Sunday, October 9, 2011

A Night in the Life of an ER Nurse

Awhile back Rachael over at Letters to Ames did a post about one of her night shifts as an orthopedic nurse. I thought this was so interesting and that I would love to do this sometime and hope that my readers would have some interest in this as well! I would like to document for you 1 of my 8 hour night shifts (2330-0730) that I worked. To maintain confidentiality and professionalism, patient and staff names will not be discussed.

2245 ~ All freshened up and ready to go to work. Leaving early so I can grab some Tim Hortons coffee and a snack or two for my shift

2315 ~ Arrive at Tim Hortons, order my large french vanilla capuccino, and the rest of the conversation goes like this:
"What bagels do you have left?"
"Ummm...okay. Well, do you have any muffins left?"
"Seriously?!? I work the night shift, man! I'm hungry, why don't you have any food?"
"Sorry. That's $1.64." 
I proceed up to the drive through window, little TH dude won't even look me in the eye, my coffee is sitting there waiting for me, I plop some change on the window counter and tail off. At this time I'm contemplating stopping at McDonald's next door because I am hungry and also now grumpy because Timmy's has failed me in their "24 hour" service. If you're open 24/7 you should provide all items on your menu, just sayin'!

2320 ~ Ah crap, better get to work!

2330 ~ Arrive to work, all of our 6 rooms are full with a few in the waiting room. Get report from the evening nurse who's leaving, and decide where I should go.

(By the way, in report I learn that we have a male in his 20's who's wife called 911 and was brought in by ambulance for an evening's worth of gastro symptoms. So, essentially he has "man" gastro and just didn't want to keep his pooping and puking to himself at home like a sane normal person would. Not only was an ambulance abused, in my humble opinion, but then I find out he has shat himself. Yup. 20-something years old, pooped his pants and didn't care. When I did my rounds he was wearing a pull-up diaper. 20-something years old - just in case you missed that).

2345 ~ Discharge a patient, clean the room, finally get to my coffee to take a sip of french vanilla goodness - wrong coffee!!!!! Are you effing kidding me, Tims?!? You don't have any food for me and you screw up my coffee order? Official boycott of Tim Hortons begins.
0005 ~ Ring ring. The ambulance is coming with another person with gastro symptoms. Awesome...I better not get gastro!
0020 ~ The ambulance shows up with female patient in her late 30's with gastro since after supper. Right away my bitter nurse brain, again, is thinking "why don't these people just want to stay at home to poop and puke in the privacy of their own home?" But anyway, I admit her, do her assessment and hook her up to what would be the cocktail of the night - a 1 litre saline bolus with 10 mg of Maxeran infusing.

0100 ~ A young male with suspected viral meningitis is transferred to a city hospital for further testing.

0130 ~ The gastro lady from the ambulance's lab work is out of whack with a very high white count [indicative of infection] so she also gets sent to the city for further management of care, since in our small rural hospital we don't have ultrasound at night or a CT scanner.

0200 ~ Check on our overnight patient who's awaiting bloodwork for repeat troponins in the morning to see if the SVT they had earlier has raised the enzyme, or if they're also having a heart attack, a NSTEMI. (Too wordy? essentially her heart was in a really fast rhythm of 220 beats per minute [normal is 60-100] and we were keeping her to see if she also had a heart attack which will show up in the blood work and with a repeat ECG).

0230 ~ I'm starving, things are slowing down, so I'm making a McD's run for me, the other nurse, and the doc.

0245 ~ Get back to ER. Crap. They forgot part of my order. I'm going to boycott drive throughs in this town!

0300 ~ Another round-trip and I've scored some free pies. The girl was really apologetic and felt awful, at least! McD's you're on my good list still.

0330 ~ We get another ambulance come in with a drug dealer in his 20's who is drunk, high on cocaine, and has also been assaulted. Medically, he's fine, and was going back to "cells" which is essentially the holding area for residents of this town until they get released or transferred to a prison in the city. We get a lot of patients from cells who are looking for a "get out of jail free" card - literally...sorry, buddy - not for you! We always enjoy talking with the RCMP officers, they've got lots of good stories to tell!

0345 ~ I triage a patient with man cough.
"So what brings you into emergency this morning?"
"My wife couldn't sleep, she made me come here because I'm coughing."
[I take a deep breath, do a silent sigh, and think to myself...#1 why didn't you just go sleep in the guest bedroom or #2 why aren't you on the couch at home???]
"Okay. When did your coughing start?"
"4-5 days ago."
"Okay, well the doctor isn't here right now [white lie] so I'll give them a call and call you into a room when they're here to see you."
0415 ~ A pregnant patient comes in with an ear ache....and gastro symptoms. IV, saline, Maxeran...getting the hang of this?

