happy

                                                                    happy new year.

                                                                         Kthxbye.

its a man candy xmas - goodbye soa

no Christmas bonuses

I might just pull a radical act.  I may bring a red Christmas ornament and put it on one of the two pathetic excuses for Christmas trees in the lobby.

These two small trees sit in a large box that normally holds foilage.  They have these tannish looking ornaments.  Real Christmassy.  Ah...yeah.  They kind of fit our lobby with its dim lighting, mismatched furniture and 1950's TVs bolted a the corners of the room.

The rest of the hospital has these beautiful kind of old fashioned  decorations. The lobby looks like a million bucks. Its that kind of look where cherubic red faced children would be singing a rousing chorus of jingle bells, as complimentary hot cocoa is passed to the crowd along with this years large Christmas bonuses are given to happy employees....Poof!! oh...its a fantasy.  Snap out it madness!  There will be Christmas bonus. We may throw you a lunch bag embossed with the hospital logo.   Maybe...if we can get a good deal.

Christmas time in the ER is just more of the same tomfoolery of tummy aches, womitting, THE FLU (which is rampant right now).  There are no gross fruit cakes, candy canes, Christmas cookies. Santa ain't comin'.

I remember the good old days when we had a Christmas tree in back of triage that spun around in a circle. It was magical.

m. candy sat.

yup

the harsh reality

America is a country of individuals. There is little sense of a collective identity.  Yes we are "proud to be an American" ad nauseum, but it is more a feeling of proud to be an individual American.  Its no accident there are more guns here than in any other country in the world. Its to protect us from our fear of each other.

Americans are supposed to be strong, personally responsible, able to take care of themselves and their families. If we can't do that we are considered weak, somehow defective. Whiners. Loafers.

With all that in mind, the mentally ill are considered defective. We fear them. We loathe them. We expect them to just get it together, snap out of it. Hey life is tough for all of us, buck up. So they are treated as what they are: outcasts. We pretend we care, but not really.

Having worked in the ER a long time, I have seen a big increase in mental health patients in recent years.
. It is common to have 5 or 6 at any given time. There are more and more adolescent psych patients. These days they spends hours, sometimes days in the ER.  There is a shortage of beds and psychiatrists.

They spend hours in bare rooms, stripped of the usual ER clutter, due to concern for their, and the staffs, safety.They are placed in special clothing, all of their possessions taken.  They stare at walls for hours. Most are suicidal, others are psychotic, hallucinating.  Little attention is paid to them in a busy ER. The patients with physical problems take priority.

Many times there are no beds at the hospital they have chosen to come to. Sometimes beds can be arranged at other local hospitals.  Sometimes they are sent hundreds of miles away to outstate hospitals, far from their home and family. In the last few years, commonly, there is no where to go.  They sit for hours, days waiting for a bed to open up.

So imagine this: You are psychotic, perhaps bi polar or schizophrenic. You sit on an ER cart for hours, occasionally being given a meal, being watched by a camera or security.  You are hallucinating. You are alone. Your family ain't coming. Eventually, you lose it. You get out of control, shouting, perhaps threatening. Maybe you will be restrained. You will most definitely be sedated.  You are now in a stupor, no longer a problem.

Like an animal, you are tranquilized because in the end, we don't really care.  Its easier for us when you are quiet.  We don't want to deal with you anyway, as a society or an ER.

mc saturday

medical school students stage die-ins to protest michael brown, eric garner decisions

This is Harvard medical school.  It is one of 70 schools across the country who staged die-ins to protest the 

recent decisions in Ferguson and NYC. 

Would you do this?

after a long hard week, thank goodness there is m. candy Saturday

did you know?

that I love motorcycles?

Yup

A black guy lies unconscious on the ground after being choked unconscious by a police officer after being accused of selling cigarettes for 50 cents.  EMTs are called. They do nothing. They don't apply oxygen, a monitor, anything. Everybody throws him onto a cart. The ambulance leaves.

He dies. He dies because he was choked. He also died because EMTs failed to do their job. They assumed he was a low life probably faking it. They didn't care.

Pet peeves # 567-569

pet peeve #567 -  "Well I used to be 5'8", but I shrunk..."

pet peeve #568 - "I normally run low, so 98.6 is a high temp for me..."

pet peeve #569 - "This is my hospital...I don't like the treatment at (fill in the blank hospital)".

nursing school in a nutshell

This is probably the most accurate description of nursing school that I have ever seen.

man c. saturday

pet peeve #678

Pet peeve #678:

Any health care worker that makes a point of wearing their name badge when they bring a friend or relative assuming we will treat them "special" because of it.  Especially arrogant doctors. Ah....no you are going out to the lobby just like any other person.

Doctors who call in to say a friend of theirs is coming in....ah...so what...

thanksgiving....happy....all that

thanks for reading the blog

an ER doc goes to work

From humans of new york

"I’m about to go to work. I’m an emergency room doctor and I work the 10 PM to 8 AM shift."
"What’s been your proudest moment as a doctor?"
"Probably just the moment when I finally felt comfortable— it took about three years, and one day it just kinda clicked. Starting a shift in the emergency room is like the feeling before a giant battle in a movie like Braveheart or Lord of the Rings. You just have no idea what’s going to come through the door. Sometimes five serious cases can come in at the exact same time, and you have a lot of decisions to make, and you have to know exactly how long each procedure takes, and what can wait, and what can’t. I think my proudest moment was when I finally stopped feeling nervous, because I’d reached a level of experience where I could make the correct decisions without thinking about them.”

Doctors and Nurses Fight Back; Proposal to Link Hospital CEO Salaries to Employee Satisfaction Passes Senate

Hilarious story on one of my favorite blogs: the Gomer blog

yup

Genocide: the deliberate killing of a large group of people, especially those of a particular ethnic group or nation.

young people die in the emergency room too

Sometimes a couple of hours into a 12 hour shift something bad happens.  Your patient dies. And its a really young patient.

