Saturday, April 30, 2011

equal opportunity to die

Has being a gangster become an equal opportunity profession? In the last couple of months we have seen 3 young women with GSWs. When I say young, I mean 19,20 years old. Young women (or men) shouldn't be dying of this riduculous shit.

I have a feeling its going to be a long summer, because its all starting so early.

Thursday, April 28, 2011

ridiculous medicaid programs

I wonder whose idea it was to start a program called NET (nonemergency transportation) for medicaid recipients. This program provides cab rides to clinics, hospitals, etc. It costs this country billions a year. In New York state alone, according to a local newspaper, 446 million was spent in one year for these rides and for gas reimbursement. Take that figure and multiply it by 50 states, an astronomical number. Hard to believe.

In this article it talks about how methadone patients can use it to go back and forth to clinics on a daily basis.

I see this being used daily in the emergency room. Young adults (who seem to be the main people using medicaid) who are walking just fine call the 1-800 number for a cab to pick them up at the ER entrance. Now, mind you if you and I don't have a car, we either get a ride, take a bus or walk home.
Even the elderly who are on medicare can't get these cab rides.

No doubt this program was started so people would keep their appointments. Well intentioned, I guess....Now of course it is being abused like all the oother programs like this. THe question is why is this not addressed when talking about budget deficits? Eliminating this program would save billions. Somehow, I think that the people on medicaid would find a way to get to the doctor just like everybody else.

Wednesday, April 27, 2011

skunk tales

Here's the kind of day it was: It started off with a psych patient doing what sounded like tarzan yells. That went on for a couple of hours. It ended with someone who literally smelled like a skunk. Now mind you this patient was from the hood so no way they be comin' in contact with no skunk. They actually looked fairly clean. I don't even want to know where it was coming from and why. Of course we were busier than shit when skunk man came in. I actually put him to the side of triage in a curtained off area. I didn't want to put him in the lobby because it would have cleared the lobby and no doubt everybodys sinuses.

There was a patient who stood up on the ER chart, no small feat I tell you. A person came in restrained and had such a potty mouth, I almost went and got the soap and gave their mouth a good washing. Here come 2 people carrying in their relative who is not breathing. Down went the tube and onto the vent they went. They were young and stupid and almost killed themselves with dope.

Relatives were in nasty moods today and of course, took it out on us. As usual.
Mostly it was psych-o-rama, at one point we had five. Another fun day in the hood.

Tuesday, April 26, 2011

hospitals are gross

There is a new acronym afoot - MDRO (Multi drug resistant organism). I saw this on one of my charts this week. Had no idea what it was. It represents things like MRSA, VRE, EBSL, KPC. They are resistant to many antibiotics.

As time goes on I realize how filthy hospitals really are. I mean our ER is not clean. It seems like all the housekeepers do is mop the floor and empty the trash. Apparently the rest is up to us. Do you think that every time a patient leaves the entire room and all the surfaces are wiped down? You are kidding yourself. The hospital doesn't seem to care.
It seems like there is more and more MRSA. How is MRSA spread? From one person to another, not washing your hands. I also think that the isolation precautions we do are a joke. For instance, the supply cart in the room is used before and after someone with one of these infections is in it. Its contaminated.

Hospitals gross me out and I work in one. It seems like if you are ill they are the last place you want to be. Sometimes you come out worse than when you came in because there are so many opportunities for problems: infections, medication mistakes, etc. Hopefully in the future the environment will be so much better it will make now look like the dark ages.

Sunday, April 24, 2011

glee and merriment abound

You know how when you go in a movie theater and your eyes have to adjust to the darkness? Well I am experiencing a similar phenomenom today. I am havinhg to shield my eyes like I am a migraineur. It is so bright outside. There is some kind of gigantic round object in the sky that is so bright that it lights up everything. Wait a minute...whats that you say? The sun....oh the sun....nah can't be. Well of course it is the sun. Didn't recognize it. Its been gone for so long that I thought it ceased to exist.

It has been a LONG HARD winter up here in the nortern tundra boys and girls. The natives are restless. There are people dizzily dancing in the street as I speak. It doesn't take much to make us happy. 20 minutes of sun in a day, temps above 40 and we're good.

It is rather frightening the mirth and merriment outside my window. Us people of the north are usually a reserved, close to vest type of folk. We are not a people prone to outward expression of glee. F--k it...I'm going out there to join them. Who knows when the sun will appear again???!!!

