Saturday, December 26, 2015

Help wanted: blank fillers

My days in nursing are numbered. There is light at the end of the tunnel.

I have to say I am glad to be getting out because medicine is losing its human side.  The focus of hospital administration's these days is money, staying in business.  In order to stay in business all attention is focused on meeting criteria.  JCAHO pretty much controls hospitals . They decide how things should be and threaten loss of accreditation and therefore, loss of government money which would  close most hospitals.  Administrators live in fear of their visits.

Then there are the certifications. All hospitals are in competition with each other so there is a rush to rush to be a certified chest pain center, stroke center, trauma center, magnet status, etc, etc, etc. Banners are hung proclaiming the hospitals achievements but no one talks about the millions spent to be able to put up those banners.

Hospitals are paid based on patient satisfaction. Companies are hired to measure that satisfaction and improve it. Millions are spent.

As we know only too well, shit flows downhill. At the bottom of the hill sit the nurses. More time is spent scrutinizing whether or not we are filling in all the blanks than anything else. We are called to task if not enough, or, the right blanks aren't filled in. We get email after email about JCAHO current focus,  the chest pain certifiers possible questions.

In between all of this, we squeeze in patient care.  

Monday, November 30, 2015

Romeo saves Juliet

This is proof I am behind the times....

So, let's say you are Romeo and Juliet, two star crossed lovers if there ever were any.
You share everything, as young lovers do, including your heroin addiction.   Yes you like to trip the light fantastic together.

So one day Romeo and Juliet decide today the light fantastic wI'll be tripped.  You want to try the new stuff from the new dealer.  Little do you know that this new stuff is more potent than you are used to. Juliet passes out.  She isn't dproblemo!! You whip out your narcan nasal spray, give her a couple of squirts and wa-la! Juliet comes back to life!

You live happily ever after....or maybe not. Actually I doubt it.

Yes it seems that narcan, that old reliable opioid reverser is available at your local drugstore.  Over the counter.   Me, I didn't know about this. The interesting thing is the OTC narcan is available in a nasal spray or a self injector.   Nasal spray cost? $20.
Self injector cost? $570 or so.   The injector talks you through the use.

Interesting....maybe we shoulder issuing these in the ER.

Sunday, November 29, 2015

heroes in the most unexpected places

Why is being an ER nurse so hard?

I think its because after a while you get so angry. 

In ER you see suffering.  Pain.  Terrible tragedies.  You see people who through no fault of their own are living really tough lives. You see things other people don't see.

It stuns you what a lot of people are going through, what a lot of people live with day to day, whether it be some kind of  disease that is slowly killing them, a condition or handicap that they have been born with.

You see people whose life completely changed THAT day. They are in shock or denial but you know what is to come and it isn't good.

You see people die regularly. Some expected, some unexpected.  You hear the families mourn.

Then on the other end of the spectrum you see people who, shall we say are life's ineffective copers, to put it nicely. They run in if they vomited once.  They are the drug seekers, the alcoholics. They are the frequent fliers.  They are the just plain stupid. They are the mean and nasty people.

So here you are, this human being, trying to reconcile in your mind the two ends of that spectrum. Inevitably you start to get annoyed and pissed at the ineffective coper group. The time wasters. It's hard to have sympathy for your pimple when I just watched a family mourn the unexpected death of their 50 year old mother.

But the thing is, you aren't allowed to be human.  You are supposed to have sympathy for EVERYBODY from the pimple to the family of the dead mom.  That isn't possible. You try so hard to do it, you even feel guilty because you can't be that person you are "supposed" to be, that Mother Theresa figure that loves everybody.

Here's the thing: It is normal to feel the way you do. It is normal to not be able to reconcile the two ends of the spectrum.  If you didn't feel that way you wouldn't be normal.  Your anger is justified. A lot of the snivellers shouldn't be there and they do waste your time.  They take time and space from people who really need care.  There is nothing wrong with being angry.

You are right to be angry.  You are right to be hurt when people unload their stress on you, a person who is just trying to do their job.  You are right to feel overwhelmed by the mountain of information you are expected to retain, the chaotic environment you work in.  That cynicism and suspicion you
have developed is justified, people WILL use you and manipulate you.  Those have been earned through experience.

I encourage you to not feel guilty.  Do not feel guilty because you left that sore throat sitting while you worked up relieving the pain of that kidney stone.  If the sore throat is pissed, that isn't your problem.  You were putting your attention in the place where it was truly needed.  If the sore throat doesn't like it, it' their problem.  You are doing your job. You don't have to be nice to mean people.  You don't have to "understand" why they are mean.  They are MEAN, plain and simple.  So you do what you have to do and get out.  You don't try to "therapeutically communicate", you try to save your own sanity by spending as little time with them as possible.

