miss thang becomes a nurse

You know what I hate? I hate nurses who think they know everything and act like they are an expert on everything. Those are the people who you have to watch 'cause eventually they are gonna f--- up. Especially in the ER.

I've been in the ER a long time, as we all know. I've seen a lot of stuff. At this point your arm would have to be hangin' by a thread to get me excited. I don't know everything. I know that for a fact. There are things I've never done, things I forgot how to do. When that happens I ask my co-workers. It doesn't bother me a bit that I have to ask somebody else. There is always somebody who knows more than I do.

When you think you know everything you go barreling into situations and might screw it up because you don't want to ask for help. Thats when you end up in trouble. These kind of nurses can make the new nurses feel very small because they often times are critical. They talk about new nurses in a derogatory way.

The other thing I hate is nurses who think that because they work in certain areas such as critical care, they are superior to everyone else. Critical care requires a lot of skill and technical knowledge and can be very stressful. Like I've said before, I even think nurses in those areas should be paid more, but are those nurses superior to other nurses because of that knowledge? Of course not. So stop acting like you are.

I think people with these kind of attitudes are really just insecure. They have doubt about their abilities, but are so afraid they will be exposed, they cover it up with an air of superiority.

Get over yourself. Lack of humility will eventually bite you in the butt.

all nurses are not created equal

Nurses are so funny. We accept so little when it comes to money and benefits. Its like we don't think we deserve more money. We do.

With the increasingly complex technology and medicine that we manage, we deserve a helluva lot more money. Nurses are literally keeping patients alive with technology. We are managing LVADs, CRT (continuous renal dialysis), ECMO (continuous heart bypass), hypothermia procedures post cardiac arrest, among other things. Some of these complex cases require 2:1 nursing care. Technology and medical care will only become more complex. The amount of information we are expected to retain is astounding and almost impossible. That information retention can mean the difference between life or death for your loved one.

I think some nurses deserve more money than others. A controversial statement that. The fact of the matter is, not all nurses are created equal in a hospital. With increasing responsibility and increasingly complex knowledge, should come increasing money. It just makes sense. Thats the way it works in other professions and thats the way it should work in nursing.

Do I want to get rid of unions? Of course not. Without unions, we wouldn't be where we are today. However,I do think that they should start negotiating some kind of clinical ladder into contracts that address this.

There may come a time when nurses are individual contractors. They will be hired to manage complex patients and compensated appropriately. Maybe there will be people who negotiate salaries for different types of nurses.

Nurses are key to the future of medicine. Who else will manage all this complicated care? You might say, well just hire technicians. Technicians don't have the holistic approach that nurses bring. There is a lot more to medical care than knowing how to operate a machine. Along with skills needed to manage complex care, nurses put a human face on that care. We don't let anyone forget that there is a person underneath all those tubes and wires.

Your thoughts?

hospitals doing futile procedures for money?

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.

the comment

Something weird happened at work yesterday. Someone said to me, "I think you're such a good nurse". Thanks. No big deal right? Wrong. That comment has stuck with me today. I keep thinking about it.

The emergency room is such a tough environment. Everybody who comes in is having a crisis, in their mind. We might think its stupid, but to them it needed immediate attention. Everybody who comes through the door is stressed. We all know people express that in many different ways. A lot of the time the stress is expressed in a negative way. That negative stuff is often directed toward us. People act out, can get verbally abusive and violent. Not news to any of us.

ER is a place of extremes. On the one end you have somebody who will die if we don't do something. On the other end you somebody stubbed their toe. We see people who are suffering. We see people dealing with really terrible things every day of our life. Sometimes despite our best efforts, people die.

In the middle of this is the ER nurse, trying to make sense of it all, trying to reason out some way of dealing with the extremes. Nurses deal with it in a lot of different ways. Its tough as shit.

Working in the ER, you don't get a lot of flowers, boxes of candy that you do in inpatient areas sometimes. People do thank us all the time, as they go up to a room, are discharged. Its routine. It doesn't really mean much a lot of the time. So when someone takes the time to tell you that they think you are a really good nurse, it sticks with you. You don't hear that much. You want to soak it up like a sponge. You want to take that comment and put it into a box where you can take it out on a bad day.

bearded lady visits ER

This is the kind of week it has been:

One of my female patients actually had a beard. It wasn't really a beard, more long hair on the chin. I am not just talking a couple of hairs...there was enough there to form a chin beard.

