Friday, September 27, 2013

how to make nurses happy 101

Its a friday night rerun...

How to make nurses happy 101

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?

Thursday, September 26, 2013

"my tummy hurts"

Some days I can't take another person coming up to the triage desk with their sad tale of woe.  I have had it.  I don't want to hear about your problems anymore. Go away.  Hey, I got an idea, go outside, its a nice day. Sit in the sun for half an hour. Better yet, go have a hot fudge sundae.  It will do you a helluva lot more good than coming in here, having all this shit done and then, guess what, wait for it, WAIT FOR IT, there is nothing wrong with you.  What a shock to everyone.

I've decided that I am going to start doing a lot more quoting patients in my notes.  Mostly for my own amusement.  Patient states that their "meds were stolen by their 2nd cousin, twice removed".   Patient states that their "tummy hurts when I am hungry.  Pain goes away when I eat".  "Patient states that due to back pain, they are unable to get to the bathroom to take a crap".  Etc etc etc  You get the idea..

The ER is a cesspool of dysfunction.  I like that....cesspool of dysfunction...yeah.

Tuesday, September 24, 2013

nurse report is obsolete

"Calling report" is an antiquated dumb nursing thing.  I mean seriously we have ELECTRONIC MEDICAL RECORDS that we all have access to.  Everything that happened in the ER is on that record for you to peruse at your leisure in the 2 hours it takes the charge nurse to approve the bed. Why do I have to repeat all this shit? Why? B
ecause nurses can't let go of dumb stuff.

Calling report is, shall we say, an "interesting" experience.  I would put the nurses into 3 categories when you call report:

SHORT, SWEET SALLY:  We love these kind of nurses.  They usually have already looked at the chart, listen to our dumb calling report performance and say: OK, room so and so.  No questions, just send them up.

NEW GRADUATE GEMMA: OMG...this person acts like they have never heard of an electronic record.  They ask questions that should be obvious to any half way intelligent human being. Nursing 101 stuff.  I don't know if granny had a bowel movement today, considering she is agitated as shit, it never came up.

SUPERIOR NURSE SAMANTHA:  This nurse thinks that anyone who does not work in her area is an idiot.  They are the kind of nurse that will ask you if you checked the pedal pulses on a head bleed.  Then they will condescendingly say: "You didn't, okkkaaay..." It always feel like you are taking a test with these people and you will never pass.

Report  = stupid.  One thing about report though, its allows the station to delay getting the patient.  The nurse is busy because:

they are at break
they are in an isolation room
they just got a post op
there is an emergency on the station (love that one - apparently everyone is involved)
etc etc etc

Often times you are transferred person to person to person in an attempt to "find" the nurse. You are placed on eternal hold.  You are hung up on.

The whole thing is ridiculous and a waste of time.

Sunday, September 22, 2013

the see, I'm so sick they put an IV in me ORDER SET

It took me years to realize this.  It hit me the other day.  ER docs, NPs, PAs have a DEFAULT ORDER SET. 


Here it is: 

Normal saline 1000 cc bolus

This set of orders can be justified for many, many complaints.  From tummy ache to chest pain to weakness to dizziness.  Labs are basic.  Pretty much any woman who comes to ER gets a UA and those who are of childbearing age always get a UPT.   Any pain from groin to the neck could justify a EKG and CXR.  As far as fluids, everybody could use a liter of fluid.  It makes the patient think you are really doing something.  It justifies, in their mind, that they should have come in:  See,,,I'm so sick they gave me an IV. 

If any of the tests come back positive: NIRVANA!  More tests...yea!  Ever wonder why you wait for hours in the lobby, this is part of the reason. 

Friday, September 20, 2013

that's what I get for being nice

So I'm sitting at the triage desk.  A guy comes up and says that he works in a martial arts place/boxing place in he neighborhood.  He doesn't want to be seen.  He just wants to weigh one of the boxers, apparently they don't have a scale.  So...okay big deal.  We have a scale in triage.

