bucket brigades

Now news today of NYC Bellevue hospital having to be completely evacuated.  I wonder how the rest of the hospitals in the city are absorbing hundreds of patients.  I think of how tight beds often are among the hospitals in my city.

I have seen stories about "bucket brigades" of people passing cans of oil up 12 flights of stairs to fuel generators on upper floors and this has been going on for more than 24 hours.  Also bringing patients down more than 12 floors to be evacuated by ambulance. Imagine bringing a critically ill patient and all their equipment down that many stairs...I can't imagine it. Makes you think about something similar happening in your own hospital.

Then there is the fact that there are now 2 less hospitals in a city of millions including a trauma center. Another thought I had was with the terrible traffic jams there, how are emergency vehicles getting through?

I wish them well

Donate to the Red Cross.

bomb threat

Speaking of evacuations ... I once worked at the county hospital. I was in orientation to the stabilization room.  We had just received a patient.  They were either DOA or died shortly after arrival.

There was a bomb threat. The ER was quickly evacuated. I don't even know where they sent the patients. All I know was that it was done quickly and efficiently. The dead patient stayed in the stab   room.  We all went out on a corner by the hospital until it was all over.

Some hospitals are just set up to respond to disaster. Then there are those who aren't...

everyones worst nightmare

Watching on TV  NYU hospital in New York City being evacuated right now due to power failure and back up generator failure.

I can't imagine that happening. All the lights go out, all the power goes off, including the power that runs the ventilators.  I don't know if vents have battery power, never had to think about it. Lots of modern medical technology depends on electricity.  Lots of very complex technology that makes my stomach hurt to think about going out. I hope everybody survives.

This is every hospitals, every nurses and doctors nightmare come to life. I pray for them and their patients.

JCAHO tomfoolery

So a friend  of mine who works in a smaller hospital in the suburbs was telling me about a JCAHO visit a couple of months ago...

It seems that JCAHO was someplace and happened to glance at a sprinkler on the ceiling and noted some dust on  it. Well a message went throughout the land about this.  Soon managers and their supervisors and their supervisors were sending messages all over the hospital to promptly clean the sprinkler heads in each department.

In my  friends department a man was seen, compressed air bottle in hand going from sprinkler to sprinkler blowing invisible dust off each head.  And that, my friend, is how ridiculous things have become in health care.             

gotta get a fix

It seems at a small suburban ER, patients go to great lengths to smoke a cigarette.

There is a hospital where a gas station is across the street.  Apparently quite often patients will walk over there in their patient gown to get a pack of cigarettes, butt flapping in the wind, steering an IV pole.

One guy actually drove over there with his IV pole out the window next to the drivers seat, one hand steering the pole and one hand steering the car. The lengths that addicts will go to....

believe it or not I'm human

You know its going to be a bad day when your first patient calls you a "motherf----r" and says "get out of my room, I'm not lettin' any of you do anything to me", as her alcohol tinged breath wafts across the room.    Okay.....it's 9:15 and I have 11 hours and 45 minutes to go. Among the other patients was someone in for mental health because their grown son had just been sent to prison for life.    Then there is the 55 year woman who has been fighting cancer for 10 years (and looks it) and this will be her last day of life. She will not go out quietly. Death isn't pretty a lot of the time. It involves noisy breathing that tortures family members. It can go on for a while.    There is the young man found staggering around a local mall and when the doctor asks what's going on with him, he gives her the finger. OK then....   There is the crack/pot abuser in her early 30's with seven children whose family brought her in because they don't know what to do with her anymore.    There is the man from another country with both cancer and tuberculosis who is dying. Sometimes I just feel weary of the suffering and troubles. I'm human.

the stupidity never ends...

Here's something I've never heard of. Giving an IV piggyback of caffeine for possible withdrawal from caffeine that can give you a headache...

This is unbelieveable.  I am perfectly aware that caffeine can be part of medication that is used for migraines.  Nothing wrong with that.  But using it because you don't want to have a headache from not having your daily coffee or pop t, seems ludicrious to me.  I mean is this what this country has come to? 