You are a human being with rights to be treated with dignity.  No one gets to yell at you, hit you, curse you, verbally abuse you.  I don't care whats going on with them.  You have one of the most difficult jobs there is and you are a hero for doing it day to day.

Tuesday, October 13, 2015

Sepsis is the new black

The manufacturers of vancomycin,  zithromax and ceftriaxone must be very happy right now. They are selling millions of dollars worth of their products as doctors over react to new sepsis guidelines.

Eighteen years old, temp of 101, heart rate 94?  You are automatically possibly septic these days.  You're gettin' a shit load of and antibiotics galore.

My queston is, with superbugs like MRSA, VRE, MDRO from overuse of antibiotics, how is all of this not going to help develop new strains?  What about things like c diff?

I get that sepsis is a huge problem and kills many people, but is this the answer?

Friday, October 02, 2015

Gun violence for fun and profit

1) Comparison of US terrorism death vs.  gun deaths 2004-2013.  Amount of money spent on anti-terrorism: $3 billion.  Whole new government agency created for anti terrorism fight: Homeland security. Firearms industry yearly profits: $33 billion.  Gun violence health care yearly costs: $229 billion.

2) Number of school shooting since 2012: 142


Thursday, October 01, 2015

More dead bodies

Another group of people dead and injured.  This feels hopeless.  It keeps happening and will keep happening.  There is no end in sight.

There will be talk of gun control legislation, background checks and my favorite: treatment for mental illness (you know that's a joke if you work in an ER).  None of that, even if it passed, would make any difference.  We never get around to talking about why this keeps happening in our country. Why are we so obseseed with guns? Why are we as a people so violent?

That is never discussed.  We don't want to face who we have become. It seems like if you think about it, most people want guns for protection.To protect our families.  From criminals we think are going to break into our houses.

What are the odds someone is going to break in while the family is present? Low.  What are the odds you are going to get the gun from the lockbox in time to confront the criminal? L ow. Then there are the people who want to personally carry around guns for protection.  I view them as nuts.

So with the odds of us actually needing a gun are low, why the obsession? Is it because we fear each other? That's what it really comes down to. We somehow have been convinced that there are groups of people who are out to get us. They lie in wait, waiting for us vulnerable people so they can rob us, attack us, break in our homes.

There is crime in this country. We all know that. Most of it takes place in poor communities who prey on each other for the most part. Most of crime centers around drug use. Most of it will never touch us. Yet we have this overwhelming fear that consumes us to the point where there are enough guns in the country to provide every person with their own gun.

There is a lot of profit to be made off of all this fear. Gun manufacturers make billions every year. They make money off of our fear of each other and reinforce it. They use the NRA to keep the profit going.  They point to the Constitution to justify their money grubbing.  We as a society suck it up. I don't see it changing anytime soon

Hey my life ain't so bad....

One thing about nursing, it makes you realize how good you got it.  You don't have cancer, you aren't quadriplegic, you weren't born with a terrible illness or deformity. Your kid is OK.

People handle tragedy in their lives in many ways. Some people become difficult to deal with. Some people become control freaks. Some people become manipulative.  Then there are those who somehow learn to cope and thrive. Often they are innovative in dealing with their situation, developing unique strategies to deal with seemingly impossible situations.

It's unbelievable to see what people are capable of overcoming.

Saturday, September 19, 2015

The triumphant return of man candy Saturday

The view is going down/nurses are sick and tired of the lack of respect

More advertisers are jumping ship from the view. Sweet. I hope they cancel this idiot fest.

I hope all of this makes nurses realize how much power we have.  There are over 3 million of us in this country.  Our numbers give us power.  We need to use it. The problem with our profession is we are too nice. We let people shit all over us, from the patients to the doctors to the management.

I am going to take a giant leap out there and say we are the most important people in the health care system.  Wow, you mean more important than doctors??  Yup. We are the people that actually CARE for the patients. We are there 24/7.  Without us, patients don' t get better, they develop complications, they die.

The reaction of nurses to the view comments reflects the exhaustion of nurses across this country. Our jobs become more and more complex an stressful. We work our butts off daily, with little recognition. We are EXHAUSTED. We are FED UP. Then somebody has the audacity to dismiss us as a profession on national TV.  Uh no...I don't think so.....

Friday, September 18, 2015

Thank you Johnson & Johnson

Johnson & Johnson, a well known supporter of nurses and nursing for a long time, has pulled it's advertising from the view after disparaging remarks toward nurses about a week ago.  For that, we thank them.