Its really rough. A young life gone. A family in shock.

The thing is this happens in the middle of a very busy day. The day doesn't end because this happens. It goes on. There are more criticals. The lobby is full. You have to move on. You have to move on after you tried to close the eyes of the young patient and they wouldn't close. You move on after you talked on the phone to the hysterical family. You don't get to go somewhere and think about what just happened.

You move on to the next one. The next one could be a stubbed toe. Or it could be another critical patient. You spend the next 10 hours running your butt off. That patient is still on your mind. You are exhausted. Cranky. The shift seems to go on forever.

When you get home, that's when you can think about the patient, wonder about how their family is doing, look at your son and feel thankful he is OK.

oh well...there's always m. candy saturday

patients are products on a corporate medicine assembly line

OK its official. I am overwhelmed. I have been an ER nurse for 25 years. If your arm was dangling by a thread from your shoulder, I would calmly take you back to the stab room. If you unexpectantly go into v fib, I would have the patches on so fast, your head would spin even though you are dead. In other words, I have seen a lot of stuff and can remain calm under lots of stress.

However, I am getting to the point of no return with the amount of information and job requirements there are these days.

I work in a large inner city ER in a hospital which does all kinds of fancy-dancy shit: LVADS, ECMO, CRT, interventional radiology, robotic surgery. You name the complicated medical condition and we probably do it. My point? Our ER is filled with complicated chronically ill patients on a daily basis. These patients are not your ankle sprains, lacerations, appys. They are people who are quadriplegics on dialysis with complicated heart histories. Those patients make up a good proportion of our patients.

The other population we serve is the neighborhood hood rat element. They use us as a clinic. They bring their dysfunctional lives into the ER with them. We serve a large immigrant population. We see many, many mental health patients.

In other words, our ER population is heavy duty. So we are already running around like banshees trying to keep it under control.

Now add to that the 20 emails I get daily about different changes to policies, procedures. Add to that the 10-15 education classes I am supposed to complete every quarter, preferably during my shift. Add on being preparing for various organizations that come every couple of months to certify the hospital in one thing or another: LVAD, magnet, bariatric care, stroke management, chest pain, etc. Add on to that a new drug dispensing system that has been put in place in the last month. Add on to that BLS, ACLS, PALS, TNCC. Add on to that the ebola scare and preparing for that. Add on to that JCAHO, CMS, Department of Health visits.  Add on to that monthly staff meeting, quarterly charge nurse meetings.

How much more can nurses take, seriously? In all of this ridiculous frenzy of information and certification, interaction with the patient seems to be the last thing on anybodys mind. The patients have become products on an assembly line of corporate medicine. The human element of todays corporate medicine, the nurse, has no time to talk, empathize with, care for, the patient. They are too busy trying to keep up with all the certification/regulatory bullshit.

31 uses for duct tape in the ER

Its an oldie but goodie....

1)IV pole broke: Tape the IV bag to any nearby surface: the monitor, the wall, the patients relative, etc.

2) Demented Donald trying to get out of bed? Duct tape will keep him in bed.

3) Duct tape that irritating drunks mouth shut.

4) No security available to watch your suicidal patient? Duct tape will keeep them in bed and SAFE.

4) Out of arm slings? Fashion one out of a piece of cardboard and tape.

5) Patient hairy and need to put him on the monitor? Duct tape will remove that hair for lead placement.

6) Backboards all in use? Take the sliding board, some rolled towels and tape and fashion your own version of spine stablization.

7) Duct tape your manager to a chair.

8) Low on suture or staples: A quick and easy laceration repair.

9) Tape patients gown together for trip to bathroom.

10) Out of adult diapers: use towel and duct tape substitute.

11) Tape NG, ET tube, foley in place.

12) Tape patients wig or toupee in place.

13) Never lose it again: tape you pen, scissors, roll of tape, stethoscope to yourself.

14) Make letters RN on uniform so patients will know you are their nurse. You know how everybody gets confused...

15) Afraid your patient might wander off? Put their name on it, room number and attach to gown.

16) Cheap shoulder immobilizer.

17) Confused grandma will never pull out her IV again.

18) Tape your nostrils together for that smelly clean up

19) Cheap eye patch.

20)  Patient has hyperactive kid that keeps running around.  Tape to wall (see picture).

21) Duct tape educator to chair - no more of those irritating online quarterly education classes.

22) Patient keeps coughing in your face, won't cover their mouth - use as a mask.  Hey relax...they can still breathe out of their nose...

23) Doctor order an enema?  Duct tape them out at the triage window.

24)  Never get lunch? Tape a snack to yourself.  Tape a water bottle to yourself.

25) Tape the ER entrance shut when you get too busy.

26) Tape the annoying family member/friend to their chair so they won't stand at the door looking annoyed when the visit drags on and on....

27) Cheap alternative to restraints.

28) Tape OCD/candy man/overordering  doctor to chair. 

29)  Tape the clipboard carriers into their cubicles sans computer so they can't come up with more annoying new policies.

30) Cheap hazmat suit.

31) Hold JCAHO/CMS/Department of Health, chest pain/stroke/magnet/any assinine certifier hostage at least til the end of your shift...

Your thoughts?

its that time of year

California mandates full body suits and respirators for HCWs taking care of ebola patients

Here's an interesting development: The state of California has mandated new regulations about ebola training and PPE gear for hospitals.

It requires full body protective suits that leave no skin exposed or unprotected. It also requires respirators. It is mandatory for hospitals along with training.

This is quite an accomplishment for the California nurses union.  Last week 18,000 nurses in California were on strike around contract negotiations as well as what they said were inadequate equipment to care for potential ebola patients.

