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) 

you are cutting your own throat

We are about to get PAs (physician assistants) in our ER.  They will staff part of the ER part of the day.  They will probably take on more of the ER as time goes on. Big change. From what I understand, this is being done because our doctor group doesn't have enough docs to staff the several hospitals they cover.

I don't like this. Seems like docs should staff ERs.  Here's the thing: You are not going to believe this but they don't give a shit what I think, here they come.  Its reality. So I will adjust and so will everybody else.

However, I wonder if by employing PAs, doctors aren't cutting their own throats. Lets face it folks, the vast majority of ER medicine is not rocket science. With a little experience, you pretty much know what the problem is. So PAs will do fine with their background. In fact, I would say that PAs and NPs could easily staff most ERs with a doc to supervise and handle the critical cases.

So really, is this what the future holds? Perhaps.  Health care costs will have to be cut.  PAs and NPs are a lot cheaper, will cost hospitals less, insurance companies and medicare/medicaid less. You can pay a PA/NP maybe $125,000 versus and ER doc $250,000, thats a lot of savings.

Like I have thought for a while, the future of general practice is PA/NP and perhaps some specialty areas too.  

oh no

Oh no. What has happened to one of my favorite blogs: Nurse in the hood?  Please, come back to me.

task monkeys

My ER is changing.  It is changing like all of medicine is changing.  I have been a nurse a long time. Things were different when I started. It wasn't a corporate run environment back then.   There was more of a kumbiyah feeling. 

Now it is a business. Plain and simple.  Its hard to adjust to the idea that medical care can be a business, but there it is, whether we like it or not.

The thing is nurses haven't adjusted to this new environment.  We want things to go back to what they used to be.  To a time when we had more time with our patients, where things weren't so complicated. The thing is thats not going to happen.  We will have less time with our patients and things will get more complicated.

In my ER, like most ERs these days, the bottom line is volume, patient satisfaction, in other words, money. I'm not saying we don't do great patient care, we do, but doing great patient care means nothing if nobody comes, they aren't happy and the bills don't get paid.  Its reality.

I see our doc group adjusting.  They are expanding their business to other ERs, improving their skills, trying to make the patients happy so they will come back.  They get monetary incentives to see more patients.  Everything they do, efficiency wise, is tracked.  They are adjusting to the new environment and trying to thrive within it.

There is a lot of talk in our ER among the non doc staff about how they docs don't really care  about anything but themselves. They only care about making money.  People think they treat us like task monkeys.

My thoughts: Docs have recognized that in this corporate healthcare environment, they have to look out for themselves. Nobody else will.  Nurses don't recognize that, at their own peril.  Nurse are definitely more than task monkeys,  they are the cornerstone of the healthcare environment.  IF we as a group don't start changing, promoting our profession, taking care of our own interests in this business environment, we will be gone, replaced by task monkeys.

We have to recognize that don't DESERVE anything, we have to prove our worth, change with the times, embrace change, help to create it.  The question is: Do nurses care enough about our profession to save it?

tomorrow isn't guaranteed

You don't realize it. Your family doesn't get it.  The doctor and I know you are not going to live past the next couple of days.

All you know is that you are having pain. Your family is in a state of shock. The things they say, the questions they ask, tell us they don't understand the seriousness of it.  The doctor ackwardly tried to explain to you and them that things most probably will get worse soon and decisions will have to be made that no one wants to make. He asks if you have talked about how much you want down regarding resuscitation, intubation. You and your spouse are old, but like most people you haven't discussed it. 

When the doctor leaves, I tell you that you are in very serious condition. Nurses do that. We feel we need to bring reality in, so you can prepare, even if it is hard.  We are the translators for what is going on.  I ask about children and tell your spouse that the needs to call your, tell him what is going on.

Its hard to understand when you are so stable, still understanding some, talking. Its hard for you to see what is coming. 

You go up to ICU, your pain is getting worse. When you get to ICU things are starting to  deteriorate and the doctor is called and you will have immediate surgery. You will probably make it through it, but because of other medical problems you have, you won't make it much longer.  I think about what your family will go through.  You are the kind of person I am thinking about a couple of days later.
You are the person who reminds me life turns on a dime.   

no shit rains down

Something happened the other day. I'm not quite sure if it was real. I went to work as usual, walking into the hospital wondering what shit  would rain down on me  today. As it turns out I was walking into a magical fairyland. Yes people my saggy, baggy, ratty, dirty, rundown old ER had turned into something else that day. A place I didn't even recognize. It didn't look any differnt.

Something was in the air that day. Something that I hadn't felt for years.  I didn't even realize how different that day  had been until I was in the car driving home. I was humming, feeling tired, but good.  I didn't feel that ugly, bitter, angry "I hate this motherf---king job" feeling.  I actually felt kind of good.

