In response to this post about the mountain of paperwork that we as nurses have to deal with, Mary Anne wrote this:

I thought hospital nurses had it easier with paperwork, boy was I wrong!
I’m a geriatric nurse in long term care. Have been for my 12 years in nursing, and the amount of paperwork has increased 10 fold especially in these last 7 years.

I tried to figure out, once, how many times I write my name or initials, or any type of entry, on various forms, but lost count quickly.

First, there’s the sign-in sheet, then the narc book, med and treatments sheets (there are currently 41 residents on my unit and 1-7 pages for each). Then you have the POC book, in which I as an 11-7 nurse must generate hand-written I&O sheets (both daily and weekly), glucometer check sheet, toileting sheets, assignment sheet, elimination and food/nutritional sheets (all three done monthly), the charts, the log book, and God forbid someone falls! Then you have the incident report, statement sheet, chart entry, care plan update, injury to extremity and/or head injury flow sheets, update of the fall risk assessment, call to the MD/NP and family or all the transfer paperwork if you have to send them out to the hospital.

There are weekly skin check sheets and incident report if you find a skin issue, and department copies for that. In with the med sheets (or MARS), are the prn pain monitoring sheets, behavior sheets, and O2 sats and lung sounds monitoring sheets (for use with any inhaler and nebulizer treatment).

Needless to say, the majority of my night is spent writing SOMETHING. I have been feeling like I’m pulled further and further away from the bedside and I’m getting very sad about it. Guilt when I take even more time away from my residents? I have it. Especially on Book Night. It’s the last day of the month going into the new month. And it’s hell!

We must turn over all the old month’s sheets into the new month’s sheets. Actually, leading up to it is worse. That’s where the pharmacy we use sends us all the Residents MARS AND TARS (med and treatment sheets) and we have to edit them. It’s not easy especially when they screw them up from one month to the next or a resident has a lot of new orders, or the pull doesn’t get done on time. We have to check the accuracy of every med and treatment the person has ordered along with allergies, doctor, birthdate, diagnosis, room etc.

Then there’s the Nursing Summaries. Oh joy!

These are monthly consolidated reports about what the resident has gone through in the last month, and it shows their acuity level, but it isn’t accurate if the CNA’s flowsheets are wrong which is often. This is how we get paid. If they are wrong, we lose points and money. It’s a lot of pressure when you’re not able to spend a lot of time on them.

And as an 11-7 nurse, I’m responsible for the weekly drug order for all the residents on my unit. It takes about 2-3 hours if done right. We also change the CD foley bags every 2 weeks, the O2 tubing and other equipment every week, G-tube supplies every night, do treatments, pass meds and soothe emotional or out of control residents.

Cleaning and restocking the Treatment and Med carts andordering supplies are all put aside until there’s time. No one on the other shifts ever does it. So I’m left with no supplies when I come on duty.

I’m sure I’ve missed something, there’s so much. Eight hours is definitely not enough time to get it all done. If I didn’t have to get home to get my husband off to work and child off to school, I’d leave about 9-930am everyday. As it is, I sometimes have to get my family taken care of and go back to work to finish. Sometimes I get paid and sometimes I don’t. The head honchos think we should get out on time, and they won’t pay overtime anymore. So we get in trouble if the work isn’t done, but we volunteer our time to get finished. And it cuts into my precious sleep time.

Why do I stay where I am? It’s all I know. Hospital nursing scares the hell out of me at this point. I feel dumbed down. The place is 5 minutes from my house and son’s school. I like my nighttime co-workers. And still another reason to stay is that it looks good on a mortgage application to have stayed a long time at one place, something we’re going to be facing soon.

I always wanted to be a ‘Scrub’. I loved the OR in school. LOVED IT! I know they have more surgical techs now and nurses have different roles in the surgical ward, but that’s all I ever wanted to be. Right by the doctor’s side passing instruments, watching the surgery. Cool.

When my mother lay dying from end stage chronic hepatitis, she was screaming at me “get out while you can!” She was referring to nursing. She was a nurse until the day she died, she kept up her CEU’s even though she’d stopped practicing a long time before. I wonder, should I get out or stay?

I don’t know what else to be.

It’s never too late to learn something new. Get your mortgage, then get a new job! I know, easier said than done.

I suppose this is a silly spin-off of Kevin MD’s “Doctors Gone Wild” category. “Chocoholic” submitted a story about how nurses helped her during a particularly bad time:

Over a year ago, I was admitted to ICU after a suicide attempt. Although I was only there for twelve hours, the saintliness of some of the nurses stick in my mind.

I arrived late at night, tired and confused. The first thing that struck me was the calm and quiet of the place. I always imagined the ICU to be noisy and frantic like in the movies. I think the fact that it was only a small unit in a country area helped. The only sounds were a breathing machine and the occasional beep, and someone making coffee. After the frenetic activity of the emergency department, where I had spent the past few hours, it was bliss, and I immediately fell asleep in the extremely soft, warm bed!

