a shitstorm

I actually ran at work yesterday. I mean move the legs full out run.

I don't run. I'm not a runner. At work.  I saunter.  I may walk fast once in a while.  Rarely. I'm not excitable.

This was one of those "Oh shit! That wasn't supposed to happen!" moments. But it did and I ran. It wasn't even our patient.  They were alive when they left the ER.

I started charge at 3 pm. Within a half an hour we had a  stroke come in.  Then a half hour after that the Oh shit! moment happened.  Then during that an MI came in.  Then here is news that there is a helicopter landing and guess what, the bed isn't ready.  Helicopter = critical patient.

Yes, folks, we got ourselves a GENUINE shitstorm happenin' here.

Six hours later I dragged my butt home.

our ER becomes the Target ER

My ER is shabby, old, falling apart, embarrassing really.  We are an inner city ER and last on the list for renovation because of that. Every other ER in the system has been redone, but then most are located in the suburbs where people have insurance and wouldn't come to a broken down ER.  Since the poor and elderly city folks don't have a choice, they still come to ours and don't expect a shiny new ER.  So the heads of the corporation don't really give a shit what our ER looks like.

So I have an idea.  We get Target to sponsor our ER.  We become the Target ER.  Target pays for the renovation.  We put a big bulls eye on the front of the ER.  The employees all dress in red scrub tops and tan pants with a target bulls eye on the pocket.  Everywhere you look there are signs that say: "This ER brought to you by Target".  Our patients are called guests...Target could advertise that they sponsor us at different events, on TV, the internet.  Its win-win for everybody.

In fact lets just extend this whole concept to all of medicine.  I mean health care has become a corporate, profit motivated environment anyway.  Lets go all the way.  Lets let corporations sponsor hospitals, clinics, every part of it.  It would save our system from economic collapse.  Companies would compete with each other to be sponsors of hospitals.

Becoming the Target ER is the only way I can think of that we will ever get a renovation.

ode to nurses

I was reading a book recently and one of the main characters was a nurse.  She worked in pediatric
oncology.  It talked about her work periodically in the book.  There was one patient she had that she grew close to who was a teenager.  He was on the floor for a while.  He was hanging in there.  Then he got pneumonia and died.  This person she grew to really care for. This family too.  It brought tears to my eyes.

It was just a book, a fictional book,  but it got me to thinking about nurses. What we do.  How much I respect and admire all of us. The nurses who work with kids with cancer, knowing they are probably going to die.  The nurses who work with quadriplegics who are adjusting to a life in which they will never walk again.  The nurses who work with the teeny tiny premies for months hoping they will make it. The nurses who stay with families while their loved ones die.  The nurses who relieve the pain of the people who are suffering terribly.  All of the nurses, day in, day out who care for the sick and vulnerable among us.  Its a tough job, but they keep going back every day to do it anyway.    

docs: put on your big boy/girl pants and change

Could it be that there is teeny tiny movement starting around the overprescribing  of pain medications that is an epidemic in this country?  In January Mayor Bloomberg (gotta love this guy) announced an initiative at the 11 public hospitals in NYC.  The VOLUNTARY initiative states that emergency departments "will not prescribe long-acting opioid painkillers, can only prescribe up to a three-day supply of opioids, and will not refill lost, stolen or destroyed prescriptions". What a concept....Read about it here.

In Washington state, a health care system has placed limits on how painkillers are prescribed.  Doctors are told " abide by the guidelines or face the consequences".  The states also now requires patients who are on high does of pain killers with little improvement to be referred to pain clinics.   Read the article by Kevin Pho MD here.

Here's the thing: This is really great.  Finally someone is paying attention and putting the responsibility for the epidemic where it lies: doctors.   The thing is, what politicians don't recognize is that health care has become a business, like any other business.  What is a business' goal?  Make money, stay afloat.  How do you do that? By making the customer/patient happy, so they will come back.   Lots of patients are made happy by getting that almighty narc script. Hospitals are even being paid more or less based on patient satisfaction, and therein lies the dilemma.  

Doctors fear patient complaints, poor satisfaction scores.   So what. The only people who will stop this epidemic will be doctors.  They are going to have to stand up as a group and say no.  They are going to have to stop whining about losing control of their practice, blah blah blah. 
They are going to have to put on thier big boy/girl pants and take responsibility for, change a culture, that they have created. 

Its official: I'm going insane

OK its official.  I am going insane...

