Monday, October 31, 2011

nursing is such bullshit

Top ten reasons why nursing is such complete bullshit:

1) In what other job are you expected be okay with being verbally abused?

2) In what other job, is the leadership so bad?

3) In what other job are you expected to go hours without a break and be okay with it?

4) In what other job are you asked to give dope to a junkie?

5) In what other job are you supposed to try and understand and empathize with someone who is threatening you?

6) In what other job do you get 2 dollars more an hour to be in charge of a place where peoples lives can be on the line?

7) In what other job are you physically, emotionally, mentally exhausted at the end of most days?

8) In what other job could you get a life threatening disease but are given no raise for a year?

9) In what other job are you exposed to junkies, criminals, sex offenders, psychotics, neurotics on a daily basis but you only hear from the management what you do forgot to chart some piece of bullshit?

10) In what other job do the mediocre advance to leadership positions? (see 2)

And that my friends is why nursing is such complete bullshit. The end.


your friend
after a Monday 12 hour shift

Sunday, October 30, 2011

that's me at the triage window

That's me at the triage window. The one who looks exhausted and a little bit peeved. I watch you walk down the hall towards me and, like it or not, I sum you up in seconds just by the way you carry yourself.

I watch you walk in and see how you approach me. Are you shuffling? Are you frantic? Do you have to stop to rest on the way? When you get to the window do you go into excruciating detail going back five years about why you are here? Do I have to pull what's wrong with you out of you? Are you hanging over the desk in a dramatic fashion? Are you pale, sweating? Short of breath? Did you come alone? Do you come with a posse? Do you immediately ask me how long the wait is? Do I need to run you right back? Are you accompanied by the police? In handcuffs?

I will have a pretty good sense of the seriousness of your condition and what kind of person you are before you even come through the triage door. After about a year in ER you are pretty much an expert on the human race and all its quirks and personalities. I can go into a room and take one look at you and sum up how sick you really are.

You might think that sounds unfair. I am not giving you a chance. Its reality. I have to be able to sum you up quickly. If I can't tell if you are real or fake, a wimp or really sick, I'm not doing my job. I am the first one to see you. I have to develop an instinct for people. If I don't you might die. If I assess you in your room and you are in trouble and I don't intervene immediately or call the doctor, you probably going to go down the toilet.

When people come to the hospital, often they concentrate on the doctor: when can I see the doctor? Where is the doctor? You really should be concentrating on me because I'm the one who will prevent you or your loved one from deteriorating. I'm the one who spends the time with you, monitors you, trusts my gut when dealing with you. Your life is really in my hands. Especially if you really have an emergency.

Saturday, October 29, 2011

madness: personification of evil

Dere is people out dere who be thinkin' dat madness is a cynic, a real bitch. I don' give dose drug seekers the benefit of the doubt and all dat. I am a hard, burned out old witch of a nurse....that goes without sayin', but in my defense...I have been in the ER for many a year. My job is similar to a cops, only I have to keep my mouth shut. The cop can tell your sorry ass to shut the f--- up, I can't. I could but I would lose my job. Need the job, so don't. Cops have guns, madness don'. But we do deal with all the same people. From one end of the spectrum to another.

So excuse me if I have developed jus' a little bit of suspicion, caution, you gotta prove you ain' oneadose drug seekin' idiots attitude. I, along with many of my nurse pals, have been burned. Big.

What folks don' understand about drug seekers is that they are ADDICTS. They will do anything to get the fix. They will lie, fake, tell whoppin' stories...they are really pretty dangerous people. I have seen them get out of control when they don't get what they want. Suddenly that back pain is out the window and they are fightin' security on the floor.

I have seen drug seekers tell MAJOR stories that we all believed. What they are willing to do for the fix would floor you. So check your attitude about me not carin', giving the benefit of the doubt, etc. I have big time intuition about people. I can spot a faker at 50 paces with 99.9% accuracy. Whether you like it or not.

They waste my time, your money. (yeah, dats right mr/mrs taxpayer your money - you don't think THEY are payin' do ya?)Picture this scenario: your mom is having a heart attack and you bring her to us. I can't help her right away because I am down the hall dealing with the out of control drug seeker....thats my job in a nutshell.

Thursday, October 27, 2011

runaway train, never going back

Here's an interesting development: Some states are passing limits on the number of inpatient days per year for adults on medicaid. It ranges from 10 days in Hawaii to a new proposal of 25 days in Arizona. This is all in an effort to decrease cost.

