Its a B52 for you

Go head. Click on the arrow. Its OK. You can trust me. You know that...OK did you do it? Does it make the hair on the back of your neck stand up?
Welcome to my world. At least once a shift someone is doing something similar to this. They are screaming so loud that it can be heard throughout the emergency department.



Last week it was someone who doesn't like white people screaming about their dislike, followed by yelling for their mother. Now mind you this is a grown adult.

And there is one of my co-workers at the door trying to convince the screamer to take something to calm down. Probably won't work. Usually in this situation security tackles them, they are put in 4 point restraints and a sedative is given by injection. Then we can all have some peace.

that other ER

When you come to triage and say:

"I didn't have a good experience at that other ER".

"They didn't do anything at that other ER".

We translate that to mean:

1) You didn't get what you wanted, probably narcotics.
2) They didn't tell you what you wanted to hear, that you are really sick.
3) They didn't treat you like the King or Queen that you obviously are.

you go girl

As someone who has been to Saudi Arabia and witnessed these idiot religious police, I think this is pretty cool.

fun ideas for triage

Sitting at the triage desk watching people walk down the hall of shame toward the desk. I love the ones who either walk very hurriedly or sprint toward the desk..

Anyway, I had the idea to make life in the ER a lot easier for everyone concerned. We have this sort of vestibule type area with glass doors that can be locked. At night a security officer sits there are gives out name tags since its the only entrance to the hospital.

So I thought: Have this set up in the vestibule where there is a breathylyzer machine that everyone who wants to be seen in the ER has to blow into. Just think, you would already know the alcohol level of every patient right up front. The machine would instruct them to how to use it and then say:BLOW! BLOW! BLOW! BLOW! BLOW! It wouldn't unlock the door until they did it successfully.

Part# 2: Put a bathroom down there and have everything pee in a cup for a drug screen. You put your specimen into a little door thing in the wall, like at the doctors office. You have to wait for the results before the door will announce your name and unlock the door. This would be useful for drug seekers.

The thing is how would you prevent people who haven't been approved to now move ahead to the triage desk from running through the door when it opens? Hmmmm... We could have a place in the floor that opens and somehow propels the cheaters outside.

It was a slow evening in triage....

my way or the highway

I've been a nurse a long time, as we all know. I have to say that I have probably been working in the best time in nursing. What I mean is that nurses have made progress in wages, benefits, staffing. A lot of our progress was due to a nursing shortage. Hospitals had more money too. Thats no longer the case.

I have this feeling that the time ahead is not going to be positive for nurses. In the last few years there has been a change in hospitals around nursing. For a long time, the administration and nurses in our hospital seemed to work together. The union and the hospital settled fair contracts. That has changed now.

Hospitals are feeling the same economic pressure as the rest of society. As people were laid off, less people had insurance and they used health care less for a couple of years. At the same time, reimbursement from medicare, medicaid, insurance companies continue to decrease. Hospitals are trying to stay afloat.

With all of this change, seems to come a new attitude toward the nursing staff. The relationship between the management and nurses has become adversarial. It has turned into a "I'm the fucking management and I run the show kind of attitude". We all feel it.

If nurses don't start paying attention and standing together, we have a lot to lose. Those wages and benefits and better staffing will fall by the wayside as hospitals work with smaller budgets. Think staffing is bad now, just wait.

What worries me the most are the young nurses who don't understand what it took to get here. The sacrifices nurses made in the past. The reason you have any kind of decent wage, benefits, employee rights is because the nurses in the past fought for it. I wonder if the younger generation of nurses will maintain those benefits or let them slip away.

too much

.

Is it just me or is our job getting harder and harder? To the point where I am really tired of being so tired and working so hard. Its getting to be too much.

oh come all ye faithful

the emergency room - the Mecca of the dysfunctional

dys·func·tion·al

Adjective

1.Not operating normally or properly.
2.Deviating from the norms of social behavior in a way regarded as bad.

sometimes I feel like Mr. Bill.....

ooooohhh noooooo!!

- I am almost done triaging you and I ask you when was your last period and you tell me you are not a woman....

- You have a 1/4" laceration on the palm of your hand, but you don't speak english and neither does your 18 year sister accompanying you. Oh by the way your parents phone is disconnected....

- You were seen at another hospital yesterday but had no money to fill your meds, and so now here you are at our ER so you can get your meds filled...

- Your elderly mother is in the car, can't walk in and I'll be damned if I can find a wheelchair... - You are suicidal today after drinking, using cocaine and taking "some pills that I didn't know the name of" last night....

- You are making your 3rd appearance to a health provider this week for what was diagnosed as minor the first time you saw someone... - Someone "stole", "you lost", "you didn't have the money to pay for...", your meds we gave you to fill yesterday....

- You call and ask us if we have a "service" that will pick you up and bring you to the ER....