So he brings the guy in...and the guys proceeds to take off his pants down to his boxers and gets on the scale. Now mind you, both triage bays are full..there are people at the window.  WTF?

Was I
punked?  Thats what I get for being nice...

Moral of the story: Never be nice in triage.  It will bite you.

Wednesday, September 18, 2013

Vanderbilt University Medical Center wants nurses to clean rooms now

I have a lot of readers.  I need your help. I want you to take this blog post and tweet it, copy it, facebook it, refer to it on your blog.

Here's the thing: Vanderbilt University Medical Center has started requiring its nurses to do janitorial work. After a local TV (Eyewitness News 3 in Nashville)  learned of this they interviewed an administrator who said:

"Cleaning the room after the case, including pulling your trash and mopping the floor, are all infection-prevention strategies. And it's all nursing, and it's all surgical tech. You may not believe that, but even Florence Nightingale knew that was true," said a hospital administrator to staff in a video obtained by the Channel 4 I-Team.  One manager said in an email: We have undergone some major budgetary changes ... this means we will need to pull together like never before."

If this sounds like it is just in the OR, alas, no it isn't.  Its all patient rooms.

According to another site (care2 make a difference), Vanderbilt is:

"in the midst of defending itself against lawsuits claiming that they have fired employees in violation of the Family Medical Leave Act (FMLA)".   Also:  "The hospital is also in court over accusations that it has been engaging in Medicare fraud for over a decade".  Could this be why a couple thousand employees have been laid off?

Anyway here's the topper to all of this, a nurse administrator told the nurses:

"refrain from speaking negatively about this in an open forum where our customer can hear. If you need to vent come see me."

Well if the nurses at Vanderbilt can't speak about this we will, all over the country...

Monday, September 16, 2013

a brief moment in time

As an ER nurse every day you see foolishness, stupidity, but you also see tragedy.

You see a family struggle with the fact that something really awful has happened to Dad and there is nothing even modern medicine can do about it.  Dad is going to die. What went from what seemed to be a simple problem is now a tragedy.  What went from a family that seemed suspicious about whether we were going to give the best care to Dad is now a family in shock, stunned into silence.

One door down is another Dad who a family is trying to care for at home following a long hospitalization.  Dad is confused, can't walk, is fed by a tube, in other words is total care, being cared for by children, who agreed to try to do that because that is what families do no matter what.  The thing is they can't do that by themselves.  They don't realize it yet.  They also don't realize that Dad isn't long for the world either.  The Dad they knew is already gone.

We sit as observers, comforters, listeners, well wishers for a brief moment in time.

Monday, September 09, 2013

sometimes triage is a cesspool

The triage lobby is a weird place.  Its like a  dysfunctional little community out there.  Sometimes it takes on a life of its own.

There can be children running in circles around the lobby.  Drama queens loudly telling their tales of woe so everybody knows the details.  It can be a scary place with scary looking people.  Maniacal laughing, weeping,  Angry exchanges. Wailing children.  Stinky people.  People vomitting.  Thats Penny the prostitue sitting next to Clara from the suburbs who is sitting next to the homeless guy who hasn't had a bath in a few months. Sometimes you have no choice who you sit next to. People chow down on entire meals out there. People fall asleep. People pace.  Its a cesspool of the human condition.  You never know what your gonna get.

Different days have different atmospheres.  Some days its quiet.  You could hear a pin drop.  Other times its a dull roar of different conversations.  People talk to people they don't know.  Tell their stories.  Some days it feels like they are conspiring against us.  I see them looking at us. They are fomenting revolution, coming for us, I just know it....har.  Some days people are angry.  The wait has been long. They hate us.

When the wait has been long, one them finally has had enough, they approach the desk and ask: "How much longer will it be?  Where am I in the line?"  They tell us they are feeling faint, etc. They have to get to work.  Grandma is in a lot of pain.  They ask that age old triage question: "Why are other people going ahead of me?".  They are never  satisfied with our answers.  Its not what they want to hear. They may get mad, cuss a little bite, roll their eyes.  Sometimes they leave, deciding they aren't an emergency after all.  Most sit back down.  Here's the thing we know: Now they have done it.  They have given permission to all the other people in the lobby to make a pilgrimage to the triage window.  Now they are all mad together. Sending disgusting looks our way.  It gets to a fever pitch, about to explode.  Then the triage door opens, I say: "Fancy Parker, you're the next contestant...".  The tension is broken.   For now....

