I spent my latest shift in triage. There are two triage positions in the emergency room- one prioritizes the patients arriving by ambulance. The charge nurse usually does this. The second triage position is where patients who walk in are prioritized and sometimes treated. It was a slow day by ED standards, as we had less than 200 patients for the 12 hour shift.

The interesting patients of the day were a guy who ran his hand into a table saw, removing the tips of two fingers, a woman who came here from Canada seeking treatment that she had been unsuccessfully seeking for over a year in her home country, and a fentanyl overdose who came back to us after only being discharged 90 minutes earlier (that particular patient came to us by ambulance). The nurse who wound up treating him and I agreed that this guy obviously didn’t care about his own health and just wanted to get high, and that society would be improved if hospitals simply stopped handing out Narcan to every junkie on a constant basis. Sorry, but this guy has been in our hospital more than a dozen times in the past month. I can’t see how we benefit as a society by indulging in this behavior.

I had to teach one of our new nurses how to splint. She had to do a sugar tong splint on one of her patients for a wrist fracture, but didn’t know how. I went back and had to show her how to do it. Then a second came and asked me if D5W had sodium in it. (D5W literally means 5% dextrose in water. Why would there be sodium in that?) What are these nurses learning in school?

The worst part of the shift was the screensavers on the computers. They show a nurse I work with getting an award for saving a patient back in December. Good for her, except she got the award for what I did. A patient had come in complaining of passing out several times. No one could find anything wrong with him, even after the man had been in the ED for 2 days so they were about to discharge him. I went into the ECG server and reviewed the last 2 days of his heart activity and found that his heart occasionally went into a third degree AV block. He would then spend the next couple of minutes in a ventricular escape rhythm, and his heart rate would drop into the 20’s. There’s your problem, and I can’t believe cardiology missed it. I printed the ECG strips and gave them to his nurse, who forwarded them to cardiology. The man got a pacemaker and was sent home. The nurse got an award. I didn’t do it for accolades, but it still sucks that someone else got credit for my brilliant detective work.

Everything that follows is a “me, me, me” story, so if you aren’t interested, the post can end here.

I got another offer for a job this week, this time for $11 an hour more than I make now. Even though the money isn’t as good as the offer I received a month ago, the benefits are much better. Still, I’m not interested, as that particular hospital is about 45 minutes away from where I live and I don’t feel like driving that far. Still, the jobs are there.

Perhaps the attitude about druggies is the reason why, when I had a conversation with my manager about my coming departure, he didn’t seem to care a whole lot. It went like this, “You know that hospitals around here are aggressively recruiting nurses? Did you also know that this hospital is paying more than $10 an hour less than all of the others in the area?”

He says, “Yeah, I’ve heard.”

Me: “To be honest, I have offers from two other hospitals in the area. Both are for significantly more than I make now. I want to stay here, if possible. My evals are good, above average, in fact. You say you want me to stay and value me as an employee, so what kind of a raise are you willing to give me?”

Manager: “I really can’t have this conversation right now. There are a lot of things going on, and it would be better if you came back in two weeks, and we can talk about it then. My plate is just full, and I really do want to help you, but this just isn’t the time.”

Me: “That’s what you said three weeks ago, and a month before that.”

Him: “I know. Sorry, this just isn’t the time.”

It sounds like they really DON’T value me as an employee. I can’t see any manager who cares about retaining employees saying things like that to one who is making noises like they are looking to go. I do know that they have recently (in the past three months) hired half a dozen new nurses, all fresh out of school. They aren’t hurting for nurses as badly as they were a year ago, even though we are still woefully understaffed, it’s my belief that they WANT to be understaffed. It’s cheaper that way, I guess, even if patient care suffers and nursing ratios stay at 8:1 on the floor, with 30 or 40 ED holds.

So I am going to assume that I have just gotten my answer in the form of a “pocket veto.” If they really respected and wanted me to stay, we would have had the conversation about pay and retention by now. I have done everything but put in my notice, and the manager doesn’t seem to care.

So I have decided that my last day will be in 6 weeks. In three weeks, I will put in my notice.

Categories: Me


Matthew W · March 27, 2023 at 6:56 am

” 200 patients for the 12 hour shift”
How many of those should not have been there?

Don W Curton · March 27, 2023 at 7:02 am

Company I used to work for had this general attitude that if you had a better offer in your pocket, go ahead and take it. I don’t know of a single case where they made any counter-offer to retain people. I do know of several cases where someone tried to bluff about having a better offer in order to get a raise, they ended up either eating crow or walking out with no other job lined up. So I guess I never considered approaching my boss with that issue. If I had a good year, I’d argue that my work deserves a raise, but that’s about it. My advice, if there’s a better offer, just take it.