Actually the respirator part of this makes a lot of sense. It actually could prevent HCWs from getting ebola.  If you don't have to wear a mask but instead have a respirator, it will be a lot more comfortable. You will be able to spend a lot more time in the suit. This would mean less nurses rotating into the room and having to don and doff the equipment. With the current equipment, wearing the mask and all the other stuff, I don't see how you could do this for more than an hour or two, requiring multiple donning and doffing in a shift and more potential for contamination.

What people don't realize is that the four hospitals with biocontainment units in the US use this equipment to care for any patients they have. Supposedly these people are experts in this area.  So why the disparity between what they wear and what an average nurse in the US is supposed to wear?

I can guarantee you that most hospitals will not adopt this. Too expensive. They will play the odds that they will never get an ebola patient.

One other thing California has included in the regulation is a whisteblower section. It guarantees that health care workers won't lose their jobs if they report non compliance. Employers are VERY sensitive about their preparations for ebola. I have found that if you bring up any kind of concern about their preparation, they immediately jump on it and go to lengths to explain why you are wrong.

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....

which ER supplies the softest, most cuddly and toasty warm blankie?

I'm thinking about starting a new local ER website. As a service to humanity.

On this site would be listings of every ER in the city and the waiting times on their websites. Listed in order of least waiting time to most. Length of typical visit.

In the interest of serving the community, there would be a list of whether the ER has:

1) box or bag lunches and their contents and rotation
2) types of (cold, icy) juice and selection of crackers
3) whether they supply warm, cuddly, toasty blankets.
4) footie availability and color selection
5) whether they have TV (with HDTV cable or DVD availibility)
6) probability of getting a cab voucher or bus token
7) probability of you scoring a script for percocet
8) probability of you taking an ambulance in for a sore throat and getting back to a room versus being put in the lobby
9) comfort of chairs in lobby and presence of TV, fish tank, vending machines (quality of snacks, selection of sodas), play area
10) whether your car can be valet parked on arrival

There would be a comment section in which you could name names about which docs at which ERs were Dr Feelgoods.

Oh the fun that could be had! The comments section could be entertaining in and of itself.

Hey...its a competitive world out there and patient satisfaction is the goal of every single solitary person in the ER, including of course, yours truly, thus 

donning and doffing madness

So we are finally donning and doffing at my hospital.  We are training with all the stuff we would wear when caring for an ebola patient.

Putting it on isn't hard. Its about covering everything and having someone check to see that you have.
Taking it off is a whole other ballgame.  After taking it off, I can't believe that 75% of the people caring for those with ebola haven't got it.

To say there are a lot of steps is to understate it. At my hospital there are 8 parts of the gear:

hospital scrubs
gown
apron
hood
face shield
mask shoe and leg covers
two pairs of gloves

Here are the steps to take it off:

1) you and buddy go to dirty area
2) clean hands (foam)
3) look for any obviously nasty stuff on garments and clean them off
4) foam hands
5) take off shoe/leg covers
6) foam hands
7) take off apron
8) foam hands
9) look for any nasty stuff on garments and clean them off
10) foam hands
11) take off face shield
12) foam hands
13) take off hood
14) foam hands
15) take off outer gloves
16) foam hands
17) take off gown
18) foam hands
19) use wipe to clean shoes
20) foam hands
21) take off inner gloves
22) foam hands
23) put on new gloves
24) foam hands
25) take off mask
26) foam hands
27) take off gloves
28) take shower

Takes 15 to 20 minutes to doff. Most likely place to make a mistake: taking gloves off, in my opinion.

The idea is that there will be two nurses caring for the patient. One in the room who doesn't leave except for breaks. The other is a runner, who gets what the nurse needs.

The nurse in the room will have on all the gear and an N95 mask for hours on end. Not sure how thats possible.

The people working at the centers that have been designated for caring for highly contagious patients in such places as Nebraska and Atlanta wear different gear. Theirs come in less pieces.. They wear an actual respirator. There are nurses around the country who think this what is needed.

certify this shit head

I can't take it anymore. I can't take another CMS or Joint Commission "surprise" visit. Or the Department of Health either.

I don't give two shits whether the hospital is a certified  bariatric center, chest pain center, stroke center.

I am tired of advanced cardiac life support, basic cardiac life support, each of which I have taken at least ten times. PALS, TNCC arggggh.

Every quarter there are 10-15 education things online that we are supposed to complete at work or at home.

I don't want to learn take a class about de-escalation techniques and how to restrain a patient for 8 hours once a year.

It is getting to the point where we as nurses are overwhelmed with needing to be ready to be interviewed by agencies and credentialing centers or we are doing  hours of education ALL THE TIME. It is becoming overwhelming. I'm burned out on it.

Does all of this really help patient care, or does it fill a box someplace in some office housing another useless paper pusher and justify their job?

If I am going to be required to constantly be doing all of the above, I want more than a 1% raisee a year, which is what it averages out to in the last 6 years. I am tired of being grateful I have a job, being understanding about decreased reimbursement, blah blah blah. I want  money for all of this.   M-O-N-E-Y.

Tomorrow 18,000 nurses in California will strike for 2 days because of an unsettled contract and for safety equipment for caring for ebola patients. I wish them well and support them 100%  More nurses need to get off theiir butts and do the same.

Battered ER Nurse Syndome

Being an emergency room nurse is like being in an abusive relationship.  You go to work and are subjected to verbal and sometimes physical abuse.  The conditions are sometimes so bad that you tell yourself this is it...I have had enough.  I am getting out.

Then you have a few days off and you talk yourself into going back.  Oh, its not so bad. What other job can I have several days off in a row? That was just one of those AWFUL days. I like my co workers. What else am I gonna do?

So you go back, having refreshed yourself a little bit. Then the of your patients calls you a motherfucker....that drunk pees on the floor....that snotty woman in room 6 puts her light on for the 5th time
in the last hour.  You can't believe that you thought this was okay. You look at the clock, thinking about how you are gonna make it through the rest of the shift. You do. You go home.

REPEAT PROCESS.

