if only.....

I was thinking this would be a good idea for the waiting room...but then I thought - hey - put  it outside the entrance and then people would have to come in and bother us at all....

my most popular blog post of all time: How I became a bitch

I have been doing this blog for the last 8 years.  I'm not sure why I continue...I don't have much left to say. Over the years the number of people reading it has varied up and down and sideways. The following blog post has had an astounding 344,600 pageviews.  It continues to get a couple hundred a week. It has also generated 188 comments, most by other ER nurses who identify with what I am talking
about.  Here it is:

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.

this is probably the last man candy saturday

I think its the heartless sociopath

another great new blog

Another great new and funny ER medicine blog:  First World Emergency Medicine

the Gomer blog strikes again

Aother great one on the Gomer blog:

"Urgent Care trains monkeys to dispense Z-Paks, send patients to ER"

when it seems like all else is lost there is always man candy saturday

only every day

yup

at the end of the day, I am just human

I argue with myself daily. I feel guilty. I am angry.  I am sad. I am hurt.  These are the emotions that nursing provokes in me.

I get so angry sometimes about how hard my job is. Its so exhausting. I have a job in which I come home physically exhausted a lot of days. My back is usually sore. My feet hurt. Silly me, like the rest of my co workers I work 12 hour shifts with the idea I don't have to be there as often, but I exhaust myself in the process.  Of course, its gets harder the older I get.

I get angry at the way people treat us. Sometimes it seems people walk through the entrance and it is permission to act in any way they want. They can take all of problems and dysfunction out on us and they do.

I get angry at how powerless I often feel as a nurse. Powerless about the circumstances of my job. Powerless that everyone else seems to control it but me. I get angry that nurses are so exhausted that we don't take control of our profession.

My job is such a sad one. Nobody is happy who comes into an emergency room.  They are there because of a problem. Usually they are in pain. They are anxious and stressed. Some are truly suffering. Many live lives of dysfunction, going from one crisis to another. Every day I see people living pathetic lives of drug addiction, mental illness, homelessness.  I have seen people walk in the door and be dead within an hour of arrival.  I have seen 99 year olds resusitated and 20 year olds die. I hear families cry at the loss of loved ones.

Under all the anger is hurt, an emotion we rarely admit to ourselves as nurses. We are hurt because we really do the best we can under tremendously stressful circumstances. We try our best and yet it never seems enough. Most days we go home wishing we could have just done the basics, knowing we failed, knowing it would be impossible for anyone to do all we are supposed to do.

I feel guilty a lot. Guilty that I often feel like I don't like people very much. Guilty that I have become so judgemental. Guilty that I don't have more empathy. Guilty that I am often a cynical bitch.

In the end, I am just human.

nursing school memories

This was me at graduation. The whole capping ceremony baloney. They actually had us kneel.. Yeah..I went to a catholic college. That nun beside me was my worst nightmare. I think she let me graduate just to get rid of me. I look scared don't I?

two for the price of one man candy saturday

ebola update

Ten more Americans being brought home and placed near hospitals with biocontainment units. They may have been exposed to other healthcare worker with ebola.  None have tested positive so far.

ebola back in US

What a difference a few months makes. A US healthcare worker contracted ebola in Sierra Leone. They arrived quietly to the US to an NIH facility outside Washington with little fanfare. The patient is said to be in serious condition.  That doesn't sound good. Another American is being flown back to Atlanta because they may have been exposed to this other person. They haven't tested positive for ebola. A British healthcare worker has also contracted ebola and is now back in England.

Nothing is being made public about the person with ebola - no name, sex, age. The frenzy that accompanied the the inital outbreak is not happening this time. No scary headlines, no film of the patient being transferred by people in hazmat suits.

Up to this point there have been almost 25,000 cases of ebola in Africa.  Ten thousand people have died. Currently the outbreak is still spreading in Sierra Leone and Guinea.  All the suffering is still happening.

My hospital has done a lot of work to prepare for a possible ebola patient. I feel like we are as prepared as we can be.  We are expected to ask everybody who presents in triage whether they have been out of the country in the past month.  This is a reminder to not let our guard down.

pain in the ass patients finally identified and labelled

Here's another funny blog post on the GOMER blog: "Hospital wristband finally identifies Pain in the Ass patients".   It is (satirical of course) idea of having patients who are a PTA with a bright orange wristband identifying them as such. I wish we could really do this. We'd probably run out of bands the first day.  

pain scale follies

I've decided that I am going to save myself and you a lot of time at triage. I am no longer going to ask what is your level of pain on a 1 to 10 scale.  You know, ten being the worst and all.  From this day forward EVERYBODY IS A TEN.

