Charge

I'm not a perfect charge nurse. I try, but I get bored and wander, I play with my crackberry and I generally avoid our clinical coordinators like the plague. That being said, none of that happens when we are busy. I try to help every way I can, I do the gross, time consuming crap so the nurses can more people up and out. I have found that the more time I spend doing charge, the more I am aware of what others do (and more importantly) and don't do for their staff nurses.

I try my hardest to get into every room with every new patient. Even if I just put the patient on the monitor or start a line while the nurse is doing an assessment. That way I get a very good idea of whats going on and just how sick this person is. If I can, I will actually write the patient up for the nurse, frequently doing the monitor, ekg and line, just to save him/her some time. If someone in their zone is sick as crap I will watch the rest of their patients so they can do what needs to be done.... and I can be a resource for them if something crazy happens. (thoracotomy on a chest painer).

My charge the other night was a space cadet. She has been in the department for years and has been farmed out to triage. We have some older, and less than physically capable nurses who get put to pasture and occasionally get sent to the back where they are put in charge. The idea is they have to do  less work this way. As you can see, it depends on the nurse just how much work they will actually do. (one of the more lazy ones will do "care from the chair" she doesn't de-ass the chair for most of the night)

I picked up my least favorite zone. I had an MR pt with AMS, a guy with a ready bed, a new CHFer and a chest pain. The nurse gave me report and left me with.... 1)MR kid needs urine and an IV 2) Call report on the guy with a ready bed 3)Nothing has been done for the CHFer.... no line, no ekg, no monitor, no foley, no lasix, no nada. 4) Needs cardiac enzymes sent.  Not a way to start your night. My charge, did nothing to help. She couldn't even take a charge call from our communications room letting us know about a CPAP patient that was coming. I had to take the call and pull my bed 4 out so I could get the new guy. I also got a new DKA from triage who's chief complaint was the "boils" in her crotch. She also had a blood sugar of 910. She got 15 units of insulin IV, 3 liters of NS, an insulin drip and her blood sugar still never dropped below 650. She was also 23 and a royal pain in the ass! As the resident and I were draining her multiple abscesses my CPAP patient (a frequent flier) scratched his EJ out and bled everywhere and my CHFer puked like a gyser. Thank god for the other girls who saw I was drowning and came to bail me out.

One of the girls actually apologized for my crappy night.  She was very appreciative of what I do to help her when she has a bad night. Hers was a little more exciting (if not as acutely sick) as mine. This was her patient....





Everyone turn your head the appropriate direction and you'll see that this is a human bite to the eye. Pretty fuckin nasty, huh? Optho wasn't sure what to do with it. He was sent to an optho/plastics specialist.