nursing going extinct

We have had a good union contract at my hospital for a long time. The last 5 years we have had a 1% raise a year.  Nothing, in other words. However, everything else has remained the same, which in these economic times is a good thing.  Those days are over.

I really feel like my time in nursing has been really good in terms of economic gain.  Good raises up until the last few years.  Good health insurance.  A pension. We have staffing ratios in our hospital (not in ER though).  In other words, we have a lot more than a lot of hospitals.

Our contract is up in 2 years. I anticipate a slaughter.  Health insurance will probably change to lesser policies.  Pension will soon be gone. Raises will continue to be small.

Already hearing all the whining about decreased reimbursement, blah blah blah.  Need to cut millions of dollars blah blah blah.  My thought:  The industry has known for years about coming decreased reimbursement, changes with Obamacare, etc.  Most have not prepared. They are screwed. I always wonder why when healthcare corporations are in this position and didn't prepare that the administration is not fired like they would be at any other corporation.  Can't do job, bye bye.

Other factors in why nurses are screwed economically in hospitals in the future:

- Todays nurse won't stay long term in hospitals because of many other
opportunities available outside of the hospitals. Why would they want to stay in
a stressful environment for years on end?

- Nurses as a group are wimps. We rarely stand up for ourselves.  We will cave when they decrease our wages and benefits.  As a group we already feel guilty about having jobs and good benefits.

Its possible nursing will be completely changed. The job as we know it could be gone, replaced by technicians. Oh, yeah, I can hear people saying, you can't replace a nurse with a cheaper technician.  Ah yes...you can.

When you don't value your profession as a group and aren't willing to fight for it, you are doomed to extinction.

man candy saturday - a shady character

welcome to my jungle

mean nurses

In ER we work in a sometimes abusive environment. The other day some clown cussed me out at the triage window.  With that in mind, why are we as nurses mean to each other?

I have worked in the same ER for a long time. In the last few years I have watched it change. We have a fair amount of just plain mean people working there. Sometimes its like high school, people talking about each other. Cliques.

Its really discouraging to see nurses treat each other badly. I've been the subject of it myself a couple of times. It makes me feel like leaving. I mean seriously, it gets to be too much.  The job itself is hard enough, let alone seeing nurses be so mean. We are own worst enemy.

drug seeker 101

Sometimes I am amazed at how stupid drug seekers are. In an effort to educate them, I offer Drug Seeker 101: an ER nurses guide to what not to do when seeking drugs..

1) You came in the door just fine and then by the time you get to the desk you are limping like the hunchback of Notre Dame: RED FLAG.

2) You say you are allergic to: tramadol, NSAIDs, tylenol: RED FLAG

3) You say your pain is 10/10 and your BP is 100/60,  HR 62: RED FLAG

4) You are too polite: yes sir, yes ma'am: RED FLAG

5) You say you just got here from out of town, you can't get an appointment for a couple of weeks, your meds got stolen/lost: RED FLAG

6) You kneel, lay on the floor, lay on the bench out in the waiting room: RED FLAG

7) You say you were seen at another hospital and "they didn't do anything": RED FLAG

8) You have been here a couple of times recently, received narcotics and never followed up: RED FLAG

9) Your relative says you need a stretcher and have to be lifted out of the car, but somehow you made it into the car at home: RED FLAG

10) We know your name without having to ask: RED FLAG


There will be a quiz later...

my job: where the impossible is supposed to be possible

So apparently the "bed to med" time has become a big thing.  In other words, you hit the bed, how long does it take us to get you pain medication?  They are measuring this time now.  The goal is 40 minutes.

Steps in the process:

1) Doctor has to see you.  If we are busy, there is a critical, that is delayed.
2) Doctor orders med.
3) Nurse acknowledges order.  Busy with your other patients? Delay.
3) Pharmacist has to approve med.
4) Nurse goes to pyxis to get med.
5) Nurse goes to room and has to start IV.  90% of pain meds are given IV.  Bad veins? Delay. Our ER is full of chronically ill, old people, druggies and drunks who sometimes are a difficult stick.
6) Scan meds into computer.
7) Give med.  Or several meds.

So lets say I have 4 patients.  I may be doing this or something else for 3 others. I might not get to you right away.

This is the problem with standardizing things in medicine.  It doesn't take into account what else is happening.  It assumes the ideal.  It is decided by those who don't do the job.

this is me at triage

man candy saturday

man pretty

triage-o-rama

Highest number of people waiting in the lobby to get in yesterday: 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 

my life as an ER nurse

You can't move anything. Well maybe your eyeballs. A machine breathes for you. You can't talk. You are vulnerable and alone inside this body that doesn't work anymore. You used to run and laugh and frown and smile. Now you can do none of that. And the thing is you are a baby, as far as adults go. 

This is your life now. Completely dependent on others. You must hope those who care for you are having a good day. You are one of the lucky ones, not in a nursing home. I wonder what your life is like. I wonder if you enjoy it. I wonder what you think about all of this.

