another year of the blog gone by

May this be the best year you ever had.

 

 

tired of your shit

I hate to say this....but  I am REALLY sick of taking care of people. I've been doing it for a long time and I am just tired. I'm tired of cleaning the butts of people I don't know. Is that okay?

Before you say, you knew what you were getting into blah blah blah.  Time for you to quit blah blah blah. Don't say it.  I will be gone within the year.

Is it possible to get a job where you sit in front of a computer, make the same money I do and only work a couple of days a week? Har.  I am looking for the ideal job. The pickins are slim.

you are going to hell

You go up close and personal to look at a Christmas manger scene.  Somehow you fall, right into Joseph, knocking his head off...

A question and a couple of comment:

1) You are going to hell. God don't go for that knocking Josephs head off shit.
2) Is God punishing you by breaking your ribs?
3) Next time, admire it from AFAR.   Geez.

Twas two days before christmas...

Merry Christmas to all of you.   See you next week.

patient satisfaction sweepstakes

The patient satisfaction thing has officially gone off the rails.

I read that an emergency room in Massachusetts is starting a policy in which nurses can order pain medication on their own. Due to medicare reimbursement being linked to patient satisfaction scores, a policy has been developed in which nurses can order anything from tylenol to vicodin to morphine to dilaudid after using some kind of pain assessment scale. The goal is to treat pain within 30 minutes of arrival.

Isn't this outside the scope of nursing practice?  Isn't this practicing medicine without a license? Doesn't this open nurses, hospitals, the doctor up to a whole lot of liability?

With the increasingly common use of NPs and PAs in the ER, along with stuff like this, why do we even need ER docs?

Your thoughts?

those people

SE PEOPLE

Some people won't like this. Oh well.

As the hours go on since the shooting of 20 babies, I find myself feeling ashamed.  I am ashamed of living in a country, of being part of a society where this has happened. It is the latest of a series of  mass shootings.  There is something very wrong with a country where this is starting to occur on a regular basis, now affecting babies. 

I am hearing the same thing that always happens: This guy was a nut, blah blah blah.  Nuts shouldn't have access to guns blah blah blah.  If we could have everybody who bought a gun be psychologically profiled this wouldn't happen blah blah blah.  When are we going to stop fooling ourselves? 

We live in a culture in which violence is acceptable.  It is celebrated in movies, on TV, in music.  Its entertainment. We think it is okay for our children to play video games in which they "pretend" to shoot people.  We have become immune to violence. We don't really care that there are 30 shootings a day in the country, 1,000 shooting a month, 100,000 shootings a year.  It doesn't affect us personally, so whatever. If affects "those" people. They aren't like "us". 
There are 300 million guns in a country with a population of 350 million. Why do we need all these guns? I hear the answers: for hunting, for self protection.  Guns are rarely used for self protection.  They are mostly kept in lock boxes.  I guess its the psychological idea that we have a gun in the house that makes us feel better.   It protects us from "those people" out there, the ones that would harm us if they could. 

Why are automatic weapons that are mostly designed to be used in war, available for purchase to the average person? Why can you buy as many bullets as you want?  Under what circumstances would you, personally, need to use an automatic weapon? 

We hold ourselves up as this great country, always bragging about how great we are.  Number one, etc.  Best in the world. Others should aspire to be like us. There is nothing great about a country in which 20 babies are killed and it is the third incidence of mass killings in the last 6 months.  Our culture is twisted. It is sick in so many different ways. If the killing of these babies does not cause a massive national examination of where we are headed, what we are about,  then    it is only a matter of time before this country ceases to exist.

gotta get me some thunderbird

What alcohol level is incompatible with life? I guess it depends on your age, your tolerance, your liver function. In ERs we see the worst of the worst chronic drunks. Like the people who are conscious and can eat a sandwich at .445. Unbelieveable. These are the kind of people who never probably go below .20 if they can help it. Every day their goal is .44, however they can get there.

 

These are the people you see at the freeway exits and entrances with the signs about being homeless. I have often wondered, how much can they really be making standing there? Not that much. I mean most people are irritated by them more than anything. But then they probably don't need that much. A cheap bottle of booze probably costs a few dollars. If they're desperate there is always rubbing alcohol. It is just unimagineable to be so addicted to alcohol that you will pour just about anything down your throat that contains alcohol. Its pathetic.

 

Sometimes I wonder, who could they have been if they hadn't fallen into addiction? I'm sure most of them die at a young age. I would guess a lot die due to violence. Its a rough life out there trying to get that daily bottle. In my state there is no law against public drunkenness. We have 2-3 detox centers. When those are full the drunks come to the local emergency rooms. The county hospital has a specific area for them. All the other ERs just find a room.

 

Thousands and thousands of dollars are spent every year on these people. They aren't the kind of people you are going to help. All you can do is let them sleep it off and stagger out the door to start a new day of searching for that bottle. For the average person, a high level of alcohol in their blood is incompatible with life.  

