would grab my hands anytime they saw me and escort me wherever I was going.









The refeeding tents were where we would go when we needed a little cheering up. To see all the little skinny babies getting nice and fat was great--and getting to hold the babies was even better!












We would vist the peds tents; I found some crayons and brought them over for the kids to draw with.