I have thought of you since that day. Wondering about you. Thinking you didn't deserve this. Once you were a kid full of hope and joy. Then you grew up and drifted toward people who made you feel like they were your family. Then you caught a bullet and here you lie. I wonder what you could have been.

"Hey madness, the guy in bed 3 with the stubbed toe said he needs something for pain."

dave the drunk

Every ER has frequent flyers of various descriptions.  Chronic pain, mental health, drunks.  Well being an inner city ER we get our fair share of drunks.

I don't mind drunks most of the time as long as they aren't mean or haven't peed all over themselves.  Mostly they just go to sleep and are no trouble. We arrange a detox bed or let them sleep it off, feed them
and its all good.

So we have our regulars. One guy is there at least once a week. He's not nice. He's verbally abusive.  No one likes him.

Well one day here comes Dave the drunk by ambulance.  That's how they always come.  They are laid out on the street someplace and some "good samaritan"  calls an ambulance.  So Dave rolls in and one of the EMTs goes in to settle him while the nurse gets report.  All of a sudden she comes RUNNING OUT!!!!

She was undressing Dave to get him into a gown and out falls a DEAD MOUSE, yes I said a DEAD MOUSE...

Another fun day in the ER...oh well, I guess it could have been alive..**


**I know the picture really has nothing to do with the blog post, but I couldn't resist using it...its my twisted sense of humor

man candy saturday

its like a jungle some times, its makes me wonder how I keep from going under

The ER waiting room is a cesspool of pain, ang
uish, resignation. Many people populate such a place. Here are few of the standouts:

1) The Martyr - this person will drag themselves back to the waiting room and lay down on an available bench usually with a hospital blanket and look forlorn. Lots of heavy sighing here.

2) The Enforcer - this is usually the indignant relative or friend of a mildly ill person who stalks up to the desk, hands on hips, and states in a loud voice that the person they are with is
a) in a lotta pain
b) can't sit there much longer
c) that they cannot believe they are being treated this way.

3)Nervous Nelly/Ned - They sit in the far corner away from the other patients and visitors looking like a deer in the headlights, glancing around nervously hoping none of the homies in the waiting room pull a gun before they get in to be seen.

4) The Instigator - this person comes in with a chip on their shoulder and when they don't get in right away, they go back and start talking loudly about, "what crap this hospital is", getting others to join in, creating a mob like atmosphere.

5) Disappearing Dan/Diane - these are the people who either come up to the desk (or not) to tell you they are going to a) McDonald's b) the pop machine c) outside d) to have a cigarette e)to use their cellphone. Sometimes they disappear all together.

6) Mom of the year - these are the women who come in trailed by 3-4 kids who of course are out of control. She and the brood go back to the waiting room to eat their big mac and fries that they purchased on the way to the ER. Then the kids run wild through the waiting room while mom sits and watches TV. Then she gets annoyed and yells, "Peter get your mo'f---ing butt over here boy, I told you 'bout that shit!".

7) The unknown patient - these are the people who are still there after everyone else has left. You don't know who they are. Often they are sitting in a chair sleeping. They don't want to be seen. They just wandered in looking for a place to catch a few winks and use the facilities.

8) The skipping record - this is the person, who like a bad CD that keeps skipping, keeps coming up to the window and saying the same thing over and over, "how much longer will it be? Where am I in the line? Why did those people go in before me?" This type of patient can replicate itself at will, and does, throughout the waiting room.

9) The drama king/queen this person loudly vomits (the whole ER will know they are losing their lunch), seems like they are coughing up a lung, moans loudly, often presenting back at the window requesting to lay down in the hall in back of triage where there is more traffic to witness their performance.

10) Emotional exiter - this person presents to the window after usually waiting an excruciatingly long half an hour or less, proclaiming their unhappiness at their plight for all to hear. They accuse you of being
a) prejudiced
b) a bad hospital
c) lazy
d) uncaring.
They demand the supervisors name, the patient representatives number, anyone with more authority than your lowly self. They state they are, "going to another hospital". Oh please don't....

don't push me cause I'm close to the edge
I'm trying not to lose my head

he he he

Can I just say that I take a perverse delight in being obnoxious. Thats me rubbing her hands together with a twinkle in my eye thinking about all the goody two shoes I will piss off with the blog. You know the "you shouldn't be a nurse", "You are mean and evil", "I hope I never get you as a nurse", "May you develop a terrible disease", etc.

I just can't help it people...I'm sorry...it's really fun.

ATTENTION ALL MORONS

****ATTENTION*****ATTENTION****ATTENTION****

Dear Jane/John Q. Public:

May I have your attention for the following announcement:

CONSTIPATION FOR 3 DAYS IS NOT AN EMERGENCY.

REPEAT

CONSTIPATION FOR 3 DAYS IS NOT AN EMERGENCY.