Every year we have to go through a "which frickin' waste basket do you put the moutain of waste we generate doing patient care?" education session.   Is it that red one, the pink polka dotted one, or the evil BLACK one? As of now, there are 8, count 'em 8, different plastic garbage containers with various names.  

I am sorry, perhaps I am a complete moron, but I can't keep track of what goes where. Its too much for my feeble little brain to comprehend...or maybe it is INSANITY to think we can remember.  Ya think?

Well, I'm doing the education online and actually reading it...not skipping to the end hoping to pass the test.  I come across a piece of information I had not known, may have skipped, subconsciously blocked out in an effort not to spontaneously combust:  The little chloraprep thingies we use to clean skin before IV insertion are considered HAZARDOUS WASTE.  OK...let me get this straight...the thing that I use 20 times a shift is hazardous waste.

Those little 1 1/2" x 1/2" cylinder thingies are hazardous waste...meaning they have to be put in a ziplock bag and into the EVIL BLACK plastic container that are only in certain areas of the ER?  You are kidding right? So I need to hold this EVIL cylinder, which by the way I have just applied to the patients skin, two feet in front of me as I go to search for a ziplock bag and then place it in the EVIL BLACK plastic container?

Now, take the amount of nurses who work in a day x amount of IVs they start and you will have many ziplocked EVIL cylinders to be disposed of.  We are gonna need a way bigger EVIL BLACK container.
In other words, it ain't gonna happen.

Here's the thing about all of this: The disposable system is very complex but its okay for us to waste narcotics galore down the sink, into the sewer, whose contents go to the water plant to be "purified" and straight into your kitchen...

Has Crayzee Central closed for good?

What is the point of going on I ask you? What is really the ('sniff) point? All of the bloggers I started with or joined along the way have died a slow agonizing death...

RIP:

Emergiblog (the mother of all ER nurse blogs)
Nurse Ratcheds Place
Weird Nursing Tales
You Can't Fix Stupid
Etc Etc Etc

And now worst of all, Crass Pollination has died.  Is the world coming to an end? First she moves to Montana (why would anyone do that?), then the blog dies. What the hell happened in Montana?  Was it all the perverts who took over the forum? Who has Nurse K and what have they done with her?

Its hard to go on....I know how hard it is to keep the blog going.  Its a been there, done that, blah blah blah situation.  Whats the point? Who really cares?  Whats it all about (Alfie)?

The only thing keeping me going are

New Nurse in the Hood

White Coat

If they quit, I stick a knife in the blog....

Duh....

Here is a word to the unwise:

If you have to have security escort you out because you refuse to leave, you probably aren't going
to get a free cab ride home from us, so don't ask...Duh

If you are discharged and refuse to leave the lobby, security comes, and you comment: "This happens every time, I have to be escorted out by security", maybe its a sign you should try another hospital...Duh

If you didn't get it at the other hospital, you ain't gettin' it here....Duh

what a week

It has been a long and stressful week in lots of different ways.  Time to look at some man candy.

walk a mile in my shoes

made by the Cleveland Clinic

health care in a nutshell

hey, I'll do that for 50 bucks

As a nurse in the ER, you don't think much about cost.  That is, how much what we do costs.  It is only when you or your family go to the ER for something and get the bill, that you realize just how riduculously expensive it all is.

Case in point:  My friend developed a bad cellulitis.  So they went to the ER.  Even though, the cellulitis was already bad, they chose to give here antibiotics and send her home.  Of course, it got worse.  Way worse.  So back she went to the ER.  Mind you, she had called her doctor, but they said they didn't handle something like that is in the office.

She was seen by a NP.  She ended up having and I and D (incision and drainage).  She got an an IV antibiotic. Probably should have got all this on the first visit, but whatever....

So here's the point of all this: The I and D cost over 1,000 dollars.  Now mind you, here is what happens in an I and D:

1) Area is numbed up.
2) An incision is made by a scalpel and pus is squeezed out.
3) Iodoform guaze is put in hole that is left.
4) Dressing is applied.

Time this takes: about 5 minutes.

So a five minute procedure that uses a bottle of numbing med, a syringe and needle, and I and D tray, sterile gloves, idoform gauze, a dressing costs 1,000 dollars.  Okay......