Johnson and Johnson has had commercials on TV for some time promoting nursing as  an effort to recruit more nurses into the profession. They call it " the campaign  for nursing's future". The whole "you're a nurse, you make a difference" cornball song.  Even though that commercial was lame, the thought is appreciated.

They have had some really good views of nurses on their commercials, including one about ER Nurses that I have included.

This whole debacle is an example of how little the public knows about our job .

Wednesday, September 16, 2015

Dear Joy Behar and the rest of the intellectual giants on "the view"

Dear Joy Behar and the rest of the intellectual giants on the view:

I hope you never come to the emergency room where I work.  You probably expect me to be wearing a white uniform with white hose and a nurses hat.  That's me trailing the doctor looking at him adoringly (I only went into nursing to find a rich doctor) carrying HIS (in your world only men are smart enough to be doctors)
 clipboard from room to room.  I'm also carrying his STETHOS COPE. I'm not sure what it's for but it seems like it's something really important.

Guess what moron? Nurses are the people who keep your dumbass alive in the hospital. We are there 24/7 while the doctor is home in bed. You have no idea, nor would you ever understand, the complexities of my job.  I take care of babies in the neonatalk intensive care unit who weigh less than a pound at birth.  I take care of people who have had heart transplants, lung transplants. I take care of the little kid who was hit by a car whose life is hanging by a thread in the ER.  I have saved people's lives.  Today I'm taking care of your mother on the ventilator who is on continual dialysis with ten different infusions and my knowledge is keeping her alive.

What did you do at your job today? Oh I bet you wrote you wrote one of your cute little "jokes".


Every nurse in this country

Tuesday, September 15, 2015

ER daily work checklist

1) Check to see who I am working with an whether or not I can stand them

2) Walk past triage and see if there are any patients on carts in the hallway.  Yes - day just went to shit.   No - day won't go to shit til later.

3) Go to assignment area. Are there any drunks sleeping it off?  Prepare "heave ho" speech in head.

4) Are there any psych patients we are boarding?  Retrieve ear plugs for inevitable episode of agitation and scream fest later in shift.

5) Do I hate the doctor I am working with? Is it "order every test so I can bump up level of care and put money toward that boat I have my eye on" Dr. ? Retrieve flask from locker.

6) Am I the stabilization room nurse?  Psych self up for inevitable 99 year grandpa cardiac arrest that is not a DNR.

7) Are there no beds in the hospital? Prepare "I'm sorry you have to wait...." speech.

8) Fill pockets with snacks knowing your break will be hours from now as usual.

9) Gather mask with Vaseline for bad smells, ear plugs for screaming,  wipes for the bottoms of your shoes, extra pair of scrubs because you never know.....

10) Let the games's first contestant is a guy covered in shit who laid on the floor all night with decreased loc who reeks of booze....

Monday, September 14, 2015

Screaming Mimi

Hear that blood curdling scream?  That's my patient who isn't, shall we say, happy, about her impending mental health admission. Get ready, because her screaming will continue for the next half hour....til the meds kick in. The med I gave her after she was put in 4 point restraints.

Did I mention that this patient of mine is fourteen?  Mom and dad watched the whole scene unfold.

Did I mention that this patient is already on 3 psych med and has a couple of psych diagnoses? She is one of many teenagers we get in on a regular basis. I would say at least 50% of the mental health patients now are adolescents.

Did I mention that, as usual, there are no psych beds? This kid will probably still be here when I come back in two days....

Sunday, September 13, 2015

Sunday, August 30, 2015

Saturday, August 08, 2015

is there a nursing shortage going on?

The hospital I work in has been full for months.  It is so full that they have been offering big bonuses this summer to work extra shifts.  There is no sign this is ending anytime soon.

Nowadays hospitals hire bare minimum staff and count on nurses to work extra shifts.  So if they run out of nurses they are screwed.  They are running out of nurses. Even with bonuses, nurses can only work so many shifts. Hospitals have the mentality that it will eventually slow down and they don't want to pay for staff they don't need.

What they don't seem to get is that patients are so much sicker now.  With the baby boomers getting older, there are more of them. What we are doing in hospitals has become  so much more complex with things like ECMO, LVADS, CRT, TPA, etc.  The things we do now require so much more nursing care.

ERs are becoming high tech nursing homes.  Our typical patient has become someone who has a couple of chronic illnesses like diabetes an kidney failure who is now septic. They are complicated and require a lot of care.

We run our asses off to get it done.

Yup it feels like there is a shortage brewing. There are a lot of new grads out there looking for jobs. They have those wonderful bachelor degrees hospitals are requiring these days. The thing is they don't have the experience that is needed to care for today's complex patients and there are only so many med surg openings. So then what?

