don your bonnet

Here I am doing a dress  rehearsal for the big day tomorrow.

will nursing unions survive?

I'm probably the biggest union advocate you could find.  I grew up with a mom who worked in factories all her life and was the sole support of my brother and I.  She was a fierce union advocate and she passed that on to me.

Without unions, nurses wouldn't have what we have today: somewhat decent wages, benefits.  Nurses worked hard to get to this point, they sacrificed.  However, I am beginning to wonder whether our unions need to change in order to deal with a changing health care environment, otherwise they might cease to exist.

I think a lot about what is the future of nursing in health care.  I see the health care system painfully changing to adapt to less reimbursement, patient satisfaction, obamacare.  Hospitals are quickly changing to adapt.  I see our doctor group adapting.  Then there are nurses.  As usual, we sit back and let it all pass us by.  We resist change for the most part. We aren't proactive, but reactive.

These days our unions settle contracts that try to keep what we have, forget about getting anything more. Unions have rigid contract provisions, necessarily so.  They have to be clear cut.  The thing is, how does that fit in with a changing health care environment?  How does nursing adapt and change and prosper within this rigidity? It doesn't.

If we don't change, adapt, we will be left by the wayside, replaced by cheaper workers.  An example of this: there is a new program in my city that is called community paramedics.  It is just starting. The goal of this, bottom line, is to keep people out of the hospital.  They will do followup, do preventative care, anything they can to maintain peoples health. This fits right in with obamacare, medicare changes.  In other words, they are doing a lot of what home health care nurses are already doing.  The thing is they can be paid half of what nurses do.  This is an example of things to come as health care systems look for ways to decrease costs.

Can our unions become more flexible or will they cease to exist? Are unions outdated?  Will nurses care enough about our profession to wake up and take control of our future?  Only time will tell. Any thoughts?

       

the spice of life

The thing about working in the ER a certain amount of time is you could walk in with two heads and I would say: okay...what can I for you? Just when you thought you seen it all, in walks somethin' you ain't never seen before.

So I'm sitting at the triage desk and you walk in. To say that you are "different" is to understate it. Shall we say that your fashion presentation is a little out there on the edge? The edge where no one else has been and won't go.  Lets put it this way:  You are a combination of lady gaga and cindy lauper with a dash of street hooker thrown in.

You are, shall we say, UPSET?!!!!  Only your upset is different than other peoples upset.
Your upset is theater.  The angst is off the charts.  Your arms flail, your face contorts. You tell me your problem which is equally bizarre.

You are eventually discharged after being evaluated mentally and physically.   I love people like you .  Variety is the spice of an ER nurses life.

when life ends

As a nurse, you don't think much about what you are witness to on regular basis.  Birth, death, trauma...life changing events.

One of the things we see as nurses that most people don't, is death.  A lot of the time it isn't pretty.  A lot of the time its not like in the movies where someone just goes and its over quick. Sometimes it takes a while.  Sometimes a family sits waiting for death, watching their loved one gasp. Sometimes that goes on for a while.  Its difficult to witness.  To see you mother or father seem to struggle for breath for a while.

As a nurse, to be honest, you just want it to be over.  For them.  Those are the times you pray for the end to come.  So they won't have to remember an awful end.

Nurses stay with families as death nears.  Its part of what we do.  We don't want them to be alone. Its too hard for them to be alone. So we stand there while they talk about mom or dad or grandma. You learn a lot about the person at times like that.  

Its hard to watch people cry.  Its doesn't matter how old the person is, they are still mom or dad.

be humble

One thing you have to learn as an ER nurse is humility. I see some young nurses with say a year under their belt, overconfident.  Its like they say to themselves: I've done this a year, I know it all.  Here's the thing: That kind of attitude will eventually bite you.

There's nothing wrong with confidence.  Its a good thing.   I have a lot of confidence. The thing is I have been doing this a long time.  But there is one thing I know: I don't know everything and I never will.  On a regular basis, I ask my co-workers for help.  I depend on them. If I've never done something, I know one of them will help me do it.  If I need help, I ask for it.

The longer you work in ER, the more humble you become.  The more you see, the more you realize you will  never see it all.  Overconfidence leads to mistakes.  

after a 12 hour shift

here's a reality check

You know what I can't stand?; (No, what can't you stand madness?)  I can't stand nurses who act like those of us who are REALISTIC about nursing are somehow denigrating the profession.  I particularly remember one blogger saying we should be "lifting up the profession".  Why is it that a  statement like that irritates the shit out of me?

Nursing is a damn hard job that keeps getting harder. Especially if you work in a hospital.  What is expected of us is ridiculous.  More and more is dumped on us with no real increase in pay.  We are responsible for the patient 24/7 and aren't compensated for that responsibility and liability.  We are expected to learn technology that is more and more complicated.  We are expected to retain mountains of information.   We are supposed to smile in the face of verbal and sometimes physical abuse.

So I ain't gonna sugarcoat it folks. It take a tough person to be a nurse.  We don't give ourselves credit for doing one of the most difficult jobs out there. It is mentally, emotionally and physically exhausting on a daily basis. The fact that we are able to do it at all is amazing.

One of the reason the public has this unrealistic picture of nursing is that we don't portray it realistically.  Nurses need to tell the truth about their profession.  How complicated and hard it is.  Nursing schools need to tell students how it really is, so they will be prepared.  If nursing was portrayed more realistically, you would know what you are getting into.

yes

Its like I'm a normal person or something

There is an ER God after all.  How do I know? Today was a day of respite.  It was mysteriously slow.  A welcome departure from the two days I worked  this past week which sucked.

I should have known the day would be different when I walked to the back of the ER and there were no drunks sleeping it off.  And last night being St Patricks eve and all....weird.