Another guy had on shorts so short that it looked like he had nothing on under his teeshirt. Now we get some chicks like this, but men?

A gang banger who was high and had been drinking and was in a fight, wanted me to hold his hand and I said no. According to our management that probably makes me a bad nurse....so be it.

Then there was out of town peed pants person with the mommy calling from another state (see previous post).

I may not have seemed "engaged" in patient care. I may have been "rude or short" this week. So sue me...

the overinvolved mother

You are on your way somewhere and you have a layover. You get on the 2nd plane and faint. A shame and a bummer for everyone concerned. 911 is called and you are brought to the emergency room. You are in your late 30's with a family.

Well it seems when you fainted you had a little accident. You peed your pants. Bummer. Unfortunately your luggage is on its way to your destination. Hey its embarassing, although I don't think anybody would have noticed if you hadn't pointed it out.

So naturally you called your family. They are concerned of course. The thing is I get a call from your mother. She is very concerned about the state of your pants, being peed on and all. She wonders if there is a cleaners that we could send them to while you are in the ER. She is willing to pay for it. Ah...no maam, there is no cleaners in the hospital and we are a ghetto hospital and there is no one hour cleaning service around here. Espescially on a weekend. I tell her we can probably give her "child" a pair of scrubs or something. End of conversation.

You are discharged, wearing said pants. I have a feeling, grown person that you are, that somehow you will manage the situation. You seem capable. Mom can rest easy.

Larry in the sky with diamonds

Back in the 1960's certain kinds of mushrooms became popular because of their ability to cause hallucinations. Apparently some people thought that was fun so they ate mushrooms and freaked out and said and did dumb stuff. A few even jumped out windows because they thought they could fly. They couldn't. That was a real bummer for all concerned.

With the rise of the internet, these darn rascal young experimenters have a new place to get drugs, no questions asked. They come from other countries. One of the things that has become available are mushroom spores. They are intended to help you grow your own mushrooms (oh what fun) to use as dope. Kind of like a science experiment in your room.

So one of the ways that these mushroom spores come is in a big syringe of say 10 ccs. They are mixed with water. Apparently they come with a needle attached. Do you see what's coming next? Can you guess? Yup. There have been fools who decide to shoot themselves up with this shit. They shoot themselves up with a fungus, a very unbright thing to do. As humans we really should try to avoid fungus.

Well, the outcome was, of course, not good. They got infections in places that are not good places to get infections. They got them in areas, that if you mess them up, will most certainly cause your demise. They eventually died. A bummer for all concerned. Moral of the story: stay away from fungus.

I live for this shit

According to management we are supposed to have a smile on our face and act very enthusiastic about your constipation, withdrawal from meth, drunken stupor, chronic back pain. I need to show you that I love my job and it is my mission in life to serve you. Otherwise you might consider me "rude or short". You might make a complaint.

If I don't seem engaged its because I am fucking tired. Okay? I have been running around this ER for 12 fucking hours. Did I mention that we are down a nurse and that the hospital is full with no beds? Oh....thats right...I'm being rude, I'm not showing my enthusiasm.

I just cleaned up grandma who has been lying in her own excrement for the past day because no one checked on her. Drunk Jerry just peed all over himself. Suicidal Susie is getting out of control because she has been waiting for hours for a nonexistent psych bed. She is heading toward restraints. Oh but let me put back on my shit eating grin. I love my job and I want you to know it.

You are the center of my universe with your stubbed toe. I will buddy tape the shit out of that sucker and I will give you a toothy grin while I do it and say what a very nice patient you are while you whine about needing pain medication.

I want you to know that I would volunteer for this shit if I didn't get paid. I live to serve humanity.

like a bat out a hell

A bat would have to bite my entire nose off to put myself through rabies shots. Seriously. I have spoke about this before, people who come in for rabies shots because there was a bat flying around their house. They did not get bitten, just had the bat flying around. I have even seen them bring in their children to go through all of this shit.

Why does everybody think a bat bites them while they are asleep? Honestly, do bats have this big need to bite humans with their tiny little bat teeth? You would think so with all the paranoia about bats. I mean wouldn't a rabid bat be acting like rabid bats would act?

So when you don't have a wound/bite, we have nothing to infiltrate. By infiltrate I mean we take about 10-12 ccs of liquid and inject it around your wound. Its a lot of fun for everyone involved. So if you don't have the wound, we dived that 12 ccs of fluid into 4 shots of about 3 ccs each. Then we also give you the rabies vaccine. If you need a tetanus we give you that. SO that is a total of 6 injections because a bat was flying around your room. Hey, it that makes you feel better, whatever....

are we cogs in a wheel?