The first thing I found wonderful about the nurses was something simple, yet wonderful to me. While in the emerency department, I had to use a pan, and due to the fact that they had stuck me on a drip, I had to go quite often!! After waking in the night and holding on for as long as possible, I buzzed the ICU nurse and told her I needed the loo. She disconnected the monitors, unplugged the drip and said, “OK, let’s go.” I was amazed. Something so simple, yet so dignifying. I was suffering no symptoms, and felt completely well in myself and was stable, so she had let me up. The reason I felt like this is that in the emergency department, I felt so vulnerable and like all my dignity had been stripped away using a pan. We chatted about life as we walked, and I complained that the drip was worse to push than a shopping trolley, and she told me I was a card!

The second nurse I had came on around breakfast. After seeing my plate of watery, tasteless scrambled eggs on cold toast, she said, “You can’t eat that,” and made me some hot peanut butter toast. Later that morning, she sat with me and we talked. I told her about my life, where I was from, what I was studying, about my life living on-campus at the university and the crazy things students get up to. I told her about the emotional hurt I was suffering and how I was frightened of the future, and frightened to go back to university. I told her about a song I had heard on the radiio that morning that had epitomised the way I felt and I told her of my passion for music. After my 18 hours of monitoring was up, she took me and my drip out onto the veranda so I could use my mobile to catch up on things at the university.

When she delivered me, fully dressed and freshened and neat (the way I always like to dress and feel), to the Psych ward that afternoon, she stopped and took my hand.

“You are an inspiration,” she told me, “You are a beautiful, sensitive determined person. I just hope now you can get the help you need, and I wish you luck in finishing your degree, which I know you will.”

When she finished, she started to tear up. I hope she knows that I am finishing my degree, and loving every minute of it, and I remain greatful to this day of all the nurses – in Emergency, ICU and Psych-and their compassion, humanity and sensitivity.

That was sweet, huh? It’s nice to know that we’ve really helped someone out, even if they don’t or can’t tell us at the time.

This is a very well-written submission from “smack.” She cites several examples of intolerance and unhelpfulness from her instructors and the nurses she’s supposed to be learning from:

I am a “non-traditional” nursing student. Nursing is not my first career. Like many others in my generation, in our restless quest to find deeper meaning in our lives, I have chosen to pursue an emotionally fulfilling life rather than to continue to pursue the Holy Grail of financial success. My former preoccupation with my career and financial success cost me a marriage, caused major burnout, left me feeling hollow and unfulfilled, and contributed to my becoming a grandmother before I was 40.

Not for the first time in nursing school, I am wondering if I am cut out to be a nurse. Do not get me wrong, I love the art and science of nursing.. I have worked as both a “tech” and a unit secretary on a medical-surgical floor for over a year now. The small hospital where I work has become a second home and the nurses I work with, a second family. I love the rich mix of skills needed to provide care for patients. I enjoy the challenge of giving a smile or laugh to a grumpy or blue patient. I love caring for people.

Where I begin to question my ability to fit in has come beyond the safe cocoon of the hospital floor where I work. I have witnessed other students struggle with some of the same issues as I have. I just do not know if I can work with some of the nurses who care for clients but lack the capacity for caring for anyone else. My first experience with this type of behavior came from one of my instructors.

At the time, my daughter was a 15-year old high school student and a new mother without a car. We had just recently moved to the state. I was saddled with the responsibility of transporting both my daughter and grandson to wherever they needed to go. During class, I received a desperate call from the babysitter saying that she thought that my grandson was having an allergic reaction to something he ate. I pulled my instructor aside, explained the situation, and apologized for my having to leave. She tersely advised me not to allow my family situation to interfere with my education. By the way, the class I was missing was intended to teach us how to “care” for patients in the non-traditional emotional and spiritual sense.

The next experience came from a registered nurse who I was to assist during an obstetrics rotation. When I arrived at the clinical site, she was in hysterics and crying over her assignment for that evening. She told my instructor that she did not want a student following her. My instructor forced the issue and the nurse spent the rest of the evening literally sneaking behind me into the patient’s room and coming back out and reporting that she had “already taken care of things”. I was assigned to follow her on two different occasions. I have had the misfortune to be assigned to two other nurses in two other hospitals who have had the same type of “stay out of my way” attitude. Some have been downright rude and condescending. I wonder how it is that these particular nurses, who do such a wonderful job teaching their patients, are so awful at helping to teach the next generation of nurses.

My most recent experience of this behavior came in a one-two punch. It is the first semester of my senior year. In my one clinical class this semester, we are learning about community nursing. I am learning about what community nursing is and am finding that I like it a lot. My first clinical experience as a visiting nurse was great success and I thoroughly enjoyed it.

However, the instructors of this class are grappling with a heavy clinical schedule and more students than they are used to. There have been several mix-ups in the dates posted for clinical assignments. Like several other students, I am struggling to make sense of the various assignments and where I am to go and when.