Next time, I'll do it for her and I'll only charge her 50 dollars.  I mean seriously folks, this is not rocket science.  You could train a ten year old to do this.  Numbing up an area is simple, similar to injecting for a dog bite where there is concern about rabies.  I've done that a few times. I think I could make an incision and squeeze.  I also think I could put gauze in a hole, having done so back in my med surg days.  Honestly, can someone tell me why this costs 1,000 dollars?

Oh by the way....that 1,000 dollars is only part of the bill - it is called a "minor surgical procedure".  Then they are the other charges adding up to a few thousand dollars.  Then we wonder why medical care costs so much...

doctors are wimps

I've been neglecting the blog, I know.  Its the weather. Its still winter here and I can't stand it anymore.

Anyway...
There is a horrible prescription pain med problem in this country.  One we don't want to face. Its an epidemic. Its an epidemic doctors in particular, don't want to face. Their part in it is shameful.

I'll give you an example of how completely out of control this problem has become.  There was a man who
 came in who had someone managed to get over 800 tablets of pain meds  (two different kinds) in 2 months. 800 tablets! Thats insane.

Thats just one person. Imagine the millions of pills people get each month in this country. Why does this keep going on? Because doctors are a bunch of fucking wimps who can't say no. Its easier to say yes and pass it along to the next person.  I don't know how they sleep at night.

I can hear all the doctors say:  Patients expect his. We'll get complaints. Blah blah blah. Doctors have created this epidemic and they are responsible for stopping it.

it ain't rocket science

Good luck to hospitals in the almighty patient satisfaction sweepstakes. They are approaching it all wrong.  They are approaching it from the top down, instead of the bottom up.

I am currently on a committee addressing this.  I sat for an hour and a half at the last meeting listening to a "performance improvement specialist" talk about what we say to patients.  What do we say to them when they present at the window?  Do we say: Can I help you? What can I help you with? How do we acknowledge them?  I mean seriously....

It seems the triage area is a place where people don't "feel welcome".  Could that be because the staff appears stressed out? THEY ARE STRESSED OUT.  Here is a list of what the two nurses at the triage desk deal with:

1) Answer phones:
     - from ambulances coming in, place those ambulances in the ER (if there is a bed available)
     -from idiot doctors offices, nursing homes, therapists, etc. who call to tell us their patients are coming in.
WE DON'T CARE.  We will deal with them when they get here.
     -calls from information desk about patients they can't find
     -random other calls

2) Let people in the door to main ER a thousand times a day. Deal with frantic relatives.

3) Give directions to people to inpatient rooms,  the cafeteria, coffee shop, pop machine, admitting, etc. etc. etc.

4)  Deal with people who have to be transferred to labor and delivery.

5)  Go outside to help people out of cars.

6)  Check people in.

7) Triage people.  WOW, yes we actually have to do this in the middle of everything else.

8) Take people to rooms.

All of this is really great, especially when there are 10 people at the window, 20 people in the lobby.

In the middle of all this we are expected to smile like a frickin' idiot.  Let me ask you, could you smile like a frickin' idiot in the middle of all this?  I don't think so.

Here is what will help patient satisfaction in triage:

WE NEED HELP!!  

No doctor office, etc. calls

Security handles traffic in and out.

Charge nurse gets ambulance calls.

Come up with the money to have someone at the desk which allows nurses to actually TRIAGE (what a concept).

If you take some of the  stressors in triage away, staff will be happier, less stressed and they will be able to welcome patients as they should.  Patient satisfaction improves. This ain't rocket science folks.

Here's a clue: Maybe you could ask the staff who works in triage what they see could help the situation.  What a radical idea.

yup

idiot test ordering

Can I just say that it has gotten to the point of ridiculousness with test ordering in the ER?  I mean seriously,  MRIs have become the norm.  When did that happen? It used to be MRIs were considered an exotic test that was never ordered in the ER.  Now there are at least a few a day.

Yesterday I had a patient who had not one, but two, MRIs ordered.  And you are not going to believe this, but they were both NEGATIVE.  Wow what a shock.

I have an idea: Lets just have a standard order set for EVERYBODY that comes into the ER.  Everybody gets CBC, Panel 8, belly panel, troponin, UA, a complete body MRI. Damn it, if there is anything off in your body we will be able to diagnose it, whether you like it or not.  Just think, if we find something a little off, we can order even more tests and charge your insurance company even more money!  What fun!

This way, the hospital gets to use those expensive MRI machines, the doctors can jack up their acuity level and everybody will be happy.....