EN2 SS · March 27, 2023 at 7:45 am

I once let it be known that I was unhappy and looking for another job. After a couple of weeks the boss finally asked if that was true, I replied ‘yes and as a matter of fact, I found one, here’s your keys to the building, bye’, and walked out. I give the same advance notice companys give us when being fired.

SiG · March 27, 2023 at 8:27 am

Bear with me because this is literally a 50 year old memory, but isn’t there a D5S where instead of pure water, it’s dextrose in normal saline? Is that still around? Maybe Newbie Nurse was thinking of that.

    Divemedic · March 27, 2023 at 9:15 am

    It’s called D5NS. She should know the difference. It’s her job.

Woody · March 27, 2023 at 9:03 am

Management never believes an employee will leave till the notice comes in and then you find out they have time to talk about your future and discuss raises.

Dan D. · March 27, 2023 at 9:13 am

Great catch on the AV block. The complete dissociation of QRS is the clue, right out of Dubin’s book. If a cardiologist can’t catch that… wow. You may never get the thank you note from that patient about the increased quality of life you gave to him so let me substitute in a small way to say thanks.

As for your boss: no, he doesn’t value you. I always ask bosses if they are surprised when an employee quits. If the answer is yes then I conclude they have their own disocciation. I reckon you are “free and clear to navigate at your own will” at this point.

Henry · March 27, 2023 at 9:41 am

Just as disappointing as your manager’s lack of a conversation about a raise is his/her unwillingness to be truthful and candid about the reasons why. I was in the engineering world and when someone threatened to leave the common situation was a very candid discussion and more often than not, a counteroffer.

Jonathan · March 27, 2023 at 11:26 am

Unfortunately, some employers care more about keeping costs down than doing quality work – as evidenced by their hiring know nothing new nurses. I’d be curious to know how these nurses did academically and whether they had any other offers.

I’d leave a place like that to make sure I wasn’t present for a situation that lead to big legal problems!

It’s sad how often we see this myopic view these days…

Botan · March 27, 2023 at 1:06 pm

I worked for a company where one very qualified employee got an offer that included a position and pay increase from another company. When he went to turn in his 2 week notice they offered to match both pay and position if he stayed. So he agreed. “They” just had to get approval from the “higher ups”. About a month later he inquired how the position and salary increase was coming? Unfortunately the “higher ups” wouldn’t approve either the position or salary change.
By that time the other position was gone.
That means, to me, when you put in your notice that’s it!
Even if they put it in writing you have demonstrated “your not team player”.
BTW – that company no longer exist!

    EN2 SS · March 27, 2023 at 4:52 pm

    I’ve worked at several places, that when someone gave notice, the assholes fired them on the spot. I give a two second warning, or less.

By Any Means Necessary · March 27, 2023 at 3:17 pm

During the ICU tour from the stroke and coma five years ago, I always said look out for them God as you could hear the ambulance pull in all the way up to the tenth floor.
That is the you are about to go home floor and you can walk around the ward.
Thank You God for the conscientious competent hospital workers and medical care people!

AL · March 27, 2023 at 7:34 pm

I appreciate hearing about what you do. I do similar for horses. Some crazy comes in regularly. Especially this time of year. Pay sucks but has improved some in the past couple years.
I’m of retirement age and work 24 hours/week. (++) They regularly exploit non trained peeps, for double+ shifts + on call positions. And when 4 emx come in within a couple hours of each other I get to deal with clueless techs. Luckily interns have a clue now… But their time is short now. Think its $14hr for entry tech now no training… And the “horse experience” they require is questionable. This is my last year.
I guide the interns. I’m okay with that, and don’t want the accolades. They do appreciate me… But the adequate pay would be nice. Graveyard shift is hard.
Although high drama is HIGH drama, for the most part horse people are either an emotional wreck, (pet owners with a sick 1100# baby) or its a business and they know what to expect…
I admire you for what you do. Went thru hundreds of ER visits with dad in his last dozen years….
Bless those of you who love it enough to stick with it!

TRX · March 28, 2023 at 9:35 am

> What are these nurses learning in school?

Woke ideology, probably.

B · March 28, 2023 at 6:30 pm

I am of the firm belief that when a person is given Narcan that they should get a notch on their ear (Or a tattoo on their ear) telling medical and police personnel that they have already been given Narcan once.
If they can’t learn the first time……

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