Lets say your patient has an illness that requires more than 10-25 days...or that your patient comes to the ER and needs to be admitted but has used up their yearly inpatient days...then what? They will be admitted to the hospital because the hospital is not going to throw them out. For liability reasons, for EMTALA reasons, they will get the care they need and the hospital will absorb the cost.

These changes, along with the coming 30% cut in reimbursement of physician fees come 2012, are going to have a dramatic effect on hospitals bottom line. I really wonder how the government and our country expects hospitals and doctors to deal with all of this. We will see more hospitals closing, more doctors will refuse medicare/medicaid patients.

At a time when medicare and JCAHO are requiring more and more of hospitals, reimburnsement keeps going down. It doesn't make sense. People want sophisticated treatment and the latest technology, but the money is not there to pay for it. Health care in this country is like a runaway train that gets closer and closer to crashing. Like most problems, we will no doubt wait until the crash happens.

Wednesday, October 26, 2011

Four Loko is muy loco

Four loko. I have vaguely heard of it. I thought it had been banned.

It is an alcoholic energy drink. Described on one web site as: "Legalized cocaine in a can. If you consume Four Lokos you can expect to encounter the same results typically associated with snorting a small mountain of cocaine".

It contained caffeine and alcohol, apparently not a good combo. If people drank 2-3 cans, blackouts are common. People end up in jail and ERs a lot. It was popular with college students. Why wouldn't it be? As of 2011 caffeine was removed from it because of all the problems associated with the combination of ingredients.

Why am I telling you this? It is all part of the Madness Emergency Room Information Initiative. Har. Actually one of my patients told me they had been drinking Four Lokos to dry and relieve pain they were having today. Guess it didn't work...

Tuesday, October 25, 2011

danger, will robinson, danger

Just when you thought health care couldn't get any stupider comes news:

JCAHO requires that your bulletin board hold limited information and that all sheets of paper on the board MUST HAVE TACKS IN ALL FOUR CORNERS.
Apparently if your don't have it tacked down in four corners you could lose your accredidation.

I can understand their concern about the whole four corners thing. Paper can be dangerous for the following reasons:

1) Someone could get a nasty paper cut from that fluttering piece of paper.

2) Lets say the paper comes loose due to only having one tack, it could become a missle and take somebodys eye out.

3) A wind could come by and move the paper around helter-skelter and your eyes could follow that motion, causing dizzines and a fall to the ground perhaps requiring boarding and collaring.

4) The paper could become loose, fall to the floor. You bend over to pick it up and herniate a disk. You become addicted to narcotics and lose your job as a nurse becoming an aimless drug seeker.

5) The paper becomes loose, a random gust of wind takes it down the hall. You chase after it, slip on the floor, hit your head on the corner of a desk. You develop a massive head bleed and become a vegetable.

Shit. I never knew paper could be this dangerous.

Monday, October 24, 2011

more complexity = more money

Nurses should be making more money. Period. End of conversation. Our jobs have become increasingly complex. The amount of information we are expected to retain has become impossible.

The patients coming to the emergency room these days are no longer as simple as a sprained ankle or UTI. We get those, but they are a increasingly small percentage of who we see. Our typical patient has become someone with some kind of chronic underlying illness, sometimes a couple of them, who is in for an exacerbation of the illness or another problem complicated by their underlying illness. For example, we might get an ambulance call for someone with abdominal pain. They forget to mention that they are also a quadriplegic with decubitus ulcers that are MRSA positive. A woman with a UTI comes in, however she had a heart transplant last year and is having signs of rejection. Honestly, these kinds of patients are becoming more commonplace.

Everyday,policies and procedures change. Documentation requirements change. New drugs are being used. New programs are started. We have an MI program involving getting people to the cath lab in 15-30 minutes within arrival. Before they go,they have to have IVs, meds given, drips started. Documentation done. We have a stroke program. TPA started within an hour. A post cardiac arrest hypothermia program which involves placing the cool down device, staring about 5 drips, foley, OG etc. These are just a few of the complex procedures that are becoming commonplace in ERs along with
handling ventilators, bipap, rapid infusers, central lines, CVP lines, rapid sequence intubation, etc.

Then there is the documentation. We do electronic charting. Charting around conscious sedation, blood transfusion, restraints, critical patients has become a nightmare. With increasing HIPAA, medicare, CMS requirements, documentation is nearly impossible to keep up with.

