Monday, September 8, 2014

A Puzzle for You

License plate seen in a hospital parking lot:

2MLX3

Thoughts?


Friday, September 5, 2014

Cat and Mouse, 2.3, or, I Hate Those Meeces to Pieces

If you have read any of my previous postings on  mice,  mice, and more mice, you may have gotten the impression that I don't mind them.  Seriously, I hate mice.  They are just so….rodent-y.  Filthy. Gag.  It is one thing to have them in the work place, but at home…..nope.  I was understandably VERY disturbed when I found mouse turd under my kitchen sink last week, having discovered that my packet of dishwasher gel packs was nibbled at the bottom.

"The dog got it",  Mr. Ednurseasauras told me.  "Two months ago".  As if it could ever be just a single mouse.

But, I bought it.  I don't do a lot of machine dish washing, probably only one load per week so it was possible that the packet had been nibbled months ago.  I put on two pairs of rubber gloves (which I threw out) and spent a morning clearing up and organizing the assorted cleaning clutter, vacuumed, bleached and decontaminated the entire area.  Then searched for further sign of the little f*ckers and cleaned every cabinet.  Having had enough mini drama for the day,  I washed my hair and puked.

There was no sign of additional rodents until yesterday when I FOUND MORE MOUSE TURD under the sink.

I have both a cat and a dog who have faithfully alerted me to the presence of mice in the past.  They have each caught a couple, and have even collaborated with mouse hunting/ slaying in the past.  The cat once left a mouse head on the kitchen floor to rebuke us for leaving her for the weekend, but the dog also impressive stats.  There was, however, no alert the time.

"You guys have failed", I berated them. Neither had the good grace to look ashamed.  The cat yawned, the dog licked herself.  Rude.

"We need to set traps", I announced to Himself.

Mr. Ednursesauras discussed the merits of various kinds of mouse-killing apparatus which we have collected and deployed, but never caught a thing.  We had some where they could wander in, but not out.  And some that are pads the rodent-y little feet stick to.  And of course the classic mouse trap-mouse traps, which are hazardous to human fingers.  Letting mice go is the same as leaving our borders unsecured, they just get back in.  Also, since our experience last spring with the beavers that resulted in the flooding of our property that we had just put on the market, I'm out for  invasive species annihilation.  My only rule is that I am not removing the carcass.  Nope.  Not looking at it.  NOT touching it.  Nope.

I do bees.  Hornets.  Yellow jackets.  I don't mind snakes.  I even had to clean up after a duck had gotten into our family lake house and died, and you can imagine the mess that made.  I have a lifetime of experience with body fluids,  both man and beast.  I think I am entitled to draw the line at dead mice.  Oh, and spiders.  I won't do spiders.

I baited the trap with a dab of almond butter and a small piece of 9-grain cracker believing that I would, a usual, not catch a thing.  I had the pest control service on speed dial and anticipated calling in the morning.

Two hours later I heard a rattling.  Shocking.

Dog: 0, Cat: 0, Human: 1.  Number of dead mice in the trap: 1

Mr. Ednurseasauras put on an old pair of work gloves and disposed of it.  I suggested he put in on our nosey neighbor's mailbox, but he wisely declined.

"Well.  That's that".

With the bait intact, the trap was returned to duty under the sink, Mr. Ednurseasuaras convinced that was the end of the problem.  Forty minutes later, I alerted him that there was a companion  dead mouse called to Final Accounting.

"What!?  How do you know that?  The dog hasn't moved".

I could hear it. Above the sound of the TV, my computer, and the air conditioner.   Call me crazy.

"Wow, you picked good bait", Mr. Ednurseasauras commented.

"Why, what did you use last time you tried this?", I asked.

"Provolone cheese".

NOW the dog was interested.

Today I cleaned under the sink, vacuumed, bleached, and disposed of another pair of Playtex Living Gloves.  Then washed my hair and puked again.

The dog has been at her post.



Tonight we hunt again…..
Stay tuned.








Thursday, September 4, 2014

Order Up

It still astounds me that the single most important need (aside from narcotics) for individuals in the ER is a meal tray.  I have come to hate the hours between 4:30 and 6:30 PM.  There is no room service available in the ER, unless the patient is a boarder (psych patients who have been there for days, usually).    People are like rabid dogs when it comes to food, "My mother hasn't had a thing to eat all day!!", like it's my fault that mother hasn't wanted to eat, been vomiting, or has been lying around too weak to eat for the weekend because you went away.

Here is a handy guide as to why food is not on my immediate list of important tasks:

1.  If you have come to the emergency room for abdominal pain, nausea, vomiting, or bleeding out the ass, we are not feeding you.

2.  If your blood pressure is 250/120, and I am trying to lower it by giving various medications, we are still not feeding you.

3.  If you come in with chest pain, we are not feeding you until you are seen by cardiology, which is after an EKG and many hours.  Don't ask.

4.  If you eagerly drink both quarts of the oral contrast (berry or vanilla flavored) for your abdominal CT and declare that it was delicious and hit the spot because you were so hungry, I am not feeding you anything else.

In case you are wondering what kinds of delicious treats and culinary magic we are able to whip up after the real kitchen closes, here is a short list of items we keep in our  ER"s "kitchen".

Apple juice, cranberry juice, orange juice, milk
Gingerale (regular and diet)
Graham crackers
Saltines
Fruit cup
Custard
Peanut butter (individual servings)
Sandwiches (4 each: turkey, veggie, roast beef, ham and cheese)
Popsicles

At BWOM and the med center we had Lorna Doone's and Oreo's, which the nurses mostly ate.  And REAL Coca-Cola.  But not at Pseudocity.

Our refrigerator at Pseudocity is locked, by which I mean both the freezer and refrigerator.  Padlocked.  In order to unlock it, you must reach behind the fridge and find a magnet to unlock the cracker cabinet, then retrieve one of the keys to the padlocks for the fridge.  The ginger ale is under the counter.  It is unlocked.

