Just Nursing Things

With many of my blog posts I've talked about the joy in traveling and experiencing the United States. That being said, not all of it is sunshine and rainbows - especially with regards to the nursing world. While I haven't been victim to extremely abusive situations as seen with other nurses, I feel obligated to shed light on the change in the nursing atmosphere. I will a more recent look into my life just to amplify the stressors involved on a daily basis. I would like to say, though, that I never intended to make this blog about nursing in general because once I leave work I like to not think about it. I guess that has always been my way to deal with some of the more unpleasant aspects of the Emergency Department. However, I do have have a voice and a platform with about ten viewers, so I'll share. 

In the hospital that I currently work at, the Emergency Department is separated into about four different sections, or pods - A, B, C, and D. Each pod has a designated "sickness level." I say "sickness level" because I think that is the easiest way to describe it. When a patient walks into the front and checks in, the front nurse assigns that patient a letter depending on how sick they are presenting. Vertical (V) patients are the least sick, meaning those that will maybe get a COVID test and get sent home. Those patients are quick, easy, and meant to only be in the ER for about two hours or less. Diagonal (D) patients are a little more complicated. They will most likely get an entire work-up including labs drawn, medications given, or imaging. They won't necessarily be admitted, but that is a possibility. Lastly, horizontal (H) patients are sick. They come in with their oxygen saturations below 90% on room air and working to breathe or complaining of stroke-like symptoms. These people need immediate care. That being said, this hospital doesn't have a true triage system. They go by the letters for placement into the ER, but will not get vital signs, height and weight, or their official story for coming into the ER until they get a room in the back. That being said, if you have a bad front nurse, patients won't get accurately placed and care could be delayed. I digress.

I walked into the hospital expecting to be placed in either D or C pod, which is where the mid-shifters typically go. However, I was pleasantly surprised to be graced with B pod, in which I could actually see some sick people. Let me tell you, I was unprepared for the day that I would have. We had a TON of severely ill people that day. I sent three to the ICU and one to intermediate care. Not only that, but I seemed to have all of these sick patients at the same time or back to back. There was no break and while that makes my shift go by quickly, it is completely exhausting.

One chronically ill woman came in ventilated through her tracheostomy with oxygen saturations in the 70's. She was sent by the facility for a blood transfusion due to her hemoglobin being low at 6.6. Since we were questioning the accuracy of our oxygen saturation readings, the respiratory therapist said she would recheck after visiting another patient in the ER. Meanwhile, I'm attempting to stabilize this patient while awaiting a unit or two of blood. While this patient is unstable entirely, I had another ICU patient next door on a diltiazem drip. Diltiazem was started on this patient since he was in a-fib RVR and we needed to get his heart rate controlled. This particular drip is a titratable medication, meaning that the nurse is to titrate the rate at which the patient is receiving the medication depending on what the heart rate and blood pressure do. If you give too much you can decrease their blood pressure, but if you don't give enough the medication won't be effective. My last patient in this assignment was a man that had such a consolidated pneumonia that the physicians almost placed a chest tube thinking he had a pneumothorax (collapsed lung for simpler terminology). These three complicated patients were the first three patients I was only able to see two of those patients once. Two of the three complicated, sick, and time-consuming patients I laid eyes on ONCE. Not because I didn't want to check on them more, but because I was trying to stabilize my new ventilated patient who almost died while I was in the room. 

I'm explaining my assignment to you because I want to paint a picture. I want everyone to know the stressors that we nurses go through on a daily basis. I am glad I got to care for these sick patients, don't get me wrong, but the amount of pressure we have on our shoulders is unparalleled. Everyone has stress in their lives, but not everyone has the life-line of a human being resting in their hands. Luckily, my pod-mates were able to keep an eye on my other patients while I stabilized the sickest of the bunch. However, if I didn't have that kind of help things could have gone downhill fast. The worst thing in a nurse's career is knowing that the care you've given wasn't enough to save a patient's life. In the ER, we are faced with many weird and challenging situations which always include the possibility of a patient dying. I think that's why a majority of us have a dark sense of humor.

Getting back to the point I want to make, imagine sprinkling difficult family members that ridicule and question everything into the mix. Not only do I have to make patient care decisions that are crucial, but now I have a family member yelling at me because I didn't get an extra blanket for them. I understand being upset about family members or trying to look out for them, but I only ask for people to be respectful of the profession. We have a ton of things to think about and do for more than one patient. Do you work well when people are breathing down your neck or yelling at you? I've learned to, but I don't think that's something I'm proud to admit. I like to think of myself as a people person. Getting along with people has always been easy to do for me, but times are changing and tensions are high. The fear that COVID has instilled in people has only added to the stress of my profession and created a distrust between patients and medical staff. Nurses used to be the most trusted profession, so what happened? 

With that, I will sign off and post more about nursing in the future. It is about time I talk about it. Until then, keep in touch, keep in mind, and stay curious.