REPEAT PROCESS ad naseum.

You have a case of Battered ER Nurse Syndrome, my friend.

man c. saturday

Margaret the agitated, hallucinating schizophrenic visits the emergency room

She was seen talking to herself, minding her own business. I'm sure she talks to herself all the time, she is mentally ill. This is her daily life.

The police were called because she was talking to herself and making people uncomfortable. Of course she was confused. Police called ambulance. Ambulance brought her to us of course.

She was confused and agitated when they took her in the ambulance. So they restrained her. She arrived in restraints and on a hold.

When she arrived, we debated whether to keep the restraints on.  Here's the thing: she weighed 300 pounds. If she got out of control, somebody could get hurt. Decided to keep two restraints on. She went to the bathroom soon after arrival.  Spent too much time in there until I had to make her get out. Went back to the room and started pacing the room. After 15 minutes of asking her to lay down, she finally did.

OK, whew, at least she is under control.  Security on watch. Let me start the restraint paperwork which means charting about 15 things every 15 minutes.

She continued to be agitated, trying to get up.Security and I spent lots of time trying to redirect her.  I could tell she was in her own little world, talking to at least three other people. Eventually, I gave
her meds, not sedatives, anti psychotics. Didn't work.  Finally talked the doctor into something to sedate her. She calmed down some. I took the restraints off.

She went to sleep. When she woke up, she would pace the room, try to walk out the door.

Of course, she would be admitted for about the 4th time in the last 6 months. Here's the thing: no beds available at our hospital.  Getting a psych bed at our hospital is impossible these days. Of course there were no other psych beds in the city either. They were looking at a bed two hours away.

When Iest 12 hours later, she was still there, up walking back and forth in the room. She'll probably be there in the morning, pacing and talking to herself. This is the lot of mental health patients in emergency departments these days, waiting hours and hours, sometimes days for nonexistent beds.

more education = more money

Hospital jobs are increasingly calling for a bachelors degree in nursing.  At least where I live. I think its a good idea. If nurses want to be taken seriously we have to have the education. I am not saying that two year nurses aren't very good nurses. They are.  Nursing is increasingly complex and if we want to keep our place in it, we have to keep up.

BTW, I am a 2 year nurse.

So if nursing is going to a bachelors degree standard, then it makes sense that nurses should be making more money. If you have more education you make more money.  Right now bachelors degree nurses make about 1.50 more an hour where work.  One fifty an hour for two more years of school, two more years of debt. Hardly worth it.

When you have more knowledge you make more money. There are many studies on how people with educations make more money than those who have none. From what I have seen those with a bachelors degree make about 1/3 more than those with an associates degree.  So lets say the average salary in the US for nurses is 65,000 with a combination of associate, diploma and BSN workforce. . The bachelor degree nurses should be making at least 20,000 dollars more than the associate degree or diploma nurses. Now that would be an incentive to further your education.

yup

no ebola training at my hospital yet

No full coverage isolation gear or mandatory training  yet at my hospital. Keep saying they are going to do it.

ebola can be fun

Here is a video parody about ebola by one of my favorite docs in the world: ZDoggMD:

how I became a bitch

This is a post I did about a month ago.  It was viewed over 23,000 times. It definietly struck a nerve. It got 160 comments. The comments were mixed with a lot of people agreeing with what I said and many saying I should get out of nursing. So here it is again. What do you think?

Working in the ER changes you.

It is unlike any other place in the hospital. You are dealing with a constant stream of people who are having some kind of stressful event in their lives.  We may not think it is a crisis, but for them it is.

The ER never ends. It never closes. Its 24/7.  There is never a break. It can be quiet one minute and chaos the next. You can be dealing with a stubbed toe and in rushes someone with a gunshot wound or a cardiac arrest We live our life on the edge.

You are dealing with everyone from A to Z.  Many of the people who frequent ERs are living dysfunctional lives. They bring that dysfunction into the ER with them. They can be drunks, junkies, criminals, the homeless, the mentally ill, the neurotic.  We deal with violent drunks, drug seekers,  homeless people who haven't bathed for months, out of control psych patients, manipulative people who can turn on a dime if they don't get what they want.

We work in a chaotic environment of ringing alarms, yelling patients, ringing phones, overhead paging... When it ramps up its overwhelming.

You know all of the above going in, or at least you think you do.  When you choose to take a job in the ER, you are the kind of person who thrives on chaos and crisis.  Bring it on.

Here's the thing about the ER that people don't get: It is not like ER on TV.  We are not constantly dealing with a car accident, a shooting, a cardiac arrest.  We get critical patients. Often. That's actually the fun part of my job. Ninety nine percent of the time it is routine, dull even.

My job is the everyday world of the ER: the abdominal pains, back pains, chest pains, mental health, etc. etc. etc. that make up the daily operation of an ER.  Its boring really.  Its predictable.

Being an ER nurse, you see a lot of tragedy.  Tragedy in the form of suffering people with cancer who are dying, terrible chronic diseases or conditions, unwanted elderly people..  People die.  Families suffer.  It is sad.

Then you see people who are such ineffective copers that a cold sends them over the edge and into the ER.  They are the type of people who will never have their own doctor.  There lives are such chaos that the concept is foreign to them.

Every day you deal with drug seekers in their various forms.  They lie and manipulate to get what they want.  You learn to recognize them a mile away.

Then there are the just plain mean people. You learn just how many of them there are in the world. They yell at you, verbally abuse you, threaten you, may try to hit you and succeed. They are the out of control people down the hall yelling at the top of their lungs because they didn't get what they wanted.

All this changes you.  Hardens you.  Makes you cynical..  You develop a shell that protects you most of the time. It changes your view of people, the world.   It exposes you to things most people don't see. It gives you a perspective on your own life and how it ain't so bad.

Being an ER nurse is so very difficult.  You cannot understand how difficult unless you do it. The only things that saves you is the occasional thank you, the thought that you made someone feel better or participated in extending someones life at least enough to get them out of the ER.