It takes more concentrated effort to unlock food than narcotics, and takes twice as long.  On the off-shifts when the kitchen is closed, the real food goes quickly in spite of large signs that says "Do not give out sandwiches before 6:30 PM!!".   So does any motivation to make a meal out of crackers and peanut butter for the most part.

We don't have any soup or broth for grandma, or ovaltine or hot chocolate.  We don't even have tea.  And the coffee is just….horrific.

I am not going to feed your children.  The cafeteria is that way.  If it is closed, there are vending machines in the lobby with an array of delicious cereal, flash frozen hamburgers that just need microwaving, and candy.  And Mac's is down the street.


Wednesday, September 3, 2014

Reflection, Starting Over

I came across this post from a couple of years ago:

For years and years I worked at least two and often three jobs at the same time, but at at least one was always in the ER. I have had lots of different experiences.  I've worked in schools, as a camp nurse, in home care, employee health, a travel clinic, a same day surgery unit, pediatrics, telemetry, and med surg.  I have worked in large medical centers and community hospitals.  I been a staff nurse, charge nurse, supervisor, director.  I have done independent QA audits, worked for an agency. I have worked days, evenings, nights, weekends and holidays.  I have worked from within walking distance to my job or traveled over and hour.  I have worked with individuals who have become lifelong friends and others whose names I can't remember.  I have been both student and a teacher.  Sometimes I have felt unsure of myself and terrified, but have grown enough as a nurse to feel comfortable and competent, smart enough to know that I don't know everything.  I have done a lot, seen a lot, learned a lot.

I  have been restless and not altogether happy with my job lately.  For the last 3 years, it has been my only job.  It is close to home and I work with a small group of nice, accommodating people in a small ER.

I have been thinking that maybe it is too small.  I feel as though I am losing my skills as an ER nurse.  Few codes, trauma as rare as hen's teeth.  I am SO TIRED of the constant parade of drug seekers and the pressure to just make everyone happy, even if what they want isn't what they need.  Want antibiotics for a virus?  Sure!  An Xray for your three week old ankle injury that you insist must be broken?  No problem!  Dilaudid for your migraine of 10 minutes?  Absolutely!  Why do you need doctors with experience and expertise when you have WebMD?  All we ask in return is positive customer satisfaction scores.

I have never felt less valued as a professional nurse anywhere.  It's not my boss, she's great. It's the organization we work for.  Our director talks a good game, but there is no visible support for the activities of nursing.  There is a part-time research nurse, nobody really knows what she does and I have never seen her.  Committees?  The same dull people with the same dull ideas. 

I have a really crappy attitude and no real goals since finishing school.  For the first time in a long time I have no concrete plans to move on, move up, or move out.  Maybe it is because I am working only one job in a small town, I don't know.  I am in a real rut.  I have to work about 10 more years until I can retire and that pisses me off.  I can't see myself doing what I'm doing for another 10 years.

I keep telling myself I am lucky to have a job.

And then I didn't have a job two years later.  Serves me right for being too comfortable and complacent.    While I didn't exactly lose my skills, many of them were seriously misplaced and difficult to regain.

The funny thing is, if I hadn't been forced to find a new job (actually, three new jobs)  I would still be in the same rut.  But…it has not been a seamless transition.  I have had to learn, and re-learn, a lot.  I finally broke down and bought a couple of sets of new scrubs.  Yes they are black and grey, but color blocked and not cutesy.  OK, I drank the Kool-Aid of my fashion forward co-workers, but just a little sip.  Anyway, the unit teacher noticed my new and smaller sized duds and said I looked like I had lost a lot of weight and wanted to know how I was doing it.  "Oh, you know….stress and not eating", I joked.  But I really wasn't.  It isn't the people, it is the environment and my own need to do everything flawlessly.  Of course, that is near to impossible.

She had some helpful thoughts about not being too hard on myself.  "It takes about a year for a nurse to get completely comfortable in this busy environment, I think you're doing great".  I have a lot of trouble reporting off to the next nurse sometimes, especially if I don't feel like I've done everything.  I never want to be "that nurse" who walks off the floor in the middle of a shitstorm….can't do it.

But I get more comfortable every day.  And I still tell myself I'm lucky to have a job.


Thursday, August 21, 2014

A-Z

Check out and enjoy Aesop's Nursing Primer in it's entirety.

I particularly enjoyed the letter Z

video

You're welcome.




Friday, August 15, 2014

Playing Nicely With Others

I try to be nice and pleasant to everyone, until it's time not to be.  One of my young co-workers has a tendency to rail (volubly) when there seems to be an over-abundance of career drug seekers in the department.  This makes her furious.  I keep my mouth shut and vent my frustrations in obscurity.  There is nothing I can do about it anyway, so I direct my energy elsewhere.

"She will get into trouble with that mouth, one of these days", observed another co-worker.  She has a tendency to mouth off in areas where patients and visitors can hear.  She has not yet learned that there is absolutely nothing she can do about it.

Most of the time patients are told by the provider that they can take tylenol or motrin for their pain.  The provider will then leave it up to the nurse to get the signature on the discharge instructions, whereupon the patient will be pissed and continue to argue for narcotics.  It is not so much education oriented as it is getting through the instructions, getting them to sign, and having them leave.  With a minimum of bullshit.  This is not always the case.

Me: "I have your instructions and will go over them with you now".  The alleged injury was minimal.

Unhappy Patient: "So all I'm getting is Motrin?  I explained how bad my pain was, this is bullshit".  The patient had not iced, elevated, or taken OTC pain killer in several days.

Me: "Yes, I'm sorry you are not happy with the medication the doctor has prescribed.  Perhaps if you use it the suggested three times per day as directed, and be sure to take it with some food so it won't irritate your stomach"

UP: "Motrin is not a medication!  I've been taking motrin, it does absolutely nothing for the pain, this is bullshit.  There has to be something really wrong for it to be this painful".  Patients frequently forget the timeline of their own fiction.

