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Friday, September 27, 2013

how to make nurses happy 101

Its a friday night rerun...

How to make nurses happy 101


1) Eliminate rotating shifts.  There is no reason for rotating shifts.  Pay people more money and benefits to work straight off shits.

2) Make sure that nurses get their lunch break and other breaks.  This is not that difficult. It is required by law.  Insist nurses take their breaks.  Everyone needs a break, espescially from this stressful job.

3)  Make it policy that nurses have control over their practice.  If something is going to affect nurses talk to them about their opinion about it.  Nurses are not unwilling to accomodate change, they just want to have a say in it.  They will no doubt have some great ideas.  Eliminate bullshit committees that do nothing.

4) If healthcare is a business, bring in people with business degress at the middle management level.  People who have been to school in how to MANAGE people, hold people accountable.  Promoting nurses to management posiitons, without a business background is a mistake, in my opinion.  They make awful managers. 

5)  Put policies in place that make verbal and physical abuse by patients unacceptable.  Take this so seriously, that the patient who has been medically cleared or is stable is either discharged or transferred to another facility.

6) Put policies in place that are serious about unacceptable behavior  by doctors (or anyone else for that matter). Fire them if it doesn't change.

7) Here's a controversial one: eliminate 10 and 12 hour shifts.  No one should work that long in such a stressful job.  It is unsafe.

8) Pay people with more skills and more responsiblity such as those in critical care more money.  It makes common sense.

9) Allow nurses to take an LOAs, say every five years, for a short time to rest body and soul if they choose to.

10) Pay monetary incentives to nurses around defineable goals. Managers and administrators are not the only people who should get money for achieving goals.

Any thoughts?

Thursday, September 26, 2013

"my tummy hurts"

Some days I can't take another person coming up to the triage desk with their sad tale of woe.  I have had it.  I don't want to hear about your problems anymore. Go away.  Hey, I got an idea, go outside, its a nice day. Sit in the sun for half an hour. Better yet, go have a hot fudge sundae.  It will do you a helluva lot more good than coming in here, having all this shit done and then, guess what, wait for it, WAIT FOR IT, there is nothing wrong with you.  What a shock to everyone.

I've decided that I am going to start doing a lot more quoting patients in my notes.  Mostly for my own amusement.  Patient states that their "meds were stolen by their 2nd cousin, twice removed".   Patient states that their "tummy hurts when I am hungry.  Pain goes away when I eat".  "Patient states that due to back pain, they are unable to get to the bathroom to take a crap".  Etc etc etc  You get the idea..

The ER is a cesspool of dysfunction.  I like that....cesspool of dysfunction...yeah.

Tuesday, September 24, 2013

nurse report is obsolete

"Calling report" is an antiquated dumb nursing thing.  I mean seriously we have ELECTRONIC MEDICAL RECORDS that we all have access to.  Everything that happened in the ER is on that record for you to peruse at your leisure in the 2 hours it takes the charge nurse to approve the bed. Why do I have to repeat all this shit? Why? B
ecause nurses can't let go of dumb stuff.

Calling report is, shall we say, an "interesting" experience.  I would put the nurses into 3 categories when you call report:

SHORT, SWEET SALLY:  We love these kind of nurses.  They usually have already looked at the chart, listen to our dumb calling report performance and say: OK, room so and so.  No questions, just send them up.

NEW GRADUATE GEMMA: OMG...this person acts like they have never heard of an electronic record.  They ask questions that should be obvious to any half way intelligent human being. Nursing 101 stuff.  I don't know if granny had a bowel movement today, considering she is agitated as shit, it never came up.

SUPERIOR NURSE SAMANTHA:  This nurse thinks that anyone who does not work in her area is an idiot.  They are the kind of nurse that will ask you if you checked the pedal pulses on a head bleed.  Then they will condescendingly say: "You didn't, okkkaaay..." It always feel like you are taking a test with these people and you will never pass.

Report  = stupid.  One thing about report though, its allows the station to delay getting the patient.  The nurse is busy because:

they are at break
they are in an isolation room
they just got a post op
there is an emergency on the station (love that one - apparently everyone is involved)
etc etc etc

Often times you are transferred person to person to person in an attempt to "find" the nurse. You are placed on eternal hold.  You are hung up on.

The whole thing is ridiculous and a waste of time.

Sunday, September 22, 2013

the see, I'm so sick they put an IV in me ORDER SET

It took me years to realize this.  It hit me the other day.  ER docs, NPs, PAs have a DEFAULT ORDER SET. 

What is a DEFAULT ORDER SET?

Here it is: 

CBC
Lytes
Troponin
UA
CXR
EKG
Normal saline 1000 cc bolus

This set of orders can be justified for many, many complaints.  From tummy ache to chest pain to weakness to dizziness.  Labs are basic.  Pretty much any woman who comes to ER gets a UA and those who are of childbearing age always get a UPT.   Any pain from groin to the neck could justify a EKG and CXR.  As far as fluids, everybody could use a liter of fluid.  It makes the patient think you are really doing something.  It justifies, in their mind, that they should have come in:  See,,,I'm so sick they gave me an IV. 

If any of the tests come back positive: NIRVANA!  More tests...yea!  Ever wonder why you wait for hours in the lobby, this is part of the reason. 

Friday, September 20, 2013

that's what I get for being nice

So I'm sitting at the triage desk.  A guy comes up and says that he works in a martial arts place/boxing place in he neighborhood.  He doesn't want to be seen.  He just wants to weigh one of the boxers, apparently they don't have a scale.  So...okay fine...no big deal.  We have a scale in triage.

So he brings the guy in...and the guys proceeds to take off his pants down to his boxers and gets on the scale. Now mind you, both triage bays are full..there are people at the window.  WTF?

Was I
punked?  Thats what I get for being nice...

Moral of the story: Never be nice in triage.  It will bite you.