Nevertheless, I am excited about my clinical assignments for the next day.. In the morning, I am to follow a school nurse and learn about what she does. I will have the opportunity to follow this nurse several times during this semester. In the afternoon, I will travel to a local elementary school and participate in a grant program that teaches the children there about nutrition. The program is exciting because I get to orchestrate a physical activity along with teaching. I even get to give the kids a taste-test of some unusual good for you foods. I had chosen the lessons carefully and practiced them with my three-year old over the past week and a half. I was ready to rock and roll!

About 1:30 a.m. the night before my clinical, my three year old woke up coughing, gagging, and crying. I ran in to check on her and in my half-sleep panic, I tripped over an electrical wire and wrenched my back. As I hobbled in to calm her down, I thought that maybe she had had a bad dream. Fifteen minutes after tucking her back in, I was changing bed sheets and cleaning up vomit. I did this about every fifteen minutes until almost four a.m. because, apparently my daughter has failed to develop good vomit aiming skills. I was very disappointed because I knew there was no way I could take my daughter to preschool in the morning. I was going to miss the clinicals. All that preparation was for naught.

I called my instructor’s office sometime after three a.m. and left a message explaining the situation. She had instructed us to use her cell phone over her office phone, but I was hesitant to call her at that hour, lest I wake her and her family, so I called her cell phone later in the morning before the clinical and explained the situation. The news of my impending absence was met with stony silence. Next was the question of “Are you going to miss the afternoon clinical too?!” I was sleep-deprived and frustrated. I wanted to tell her that I felt sorry for her kids if she ships them exhausted, miserable, vomiting, fever, and all, to daycare when she has a big day planned. After all, that is just what a good nurse would advise a patient to do?

The second punch occurred during my call to the school nurse who was organizing the grant program teaching I was to do. After I explained why I would not be able to come in, she said mildly, that nursing school sure had changed since she was a student. They were not allowed to be married or have children. If they missed a clinical, they were met with fire and brimstone not to mention possible expulsion from the program. She lamented how things had changed. I wanted to tell this nurse that preventing women with children from learning or working is called discrimination, and is immoral and illegal.

I want to point out that the majority of nurses I have had the opportunity to work with have been supportive, kind, wonderful, and great teachers. Many of my professors have children too and are mindful of the challenges parenthood provides to those trying to better themselves. I have the pleasure work with one of the best nurses in the state. This amazing woman has all the virtues that a good nurse aspires to have: patience, expert skill, ever-expanding knowledge, kindness, and empathy. She has love in her heart for all people but is strong enough not to be taken advantage of.

In the end, what I am hoping for are the nurses who exhibit this type of behavior to question the reasons for it. When you are in a position of power, you are teaching student nurses whether or not you intend to. What you have to decide is whether the lessons you are teaching are worthy of a professional nurse. Your attitude toward students teaches them what behavior is expected of professional nurses toward patients as well as others.. Utilize those caring skills not only for patients, but also in interactions with those you have to work with. It may be useful to keep in mind that the student who is shadowing you now may soon be your co-worker or may even eventually be your nurse. My professionalism professor gave a quote at the beginning of the class, “nurses like to eat their young”. I am hoping my writing will help some of those nurses lose their taste for us.

I don’t remember ever calling in sick for a clinical during nursing school, but I know of others who did and were met with the same stony silence. There are only so many clinical opportunities to be had in school and skipping one for almost any but the most dire of reasons was frowned upon.

Hello! Just wanted to check in and let you all know that I’m doing great. The little one is just fine and is due in the next few weeks. We’ve been busily getting ready over the last few months. Being on LOA has been really nice… I’ve been enjoying sleeping in almost every day, especially knowing that it’s my last chance to do so for a very very long time. Anyway, here’s a little story submission from awhile ago that I’m getting around to posting now. Enjoy!

In July of 2005, when I was 24, I was diagnosed with a pituitary tumor. The following November I underwent surgery for it. I was told before surgery that I may or may not end up in ICU afterwards, but that I shouldn’t be surprised if I did. I had a wonderful surgeon (almost a year later, it still looks like he got all of the tumor), but unfortunately developed a roaring case of diabetes insipidus post-op. Instead of the expected day in ICU, I was there for three.

I don’t remember much about those three days. I had a foley, and I remember that I wasn’t allowed out of bed at all. I remember how noisy the ICU was, especially during shift changes, and I remember all of the beeps. I have vague memories of Respiratory Therapy being called for the first day, because I was having trouble breathing due to my packed nose. Mostly I recall that the room was dark and I didn’t want the window blinds opened, and I didn’t want the TV on.

The biggest memory I have, though, is how my day nurse, Kevin, took care of me. He always had a joke and a smile for me, and he always made sure that he was close-by during visiting hours in case my parents had questions. And I remember how on the third day, someone asked him how I was doing… I don’t know who it was. His answer, “She isn’t smiling anymore.” That just wasn’t acceptable to him. He came in, he opened the blinds on the windows, and he turned the TV on. He put it on a John Wayne movie that was halfway through, and he went to go get me something to eat. When he came back, I was still watching the John Wayne movie, and he told me, “You know, you can change the channel!” I grinned and asked him what was wrong with John Wayne, and he grinned back and said, “Nothing, but he walks funny.” It was the exact same answer that my best friend gave me a month later when I recounted the experience.