You know what is really beginning to piss me off? (no why don't you tell us madness..) It is the fact that, more and more, nurses have little control over our jobs, over patient care.

As hospitals compete for the almighty health dollar, decisions are being made to do whatever it takes to make patients happy. In our hospital, administrators do daily rounds to ask patients how things are going, if there pain is being controlled...so you have non medical people dealing with patient care.

There is a trend in ERs to get people back to rooms asap, a noble idea. Rachedy talks about it in a blog post. We are headed for a time when there will be no triage. The problem with this is that is when no one initially talks to someone, you really don't know who is the sickest. You are treating everyone the same and we all know that all ER patients are far from the same. We are also using up our rooms, could have an influx of REALLY SICK patients and then everybody is screwed.

These decisions are being made without the input of nurses, the ones who actually do the bedside care. They are made by administrators whose bottom line is money. They are being made by doctors whose bottom line is satisfaction surveys and money. They don't ask the people whose bottom line is patient care: us.

Nurses are losing control of our practice in this age of profit and satisfaction surveys. We are becoming factory workers on an assembly line of patient care. Task monkeys. Is that what we want? In the end, it is our liability that increases with these decisions. Will we allow this to go on?

Your thoughts?

Dear ER staff....

Dear ER staff:

I'm charge nurse today. For this I make $2.00 more an hour. A whopping $16.00 for an eight hour shift. That's not a whole lot to be in charge of an ER.

It certainly is not worth being yelled at by you Dr ItsAllAboutMe who is pissed that your patient has to wait to go upstairs because of the usual housekeeping/inpatient nurse merry go round. Welcome to my world every day of the week. And Nurse Practicioner WhinyPants, its your problem that you decided to work in an ER where a large portion of your jobs is doing pelvics on the neighborhood hood ratesses. Sorry they all came today, but that is what you signed up for.

You see I'm over here trying to figure out how a patient from a small town ER transferred to our hospital instead of the hospital he was supposed to go to. By the way he is having an MI. I'm answering the fifty calls ranging from pharmacies to patients who were here yesterday to doctors sending patients in. I am trying to calm down that irate patient. I am rearranging patients to accomodate that chest pain in triage. I am making sure that everything is going okay in that stab case.

And might I say that the bitching and complainin' of the nursing and tech staff does not make this job any easier. Hey I can't help you are having a bad day. I wish it wasn't so but there it is.

Excuse me a moment while I go into the bathroom to take a few breaths to avoid running screaming from the building...

Sincerely,

Madness
your charge nurse

the perfect con

You're drunk. You're really dumb. You use your sisters name and insurance card. We are none the wiser. We don't know you from Adam. You get stitches because you fell on your dumb ass.

Being the dumbass that you are you come back the following week to tell us that you used your sisters name the previous weekend. However, you have no ID with you to prove you aren't her.

You come back a third time to get your stitches out. This time you have ID. You get them out.

Now y'all are probably thinking, call the damn police and have this fool arrested. Uh...not so fast. Consider the following: According to risk management that would be a HIPAA violation.

And that my friends, is how ridiculous the regulating of health care is. Moral of the story: Feel free to use anybodys ID or insurance card for your free health care in the emergency room.

sorry...i'm on my break

SSDD (same shit different day). We are bursting at the seams, patient has been here for 8 fricking hours. Bed is still not ready. IT IS DIRTY and housekeeping hasn't been there to clean it.

Call to supervisor to look into it and as usual, probably do absolutely nothing. Supervisor calls back and says the reason the bed has not been cleaned is that ALL OF THE HOUSEKEEPING STAFF IS ON DINNER BREAK. Apparently they ALL go to dinner at the same time. Well that makes sense. Lets have nobody available at all during one of the busiest times of the day.

Hey I think the nursing staff should try that. Every nurse in the hospital goes on break at the same time. Sorry, no one can help you, we are all on break...

fun with poop

WARNING GROSS BLOG POST AHEAD

Here's one I haven't heard of before: fecal transplant. Yes, you read right - FECAL TRANSPLANT

We all know about c diff right? It can be really, really bad and unresponsive to antibiotics and make life generally hellish for those who have it. Fecal transplant is being used to fix it.

People with healthy bowels do their business and their business is examined for any bad guys like parasites and naughty germs. Healthy business is full of good intestinal bacteria that can get rid of bad intestional bacteria.