Last but not least, you will work with people who are hilarious, smart, dedicated and some of the nicest people you will ever meet.  They keep you coming back.

yup

nurses to strike over lack of proper equipment to care for ebola patients at Kaiser Permanente

18,000 nurses who work for Kaiser Permanente in California will strike on November 12 to protect lack of training and proper isolation gear for caring for patients with ebola. Cities across the country will have demonstrations on the same day.

We are expected to use the isolation gear that doesn't cover everything at my hospital, although there have been promises to get better gear. Nothing has happened yet. No mandatory training either.

Have you been trained?  Do you have adequate equipment?

Kaci Hickox responsible for end of world

So that damn defiant Kaci Hickox is at it again. She and her boyfriend are right now riding their bike. The world will probably end during the ride. This is it people.

shitty poltiicians play games with ebola

Political opportunists are using the ebola situation to further their ambitions. They try to act like their quarantine policies are for the good of the public, but they are a cynical attempt to keep themselves in the press.

No one with any sense thinks that healthcare workers who have worked with ebola patients shouldn't be closely monitored.  Obviously. We have already seen two nurses caring for an ebola patient become positive.

Do nurses need to be placed in tents? Of course not.  They can be monitored at home. That whole debacle was ridiculous and I admire Kaci Hickox for standing up for herself.

Now more and more states are imposing these quarantine rules on health care workers.  Here is my problem with it: Why are just the people coming back from Africa being quarantined?  Why aren't all the healthcare workers who have worked with ebola patients, including those in NYC not being quarantined. Therein lies the blatant political side of this. If these politicians were concerned about public safety this would apply to all workers, not just those from Africa.

A terrible situation in Africa gets worse every day. These games being played will only discourage HCWs from going there to help.  It will also discourage nurses here from being willing to care for the patients who may come to their door.

the brave nurses who cared for Thomas Duncan

If you want to hear what it was really like to treat Thomas Duncan, read this story about the brave nurses volunteered to care for him.

nurses: take a look at your future if you care for patients with ebola

This ebola thing just gets better and better...**

Kaci Hickok, the nurse who is now quarantined in a tent outside a New Jersey hospital has hired a civil rights lawyer.  Here's the thing: She is going to get herself out of the quarantine.

You can't single out a group of individuals who decided to go to Africa to help with ebola, but let the ones caring for ebola patients here just go home every night.  If you are going to put Kaci in a tent, then you have to put them all in tents.  How long do you think those nurses will continue to care for ebola patients if they are told they are spending the next 3 weeks in a tent?  Not very long.

What if they are single parents?  Who is going to take care of their children?  Who is going to pay them when they are in quarantine? Obviously this has not been thought through.

I got an idea...anybody who had anything to do with or will have anything to do with  any ebola patient should be put in a mandatory quarantine.  If you were on the same bus, quaratine, live in the apartment building quarantine.  You walked on the same street?  Quarantine.  I don't know if you picked something up along the way.

Lets have thousands in quarantine now.  It makes sense.  It makes about as much sense as grabbing Kaci at the airport and putting her in a tent with a portapotty.

**this is the actually tent she is staying in.

nurses become pariahs after taking care of ebola patients

OK let me get this straight, the nurse who landed in Newark friday from West Africa, where she worked for a month caring for ebola patients, is currently being held in a tent outside the hospital? Is this a joke?

Wow. She has shown no symptoms of ebola.  She sat at the airport for 7 hours, then was taken lights and sirens with people wearing the full isolation equipment to the hospital where she has tested negative twice. She is now being held against her will in this tent with a porta potty, no shower facilities. So this is how we are going to treat people who have the courage to go to Africa to help?

The people who are caring for the doctor at the hospital, WHO ACTUALLY HAS EBOLA, are going home to their families at the end of their shifts and going about their normal business of life.  How does this make sense? It doesn't.

This is craziness. Isn't there some kind of happy medium?  This is what happens when politicians start being in charge of medical problems they know little about.  Makes me wonder what would happen if there was a real epidemic in the country.

Not only will this discourage people from going to Africa, but it sends a message to nurses who care for ebola patients in hospitals: you will become a pariah. That's why a lot of nurses are going to say, hell no, I'm not taking care of that patient.

man candy 2fer

I'm tired

Done this month:

1) 8 hour de-escalation/how to deal with violent patients class.

2) ACLS

3) PALS

4) Ebola baloney

5) Brand new drug dispensing system starting.

6) My regular hours

How was your month?

After you have done acls, pals, tncc, bls 20,000 times shouldn't you be able to be grandfathered in for cripes sake?

doctor has ebola

So here comes news that a doctor in NYC has ebola.  He treated patients with doctors without borders in Africa.. Doctors Without Borders is at the forefront of ebola treatment.  In other words they know what they are doing when it comes to isolation procedures and equipment.  This proves, that despite all of that, you can get ebola. Yet they keep telling healthcare workers the chances are so, so low... As of about september 1st, 240 healthcare workers in Africa developed ebola, 120 died.

Today I asked someone from infection control if, after we cared for a patient with ebola, we would keep working and taking care of other patients.  Answer: yes.

BTW,  if you would like to donate to Doctors Without Borders, a truly awesome organization, go here.    

I have become a part time psych nurse

I wonder why nobody seems to care about mentally ill patients? It is evident in the fact that patients are being housed in emergency rooms because there are no beds available. That's happening in our ER.  It has now become routine to house people for hours, sometimes more than a day.

Funding has decreased for mental health, so patients don't have access to services on an outpatient basis. Just like physical illness, if your condition isn't managed it gets worse and becomes a crisis and sends you to the emergency room.

There are less psychiatrists.  Apparently they aren't paid as well as they used to be, especially in hospitals.  The profession is less attractive because most psychiatrists have essentially become medication managers rather than the therapists they used to be.