That same day I was moved out of ICU, and 4 days later they finally sent me home. I hate to think what things would have been like if Kevin hadn’t made such an effort to make me smile and to really take care of me. I’m tearing up right now, just thinking about it.

I just wanted to tell ya’ll my story, so that you can know that there’s one more person out there who truly appreciates everything you do. It’s amazing the difference that one person can make in what could otherwise be a pretty miserable experience.

… from my blog. Sorry for the absence. I’ve been working on a project that has taken some precedence over the blog. I’ve been very sad to see some of my favorite bloggers decide to throw in the bloggy towel – Medpundit and Shrinkette. Best wishes to them both!

Work has been very busy as usual. There are a few posts floating around in my head, but for now I will leave you with some story submissions! Enjoy.

Sam, Student Nurse writes:

This happend to me last week and is a message for all you RNs. I work on a PACU unit at a university hospital and often we bring people to the floor after they get the ok to leave recovery. I was asked to bring a 16 year old girl up to the Neuro floor. She was reporting pain her pain at 8 but the RN’s were ready for her to leave recovery and giving pain meds delays the process 20 more mins. So I push her bed up to the 7th floor and I could tell she was hurting. I explained how we were going to move her into her bed. The floor was busy and a few RNs popped in and out of the room as I waited for more lifters. I could tell the pain was getting worse and I started to talk to her. I was only 19 and it looked like we could have been friends. I asked her about school and told her to breathe through the pain and once we got her in bed we could give her something and let her family in. Suddenly she reached for my hand. I was shocked, no one had ever reached out for me before. I held her hand, I stroked her arm and talked to her for 20 minutes when finally more people came to help move her. Her nurse told me “Sorry it took so long, I bet you had better things to do”. My honest reply was “NO, I think someone needed me to be here more”.

Nurse Steph writes:

I work on busy telemetry unit, and the shift had just started. We had just finished taking report from the off-going day shift and were walking out of the breakroom when I heard some loud but beautiful singing. As I neared the nurse’s station I saw a large lady with her hair sticking straight up sitting in a wheelchair at the desk and singing her heart out. Several nurse aides invited her to return to her room and she refused, they tried pushing her wheelchair and she planted her feet on the ground and wouldn’t budge. One of the nurse aides was standing behind a plastic utility cart and the Singing Lady grabbed it and pinned her to the wall. Now, this is shift change and there are Dr.’s, nurses, family members, etc at the nurse’s station. The Singing Lady became louder with singing and intermittent cursing that would make anyone blush. We all tried to no avail to get her to her room and put her tele back on (which we discovered she had placed in the trash).
Finally, we had to call security for assistance. It took 4 security, 2 nurses, and 2 male nurse aides to get the lady to bed. We all thought that the night would calm down and we could get busy. We were very wrong. I had a patient having chest pain, and went to attend to him (nitro, stat ekg, labs, vitals, etc.) While I am assessing the patient’s pain level and finding that his chest pain is completely gone, I hear a blood curdling scream “Stephanieeeeeeee”. I go running down the hall to my schizophrenic patient’s room (where nurse aide Stevy is assigned as a 1:1 sitter) and find the aide with her head on the bedside table. My patient had grabbed her ponytail and put her head to the bedside table and was scratching her face. Several people had run in by then and we got the lady calmed down and Stevy free. Stevy had to go to employee health because of nasty scratches to her neck. In the meantime another nurse had the Singing Lady and a foley was ordered for her. Well, you can only imagine how that went. You could hear her all over the floor! She was yelling obscenities about her private parts to the nurse and the tech helping. She described her privates in a way we had never heard. We couldn’t believe our ears, this is a elderly lady soliciting the young male tech assisting the nurse, who quickly left the room.
Another nurse had been looking for a patient for an hour or more and the patient in the next bed said he saw him and his foley (urinary catheter) bag leave the room. Well, we called security, house supervisor, Dr., patient’s family, etc. About 30 minutes later we receive a call from the local police department asking if we had a pt by the name of ——. They had found him 2 city blocks away carrying his foley bag. When they stopped him, he threatened them with his foley bag raised in the air. Needless to say they called EMS to return him to the hospital. Upon his return when the nurse asked him why he left, he stated he was going to get help for the lady that was being killed down the hall (the singing, screaming lady). All of this happened in a period of 3 hours and then the night finally settled down. We still laugh about that night 3 years later. You never know what is going to happen from one hour to the next. And just because you don’t clock in on psych doesn’t mean you don’t work on one.

(Oh, that last sentence is so very true.)

