Forty

The tale of Nurse No.

Many entries ago I promised I would write the story of Nurse No. Well the time has come to put one of my fave stories of floor nurse idiocy down for the ages. After many years as an ER tech working west of the Mississippi I moved to the east and started working in BCH. I had cleared "orientation" and just started working the night weekend shifts. I was liking it so far, constantly busy with interesting cases. We were still using paper charts at the time which in hind sight was a horrific way for ANY big city hospital to have to operate.

I was asked to take a pneumonia pt up to the floor. The pt did not have any kind of funky PCP or TB for that matter, just a plain old case of pneumonia. The pt was a middle aged woman, she was one of the sweetest ladies ever no deficits, no drugs or etoh. Just one of those rare times in the ER where we treated a normal person. Her family and I chatted as I got her belongings together to transport her upstairs. They were all nice folks. After they saw that I was taking her upstairs they all left confident in the fact that she would be well taken care of by the nurses on the floor. This is around 0100 in the morning.

Heavens if they only knew.

I get the pt upstairs drop off the chart to the ward clerk and push the pt to her room at the end of the hall way. It's a semi private room and she has the bed closest to the door. I walk her inside get her settled, tell her I hope she feels better. I grab the stretcher roll back past the nurses station and head to the elevators. Naturally at BCH even on a weekend night halfway through the shift the elevators are slow. So I'm waiting and waiting then all of the sudden I hear feet running down the hall and the door bursts open and a very irate nurse says to me "You have to take that pt you just brought up back down to the ER!"

Clearly something has gone awry.

One thing the Ol' Crusty ER tech has learned in his ER tech career is that you NEVER take pts back down to the ER. The reasons are many:

1) The room or spot they were in is usually occupied by another pt.
2) The pt is no longer under the care of the ER doc they have been signed out and have orders written by a floor doc. The care of the pt is going forward by going to the floor.
3) The nurse caring for the pt previously does not want nor do they need an extra pt. especially one that JUST got admitted
4) It frustrates the HELL out of the patient. "Why am I going back to the ER?!"
5) Lastly and most importantly it REALLY pisses off a charge nurse.

Unless the floor nurses put a gun to my head there was NO WAY I was taking this pt back down to the ER.

I walk back inside the med/surg unit with my stretcher to discover and even more irate med/surg charge nurse. This male nurse immediately jumps up from his chair once he sees me and begins to scream at me (keep in mind this is at 0100) because I am the complete idiot who brought up an active TB pt to floor unmasked to an occupied semi-private room. I'm non-plussed, I looked at the chart and talked to the nurse before coming up, this is a simple pneumonia plain and simple I says. While I was waiting on the slow ass elevators the admit docs (a couple of first year and second year residents) tubed up the rest of the admit orders in which one of the boxes checked said this was an active TB pt.

This charge nurse is waving this chart all in my face and is demanding I walk down to the room and get this pt. At one point during this dressing down of my professionalism, intelligence and genetic back ground he grabbed my arm to encourage me along. I asked nicely that he release my arm while I call my charge nurse. He came to his senses for half a second and I was able to call from that nurses station. As soon as the ER charge nurse answered the phone the floor charge nurse got all riled up again. I could not even tell my charge nurse what was going on. I told the ER charge nurse I'd call back in a second.

At this time I made a point to show this floor charge nurse my badge "My name is 'Crusty ER Tech' I am trying to solve this problem, it's not my fault there the chart is screwed up. If you don't quit screaming at me and leave me the hell alone this problem won't get solved. I'm going to the other side of the nurses station and call my charge nurse again, please this time sir don't scream at me while I am on the phone." I said it in the nicest tone possible, I wanted to explode. Getting into a screaming match on the floor with another co-worker is a sure fire ticket to get paper on you especially when you are not on your home floor, it's an easy way to stand before the man.

