PANIC!!!!!! in the streets

Unless you live in a cave, you have probably heard about the fungal meningitis outbreak.  A company that supplies steroids to doctors who inject them into the spine of people with back pain sold contaminated vials of medication.  Seven people have died.

So apparently these medications went all over the country. It seems state department of health agencies are in charge of notifying individuals who have had injections from these medications. So alas, they have been individually calling people in my state and asking them if they have any of a list of about 14 symptoms.  If they do, they tell them to go directly to the emergency room. Now mind you some of these people had the injections 2-3 months ago.

These patients go to pain clinics. so they have chronic pain.  What do you want to bet that they will have one of the symptoms? Oh about say 75%, lets say.  Then you have the other 25% who PANIC!!!! It doesn't matter if they have any symptoms or not.  They want to be checked. They want the doctor to tell them they DON'T have it.

And so these people trickle in, wanting expensive time consuming tests (LPs) that the majority probably don't  need. Just kill me now.

you give me the creeps

Does this ever happen to you? You are just creeped out by a patient or their family? I'm not even talking about the people who would most likely creep you out: criminals, mental health patients.
I am talking about patients and their families that are just creepy.  When you are in their room it feels like something is just off in the family, something you probably don't want to know about.  They make your skin crawl. You avoid them. You just want them to go.

I am always amazed at our ability to keep a straight face in a lot of situations and not reveal what we are feeling.  We just go along with stuff, saying...uh ...yeah ...OK...when we are really having a whole other conversation in our heads.

ENDANGERED SPECIES: Nurses

Are nursing an endangered species?

Healthcare is changing. In my ER we are going to PAs as  the main providers. They will be seeing all the patients except those who are critical. This will mean less doctors needed.  Now mind you, this is a decision by our doctor group to do this.  They cover 3 hospitals and its hard to find enough doctors to staff them.  These doctors are saying that the majority of our patients don't really need to be seen by a doctor.

Is this the future of medicine? I mean think about it. Overall, isn't the vast majority of medicine routine?  Couldn't most of the patients in the healthcare system be managed by PAs or NPs?  Most of it is not rocket science. I've always thought that eventually medicine will go to exactly this model. Cost will dictate the change.

Could this same thing happen to nurses? Lets face it, some of what nurses do is not rocket science either. The tasks I mean.  A lesser trained person could easily manage them.  Where the value of nursing comes in is to manage and coordinate the whole picture, to monitor the patient and catch changes,  The value of nursing is our holistic approach.  We are the ones who see all aspects of the patient as a person and address it.  We have the knowledge to know how things should look and can recognize when something is wrong.   We are the person who stands between the patient and all of those specialists focusing on their own unique area. We coordinate the care and keep the patient safe.  We're the ones there at 3 am when the patient goes down the toilet.

WIth the emphasis on costs, do nurses need to care for individual patients? Would it be more cost effective to have 2-3 nurses overseeing a unit and other people doing the tasks? Will hospital managements start to think about cutting the more expensive nurses and replacing some of them with those who cost less, leaving nurses to supervise?  With the inevitability of NPs and PAs providing the majority of primary care, will nursing go the same route, being replaced by perhaps paramedics, EMTs?

Why do I bring this up? Because I see a rapidly changing health care system in which interest groups (doctors, management) are changing the way things are done. They recognize things have to be different. And then there are the nurses.

For a long time, nurses were in the drivers seat with the nursing shortage. We got what we wanted. They wanted to make us happy to keep us. That has all changed.  There will be another nursing shortage but it will be different. Nurses are being asked to do more with less.  We already are.

The nursing profession seems to be in a state of shock right now. Things are changing rapidly.  Corporations control medicine.  Yet we as a group are not stepping up to be a voice in this new environment.  We complain and whine about what is happening (I'm really good at that), wanting it to go back to where it used to be.  It isn't going to.  Unless we step up to the plate and deal with the reality of this health care environment and advocate for our very important place in it, nurses will be replaced. We are a costly part of the system in an environment that emphasizes cost. If we don't take control of our profession and prove our worth, take our rightful place, we will be gone.

EVERYBODY CLEAR! SHOCKING...

You know how many times I have been going to ACLS classes every two years? A whole helluva lot of times. I have seen epi doses range from 58 mg every 10 seconds to .00000001 every hour. Back when I started there were no such things as defibrillators.  If someone arrested we just stuck their finger in a socket.....bada bing!

In other words, I dread and hate this q2 year obligation to keep working in the ER. I wait until the last minute to renew. I avoid the book til the last couple of days.  The renewal is always fun.  They jam all the shit into 8 hours, including BLS. 

CPR has become too much of a workout for this old gal. I mean 100/min, hard etc?! One cycle in and I called for a switch.  I mean I didn't want to have a stroke in class. (Although everyone would have know what to do...)

Then there are all of these numbers swirling around in my half demented brain: 30:2, every 6-8 seconds, 1mg, 300 mg, 2-10 mcg, 15:2, 300 jules, 100/min.....its too much.

The worst thing about ACLS is that every time you go, you think you will fail and humiliate yourself.  You picture yourself going back to the educator at work and telling her you failed and you have to take it again.  It never happens, but there is still that stupid fear, no matter how many times you take it.

I passed it. Like I always do. I'm traumatized, like I always am.

The worst thing? I have PALS next week 

ER wait time: you will never be seen

OK, whose scathingly brilliant idea was it to put ER wait times on  hospital web sites?  There are apparently enough morons out there that go there and check them.

MESSAGE TO THE PUBLIC:

If you have time, if you are thinking about this before you even come, YOU ARE NOT HAVING AN EMEGENCY. REPEAT YOU ARE NOT HAVING AN EMERGENCY.

So I am sitting at the triage desk with the usual snarl on my face (sort of a get the the hell away from here presentation) and a person comes up to discuss on the wait time that was on the web site. The conversation went a little something like this:

MORON: The web site said the wait was 15 minutes and we have been waiting 30 minutes.

ME: Those wait times are usually not acurate.  ER situations can change minute to minute.

MORON: But, your hospital operator told me the wait was fifteen minutes...

ME: They shouldn't have told you that. Things change quickly.

MORON: Well who can I talk to about this. This is public information and it is not correct.  BLAHBLAH BLAH.  LALALA.

Now mind you it is Monday.  There are 58 people in the waiting room who have been waiting for hours. There is a line of people behind this guy. I gave them the ER managers home phone number and encouraged them to call  and have a long talk about the fraud being committed by the hospital in regard to ER wait times.  I told them the manager won't be home until midnight and doesn't mind being called that late.