Last one, from “CICU Nursie:”

I was reading your post about the meat fibers and it sounded so familiar. One woman in particular comes to mind. I came in and got report from D. She was telling me how this lady came in to the ICU confused and hypotensive and that it was all downhill from there. O2 was now 100% NRB and she looked like she was gonna buy a tube. I went in to assess her and her posture just jumped out at me. It looked like she was gasping for air, neck arched and head thrown back. Decided to perform oral care first when I peeped the dried secretions making a ring around her mouth. I had to assemble the sponges, water and moisurizer because no one had taken the time to do so in the nearly 72 hours she was with us. I started by removing large hunks of dried secretions from her mouth and eventually got my fingers on a three inch long hunk of what looked like meat only it wasn’t meat…it was mucus that dried and built up on the prior dried bits to eventually block her airway. I can’t really recall how many times I have received patients in severe respiratory distress due to an easily removed blockage. How many times do these elderly NPO patients have to code before some of these practitioners realize that a little regular mouthcare goes a long way.

I haven’t gone anywhere :) I was out of town for the holidays, and the rest of my time has been filled up with other adventures. Nothing interesting has happened at work; at least nothing I find interesting. Same kinds of patients. Henceforth, I have little more to offer you than some short story submissions. I suspect most blogs go through extended dry periods at times. I briefly entertained the idea of quitting codeblog, but I don’t think I want to do that.

“JLo” writes:

I had been an LPN for about 5 years when I decided I had had enough of taking crap from RNs [Ed: Well then!!], so I went back to school to be one. I didn’t realize I’d still be taking crap, just from a different group of people.

Anyway, while I was an LPN I did enjoy the patient care and took pride in my patient’s appearence. I had a patient that for whatever reason was difficult to understand at times (it came and went). He was trying to tell me something during his a.m. care, I really did attempt to understand him, but I couldn’t make it out and had to keep moving. He was scheduled for physical therapy and looked rather scruffy so I got him bathed and shaved. He was looking good when he headed down to physical therapy. I saw him being wheeled back some time later, and when he saw me he shook his finger, and said, “YOU, YOU SHAVED OFF MY MUSTACHE EVEN THOUGH I TOLD YOU NOT TO!!”

Whoops that’s what he was trying to say!! Well my intentions were good.

Doesn’t sound very good, but I’m sure it’s done every day across the nation. I have certainly done my share of misinterpretation. Anyway, “Gina” writes:

I’ll always remember the day I took shampoo in to one of the other nurse’s patients. I heard that the patient had given birth while crossing the border. She and her family cut the cord with a calling card, wrapped the baby in her sweater, and walked on. What an ordeal! I expected an exhausted, disheveled woman.

However, when I walked in with the shampoo, I saw an island of happy faces. Two of them were young enough women that one of them must be the patient, but they looked equally healthy and energetic, and neither one was wearing a hospital gown. I had to clandestinely look to see who was wearing hospital armbands. She was going to be sent back to Mexico for now, but at least her baby was going to be able to stay with family in the U.S., since the baby would be a U.S. citizen. I have to say, I admired her family support and her strength, even though she did take a big risk with her own life and the life of her baby. After all, plenty of American women take similar risks giving birth at home just for the thrill of it. And I’m sure she meant to give birth at the hospital, not outside in the dirt.

Well, I’m not sure I’d say that homebirthing women do so for “the thrill of it.” Probably more that they view birth as a normal, natural process that does not need medical intervention. And here is a true confession from “A.D.”:

Well as horrible and embarassing as it is to admit, at one time I became so addicted to pills and shots that I would receive in the ER after my many laparoscopies. I became so addicted to narcotics that I would feign illnesses once a week. It became so embarassing to me that I actually started to hurt myself intentionally so that I would be able to go to the ER with a clear (if you can call it that) conscience. The worst of the worst (and I say this with much shame, behind an anonymous name) has to be the time in which I actually took a .22 revolver and blew a hole through my right foot. Luckily it went clean through without touching a bone. I was sent home with Demerol….probably enough to kill a small elephant. I’m no longer like that and I find it frightening to think that I would ever do that. No therapy, I just snapped out of it. My hat’s off to those medical professionals that have to put up with the likes of me… Weeding out dope fiends while taking care of genuinely ill people. All I can say is….thank you and I’m sorry.

The ER sends people home with Demerol???

Okay, that’s all I have for you for now. Sorry for the recent absence and I promise to be more updative in the future :-)

Joy, EMT/RN, writes:

The opportunity to provide medical care brings with it risks unimaginable before the actual practice of care is begun. The timber and nails of the academic and the practicum seem, at first glance, to create a sturdy dwelling, a safe place from which to work. But when the winds of crisis blow, when the unexpected occurs, the house, if it has no sure foundation, if its framework is not both supple and strong, will fall.

The following story illustrates what happens when a nurse builds beyond the books and the gadgets and into true nursing.