Wait a minute......SCREEECHHHH!!! STOP THE PRESSES!!! Yes, people I actually felt good about my day at work that day. I felt like I had accomplished something, done something worthwhile. No, I didn't sit on my butt all day because people trickled in. It was a steadily busy, post holiday type day. Lots of grandmas and grandpas.

I had sick patients, really sick patients, they might die sick type patients.  The kind of patients you are still thinking about a couple of days later, wondering what happened to them.

The point of all this?  I actually took care of  REAL emergency patients.  Patients who truly needed help.  No whiners, seekers, fools, crazies,  drunks, dopers.  It was actually like you think an ER should be. 

I doubt it will ever happen again.....in fact it may never have happened at all....maybe it was a dream.

emergency room nurse saves life

I can save your life this Christmas.  Buy one of my bracelets on Etsy.  Everything in the shop is 15%off through Monday with the coupon code BLACKFRIDAY15 at checkout.  Click on beadnurse below pictures to go to my shop.

thanksgiving....happy

I'll have cuppa joe with half and half..

Just when I think I have heard it all in medicine, something else comes along to amuse, amaze and trouble...such as: I have seen this twice in the last couple of months. A doctor orders an infusion, YES I SAID INFUSION, of caffeine in order to avoid those pesky headaches from withdrawal of caffeine.  Both were given when someone was having surgery.

Okay....perhaps we should give a nicotine infusion, for smokers,an alcohol infusion, for alkies.  Maybe a chocolate infusion....the possiblities are endless.

if only Gerard Butler were a doctor

Even though I sometimes poke a stick at and make fun of doctors on this blog, I have the utmost respect for 15 out of 16 of the docs I work with (OK I'd like to dropkick number 16). That being said, I take you on a tour of types of ER docs:

THE ENERGIZER BUNNY - This doc (usually not too far out of residency) is sometimes standing at the door as you bring them to the room from triage. They are like a dog with a bone. AMOS ADD ON: This doc will initially order some stuff and then as that comes back he will order more tests and then more and then more....

THE ABSENT MINDED PROFESSOR - This doc is really too smart for their own good. When someone has vague symptoms they will go off half cocked looking into whether this could be some rare exotic disease. Wanders off easily. Messy.

JACKHAMMER JACKIE: They learned how to do an extensive history and physical in a short period of time and by God, they are going to do it on every patient. Patients is often confused and can't keep up when doc says: do you have this symptom? this? this? this?....in a rapid fire manner.

OVER ORDER OLLIE: This doc orders everything under the sun and then some. Damn it, I'm going to order everything, there's got to be something wrong with you and I'm going to find out what it is!! Keeps CT and MRI in business.

PANICKY POLLY: Voice goes up 10 octaves in any emergency situation. They are so nervous they make everybody else nervous too. Creates chaos at the beginning. She's the kind of doc you want to slap across the face and say: "Stop it! You're hysterical!" (Usually an internal med doc working in an ER - sorry IM docs)

MACHO MIGUEL: You set up everything perfect for that procedure and it goes without a hitch. But alas, macho miguel will point out one small thing that you should have done differently....to keep you in your place and reinforce WHO IS THE DOCTOR HERE.....

NANCY NICE: This doc is SO nice and kind to EVERY PATIENT. Never raises their voice. Never gets angry. You know one day they will probably go postal and it won't be a pretty sight...

NO BULLSHIT BILL: Doesn't allow those drug seekers to get drugs. Cuts off the chronic painers after a couple of pain shots. Throws out those abusive patients. The nurses best friend. Lest you think that ER nurses have nothing but negative things to say about docs, oh contraire dear reader...here is the ideal doc in an ER nurses eyes:

DREAM DOCTOR: Is very good at his/her job. Respects nurses. Goes to the doctor's lounge and brings back cookies. Occasionally gets the patient a drink of water or warm blanket THEMSELVES. Buys an occasional pizza. Has a sense of humor. Looks like Gerard Butler. Has that accent Been around a while, been there done that, doesn't get too excited about stuff. Calm under pressure.

The HELLHOLE, CRAZY TOWN, HOOD RAT PLAYHOUSE, SATANS PLAYGROUND

There are four areas in my ER.

Area #1 AKA the HELLHOLE

This area is where the drunks, dopers, old lady/man weakness, suiciders, people with 89 problems and now they got another one.  Its the patient who need to be cathed, put on the commode, need every test know to man. It has 2 critical rooms, one of which is right next to the desk.
Last week I sat at the desk, across from the desk while my patient kept shouting that I was a "bitch", "aren't nurses supposed to be nice?" All this because I turned down a request that this person made which couldn't happen.  2 psych rooms.  BTW, as a general rule I AM NOT NICE.