Me: "Yes, I understand.  Also, in addition to the Motrin, you should rest it as much as possible and use ice on it 20 minutes at a time.  Elevating will help minimize or relieve any swelling, which will also facilitate healing"

UP: (getting louder) "This was a waste of time!  Nobody cares about my pain!  This is bullshit".  The security guard now makes his presence known in a casual manner, but an obvious presence nevertheless.  

Me: "Yes, I'm sorry you were not happy with the care, sir.  Please follow up with your own provider if the condition does not improve or gets worse after following these instructions.  Also, please lower your voice as we have a zero tolerance policy on shouting and cursing.  I hope you feel better soon.  Please sign here, and this is your copy"

I do not encourage too much discussion.  What is the point?  I do not egg them on.  I do encourage them to complain about their dissatisfaction (in writing) to my boss/administrator/CEO.  I stay pleasant and noncommittal. My co-worker frequently makes the mistake of either being defensive or confrontational.  This is not a practice that is healthy for anyone.

Often the patient will refuse to sign, frequently accompanied by:

1.  Throwing the discharge instructions on the floor and stomping out of the department on the affected, excruciatingly painful ankle.

2.  Stomping out of the department after throwing the discharge instructions on the floor, and then stomping back in to demand the name of the treating provider, which was printed on the instructions.  I helpfully circled it after retrieving from the trash.

3.  Storming out of the department while loudly complaining on the cellphone what bullshit the patient had been subjected to (with the excruciatingly painful elbow) and then having to return to ask for the phone charger he left in the room.

One patient demanded both a new doctor AND an new nurse, as she did not consider the bedside manner up to her standards based on her past innumerable visits.    That nurse was not my mouthy co-worker, oddly enough.








Wednesday, August 13, 2014

Keeping Count

I had inexplicably become the week's IV Ninja, having been asked to start a number of difficult ones.  Apparently I am more accommodating than Best Paramedic on the Planet who always seems to have 5 (minimum) other tasks to accomplish before he can get to it.  I have learned to trade tasks, such as requesting vital signs or medication for one of my patients.  This usually works well.

I came out of the 3rd room within 45 minutes after my latest success to, "Did you get it?  Did you get the labs?" Yes, and yes.

"But I think that's it", I said.  "I am probably out of Hail Mary's for the day, maybe even the week."

"Indeed", said Partner sagely.  "Like heartbeats, there are only a finite number of miraculous IV starts.  You never know when it will be your last, grasshopper".

True.  Karma is a bitch.

Monday, July 28, 2014

Space Available

I work with a few of the docs who had moved on from the Bait Shoppe but remembered many of my coworkers fondly.  They do not remember Bobo fondly, thinking him as much of a tool as I do.

Rocket Scientist is a doc I always enjoyed working with, and he enthusiastically welcomed me back on my first day.  We don't get much chat time because it is just too darned busy, but he exuberantly waved to me when I arrived the other day.

Rocket: "Hey EDnurseasauras!  I got a call from Bobo to expect a patient!  What exactly can they do at the Bait Shoppe now?"

Me: "Not much.  A little point of care testing.  No labs, so they don't usually send patients with IV access unless they send 'em by ambulance.  And no more pesky transfer forms"

Rocket: "So it's more like an office practice without bells and whistles?"

Me:  "No bells.  No whistles.  No narcotics."

Rocket: "Seems kind of a waste".

Heh.


Sunday, July 27, 2014

Walk...Don't Walk

I worked a fun-filled shift in the urgent care pod.

It is an interesting place, 2 providers, 2 nurses, a secretary, registration clerks, and our very own LNA.  it was kind of like the med center when it was an ER, except with more help.  And a CT scan for all the abdominal  pain work-ups.  At one point I had 4 people out of 12 drinking the contrast.

Sometimes you can get pretty sick people depending on the acuity of the department as a whole.  Sicker patients overall means sicker patients in urgent care, that's the trickle down effect.

But we still get a steady stream of boo-boo's, hoppers and limpers, head bangs, kids with fever, and the Holy Trinity of Chronic Pain complaints (back pain, migraine, toothache).  And career drug seekers.

Partner assisted someone to the door and watched a couple stroll down the street and across the parking lot.  She intuited that they would be seen in our ER.  She guessed for back pain.  Correctly.

Thus she observed the reverse miracle.  An upright patient, walking with a spring in his step, became a bent-over, shuffling, moaning, miserable piece of humanity before her eyes.

I've seen lots of miracles.  In fact the med center had some lovely shrubbery that we called "Lourdes".  We would frequently find crutches, slings, air casts etc in those bushes.  Miraculous.


Saturday, July 26, 2014

Call Me….Maybe

Got into a minor MVC, sideswiped by a guy in a pickup at 60 MPH.  No injuries, thankfully, but I  did lose my passenger side mirror along with scuff marks all along the right side of my 2 year old vehicle.  Sigh.  Of course it could not be my 10 year old SUV that got banged up, right?  We both drove home to deal with the insurance.

With multiple phone calls expected, I tried to make it clear that could not take personal phone calls at work.

Insurance Lady:  "What?  No personal calls at work, how perfectly awful!  You must works for a real slave driver!"

No, not really.  But it is frowned upon to answer your cell phone during a cardiac arrest.  People who work in offices just don't seem to get that.



Friday, July 25, 2014

Your'e Soaking in It

At Pseudocity we nurses work in pods.  We share rooms and general work areas,  and are given about 3-4 patients to care for (not including hallway beds which increases individual patient load).  It is meant to cut down on confusion and running around in general.  Some pods are more acute by nature because there are two critical rooms.  It is also a way to prevent one nurse from having, say, 4 chest pains, or 4-5 psych holds, or 3 or for vag bleeds at a  time.  Of course they try, but there is never any way to make all the assignments absolutely equal.  Some days you're the dog, some days the hydrant.

My pod mate and I had somehow gotten 3 of the nastiest  drunken frequently flyers. Their collective blood alcohol numbers equaled the national debt.