Sunday, 1500, my pager tones. ‘Medic 1, Rescue 2, Engine 3, Engine 4. Respond MVA with injuries.’ I shovel the last bite of food into my mouth and put on my jacket. My partner meets me in the ambulance bay. We do not speak. It’s Christmas and there is a crash. There is nothing to say. We leave two minutes ahead of the other units.

Enroute we learn the location and nature of the crash. We do not look at each other. I request two more ambulances and additional rescue assistance. I move to the back of the rig to hang fluids. I put three constricting bands into one pocket and stuff a pair of heavy gloves into another. A couple of trauma dressings go into other pockets.

We arrive to an obvious high-speed, off-set head-on collision. A small pickup and a small, 2-door car are separated by 25 yards, one headed east in the west-bound lane, the other crosswise in the east-bound.

I run to the closest, the pickup. The passenger door is bent out of frame and is immovably 5 inches ajar. In the broken seat a middle-aged woman, sparkling with glass dust, sits with eyes closed, arms limp. When asked, she says she is at the mall. She is pale, breathing OK, has a rapid, thready pulse, no significant external bleeding. Move.

I go to the driver. He is enmeshed, the front of the vehicle folded around him like frosting on a cake. Awake, he looks at me with huge eyes. He does not speak. He is breathing OK, has a strong radial pulse of less than 100, no visible bleeding. Move.

I race to the other vehicle. Oh, Dear God. The two young adults in the front seat look like my oldest children. They are dead. Move.

I look at the back seat. The approximately 18-months old baby in the car seat in the middle of the bench appears boneless. He is slumped forward; his struggle to breathe is weak and uneven. His lips are white. Both eyes are purpled shut. Time stops. He looks like my Matthew. The doors are crumpled. I can’t reach him through either shattered window. Move.. Almost two minutes have passed. Move.

I straighten up and key my mike. As the first units arrive, I call for life-flight, activate the trauma system at the closest hospital, and request increased scene and traffic control.

I then order the scene. You guys, use ‘jaws’ on this door. You, the kid is yours, life-flight ETA 15 minutes. You and you, help him with the kid. You guys, use the other ‘jaws’ on the driver’s side of the pickup over there. You, that man is your patient. You, you, and you, get the woman out of the pickup. I’ll be right there.

I use the mike again to contact the second-arriving units. Rescue 6 and Engine 7, set up a landing zone. Medic 8, help them with Matth’ with the baby. Get the baby out of the car. Medic 2, find me at the pickup. You will take control of the scene.

I sprint back to the pickup. My partners yank off the door as I hand over the scene. Move. We are losing her. Never mind the c-collar. Move. We slide her onto a spine-board, place the board on a gurney, and leave.. Eleven minutes from time of arrival we are screaming down the highway. Move.

Her eyes are closed. Her breathing is peaceful. She has a fluttery carotid pulse that comes and goes. She moves her feet when asked. I give high flow oxygen and place two large bore IVs with blood tubing, NS wide open. Time now for a secondary exam. I cut off her clothes. Her anterior chest is crushed. The skinny woman has a round abdomen. I prepare to intubate.

She speaks. She is still at the mall buying pretty things. I listen to the woman. I put the laryngoscope away. I update the ED. The woman is taken into the OR within 10 minutes of our arrival. She dies there.

I ask an ED nurse to keep me company as I race-walk the parking lot and tell my story.

Two days later a critical incident stress debriefing is held. A cop says he has had about all of this he is going to take. His partner nods. A dispatcher says, ‘It was awful listening to what was happening. It was Christmas, this shouldn’t happen on Christmas.’ She can’t sleep. A cop jokes that she sleeps on the job all the time. She smiles and threatens, ‘I’ll send you out on the next barking dog complaint!’

The paramedic to whom I had assigned the baby says to me, ‘I knew the kid was bad when you walked away. I knew you’d never leave him if he had a chance. As soon as the helo took off, I went behind the ambulance and vomited.’

Someone says everything happened too fast, another too slow. A firefighter talks about the incredible noise of the scene. Another says he did not hear a thing, all he remembers is the stillness of the baby as he held his head for intubation. Another whispers in horror as she recalls the man in the pickup saying, ‘I did not hurt anyone.’

It’s my turn to talk. I thank them for being on scene. I thank them for coming to the debriefing. I thank them for talking. I say that I feel as if I had killed the baby.

A paramedic immediately and emphatically states, ‘You were first on scene. You had to triage. You did the right thing by walking away. You gave that lady the best and only chance she had. You did good.’ A few nod. A few look into the distance. A cop says, ‘That’s right.’ Someone puts a hand on my shoulder.

We tell our stories again. We listen. We joke. Some of us cry, others curse. Some do both. The next day, we go back to work. And I think about buying pretty things.