10 positive things about nursing by that cynical bitch Madness

I'm a bitchy, naughty, cynical, crusty old nurse who does a lot of complaining and ranting about how bad nursing is. So I have decided to atone just for one day. I have somehow (it wasn't easy) come up with ten things that are positive about nursing. So there. I too can be positive. Believe it or not. PSFFFTT! (Thats me sticking out my tongue..)

1) FLEXIBILITY - You can work a variety of shifts and hours. For example I work 9 am to 9 pm.
2) VARIETY OF JOBS - In nursing there are so many different things to do - hospital, clinic, schools, nursing homes, private duty, military and many many more. If you don't like one area you can move to another.
3) CHALLENGING - If you like a challenge, nursing is the job for you. A challenge it is. It is always changing, you are always learning something new.
4) NEVER ROUTINE - I suppose some nursing jobs can be routine, but most are different day to day, because you are meeting different people day to day, doing different things day to day.
5) DIVERSITY - You can meet and talk to people from every walk of life from the crackhead to the US Senator. Some people are really interesting.
6) PERSPECTIVE - Nursing gives you a real perspective on your own life. It makes you realize how lucky you are that you and your family are healthy and mostly happy. Lots of people aren't.
7) A LIFE WELL LIVED - As a nurse you can feel good about helping people, relieving pain, listening to people, educating them. You have spent your life doing something that benefits humanity.
8) JOB SECURITY - There will always be a need for nurses. Another shortage is coming.
9) FUN CO-WORKERS - People who do this kind of job are nice. They have a sense of humor. They are interesting. They are open. They are opinionated. They are the best part of the job.
10) UNIFORMS - You don't have to come up with, or spend money on, outfits for work. You just throw on scrubs and you're good to go.

I am powerless and my life has become unmanageable..

Someday I am going to have a gigantic ulcer that eats away half my stomach. I'm going to be rushed to the hospital vomitting bright red blood, pale as a ghost and have a hemoglobin of 3 and a BP of 60. Then I'll need an endoscopy. I hope they give me enough sedation. I'll need blood. It is so gross to think about someone elses blood drip, drip, drip into your body. Yuck. When you get blood it is always so cold. I wonder if it makes you cold. Cold slimy red blood from some unknown person drip, drip, drip into me. Yuck.

The alternative is kidney failure. I end up on dialysis. I'm not going to be one of those loser dialysis patients who skip dialysis and then come into ER because they don't feel good. I'm going to have to have one of those gross looking fistulas in my arm. Yuck. I am going to have to spend hours every week having all my blood put through a machine as I read the latest enquirer, sitting next to a bedraggled looking former crackhead.

All of this because I am a nurse. I am a nurse and therefore, I take NSAIDS on a regular basis. I admit it. I know its not good. The thing is I don't think I could be a nurse without NSAIDS. I think I might be addicted to them. I take them for the aches and pains that come with being a nurse, especially an aging nurse. Hey shut up! I take them with food, OK?!! I'm not a complete idiot. I worry about it though. Iknow its not a good thing. Here's the thing: How else do you cope with a job in which you are on your feet for 12 hours, bending and lifting and contorting around small rooms with too much equipment? HOW DO YOU?!! I'm an addict. I admit it. That's the first step to recovery, right? I'm doomed.

the elephant in the room

Why doesn't nursing change? You won't like what I am about to say. I think nursing doesn't change because 99% of nurses are codependent. I would be willing to bet that if you did a survey of nurses you would find that the vast majority of nurses come from dysfunctional homes, most of the time with an alcoholic or drug dependent father.

Nursing is a shitty job. Literally. You work your fucking butt off every day. You are given an impossible task to do and therefore, always fall short in accomplishing it. Its like banging your head against the wall. Every day. You can't do what you are "supposed" to do, but you keep coming back every day anyway.

We let people treat us like shit every day: patients, doctors, management and do nothing about it. We go along with a management that tells us that we have to put up with rude, abusive behavior from people and not complain about it. They tell us thats just part of the job and we believe them.

We work for shitty wages. You might object and say: I don't know what you are complaining about, I mean you can do this job with a 2 year degree and make a decent wage...I don't care if we only had to go to school for 6 months, we don't make enough fucking money people! For what we have to do, put up with, the responsibility we have, the hours we have to work, are you fucking kidding me? If you think that you make enough, you are demonstrating my original hypothesis of codependency.

The vast majority of people would never be a nurse. Because they are normal. Normal people would never put up with this job. The first person who called them a bitch, they would be out the door. A normal person is not going to bang their head against the wall on a daily basis. Most people don't want to clean up shit and vomit for a living and they don't want to do it at 2:30 in the morning while everyone else is sleeping.

