Wednesday, August 29, 2012

are nurses going insane?

Are nurses going insane? Has the pressure become too much?

Recently a nurse through a kidney that was supposed to be transplanted into the garbage. I guess I wonder how that would happen. Did she/he mean to throw away the kidney that was removed? Is that what they do with the old kidney? Who knows....

Another 68 year old nurse set like 17 fires because she had taken care of people all of her life, no one paid any attention to her or cared about her. Well I guess everybodys paying attention to you now...

I hate when nurses are in the news for bad stuff. Makes the rest of us look bad.

Monday, August 27, 2012

the moron list

Dear Mr/Mrs John/Jane Q. Public:




Your tummy upset is not our problem. I don't care if you literally puke your guts out. Do not come to your local emergency room. If you do, here is what will happen:

We will talk about you. The staff will talk amongst themselves about what an idiot you are.

If you take an ambulance into the ER for this you will go to the top of the moron list that we keep in a drawer in triage.

*****THAT IS ALL*****

Go about your business. Nothing to see here.

Friday, August 24, 2012

a change in barometric pressure

One of the things people who work in ER always wonder about is: WHY IN THE HELL DOES EVERYONE DECIDE TO COME AT ONCE??!!! Why is it that certain days, the teeming masses present at the triage desk?

Some theories:

1) Change in barometric pressure
2) Full moon
3) Nothing on TV
4) Get it over with before the big game
5) Nothing else to do
6) A voice told them to come
7) Out of crack, meth, heroin
8) Solar storms

After about 2 weeks working in ER you give up ever trying to make sense of it. Its random, there's no rhyme or reason.

So why, pray tell, do I bring this up? Because it has been so damn busy in the last couple of weeks. We're not talking regular busy, we're talking
****BUSY!!!!!!!****. Most people ever seen on one day in ER history this past week. 30% more than budgeted daily census. People waiting hours.

Did something happen that I don't know about? Was there some shift in the universe? A change in gravity? What in THE HELL is going on? I don't like it. I don't like it at all...

Are you busier?

Tuesday, August 21, 2012

living in the hospital fantasy world

I work in the land of make believe. Its a place where everybody pretends things are different than they really are. There are beings here who run this land of make believe. They are the ones who make the rules. Lets call them the rulers.

The rulers like to get together and think up new rules and change the rules they already made. That's what they get paid to do. They send the rules and changes they have thought of down to another group of people who deliver the rules, make sure the rules are followed. Lets call them the enforcers.

The people who receive the rules and changes and have to live by them are at the bottom of the pyramid of make believe land. They are the people who actually try to follow the rules as they do the work. Lets call them the nurses.

Here's the thing. The rules that the rulers make, and the enforcers enforce are rules that nobody can ever follow. There are too many rules, they keep changing. The nurses can't possibly follow the rules. There are too many. Its impossible to keep up with them. The changes are too numerous and often make things more complicated.

So the nurse eventually give up. They tell each other, forget it. I'm not even going to try and follow the rules. There is no point. I can't keep up. I'm just going to follow the rules I can and screw the rest.

Moral of the story: If you keep changing policies, increasing charting requirements, making things more complicated, the nurses will just do what they can and you won't get what you want. And when the rulers of the rulers, the kings and queens of make believe JCAHO) appear, everybody will be screwed.

Saturday, August 18, 2012

you can't come here...not

In my state there is a program within medical assistance restricts those "who have used services at a frequency or amount that is not medically necessary and/or who have used health services that resulted in unnecessary costs to MA. Once identified, such recipients are placed under the care of a primary care physician/other designated providers who coordinate their care for a 24-month period."

This includes these people being required to go to only ONE assigned hospital for their care. Do they follow this program. OF COURSE NOT. They regularly come into our ER even though they are assigned to another hospital.

Here's the thing: If they go to a non-assigned hospital, unless it is a life threatening emergency, the bill will not be paid. Of course they have to have a medical clearance per our wonderful EMTALA regulations. After that they can be sent out the door to their assigned hospital. Does this happen? OF COURSE NOT. Docs still see them, order tests, etc. Why? WHO KNOWS.

Here's the thing, the person has no incentive to go to their assigned hospital. They don't care if it won't be paid. Even if they are billed, they won't pay it anyway. So in other words, this program is a joke. It no doubt spends thousands if not millions of dollars to run with no success.
Wonder why the health care system is going down the toilet? Here is one more reason...

Thursday, August 16, 2012

more money for nurses coming

Nurses, I've got good news and bad news.

