Burn-out

I was standing in the trauma room, wedged in a space between the trauma closet and another patient bed, holding the penis of a rotund drunk who could not reach it himself. He possessed a perfumed aura of fermented dairy products and neglected hygiene and graciously obliged us with a true-to-life rendition of his favorite soundtrack of mating large mammals. As I nimbly caught most of his interrupted spurts of diseased brown fluid in a deluxe male urinal, the techs who were gossiping on the other side of the trauma room looked at me in disgust. Then, they turned away and continued their analysis of a co-worker's perceived slight in hushed tones, lest I hear too much.  The absurdity almost made me laugh out loud.  It was my second time holding someone's genitals that day.

The first was a very weak old man who could not move much. From behind the curtain, I had heard the doctors musing, 'well we definitely need a urine on him' so I quickly fetched a urinal.  From across the room, I heard, 'Oh, sir, are you able to pee? Oh, he's going now.' Rushing in and pushing aside the curtain, I saw the doctors standing nonchalantly away from the bed. The looked at me and nodded as if it were a matter of course that I should be getting that urine sample now. I cut open the soaked diaper and despite that urine sprayed in uncertain spurts all over the bed, I managed to grab the slippery thing and get enough of a sample to send.  Unfortunately, Mr. Peed-on-Me was soiled and nobody would come in despite my pleas, so I moved him, cleaned him and changed his linens by myself.  As I was preparing to send the hard-won urine sample, a nurse popped her head in "Hey, what's your name again, can you go put bed 1 on a bedpan?" Before I could reply, she left, and the very obese lady in bed 1 refused to use the bedpan until I lugged a commode across the department to accommodate her. When I helped drag her body out of bed, I felt something in my mid thoracic back shift and twinge... so far, it's turned out to be nothing. (knock on wood)

The trauma room was uncomfortably warm and my drunk seemed to stop grunting.
"Are you about done, Mr. Drunk Half-Passed-Out?"
"LEAVE ME ALONE I WANNA SLEEP why won't you just... let me... go... ho... zZZZZzzzzzzzzzzzzzzzzzzz......"

I wheeled the sleeping Mr. DrunkHPO back to the hallway where I had first apprehended his "I NEED TO PEE NOW NOW NOW NOW NOW HURRY I NEED TO PEE NOW" request to find that the spot was already staked by a little old lady who looked like she had Death flexing his fingers over her shoulder.  I left Mr. DHPO in front of a closet to assess Lady Shriveled and a transporter yelled into the phone next to me "I'm sorry, but it's crazy down here, I can't find her. They've got people in hallway spots that aren't even spots! Does that even make sense?"

I had more than 12 patients in my section of critical care, several of whom needed labs, several more of whom needed to use the bathroom/had already gone in bed and needed to be cleaned, almost all of whom needed vital signs charted, urines dipped and sent, a transfusion to pick up from the blood bank, and the nurses from the other critical care section asking me to do quick blood assays.
What's more, patients just kept coming into my critical care section, one after another, with no end in sight.
With each patient comes a set of duties that should be performed immediately, such as the vital signs monitor, bloodwork and an EKG.

EKG's can be difficult to perform with certain patients, but each patient needs to have an EKG within 10 minutes of being triaged. In the time it takes to be registered, triaged, then brought to our section, I am left with only a few minutes to undress, expose, and perform the EKG with nurses and doctors at my elbows trying to assess the patient.  An EKG requires the patient to stay still, so this can be a challenging task if the patient is nervous and moving incontrollably.  As I was doing an EKG on Lady Shriveled, a student nurse sniffed at me, "we've got this, can you go put bed 3 on a bedpan?" Bed 3 was a code-brown.  As I gathered the materials to clean her/change her linens, a nurse from the other critical section team came to ask me to do a quick blood test.

I was wearing thin, and somehow, this helped me think more clearly.
S: "I can do it, but where is your tech?"
RN: "Tech Useful is doing an EKG in room 9."
S: "Wait, Tech Useful is extra today."
RN: "Oh, really? Who is our tech?"
S: "Actually, Tech Laid-Back is supposed to be in your section... Also, Trauma Tech Sour-face is supposed to be out here too.  You have 3 techs, and they only have me. Nobody has helped me out all day."
RN: "Hm, let me go check."

He walked around the department and looked at the assignment sheet- nobody else was to be found.  I ran the blood test anyway, but at least now, the charge nurse and team leader nurse became aware and concerned about the people missing in action, even prompting an overhead page, to no avail.