I make a decent wage after all these years, but I should be getting a lot more. My job is complex, the responsibility is enormous, the stress is at times overwhelming. What other job involves this kind of complexity and makes this little money?

If hospitals don't pay more money, they will face a severe shortage of nurses, worse than the one that is predicted in the next 20 years. Nurses coming into the profession are not going to stay in this kind of
environment if they are not paid equal to the requirements. Why would they? They have so many other opportunities. I see them talking advantage of those opportunities. Many of them are becoming nurse practicioners, CRNAs, heading straight out the hospital door.

Sunday, October 23, 2011

can you work in the ER and still be nice?

One of my co-workers retired last week. They have these things called teas for people when they leave. The cafeteria in the hospital brings up some appetizers and cake(whoopee). People are supposed to come and say goodbye to you. I told a co-worker today I am either going to just disappear into the fog or cancel the tea and have a drunken party.

The person who retired today had put in 29 years. She was the kind of person who was always nice, never said a bad word about a patient, a coworker. In other words she wasn't really human...just kidding. There are maybe 2-3 people in my department who have been there a long time who are always nice, don't speak negatively about things. The rest of us rant and rave.

Some days I come home and tell my husband or son about some bozo I saw that day or a funny story. My son told me he thought I was mean the other day because I sometimes have little sympathy for the users and abusers of the ER. I told him that the people I have sympathy for are people like the guy who is mentally disabled, has a brain injury, now has sores on his back that have MRSA, can communicate little. Or I have sympathy for the cancer patient who is suffering. The mother miscarrying. Those are the kind of people I have sympathy for. I have little sympathy for the drug seekers, manipulators, fakes, phonies. I call 'em like I see 'em with those people.

I have often had the thought can you spend years in an ER and still be a nice person? ER does give you a jaded view of humanity. It's hard not to start viewing the whole world that way, to bring that attitude into your personal life and how you see other people. Honestly, I don't think that you can work in ER long and not develop somewhat of a hardened cynical attitude. That is probably the most challenging thing about working in ER or being a nurse in general,to maintain your view that people are basically good, 'cause you run into a lot who aren't. If we didn't all believe in the goodness of humanity somehow, I guess we wouldn't be doing what we do...

Saturday, October 22, 2011

you are nuts until proven otherwise

After years of experience, thousands of hours of patient care, I have arrived at a personal philosophy of ER medicine that works for me: YOU ARE NUTS UNTIL PROVEN OTHERWISE.

You know, to crystallize this phrase and philosophy in my mind gives me a sense of inner peace. I can relax. There will be no more surprises as I enter a patient's room. I will already know they are nuts, so nothing they do or say will surprise me. I can say to myself - you're doing that because you're nuts! I may even start to develop more empathy for people. Hey they can't help it - they are nuts...

What is genius about this is that when they aren't nuts, I will be pleasantly surprised! really are a normal unique. That knowledge will put a spring in my step, a song in my will restore my faith in humanity people I tell you. I'm so relieved...

Friday, October 21, 2011

and the award goes to....

Welcome to this years Drug Seeker awards. I am your host girlvet. Sit back ladies and gentlement as we honor those emergency patients who gave the most convicing performance over the last year to obtain that almighty bottle of Percocet. Yes, people,these performers put a lot of thought into those requests and now they will get the recognition they deserve....

In our first category, the nominees for best performance by a chronic back pain sufferer, the nominees are: 1) car bound junkie - this billiant performer is in the back seat of the car lying flat on their back unable to move without assistance. They send a concerned relative to the triage window who requests a cart, not a wheelchair, because they cannot possibly make it into triage by themselves. The ER must come to a grinding halt as 3-4 staff go out to lift their carcass onto a cart, no small feat. Bravo, car bound junkie.

2) MRI toting junkie - this performer, in a well thought out strategy,walks in with with an earnest, yet tense, look on their face and does a lot of heavy sighing. Requiring no direction, they bring their own props in the form of an MRI or at the very least a typewritten report of an MRI, thus proving their legitimacy for all concerned. What can I say, they dominate the screen with their presence...