I was able to call down stairs to the ER charge nurse and I explain the situation. That I got this male charge nurse going bat shit over the situation and trying to intimidate to get me to bring a pt back down which I know is a total no-go. I don't go into detail, it's clear I'm in a jam. The ER charge nurse says alright stay RIGHT there at that phone, she KNOWS this is not an active TB pt just in any case she'll get an isolation room on another floor so things can go forward and whatever I do, DO NOT BRING THAT PT BACK DOWN. She says she'll call back in less than five. I hang up the phone quickly because the floor charge nurse is running over and I'm thinking he's going to jump into my ass again and this time I won't be so pleasant.

The floor charge nurse demands to hear what she had to say. I'm to the point I tell him we are getting another room on another floor, that I'm camping on this phone for the next five minutes. Naturally he does not believe me and wants to talk to the ER charge nurse. No problem says I. I look on my badge and give him the number to the laundry, a phone I know that won't be answered at 0130 in the morning. I do this because he needs to be occupied with something other than leaping into another temper tantrum. I'm confident that situation will be handled. In the mean time ALL the floor nurses are glaring at me like I just kicked a puppy or some shit.

Less than 5 minutes later I get a call back. ER charge nurse says take the pt to such and such isolation room on another floor. Now is when things get REAL interesting.

I walk back down to the room with the chart and stretcher, walk inside to see that the pt is not in her bed. I do see that a nurse (Nurse No) is bracing herself in front of the room's bathroom door like she is trying to keep a ferocious zombie at bay. I ask Nurse No "Where is the pt?" and she says in her broken english (turns out she is from china) that the pt is being isolated in the bathroom because she is infectious. "You no take pt out of rest room." I tell her that the bathrooms in this hospital are not negative air pressure, and even if the pt was and active TB'er that you Nurse No are not wearing a mask, now let me get this pt to a floor where there isn't crazy dripping from every surface. Nurse No reluctantly unblocks and opens the bathroom door.

I find this sweet normal female pt sitting on the toilet with her knees drawn up to her chest.Oh and since the floor thought she was an active TB'er they did not put a mask on her, obviously keeping her trapped in a bathroom was the best choice. It was a pitiful sight, she then asked me "Am I contagious?" I assured her that she was not and that there was a mistake with some admitting paperwork. I further explained that she lucked out and gets her own private room up on a floor where it is nice and quiet.

I get her back on the stretcher and head back out to go to another floor without incident. I was rather surprised by that. I get the patient up to her new room get her settled and it's all good. the nurses on this floor are much less crazy that the other ones I just dealt with. I head back to the ER sure that I was going to have to deal with another irate charge nurse this time though it was going to be my boss. I was sure I was going to have paper on me cause this whole episode from beginning to end took over an hour. Naturally I get stuck on the shitty elevator for 10-15 minutes.

I get back to the ER and find the charge nurse. I ask her if everything is cool. She looks at me strangely and asks "What happened up there?" I tell her in vivid detail of my life of the past hour. When I get to the part about Nurse No trapping the pt in the bath room I get a face palm reaction and hear "Oh no they didn't!" The charge nurse then finds the admit residents and asks WTF? They reply "Ooops oh my we made a mistake she is just a regular pneumonia pt." This gets a face palm from me and the ER charge nurse gets visibly angry calls those residents into the med room "talks" with them about their error and storms out of the department.

The ER charge nurse walks back into the ER about 15 minutes later. With a rather smug look on her face, turns out she went up to the med/surg floor and raised all kinds of hell. She even came back with a list of names. She assured me that I did the right thing and that those people up there are all sorts of out of control. I fully expected a follow up to this episode. Nothing came of it.

About one year later.

I see an orienting group of nurses for our department and who do I spy with my little eye. Nurse No. I immediately grab a N-95 mask and hand it to her and walk away without a word. I doubt she got the joke or refrence. Somehow the word quickly spreads about Nurse No's unique form of isolation. Nurse No to her credit stayed on in the BCH ER for around a year and then left for greener pastures I imagine.

And dear readers was just one night and one patient. Sheesh.