One patient began to code, and out of nowhere, Trauma Tech Sour-face, who had been hiding in the trauma room appeared, pushing us all aside to say, "I've got this," and jumped on the patient's chest to do compressions. Other techs appeared too, and suddenly, our department was full of dedicated, hard-working heroes. It wasn't the first time I laughed in absurdity that day.

It was, however, the first time I ever reported anyone to the managers.  Tech Laid-Back had tried to do damage control with me, saying that she accompanied a helipad transport. However, helipad transfers usually take 45 minutes and she was gone for more than 3 hours.   She offered me help when she finally appeared, but the rush was already over. My impending burn-out was still prescient, however, and it took all I had to finish the shift gracefully.

Believe it or not, the overall workload that night was only a bit heavier than it usually is for our busy sections.   I was only subjected to the abuse that night because of the lack of teamwork that night.  In my section, 2 of 3 nurses were new graduates and unused to the procedures and stress of treating of critical patients.  Their preceptors unfortunately took their training status as an opportunity to gossip instead of helping.  Between Tech Useful and me, the sections stayed functional, but barely.  If any of the other techs had done even the bare minimum instead of hiding wherever they were, we could have functioned very smoothly. The coding patient in 9 might even have been caught earlier had another pair of eyes been watching.  Ugh.

I carefully control my internal environment to exclude resentment, but it became very difficult that night last week.  It took me a week to work through these emotions and I can only hope the new nurses don't learn to become complacent like their preceptors.

Meanwhile, here's to the successful completion of another week in the life of a ERTech.

S

Luck of the Draw

For some patients, coming to the ER can be a wonderful experience.  The team that is taking care of you might be the A-team, a well-oiled machine that provides conscientious, pleasant, professional, and indulgent care of you. Not only are things done immediately and with great skill and precision, the bedside manners of the doctors, nurses, and staff are warm and reassuring.  Especially if you are in critical care, this can make a huge difference for your nerves, happiness, and prognosis during your considerably shorter stay.  Don't worry, a few hours is normal- if you had the L-team, you might have to suffer through many more hours of discomfort, though.  Working with the A-team is an incredible learning experience; we are calm, at ease, and responsible.  Therefore, when working with the A-team I might even venture to ask and doctors might even approach me about the biology behind what is happening to a patient. On these days, I don't even mind working double-shifts. It's such a good experience.  And even crabby patients leave us with a grudging respect, because everything that could or should be done, was. (picture of lucky cat)

There are other teams, of course, made of a mix of these personalities: http://talesofanemergencytech.blogspot.com/2011/08/nursing-species-in-er-jungle.html

Some teams are all-business. Things get done, but you leave feeling a little cold. Other teams are anything but professional; the staff is "personable" but you can't help but question if they know what they are doing.  Then, there is another category entirely- team-Lazybones.

I had to work with the ultimate L-team the other day.  Between the three nurses, Nurse Negative, Nurse Airy Fairy, and Nurse Lazy, all of whom liked to disappear into the ether when the trauma drama died down, I could not find a single one for an hour and a half at a time when my trauma patients were begging for legitimate pain relief.  Then, they ignored my request on behalf of the patient until the resident asked them directly, and disappeared again.  The surgical resident was more frustrated than I- the medications were ordered as she was suturing pieces of torn muscle and skin and the patient was crying out. But for the life of me, I again could not locate a single nurse from my team.  Then the O.R. secretary called me, livid, to pick up a stretcher that Nurse Airy Fairy had left there on purpose, covered in blood, bloody vomit, and other bloody gore.  She decided she didn't want to clean it.  Nurse Lazy couldn't get an IV in a patient and stuck him 5 times with the same needle, ripping off the blood pressure cuff sloppily every time I applied it. We never got a good blood pressure reading until it was absolutely required when the unstable patient went to CT scan, and then he asked me to draw all the labs with a butterfly.  Meanwhile, I was still the only one doing all the vital signs every hour, stocking the room, cleaning the rooms, helping the residents with the patients.  Where did they go for the whole shift? I still have no idea- maybe taking smoke breaks.  It's scary to imagine anything serious coming in that trauma room with such a dysfunctional team of nurses; thank you, white cloud! I can't imagine that any of them actually consider themselves competent with such attitudes towards working.

(picture of doom cat)
How to avoid such craziness when or if you come in as a patient? How do you make sure that we don't harm you more than whatever had happened to you already?