3) victim of circumstances beyond my control junkie - this person, is a credit to their profession, a method actor really,who has obviously spent time in ER waiting rooms across the country observing other drug seekers in order to get a real picture of the lifestyle. It brings a tear to the eye, as they explain that their medication a) tragically fell into the toilet b) was stolen by some rapscallan or in a surpise turn the script was lost BEFORE IT WAS EVEN FILLED..It makes the average ER staff want to shout "NO!! NO! IT CAN"T BE! SURELY LIFE CANNOT BE THAT CRUEL!!" But alas, dear viewers it can indeed be that cruel and victim of circumstances beyond my control lets us in on that emotion brilliantly...

4) I have an appointment junkie - this performer, comes right out of lest field during the triage interview with a left hook. Things are moving along nicely in the story when all of a sudden POW!! they hit you with an emotionally wrenching: "I can't get into my doctor for 2 weeks and I am out of my Vicodin!" Of course, this dramatic twist was unexpected and leaves one breathless...

5) I just moved here junkie - in a subtle yet convincing performance, this actor's actor, will casually let drop the fact that they just moved here from out of town and, cue the dramatic music, DO NOT YET HAVE A leaves you reeling.. and before you can recover from that startling news, in a moment of sincerity they request that maybe you could refer them to a local doctor. Shades of Sir Lawrence Olivier, you sit there stunned, speechless, jaw open applauding your heart out...

And the winner is...ome up here you talented fool and receive your beautiful beautiful tiara, along with a years supply of Percocet...VICTIM OF CIRCUMSTANCES BEYOND MY CONTROL JUNKIE...that's right...I think you will agree that victim is the most versatile and creative performer this year. You literally never know what excuse they will come up with next and it keeps you on the edge of your seat.We'll be right back after a word from our sponsor, why Percocet of course you silly.

Thursday, October 20, 2011

harriet the hoverer

This will offend some people. Oh well...

Sometimes I wish that family members were not allowed in the ER at all. They can be a real pain in the ass. The minute I walk in the room I can tell whether you will be a PITA. First clue: you try to talk for the patient. That is such a condescending move. It shows that you don't respect your loved ones ability to speak for themselves. I get that you may have more information but please wait until I have talked to the patient before you butt in. Otherwise I will have to tell you to stop talking and let the patient talk. I really don't care if you don't like it.

Then there are the HOVERERS, the bain of the ER nurses existence. Sometimes I think if you could be on my shoulders while I start an IV or give a med, you would be there. I really do know what I am doing and I have the best interests of your loved one at heart. Let me do my job please without feeling your breath on my neck.

HOVERERS are the kind of people who instead of putting on the call light will come out to the desk every fifteen minutes to find me to ask something. We give you the call light for a reason.

Now I can hear some of you with ill loved ones getting mad at me for talking about this. After all, you tell yourself, I am just looking out for my relative. OK, I get that...but talking for the patient, hovering over the nurse is not looking out for the patient. It is weird and kind of neurotic. If you speak for the patient, hover excessively, we are gonna let the next nurse know. Warn them about you. You might think thats wrong, but I've got news, nurses talk to each other about this kind of stuff.

Back off. Let us do our jobs. We really do them well.

Monday, October 17, 2011

oh what a tangled web we know the rest.

You had me fooled and I have been around a while. There you were about 10 feet from the triage desk, on the ground having a seizure. I went out there while my co-worker got a cart. So your "seizure" (do you see where this is going?) lasted maybe a minute.

I mean you were on your side, rigid, moving, making the appropriate airway gurgle type noises. Here's the thing: if you are gonna do the seizure thing you have to work on your postictal period. You woke right up and were even able to stand and get on to the cart. Here's a clue: when someone has a seizure they are out of it afterwards...

So yeah you were full of shit. You added drama to an already bad day. You took up a bed that one of the 20 people waiting in the lobby could have had. But hey, you had me convinced, cynical old madness bought your act for a minute. Congratulations.

Sunday, October 16, 2011

don't call us, we'll call you

Dear doctors/clinics/home health nurses, etc:

Effective immediately you may no longer call ahead to tell us that you are sending in so and so to be seen in the ER and you want to give us a "heads up". We don't want a "heads up". We find you "heads up" a waste of time.

I am in triage, it is busy and your sorry butt calls up in the middle of all of it to tell us about this patient. I don't care. What you have to tell me is useless information. Sometimes I don't even write it down. Nothing you say will change the way your patient is treated in the ER. They will go through the same process as everyone else. They will be triaged, may or may not go back to a room right away, our doctor will see them and THEY will decide what to do.

