Wednesday, June 20, 2012

A Gross One

People, please, don't ignore what the doctor tells you. If your instructions say to follow up in a week, we're not just trying to milk another copay out of you. If they say to keep your wound clean, we're not just being the handwashing police. We're trying to save you from something uncomfortable and dangerous.

For instance, let's say you're somebody who hurt yourself fixing your car. You went to the ER with a big laceration, and got 19 stitches up the side of your forearm. The doctor told you to keep it clean, wash twice a day with soap and water, and come back in 7 to 10 days to have the stitches removed. The nurse repeated the same instructions. They're printed on your discharge paperwork, in bold face, underlined. Don't ignore them.

Don't let the wound get covered in dirt and engine grime because a bandage sounds like too much trouble.

Don't leave it unwashed for a few days because you think dirt is macho.

Don't goof around for two weeks because you're afraid the suture removal will hurt. It'll take ten minutes and I promise I'll be gentle.

After the third week, when the wound starts to get swollen, red, and scabby, don't procrastinate while you show it off to gross out your buddies.

In week four, when it swells more and starts to get really painful, that would still be a good time to see the doctor. Don't put a bandage on and avoid us because you're afraid we would criticize your choices. We might, but we'll do our best to be polite about it.

At the beginning of week five, when your girlfriend catches a glimpse of the wound and flips out, don't tell her she's overreacting. Don't make her have to threaten and manipulate you for days on end just to get your silly ass back to the ER.

Don't do these things, because your 19 old dirty stitches may lead to 38 individual abscesses, and they will swell up and glom together into a painful, oozy, disgusting mass of skin and pus. You'll need a good scrubbing and some powerful antibiotics in order to head off the infection and save your arm. And those sutures still need to come out, which means I need to take tweezers, scissors, and face shield, and go spelunking to find each individual knot somewhere inside the mass. This will take ten times as long and hurt a hundred times worse than if you had followed instructions in the first place.

Tuesday, June 19, 2012

Safety Tip

Emergency nursing is interesting and educational. I've already learned about some important things not to do.

For instance, don't pick a fight with your reflection.

Some dude was practicing his ninja moves in the street, walked past a plate glass window, and freaked out when he suddenly saw another guy doing ninja moves. So he started throwing punches. (There's a suspicion that drugs may have been a factor.)

I don't know who won the fight, but the window got a few hits in. Dude strolled over to my ER and wound up with stitches all up and down his forearms.

Friday, June 15, 2012

Job is Go!

I had my first emergency shift as an RN today. Woo! Adventure and excitement!

...tempered by two boring facts.

First and boringest, I don't yet have any of my login passwords. This means I can't chart and I can't check out medications from the drug cabinet. I was stuck doing physical jobs and watching over my preceptor's shoulder.

Second, this was the slowest day shift this ED has had in recent memory. They got less than one-quarter as many patients as they expect on an average Friday.

I was assigned a few patients, widely spread over the course of the day, but in between them I didn't know what to do with myself. For starters I practiced on new equipment, assisted with radiology, toured the building, memorized the stock room, and made myself a nuisance in triage. This still left me enough slack time to download and read an entire novel on my smartphone.

But hey, who cares about that stuff? I'm officially in my new job! The people are great, the environment seems fun, and I'm absolutely sure I'll soon have as many patients as I can handle. I'll enjoy the quiet while it lasts.

Monday, June 11, 2012


Day One of the new job just finished!

This was new employee orientation, which seems to be much the same in every industry. It was a long run of mission statements, benefits information, parking passes, and other administrivia. I lost track of how many different HR people came to speak with us. We also got short presentations from people in pastoral care, the security department, ethics & compliance, and a couple of other departments along the way, but mostly, it was HR people with PowerPoint and paperwork.

Today's stuff was for new hires in general, from all departments, from nurses and techs to pastors and environmental services. Nursing orientation begins tomorrow. That's where they teach and test our clinical skills, like how to correctly operate their blood glucose meter, or how to place an IV with their chosen brand of catheters and supplies. Somewhere in there will also be a test on drug information and calculation.

The testing does not worry me in the slightest. After working nine months in the state's best critical care unit, I've got all my basic skills nailed down hard. I'm more worried about avoiding hypothermia in their too-aggressively air-conditioned conference room.

More posts will follow, assuming I don't get frostbite in my typing fingers.