The details of the room you enter might give you a clue: if the johnny coat is strewn across the bed in a haphazard way, if the bed wasn't cleaned and newly made from the last patient, if there is garbage on the floors, if the drawers aren't stocked, you might be out of luck. That or we're just having a busy day. Nothing is for certain in that crazy place, after all.

S

Idle Tongues

At work tonight, I found out I am an exotic bisexual, great at performing oral sex, and wild in bed. Great to know- I always wondered about that, but now I'm sure, since I heard it from my co-workers who know much more about it than me. While I was covered in (other peoples') blood, much less. Silly me. Who needs to watch TV dramas when you can live the real thing working in the Emergency Room? I wish I lived half as exciting a life as they think I do. ;-)

S

A Social Faux Pas

A month or two ago, a bunch of nurses were talking about Nurse Needy- a huffy-puffy, heavy-set, short, and reeally needy nurse. There is something in the water in our ER- everybody is pregnant- about 15 nurses at a time. Anyway, they were saying how Nurse Needy was expecting, was slowing down a bit at work, looked good being pregnant, etc etc. That stuck in my mind for the past month and I had a silly moment last night.

NN: S, can you go move bed 4 into 7 and 11 into 7 for me?

S: Sure.

NN: Ugh, what is wrong with today? There are so many people and yadda yadda yadda and I get so tired and cranky, as if enough wasn't on my plate already, yadda yadda yadda and it's hard to move around, yadda yadda yadda.

S: Is it that you're expecting?

NN burst into bewildered laughter. WHAT? What are you talking about? I'm not pregnant.

Insert foot in mouth.

S: Oh, I am so sorry- I was just thinking to myself, I see you all the time and you never mentioned it. A bunch of people were talking about it and they were so sure, like it was a done deal. I am so sorry.

NN: It's ok, don't bite your tongue about it (more loud, high-pitched laughter)- it's just that I have no children and can't have any children, ever.

S: I am so sorry. Really.

NN: It's ok. It's just really funny to me. I can't believe anybody would think that.

S: :-( Ok, I'll go move the beds now.

I was going without eating for 8 hours, on my feet for the past 11, and caused a terrible moment for somebody. There was no excuse, though, and I just felt so young, so inexperienced, so socially awkward. But I had patients to see so I bit my lip, refocused, and continued with my crazy night. I'm so sorry, Nurse Needy!!!

And I work with some real a-holes. And I am not referring to patients.

S

Nursing Species in the ER Jungle

The Lifer: She's hardened, ruthless, scathing. There is sarcasm driven deep into every wrinkle and she is a valuable warhorse in the trauma room or when something serious is happening because she knows due process for almost every situation. She is usually precepting some meek new nurses and works them hard as a rite of passage. Other people would call it hazing- she will call it conditioning. She was probably nice once, but got twisted and jaded one day and crystallized to be stuck as the timeless ***** she is now. She needs to retire or take a long vacation. Seriously.

The Student/New Nurse: Unambiguously awesome; will do what s/he is supposed to do- does not depend on the technician for everything. Might actually take vitals for him/herself. Still speaks respectfully to patients, will grab them blankets, food, drink, socks, bedpans without sarcasm. Will get picked on early on. The nice ones tend to leave fairly quickly to become a floor nurse or take Nurse Practitioner school. The tough ones who stick it out usually have all the trappings necessary to eventually become a lifer.

The Filipinos: Glib, quick on their feet, generally cheerful- they get worked hard and take on some of the toughest patients per ER hierarchy. They generally socialize closely with each other only and are friendly but reserved to everyone else.

The Perpetual Team Leader/Charge Nurse: They no longer touch patients, might start an IV once in a while if everyone else is busy/not to be found for a new patient. Otherwise totally immersed in the drama of assigning patients to other nurses, getting the the patients upstairs into the wards, moving patients around. Stand in direct line to eventually become managers or administrative workers.

The Traveler: Have seen and done it all. Keep to themselves and will tell great tales if you get them going. Usually leave as soon as everyone starts to like them.

The Technician-turned-Nurse: They know the exact job description of the technician and will use one to the fullest extent of their power. Some had built up heavy resentment and will ask more of you than is practical or necessary. Either super sweet or rife with issues- there is no in-between. Are usually very handy and have a wealth of experience.