Reimbursement for psychiatric patients is less than those who are physically ill making hospital reluctant to increase bed space.

I don't see any of the above changing anytime soon. So the situation will get worse.  We will be part time psych nurses trying to manage patients for hours on end, sometimes overnight and beyond. Patients will lay there with nothing to do, getting more agitated because of it.  They will get bad care because we don't have time to care for them. Our wait time in the ER will increase because there are times when 30% of our beds are occupied by psych patients.  It is more dangerous for the staff because after sitting for hours, sometimes these patients get agitated and start acting out and become violent.

So ERs have become part time psych wards and I have become a part time psych nurse.

nurses have perverse sense of responsibility and loyalty

The administrators at Dallas Presbyterian where the ebola patients have been treated are scrambling. From what I have read only 30% of the hospital is full.  It seems nobody wants to come to a hospital which fumbled so badly.  Can't say I blame them.

Well, everybody knows that a hospital can't survive at 30% so its panic time. It is time to trot out the nurses who are willing to be on TV and say what a wonderful place our hospital is, led of course by the head honcho nurse at the hospital.  They held a press conference praising the hospital essentially saying that those damn radical nurses who said we weren't prepared are wrong, wrong, wrong.  We are a great hospital, so there. This is essentially like saying to someone who is going to intentionally harm you: Its OK, I love you anyway.

Unfortunately, this kind of behavior is typical for a lot of nurses. Oh, the poor hospital, they tried their best, they didn't do it on purpose. Instead of standing up for ourselves and demanding that we be protected, we say to ourselves they are doing the best they can.  Then we go forward and put ourselves in harms way because we are so wacked we are willing to sacrifice ourselves out of some perverse sense of responsibility and loyalty.

Will this hospital recover? They are apologizing profusely left and right. They are shitting their pants about law suits, because they know they will be filed.  They are already mounting their defense. I saw on the internet that the CDC said they were following their protocol, now the CDC realizes that it was inadequate. Our bad, not the fault of the hospital.

Dallas Presbyterian is finished. This will bankrupt them. The public won't forget this for some time.  When they do, it will be too late, the hospital will be closed.

Dear Mr. hospital administrator: you know that ebola patient at the triage window? Good luck with that.

The thing about the ebola crisis is that nurses are at the mercy of hospitals that worry more about the bottom line than they do their own workers. They are playing the odds.  What are the odds that a patient will come into our hospital?  Near zero. Therefore, we won't spend the money on training and isolation suits that are needed.It would be a waste of our money.  We will cover our butts by saying we are "following CDC guidelines".

We will make the training voluntary. We will tell the staff basically: all you have to do is put the patient in isolation and all of our experts we have on call will come to your area and take over. Never fear. We got this.

So here is how I interpret this: When the patient appears at the triage window, I give them a mask to put on. I take them immediately to the designated room.  On the way to the room, I get their name and birthdate. I put them in the room.  I put them in the computer.  Then I call the hospital experts and wait for them to come. I note in the computer that the patient  has no respiratory distress, able to walk independently to room, etc.  In other words, they aren't near eminent death.  I also note that they have been placed in the room and experts called per protocol.

Then we wait, because if you think that I am doing anything beyond that, you are fooling yourself Mr. hospital administrator.  If you aren't going to train me and give me proper equipment, that will be the extent of my involvement.  Good luck with that.

bedside nurses are the experts on how to safely care for a patient with ebola

It turns out Thomas Duncan sat in the emergency department for 30 hours. More than a day. Despite the fact that the second time he came in they immediately knew he had come from Liberia. They isolated him. He sat there for 24 hours before they even did an ebola test.  Then it takes 4-6 hours for that to come back. Did the hospital have the capacity to do the test?

I'm trying to think of why it took so long for the ebola test..  My only conclusion is the doctor didn't think that ebola could have possibly come to the United States, so they weren't thinking in terms of ebola.  They thought of other things, did labs, CT.

So I'm sure that this guy was treated as a typical, perhaps, contact precautions. Since he had no respiratory symptoms, droplet precautions were probably not used.  So that means paper gown and gloves.  Thats it.

As an ER nurse, I'm thinking about what happened in the ER.  Did his nurse have other patients? I have a feeling they did. This guy was sick yes, but not sick enough to be one to one if they weren't treating him as an ebola patient.  No doubt several nurses took care of him over the course of 30 hours. They went in and out of the room many times.  Lab drew his blood, no doubt no special precautions were taken.  He had a CT. He had to go through the halls to CT. He contaminated the CT machine.

No one has talked much about the emergency department part of this. The focus has been on inpatient care because that is where the nurses have become ill.  It is miraculous no ER personnel have not become sick. Little attention has been paid to what should happens when someone shows up at the triage window with symptoms and recent travel.

Most emergency rooms are congested tight spaces.  Mine sure is. My first thought with all of this was: where would we take off the isolation gear?  Not in hall, thats for sure.  Fortunately, my ER has figured out a place with more room to put this patient, with an area outside that could be used for removing gear.

These are the kind of small details that have to be thought of. You can't have an ebola patient in the middle of a busy ER. Would we shut down the ER?  Would we allow other patients to keep coming in? The public would want to know if there was a potential ebola patient in their midst. Do you keep a potential ebola patient in the ER until they turn up positive?  Or do you immediately put them in ICU?  Is ICU ready?  Do they have an area that is empty?  Do they have the equipment ready?

There are a lot of questions. The problem with this is that the people in charge are not the ones who care for patients. They do not think of the details of patient care that we deal with every day.  Bedside nurses should be involved in preparing for something like this.  They aren't.  This is typical of medicine.  All of the daily changes to our practice are decided by people who haven't cared for patients in years. That fact is what makes working as a nurse more and more difficult. This is just one more example.

m....c.....saturday

Dear Mr/Mrs John/Jane Q. Public: don't bite the hand that feeds you

There is starting to be a backlash against the nurse who took a flight to Cleveland and now a lab tech who went on a cruise.  People are starting to turn on them, exclaiming, "how could they travel knowing they took care of the patient!"  They are so SELFISH, so STUPID.  Lacking in COMMON SENSE.