 

A college student in a town about an hour from here found that out the hard way. She died after doing 21 shots on her 21st birthday. The ironic thing is she was a nursing student.

oh yeah

you're crazy and we don't care

Why is mental illness treated so much differently than physical illness in our society?  Is it part of the individualism that this country so highly values?  Pull yourselves up by your bootstraps and stop  complaining,whining.  Be strong. Get it together.

Mental illness is no different from physical illness. It is not something that an individual chooses.  It happens due to circumstances, stress, heredity.  It is a chemical imbalance that very often needs medication to manage.  Not always, but more time than not.

Mental illness is an epidemic in this country, but we don't treat it that way. The way we treat it reminds me of how those with AIDS were treated when it first started being recognized.  There was fear, blame, stigma. So many people never get treatment because they don't want to be labelled.  They believe what we are told that going for help means you are weak.  So their illness gets worse.

When it gets to the point of no return, they can't deal with it anymore, they present to ER.  They are feeling suicidal, have attempted suicide. They come into an ER that is not  prepared to deal with them.  Physical stuff can be dealt with, maybe fixed.  Mental illness? Not so much.  ER staffs don't    have time to spend listening.  Often patient sit waiting for hours.  Their admission, unlike physical illness problems, has to be pre-approved.  There is a shortage of psychiatrists.

Their are often few, if any, beds available.  Mental health beds are not a priority for hospitals. They're not money makers.  When their are no beds, people have to be transferred to another local hospital, and in some cases, to a hospital a couple hundred miles away.  Sometimes they spend 24 hours in the ER.

That's what happened to a lady I had last week.  They wanted to transfer her to a hospital about 150 miles away. She was not rational to begin with, this caused her to lose control.  Security was called.  She ended up not going to the other hospital, after a few hours she got a bed with us.

When I see these kinds of things happen, I think about how hard it must have been to come in the first place. Then you sit for hours.  Then you are told you will be going 150 miles away from your family to be hospitalized.  Its a crime how mental health is handled in this country.  

babies

What can you say about 20 babies being killed? Nothing. All you can do is pray for their families.

why me Lord

I was gnarly last week, I admit it. Working too much with too few days off. No time for recovery of sanity.

So its my last day before a few days off. The black cloud that was hovering over me is slowly lifting. Then HE comes in. Histrionic Harold.

Red flags:

1) Medics wanted to give me report outside the room

2) From the time he arrived and was transfered to the cart, he made this WOOOOOOOOOOOO!!! sound while sitting there with his eyes closed.

3) Daughter arrives and does not want to go into room with Dad.

4) He normally gets care at another hospital.

So we manage to get throught the first few minutes. I am entering stuff in the computer and He is rambling on about all of his medical history back to the Mayflower. And I let him ramble. Half listening. Not really caring what he is saying.

I didn't give him the call light. I'm no fool. At some point he requested to have the call light and I had to hand it over. Mistake.

Periodically throughout the visit I hear WOOOOOOOOOOOO!!!

At some point daughter leaves in disgust.

First he will go home. Then he will stay. Then he will go home. Finally a bed is ordered. I consider making a run for it out the door.

I actually maintain my patience remarkably well. One thing about the ER, eventually even the worst patients leave. Besides, I'm off for a few days starting the next day, so its all good

bless me father for I have sinned

I had an older man who got his first tattoo at 72 years old.  Then he got another one after that.  One on each arm. They actually didn't look bad.  He was kind of a heavy man so his skin didn't sag where the tattoos were.  Apparently his kids wanted him to get them. His sister was mad he got one at his age.

When he went to the tattoo parlor he asked the person doing it if he was her oldest customer. He wasn't.  She told him that there was an older women she had done.  Being a religious women, she went to her priest and asked what kind of tattoo would be okay.  The priest told her a cross. So thats what she got.

I really enjoyed taking care of this guy.  He seemed to enjoy life and have a lot of fun. He made my day go faster.

Got any interesting tattoos?

bumper cars

Well its a winter f--kin' wonderland out there: "Isn't it pretty blah blah blah?" Our first major snowfall  of the season and of course, people go nuts. Its like bumper cars on the streets.  300 accidents as of this afternoon.  Every Tom, Dick and Harriet comin' in with their fender-bender neck pain, back pain.  Blah blah blah.  Willing to sit in the waiting room for hours to get their non-existent injury looked at.  Whatever, easy patients for us.

What always amazes me is the people who despite the blizzard like conditions, still make their way to the ER for their chronic back pain, puncture wound, STDs.  I swear there could be 6 feet of snow on the ground and they would tunnel their way through.