Good news: Chances are you are going to be making more money in the next five years.

Bad news: The healthcare system is going to be so overwhelmed with people that you will be even more stressed than you are now.

In two years Obamacare starts. This means 30-40 million people who never had healthcare before will now be able to have it. They will feel free to go to the doctor, the emergency room, etc. And they will. Of course, there won't be enough doctors, so they won't be able to get in and where will they head? Why, the ER, of course. They will, in fact, overwhlem the doctors office and emergency room as the nations healthcare system tries to absorb them.

There will be a shortage of all healthcare workers. Guess what? That means more money for us. Now you are probably going to say: Where will all the extra money come for more nurses when healthcare is already financially strapped? I don't know. Maybe they will have to fire some redundant bereauocrats. (what a concept) The money WILL come from some where, I guarantee it. You have to have nurses. There is no way around it. Ifthe money doesn't come, nurses will quit and go to temp agencies which will explode with need.

Healthcare is going to change so much. It will have to. Otherwise, it completely collapses. Roles within healthcare are going to change. NPs will become the foundation of primary care and be paid better. Healthcare employers will try to "supplement" nursing staff with other less expensive workers. Here's the thing, nurses will still be needed with the increasingly complex technology based medical care we provide.

However, nurses better wake up. We need to prepare for a time when employers will try to replace us with less skilled workers to save money. It we don't recognize this and be prepared to prove our worth, stand up for ourselves, we might be on the losing end of change.

Show me the money.

Wednesday, August 15, 2012


You know what sucks? When someone comes in - la dee dah dee dah - they are here for a legitimate probably, but it is not life threatening. So we go about our business with the usual labs, IV, blah blah blah. The person is not elderly. ALL OF A SUDDEN - SHIT!!!!!! CARDIAC ARREST. This perfectly normal person, with a legitimate problem is dead.

Rush to resus room
CPR continues
epi etc.

Get a rhythm back. They live. For the time being

central line
drips and more drips
hypothermia protocol
blah blah blah

Get a rhythm back. They live. For the time being.


This is the worst scenario in the ER: the unexpected. The unexpected arrest. Coming out of no where. We are used to criticals that come in. We know about them ahead of time. We can prepare for them. Its when something suddenly happens that it sucks.

Fortunately, they were able to be brought back. What will the outcome be? I don't know. All I know is that they made it out of the ER. We did our job.
Hopefully they are still with us six months later.

Sunday, August 12, 2012

Do hospitals do futile procedures for profit?

I've been a nurse a long time. I've been at the hospital where I work a long time. When I started here the hospital was by itself, now it is part of a large corporation like most hospitals.

As it became a larger corporation, it changed. There were moves toward "standardization" and "increased efficiency". I've seen medicine change and become big business. At this point it feels more like a business than a place where people get cared for. I guess thats reality.

As with any business, emphasis is placed where the money is made. Cardiac medicine has become a huge money maker. Cath labs make millions putting in stents. Hospitals are doing more and more sophisticated procedures like putting in LVADS (left ventricular heart device), heart transplants. They are doing CRT (continuous renal replacement therapy). Another technology is called ECMO which, if I understand it, is continuous cardiac bypass to rest the heart. This stuff is becoming like science fiction.

There are nurses who say that these procedures are being done on people who will die anyway, in other words they had no chance to begin with. They think some of it is inappropriate. The thing is it makes a lot of money for the hospital and the cardiologists. I wonder if down the road there will be an investigation of all of this. Profiteering at the expense of realistic patient care.

Hospitals are scrambling to stay afloat. I wonder how many are doing procedures that are questionable in an effort to do that. There are already rumblings about stents being no more effective than drug therapy in prolonging life.

The emphasis in hospital is on the areas that make money. They look like hotels. The rest of the hospital is like the ghetto things shabby and falling apart. How far will all of this technology, and along with it money making, go? It will be interesting to see.

Friday, August 10, 2012

ten, count 'em ten, weird moments in the ER

summer rerun

In my 59 years in the emergency here are a ten weird things that have happened:

1) A man comes up to the triage window and says his car broke down a couple of blocks away and can we borrow him some money. He promises to pay us back.

2) My 250 pound patient becomes so agitated he stands up on the ER cart, swinging his arms around and almost goes over the side.

3) I am triaging a woman and when I ask her when her last period was, she says, "I'm not a woman". Fooled me.

4) A kitten is found wandering down the hall in the ER. My coworker takes it home and adopts it.

5) A man ties up his dog outside the ER and comes in to be seen.