Now I can just hear some of you saying, oh but nursing is so rewarding, you can help people, blah blah blah. True. But lets be honest with ourselves, most of the job sucks. Thats the harsh reality most of us don't want to admit. Someones got to do this job, boys and girls. We keep banging our heads. That won't change anytime soon.

random shit

South Central vs Beverly Hills

My husband has a relative in the hospital where I work. His relative is in the NICE money making part of the hospital. In that part there are hardwood floors, flat screen TVs, private rooms, fireplaces, mini bars, rec rooms...on those floors the housekeeper is called an environmental specialist, the dietary aide a personal chef, the nursing assistant a valet, the nurse a health concierge, the chaplain a spiritual adviser,iyou get the idea.. the patient is called a guest. Healing touch, aromotherapy, shit, somebody will walk on your back if you want them to. Its all very calm and serene.

So when he visited the relative while I was working, he stopped by the ER the NOT SO NICE part of the hospital, and was struck by the contrast between us and the NICE part of the hospital. In ER there is brown linoleium and walls, a couple of tvs in the lobby bolted to the ceiling, Yes we have private rooms, but you have to wait to get one in the lobby and you may be moved out of it into the hall. The only warming fire we have is if somebody lights a cigarette in the bathroom. As far as refreshments - juice and water, thats it. There is no recreation unless you consider what goes on at the triage windown and in the lobby recreation.

The nurse is a bitch, sometimes a fat bitch, a racist bitch. The housekeeper is just that, a housekeeper. Theres no personal chef, only a box lunch with a plastic cover. The EMT is a tech, The chaplain might come if you died.

In other words its like contrasting South Central and Beverly Hills.

yes...yes you can

i become a garbage sorter

Want to become a nurse? Part of your job will be to be a garbage sorter. There is an elaborate system for waste disposal in hospitals involving different colored receptacles. It will be your job as a nurse to know what goes where. You are expected to remember which drugs are hazardous and go in the evil black bin, which drugs and IVs, etc. can go in the blood colored red bin and which can go in the boring white sharps container. There will be a quiz later. If you can't pass it, you're fired.

We are told that if we don't dispose of things in the proper container, it costs the hospital hundreds of dollars a day to pay people to sort it (hey there are worse job than ours). This is supposed to make us feel bad and motivate us to sort it into the proper container. Not. Doesn't happen. Its crazy to expect us to do this.

Today we learned that all used IV bags must be placed in zip lock bags and then disposed of. Why? Who the hell knows..to make the ziploc people rich? What gets me about all this, is where all the meds we waste, IVs we waste go: right down into the city sewer system. It is a known fact that drugs have been found at very low levels in water systems. Don't worry about that, just remember to put your empty IV bag into a ziploc...

Is it just me, or does this job get bat shit crazier every day?

Its a pirates life for me

I'm tired ok? Really tired. The last couple of days have been killers. The kind of days where it is chaos. You don't know what chaos really is until you work in ER. The phone is ringing, the call lights are going off. Someone is screaming, an old person is calling nurse. Bed 2 wants something for pain, bed 4 wonders whats taking so long. Bed 5 wants something to eat. Bed 6 some footies. Bed 7 just vomitted. Bed 8 has to go to the bathroom. I have to call report on bed 9. Bed 10 needs an IV. Has anyone done an EKG on bed 11 yet? Surgery is on line 2. They want to come and get bed 12. Bed 13's packed cells just arrived. Bed 14 needs a cardioversion. Bed 15 is crying about something. Bed 16 needs to come off the backboard. Bed 17's family wonders what is taking so long to get a room. And on and on up to room 30. An alert red alarm was just announced (fire alarm) and the lights are flashing and the bells are ringing. There are two ambulances coming and two people in hall beds. Its 2 pm and I haven't been to lunch. I have to go pee. Someone fainted in the main lobby and their on their way to ER...and on and on and on....til 7 hours later when I finally drag my sorry butt out the door.

I need to have a couple of glasses of wine and put on my pirates hat...har. Yo ho ho...yup I've finally lost it folks.

all that and a bag of chips

It seems like every day for the last several months there have been 15 people in the waiting room most of the day. What is going on? And nobody is a sprained ankle anymore. They are fibromyalgic migraineurs with some auto immune disease with chronic back pain and they are accompanied by their dysfunctional family members who set up shop in the lobby.

Whatever happened to the good old days of lacerations, broken arms, appys, etc. They have all gone elsewhere leaving us with the chronically ill dysfunctionistas who frequent ERs these days. Its like we have a sign out:

***** COME YE OH COME YE ALL DYSFUNCTIONISTAS ******

Come here and let us cater to your every whim. We offer warm blankets, footies, juice, crackers, box lunches, bus tokens, cab vouchers. We have magical nurses who will listen to your tale of woe. All this and a month supply of Percocet.

this IS gonna hurt

I wonder how long its going to take (how many years) for healthcare to be forced to change in this country? I predict within the next ten years there will be a tumultuous change. That is about the midway point for the baby boomer generation to be turning 65.