The Clique-sters: You know them. They wear the same danskos, same brand of scrub bottoms, wear their hair in similar ways, smack of gum and gossip. Hipper, hotter, holier than thou- as far as they think. They patronize patients by calling them sweetie, honey, young lady (when referring to grandma). They get grossed out by pee and vomit even though they are ER nurses. Will question or defy new residents (especially female residents) on decisions and laugh constantly, usually regarding inside jokes. The male version are all, for lack of a better word, studly- who trade workout tips behind the nursing station and strut around. Most likely found carrying heavy boxes, putting the largest gauge IV catheters in patients as possible, or looking up supplement/motorbike/working out information on the computer at the working station.

The Whore: Males love her but still call her one. Females won't touch it with a 20-foot pole. Probably has the phone numbers of the male residents over there, there, and there if you look in the phone that is permanently stuck to her hands.

Former Floor Nurses: Genuinely nice nurses who love the excitement of the ER. Invariably shocked at the lack of caution and regard for isolation procedures. They don't get caught up in drama when they first come in because they actually like it here. Yay!

Nursing Managers: Super diplomatic. All have the "soft" voice they use when talking to patients who are pissed off. Know everything about everyone- up on all the gossip. Harbor secret desires to return to the floor, but know that everyone else depends on them to do what they do. Unpopular by default, which is too bad- they are probably wonderful people, but it's hard to tell anymore.

Everyone else: it really takes all sorts- for example, the Paramedic-nurses are really cool to talk to. They are in the field half of the time- they know what it's all about and tell great stories. Everyone else keeps to themselves and are inconspicuous. They deserve to be treated as the awesome individuals they are, not subscribing to drama, gossip, or bile. These are often the introverts and observers who put patients ahead of their own "personas" and perceived values. There are d-bags in this group too, by the nature of all-inclusiveness, but nobody cares about them.

I raise a toast to everyone, good and bad, for making my workplace the menagerie it is every day. Thanks for keeping it interesting- I'll see you at work in a few hours...

S

Adventures in Sitting: The One Who Got Away

Occasionally- though lately it has been more often than not- I have had to sit. That's what we call it when a patient comes in for "psychiatric illness", or "suicidal ideation", or "ingestion", or "homicidal intent", etc, and a technician leaves off normal duties to make sure s/he is watched while in our facility. Either the patient has proven to be a danger to him/herself or others or has said the magic words "I want to hurt myself." Then s/he is granted the privileges of having someone watching them one-on-one for all the uncomfortable hours spent in the ER, of having that same lucky companion to accompany any trips to the bathroom, and facilitate the removal of all plastic cutlery from meal trays before eating. Apparently plastic knives have been an issue with cutters.

I hate sitting. It is an unwanted break from the action of treating emergent medical issues; it also makes me really tired, even though I'm not doing anything. My heart rate drops, my adrenaline gets used up, it's all sorts of terrible and useless. At least, that's how I felt, until I didn't meet my Mr. Towga.

One ordinary day, upon seeing me arrive to my shift, the tech I relieved sprang up happily, gave me a hug, and ran off to live his life. I was not informed that I was supposed to be sitting for two patients: one who had ingested a bottle and a half of aspirin, the other, usually a regular drunk, who had jumped into the river in an attempt to harm himself. I went about my duties, stocking and checking up on my new patients, when I heard "He went that way!"

"Were you sitting with that patient??" A nurse rushed up to accuse me. I looked at the rumpled empty stretcher.

"No, I was definitely not," I replied.

"Then who was? He jumped in the river yesterday. If he jumps in again, someone's head is going to roll. Are you sure you were not sitting with him?"

"I was never told I was."

"Then what are these?" She discovers sitter forms on the counter; it was a scary moment when I realized I was supposed to be sitting for both my ingestion lady and Mr. Towga.

"I was never informed I was sitting. I've never seen the man in my life."

"Well, we'll see about this," she huffed.

Mr. Towga took off in several wrong directions in his clumsy escape and was not wearing a hospital gown, only street clothes. Several seasoned nurses pointed him in the right direction of our exit. The last people to wave him goodbye were the security officers out front. It was only when he took off running that people got suspicious and realized he was a psychiatric patient.

The police were informed and a search was performed, but Mr. Towga was long gone. I didn't get in trouble because I was given improper (nonexistent) report, or so they say. I have a feeling it was more that some of our oldest and crankiest nurses were the gracious souls who showed him the way to the exit.

I take sitting duty very seriously now. Woe be to the uncooperative patient under my watchful eye! Mr. Towga came in again a few weeks later, thank goodness, and only as a drunk this time. I made sure to get a good look at him. Nice to finally meet you.

S