Your poor little puddy tat, let me get your caffeine fix for you....I don't want you to suffer.  Oh my no.  Having any kind of discomfort whatsoever is completely unacceptable in this riduculous country of ours.  I'm a daily jelly donut user, can I get a jelly donut infusion?  How about chocolate?

ha ha

Funniest tweet about the 3rd presidential debate:


"President Obama has that "I have Bin Laden's head in a bag beneath the desk." look in his eyes."

hop hop hop....

Lately there has been an explosion of ER hoppers in our ER. What are ER hoppers? They are those patients who yesterday, two days ago or whatever went to another ER but felt the need to come to our ER this time. They have various reasons for doing such an idiotic thing. The seven deadly sins. Among them:

1) I didn't get any pain meds for my neck injury from an MVA 2 weeks ago at the other hospital and I'm hoping you will be nicer.
2) I had surgery last week at another hospital, now I am having problems, and your hospital is closer.
3) I didn't like the way they treated me at XYZ hospital.
4) The wait was way too long at the other place
5) I want a second opinion.
6) They didn't do anything for me over there.
7) Family is not happy with care of other doctor, hospital, etc.

ER hoppers are sometimes dumb enough to tell us they were at another hospital. Then there are those who don't. They think we won't find out. But BEWARE, these days we can see if you have been to another hospital in our system. We are also connected to other hospitals as part of a network that shares info, with your kind permission of course.

When I ask people why they didn't go back to the hospital that treated them before, did surgery on them, they are often offended, like I shouldn't ask that. It should be okay to come to a hospital that has no records of your surgery, history, etc. Sorry if I think thats stupid.

 

how to make nurses happy 101

How to make nurses happy:

1) Eliminate rotating shifts.  There is no reason for rotating shifts.  Pay people more money and benefits to work straight off shits.

2) Make sure that nurses get their lunch break and other breaks.  This is not that difficult. It is required by law.  Insist nurses take their breaks.  Everyone needs a break, espescially from this stressful job.

3)  Make it policy that nurses have control over their practice.  If something is going to affect nurses talk to them about their opinion about it.  Nurses are not unwilling to accomodate change, they just want to have a say in it.  They will no doubt have some great ideas.  Eliminate bullshit committees that do nothing.

4) If healthcare is a business, bring in people with business degress at the middle management level.  People who have been to school in how to MANAGE people, hold people accountable.  Promoting nurses to management posiitons, without a business background is a mistake, in my opinion.  They make awful managers. 

5)  Put policies in place that make verbal and physical abuse by patients unacceptable.  Take this so seriously, that the patient who has been medically cleared or is stable is either discharged or transferred to another facility.

6) Put policies in place that are serious about unacceptable behavior  by doctors (or anyone else for that matter). Fire them if it doesn't change.

7) Here's a controversial one: eliminate 10 and 12 hour shifts.  No one should work that long in such a stressful job.  It is unsafe.

8) Pay people with more skills and more responsiblity such as those in critical care more money.  It makes common sense.

9) Allow nurses to take an LOAs, say every five years, for a short time to rest body and soul if they choose to.

10) Pay monetary incentives to nurses around defineable goals. Managers and administrators are not the only people who should get money for achieving goals.

Any thoughts?

top ten reasons nursing is so hard

10) poop, vomit, blood, snot,  etc. 'nuff said.

9)  borderline personalities

8) inept management - Is there a good nurse manager/supervisor/administrater anywhere?????

7) rotating shifts

6) the growing number of obese people

5) exposure to disease

4) jerk doctors

3) working holidays

2) lack of appreciation

1) impossibility of completing required tasks, charting, etc.

Your thoughts?

THIS IS WAR!!! DAMMIT

I know bed bugs are no laughing matter, but geez.....it is getting out of control how we deal with them.

I pity the poor housekeeping staff, who have apparently gone through a detailed class on how to identify and COLLECT, yes I said COLLECT, said bed bug in a speical BED BUG container.  Apparently we are now collecting specimens.  I bet the housekeepers are saying: "HEY I DIDN"T SIGN UP FOR THIS SHIT WHEN I WAS HIRED!" My question is: what if they are still alive? Do they expect the housekeeper to chase them around the room and trap them under the specimen container? What do they put them in the cup with? Tweezers? Special bed bug catching instruments?  Shit its enough to give them nightmares.