It is given in the form of an enema or can be given via nasojejunal tube. It is put in a blender, liquefied with saline and given. The thing is it apparently really works

I have two things to say about this: 1) do the people donating the poop get monetary compensation? How much? 2) the day I would have to do this, I quit.

my evil twin

I have an evil twin. The evil twin comes out of the patients room and grumbles to herself, using words like "idiot, moron, fool". My evil twin has to keep herself from dozing off as you drone on about your myriad of problems. My evil twin talks trash about you to her co-workers. My evil twin silently shouts "whadda think of that sucker!" when she gets an IV after you said no one can ever get one. My evil twin thinks you should be able to find your own way home....you don' need no bus token or cab voucher...you found your way here - now follow the yellow brick road back home Dorothy.

My evil twin doesn't want to hear a history of all your medical problems going back to that traumatic experience in Haight-Ashbury in 1968. My evil twin doesn't want to hear that you are sorry that you peed all over the floor. I'm sorry too. My evil twin thinks you are nuts if you have more than three allergies in three different categories.

My evil twin feels sorry for the nurse upstairs who has to take care of you for 8 or 12 hours, but is glad it isn't her. My evil twin knows you are on something so don't bullshit her. Remember she's evil. Never forget she's evil. Remember she has the sharp objects.

the tale of the evil nurse gnome

Somewhere in the hidden recesses of any hospital, in a dark, dank cubby next to the boiler room, sits an evil PHD nurse gnome, rarely seen, with lots of time on their hands. She appears periodically to drop pearls of wisdom into the unknowing laps of the bedside nurse peon. These gnomes have a magical ability to cast a spell over anyone above the level of staff nurse in the food chain. They call a meeting of "the nursing management", enter the room with a flourish with charts and graphs and data and statistics, so loaded down with research that it scares the shit out of everyone in the room. Being dazed with fear and under the spell cast by the gnome, they can only mumble "oh yes", nodding their head so rapidly that they have a sore neck the next day. The gnome dazzles, gesturing wildly, spinning tales of happy nurses, happy patients, happy satisfaction surveys, enchanting all who listen. She paints a picture of peace of earth, good will toward men, brotherhood, a veritable garden of eden if only her scathingly brilliant idea can be implemented. She is a powerful sorceress and "the nursing management", readily agrees to go immediately forward to convince the ignorant masses (read nurses) that this idea is heaven sent.

On the occasion of the monthly staff meeting, the nurse manager appears, somewhat dazed, twinkling, eyes bulging, pacing back and forth at the front of the room, suddenly shouting, "cast your attention this way all ye who enter here, for I have a tale to tell that will astound you and inspire you....". A wave of fear crosses the room...alas the nurse masses recognize the signs....an edict is about to come from on high that will add yet another burden to their already heavy lot....the managers voice booms forth the new and heavenly idea: "We, the esteemed leaders of this institution have come forth once again with a spectacular, brilliant, genius of an idea...and it shall be called HOURLY ROUNDING. Yes hourly rounding my brethren. At the beginning of the patient visit ye shall enter the room, introduce thyself, put thy name on the board with the magical magic marker, inform the patient that you will be back hourly to check on their myriad of needs: pain, potty, hydration, warmth, updates, perhaps you can do their taxes in your spare time...then as you exit the room, I want you to initial a document a scroll (paper) attached outside each room...a tracking device as it were which shall be collected each day - analyzed, sorted, recorded, stored...well you get the idea....and woe to those whose initials do not appear.." "Now many of you may be wondering why we would institute such an idea in an emergency room where we run in and out of the room every five minutes it seems....ah....well...because...well just because...just do it you fools! Now go forth, spread joy and happiness throughout ER land...."

As the nurses filed out, shoulders sagging, one nurse drew up to her full height of 5'3" and stated boldly: "Forget this shit, I ain't doin' it and strode away..."

RIP

May those soldiers killed in Afghanistan last night, along with all the others killed in both wars, rest in peace. My thoughts are with their families. Don't forget them.

I'm scared. Are you scared?

I'm going off topic today. I can't keep my mouth shut about all of this any longer. I'm worried. I am worried about the country.

I have a good job. The chances of me being laid off are pretty low, although with the way things are going who knows? It doesn't stop me from worrying about the economy. Today the stock market is way down. The unemployment rate remains the same. Things are not looking good. There is talk of a worsening, or second, recession. If that happens many more people will lose their jobs. More businesses will close.