I don't care if you have a puncture wound that is so small I can't see it. I don't care if you haven't had a bowel movement for 2 hours. I don't care if the nurse line told you to check into the ER for that stubbed toe.  ALL OF YOU ARE A TEN, DAMMIT.

That way I won't want to slap you silly when you tell me you are ten for elbow pain that has been going on for ten years and your doctor in the state you moved here from just retired and you are out of your pain meds and you can't get into the new doctor for a month and you just need enough pain meds to make it through til then and you are very sorry for bothering us and you have a very high pain tolerance normally, but this is just too much for even you, who had a broken leg in 1978 and this pain feels very similar to that and you wouldn't bother us if it wasn't that bad.

YOU ARE A TEN!! GO SIT DOWN.

my nursing career: then and now

I thought you might enjoy a picture of me when I just graduated from nursing school and a current photo. As you can see, nursing has taken a bit of a toll on me, but my hair still looks awesome.   

its all about timing

There is a column in the New York Times today by a title "No cure for bad timing".  In it she talks about the two different kinds of patients that come into her office for minor problems like a cold, back pain, ankle sprain.

The first type of patient is one who has little tolerance for discomfort. They are up and out the door to medical care within a couple of hours of symptoms.  They are the people we see with onset of vomiting 4 hours ago or a sore throat that morning.

The second type of patient waits. They are willing to give it a couple of days to go away. They feel worse so off they go to the ER.

The first  patient is gonna be disappointed. They ran in just as the problem was starting. We may do a throat culture which most likely is negative. They are sent on their merry way and told to ride it out with hydration and tylenol. They will feel worse the next day. They may come back or just say we gave them bad care. Either way it goes away in a couple of days.

The second patient is going to be happy.  We probably won't do much for their sore throat either. Maybe give them some ibuprofen.  They will feel better tomorrow. Why? The illness has run its course. They waited to come.  We will be their hero. The ibuprofen is what made the difference they think.

Moral of the story: If you have a minor problem, wait a few days to come to the ER.  At least when you feel better the next day as you would have despite coming to see us, you will feel better about having sat in the waiting room for 3 hours.

no poop = no problem

Hospitals are falling all over themselves to get different certifications in an attempt to outdo their competition.  Ha ha we are a certified stool transplant center and you aren't....  We spent 50,000 dollars to be able to put on our internet sit that we are ready, willing and able to transplant any stool that needs tranplantin' and someone with a clipboard and 3 piece suit said we are experts at it. Now our administrators, when they send out an email can add certified stool transplant center to their list of credentials.

So I have decided to come up with my own certification agency.  There is obviously money to be made here. Of course, it goes without saying, I will be non-profit.  Everything I do in my agency will be done for the good of humanity. The 50,000 dollars I charge per site visit will go into further research that my agency does to improve care.  The 500,000 dollars plus bonus salary I make is commensurate with what is expected to be paid to someone at my level. (cough)

My area of expertise: constipation and flatus. I will certify your hospital in constipation and flatus care. You will set up an area in your hospital which will be called the "Centre for Constipation and Flatus Care" (clinics are so passe)

You will become an expert in constipation and the art of the bowel movement. Your institute will guarantee a bowel movement or flatus removal at every visit, come hell or high water (!). Your staff will develop an expertise in the fleets, tap water or pink lady enemas, the likes of which no one has ever seen. Your long fingered staff will take care of that fecal impaction in a matter of minutes. Gas = gone!

Since very few institutions are capable of this kind of expertise, you will no doubt become nationally know as a centre of constipational and flati excellence, drawing people from around the country, perhaps the world.

With this certification comes the right to advertise your new status as a certified Constipation and Flatus Centre in any manner you choose. No doubt you will want to have a large banner made to put on the outside of the hospital to display your pride to all comers.

Please contact me at Kate's Constipation and Flatus Accreditation Centre: 1-800-N-O-F-E-C-E-S.

sometimes all there is, is man candy saturday

just sayin'.....

If you:

1) don't realize how often your period should come...
2) how soon you can get pregnant after having a baby...

It stands to reason you should not:

1) have unprotected sex....
2) have children at all.....

Just sayin'.....