After they catch Bob the Bedbug, then they call in the BIG TIME inspectors from some other department that has been specially formed to deal with these problems.  I hear they have shirts that say BEDBUG INSPECTOR.   After that they can clean the room.

Now all of this takes up to two hours.  If you can believe that.  A room out of commission for two hours because of the possibility that a bedbug has set up shop in the room. 

Here's my idea, I think I'll report that I saw a bed bug in a couple of rooms on a routine basis so that we have those rooms out of commission and there will be less patients brought back...

MAN UP

Well, its that time of year again. Its a little bit cooler and people start to go indoors and spread disease among themselves.  First up in the season: vomitting, diarrhea.  With this in my I present the following:

DEAR MR/MRS JOHN/JANE Q. PUBLIC:

If you have vomitting or diarrhea or combination of the two and are somebody who is in a normal state of health,  IT IS NOT AN EMERGENCY.  REPEAT, IT IS NOT AN EMERGENCY.  It is most likely a virus you have picked up in your travels through the world.

DO NOT COME TO THE EMERGENCY ROOM. WE DON"T WANT TO SEE YOU.  You clog up the system, fill the chairs in the waiting room, spreading your virus to others.  You take beds from people having an MI, a dissecting aorta, a stroke, a major trauma. 

Your day or two or even three or four of vomitting or diarrhea  will not kill you.  You will recover. It takes time. 

MAN UP.  Wash your hands.

with affection,

Madness the nurse

PANIC!!!!!! in the streets

Unless you live in a cave, you have probably heard about the fungal meningitis outbreak.  A company that supplies steroids to doctors who inject them into the spine of people with back pain sold contaminated vials of medication.  Seven people have died.

So apparently these medications went all over the country. It seems state department of health agencies are in charge of notifying individuals who have had injections from these medications. So alas, they have been individually calling people in my state and asking them if they have any of a list of about 14 symptoms.  If they do, they tell them to go directly to the emergency room. Now mind you some of these people had the injections 2-3 months ago.

These patients go to pain clinics. so they have chronic pain.  What do you want to bet that they will have one of the symptoms? Oh about say 75%, lets say.  Then you have the other 25% who PANIC!!!! It doesn't matter if they have any symptoms or not.  They want to be checked. They want the doctor to tell them they DON'T have it.

And so these people trickle in, wanting expensive time consuming tests (LPs) that the majority probably don't  need. Just kill me now.

you give me the creeps

Does this ever happen to you? You are just creeped out by a patient or their family? I'm not even talking about the people who would most likely creep you out: criminals, mental health patients.
I am talking about patients and their families that are just creepy.  When you are in their room it feels like something is just off in the family, something you probably don't want to know about.  They make your skin crawl. You avoid them. You just want them to go.

I am always amazed at our ability to keep a straight face in a lot of situations and not reveal what we are feeling.  We just go along with stuff, saying...uh ...yeah ...OK...when we are really having a whole other conversation in our heads.

ENDANGERED SPECIES: Nurses

Are nursing an endangered species?

Healthcare is changing. In my ER we are going to PAs as  the main providers. They will be seeing all the patients except those who are critical. This will mean less doctors needed.  Now mind you, this is a decision by our doctor group to do this.  They cover 3 hospitals and its hard to find enough doctors to staff them.  These doctors are saying that the majority of our patients don't really need to be seen by a doctor.

Is this the future of medicine? I mean think about it. Overall, isn't the vast majority of medicine routine?  Couldn't most of the patients in the healthcare system be managed by PAs or NPs?  Most of it is not rocket science. I've always thought that eventually medicine will go to exactly this model. Cost will dictate the change.

Could this same thing happen to nurses? Lets face it, some of what nurses do is not rocket science either. The tasks I mean.  A lesser trained person could easily manage them.  Where the value of nursing comes in is to manage and coordinate the whole picture, to monitor the patient and catch changes,  The value of nursing is our holistic approach.  We are the ones who see all aspects of the patient as a person and address it.  We have the knowledge to know how things should look and can recognize when something is wrong.   We are the person who stands between the patient and all of those specialists focusing on their own unique area. We coordinate the care and keep the patient safe.  We're the ones there at 3 am when the patient goes down the toilet.