My change of shift assessment included the notation that my patient was pissing between the side rails onto  the floor.  And asking for a sandwich, and a change of socks whilst insincerely apologizing for pissing on the floor.

My partner found her personal drunk, who had spent the previous night and was discharged just 5 hours previously, standing at the sink.  Pissing.  And missing it badly.

"Um, you know, sir, people have to wash their hands in that.  Not cool.  And no, you are not getting any pain medication", said my partner.  

You would think that individuals who have had the equipment their entire lives would better be able to operate it, even while intoxicated.  Just saying.

Number 3 drunk, whom we shared because he was particularly nasty, insisted on a commode to piss in.    He actually managed to get some in it, but also took a monstrous dookie and used the  pillow case to clean himself up.

Me: "Hi, housekeeping?  I have 3 rooms that need to be cleaned.  Actually, they are flooded…..no, with urine…..do you have boots?  I'm thinking a firehouse would be good"

Note: I burned my shoes and scrubs in the driveway and took a shower with the backyard hose.  Needed new clogs anyway.







Thursday, July 24, 2014

OK, So It's New to ME

I learned a new word today: incarceritis.  It's been around for some time, I'm told.  Guess I have just lived under a rock.

I heard it from the officer who brought in the individual from the courthouse after allegedly having  a seizure immediately following his sentencing (note:  I never want to know their offenses.  Besides, it just isn't relevant.  All I need to know is "violent", "grabby", or "just do what you need to do from the doorway").  

I try not to be judgmental but, when all the officers and EMS people tell me that is a stone-cold case of incarceritis before the patient even hits the room, it can be difficult.  Shaky Dude was rolled by (in shackles) and placed in a hallway bed.  My partner eyed this dramatic scene over the top of her ever-present half-glasses as she sipped her coffee.    "Incarceritis", she said knowingly.  She is rarely impressed by the antics of the general population.

Paramedic Pete:  "He wouldn't let me do vital signs, wouldn't let me do a fingerstick glucose because he didn't want me to cause him any pain, ditto on the IV.  Couldn't get any history, allergies, or med history"

Why?

Paramedic Pete: "He has been shaking the side rails, whipping his head back and forth, and faking a seizure, while also telling me he couldn't talk to me right now because he is having….a seizure".

Officer: "Yep.  A clear cut case of incarceritis if ever I saw one"

Alrighty, then.

My triage note included the patients first words to me, upon asking him what happened today

Shaky: "I need to make a phone call"

Me: "Not my decision to make, sir, this gentleman with the badge is the boss of your extra-medical activities this evening.  He says no phone calls until you get to the jail".

Eventually the doc saw him and suggested the complimentary head CT for aberrant behavior along with the usual assortment of lab tests for various medical maladies (and the presence of drugs in his system), whereupon Shaky stopped shaking and became perfectly lucid.  "Nope, I don't want any of that.  I'm fine.  I need to make a phone call, just let me make a fu*king phone call!"

Doc: "No sir, the officer has said you can do that when you get to where you are going.  Are you refusing any treatment or diagnostic testing that I have determined is  necessary for your seizure-like activity?  Because if so I will have you sign out Against Medical Advice"

Bye.  Incarceritis.  Use it in a sentence today.






Monday, July 21, 2014

This Post Brought to You By the Letters : A, B, C….

It's been my week for unhappy patients.  I collect them like dust.   Would that we could devise our own survey for difficult patients, wouldn't THAT be a hoot.

Some people just hit the door itching for a fight, pre-programmed to have some kind of issue. These individuals quite frequently come with potty mouth, bad manners, and a lack of patience in general.    They are disrespectful of staff and other patients.  Maybe it is defensive, based on a past experience or just having  a bad day in general.  I get it,  for many people it is literally the worst day of their life.

Or maybe they are just an entitled A-hole.

Regarding the Worst Day people, I give them a lot of slack and take it in stride.  As for the others, not so much.

A-holes seem to have a lot of similar characteristics, many of which, interestingly enough, begin with the letter A.  The Big A.  Which is just the beginning of the alphabet.

Some lead off with a clearly defined AGENDA, and  are often ARGUMENTATIVE.
They know exactly what they want, even if it is ABSURD.

 Some have lots of ALLERGIES.
 Usually to NSAIDS or every narcotic except Dilaudid.

Often they ANTICIPATE a fight for what they want specifically, and use words like "horrible bedside manner", "letter to administration", and "calling my lawyer" when they don't get it.

Lots of patients become a strong  ADVOCATE for their pre-determined diagnosis and treatment plan, no matter how bad an idea it might be.  It has all been spelled out for them thanks to Dr. Google (note:  I am not talking about informed patients who have done some research.  Calm down.).  They simply need a provider to write for their desired antibiotics or a therapeutic X-ray.  Some sign in to the ER with the complaint,  "Need an MRI".  They do not get one.  Hilarity ensues.

ALIBI  is not a reason to come to the ER, but it happens a lot.  Roommate stole your Adderall?  Need a prescription refill?  Need documentation for missing a court date?  Too busy to wait for a PCP appointment for rash cream?  C'mon down.

Rarely, after using foul language and creating a hostile atmosphere which does not produce the desired outcome, there will come an APOLOGY for their bad behavior.  Not often.

Moving on, I present my top selections of the letters B-E.

Talking smack and BADMOUTHING about previous providers who did them wrong, be it in the community, another hospital,  may have fired them for being an A- hole, or not helping them just because they broke their pain contract.   Also they may refer to the last nurse who started an IV on their track-mark tattooed arms "that bitch that stuck me 11 times".  

CUSSING:  Uses the F bomb a lot.  Complains about "the wait is f*cking ridiculous, my f*cking pain is f*ing out of control, this place is bulls*it".  They don't "f*ing care if it's busy" or if people in the next room are trying to die.

DEMANDING, DILAUDID, DISRESPECTFUL, DRAMA:  The first two self explanatory.  Some examples of DRAMA?  Sighing loudly.  Moaning loudly.  Banging the sides of the bed.  Yelling out to the nurses every two minutes.  Throwing themselves around on the bed.  Whining, lots of that.