Area #2  AKA CRAZY TOWN

This area is twice as big as area #1.  The only thing I could compare this area is times square. Sensory overload.    It is loud, chaotic.  Too many people in too small of a space There is always a dull roar.  As a nurse, sometimes its hard to find a seat here. It is the kind of area, where when it starts ramping up, it really ramps up.

Area #3 AKA HOOD RAT PLAYHOUSE

This is the area where all the local hood rats come for their boo boos, drips, pregnancy tests, womitting x 1 hr, BACK PAIN!!!,  etc.  It is supposed to be a kind of urgent care area but of course it isn't.  People often stay here longer than in the main ER because everybody has to have a "liter of saline, zofran and  Dilaudid".  You know how diners have specials?  Well, the special in HOOD RAT PLAYHOUSE is saline, zofran and dilaudid. Working there makes you want to jump off the parking ramp.

Area #4  AKA SATANS PLAYGROUND
Ah, triage, every ER nurses nightmare.  You never know whats coming next. Sometimes the devil himself shows up at the window.  There is a lot of temptation in triage.  The triage staff is tempted to slap some people silly.  My tongue is always raw and bleeding after a triage shift, because I am contantly biting it. Unbelievable things happen in triage: heads spin and green vomit spews, people roll on the floor, there is screaming, weeping, many a tooth are gnashed. Its the seventh layer of hell.

And that, my friends, is my ER in a nutshell.

this is war dammit

This is war, people.  Stand back while we fight the almighty bed bug.

Hey I get it...the danger of spreading bed bugs throughout the land and throughout the hospital...no one likes the little critters.  But what I saw today makes me think that we have gone off the deep end.

First  of all, apparently there is a 15 page explanation of the hospital bed bug policy, which is very complex and intricate in a binder.  Who knew? 

Whats funny is that apparently we are now supposed to wear a disposible paper jumpsuit.  Yes, I said jumpsuit, a la Elvis or some shit. I mean that is how serious this has all become.  Here's the thing because the paper "jumpsuit" could not be found, someone brought hazmat disposable suits to wear. 
So registration goes in wearing a hazmat suit with hood up over their head.  They also had a mask on due to droplet precautions. I tell ya, what we go through to get insurance information these days.

So there is registration making their way into the room for those signatures.  Following them  lab, with same get up and hood and mask.  They look like they are entering some chemically contaminated scene.  It was bizarre to say the least.

I wish I had a camera..

Insanity

Only in  this insane place that I live can you go from 60 degrees (which in November here is miraculous,) to an evening thunderstorm, to 30 degrees and snow in the space of 24 hours...

BTW, honor the veterans today and make a donation to Fisher House.

nursing is bullshit

Top ten reasons why nursing is such complete bullshit:

1) In what other job are you expected be okay with being verbally abused? 

2) In what other job, is the leadership so bad? 

3) In what other job are you expected to go hours without a break and be okay with it? 

4) In what other job are you asked to give dope to a junkie? 

5) In what other job are you supposed to try and understand and empathize with someone who is threatening you? 

6) In what other job do you get 2 dollars more an hour to be in charge of a place where peoples lives can be on the line?

7) In what other job are you physically, emotionally, mentally exhausted at the end of most days?

8) In what other job could you get a life threatening disease but are given no raise for a year? 

9) In what other job are you exposed to junkies, criminals, sex offenders, psychotics, neurotics on a daily basis but you only hear from the management what you do forgot to chart some piece of bullshit?

10) In what other job do the mediocre advance to leadership positions? (see 2)

And that my friends is why nursing is such complete bullshit. The end. 

Sincerely, 

madness
the bullshit detective

triage-o-rama

Highest number of people waiting in the lobby to get in today: 22

Highest number of people in line at the triage window at one time: 10

Highest number of people in the ER at one time today: 52

Longest length of time someone waited: 3 hours

Most members of one family triaged today: 3

Longest time someone had a symptom they were being seen for: 2 years

Shortest time someone had a symptom they were being seen for: 1/2 hour

Percentage of people who didn't really need to be there: 90%

Dumbest reason to come to the ER: "I want to be seen for an std, I have no symptoms but something doesn't feel right".

Smartest reason to come to ER today: severe chest pain for 3 days

Amount of time left in the shift when I got dinner: 1 hour

Amount of times I felt like running screaming from the ER while working in triage: 12 - at least twice an hour

 

once upon a time..

Once upon a time there was a rocket scientist. Now this rocket scientist did not go to the dentist on a regular basis, who knows why. Well one day rocket scientist has a toothache. Now toothaches suck as we all know.

Well of course rocket scientist does not have a dentist, not using such services on a regular basis. Didn't think of going to the drug store to get something. Eventually rocket scientist decides that this toothache requires emergency intervention. So rocket scientist calls an ambulance. Yes, an ambulance. Now Mr/Ms. paramedic are obligated by regulation to take rocket scientist to the ER, code 58 (if we get stuck in traffic we don't care). Paramedics walk rocket scientist into ER triage. Rocket scientist is put in the lobby after triage. Eventually they are taken back to the fast track and put in a room. Within 5 minutes rocket scientist is on the light asking for pain meds.