I actually came across this story on a nursing message board that a member had written as a post. The topic was whether nurses dress up for Halloween at work. Many nurses wrote saying that they wear Halloween scrubs, but not costumes. Our manager has pretty much barred us from wearing any Halloween costumes at work, but some of us do wear print scrubs. Anyway, I thought it a very cute story and asked the author for permission to post it here. Sarah, RN who works in NICU (Neonatal Intensive Care Unit) writes:

We have to wear the hospital’s surgical scrubs on our unit, so people really can’t dress up. Many have Halloween-themed warm-up jackets around the holiday, and some nurses wear those funny headbands. Nothing too crazy though, it is an intensive care unit after all.

BUT…

We do dress up the babies!!!

Sometimes the parents bring in little costumes, but more often than not, we make them. Nothing fancy – we usually just use those squares of felt and cut out little costumes that can lay on top of the babies. On the night of Oct. 30th, a bunch of us will bring in glue guns, felt, ribbons, pipe cleaners, fabric, etc.

There are some parents who don’t celebrate Halloween for religious reasons, and we are always respectful of that. And if there is a baby that is very very sick, we’ll make a costume, but then ask the parents if they want to lay it over the baby or not. Most do – they long for something “normal” like dressing up their child for Halloween.

The best was the year I made a Harry Potter costume for my primary baby – all 1200 grams of him! He had a robe, broomstick, and “scar” on his forehead made of Duoderm. I even got doll glasses, painted them black, and put tape on the nosepiece! There were nurses from all over the hospital coming up to the unit and asking if they could please see the Harry Potter baby? It was huge for his mom, too. Up until that point, everyone would always say, “Oh, your son is so small, is he going to be okay?” because this baby had been born at 495 grams. But on Halloween, she sat next to his incubator all day while dozens of people came by to rave about how adorable her kid looked. She said that was the day she finally started to believe that he was going to be okay.

RN writes:

I want to share my experience as a nurse taking care of wounded coalition forces and insurgents near Baghdad, Iraq. It was the most meaningful thing I ever did and the most horrible. I carry mental scars that I hope will heal.

11 military nurses and I deployed to a field hospital just outside of Baghdad in Jan 2005. The stress levels and workload we carried were incredible. We staffed a 75 bed ward with just the 12 of us, around the clock. A normal patient load was 13 to 16 patients each (Gasp). We took care of patients with traumatic amputations, chest tubes, bullet wounds, drowning victims, children and infants who were in the wrong place at the wrong time, prisoners…and we did the best we could. Did we give good patient care? By stateside standards a resounding no! We worked six 12 hour shifts each week and we were just plain exhausted. We were attacked by missiles and mortars daily. I became convinced I was not coming home; that I would never see my husband or children ever again…especially after a missle landed 10 feet away from me…and it did not detonate!

The Iraqi patients threw urine and feces at us, and spit on us (and those were the “good guys”). One nurse was bitten. Three of us were sexually assaulted (we were the only females on the base who were not armed and were easy targets). We cared for patients in tents, with minimal medical equipment, and we saved a lot of lives (1100 patients in 4 months). Some we couldn’t…and we cried.

One patient, a middle aged obese Iraqi woman did not deserve what fate handed her. She was a mother and a wife, and just wanted what each of us wants out of life – to keep her children safe, and love her family. As you can imagine, work is hard to find in Iraq right now, and people need money to eat. My patient had a daughter who spoke English. Her daughter gained employment as a translator for the Army. The insurgents planted a bomb just outside the family’s front door to discourage others from doing the same. My patient stepped out her front door (she thanked her gods repeatedly that it was not one of her children) and lost both her legs and her right arm. We saved her….but only temporarily. She developed infection after infection. We did as much as we could for her, but in the end, had to send her to the Iraqi hospital in Baghdad; which had few staff members and few medications. I know we sent her off to die somewhere else.

Events became interconnected there. An Iraqi National Guard Major led his men into a skirmish where American soldiers were slowly being picked off. He saved them. The insurgents planted a bomb in the Major’s house. He was killed; but a visiting female relative, a 1 month-old and a 3-year-old survived (all others in the house were killed). The 3 survivors were severly burned. The newborn and the mother spent several weeks with us and both were discharged healthy but scarred. The 3-year-old died after 6 weeks. We were devistated. Fast forward a couple of weeks. Coalition forces captured the insurgent who planted the bomb and shot him 3 times in the process. We saved him. I wanted to hurt that man, at the very least I wanted to withhold pain medicine, food, etc. But I did not. None of us did.

An Iraqi soldier/patient began touching one of my young nurses inappropriately. I had a gun placed against his head while I explained to him that touching was not allowed. I help people, I don’t hurt people.

I have been home 4 months now. I do not laugh easily any more. I don’t sleep.

If you know a nurse that went to Iraq, be kind, invite her out for a cup of coffee…and listen if she wants to talk about the horrors she lived through. Help her heal.

Wow. Think of this next time you have a bad day at work.

First of all, thanks SO MUCH to NurseWeek for the wonderful article in which Codeblog was mentioned. It’s very exciting to see something that you’ve worked hard on in print! If there are any nurses out there that want to share a story, you can do so here.