EXPLANATIONS, in which the patient is intent on convincing everyone that their particular problem is an original complaint, never before thought of in the history of scamming for narcotics.  The pain scale does not apply to them, and usually it is 11 or more.

FAKE CRYING: See DRAMA.  I need to see actual tears.  Sorry.

I could move on to the rest of the alphabet, but….nah.




Friday, June 20, 2014

…and then there were three.

Jobs.  I have 3 jobs.  I was hired back at Pseudo City, a job with plenty of action.  And help.  Lots of help.  I had forgotten what it was like to have transport techs, LNA's, and paramedics to work with.  Not to mention lab techs, EKG techs and, joy of joys, an actual pharmacist to do the med reconciliation on the admissions.  Bliss.  Busy, of course, being 3 times the size of BWOM Hospital and 6 times more beds than Scary Hospital's Bait Shoppe when it was an ER.

I was welcomed back by my old nemesis, Dr. Dewshe Bagghe.  He lifted an eyebrow and patted me on the shoulder.  "You're back?"he said wryly.

"I missed you terribly Dr. Bagghe" I said sweetly.

"Well, (he grumbled). Welcome back".

Of course, each new job requires an excruciating orientation.  Oh, the pain.

And because I am a glutton for punishment I was also hired back at the Bait Shoppe turned urgent care.  My severance ran out sometime in February or March, but my former co-worker who is wearing the boss hat  is now on-site supervisor and begged me to reapply so I could do some per-diem.  I really just wanted to tell them to stuff it and that was, in fact, my plan.  I figured they would low-ball me on the money but was shocked out of my clogs when my offer letter was for money than I was making, plus the raise I would have gotten had I remained another 25 days.  At $10 more an hour than BWOM I couldn't say no.  I did make it clear that I would not be working 12 hour shifts.  It's right around the corner from my house, easy money.

Except for the excruciating one day orientation even though I had only been gone for a few months.  I have had co-workers who were out on medical leave for longer than that.  So I had to spend a day sitting through useless shite.  The upside was that we were given a pass for the entire day to both the cafeteria and coffee shop to get whatever we wanted for our MANY breaks, as well as a $5 gift certificate to spend at the gift shop, which I rapidly used.  I did have to coach the poor little elderly volunteer how to make change as she seemed completely flustered.  Thankfully that is a skill I was taught by my father ("always count it back!") and I managed to make her feel confident for next time.

So, yeah, three jobs.  It's been awhile since I have had to juggle like that, but since I am not a tremendous fan of BWOM, I am doing very little there.  I probably will not last the summer, but feel kind of bad since they are in the process of a staffing crisis.  Clearly, where there is a staffing crisis, there exists unhappy staff.  Almost everyone there works at least 2 jobs, so maybe they should look into increasing the pay.  Just saying.




Thursday, June 19, 2014

LOL's

The term "LOL",  before gaining widespread popularity as an acronym for responding to text messages and emails for which we are too lazy to write a proper response,  had another meaning   LOL= Little Old Lady.  At least in health care.  Of which there is an abundance at BWOM, a distinctly aged population, this hospital.  On any given shift the department will have a uniformly unhealthy selection of patients in their late 80's, 90's or even a scattered centenarian awaiting admission or transfer.  There are a lot of nursing homes and somewhat upscale assisted living joints.  There are lots of gravitationally challenged elders.  Lots.  Everyone sports yellow socks, yellow bracelets, and cute little yellow "falling stars" on the doors of the rooms for fall risk.  "Yellow socks for LOL's cause they will fall"

One LOL was brought by the usual contingent of  Entitled Concerned Family Members having become increasingly weak at home.   She had taken a fall several days earlier and evaluated at the ER (not ours) and sent home with family.  She did not do well.  She refused to eat or drink, take the pain medication, or participate in her care.  I don't know how the Entitled Concerned Family Members got her into the car, but it was necessary to lift her bodily out of the front seat by one of my heftier co-workers and was marked for admission within the first 3 seconds of her visit.  

As previously mentioned, the admission ritual is pointlessly lengthy.  There are also two issues that make the process just that much more difficult: the layout of the department and the happy bunny concierge service that management insists we must provide, even it if means that actual stuff we're supposed to do is not done in a  timely fashion, let alone properly documented.  I have many times stayed hours after my shift to document.  It's crap.  But I get paid overtime. Don't bother complain, Boss Lady.

It is often necessary to work around all the Entitled Concerned Family members who hang out in the room and think nothing of coming out to the desk and asking for everything they can think of under the sun.  The physical lay-out of the department is moronic.  Juice.  Crackers.  Pillows.  Warm blankets.  5 more warm blankets.  Reposition.  Toilet.  Toilet.  More juice.  Cardiac monitor beeping.  Concerns about BP.  Concerns about o2 Sats.  When will she go upstairs.  Can she have pain meds.  Can she have blood pressure meds.  Can she have tylenol. Will you recheck her temp.  It is a constant barrage; nothing gets done and woe if I have other patients to take care of with equally demanding Entitled Concerned Family.

The two nursing stations are placed back to back, but with the doc's dictation room and pyxis / med room in the middle.  You can't communicate well with the secretary.  The problem with the placement is the proximity to the doors of patient rooms which is less than 8 feet.  It looks like a bank, but with low counters and no bullet proof glass.  It is not possible to have a private conversation, speak on the phone, communicate with providers, or in any way follow any patient privacy policies.  Like all nurses,  I usually have a couple of  situations going at one time.  Consider juggling three bowling balls and a chain saw.  It is exhausting.  The desk placement makes the nurses sitting ducks for anyone with a questions or request;  ALL  the Entitled Concerned Family members  think nothing of coming over to the counter and asking for everything they can think of under the sun.

 It is NOT OKAY to interrupt constantly.

Herewith, my open letter to same.

