no. 52: 2012, the year of the dragon....nurse

well, here we are in 2012. at least 6 months have passed since my last rant. now, before you go worrying that my ranting days are over, let me assure you that the cavalcade of ED boobery and ass-holery have not slowed, and in all likelihood will never stop. winter brings a special different boobs than summer, but that's another rant. today's rant is on a topic near and dear to my rage bone: nurses.

yes, that's right, i'm back to this topic. let me explain the system for assigning patients to the various teams. actually, let me begin with an explanation of how it is supposed to work. the basic idea is that there are 2 critical care teams, red and blue. each team has 2-3 residents plus an attending. then each team has a complement of nurses--after 4 years i cannot seem to figure out how many nurses staff a particular area in the ED, but there are always some nurses around to do the various nurse tasks, like take breaks, break my balls, go outside to smoke, explain why they won't push some med because they don't want to jeopardize their license.

nurses work really hard--particularly ER nurses. it's a tough job. some people are really cut out for it, and others are not. the vast majority of our nurses are outstanding, but the minority really drags down the majority here.

the basic idea of the teams is that new patients alternate between each team do docs and nurses have time to start a workup on a patient before the next patient arrives. if course there are busy times when people stack up, and that can't be avoided, and if 1 team is getting killed with a few really sick people who are taking lots of time (eg, needing intubation or other lengthy procedures), the the other team will take some extra patients now and the busy team gets some extra patients later. but the basic idea is that each team has the same number of patients.

so imagine my surprise when i return from talking with the parents of a 16 year old who fell 100 feet and shattered his spine and pelvis. in case there was any doubt, telling parents that their 16 year old just sustained a non-survivable traumatic injury is not the most uplifting experience in the world. so i return from the heart-wrenching task to find my team with 7 patients and the blue team with 3; i'll also mention that i've got an intern on my team instead of the usual pgy 2. the guy i left in bed 7 when i started working on the trauma who looked like death and like he needed a tube in his throat 2.5 hours ago now looks like he really needs that tube. my team is setting up for that, which means the other 6 patients are getting no attention. so i casually ask the team leader (a nurse) what's up with the pt distribution. she says "they're intubating in there," referring to the other team.

i look over and all 3 of the blue folks sitting at the desks, working on the computer. and i see that at least one of them is reading "the onion." i briefly wonder how he got past the firewall to read that site, but i'm quickly brought back to reality by the 350 pound person to my left turning blue in fornt of my eyes. i point to this guy and i tell the team leader "so are we!" then i say, "ok, so it goes..."

we intubate the giant and things are calming down (sort of..actually, not at all) when team leader walks over and says to me "you were rude before. it's rude to make pronouncements to people you don't know. i don't really know you that well, but it's rude to walk over to someone and just make pronouncements." this didn't seem like the time to point out that she was doing exactly what she was accusing me of doing, but i did say that i didn't make a pronouncement, i just asked a question; that did not sway her. she explained to me that i didn't understand her job and there was more to it than just the numbers--i agreed to this, but she was not placated. she continued to explain that the other team was intubating and thus couldn't take new patients. i repeated the news that we were preparing to intubate but had just gotten 2 new people. needless to say, this did not go over well. she again pointed out that her job is affected by more than just "numbers."

i apologized again and explained that i was a bit frazzled from the discussion with the parents of the dying 16 year old and that coming back to see such disproportionate numbers caused me further consternation. this was not the right thing to say. "it's not just about numbers." "but we were both intubating, says i.

it really happened like this, with the same phrases being repeated over and over again. she clearly wanted me to know that her job is about "more than numbers." i told her that i understood but that it was hard for all the patients to get good care because we didn't have adequate time to spend with them. i said that while i was happy to care for all the patients it would slow things down in the ED as a whole if the teams weren't evenly filled. i can see that she is just getting madder with every word i say, and although i'm trying to end the conversation i just keep getting myself in deeper. then the charge nurse comes over and ask what the problem is--i mistakenly say i had asked why the teams weren't evenly filled, with the intention of saying that it was explained to me and i was ok with it, but i never got the chance cause the dragon nurse cut in and stated full on yelling at me, repeating the same damn things from the previous 5 minute discussion.

fortunately, another sick person came in, and you guessed it, got assigned to my team. i smiled and said, sure, we'll take him. and i know that the next few shifts i work will be hell because the nurses will gang up on me and give me the worst patients, the most patients, and i am powerless to stop it. it's like some kind of torture/mindfuck. you see something bad happening and you want to make it stop so you say something, but once you've opened your mouth you've instantly made it worse, and despite the fact that you know that this is exactly what will happen you say it anyway...

i never seem to learn my lesson...