And so the story goes on....Act 11 scent 28...enter stage left - nurse practicioner. Nurse practicioner won't give narcs for toothaches, bless her heart. When Nancy nurse goes in to discharge rocket scientist they are no where to be found. They have left without instructions, realizing no narcs are forthcoming.

Your tax dollars at work.
Fade to black....

Larry, Moe and Curly visit the ER (a typical Friday morning)

Hey I'm sorry if your life is shit, but that doesn't give you the right to become so enraged that you tear the reciever off the wall phone and throw it across the room hitting the wall. The wrath of madness will be upon you. You endangered us and we don't like that.

Hey I'm sorry you are a pathetic drug addict who told us you are suicidal. That doesn't give you the right to make a run for it. You are fast, but we are faster. It is our security's pleasure to tackle you out in triage. They live for that shit.

Hey, I am sorry that your life has gone badly, but that doesn't give you the right to light up a cigarette in the patient bathroom. That does not endear you to the staff or the other patients. The tenor of your visit has now changed. Not in a good direction.

How was your Friday?

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.

GOK and SWAG

The bain of our existence: charting.  More and more required charting, to the point where it will drive us all insane.  In the interest of collegeiality here are some abbreviations that might help you:     AQR - Ain't Quite Right Call Button Jockey - patient that uses call button, every few minutes  for no good reason SALT Same as last time CTS - Crazier than shit DQ - Drama Queen ETOH - Extremely Trashed or Hammered FMPS - Fluff My Pillow Syndrome (attention/sympathy seeker), like Call Button Jockey FOS - Full Of Shit GOK God only knows Gomergram - Ordering all available tests because the person is unable to explain what is wrong with them JPS - Just Plain Stupid PRATFO - Patient Reassured And Told to Fuck Off LGFD - looks good from door (but not closely examined, possibly an obnoxious patient) OBS - Obvious bullshit Urban Outdoorsman - Homeless person MFC measure for coffin SWAG scientific wild ass guess   Additions anyone?

I been robbed, I say, I been robbed

Here are the top ten things stolen from our emergency room:

1) syringes - before drawers were locked

2) linen - sheets, towels and wash cloths

3) phones off the wall

4) fetal doppler

5) lap top

6) bandaids, bandages

7) box lunches

8) gowns

9) oximeter

10) staff purse


Extra added bonus points:

thermometers

ornaments off Christmas tree in lobby

send in the clowns

***PUBIC SERVICE ANNOUNCEMENT***

Attention all citizens:

The following are not emergencies:

1) bug bites - unless it have swollen to the size of a baseball

2) the fact that you cannot control your teenage daughter or son

3) you are fatigued or can't sleep

4) you want your son, daughter, brother, sister, etc. to get chemical dependency treatment

5) the condom broke

6) you are hungover

7) G tube not working

8) the cut is less than 1"

9) any kind of medication refill

10) menstrual cramps

Thank you,

your neighborhood ER

fraud is fruad is fraud

If you come into the ER with a stubbed toe, you could go out with ten diagnosis' on your visit record.  If you are admitted there will probably be twenty.  Everything that has ever been wrong with you will be noted as part of your discharge or admission diagnosis. Depending on which doctor you get, it will be more or less.

Knowing this, when I saw an article in the New York Times a couple of days ago (September 24: "Medicare Warning to Hospitals on Medicare Abuse"),  I was fascinated.  It talks about how the government isn't going to tolerate hospitals that try to "game the system".  In a statement, government officials were quoted in the following:

 “There are also reports that some hospitals may be using electronic health records to facilitate ‘upcoding’ of the intensity of care or severity of patients’ condition as a means to profit with no commensurate improvement in the quality of care".

The article also states:  
 

"Much of the higher billing is taking place in hospital emergency rooms, where hospitals are classifying many more patients as sicker and needing more care". 

Oh my goodness, ya think?????!!!  ER nurses have been talking about this for YEARS.  The fact that people are being way overtreated. There are very few people who come into the ER who don't have an IV started, aren't given IV medications, lab tests, xrays, etc.  It has gotten to the point of ridiculousness.  If you have a virus or a tummy ache you get all of this shit.

Doing all of this allows doctors to up the level of care and CHARGE MORE MONEY, and therefore MAKE MORE MONEY.  It is nothing less than fraud.  Now doctors try to justify all of this by whining about "liability", "patient satisfaction",  etc.  Bullshit. This is called greed folks.

It is done for all patients, not only medicare patients - espescially patients with insurance. Your chance of getting an MRI or a CT ANGIO increase in direct proportion to what kind of insurance you have.

Lets hope the government truly cracks down on this shameful practice of medicine.