In the midst of this our government is paralyzed. Paralyzed by politics. We all saw the debt ceiling fiasco. To say that I am angry with politicians is to vastly understate it. I think those feelings are shared by many. I can't ever remember feeling that our government is just worthless to us.

I get the worry about the government spending too much money. No doubt it does. I'm not sure now is the right time to restructure things like medicare and social security. Why do we never talk about cutting all the aid we give to countries around the world? We need to get out of Iraq and Afghanistan. Period. End of conversation. Doing that would probably give us a surplus.

We need a jobs program. Now I know a lot of people will be against this. The government spending more money and all that. But people working stimulates the economy and they pay taxes. I honestly don't see any other way out of this. Raise my taxes if thats what it takes to put people back to work. In the long run it will benefit me.

Will this jobs program happen? No. Not in the current political climate. Perhaps it is time to take a lesson from the 1960's and start organizing marches and demonstrations in Washington. Maybe thats the only way these idiots will listen and do whats necessary.

What do you think?

UNCLE! and show me the money

Do you ever feel like saying UNCLE!! I do. The nursing education requirements have now officially become out of control. Every quarter we have to complete nursing education online classes. This quarter it is up to nine. Ideally they want us to complete this during our work time when things are "slow". Ha. Yeah. Like thats going to happen.

It used to be that once a year the hospital had a mandatory education day in which this stuff was done. Apparently this is out the window. Now its being divided up throughout the year like this. This in addition to the constantly changing policies, procedures, new drugs, new equipment, etc. etc. etc. When does it end? My brain isn't big enough to store all this shit.

In other news, our hospital is screwed right now. Census is up. Way up. Of course they don't have enough nurses (surprise, surprise). There has been pretty much a hiring freeze up until the last few months, we are down lots and lots of nurses in the hospital. So we are back to the we will give you anything to work an extra shift era. Any extra shift brings a bonus. If this keeps up, I can see a return of the thousands of dollars bonuses to work to take a job at so and so hospital. I hope this helps the thousands of nursing graduate nurses who haven't been able to find a job.

Is this going on at your hospital?

what about my boo boo?

In January 2012 Medicare will pay physicians 30% less if the cuts proceed as proposed. This was postphoned by congress a year ago. Will it go into effect this time? Who knows.

Physicians have a lot of concerns about the debt ceiling bill too. It pretty much requires cuts in entitlement programs like Medicare in the next few years. If congress can't decide about cuts, they will be automatically triggered. Lots of concern that cuts will be made in provider fees.

There is no question that physicians are struggling with medicare reimbursement now, let alone with the proposed cuts. The choice in the future will be make less money or don't see medicare patients. Guess which one they will choose? Don't see Medicare patients of course.

So the question becomes, as doctors quit seeing medicare patients, who will see them? Everybody knows about the exploding elderly population that will only increase in the next 20 years. Primary care is already a dying specialty and this won't help that situation. Is the future of primary care NPs and PAs?

All of these developments only move us closer to a meltdown of our health care system. The proposed Obamacare will do nothing to prevent it. It is inevitable that this country will have a government run universal health care system whether we like it or not. It will change the way healthcare is done. It will change the way we look at healthcare. You might have to stay home and take care of your boo boo without any help. Maybe that wouldn't be such a bad thing.

GOUT: slimy, bottom dwelling scavenger fish

So I have pain and swelling and redness. In my foot. Went to the doctor. Never seen this doctor before. I'm not a big doctor user. She looks at the foot, presses on the swollen and reddened part and I say OUCH! and think about hitting her. She orders an xray to rule out fracture and on the way out of the room says that she thinks I have gout.

Now gout is a very unattractive word. I mean GOUT. It sounds like some kind of slimy bottom dwelling scavenger fish. Gout is something old men get isn't it? WTF? How can I have gout?

She orders some blood tests, gives me an antibiotic and motrin script and tells me to come back in a couple of days. So I go home, immediately go on line to look up GOUT. I convince myself I have GOUT, that at that very moment uric acid crystals are surrounding my joint destroying it. That I will have chronic GOUT. I mean what woman of my age has GOUT? For cripes sake. I don't even want to tell people. I mean GOUT. Its embarassing.

Turns out, you guessed it, I don't have GOUT. Thank God. I have cellulitis. That I can live with. Its a lot more socially acceptable. Here that doctor had me all worked up thinking I had GOUT and shit. She shouldn't scare people like that.