Friday, April 22, 2011

attention everyone


Hi boys and girls. Here is a story for you. It is a puzzle. It tests your knowledge of medical acronyms. I bet your can't get them all.

I was in the middle of a SSDD shift. Enroute was a LOLLOL who FDGB and apparently was CTD, FTD. She had TMB. She was CODE 3 to our ER. Well of course when she got there she was FOS and FTD, time to MFC. I ran to get the RSI kit when the doctor said she was a DNR. End of story. Literally.

Wednesday, April 20, 2011

the candy store

When in the hell are doctors going to step up and deal with the fact that far too many narcotics are being prescribed? Because they lack the courage as a group to deal with this problem, now the government is trying to step in and deal with it. Today the Obama administration announced plans today to force drug manufacturers to teach doctors about the safe use of narcotics. What a bunch of bullshit. Doctors already know exactly what they are doing when prescribing narcotics.

One good idea is to beef up prescription drug monitoring programs. In my state there is a data base that providers can access to see exactly how many scripts the patient has got in the last months.

Excuses I have heard doctors say about prescribing narcotics in ER: They just want to get rid of the patient. They don't want a confrontation. They don't want to be complained about. They figure they are only doing it once, no refills. The thing is every doctor thinks that and it goes on and on.

I hate participating in this as a nurse. It doesn't take a rocket scientist to figure out who the drug seekers are, especially the frequent flyers. It turns my stomach to give these people narcs. I honestly don't know how docs live with themselves around this issue. The whole thing is shameful.

Tuesday, April 19, 2011

when ya gotta go ya gotta go

Here's an interesting happened here locally a couple of months ago. A man calls 911 and is transported by ambulance to the hospital. He lives 25 miles from the hospital. He called because he was having some trouble breathing. Apparently the breathing trouble wasn't life threatening because the medics didn't use lights and sirens.

They started an IV, no doubt gave him a little 02. During the trip they pulled into a parking lot about halfway to the hospital. The paramedic driving got out and went into a building. The patient noticed that there was a Subway and a liquor store in front of them and the medic went into the Subway. So the medic comes back out and they are on their way.

They get to the ER where it is determined that the guy has an abscess in his throat and a swollen epiglottis. He spent a night in intensive care and was released in a day. During the stay he mentioned the stop at Subway to the wife. Naturally he and the wife assumed that the medic had stopped for a sandwich. They complained to the hospital and apparently called some whistleblower operation.

It turns out the medic had a sudden bout of diarrhea and that was the reason for the stop. The guy and his wife still didn't think they should have stopped even though there was a medic in the back with him all the time. Apparently they thought the medic should shit all over herself so they could get a routine transfer to the ER. Your thoughts?

Monday, April 18, 2011

once upon a time...

Once upon a time there was a rocket scientist. Now this rocket scientist did not go to the dentist on a regular basis, who knows why. Well one day rocket scientist has a toothache. Now toothaches suck as we all know.

Well of course rocket scientist does not have a dentist, not using such services on a regular basis. Didn't think of going to the drug store to get something. Eventually rocket scientist decides that this toothache requires emergency intervention. So rocket scientist calls an ambulance. Yes, an ambulance. Now Mr/Ms. paramedic are obligated by regulation to take rocket scientist to the ER, code 58 (if we get stuck in traffic we don't care). Paramedics walk rocket scientist into ER triage. Rocket scientist is put in the lobby after triage. Eventually they are taken back to the fast track and put in a room. Within 5 minutes rocket scientist is on the light asking for pain meds.

And so the story goes on....Act 11 scent 28...enter stage left - nurse practicioner. Nurse practicioner won't give narcs for toothaches, bless her heart. When Nancy nurse goes in to discharge rocket scientist they are no where to be found. They have left without instructions, realizing no narcs are forthcoming.

Your tax dollars at work.
Fade to black....

Sunday, April 17, 2011

remember me? the patient?

It feels like lately the patients are being lost in the shuffle. Caring for the patients that is. In our efforts to have bigger machines, accredidations, number one ratings we are forgetting what is probably the most important thing: the fact that people want to feel cared for. Nurses can't really sit and talk to a patient anymore. We don't have time. We are too busy filling in the blanks, dotting the Is, crossing the Ts. We are troubleshooting the myriad of machinery. We are completing the educational things we are supposed to do when we have TIME. We are looking at the 10 emails we get daily explaining all the changes.