WIth the emphasis on costs, do nurses need to care for individual patients? Would it be more cost effective to have 2-3 nurses overseeing a unit and other people doing the tasks? Will hospital managements start to think about cutting the more expensive nurses and replacing some of them with those who cost less, leaving nurses to supervise?  With the inevitability of NPs and PAs providing the majority of primary care, will nursing go the same route, being replaced by perhaps paramedics, EMTs?

Why do I bring this up? Because I see a rapidly changing health care system in which interest groups (doctors, management) are changing the way things are done. They recognize things have to be different. And then there are the nurses.

For a long time, nurses were in the drivers seat with the nursing shortage. We got what we wanted. They wanted to make us happy to keep us. That has all changed.  There will be another nursing shortage but it will be different. Nurses are being asked to do more with less.  We already are.

The nursing profession seems to be in a state of shock right now. Things are changing rapidly.  Corporations control medicine.  Yet we as a group are not stepping up to be a voice in this new environment.  We complain and whine about what is happening (I'm really good at that), wanting it to go back to where it used to be.  It isn't going to.  Unless we step up to the plate and deal with the reality of this health care environment and advocate for our very important place in it, nurses will be replaced. We are a costly part of the system in an environment that emphasizes cost. If we don't take control of our profession and prove our worth, take our rightful place, we will be gone.

EVERYBODY CLEAR! SHOCKING...

You know how many times I have been going to ACLS classes every two years? A whole helluva lot of times. I have seen epi doses range from 58 mg every 10 seconds to .00000001 every hour. Back when I started there were no such things as defibrillators.  If someone arrested we just stuck their finger in a socket.....bada bing!

In other words, I dread and hate this q2 year obligation to keep working in the ER. I wait until the last minute to renew. I avoid the book til the last couple of days.  The renewal is always fun.  They jam all the shit into 8 hours, including BLS. 

CPR has become too much of a workout for this old gal. I mean 100/min, hard etc?! One cycle in and I called for a switch.  I mean I didn't want to have a stroke in class. (Although everyone would have know what to do...)

Then there are all of these numbers swirling around in my half demented brain: 30:2, every 6-8 seconds, 1mg, 300 mg, 2-10 mcg, 15:2, 300 jules, 100/min.....its too much.

The worst thing about ACLS is that every time you go, you think you will fail and humiliate yourself.  You picture yourself going back to the educator at work and telling her you failed and you have to take it again.  It never happens, but there is still that stupid fear, no matter how many times you take it.

I passed it. Like I always do. I'm traumatized, like I always am.

The worst thing? I have PALS next week 

ER wait time: you will never be seen

OK, whose scathingly brilliant idea was it to put ER wait times on  hospital web sites?  There are apparently enough morons out there that go there and check them.

MESSAGE TO THE PUBLIC:

If you have time, if you are thinking about this before you even come, YOU ARE NOT HAVING AN EMEGENCY. REPEAT YOU ARE NOT HAVING AN EMERGENCY.

So I am sitting at the triage desk with the usual snarl on my face (sort of a get the the hell away from here presentation) and a person comes up to discuss on the wait time that was on the web site. The conversation went a little something like this:

MORON: The web site said the wait was 15 minutes and we have been waiting 30 minutes.

ME: Those wait times are usually not acurate.  ER situations can change minute to minute.

MORON: But, your hospital operator told me the wait was fifteen minutes...

ME: They shouldn't have told you that. Things change quickly.

MORON: Well who can I talk to about this. This is public information and it is not correct.  BLAHBLAH BLAH.  LALALA.

Now mind you it is Monday.  There are 58 people in the waiting room who have been waiting for hours. There is a line of people behind this guy. I gave them the ER managers home phone number and encouraged them to call  and have a long talk about the fraud being committed by the hospital in regard to ER wait times.  I told them the manager won't be home until midnight and doesn't mind being called that late.