Your patient will not get back any sooner because you called. Don't tell your patient that they will. Telling your patient that you will be calling us to tell of their pending arrival makes your patient think they will be a priority. They won't be. They will be TRIAGED like everyone else. Often patients have the mistaken notion that you meet them there. Please tell them that the last time you were in ER was 1965 and that you won't be seeing them.

It is not 1970 and you are not Marcus Welby and you don't need to call us. We really can manage your patient all by ourselves.

Friday, October 14, 2011

bad dog

Emergency department no-no's. You are a bad dog:

1) Don't fall and come in by ambulance and have a baggie of crack in your sock that the doctor finds when he examines you. At age 65 no less. Then keep coming out of your room yelling that we have no right to take your property.
2) Don't come in with your girlfriend (the patient) and then go out to the ER entrance and try the door on a car that is sitting there and get in and look around for something to steal. Then go back in your girlfriends room like nothing happened.You see my dear moron, we have cameras at the entrance, so smile you are BUSTED!
3) Don't come in with your boyfriend and both of you ask to be seen for the same thing: chronic back pain. Then expect both of you to get a supply of Vicodin. I don't think so.
4) Don't go in the bathroom and down a bottle of jack daniels before you are admitted to mental health.
5) Don't be banned from 3 local hospitals because you were sexually aggressive and threatened to kill the staff, then set your sights on our hospital.
6) Don't adjust your own IV pump to cause yourself another medical problem so you can be admitted.
7) Don't call us on the phone and ask if we do c-sections there because you are "tired of carrying this baby".
8) Don't pack some hospital sheets and towels into a patient belongings bag and try to leave with them. EWWWW!
9) Don't come in for something related to your pregnancy and then steal the fetal heart monitor that we used to hear your baby's heartbeat.
10) Don't tie up your dog at the emergency entrance and then come in to be seen.

Thursday, October 13, 2011

GOD makes an appearance at the triage desk

Damn. Has the whole world gone nuts? Today at work was like working in an insane asylum. People being thrown out and taken away by the police. People being restrained. Drunk people, high people, wacked out people.

At one point we had about 6 psych patients in the ER and a couple waiting to get in out in the lobby. What is it, a change in barometric pressure? The change in seasons? The remnants of a full moon? The economy? The fact that Herman "godfather pizza" Cain is now leading in the republican polls?

I would say the highlight of the evening was when GOD HIMSELF appeared at the triage desk and asked for a county crisis number. HE literally walked up to the desk and said HE was GOD and mentioned it had taken HIM a long time to figure out who HE was. HE took the number and headed toward McDonalds. Bye GOD...

Wednesday, October 12, 2011

mr. bear comes out of hibernation

Once upon a time there was a man...
He was found passed out on the grass. Somebody passing by called 911. In he came by ambulance to our fair ER.

On arrival he was so drunk that he just slept for a long time. Arrangements were made to send him to the friendly neighborhood detox center. An IV had been started during his admission to give him the "infamous" banana bag. The IV had to be removed. As it was being taken out, the bear woke up and came out of hibernation. The bear wasn't happy at being disturbed from his long drunken nap. He sprang out of his lair (room), took off down the hall yelling "I'm going home! I'm going home!"

His commotion drew a crowd including his doctor who asked to see him in his room. Of course the bear was havin' none of that. He shouted "I want to go home". Not an option Mr Bear he was told. Alas, a suite has been arranged for you at the local detox-o-rama. Those accommodations were not acceptable to Mr. Bear who now refused to go back to his room in a loud voice.

Meanwhile reinforcements had been called in in the form of several security guards. (You know they are serious when they start putting gloves on). They surround Mr Bear and try the calm approach first - talking him down. Mr Bear called them among other things "bitches, toy cops". Finally Mr Bear made a wrong move and he was taken the floor, handcuffed and then placed in restraints on the cart. Mr Bear has now burst into tears. Not so tough after all. He is given sedation and waits for the ambulance to take him to detox now on a 72 hour hold.

No one got hurt. Always a bonus. Entertainment and education was provided for all the other patients. the end

Tuesday, October 11, 2011

the good, the bad and the ugly

I do a lot of thinking about nursing, not a surprise to anyone that reads this blog regularly....

