excuse me....uh...fuck good samaritans

I hate good samaritans.  Why?  They feel the need to call 911 when they see a drunk sitting or laying on the sidewalk.

Dear good samaritans:

I hate to break this to you but drunks live on the sidewalk.  When they are too drunk to stand they sit down or lay down, often going to sleep.  They aren't hurting anybody.  I know they are unsightly.  Not something you want to see in your pristine city, but they are a fact of life.  So leave them alone to sleep it off.

Sincerely

Madness the nurse
on behalf of all ER nurses everywhere

You see Mr/Ms good samaritan, when you call 911 the medics are obligated to take them to the emergency room. They don't have a choice.  They can't leave them sitting there.  They bring them directly to us, your neighborhood ER.  When you are sitting there with elderly mom and hear that person shouting: "FUCK YOU! GET AWAY FROM ME!!" that is the drunk you called 911 about in all their glory.  Here's the thing that yelling is not going to end anytime soon.  It will continue sometimes for hours.  So sit back and enjoy the fruits of your good samaritan efforts.  Its only right you share in the experience.

No doubt that drunk has peed all over themselves. Yup thats them throwing food into the hall as you pass by. Just missed you huh? Uh oh...they took off their clothes...darn it...you didn't need to see that.  Here's the thing, detox is full.  They will have a starring role in the ER all night til they stumble out in the early morning light down to the street to beg for a few quarters for thier next bottle of listerine.
 

the dawn of a new ER day

I start my shift at 9 am.  I come in the ER entrance. ( I observe how many people are walking toward the entrance, how many cars are parked at the entrance.  There are five and two respectively.(CLUE #1 that this day will probably suck).

I look down the hall and see if any nurses are sitting at the triage desk.  They aren't, meaning they are busy. (CLUE #2 one that this day will probably suck)

 I never walk through the department when I get there. I go around it. Trying to postpone the inevitable I guess.  As I walk to the staff lounge, I see the ambulance board where the rig numbers are listed and the room they are going to.  There are five (CLUE #3 that the day will probably suck).

I go to the assignment sheet and look to see where I will be. I am on the end we all hate and then charge n
urse later (CLUE #4 that the day will probably suck)\

I look to see who I am working with,  I am am working with Nervous Nelly and Jumpy Jack, I grit my teeth. (CLUE #5 that the day will probably suck).

I go to my assigned area and look to see what doc is on.  Its Orville the overorderdering maniac. (CLUE #6 that the day will probably suck).

I look at the patient board.  There are two alcoholics sleeping it off. Granny in room 2 is yelling: "NURSE! NURSE!"  I recognize 5 frequent flyers on my end. (CLUE #7 that the day will probably suck).

I get report from my co worker who gives me a group of patients  from hell with families to go along with them. (CLUE #8 that the day will probably  suck).

The charge nurse comes by to say there are essentially no beds in the hospital. (CLUE #9 that this day will probably suck).

I am charge at 3 pm and we are down 2 nurses and staffing MIGHT have one for us...(CLUE #10 that this day will probably suck).

And to think, I haven't even seen a patient yet...

another mass shooting...*yawn*

It seems like shootings that capture national attention have become the norm.  There's a different one every week. They capture our attention for a day and that's it. Its funny how there are 32,000 gun deaths in this country a year, but we don't give attention to that.  It has to be a big splashy shooting or multiple victims for us to notice.  But..hey... I'm getting away from the point of this post.

It is really beginning to infuriate me how every time there is a mass shooting, the subject of mental health comes up.  There is talk implying that if only this person had received proper help it could have been prevented.  Politicians talk about need for "mental health care reform".  Blah blah blah.  Soon that dies out.

What infuriates me is that the average American has no idea about how bad the mental health care system is in this country.  They don't realize that mental health problems are treated very differently from physical health problems.  If you want counseling it will have to be pre-approved by the insurance company who will put a limit on the amount of visits.  Then there is the fact that there is a shortage of psychiatrists.  Good luck finding one or getting a timely appointment.