Friday, September 06, 2013

susie the scammer

A friend told me about a a guy who worked for a chiropractor.  His job was to track accident reports.  Then he would go to the houses of the people who were in the accidents, especially if the people were poor. His job was to convince them that they needed to go to a chiropractor.  He would even provide transportation for them to go.  In other words it was a racket.

I have heard that if you spend so much money with a chiropractor, often times the insurance company will settle with you for a few thousand so they won't have to pay for future medical care.

Then there are the personal injury attorneys who bombard you with letters encouraging you to call them about your fender bender.  No cost to you, they only get paid if you get money, blah blah blah

So all of this encourages people to present to the ER as a way of getting more money for some kind of settlement.  We see a lot of ridiculous fender bender "injuries" by people looking to make a little extra cash. This kind of thing clogs up ERs across the country.

Such was the case a couple of weeks ago, when two young ladies presented with "back pain and numerous other pain" from a MVA 3 days ago.   Same accident.  Both insisted on "back xrays".  They weren't bright enough to come up with that request on their own.

ADVICE TO INSURANCE COMPANY SCAMMERS FROM AN ER NURSE: If you are both  coming in from the same accident for your fake injuries, at least have the same story.  Don't tell me the car you were in was hit on different sides....

Tuesday, September 03, 2013

good luck, it's Monday

Wanna know how modern hospitals work?

Its a Monday morning. The census is low.  Easy to get inpatient beds for our patients, right?  Wrong.

Nope,  our patient may wait for 2 hours or more because there aren't enough nurses.  These days our hospital, and I'm sure others, only staff for the patients they have.  So if the census is low, nurses get voluntary LOAs and there are less nurses come Monday, one of the busiest days for ER and surgery, etc.

You may ask yourself, why would the hospital not staff up on a day like Monday, knowing it will be busier?  Because they ONLY STAFF FOR THE PATIENTS THEY HAVE.  In order to squeeze in the patients who need rooms, they count on discharges.  Well, if you have ever worked in a hospital, you know that the discharge process is anything but efficient. So patients stay much longer than they really need to, for various reasons.  Then the bed has to be cleaned, etc. etc.

So the patients in ER, in PACU, the direct admits are screwed.  This doesn't only happen on Monday, but its the day it is most noticeable.
 Welcome to modern healthcare...

Monday, September 02, 2013

what a naughty ER patient

Emergency department no-no's:

1) Don't fall and come in by ambulance and have a baggie of crack in your sock that the doctor finds when he examines you. At age 65 no less. Then keep coming out of your room yelling that we have no right to take your property.

2) Don't come in with your girlfriend (the patient) and then go out to the ER entrance and try the door on a car that is sitting there and get in and look around for something to steal. Then go back in your girlfriends room like nothing happened.You see my dear moron, we have cameras at the entrance, so smile you are BUSTED!

3) Don't come in with your boyfriend and both of you ask to be seen for the same thing: chronic back pain. Then expect both of you to get a supply of Vicodin. I don't think so.

4) Don't go in the bathroom and down a bottle of jack daniels before you are admitted to mental health.

5) Don't come in after being banned from 3 local hospitals because you were sexually aggressive and threatened to kill the staff, then set your sights on our hospital.

6) Don't adjust your own IV pump to cause yourself another medical problem so you can be admitted.

7) Don't call us on the phone and ask if we do c-sections there because you are "tired of carrying this baby".

8) Don't pack some hospital sheets and towels into a patient belongings bag and try to leave with them. EWWWW!

9) Don't come in for something related to your pregnancy and then steal the fetal heart monitor that we used to hear your baby's heartbeat.

10) Don't tie up your dog at the emergency entrance and then come in to be seen.