IT IS ESPECIALLY NOT AN EMERGENCY THAT REQUIRES YOU TO CALL

911.

Seriously, people, do you realize when you call an ADVANCED CARDIAC LIFE SUPPORT AMBULANCE for your silly constipation, sore throat, vaginal discharge, etc. etc., you are putting an ambulance out of service that could respond to someone having a heart attack, has a cardiac arrest, has been in a major accident. They aren't available because they are hauling you sorry, dumb ass in. And here's the thing: You aren't going back to a room. You will go to the waiting room with all of the other non-emergent problems.

There should be some kind of consequence for this stupid shit.

sex in the city

So its Thursday night and ya ain't got nothing to do.  Hey why don't ya try out some of those new fangled erectile dysfunction pills?  Just for fun ya know.  Then here's another scathingly brilliant idea: go down to the local love shop and buy yerself some rings and put them on yer johnson. Then just sit back and let the party begin...

Have fun for four days straight and then figure out that said rings won't come off and that you need to make a trip down to the local ER.  Hey no problemo, this could be fun.

In comes the nurse.  In comes the doctor.  Then they come in all at once. You lay back with your hands behind your back, basking in the attention...first they try a ring cutter...no dice...after trying unsuccessfully to dislodge your terrible toys, a call is mad to maintenance asking for a bolt cutter. Yes, a bolt cutter.

An hour later you are free at last, free at last...we're glad you're free at least...

One of the docs, seeing a teachable moment for future wanna be ER docs, takes during this whole ordeal, with your permission of course...You are heard to comment: Hey it wouldn't be the first time I was naked on the internet!

There is a place reserved for you in the ER hall of fame.

a day in the life of me

Here is a sampling of the patients on my end of the ER yesterday:

cardiac arrest
MI
septic shock
V tach
hysterical allergic reaction
violent drunk
weird drunk
hysterical person who thought they had a tumor
poor pregnant lady who dislocated ankle (only normal patient of the day)
19 year tummy ache with hovering mommy
man with chest pain and nurse girlfriend who were too touchy feely
chronic pain angry drug seeker
short of breath out of inhaler
fender bender future personal injury lawyer client

yup

man candy saturday - ode to the NHL playoffs

naughty things ER nurses do

I put a picture on here of the " most interesting man in the world" with the words: I don't always give kayexalate but when I do its right after I call report to the floor.

I thought you might like to know some other naughty things ER nurses do

1) aforementioned Kayexalate. Ditto: lactulose.

2) Give lasix to that little old lady who is too weak to get up and has to get on the bed pan.  Oh...my...when did that lasix order appear?  Oh, let me give it before transport comes...

3) Wait until the detox van/ambulance to tell the patient they are going to detox.

4) Wait until the mental health staff is on their way down to tell that unhappy patient they are being placed on a 72 hour hold.

5) Try to talk the doctor into a barium enema for that fecal impaction.

6) Tell that annoying family member who has called twenty times that there is no point coming to the emergency because the patient will be going up soon. Give them the station number.

7) Try to get the doctor to order an inpatient bed for that mean patient as soon as possible.

8) Fudge the breathylyzer results for detox requirement of <.3

9) Say we don't know how long the wait will be.

10) Say the doctor will be in "shortly".  Say the bed will be ready "shortly".

Yes we can be evil.

the truth hurts

yes I am a wicked bitch

There are people out there in bloggerland that think madness is a cynic, a real bitch. I don't
give those drug seekers the benefit of the doubt and all that. I am a hard, burned out old witch of a nurse....that goes without sayin', but in my defense...I have been in the ER for many a year. My job is similar to a cops, only I have to keep my mouth shut. The cop can tell your sorry ass to shut the f--- up, I can't. I could but I would lose my job. Need the job, so don't. Cops have guns, madness don'. But we do deal with all the same people. From one end of the spectrum to another.

So excuse me if I have developed just a little bit of suspicion, caution,  gotta prove you ain't one of those drug seeking' idiots attitude. I, along with many of my nurse pals, have been burned. Big.

What folks don't understand about drug seekers is that they are ADDICTS. They will do anything to get the fix. They will lie, fake, tell whopping stories...they are really pretty dangerous people. I have seen them get out of control when they don't get what they want. Suddenly that back pain is out the window and they are fighting security on the floor.

I have seen drug seekers tell MAJOR stories that we all believed. What they are willing to do for the fix would floor you. So check your attitude about me not caring, giving the benefit of the doubt, etc. I have big time intuition about people. I can spot a faker at 50 paces with 99.9% accuracy. Whether you like it or not.

They waste my time, your money. (yeah, thats right mr/mrs taxpayer your money - you don't think THEY are paying do ya?)Picture this scenario: your mom is having a heart attack and you bring her to us. I can't help her right away because I am down the hall dealing with the out of control drug seeker....thats my job in a nutshell.