Dear Entitled Concerned Family Members:

Let me just make a comment about why I am sitting ever so briefly at the desk.  It is not for your convenience.  It is not the check-out counter at the market.  It does not say INFORMATION in bold neon letters about my head, nor does it say HANG OUT HERE.

Please note that there is a computer, a centralized monitoring system, and a phone.  There are other personnel with whom I may be speaking about other patients; what she and I are speaking about is not only none of your damn business, but a violation of the privacy rights of other people.  We do not have the Cone of Silence.

What I want you to know is that while I would love to spend each and every moment of my evening with your loved one, you and your family members are rapidly sucking the life right out of me, as well as every ounce of empathy.  Your very nice but markedly demented grandma has been toileted 4 times in the last hour (3 of them needlessly because you keep asking her if she needs to go.  She's demented.  She says yes).  Turned her.  Given her water, juice, and a snack.  I have acceded to your requests for warm blankets and more pillows.  I have put all of the chairs into the room that are appropriate for the 2 allowed visitors even though there are 5-6 and I am stepping around them.  I have been into the room to address each and every variation of blood pressure or heart rate that has concerned you and reassured the lot of you that I am indeed keeping an eye on it and there has been nothing dangerous or even noteworthy about these variations.  I have relayed each of your requests, comments, concerns to the treating physician.  I would love to get her medication for pain but THAT ORDER IS IN THE COMPUTER AND I NEED TO SIT AT MY DESK IN ORDER TO ACCESS IT.  I also need some consideration for figuring her dosing and you keep distracting me.  It is dangerous.  I think she needs those packed cells more than another warm blanket.

I do not know when the floor will be ready to accept grandma.  Again, addressing that situation requires me to be away from the bedside for more than 30 seconds at a time while you dream up yet another inane request. Before I can consider giving report, I must call the pharmacy to get a complete list of her medications because you didn't bring one, assuming that "we have it in the computer".  We do not.

 I am sorry grandma is not feeling well and you have had to sit by her side for the last four hours, but really, I have this.  You guys apparently did a shitty job of taking care of her needs at home, why don't you all just go away now and let me have a crack at her.  You are so busy making sure that all the bases are covered that you are not letting her rest.  Now, beat it.

Yours Truly,
EdNurseasauras

Wednesday, June 18, 2014

Tales from the Crib

Babies.  Hate 'em.

Well, not really, just don't like 'em in the ER cause it's generally no place for a healthy child.  There are few reasons to actually bring your young baby to the hospital.  Obvious reasons notwithstanding (AKA life threatening or extremely troublesome symptoms that cannot wait for an appointment), about 90% of the babies we see in the ER have no need to be there.

Mosquito bite.

Low grade fever absent other symptoms.

Diaper rash.

Earache.

Teething.

Vomiting if you have reloaded your child with Hawaiian Punch every time he spits up.

I can't even talk about every kid who ever played a sport and bumped his head on a Nerf ball.

One mother brought her pink as a rose 9 month old by ambulance.  This followed a visit to urgent care, as well as another visit to their pediatrician where she was told the child had an ear infection.  She loudly complained about both of those visits, calling the pediatrician "stupid", and the urgent care "idiots".  No, she didn't give the kid with a temp of 100.2 any tylenol.  No, she didn't fill the prescription for antibiotic.  No, she didn't bring diapers, formula, or clothes.  She refused to let me take a rectal temp.  "He as a diaper rash".  Um, ok.

The kids was bright-eyed, playful, beautiful.  The mother held him and rocked him but was more intent on being on her phone.  In a perfect world, no patient or visitor cell phones would work in the ER when health professionals get within 3 feet of them.  Some sort of jamming device would be nice.  Thank you to all the patients and visitors who actually ask if they can use their electronic devices.

The PA spent a LOT of time with her, going over tylenol dosing, being specific about when she should give the child meds, and in general providing her with the one thing the child would benefit the most from aside from a parent with an actual brain:  education.

I really don't know what she wanted, possibly for the child to be admitted so someone else could take care of him.  Between the two of us, the PA and I, we gave her formula, med syringes clearly labeled, diapers, wipes.  She got fed a meal.  Still, after being discharged the registration clerk came back to let me know that the mother was out at the front desk, talking loudly on the phone, complaining that her child got crappy care and "she needs answers now, and she got nothing".   You just can't fix stupid.  The kid is doomed.


Tuesday, June 17, 2014

Splatterfest

It happened so fast, yet I recall the details like it was slow motion.

I jumped up from my computer at the request of a family member for food for their entitled loved one.
Feet get snagged by my tote bag, which had become entangled in my chair.  I was going down, down, down.

I instinctively tried to employ tactics learned from years as an adult not-very-good figure skater.  Go with it.  Protect the head.  Try to slide.  Unfortunately not always transferable  to unfrozen surface, but better linoleum than pavement.

I managed to slide into the side of the waste basket, making a racket and commanding far more attention than I wanted.  "I'm OK!"

Unharmed except for my dignity and a dinged little finger.

So yeah,  I have a new nickname at BWOM.

Mary Katherine Gallagher.



Monday, June 16, 2014

Best Of, Worst Of

I bagged a four hour princess shift as a float (in the ER) in which our rooms were at 60% all day.   This followed on the heels of a 10 hour shift in which I could not get anything done because we were so short staffed.  

For 4 hours I leisurely wandered around from nurse pod to nurse pod, chatting, occasionally doing some work when requested, and a lot of transport.  So it was a fairly boring day but no stress.  That's a nice change.  Day shift has it made, too bad I hate to get up in the morning.
Here are the highlights.

Best Transfer of the Day:  an 18 month old bound for peds.  In a stroller, no IV, sound asleep.  Chart in hand, I led the mom off the floor and was back in the ER in 2 minutes.

Second Best Transfer of the Day:  a demented 80 year old to the medical floor.  The floor nurse and an LNA appeared magically (there can be no other explanation) immediately upon my arrival to transfer the patient from the cot to the bed, completely prepared along with the slide board and IV pole with pump attached.  Wow.  This should be number one, actually.