Nursing is such a weird profession. When I was a nursing asst way back when, I swore I would never be one of them bedpan carrying nurses, but here I am. If you look at nursing intellectually it is a pretty cool job. It is interesting, challenging, rewarding. It is always changing. Not everyone can do it, particularly ER nursing. It is never dull. It really fits me to a T. I don't like routine. I like a challenge. I like the chaotic environment of the ER and function well there. It has variety. So sometimes I say to myself, cool. I'm glad I went for this job.

Then someone calls me a "fucking bitch!" and all of the above goes out the window. I ask myself why am I in a job that is as hard as this one? A lot of the time it feels thankless. It exhausts me physically, mentally, emotionally. It overwhelms me at times. Its too much responsibility for too little.

Now some nurses would say, oh when people thank me it makes it all worthwhile. Whatever. I suppose. That is somewhat important but not that much to me.

I would say what has kept me in nursing (ER nursing in particular) and what I will miss most is the challenge. Nursing is one of the most challenging jobs you can have. It challenges you intellectually because you are always learning something new. It challenges you as a person to be able to function in situations that are life or death and be able to do it. It forces you to handle anything from the very weird to the very scary and learn to deal with it. You never know what will walk through the door and that is both ominous and interesting.

Can you ever integrate the two sides of nursing: the good and the bad? I really don't think so. All you can do is take it day to day and do the best you can.

Monday, October 10, 2011

there was joy throughout ERland

Having been in the ER for 59 years, I have always wondered why there are some days that bring in hoardes of people. Like today for example. There has to be some kind of rational scientific explanation involving atmospheric changes or something that brings everybody out at once. Someone work on that alright?

Anyway...I would like to propose a new national holiday that would only apply to ERs. It would be called the "national ER chronic pain patient free holiday". One day a year, all ERs could have this one day in which they wouldn't have to take care of any of the following patients and their complaints:




low back pain

neck pain

chronic abdominal pain


any weird syndromes

carpal tunnel

knee pain

Joy would ring throughout ER land. Angels would be singing. Nurses would be dancing. Everyone would want to work that day. The day no one did a crappie flop on the floor, threatened to call their lawyer, had to be put out by security...oh happy day....

Sunday, October 09, 2011

red flags inER

Red flags in the ER:
1) You say you have "chemical sensitivities".
2) You have more than 2 allergies.
3) You have fibromyalgia, chronic fatigue syndrome, some kind of syndrome no one has ever heard of.
3) You bring your MRI or CT with you, usually of your back, stating you can't get into see the doctor for a "couple of weeks".
4) You say you just moved here from out of town.
5) You bring a suitcase with you.
6) You brought something in a bag that you want to show me.
7) You can't tolerate the "pain" of an automatic blood pressure cuff.
8) You're allergic to haldol or thorazine.
9) You are 40 and your mother is accompanying you
10) You say another emergency room "don't know what they're doin'".
11) Your medical problem started in 1930.
12) You say "yes ma'am a lot.
13) Your relative is taking notes.
14) The medics want me to come outside of your room to give me report.
15) You are taking more than 3 psych meds.

Saturday, October 08, 2011

just kill me now

Is there a limit to the number of narcotic pills that a doctor can give a patient in one prescription? Apparently not.

A lot of states have a system in place that tracks prescriptions and is accessible by doctors and pharmacists. Enter patient who had never been to our ER before... Presents with story of chronic neck pain from an accident a year ago. Blah blah woof woof. SSDD. Okay?

Look this guy up and he had received a script for prescription narcs for a month ago in the amount of 350 tablets. I kid you not - 350 tablets. Oh but that's not all. In the following 3 weeks they recieved one script a week I assume from another doctor for more narcotics in the normal amount someone would get. So lets say he recieved only 20 tablets in each of the next 3 weeks because I can't remember the exact amount. So that is 410 narcotic tablets in a months time. So I wonder what this guy is doing with all these narcs? I'll give you three guesses and the first two don't count. Lets say the street value of the pill he got is $5, that a cool $2,050 in the pocket with no trouble at all. Then we wonder where the prescription drug problem comes from in this country.

Oh did I mention that despite all of this info, the patient got an injection of narcotics? Oh did I mention that they left as soon as they got the injection?

A lot of docs seem to have this philosphy that you give 'em narcs in ER and then don't give them a prescription and everything is copacetic.

Docs would say I have to relieve their pain, thats why they came in. I don't want a complaint. I don't want them to make a scene. There is toradol, ibuprofen. Why not go there? I just do not get it and I never will. I really want to understand a docs reasoning with all of this because this is the kind of stuff that makes you want to leave nursing. It feels really sleezy to be part of this. Every time you are part of this kind of stuff it takes away a piece of your soul.