The employer spends a lot of time now a days wanting the employee to do things. Things like giving financial incentives to get physicals, blood tests, taking stress reduction classes. Now they want us to become community volunteers. They want us to change uniforms.

This is all really nice and everything, but with all of these distractions the patient gets little of my attention. It would be interesting to see how much time a nurse actually spends with a patient during a shift. I would be willing to bet it is very little.

Hospitals make over their facilities to look like hotels, putting in feng shui elements, fireplaces, wood floors. They change how food is given to patients every six months. Administrators visit patients.

I would be willing to bet that if you asked a patient what is most important about their stay it is feeling like somebody cared and listened. Thats being lost in the shuffle of competition.

Saturday, April 16, 2011

teetering on the edge of sanity

OK there may be a mass suicide up here in the frozen tundra. Yesterday we had a couple of inches of snow and it is the middle of April and ICAN'TTAKEITANYMORE!!!!! The snow is gone this morning but I don't care! It is still frickin overcast like it has been all week and cold. Why is it every time I have a few days off it is cloudy and cold. It is a conspiracy against me.

I hope the few flowers I have seen have not died a quick death. I think I'll go out and have a massive choclate sundae.

Monday, April 11, 2011

refusing a doctors order

Can a nurse refuse to carry out a doctors order?

I am getting to the point of no return on an issue. The issue is giving narcotics to people are know drug seekers. They are the people who come to the ER every one to two weeks with some pain complaint, have documented drug seeking behavior and are still given narcotics. This happened this past week with a patient of mine. I am beginning to feel really uncomfortable with it. To the point where I am going to make a stink about it.

Doctors hate these patients just like we do. Many times they will placate them so they will leave. They don't want to have a confrontation. They put the nurse in the position of having to carry out something that is unethical. We continue to enable the patient to keep coming back for more. I am tired of being put in this position. I'm going to bring it to the management. I'll let you know what happens.

Your thoughts on this issue? Have you ever refused a doctors order?

Sunday, April 10, 2011

detox reject

Scenario #1:
You are sitting at home having just finished 1/2 quart of vodka, a case of beer, when you call 911 because you are short of breath. Of course you are a smoker. You use 02 24/7. When the medics get there you are drinking a beer. Off they bring you to the ER where you are checked out and booked a room at detox.

Nurse calls report, forgets (?) to tell the RN at detox that you are on 02. You get there with your oxygen running and light up a cigarette. This does not endear you to the detox staff. You think its pretty funny. They don't. Off you go back to the ER to sleep it off.

Scenario #2:
You are a drug addict who comes in for who the hell knows why, I guess because drug addicts sometimes do. You are discharged and proceed to the bathroom where you take a few of your sleeping pills. Someone finds you asleep there in the bathroom, difficult to arouse. Back you go to the ER room to sleep it off.

Another day in paradise.

Friday, April 08, 2011

i'm still doing okay Betty Jo

Honestly I wish the hospital would issue us scrubs. I HATE shopping for scrubs. HATE IT. You walk in the stupid store and there are thousands of scrubs to choose from. I don't want that many choices. I don't want that many colors. I don't want to have to choose v neck, square neck, round neck, ruffled neck. I don't want to look like walking wallpaper or wear something that looks like something you'd see on a bad LSD trip. I don't want hello kitty, mickey mouse, holiday scrubs. I don't want scrubs that reflect the local sports team.

Then, have you ever noticed that scrub shops are always staffed by middle aged women who have probably been there for 15 years....? They want to help you SO BAD. I hate that. Leave me alone and let me looks through all of these assinine patterns.

Inevitably you find something you like and they don't have your size. Here comes Betty Jo again asking if you are "STILL DOING ALRIGHT"? No Betty Jo, didn't you notice I had a seizure 2 minutes ago?

You go to the counter and of course they want to put you on their wonderful mailing list where you will get all those great discounts. They want to know where you work, your blood type, you mothers mothers uncles cousins name. And of course, Betty Jo does this with a big smile plastered on her face in her chirpy voice wearing her Uniforms Personified get up with "Betty Jo" stitched on the pocket.

I run outta there, my sanity barely intact.

con artists?

I'm a genuis okay? I fixed my computer by myself. About 5 days ago I really messed it up. I would turn it on, log on and it would shut off. After trying all this shit to fix it, it just wasn't going to happen. I took it down to a major electronics retailer where we bought the computer. They have a well known repair department. Left it there and they finally got to it after 4 days. Then they told us that they couldn't fix it because we had to order some kind of disk from the manufacturer, run it and bring it back to them and then they could fix it.