0430 ~ A guy in his early 30's staggers up to the triage window "gasping" for breath saying that he's "really sick". (Oscar-like performance here, people!) I go triage him...any guesses as to what the diagnosis is? Yay - you're getting good - GASTRO! Don't you worry, folks, he tried really hard to tough it out at home for the last 5 hours, but his girlfriend made him come in and to stop being so stubborn. ::eye roll:: So he gets the IV cocktail and after some convincing that he has a virus that just has to get out of his system, we can't really "cure" him, all we can do is treat his symptoms (which we've done), he goes home about 1 hour later.

0500 ~ We get another guy from cells come in in shackles looking for his get out of jail free card. He literally said "someone pushed me down and broke my ribs". That's all he said. X-rays proved he did not have broken ribs and back to cells he went.

0530 ~ A 12 year old kiddo comes I even have to say it? I'm getting sick of it. If anyone else comes in with gastro, I'm literally gong to start puking...not from a virus, just because I'm physically sick of all the gastro. He's a tough kiddo, has a touch of a fever, is a superstar when I start his IV and we send him home in about 1.5 hours when his bloodwork comes back good. Maybe his pain will develop into appendicitis...let's hope not!
0600 ~ Make sure all our night shift checklist items are completed...stocking linens, supplies, etc. And IV therapy patient shows up and is triaged and treated.

0700 ~ Start coffee for the day shift, tie up loose ends, wash hands profusely and pray that I don't get gastro. Do the narcotic count, tidy up...

0730 ~ Day staff is here, give report...

0740 ~ On my way home, put in my hands-free ear set thing for my cell phone and call my Mom to help keep me awake on my 25ish minute ride home.

0810 ~ Walk through the door to see this...
Picnik collage

...and immediately smile and get hugs, snuggles, and kisses as we watch a bit of the Curious George movie (we need a Thomas and Bob break!) and he enjoys his milk!

I just also wanted to note, that in spite all of the obvious bitterness in this post, I truly do love my job and wouldn't trade it for the world. It's just very frustrating to see people come into the emergency room time and time again when they really don't need to be here. BUT, we have a universal health care system and everybody deserves to, and will be treated, regardless of what we think. Work's a lot more fun when the people that truly do need to be here, are. But, having said that...if the other people didn't come, I wouldn't have a job now, would I?

Hope you enjoyed this post, if you have ever written or want to write a post about a day/night in the life of your job, I'd love to read! Link back and/or leave me a comment!
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  1. as a nurse, i can totally understand this post! i work in a family doctors office, where we have parents demanding their teenager be seen for "a horrible cough". they come in just fine texting away, not coughing once....oh can you write them off school? they've missed the entire week.

    and in the OB office i work at, we have women who come in for ER follow ups because they didn't feel their baby for an hour & they're 18 weeks...basically they wanted a free ultrasound.

    i love my jobs too, i really do, i just hate people that abuse the system & take away from those who really need appointments!

    whew, sorry that got long. great post, sarah! *hoppin' off soapbox*

  2. Well I guess there is never a dull moment for you huh? Interesting post! Thanks for sharing :)

  3. LOL! I totally need to do this. - A day in the life of high school drama anyone?

  4. So is gastro another way to say the stomach flu? People are crazy. I bet people have gone to the ER for a splinter..but here in the US, it might be different, since it costs a ton of money to go to the ER (even with insurance).

  5. What a cute idea!! You are so busy! I should do the day in the life of a dentist:)

  6. Love this post. I work at a small community hospital as well, and we see this all the time. So annoying and one of my biggest pet peeves!

  7. It's not always that busy, but I thought it would be a good one to document!

    This is the time I wish we didn't have universal health that the sore throats/coughs/pukes would stay home! BUT we are blessed to have such great health care, so I guess we take the bad with the good!

  8. Lack of universal health care does NOT make the sore throats/coughs/pukes stay home. They just come in without insurance of any kind. And we go further into debt as a country or our hospitals have to cut staffing ratios or provide no yearly raises to somehow pay for the care that we are obligated to provide them.

  9. I can't wait to be a nurse! I'm a sophomore BSN student and I love it :) I really enjoyed this post!

  10. So many ridiculous things happened to you!! I am mainly shocked about Tim Hortons and their general suckiness! We don't have them here but something similar happened to me...

    I once went to Dunkin Donuts in the evening and they were out of DONUTS!! Places DEFINITELY need to have their menu items EVEN IF it's night time. Crazy that we have to say that!

    AND they got your coffee wrong?! Geez!

    Good luck on your next shift and with not getting Gastro!!

    For Love of Cupcakes

  11. Question. Do you watch your son then during the day after working the night shift? My husband works swing shifts, one week a night shift, then watched our daughter. Ws just wondering ifyou did the same?
    Interesting post. thanks.


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