Then there is  hospital mental health treatment.  If you come into the ER in a crisis, your visit will be 4-6 hours.  It may extend up to 24 hours if there are no beds available.  You may end up in podunk city, 200 miles from the ER you came in to.  You may be transferred there because there are no rooms at our ER. Sometimes there are no beds in the state.  Then you stay in the ER, up  to that 24 hours.

Shy is mental health in such a state?  Lack of psychiatrists. Insurance companies don't want to pay for it like they do for physical problems.  A big part of it is the attitude toward mental health in the United States.  It is still considered a personal failing. You should be able to pull yourself up by your bootstraps and stop whining. There is a huge stigma.  We fear people with mental illness. For shits sake, there is talk of having a national registry of mentally ill people that can be accessed if they try to buy a gun. Well, good luck with that since half the population is on antidepressants.

My point?  Lets just stop the bullshit.  This country is not ready to really deal with mental illness. For it to be treated on the same level as physical illness, it would take a huge cultural change. That's not going to happen anytime soon.

the love of money is the root of bad patient care

I've been an ER nurse for an eternity.  Seen a lot of changes.  Seen a lot of changes with our doctor group.

When I started in the ER our docs weren't board certified ER docs, they were internal medicine.  As a nurse group, we had a great relationship with them.  They respected us, valued our opinion and because of that we gave really great care.  The doctors back then worked for the hospital.

Down the road they decided to form a group and contract with the hospital.  Thats when the changes began. Eventually they started hiring only board certified ER docs which is as it should be.

These two changes - the group separating and contracting with the hospital, hiring ER docs only, changed our ER.

This is only my perspective but when they formed their own group, it changed them.  It seemed to become more about the money.  When you contract with someone, you have to make the contractee happy.
What makes the hospital happy? Happy patients. Getting them to come back. Making money for the hospital.  Using the hospitals high tech equipment.

What makes a patient happy? Obviously, they want to feel better.  They want you to calm their fears that something awful is wrong with them.  They expect you to do things for them: run tests, relieve their pain, reassure them.

Now in this day and age, making them feel better takes the form of relieving any kind of discomfort RIGHT NOW.  Pain 4/10 here's some dilaudid.  Hint of nausea, zofran.  IV for everybody.  The days of giving you an ODT zofran, a vicodin and letting you drink water are gone.  More complex interventions make the patient happy, the more interventions the higher the level of care, the higher payment for the doctor and the hospital.  There is a money incentive to do excessive testing, over the top treatment.  Thats what our doctor group does these days. I realize that this is the norm in ERs across the country.  Is this kind of care good for the patient?

The other change, the coming of board certified ER docs changed it too.  Having worked in a hospital on call that trains ER docs, I saw the difference from our ER.  The docs separated themselves into their own area, having little interaction with the nurses other than around patient care. There wasn't the collaboration like at my hospital.  Basically the nurses were task monkeys.  They were there to carry out the doctors orders, their opinion wasn't sought out.

So that happened at our hospital too.  The docs and nurses no longer collaborate with each other like we used to.  It has affected patient care.

Then in the last couple of years, anticipating decreased reimbursement, our docs decided to start hiring PAs and went with the pit boss model.  The PAs see all the patients and collaborate with the staff doc.  PAs are a lot cheaper to employ, allowing that profit and salary to be maintained by the docs.

The introduction of the PAs has had a negative impact on our ER.  PAs, at least in our ER, are not collaborators.  They collaberate with the doctor and thats about it.  They have not been receieved well by the nurses, further alienating the relationship between the docs and nurses.  Once again, all of this has affected patient care.  Not in a positive way.

The point of this blog post: As money becomes more and more the center of medicine, the best care for the patient falls by the wayside, replaced by the pursuit of profit.

gimme that damn call light

This is me about five years ago.  What can I say?  I believe that a nurse should look like a
nurse and that includes the hat..