Best IV Start of the Day:  anemic, pale, tachy,  45 year old who asked for "the best sticker in the ER because she was a tough stick".  I was the oldest.  I won.  One stick.  I was compared favorably with the Best Paramedic on the Planet (she said she called to inquire if he was working before coming to the ER) by the grateful patient.

Best Provider Encounter of the Day: the nice PA asked me "hey, when do I get to work with you again?" as I passed her in the hallway.  Tomorrow.  A genuine "Oh, yay, happy dance!".

Best Cup of Dunks of the Day: The one I bought on the way to work.  As I usually do.  This is only on the list because the one I bought yesterday tasted like soap.  Seriously, I had to throw it away, and wasn't I pissed about that.

Best Meal of the Week:  Yummy salad that I actually got to eat.  Because my last shift I got to the cafe 1 minute after they locked the doors and had to resort to a meal of peanut butter in a teeny cup and a couple of saltines.  And a lot of water in the soapy Dunks cup that i rinsed out.

There is no worst.  I lied.  

In closing, I let my happy little dog off the leash, in the woods, for the first time in months to chase a chipmunk or two (she had surgery in April) and ate ice cream for dinner.  I shared it with her.  A good day for me is a good day for my dog.  

Day 5 of my captivity…..I ate the cone of shame.  I 'm not sorry.



Friday, May 30, 2014

Make Mine Fried, Please

An older lady with dementia had been parked in one of my rooms for the entire day when I took over her care.  Because she had a habit of reporting that her care givers beat her, which turned out to be the dementia talking, she had pretty much burned bridges everywhere and now she had no place to go.  Her estranged elderly husband was willing to take her, but there was a small matter of a restraining order to be dealt with first, which was some big misunderstanding according to the many parties involved.  Somehow the restraining order was vacated by a judge in record time.  Gotta love small town America.

The poor wandering lady had been fed, watered, toileted, walked, sung to, chatted with and entertained.   She was kind of entertaining herself as she kept up a steady stream of consciousness.  Every few minutes she asked where her husband was, and that she was tired of waiting.  Mostly she talked nonsense, but once in awhile she seemed to make sense, even if momentarily.

"Have you seen my bird?"
"No, I have not.  Where did you see it last?"
"I had it here, it was in the bag when I came here"
"What kind of bird, can you describe it?"
"It was a green bird, with blue feathers and small red feet,  I fed it some birdseed.  Do you have any chocolate?"
"I have some Lorna Doones.  Your bird sounds pretty, was it a big bird or a small bird?"

She indicated the size with her hands.

"Oh, about the size of a chicken?"

"Yes, like a chicken".  She fiddled with her bracelet, folded a washcloth, and placed the kleenex box on the center of the table.  She sighed loudly.  "I've been waiting hours and hours! Is my husband coming?"

"He said in about a half hour.  It shouldn't be long now"

Another big sigh.  "He should come now!  He is taking too long, if he doesn't come soon……
I will kill him like a chicken"

Me: "I didn't hear that"

The social worker in the next room actually giggled.
But props to her for getting the wheels of justice turning to get the lady a safe place to go.

Thursday, May 15, 2014

Dirty Secrets

I had some fun with the infection control nurse, a pompous and self righteous D-bag,  who harangued us with the usual hand washing stuff.  I asked about disinfection of things like stethoscopes, and she rather snidely told me that, of course, they should be routinely disinfected, before launching into a lecture on precautions, MRSA, and disposable stethoscopes.

I was bored.  So I started it.

Me: "Mmm-hmm.  What about ID badges?  Do you have any policy on disinfecting those?  I mean, they are at chest height, in the sneeze and cough zone, dangle onto patient's skin, onto sheets, they go to every patient room and are never washed or disinfected…it seems to me they would be just a germ farm".  I pointedly glanced at her ID badge, on a nylon lanyard, which was covered with 27 pieces of flair.

Blank stare.  She was gob-smacked.  "I've never thought of that".

Yeah. ID badges are filthy things.  Think about it.  Along with watches, rings, bracelets (which I never wear to work) and neckties on the men.

Name badges are mandatory.  It goes everywhere the nurse goes.   It gets touched 150 times per day because they always flip around so that my various passwords are showing instead of my name.   It gets handled and scanned for glucometers and to enter/exit certain areas.  It is used for the time clock.  It goes into the bathroom, the poopy patient's room, and the cafeteria.  Into.  Every.  Patient.  Room.

Yesterday I had a horrifying thought.  BWOM hospital issues clip-on visitor badges, which are never, to my knowledge, washed or disinfected.

Eeew.

Just so you know, I do bleach-wipe my name badge every day.  Always have.  Always will.  
And now you will, too.

You're welcome.

Wednesday, May 14, 2014

Tao of Scrubs

I have 3 different colors of scrubs.  Navy, black, and the standard ciel blue.  I have no pink, lime green, or tiger stripes.  My scrubs do not have cute rainbows or unicorns on them.  If that is your preference, power to you.  It's not mine.   I choose to be simple.  If I wear black pants, I wear a black top.  Sometimes I mix it up and wear the ciel with the black, or navy with the ciel, but that is rare and only if I have laundry issues.  I used to have one scrub jacket that commemorated winter, but no holiday stuff.  I am frequently called on this.  "Where is your holiday spirit?"  "Don't you have anything orange and black?", (or red, white and blue, you get the picture).  Again, no.  For ME, I just don't feel like a woman of my age can be taken seriously while wearing teddy bears.  Someone once mentioned to me that when doing CPR, people can look down a scrub shirt and see your boobs, so I generally wear a long sleeved shirt of a different color underneath no matter the season, which can be considered a slight holiday nod.  Actually I just hate for my arms to be bare because of the old lady jiggle.

