miss thang becomes a nurse

You know what I hate? I hate nurses who think they know everything and act like they are an expert on everything. Those are the people who you have to watch 'cause eventually they are gonna f--- up. Especially in the ER.

I've been in the ER a long time, as we all know. I've seen a lot of stuff. At this point your arm would have to be hangin' by a thread to get me excited. I don't know everything. I know that for a fact. There are things I've never done, things I forgot how to do. When that happens I ask my co-workers. It doesn't bother me a bit that I have to ask somebody else. There is always somebody who knows more than I do.

When you think you know everything you go barreling into situations and might screw it up because you don't want to ask for help. Thats when you end up in trouble. These kind of nurses can make the new nurses feel very small because they often times are critical. They talk about new nurses in a derogatory way.

The other thing I hate is nurses who think that because they work in certain areas such as critical care, they are superior to everyone else. Critical care requires a lot of skill and technical knowledge and can be very stressful. Like I've said before, I even think nurses in those areas should be paid more, but are those nurses superior to other nurses because of that knowledge? Of course not. So stop acting like you are.

I think people with these kind of attitudes are really just insecure. They have doubt about their abilities, but are so afraid they will be exposed, they cover it up with an air of superiority.

Get over yourself. Lack of humility will eventually bite you in the butt.

all nurses are not created equal

Nurses are so funny. We accept so little when it comes to money and benefits. Its like we don't think we deserve more money. We do.

With the increasingly complex technology and medicine that we manage, we deserve a helluva lot more money. Nurses are literally keeping patients alive with technology. We are managing LVADs, CRT (continuous renal dialysis), ECMO (continuous heart bypass), hypothermia procedures post cardiac arrest, among other things. Some of these complex cases require 2:1 nursing care. Technology and medical care will only become more complex. The amount of information we are expected to retain is astounding and almost impossible. That information retention can mean the difference between life or death for your loved one.

I think some nurses deserve more money than others. A controversial statement that. The fact of the matter is, not all nurses are created equal in a hospital. With increasing responsibility and increasingly complex knowledge, should come increasing money. It just makes sense. Thats the way it works in other professions and thats the way it should work in nursing.

Do I want to get rid of unions? Of course not. Without unions, we wouldn't be where we are today. However,I do think that they should start negotiating some kind of clinical ladder into contracts that address this.

There may come a time when nurses are individual contractors. They will be hired to manage complex patients and compensated appropriately. Maybe there will be people who negotiate salaries for different types of nurses.

Nurses are key to the future of medicine. Who else will manage all this complicated care? You might say, well just hire technicians. Technicians don't have the holistic approach that nurses bring. There is a lot more to medical care than knowing how to operate a machine. Along with skills needed to manage complex care, nurses put a human face on that care. We don't let anyone forget that there is a person underneath all those tubes and wires.

Your thoughts?

hospitals doing futile procedures for money?

I've been a nurse a long time. I've been at the hospital where I work a long time. When I started here the hospital was by itself, now it is part of a large corporation like most hospitals.

As it became a larger corporation, it changed. There were moves toward "standardization" and "increased efficiency". I've seen medicine change and become big business. At this point it feels more like a business than a place where people get cared for. I guess thats reality.

As with any business, emphasis is placed where the money is made. Cardiac medicine has become a huge money maker. Cath labs make millions putting in stents. Hospitals are doing more and more sophisticated procedures like putting in LVADS (left ventricular heart device), heart transplants. They are doing CRT (continuous renal replacement therapy). Another technology is called ECMO which, if I understand it, is continuous cardiac bypass to rest the heart. This stuff is becoming like science fiction.

There are nurses who say that these procedures are being done on people who will die anyway, in other words they had no chance to begin with. They think some of it is inappropriate. The thing is it makes a lot of money for the hospital and the cardiologists. I wonder if down the road there will be an investigation of all of this. Profiteering at the expense of realistic patient care.

Hospitals are scrambling to stay afloat. I wonder how many are doing procedures that are questionable in an effort to do that. There are already rumblings about stents being no more effective than drug therapy in prolonging life.

The emphasis in hospital is on the areas that make money. They look like hotels. The rest of the hospital is like the ghetto things shabby and falling apart. How far will all of this technology, and along with it money making, go? It will be interesting to see.

the comment

Something weird happened at work yesterday. Someone said to me, "I think you're such a good nurse". Thanks. No big deal right? Wrong. That comment has stuck with me today. I keep thinking about it.

The emergency room is such a tough environment. Everybody who comes in is having a crisis, in their mind. We might think its stupid, but to them it needed immediate attention. Everybody who comes through the door is stressed. We all know people express that in many different ways. A lot of the time the stress is expressed in a negative way. That negative stuff is often directed toward us. People act out, can get verbally abusive and violent. Not news to any of us.

ER is a place of extremes. On the one end you have somebody who will die if we don't do something. On the other end you somebody stubbed their toe. We see people who are suffering. We see people dealing with really terrible things every day of our life. Sometimes despite our best efforts, people die.

In the middle of this is the ER nurse, trying to make sense of it all, trying to reason out some way of dealing with the extremes. Nurses deal with it in a lot of different ways. Its tough as shit.

Working in the ER, you don't get a lot of flowers, boxes of candy that you do in inpatient areas sometimes. People do thank us all the time, as they go up to a room, are discharged. Its routine. It doesn't really mean much a lot of the time. So when someone takes the time to tell you that they think you are a really good nurse, it sticks with you. You don't hear that much. You want to soak it up like a sponge. You want to take that comment and put it into a box where you can take it out on a bad day.

bearded lady visits ER

This is the kind of week it has been:

One of my female patients actually had a beard. It wasn't really a beard, more long hair on the chin. I am not just talking a couple of hairs...there was enough there to form a chin beard.

Another guy had on shorts so short that it looked like he had nothing on under his teeshirt. Now we get some chicks like this, but men?

A gang banger who was high and had been drinking and was in a fight, wanted me to hold his hand and I said no. According to our management that probably makes me a bad nurse....so be it.

Then there was out of town peed pants person with the mommy calling from another state (see previous post).

I may not have seemed "engaged" in patient care. I may have been "rude or short" this week. So sue me...