Oh well, more money for us....

Wednesday, August 05, 2015

I am traumatized after taking TNCC

I have to say that I was traumatized by the trauma nurse core course.... Bada bing.

But seriously, why does the damn thing have to be so hard? The pre-test was a joke. It lures you into thinking the actual test won't be so bad. It was BAD.  There were a couple of questions that I had no idea what the answer was.


My answer: Quit the job and move to Hawaii.

All these certifications have different acronyms and ways to do all jumble together in your head: SAMPLE, MIST, VIPP, H'S & T'S,  Cushings, Becks triad, I/Os, capnography, pelvic binders, rule of 9's.....I'm getting too old for this shit.   Speaking of that, after taking these classes 29 times shouldn't  I be exempt at this point????!!!!kk

Friday, July 24, 2015

nurses are like bats

Nurses tend to come to work when it's dark and leave when it's dark.....kind of like bats. When it's dark, this constellation is often visible....  

Wednesday, July 15, 2015

the sounds of the er

monitor alarms
phone ringing
Call lights
iv pump
fire alarm
hospital paging system
er paging system
patients yelling, crying
helicopter landing
er door alarm
negative air flow room alarming
drunk peeing on the floor
Confused grandma falling
temporary pacemaker beeping
Lucas cpr machine
patient being thrown out by security
psych patients out of control
drug seekers who didn't get narcs yelling, threatening
er staff running
er staff laughing

Wednesday, June 03, 2015

A surprise gift

In the if I didn't see it I wouldn't believe it category, here's one...?

Drunk comes in.? big deal, drunks come in all the time right? Well, for some reason we decided this drunk needed to change into a hospital gown. So in goes one of the techs to remove the no doubt gross clothes...when all of a sudden said comes running out of the room screaming.   It seems when she was getting the pants off A DEAD MOUSE fell out.....

Now I assume that mouse went in there alive....I wonder how long it had been in there to have died??

Another fun day in the ER.

Tuesday, June 02, 2015

emergenccy room triage tales

Alas, it seems like I have abandoned ye olde blog, but I haven't really.  I've just been busy frolicking through the meadow and shit. Actually I've been busy. So I'm back....alert the media.

I am trying to turn over a new leaf these days.  I am trying not to be negative Nancy all the time. Hateful Harriet. Cynical Cynthia. Complaining get the idea. I am trying not to mumble as I leave the room that every patient is a stupid fool. I am trying to accept the fact that no matter how much of a fucking idiot a person is, there they are and I have to treat them like my long long sister, all respectful and shit.

There are a couple of people I work with who should get an academy award  for their performances in triage.  They make me look bad.  There I sit grumpy Gertrude, daring the person who appears at the window to say ONE THING....before I know it cheerful Chastity has a big shit eating grin on her face, practically shouting: "HOW CAN WE HELP YOU? COME RIGHT IN!!! WELCOME TO HOOD RAT ER!

Honestly I just want to slap my co-worker silly when I work with them. Here's the thing: I know their secret. They think people are idiots too, often having a snide comment about big Betty they just took back to room 4.  They just hide their real feelings much better than I do.

They smile in the face of the girl with the bag of fast food, talking on their phone with the already out of control four kids trailing behind her that is here for abdominal pain. Its like she and I are a before and after shot of a new ER nurse and one that has been there 90 years.

So I am trying to become more like cheerful Chastity..oh who am I kidding?! I will never be cheerful Chastity.  I need to give up this ridiculous idea. Oh least I'm honest....I'm not trying to be somebody I'm not.  Faker...

Wednesday, May 13, 2015

nurse will not be dishonorably discharged for refusing to force feed prisoner

As a nurse veteran, this was an interesting article to read. Prisoners at Guantanamomo Bay have held hunger strikes for different reasons. I guess after a period of time, the military decided to force feed them.

They would be strapped into a chair and an NG tube would be inserted. Then they would be fed through the tube. Well, one nurse refused to do it. He faced discipline 8and a bad discharge, a loss of pension. He was no longer able to work as a nurse during the investigation. Those charges have been dropped. After all, how would it look if the navy dishonorably discharged a nurse for essentially torturing somebody.

I admire this nurses courage in a world gone crazy.

Tuesday, May 12, 2015

*****BREAKING NEWS***** America's nurses burning out!

Wow!  Who'da thunk it? Those wussy nurses are again complaining about being tired and stressed out.  Of  course, they are again talking about "being short staffed". Blah blah blah. SSDD When are these whiners gonna quit?

Happy nurses week. May you enjoy whatever weird gift they come up with this year....