It is obvious that the CDC did not tell these people they couldn't travel.  They were not concerned enough about them to monitor them themselves. They said they could "self monitor".  Even though these people had direct contact with the patient.  So they must have figured, I'm OK I can take my temp anywhere I go. So they went. Now they are being vilified. Just like the first nurse was portrayed as essentially "messing up" the isolation procedures until more information came out.

First of all, NO healthcare worker is SELFISH especially when they are willing to take care of an ebola patient at all.  They are LITERALLY taking their lives in their hands for the sake of caring for someone else. If you aren't a nurse would you volunteer to clean up the poop and vomit of an ebola patient?

Secondly they are not STUPID.  You can't be stupid and be a nurse.  They were following what they were told by "experts".  Their COMMON SENSE told them they should listen to the "experts".

This kind of thing pisses me off royally.  That people have the nerve to say these kind of things about these nurses or other health care workers. Nurses who risked their lives for the patient and are now very ill with ebola. I would suggest that public start thinking about how they are talking about nurses or healthcare workers in this situation. WE are the ones who take care of you when you get ebola.  When we are blamed, we may just say FUCK YOU. You take care of them. You are biting the hand that feeds you.

I haven't gone nuts

You are probably wondering when is she going to lay off the ebola.  I know I have been writing about this continually for a couple of weeks.  You think I'm obsessed, that maybe I have some kind of problem...

I love writing, hence the blog. I am opinionated. I am always analyzing everything.  I am both troubled and fascinated by this response by our country to ebola.  We have never gone through something like this before. It fits right in with what I have written here before about hospitals not being prepared for any kind of disaster. This also has effect on me personally as an ER nurse. This has caused every nurse in this country to pause and wonder about what they would do if this came to their door.

Will all that in mind, I have been writing about ebola.  I would love to have a job writing about health issues.
So anyway, I haven't gone nuts.  I'm not hiding in the basement with my hazmat suit on.

we won't ever be ready for ebola

Lets hope there aren't more than 9 patients with ebola in this country at any one time. That's how many biocontainment unit beds there are available in the country right now.  Four of them are presently filled.

This country has a real dilemna right now.  They are trying to be ready for a disease they aren't ready for. Reality is hitting all of the so called experts in the face.  All their wonderful plans aren't working out the way they thought they would.  The thing is: they still don't get it.

They still think that if they recommend a massive training exercise about isolation gear involving thousands and thousands of healthcare workers across the country it will all be okay.  If they train them using the normal isolation gear, teaching them to take it on and off properly, we will all be okay.  Here is the problem with this:

1) The training so far is not mandatory.  This is hard to believe, but not everyone will go.

2) The gear is inadequate.  There are too many pieces to the ordinary isolation gear which makes it more dangerous to take off.  The ordinary gear is not sufficient.  People need hazmat gear. It is being used by  everyone else taking care of people with ebola, including those in West Africa where it is an epidemic.  It is only in the US that workers are being asked to use something other than hazmat gear.

3) Hospitals are not going to train everyone that care for patients how to use hazmat gear. It is too time intensive. It costs too much money to train and for the suits.

4) We are not prepared to even get rid of the waste from an ebola patient.  Even the people in charge of these biocontainment units can only take care of so many because they can only handle the waste of so many.  If they are saying that, how can an ordinary hospital possibly be ready for the waste?

5) Finally: About the time, the next nurse or other healthcare worker comes up positive for ebola, nurses are going to start refusing to care for these patients.  They will be unwilling to risk it for themselves and their families. Sure, there are going to be some nurses who will being willing to risk it, but I guarantee the vasst majority of nurses will say: uh..no...I don't think so.  I am not going to put my new baby at home in jeopardy because you can't do this right.   Yup, they are going to be willing to risk their jobs over this.

So then what? As a country, we still figure we won't have to deal with more than a few cases. So far there have been seven. Hey, odds are good we won't have an epidemic.  What is very worrisome however is the fact that this is out of control in Africa right now.  I have seen figures of 10,000 a week by December if it doesn't get under control soon.  It isn't going to get under control soon.  1,000,000 cases by January.  The world still thinks it won't affect them. When it gets to that many cases, it will.  Then what?

drug shortage

the brave nurses caring for those with ebola

Here is a really good opinion piece on the brave nurses taking care of the patients with ebola.  They really are heroes.

other nurses support nurse with ebola

So I am watching CNN right now and nurses and other staff are lined up with signs to be there when Nina Pham comes out of the hospital to go to the airport.  They are there to support her.  Its really nice to see nurses support each other at a time when where we are all in a very difficult situation.

my last raise was 65 cents

My last raise was $.65.  I work in an inner city emergency room where I deal with all the people you move to the suburbs to avoid: the junkies, drunks, criminals, hood rats, the mentally ill, the homeless.. Every day I deal with the chronically ill, the neurotic.  I move patients who can be up to 500 lbs.  I am verbally abused, physically abused.  There isn't a day I go home that I am not physically and mentally exhausted.

My job is constantly changing.  New things, machines, procedures, policies, information every day.  I sometimes hold peoples lives in my hands. Literally.  If I make a mistake, you could die. I have to remain calm under tremendous stress.  I have to be ready to deal with someone running in carrying someone who has been shot, someone who is going to have a baby, someone who is dying. I have to juggle lots and lots of things at once.

And now I am faced with ebola.  A disease that could kill you.  It has already killed more than 200 health care workers in Africa.It has infected 2 nurses in Dallas.  I depend on government officials, hospital administrators to have my best interest at heart when it comes to something like this. So far they haven't looked very good.