I worked in triage and I didn't turn into the incredible hulk like I usually do.

I didn't go home mentally and physically exhausted. I wasn't gnarly with my family like I usually am.  I haven't said: "I HATE THAT PLACE!" once since I have been home. Its like I am a normal person or something. Very strange.  A feeling I don't often have.

When there is a rare day like this, I say to my co-workers that the world has come to an end and we are the only ones left alive...thats what it feels like.

I wonder if you made it

You know what I hate?  I hate the fact that HIPAA has gotten to the point of such ridiculousness that when I send a critical patient upstairs, I can't even find out what happened to them.  I wonder if they survived.

When you have a patient who you know is in a life threatening situation and you work hard to stabilize them, naturally it affects you more.  You send them up to ICU hoping they will be OK.  Maybe they won't.  Thats the kind of case that you think about longer than normal.  You are amazed they lived this long.

So naturally you want to know what happened.  You can't go into their chart to see if they made it.  Thats a no no. You can't call the station and ask about them.  Thats a no no.

Nurses don't want to know what happens to their patients out of some kind of malicious intent.  We want to know because we care.  We helped them live a little longer. We want to know if it made a difference.  Now a days we are left wondering.

I am slacker, what can I say?

I've been slacking on the blog lately.  Why, you ask? Winter boredom.  Winter blues. I live up here in the frozen tundra.  Last year we had unseasonably warm temperatures.  It was in the frickin' 70's on St Pats day last year.

This year it is NORMAL.  Normal means a long, cold, snowy March that is excruciating.  Every day is gray.  Every other day it snows just enough to make it annoying to drive.  Like yesterday it had snowed about an inch.  This is the time of year when it gets warm enough to melt the ice during the day, then it freezes again at night.  That inch of snow covered the ice.

Now here is a formula:  ICE + inch of snow + people = too many people coming to the ER.  Another formula:  ICE + inch of snow +  too many people coming to ER + madness the nurse (working triage and charge all in one day) =  a depressed and gnarly madness the nurse.

After 12 hours of running my butt off, today I am exhausted and my bones are feeling their age.

the bomb drops

Sometimes people have a bomb dropped on their lives in the emergency room.  Sometimes we find out things that no one expected and its really, really bad.  The doctor has to deliver some news that will change their lives forever. So the doctors breaks the news.  The nurse goes in to deal with the aftermath.

This is what nurses do. We deal with the human part of medical problems. Not only do we do the treatment necessary, we help people deal with what is happening to them. Whenever there is a threat to a persons physical self, its damn scary.  Some times its more scary than others. It is the beginning of an ordeal that could last for months, even years.  Many times they will die. We know they will die, but we don't tell them in the beginning.  No one wants to hear they are going to die on the day of the bomb drop.

We are saying to ourselves: "oh shit..this isn't good..." We feel sad, knowing what the person will go through.  We wonder what will happen to them.  We will never know. Is it better that way?

yup

triage is not for sissies

Triage. Every ER nurses nightmare.

Here's what triage is like:  Pretend you are at a carnival.  You sit at a booth.  There is a sign that says: HIT THE PERSON OVER THE HEAD, FREE OF CHARGE.  You are being paid to sit at the booth.  Being the reasonable person that you are, you assume that most people are nice enough to not hit you over the head. What surprises you is how many people are willing to hit you.  The first few times you are shocked. Then you get pissed.  I mean seriously, what is wrong with these people?  Hitting another human being over the head! The thing is, you can't leave, not if you want to get paid. You have to let them hit you.  Oh BTW, the owner of the booth wants you to have a big smile on your face while you are sitting at the booth.

There is a lot of emphasis on patient satisfaction these days. Reimbursement is starting to depend on it. So the goal is to make the patients happy. Noble goal. Triage is the gateway to the "patient experience". Triage is first contact.  It sets the tone.  Blah blah blah.  The triage staff needs to be polite, professional, etc.  More noble goals.

Reality: triage is difficult as shit. You are bombarded continually from all different directions:

patients presenting for care, sometimes all at once
ambulance phone calls
doctors phone calls
dealing with relatives, friends
you are an information desk for the whole hospital
   -looking up where patients are
   -directing everybody everywhere
dealing with unhappy people in the waiting room

People are impatient, angry, hysterical, anxious when they present to triage. They don't understand why they can't go right back.  Sometimes people act out in triage: crying, yelling, sometimes throwing themselves on the floor.  Often times there are people in back of triage in carts.  These are the people who can't be in the lobby.

Add to this the constant worry of the triage staff about putting people in the lobby who shouldn't be in the lobby.  In other words they are sick enough to go back, but there are no beds. Hopefully they'll be okay in the lobby.

In the middle of all this lies the triage nurse, trying to manage it all.  You are stressed in that role.  You are abused in that role.  You are sometimes overwhelmed in that role.  To expect nurses not to express their stress, frustration is unrealistic.  We who work triage are human. We are expected to be superhuman and do all of this with a continual smile.  Its not possible.

Whats the solution?

1) Eliminate as many phone calls as possible:
          -maybe ambulance calls can be handle in the main ER
          -put and end to doctors calling in about their patients
2) Have a  desk/person to field questions at the triage desk about directions, information, dealing with families.
3) Be realistic with patients about wait times.
4) Don't keep people in the ER for 4-5 hours at a time, backing up the waiting room.

nurse dodges bullet

Think you have a hard job as a nurse? On Chicago's south side, where the murder rate is out of control, home health nurses  have you beat.  Due to the danger of the neighborhood, they have to be accompanied by an armed guard as they go to care for their patients.  The armed guard is often a retired police officer.  They travel in a car together with a police radio.  If there is trouble in a particular area they either reroute or may decide not to go at all.

I wouldn't have the guts that they have.  Read their story here.