So anyway, at mid day it was chaos.  Ambulances bringing in two patients at once.  Then by evening there were 5 people in the ER.  I  got to leave early.  Yeah!

no flo

Being an ER nurse is so damn hard. The patients are more acute these days.  I've been trying to figure out lately why the job seems so much more stressful  than it used to be.  I ask myself, is it because I'm getting older and dealing with stress is harder?  I wonder about the other nurses. I mean I have been at this a long time.  I can handle just about anything.  If I am feeling like this, how are the other, less experienced or new nurses feeling?

Most people in this world are decent, doing the best they can.  The thing is, and this job teaches you this, there are just plain mean people and there are a fair amount of jerks in the world too.  They make the job even harder.

In nursing school, you are taught "therapeutic communication".  You are told that people react to stress in different ways.  Its like you are taught, "they can't help it, they are hurting, under stress, etc.".  Its your job to take care of them and understand and if you communicate with them in the right way, you will be Florence Nightingale and they will be the perfect patient and everybody will live happily ever after.

So right off the bat, there is an abyss between what you come out of nursing school thinking, and reality.  The first time someone calls you a "FUCKING BITCH!" its a shock to the system.  This isn't the way its supposed to go.  Flo runs screaming from the building and you are left standing there by yourself. This is the point where you follow Flo right out of the nursing profession or for, various reasons, you decide to stick it out. You develop a protective shell around yourself.  You do the best you can, realizing the perfection that is expected is impossible.

You get tired, weary, angry at times. Just when you think you can't take it anymore,  someone says thank you. Two little words. It stuns you.

So to all my fellow nurses.  Your job sucks a lot of the time. I know that you hate it at times. I know you go home exhausted. You wonder why you still do it. You get angry some times.  To all of you, I say thank you.  Thank you for doing a great job under impossibly stressful circumstances.

poor puddy tat

Story #1: A person gets in their car with a friend and goes on the freeway. They hear a strange sound and wonder if it coming from the radio, so they turn it off. Not coming from the radio. Its a distinctive: "meow....meow..." They pull off the freeway and look under the hood, there sits a kitten curled up on the engine. She goes to pull the cat out and puddy don't like that, so it proceeds to bite her hand. Bad puddy tat. Puddy tat runs away. Person comes to the ER a day later. There is no swelling or redness on the fingers that were bitten, but NP calls someone who connects her to the "state veterinarian" (who knew we had a state veterinarian? And why do we need one?) That person tells her that last year there were 7 cases of rabies from cat bites. Sounds bogus to me, but then I'm not the one decidin' what to do. The patient will have the rabies injection. When a rabies series is given it is given in 3 steps. The first step is to take half of what is ordered and "infiltrate" the area around the wound. (stick a needle into it) Ouch. Then the other half is given by injection - 2 shots. Next step another shot one week later. Next step another shot 2 weeks after that. No fun for anyone concerned.  story #2: Man comes in to the hospital to visit his wife who is an inpatient. Man is a insulin dependent diabetic. He takes his insulin that morning. He doesn't eat anything for breakfast. Nurse who comes in at 7 am notices him and he seems to stumble a little bit and she thinks hes drunk so she walks on. Two hours later the patient is found on the floor next an elevator by the ER. His blood sugar is less than 20. He is brought back around with D50W and orange juice, at which time he tells the ER staff, "I never eat breakfast". He has no idea how lucky he was to be in a hospital when this happened and have access to immediate help. He is sent on his merry way, but he just doesn't seem to grasp things when we tell him if you don't eat breakfast you could die or become seriously disabled.....Just another day on the cold, lonely prairie....

the jail break

You know its gonna be a bad day when you note that there are overflow patients in the area you are about to open, and one of them is dead.

You pass triage and some guy is saying in a loud voice: "I just broke my Dad out of jail".

You pass a room and another guy is loudly telling a nurse that he, "just got out of the penitenary 3 weeks ago". He's drunk.

Okay there is a theme developing and I don't like it.

Its downhill from there ending with a drunk guy who doesn't speak english and proceeds to talk loudly for the next 2 hours in his native tongue and of course he is right near the desk...

i want money

Interesting development.  The corporation I work for is offering a pretty good bonus if you recruit one of your experienced ER nurse friends to work for them.  Is this a sign that things are picking up in nurseland?

Is this the start of a shortage? I think that experienced nurses are sometimes hard to get these days. Most ERs don't want to hire non-experienced or new grads in ER.  Or ICU or other speciality areas.

Here's my take on it (hey, you knew I would have one). Nurses have not been leaving jobs because there haven't been an abundance of jobs.  We are afraid to leave a job during a recession. Some people have had their spouse laid off.

I see jobs picking up somewhat. I also know that: 1) older nurses are retiring 2) younger nurses are going back to school to be NPs and leaving  3) We are starting to see an increase in patients who are elderly (people are living into their 80's and 90's these days)

The first baby boomers are retiring. The explosion of older people and their medical problems is coming.  Obamacare is coming. You ain't seen nothing yet.

More money for us. Yeah! (rubbing my hands with glee)