So I looked up this disk on the computer and on the website it said that be sure you exercise your free options before you buy this disk. I don't know how but I figured out how to do it but now it works better than before. The disk would have cost 35 dollars.

My question is why couldn't this well known computer repair place figure out how to do this? The thing is you can take your computer in for repair, figuring that you now absolutely nothing about how computers work. They fix it and you just pay what they ask because what the hell do you know, you're just happy they fixed it. In other words, ripe for rip offs. I have found that I can usually look up problems with computers and figure out from that what to do to fix it.

Wednesday, April 06, 2011

newbie doobie do

I am always fascinated by who chooses to be preceptors for new nurses. Its usually the obsessive compulsive know it all nurses. Of course, yours truly, would never be a preceptor. Why not? A couple of reasons: 1) At this point I just want to do my job and go home 2) Lets just say I am not a big rule follower (I know that is hard to believe)

I am what you call a corner cutter. If I think its stupid I might not do it. That means I don't do half the shit we are supposed to do. Bada boom...The stuff I think is stupid is all the ridiculous documentation we have to do. For example a whole pile of shit about whether you have enough money for food, might off yourself or off someone else, etc. We are suppose to ask every person who comes in these questions, even if you are there for a finger laceration.

Another thing: everybody is supposed to have a set of vitals before they leave. Even someone who is there for a damn toothache who had NOTHING done. Stupid. There are times I have not done the medication reconciliation on people who are discharged. OH MY GOD, you didn't do that?!!!! Twenty lashes with a tourniquet.

So you see as a preceptor, I would have be a good nurse, dot all my i's and cross all my t's and tell the preceptee that they must do all of these things or else the world will come to an end. I couldn't do that with a straight face.

Sunday, April 03, 2011

dem uppity nurses

I spoke before about the corporation I work for proposing nurses in all their hospitals wear the same uniforms. Right now we can wear pretty much what we want scrub wise. The reason for this change they tell us, is that surveys done with patients say that they like it when all nurses have the same color.

At first I thought, whatever, who cares? What difference does color make? But I've been thinking. ..(uh oh).

Let me preface this by saying that in the last 10 years nurses have made some significant progress in places across the country about patient care. In California, patient ratios are mandated by law. A lot of people don't agree with it, but its an example of nurses advocating for thier patients and getting some control over their practice. Nurses are speaking up about patient care in different cities, some more loudly than others.

In other words, nurses are realizing the power they have to advocate for their patients and their profession. We are the backbone of the medical profession. When we bargained our contract last year, we felt good standing up for ourselves and our patients. Of course the hospital didn't like it. They want to be able to control nursing at the hospitals we work in. They want us to stay in our place. So when nurses demand the pay and benefits and working conditions due a professional on whom everyone in the hospital depends, the hospital answers that nurses are greedy and unrealistic. They hire PR firms to speak against nurses in the press. They hire PR firms to advocate against the idea of patient ratios in the legislature. They try to change the structure of union activities at the hospital. AND they propose things like uniform changes. To put the nurses back in their place. It says you are hourly wage earners and we can even control how you look. Its just one more way to take away our power. Dem nurses they jus' gettin' too uppity...Your thoughts?

Saturday, April 02, 2011


I know that this week the posts have been lax. But is spring and an old crotchedy gal's thoughts turn to going outside...splashing through puddles and absorbing sun light.

So I was charge yesterday evening and the minute I took over at 3 pm, it exploded. Here's what happened:

1) 4 ambulances enroute with no beds in ER
2) unexpected hypotensive person from another hospital department
3) unexpected employee VIP sort of person who of course had to be put back right away
4) involved phone call regarding lost item
5) chest pains and dyspneas and lions and tigers and bears in triage
6) suicidal people in triage with no bed in ER

Last time I worked charge, same thing happened only worse. I once again put us on divert for about an hour and a half. Maybe I won't have to work charge any more.

On a day like this I am a well paid bed cleaner and bed rearranger.

There is an emerging problem in the ER: Most patients in the ER these days are complicated and sick. They require extensive testing and treatment. A lot of them are admitted and so we play the bed waiting game. They aren't the kind of people that can be put in a hall bed, so ER is full of people that can't be moved. Meanwhile more people coming in who need beds. What do you do? The least sick go to the hall. Some patients and their families don't like going to the hall. I don't blame them. But whater we supposed to do? Sometimes I wish we had an ER admit holding area...