You are probably scared about ebola.  Will it affect me?  My family?  What's going to happen? Its all so confusing.  Imagine what nurses feel like.  We don't have a choice about caring for anybody who comes through the hospital door.  There they are.  We will have to have to care for them.

These days as  nurse, you can literally be taking my life in my hands taking care of a patient.  I could even die. It could infect my family.

My last raise was $.65.  My next raise will be about $.45.  I wonder if the CEO of the corporation I work for still makes a couple of million dollars.  I wonder if the administrators and managers still make bonuses when they meet corporate goals. They probably do.

They push paper in a safe comfortable office. . I sit at the triage window hoping the next patient doesn't have ebola.

Texas nurses claim outrageous conditions when caring for ebola patient according to National Nurses United

Once again thank you to National Nurses United, the only organization that is standing up for nurses in this ebola crisis. Nurses have been contacting them about the conditions they worked in while caring for Thomas Duncan.

Among the claims made by nurses at Texas Presbyterian:

- when they were concerned about their neck not being covered, they were told to put medical tape around their neck
-hazardous waste piled up in the corner because they had no plan on what to do with it.
- protocols kept changing during the care of the patient

With all this in mind, is it any wonder two healthcare workers have been infected?  No doubt we will hear of more.  I think its time for the CEO and the other administrators to go in and help clean up the patients.  Lets see how they do...

a second healthcare worker in dallas has ebola

Wow.  Another healthcare worker with ebola. It just blows your mind.  How many more people are going to come up posiitve?

I mean seriously, what are nurses and other healthcare workers supposed to think about this?  It gets scarier and scarier.  If I were an inpatient nurse, I would refuse to take care of a patient with ebola at this point. Not until you can guarantee that there is a group of experts in place to assure the proper precautions are being taken, no uh no....

In the ER we are sitting ducks. We won't know the patient has ebola.

What I can't understand is why these patients are not being flown to these hospitals with biocontainment units with personel trained in how to handle things like this.  When asked about why this isn't being done, the CDC director says that this could happen across the country, we all have to be prepared.  True that. Why not, once ebola is diagnosed, fly them to one of these places.  At least then we know the treatment and precautions  will be hat they are supposed to be..  Its just common sense.

At this point, the healthcare workers who cared for Mr. Duncan should be quarantined.  Its obvious there is a huge problem there.  Self reporting is not enough.  Again, common sense.

Nina Pham doing OK, thank goodness

News today that the Texas nurse Nina Pham is doing well.  That  is great to hear. She has been in all nurses thoughts the last couple of days.

It feels like things are starting to move in a good direction with caring for ebola patients.  Meetings with infection control are scheduled in my department.  I wish they were mandatory.

The CDC is starting to recognize that, NO, nurses and other hospital personel are not prepared for this.  Their protocols are very nice but we need practical experience with equipment and practical instructions on how to care for the patients.  I still think that the government should make it mandatory for all hospitals to do this.  You can't trust hospitals to do it.  Maybe its cynical but its realistic.

The CDC will dispatch an emergency response team within hours of a patient being positive for ebola that can help with all the practical aspects of ebola.  Great idea.

It still scares me as a person who works in a department that will have first contact with the patient. There won't be anyone to help us initially.  The thing about all of it is: I welcome training, but we are all human and do the best we can, but sometimes things happen that we don't intend and could contaminate ourselves.  In the ER, we have to rely on each other and watch each other very closely when putting the isolation gear on and off.  Fortunately, apparently the plan, at least in my hospital is to do little with the patient in ER.  Hopefully that will be possible.

national nurses united only organization that is speaking for nurses on ebola

The only organization that is standing up for nursing safety right now is the National Nurses United, the national union of nurses.  They are in the news demanding that hospitals provide the training and equipment needed. They are doing surveys of nurses that tell nurses do not feel they are ready to take care of ebola patients.

According to them, 76% of nurses state that their hospital has not communicated to them how they will care for an ebola patient. Eight five percent say their hospital has not provided education sessions to provide information or ask questions about ebola.  That includes mine.

National Nurses United has threatened to start picketing hospitals.  I hope they do.  Maybe when there are nurses outside the hospitals telling the public that they aren't ready things will change.

Dear Mr. CDC director: you still don't get it about ebola

Dear Mr. CDC director:

You continue to be clueless about ebola and the practicality of caring for patients with ebola.
I am no rocket scientist, I'm not even an almighty doctor, but I am some practical suggestions for you:

1) You and the government need to MANDATE that hospitals have to do practical training of caring for a possible ebola patient.  Do you really think cash strapped hospitals are going to do this voluntarily? Mandate they have the supplies they need.

2) Put any ebola patient in one of the biocontainment units in the hospitals that have them in the four states that have them.  These people have been trained for this event.  They know what they are doing.  We in other places do not and the chances of being contaminated are high. There is equipment available to fly a patient in isolation to another location.  There are companies that specialize in this.

3) Perhaps I don't understand quarantine...but it seems like people who have had direct contact with ebola patients should be quarantined.  I know, I know, they have to show symptoms to be contagious, but why would you have health care workers in their homes, possibly contaminating their families? Someone needs to explain this to me.

I will give you an idea of what it is like right now to be an ER nurse.  We have been referred to the CDC site and our own infection control information on the internet.  We have 2 ebola packets with gown, face shield, booties in the triage area.  We have been instructed to take the patient to an isolation room and expect to do little with them. No blood draws, nothing.  That is assuming they are not unstable.  Hard to believe that would happen.

So lets say the patient is unstable.  I have to go in the room.  I put all the gear on.  I'm ready to come out.  Where do I go to take it off?  I'm assuming that we don't take it off in the room. So there is really no place to go to take it off.  We can't go out in the hall.  We can't walk through the ER to another area.  So I guess we stay in the room forever.  Little joke there, but essentially we have not been told what to do.  Emailed someone about this.  Haven't heard back....