Thursday, October 06, 2011

you got da clap my dear

One of our jobs as ER nurses, at least in our ER, is telling people test results if they call or calling to tell them results. Guess what kind of results we call about? 99% its STDS of course. Gonorrhea and chalmydia take a couple of days to come back. We tell them we will call them if results are positive. Sometimes they call us. In the old days we treated people prophylactically usually with Rocephin IM. We're not doing that these days.

So, hopefully I can get ahold of you, in other words, hopefully you gave us a real telephone number. Hopefully, your number is not turned off, which is the case more times then you would think. So I get ahold of you and drop the bomb, you got the clap sweet pea, a SEXUALLY TRANSMITTED DIESEASE. I always emphasize that part. Reactions vary from a nonchalant OK to anger. Then there is the person who starts asking questions. They want to know: how long does it take this to develop? They are trying to figure out who gave it to them. Help me....

Anyway I call the script into the drugstore or they pick it up. I tell them to have any sexual partners treated. Heh. Then I tell them my favorite part: We are obligated to report this result to the state board of health and they will be contacting you. They gonna be askin' who yo sex partners are so they can track their butts down.

This whole process is a lot of fun for everyon involved...

A side note: Men with STDs are getting off a lot easier these days. It used to be that the doctor took a culterette and did a little roto router action on yer johnson. Those days are gone. Now all you have to do is pee in a cup if you are a guy. Thing is, the gals still have to endure the pelvic. Another example of how women suffer in this life. Yeah I said it: suffer.

Wednesday, October 05, 2011

now my back is wack

Dear families of potential ER patients:

This is a request by your local ER staff to call 911 when it is appropriate. If you have to carry Dad out to the car, thats a sign that you should call 911. Here's the thing: getting Dad out of the car is not easy for us. This is how ER staff get injured. Also, if you put Dad in the car don't put him in the 3rd seat in the minivan so we have to crawl all the way in to get him out.

A special note to the wives of potential ER patients: Men are notorious for ignoring symptoms and not wanting to go to the doctor, let alone to the ER. If your husband is having chest pain, severe shortness of breath, signs of a stroke, just call 911. If he gets mad, don't worry about it.

Today several of us had to crawl into a van to get someone out and now my back hurts.


your hospital ER staff

Tuesday, October 04, 2011

it's like being slowly tortured

Its like torture sitting in an ICU at the bedside of a loved one. They have tubes coming out of everywhere. You know they are uncomfortable. They are scared and the thing is there is nothing you can really do about it. You want to fix it. You can't.

So you sit there every day hanging on every word of the doctor who comes around a couple of times a day. What's todays verdict: better, the same, worse? Most days its the same. Progress in critical illness can be agonizingly slow. You begin to wonder when it will all end. It's too much. It's too stressful. You don't think you can come here another day. But you do, you will be ere tomorrow.

One thing I noticed is the kindness of those who cared for her. From the resident to the nurses to the RT person to the housekeeper who asked if she was better. I could tell they all cared. That made such a difference. You soak it up like a sponge knowing that these people are doing their very best for her. Doctors are really important, they are the directors of care and use their knowledge to make people better, but it is the everyday care that the family sees - the nurses, the RTs. They are the one who spend time with the patient and the family 24/7. They are the ones who carry out the care and notice the differences every day.

She's transferring to the floor today. Yeah!

Monday, October 03, 2011

fun with emergency room math

An oldie but goodie post..

Math. Does anybody really like it but math geeks? You have to have a certain amount of math to get into nursing school and become something like a licensed practical nurse. I wonder if you still learn the apothecary sytem...anyway we don't use much math in nursing anymore because they don't trust us to do the math, literally. Machines do it for us nowadays. In ER there is a special kind of math that we all get to know involving equations. Let me demonstrate:

1)Xanax + ETOH + Lexus +75 mph = airborne driver + multiple fractures
2)Tractors + old men = Death
3)ATVs + young men = Death
4)Bicycles + riders - helmets + cars = Death
5)300 lb old women with UTI + old man with hematuria + anybody with back pain + young woman with abdominal pain = crazy nurse
6)Mean drunk + anybody on meth + overdose needing lavage + anybody constipated = suicidal nurse
7) Unwashed feet + alcohol and cigarettes smell + GI bleed smell = sick nurse
8) Fibromyalgic + migraineur + helicopter relative or friend = nurse running out of ER

is there a "doctor" in the house?

