Tuesday, April 8, 2014

Numbers Game

Statistics explained.  Best pie chart ever
I had racked up a some unimpressive stats one day and shared my concerns with the coordinator.

"Not happy with these statistics.  25% of my patients went to the OR,  25% left without being seen, 25% died, and 25% survived my nursing care and went home.  I need to take all the patients for the rest of the night to improve my numbers".  I had seen a total of four patients.

Coordinator: "Let's just take a page out of the "Hospital Administrator's Guide to Skewing Statistics" and see if we can make it all better.  We'll start off with an easy one.  How many IV's sticks were successful?"

Me: "100%".  I had done one all day.

Coordinator: "Good.  And how many codes did you have all day?"

Me: "None.  My patient who died was a DNR"

Coordinator: "And how many patients who were NOT a DNR died?"

Me: "None"

Coordinator:  "So, 100% of your DNR patients were appropriately allowed to die with dignity according to their wishes.  That's excellent.  And 100% of your non-DNR patients are alive and well, either saved in the OR, home to their family, or taking their 4 year old to buy another pack of cigarettes and a six pack".

Me: "I like this game".

Coordinator:  "I know, right?  So now, what percentage of your patients who left without being seen are likely to receive a survey and complain about having to wait 29 minutes while you did end of life care?"

Me: "Um, none.  I didn't give her one"

Coordinator: "Strong work. Of the 25% of your patients who left without being seen, how many had no legitimate need to be seen today in the ER?"

Me: "100%",  I said, feeling  proud of myself.

Coordinator: "See, it's not nearly as bad as you thought.  Everything is all sunshine and Skittle-pooping unicorns, right?"

Me: "Yep.  Taste the rainbow"

Coordinator: "Ok, so will you take the 24 hour position now?"

Me: "No"

Coordinator: "I thought you were looking for hours?"

Me: "Looking, possibly.  But not aggressively.  I mean,  I'm not willing to hunt them down and kill them"



Thursday, March 27, 2014

A Good Day is...

….defined by the following:

The guy who scampered with the IV got boomeranged by police less than one block from the hospital

Only one drug seeking chick left AMA because she wasn't getting what she wanted, namely the narcotics the she felt she needed and deserved

I didn't kill anyone.

Good day indeed.

Tuesday, March 25, 2014

Welcome...

….to your new BWOM locker!

  As you can see, the previous occupant has meticulously maintained it.  Unless these are gifts.
Inventory includes some journal articles, a jar of peanut butter, and a bra.  

Seriously??

Wednesday, March 12, 2014

So Long…..

….since I have posted anything especially interesting.  I'm been a busy girl.  Did you think I was pulling the plug?  Nah.

I have a job, a per-diem at Bear Went Over the Mountain (BWOM) hospital.  Back to the grind of actual balls to the wall ER nursing,  at my age who knows how long that will last.  Urgent Care, which sounded boring a few months ago, might have attained some level of appeal.  I mean really….a steady diet of overdoses and high level drama?  Not so sure anymore.  Plus the pay sucks.

Not that I am ungrateful, far from it.  My new boss hates my old employer more than I do and was highly motivated to hire as many "quality people" from the Scary Hospital employee purge, AKA "transition",  that she could.  She is well aware of the unique nature of what the nurses at my former job dealt with on a daily basis and was anxious to have me on board.  Or so she said.  The people are all nice, it's a friendly place but very busy.

It has been few years since I have had to go through the process of applying, interviewing, and being hired for a nursing job.  Let me tell you it has changed.

I filled out more paperwork than was necessary to get a home mortgage.  As a first-time home-buyer.  With hardly any down payment.

I was treated to the complimentary drug screen.  I signed a form, provided multiple forms of ID, initialed the sample, and politely asked if any of the physician hires were also subjected to mandatory drug screening.  I was assured that they were.  Just curious.  I was reminded of a conversation I had with The Pirate a while back on this very issue in which he revealed that he refused a position at a hospital that drug tested physicians.  Don't worry, man, be happy.

I spent four mind-numbing, eye-poking (with hot steel needles), 10th Level of Hell excruciatingly boring days in orientation, not the 2 days of general hospital (and one of nursing specific orientation but not unit specific) which could have been accomplished with far greater efficiency.  Unprepared speakers who relied too heavily on technology they didn't understand, IT and log-in problems, someone who brought a Mac to a PC party…on and on and on.  The self-aggrandizement of middle management and the touting of the wonderfulness of BWOM hospital and all of its splendor was expected but ohhhhhhhh so redundant.  Don't get me started on the 30 minute video I had to watch to use a glucometer.  One presenter who claimed to be a marketing person divulged that his position was actually "special marketing"; he only handled the high roller donations that amounted to about a bazillion dollars per year.  Really.  A bazillion dollars per year in endowments, of course, because the nurses don't work like dogs, don't do everything, have plenty of support and are not paid a good 10 bucks an hour less than my last crappy-paying job.  I was gob-smacked.

I spent two days following 2 different nurses in the ER.  Finally, having not remotely been given an opportunity to practice with their ridiculous IV catheters I called the nursing education person and bullied her into giving me 2 hours of her time in the lab.  About an hour of which was spent in her recitation of how her experience as an infusion nurse and critical care experience from 14 years ago uniquely qualified her to do her job.  She could not answer most of my questions, so I just gave up.  At least the IV pumps were exactly the same as my previous employment, so that was good.

My first day off the leash (without preceptor after six painful 12 hour shifts) started with a code within the first 10 minutes.  OK, no problem.  I had forgotten what it was like to have people standing around waiting for an ambulance, 5 extra people to do CPR and mix meds and stuff, and one with a stopwatch to yell out how long it had been since the last Epi.  Oh, and respiratory therapy.  Plus a morgue to send the deceased instead of merely putting him in the coldest room until the organ bank stopped sipping their lattes long enough to give us a call.

It's been a couple of months, I still have lots of questions about day to day stuff, but I've got the hang of it.  ER nursing is ER nursing.  They don't get a ton of traumas, STEMI's are pack and go no differently than I am used to.  It is a pretty ancient community and in close proximity to a "rehab" facility so we get a lot of their patients.  Most of the elderly assisted living patients come with a baby sitter from their facility to keep them company so that is kind of nice.  But there isn't a lot of per-diem time available, this month I was only assigned to 3 shifts (in one week, two of which the nurse took back because she had cancelled her elective surgery).  But they call me at least 3 or 4 times per week and individuals ask me pick up time for them.  I feel like I can pick and choose, and I'm not doing 12 hour shifts since you never, EVER get out on time there.  Their EMR is really, truly the most cumbersome I have ever used.  It surpasses SCPED (Shittiest Computer Program Ever Devised) in so many ways, mind-boggling to the extreme and beyond imagination largely related to how ER CHARGES are captured.  I'm sure I miss a lot of charges because I'm more interested in how I document those silly, unimportant things like medications and IV's, patient assessments, and irrelevant nursing crap like patient teaching.

BWOM Hospital you REALLY don't pay me enough money to care if I'm missing charges.  Have your marketing specialist go trolling for a few more million, I'm sure he's getting paid six figures.