The public has no idea what is happening in medicine. It is becoming more and more sophisticated (increasing complex technology and procedures) and therefore, more costly. People are living a lot longer. There has been an explosion of people living well into their 80's and 90's. I see them every day. Old people have more medical problems, increasing health care costs. Add that to the aging boomers, and you have a recipe for disaster. The system WILL go bankrupt, its just a matter of when. The cost of insurance will be out of reach for the average consumer.

We will end up with a national health care system. Its inevitable. Its the only way that all the people will be able to get the health care they need. The fact of the matter is, more of our national budget and taxes are going to have to go to paying for health care for all of us.

Health care will change tremendously. It will be rationed. Not every old person is going to be able to have the very costly care to keep themselves alive. You won't be able to run to the doctor at the drop of a hat. The health care of the future will look very different from the health care of today.

Along with all these changes, interest groups in medicine, who up until now have had a lot of power, will no longer have it. Insurance companies will probably cease to exist, replaced by companies that coordinate care in a cost efficient manner and work for the government. Doctors will become specialists, general medicine will be in the hands of nurse practicioners and PAs who are less costly. If the nursing profession is smart, it will change too, taking on a role as care coordinators, a task we are well suited for.

In order to survive, those with vested interests (nurses, doctors, insurance companies, etc.) are going to have to change and be open to
new ideas and roles. This is going to be very hard for some groups such as doctors, who have had a lot of power in medicine up until now. They will now become part of a health care team which cares for the patient in the most efficient and cost effective manner. Either you are open to the change coming, or you will be left by the wayside.

RIP Goober

one pill makes you larger and one pill makes you small...

Why is an 85 year old taking coumadin? I mean seriously. I understand why people are put on blood thinners and the conditions that prompt its use, but really, don't the risks outweigh the benefits?

A lot of older people fall because they are weak, unsteady on thier feet, etc. If they get a head injury and are on coumadin, the risk for a head bleed are high.

If I'm 85, I'll take my chances with a stroke or atrial fib, rather than take the risk. I have seen older people on coumadin take a fall and die as a result due to hemmorhage.

While I'm at it, why are old people on statins? I mean who really cares what your cholesterol is at 86? The point of all this? Old people are on a riduculous amount of medication these days that probably won't extend their life. A lot of the time all these meds make them dizzy, confused, weak. They affect their quality of life. Its a full time job to keep track of when to take them.

Its stupid. All it does is make money for the drug companies.

sometimes things are not ok

Sometimes a person comes in and they are alert and talking and know whats going on. They have suffered some kind of trauma, but it appears they are OK.
The thing is they aren't always OK.

A couple of hours into the visit things change and they go from talking to unresponsive. Now they are dying. Sometimes things happen that fast.

That person who was talking to their son an hour is now going to die. There is nothing anyone can do. Somestimes things are out of our hands even in this world of sophisticated treatments and machinery. They are useless.

This person will die today. They didn't know this was their day to die. A series of events happened to bring them to this. No one expected this to happen today. Certainly, not me, their nurse who greeted them when they arrived by ambulance. Certainly not their son who arrived to be with them. You just never know.

YOUR NURSE = POOP BROWN

I was in my new poop brown scrubs yesterday. All the nurses were in their places with bright shiny faces like good girls and boys. Yes, it was the first day of the new uniform policy.

A lot of the patients noticed we were all wearing poop brown. When it was explained it was the first day of the new uniform, many were heard to comment: "I don't know why they chose poop brown. Its really not very flattering. I certainly won't have any trouble identifying the nurses." One thing you can bet on, we will become know as the poop brown hospital. I think the whole thing may actually backfire on the hospital.

Its actually very convenient. The walls where I work are poop brown. The floor are even kind of brown. Actually I think the color is kind of environmentally friendly (if you know what I mean), kind of our version of going green as it were. I find the color kind of cheery... I need to find some poop brown nail polish.

Time to make the Donuts

good old days

one of those days

Today was one of those days. Strokes and MIs and hypotensions and heart blocks. This in the middle of all the usual baloney. You know the back pains and abdominal pains and depressions and weak old people and chest pains and assorted wackos and weirdos.

And I'm sorry but you can hang around for hours in the hospital after you are discharged saying you are trying to get a ride to your home 40 miles from the hospital and woe is you, you have no money....and guess what, you still won't get a cab voucher. We will however, give you bus tokens. And yes indeed, there really is a bus that goes where you live...

And is it my imagination or are the people who come to ER getting more and more down and out looking? I mean some of these people look like they have been run over a few times. They remind me of old pictures I have seen from the depression of these exhausted looking bedragged people. I guess the world is getting more stressful and peoples faces and demeanor reflect that.