Nursing is complete bullshit part 2

In what other job is the public allowed to come into your workplace and act like complete assholes?  They can act like 2 year olds with no consequences.  They can call you names, threaten you verbally and sometimes physically and we are supposed to "understand". Bullshit. I am sick and tired of people treating us badly. I am not going to "therapeutically communicate" with someone who is calling me names. It is ridiculous.

Just because you are sick or your family is worried about you doesn't give you the right to bring your dysfunctional bullshit into the hospital. Nurses are idiots to allow it. We show how dysfunctional we are when we do allow it.  I honestly think you have to be somewhat of a masochist to be a nurse.

All of this passive bullshit is drilled into nurses heads starting in nursing school where we are taught to "therapeutically communicate" and "understand" when people are under stress.  We are not taught to assert ourselves to stand up for our dignity as human beings. We are taught to be doormats for the medical profession.  Let people abuse us.. Work under horrendous working conditions, not taking breaks, throwing out our backs, developing stress related illnesses. Have no control over our job. Let the people who are in management make lots of money off our back.  We take our frustration out on each other.

It is insanity this job of nursing. It gets more insane daily, but we go along with it, wanting so badly to please everybody by killing ourselves. It is truly pathetic.

This is the untalked about reality of nursing.  It is the truth about nursing  We pretend its not like this, lie to ourselves about it,  When we stop pretending this reality of nursing doesn't exist, it will be the beginning of change. I'm not getting my hopes up.

nursing is total bullshit

Nursing is really just a horrible job. It is self abuse. You have to be nuts to be a nurse. You are overworked. You have tremendous responsibility with lack of compensation. You are treated like shit by patients, doctors, administrators, even co workers.

Here's the thing: Nurses put up with all of this and then feel guilty they would demand to ask it to be different. We don't feel worthy of having better working conditions. We let people put more and more shit on our shoulders every day.

We get high blood pressure, have stomach problems, are depressed.  We literally kill ourselves in a thankless jobs and tell ourselves its all okay because we are "helping people".  Such bullshit.

Nursing is not a calling, that too is bullshit spread by people who think we should sacrifice ourselves for the good of humanity.  Nursing is a JOB, like any other job. We are not special.  We make an hourly wage and put in hours just like anybody else.  The whole "calling" thing, "helping humanity" crap hurts nursing.  It allows us to not get the pay we deserve and to keep being treated like second class citizens in the medical profession.  Oh, its okay, we can give the nurses a 1% raise and cut their benefits. They won't care because they won't stand up for themselves anyway. Meanwhile the people who are saying this are earning bonuses off of our hard work and sweat.

So, nurses, you keep telling yourself that this job is your calling,, you are "serving humanity", blah blah blah. You keep letting everybody shit on you on a daily basis. If we are okay with working under these conditions, we deserve what we get.

(cue all the people who live in this fantasy world of nursing and defend all the bullshit)
 

nurse Nina Pham who had ebola sues her hospital employer

Nina Pham, the first nurse to contract ebola in Texas has filed a lawsuit against the hospital she worked for claiming that they were not prepared to deal with ebola. They didn't have the proper equipment and did not train the nurses on how to care for an ebola patient.

She also states that they violated her privacy by announcing her name to the public and filming her in her room without her permission.  She says they tried to use her to save their reputation.

I am sure they will settle with her out of court, just like they settled with the family of Thomas Duncan. They don't want all of this dragged through court. Their reputation is already down the toilet.

Neither Pham or Amber Vinson have returned to work after going through this. Pham states she has had physical and emotional problems.  I can only imagine.

She implies the hospital where she works was more interested in its reputation than it was in her.

This isn't a big surprise. Nowadays a hospitals reputation is everything.  There is so much competition between hospitals. If a hospital has bad publicity, they worry it will affect their bottom line: MONEY. That is the purpose of hospitals in this day in age: to make money. To specialize in things that make money: cardiology,  neurology, orthopedics, different types of surgery. Doctors in specialties make out like bandits and administrators make a few million a year plus bonuses.  All in "non -profit" hospitals.

When are nurses going to understand that the only people that will take care of us, ensure our safety is US. We certainly can't depend on administrators to take care of us. They are going to try and get by as cheaply as possible. I have big news for you: They don't care about you.  You are replaceable.  With a newer nurse that is cheaper.

The only thing that protects us are organizations that bring us together to demand our rights and yes, that is usually in the form of a union.