Fascinatin' article in the New York Times today. Most of you probably know that nurse practioners will require a PHD to practice by 2015. They can call themselves Dr. so and so because of the doctorate and all. Some are doing so. And guess what? Them other medical Drs are not happy. What a shock...

They are concerned over who gets to be called "doctor". If they allow other people to use the doctor title, they could "lose control of the profession". There is so much concern about this that legislation has been proposed bar people from "misrepresenting their license". Various states have taken up the issue in their legislatures.

Why do NPs think they need a doctorate? They want to have parity with other medical professions that require a PHD such as pharmacists. They think it gives the clinical knowledge that will allow them to be leaders in clinical practice, research and teaching.

I think this is about one thing: independent practice. NPs want to be able to have their own practices that are not being supervised by an MD. This is a move in that direction. And why not? Whether we like it or not, NPs are the future of primary care. They are the ones that will be working in the offices and doctors will be the specialists. Its inevitable the way medicine is going.

I think the whole "doctor" thing is really kind of amusing. Its a non issue. Most NPs will not call themselves doctor. Most NPs identify what their profession is to patients. Doctors are scrambling around these days as they see there role changing. They are panicing about having to justify everything they do. Are medical schools still teaching them that they are the center of the universe? I think they are. The thing is doctors have become just like the rest of us: part of a team. And they don't like it.

Sunday, October 02, 2011

between a rock and a hard place

OK I have newfound respect for ICU nurses after watching them for the past 9 days. One thing I have observed is about staffing. When you have a vented patient, and another patient, it must be hard to keep up. That seems to be the staffing I've seen - two patients. The thing is when something goes wrong with one of your patients you are screwed.

So I'm sitting there with my relative who is on the vent but stable. Her nurse gets another patient post op I guess, since we are in SICU. The patient arrives and within a half an hour I hear: "anesthesia stat to room ---". Its the person next door. He had to be intubated so everybody is scrambling around.

So now my relative's nurse has 2 vented patients, one of whom is unstable. Now you might think, the other nurses will pick up the slack, and they do, but they still have their own patients. So a burden is put on them. There is no "extra nurse" to pick up one of her patients. They staffed for what was there at the beginning of the shift. So her nurse struggles to keep up until they move my relative down the hall and she gets a new nurse. Thus is the juggling that goes on in the ICU.

That's part of why we can't get people upstairs, the tight staffing. Hospitals never staff extra for emergencies. They staff for what they have. Its understandable because they don't want to pay a nurse to do nothing, but this is all part of the delay in getting beds.

Another delay is waiting for doctors. They extubated my relative today. It took til 1 pm for the staff doc to come and say it was OK. Nurses are always waiting for docs to come to transfer patients, discharge patients, do procedures on patients. Its all so inefficient.

These factors play into people in ER, PACU and admitting waiting for a bed. I don't know what the solution is. They aren't going to have any extra nurses. Doctors probably won't get more efficient. So you are left with an inefficient health care system with no real solution.

On the positive side my relative is extubated and her and the baby both are looking good. Its been a long week...

Saturday, October 01, 2011

I wanna be a virtual nurse

So I have been hanging out in the ICU lately and I talk to the nurses. One nurse told me about a new thing that is coming to their hospital - it's called the EICU. Enhanced Intensive Care Unit.

Apparently 10% of all ICU patients in the country are electronically monitored with this system. A center is set up with critical care nurses and intensivists who continally monitor patients and see trends and help manage critical situations. They can make suggestions on how to manage patients. In the hospital in my area it will be used to monitor patients in outstate small hospitals. Its a 2nd set of eyes and links smaller hospitals to advanced help.

I think this is being done in all kinds of hospitals, not just rural or small town hospitals. Some hospital systems have it for the majority of their hospitals.

I wonder what the ICU nurses think of it. In the smaller hospitals I would think it would be welcome. In the bigger hospitals, nurses might not like it. There are a lot of nurses who want control of their patient situation and don't want anyone interfering. They would have a hard time with someone trying to help manage the patient from some remote location.

Is this the nursing of the future? I can envision hospitals having this and figuring they can have less nurses or give the nurses they have more patients because there is always someone watching.

Your thoughts?