“Jules” has already taken advantage of the Submit Your Story link and this is her submission:

I work in recruitment for a large health system – sometimes we tend to look more at the paper credentials, and forget the humanity behind what you all do – I have the highest respect for nurses!

I’d like to share my experience as a patient, though. Hopefully any of you who have cared for someone like me will know how lasting the impressions are, and know how much the things that you do to treat the whole person are appreciated!

I was pregnant with my first son, and was utterly convinced (and still am, frankly), that women’s bodies were built to bear children, and that we don’t need medical intervention to help us along in a normal situation. Further, I was convinced that once you start intervening, the interventions keep coming until you end up with (gasp!) a C-section. I had a very supportive husband, an excellent direct-entry midwife, plans to give birth in water at a free-standing birth center, yada-yada. What I didn’t do, was listen to everyone’s advice to prepare myself in case the birth didn’t go exactly as I pictured.

Fast-forward to my 37th week of pregnancy. Picture lots of edema (I had to wear men’s shoes because women’s shoes weren’t “tall” enough for my swollen feet), a HUGE belly (something about too much amniotic fluid), labs that were off in many many ways (high uric acid, anemia, etc) and the beginnings of preeclampsia. Long story short, I ended up being admitted and induced, which was the second-to-the-last worst outcome I could imagine.

You L&D nurses are probably smiling to yourselves thinking, yep – I’ve treated her. And I’m sure it will come as no surprise that I marched onto the L&D unit with all kinds of demands – rolled into a “birth plan” – - no pain meds, hold baby ASAP, don’t cut cord until it stops pulsing…. Silly me, I still thought I could control what was happening!

I had some fantastic nurses. There must be some kind of communication that goes on with you-all, because everyone seemed to both know and respect my wishes. With one exception, all of the 28 nurses who cared for me during my week at the hospital hotel (my friend counted) treated not only my physical condition, but my emotional state as well. I had expected to have the nurses roll their eyes and say “Oh, a granola mom” or “Ha, Natural Birth. She doesn’t know what she wants” – - I NEVER felt as though this was the case. In fact, every one of my nurses bent over backwards to welcome my midwife into the room (though she didn’t have hospital privledges), and help me make sense of what the OB was ordering. One even said to me “You know, you can wait to have that done if you want” when he wanted to break my waters on the second day.

After 65 hours of labor (yep, not a typo – we finally succombed to an epidural at Hour 59 – blissful sleep!), my husband and I finally decided to have a C-section. Both our decision to continue with the labor, as well as our decision to have the surgery were unconditionally supported by our nurses. I was very frightened of the surgery, and the nurse who would be assisting took extra time to hold my hand, stroke my forehead (amazing what touch can do to calm a patient who’s frightened!), and explain over and over what exactly I would be experiencing, who would be there, etc. Even though I know she must have been incredibly busy to coordinate two nurse-anesthesists, the OB, two additional nurses, a resident, a clean OR room, etc, etc – she took the time to make sure I was comfortable, and to listen to my fears. In the OR, she made an extra effort to ensure that I could see my baby the whole time they were fiddling with him on the table, and brought him over as soon as possible. For
her kindness, I will be forever grateful, as she truly helped ease my fears.

I also remember a night shift nurse who had been assigned to me for two of the three nights I was in labor. After my son was born, she popped in my room to check on me, even though I was assigned to a different nurse (so appreciated!). Later that night my son woke up and started crying. My husband, who was staying with us in the hospital got up to get him and bring him to me, but I was having a hard time sitting up. I remember being so distraught that I couldn’t even sit up in bed to help my newborn son – I was so upset and discouraged. The nurse, who was not even assigned to me, answered the call button and both she and my assigned nurse helped me sit up in bed and nurse our son.

The other item that I want to share, which I truly think is a kindness, was the postpartum nurse who we had in the days following my son’s birth. What I appreciated most about her was how matter-of-fact she was. She helped me stand and take my first few steps after the surgery. She helped me shower. She helped to clean me up after I went to the bathroom for the first time post-cathater. Never was I embarrassed by the VERY INTIMATE things that she was doing, because she did not make a big deal out of it at all. It was just “You need to get up and go to the bathroom. Great job, now let’s get you cleaned up.” Ditto to the help we had learning to breastfeed. Fourteen months later, my son is a pro, but it took a bit for both of us to get the hang of things.

I am so thankful to all of the nurses who helped bring my son into this world, and helped me let go of my pre-conceived (get it!) notions of a hospital birth setting. I am humbled and amazed by the caring, compassion and love that we received while spending a week in the “hospital hotel.” Thank you for educating me, respecting our wishes, and coordinating the meals, labs, visitors, visits from the OB, and lactation consultant. Thank you for holding my hand, brushing my hair, encouraging me to take a shower, and cleaning me up. Thank you for welcoming my midwife, my family, and allowing my husband to stay overnight. Thank you for keeping me safe and healthy, for watching over me, for helping my son take his first breath, for teaching me the finer points of being a mom, and for turning a very scary situation into a powerful and empowering experience. Thank you.