6) My husband is sitting outside the ER entrance waiting for me to come out. A car pulls up in front of him. Suddenly 3 or 4 cars appear and people jump out with guns and rifles, pointing them at the car. A cop yells to my husband to "get down!". It turns out that the guy in the car was wanted for murder and the cops had been trailing him.

7) A man comes in with a cat bite. He and a friend had been driving on the highway and heard a strange sound coming from the front of the car. They found a kitten curled up under the hood apparently trying to stay warm on a cold day. When they went to get the kitten out, it bit him. Rabies shots.

8) A man is on a flight from a South American country to Canada. He becomes so drunk that they can't arouse him. They divert to our city and he is brought to ER. He doesn't speak any english of course.

9) A man comes up to the ER desk and says that he is God. He says it took him a long time to figure this out. Does he want to be seen? No he just wants to know the way to McDonalds.

10) A man in his sixties comes in and for some reason that I can't recall, we take his shoes off. Lo and behold there is a baggie of crack which we confiscate and give to security. They flush it down the toilet. At the end of the visit, the man becomes irate because he wants his crack back...

And the beat goes on...

Thursday, August 09, 2012

I don't get it.

My son recently told me a factoid from the internet: Every time you sneeze, you lose a few brain cells...that explains a lot about the people with 30 allergies.

A man came in today who claimed that he was allergic to "water", then in parentheses in the allergy section it says: "takes quick showers". Just kill me now. Them showers must have to be damn quick. And take an epi pen in there with you...The human body is 50-65% water. By rights, this man should have died years ago. But unfortunately, he is still with us and chooses to present himself to our ER. He has a legitimate problem, but somehow its hard to get past the whole water thing.

There is actually a scientific name for this: aquagenous urticaria. Only 30 people in the whole wide world have this allergy. There is no cure. Their is a 14 year old girl who is allergic to water. Every time she comes in contact with it she develops a rash or blisters. So she applies a barrier foam that has allowed her to function somewhat. My question is what about her body's water content. How come that doesn't cause a reaction? Hmmmmm...

Another allergy someone had recently is an allergy to "cold". "I have just been diagnosed with it" she said. Woman, you are in the wrong part of the country and I suggest you move south my dear. I know someone who is allergic to the sun. Bummer. Here's a good one: "I'm allergic to holy water at church. Whereever it touches me, I break out in hives". Hmmmm.....maybe God is trying to tell you something....

Monday, August 06, 2012

boxers or briefs?

I kid you not. A man comes up to the triage desk and says:

"I need my stitches out and a clean pair of underwear and socks..."

No problem sir, let me go to the ER underwear drawer..Do you prefer boxers? Briefs? A thong? Color preference? Solids or patterns?

Saturday, August 04, 2012

they were alive when I left...

You know you are having a bad charge shift when you finally get to dinner two hours before the end of your shift and a patient dies while you're at dinner. Now mind you the patient was a DNR, but still...when they came in they were alive.

You know you will have a bad shift when you are walking past triage and a perfectly healthy young patient is on the phone trying to get a free cab ride home paid for by medicaid. They wave me over. I am barely awake. I said "what". This charming young hood rat proceeds to call me a "RUDE ASS!" several times over...

You know you are having a bad shift when you are starting an IV and have to listen to someone who you know, from past experience, is a complete wacko, tell you about their imaginary life in which they are going to school to be a nuclear physicist, have met the president, etc. Yeah...okay...right...

You know you are having a bad day, when every other patient is a frequent flyer migraineur, fibromyalgic, back pain entrepeneur, bipolar PTSDer.

Oh and by the way, we're down 2 nurses and staffing don't have anybody..

Thursday, August 02, 2012

the get out of jail free card

You are the stabilization (critical) room nurse. No stabs this shift. Its a half hour before the end of your shift. "Helicopter to room 598 stab team 5 minutes". Shit. Turns out this is a transfer from another hosptial with a complex medical history who is now having an acute problem. In other words, get ready. This will be an involved situation. You KNOW you will not get out on time. Despite the fact that you will pass the patient on to a new nurse in half an hour, all the initial stuff, along with charting will have to be done by YOU. Conclusion: You will probably be there another hour. Its been a long day and you just want to go home.

Thats the thing about nursing. You can't just end the shift and say bye bye. Things you are responsible for have to be done. You could be in the middle of a critical situation and aren't just going to walk out.

Oh well.....

Hey wait! "Cancel helicopter to room 589". YESSSSS!! Turns out the patient was a direct admit! You go merrily on your way at shift change. Life is good.