Sunday, April 26, 2015

my job ain't no tv show

Every time I flip through the cable channels, there seems to be a new ER reality show.  So I thought I would put together a list of one's that I know of.  Here they are:

Trauma life in the er

Untold stories of the er

Bizarre er

Las Vegas er

Sidney er

NY med

Boston er

The little I have watched of these shows, naturally it's about dramatic shit. Every time you turn around someone's crashing or they're cracking a chest. So this is what public has come to believe an ER is, one exciting moment after another. In reality, working in an ER on a daily basis can be boring and routine. It has its moments, but really it's about a lot of abd pain, back pain, LOLLOL's, drunks and drug seekers.   It's a lot of starting IS an giving Zofran and Dilaudid......*yawn*.

I guess vomiting and grandma coming in covered in stool or Harold the drunk making his 3rd appearance that week doesn'the attract an audience and advertising money.

Friday, April 24, 2015

fun ideas for triage

Sitting at the triage desk watching people walk down the hall of shame toward the desk. I love the ones who either walk very hurriedly or sprint toward the desk..

Anyway, I had the idea to make life in the ER a lot easier for everyone concerned. We have this sort of vestibule type area with glass doors that can be locked. At night a security officer sits there are gives out name tags since its the only entrance to the hospital.

So I thought: Have this set up in the vestibule where there is a breathylyzer machine that everyone who wants to be seen in the ER has to blow into. Just think, you would already know the alcohol level of every patient right up front. The machine would instruct them to how to use it and then say:BLOW! BLOW! BLOW! BLOW! BLOW! It wouldn't unlock the door until they did it successfully.

Part# 2: Put a bathroom down there and have everything pee in a cup for a drug screen. You put your specimen into a little door thing in the wall, like at the doctors office. You have to wait for the results before the door will announce your name and unlock the door. This would be useful for drug seekers.

The thing is how would you prevent people who haven't been approved to now move ahead to the triage desk from running through the door when it opens? Hmmmm... We could have a place in the floor that opens and somehow propels the cheaters outside.

It was a slow evening in triage....

Tuesday, April 14, 2015

SEPSIS is the new black

All of a sudden sepsis has become the IT thing in the ER. We have had septic patients for a long time and have treated them with fluid, antibiotics, sometimes pressors, etc.  We aren't really treating them any differently now, its just that now someone with sepsis has become

       ******THE SEPTIC PATIENT!!!*****

Now..if you have a fever you are possibly septic and we treat you as such.  The whole world has become
possibly septic and all that entails: fluids, blood cultures, lactates, etc. Sniffles with fever - SEPTIC!  Sore throat with fever - SEPTIC!! Everyone is septic until proven otherwise dammit!

We are getting new machinery around this that has us tilting the patients legs up at a 45 degree angle for a few minutes to determine where they are with their fluid status involving CO, SV and all those other letter things that they understand on CCU and I never wanted to understand. Its too complicated for my feeble brain. Another machine to hook up to the patient.  Its getting to the point where we won't be able to see the patient because of all the cables going from them to the machines. 

Of course we had an inservice which went in one ear and out the other.  

It is admirable that attention is being put on sepsis and trying to decrease the mortality rate that goes with it. Why does it seem like whenever a something like this starts, they go overboard? **

**I know the picture has little to do with this content but I thought it was sue me.

Tuesday, April 07, 2015

it ain't rocket science folks

Good luck to hospitals in the almighty patient satisfaction sweepstakes. They are approaching it all wrong.  They are approaching it from the top down, instead of the bottom up.

I used to be on a committee addressing this.  I once sat for an hour and a half at a
meeting listening to a "performance improvement specialist" talk about what we say to patients.  What do we say to them when they present at the window?  Do we say: Can I help you? What can I help you with? How do we acknowledge them?  I mean seriously....

It seems the triage area is a place where people don't "feel welcome".  Could that be because the staff appears stressed out? THEY ARE STRESSED OUT.  Here is a list of what the two nurses at the triage desk deal with:

1) Answer phones:
     - from ambulances coming in, place those ambulances in the ER (if there is a bed available)
     -from idiot doctors offices, nursing homes, therapists, etc. who call to tell us their patients are coming in.
WE DON'T CARE.  We will deal with them when they get here.
     -calls from information desk about patients they can't find
     -random other calls

2) Let people in the door to main ER a thousand times a day. Deal with frantic relatives.

3) Give directions to people to inpatient rooms,  the cafeteria, coffee shop, pop machine, admitting, etc. etc. etc.

4)  Deal with people who have to be transferred to labor and delivery.

5)  Go outside to help people out of cars.

6)  Check people in.

7) Triage people.  WOW, yes we actually have to do this in the middle of everything else.

8) Take people to rooms.

All of this is really great, especially when there are 10 people at the window, 20 people in the lobby.

In the middle of all this we are expected to smile like a frickin' idiot.  Let me ask you, could you smile like a frickin' idiot in the middle of all this?  I don't think so.

Here is what will help patient satisfaction in triage:


No doctor office, etc. calls

Security handles traffic in and out.

Charge nurse gets ambulance calls.

Come up with the money to have someone at the desk which allows nurses to actually TRIAGE (what a concept).

If you take some of the  stressors in triage away, staff will be happier, less stressed and they will be able to welcome patients as they should.  Patient satisfaction improves. This ain't rocket science folks.

Here's a clue: Maybe you could ask the staff who works in triage what they see could help the situation.  What a radical idea.

Friday, April 03, 2015

danger will robinson danger!

Just when you thought health care couldn't get any stupider comes news:

JCAHO requires that your bulletin board hold limited information and that all sheets of paper on the board MUST HAVE TACKS IN ALL FOUR CORNERS.
Apparently if your don't have it tacked down in four corners you could lose your accreditation.

I can understand their concern about the whole four corners thing. Paper can be dangerous for the following reasons:

1) Someone could get a nasty paper cut from that fluttering piece of paper.

2) Lets say the paper comes loose due to only having one tack, it could become a missile and take somebody's eye out.

3) A wind could come by and move the paper around helter-skelter and your eyes could follow that motion, causing dizzinessand a fall to the ground perhaps requiring boarding and collaring.

4) The paper could become loose, fall to the floor. You bend over to pick it up and herniate a disk. You become addicted to narcotics and lose your job as a nurse becoming an aimless drug seeker.

5) The paper becomes loose, a random gust of wind takes it down the hall. You chase after it, slip on the floor, hit your head on the corner of a desk. You develop a massive head bleed and become a vegetable. 

Thursday, April 02, 2015

we interrupt this blog...


Attention all citizens:

The following are not emergencies:

1) bug bites - unless it have swollen to the size of a baseball

2) the fact that you cannot control your teenage daughter or son

3) you are fatigued or can't sleep

4) you want your son, daughter, brother, sister, etc. to get chemical dependency treatment

5) the condom broke

6) you are hungover

7) G tube not working

8) the cut is less than 1"

9) any kind of medication refill

10) menstrual cramps

That is all...go about your business.

Wednesday, April 01, 2015

what kind of nurse should you be?

the land of make believe

I work in the land of make believe. Its a place where everybody pretends things are different than they really are. There are beings here who run this land of make believe. They are the ones who make the rules. Lets call them the rulers.

The rulers like to get together and think up new rules and change the rules they already made. That's what they get paid to do. They send the rules and changes they have thought of down to another group of people who deliver the rules, make sure the rules are followed. Lets call them the enforcers.

The people who receive the rules and changes and have to live by them are at the bottom of the pyramid of make believe land. They are the people who actually try to follow the rules as they do the work. Lets call them the nurses.

Here's the thing. The rules that the rulers make, and the enforcers enforce are rules that nobody can ever follow. There are too many rules, they keep changing. The nurses can't possibly follow the rules. There are too many. Its impossible to keep up with them. The changes are too numerous and often make things more complicated.

So the nurse eventually give up. They tell each other, forget it. I'm not even going to try and follow the rules. There is no point. I can't keep up. I'm just going to follow the rules I can and screw the rest.

Moral of the story: If you keep changing policies, increasing charting requirements, making things more complicated, the nurses will just do what they can and you won't get what you want. And when the rulers of the rulers, the kings and queens of make believe (JCAHO) appear, everybody will be screwed.