I find it interesting that the staff in different facilities have widely varying preferences in the variety of scrubs they choose….provided they are fee to choose.  I think it is enormously detrimental for nurses not to be able to choose what they wear to work unless the hospital plans to purchase and launder them.  Then I wouldn't care so much, but I think it is bull shit to be required to wear a certain color or style so the idiot public can differentiate between nurses and non- nurses, especially since my name badge identifies me as a nurse.  Also because the badge "RN" that I am also required to wear is the size of a dinner plate.  One size does not fit all.   At one time a co-worker at the Bait Shoppe was rabidly advocating for all the nurses to wear teal colored scrubs; I  shut her down with a curt "NO".  To this day I have no idea why it was so important to her, unless it was because I hijacked her idea to get  fleece vests with the company logo on it.  I did this because I have narrow preferences for vests and, selfishly, wanted to get what I wanted.  It worked out well because nurses decided on one color, the secretaries decided on another, and the X-ray techs still another.  I liked that we chose our own without a fight.  We could wear them whenever and with whatever we wanted to.  Plus they were a good deal at the time.

BWOM nursing employees are free to choose what they want.  They are a stylish bunch.  There is lots of pink, lots of bunnies.  I have seen all manner of the latest styles with these gals.  A couple of the nurses seem to change their nail polish to go with whatever they happen to be wearing.   Boss Lady shows up everyday in plain boring ciel scrubs even though I have not personally seen her do any patient care in awhile, although she is ready to go when called upon.  Which is great.  Most bosses just wear their business attire with a lab coat thrown over it, although why they are compelled to do so is puzzling since they never, ever touch humans.  I find a white lab coat with heels and hose is insincere somehow, but if that is what you want to wear, fine with me.

Sometimes the match thing can get out of hand, though.  I have to say the the prize for most color coordinated attire in the At Work in the ER category is Newchelle.  Always with a matching set of scrubs and jacket.  Prints, stripes, bright colors, she has it all.  If there is a set of scrubs in any color of the rainbow, she has them.  She has earrings to match all her outfits and seems seems to put all of her money into accessorizing her look with colored or patterned  clogs or tennis shoes.  Lately she has been taking her look to a new, and perhaps, more obsessive level.

She has several different hair pieces with colored barrettes or headbands, one with a big fat flower on it.  WTF.  I think we will be seeing more of the flowers, just a hunch.  She can be counted on to wear a coordinating lanyard for each outfit.

Yesterday her pens were the perfect shade of fuchsia to match her pants and shirt.

I don't want to know if she had matching underwear.  It is disturbing enough.

Thursday, April 24, 2014

Test

The happy couple strolled into my last remaining critical room about 2 hours before the end of my shift.
Headache.  All day.  Woke up with it.  Not like usual migraine because he didn't have any vomiting.  But he thought that as long as he was in the area because of his shopping trip to Target that he should get it checked out.  No, he didn't take anything for the pain.

Wife was apparently in need of most of the attention and interrupted every question with observations about how her difficulties with pregnancy had caused her to come to the ER 4 times.

"They are breeding", I whispered, horrified, to my work partner.
"I noticed.  She already told me 3 times that it is usually her who is seen for her problems of pregnancy".

Namely vomiting

Headache Man received Toradol and the complimentary head CT.  Wife was quick to point out that she was allergic to Toradol, it made her nauseous.  The two of them laughed and carried on in the room for awhile.  Wife wiggle the IV tubing and touched the monitor a lot.  For no apparent reason.

BEEP.  I answered the call light.  "His blood pressure is 170/120!  That has to be really dangerous"

Me: "Yes, it can be.  I will just check that again manually".  120/66.

Wife: "It dropped a lot, that can't be good!"

Me: "With the arm bent and tightened like that, it would be higher.  I will reset the monitor to check it every 30 minutes instead".  He told me about the transient nausea that had been caused by his wires allergy to Toradol.  But he was apparently feeling fine as evidenced by his use of his cell phone to take selflies.

With a heroin overdose and a GI bleed, the People Who Care Committee were busy for the next 2 hours.  Headache Man and his wife were apparently not getting the requisite attention they apparently felt they deserved as Wife was on the call light complaining about the high blood pressure, the lateness of the hour, the need to get home, the long wait, etcetera, etcetera.  Wife sighed and complained and stood in the doorway, which drives me nuts but does noting to expedite the discharge process.

Headache Man got tired of complaining and decided to appeal to my intelligent rather than my non-existent caring side by revealing that he had an IQ 3 points shy of genius level.

I shared that little gem with my Work Partner.
"Wow.  How did you keep a straight face?"
"Oh, years of practice nodding and smiling.  And then I asked him if it was scaled for humans on this planet"

Work Partner: "Wow, Interplanetary Mensa material.  Cool".

Wednesday, April 23, 2014

It's All in the Timing

I hate getting up early but agreed to a 4 hour 7 AM princess shift at BWOM.  Bad idea.

At 80 minutes prior to the beginning of my shift, I arose having gotten about 5 hours of sleep after leaving my other job at midnight (1 hour late).  I had a 20 minute drive home.  I made it through 27 stop lights without getting a single red one, a personal best for me.

At 45 minutes prior to the beginning of my shift, I left my house to start my 35 minute drive to BWOM with a quick stop of coffee.  I hoped that the fact that it was lightly snowing would not interfere with my drive but forgot that I also had to stop for gas.  Damn.  No coffee.

At 5 minutes prior to the start of my shift, I arrived without coffee and grumpy, but found my 4 assigned rooms and 6 patient beds delightfully empty.  Coffee was my only plan for the next few minutes.  I checked my emergency carts and supplies while I sipped.  It wasn't Dunk's, but it was hot and black and nobody wanted to talk to me just then which suited me just fine.

At  30 minutes into my shift I got a single frequent flyer psych patient with a simple medical problem.

At 2 hours into my shift I got a different assignment and inherited a COPD patient bound for the ICU who had been there for about 6 or 7 hours.  Admissions generally take forever at this hospital, there just does not seem to be any sense of urgency.  

At one hour prior to the end of my shift the hospitalist had finally seen the patient and I was ready to get her out of the ER.  Frustrated with 2 computers that were frozen for 25 minutes and unable to get the Tech Monkey on the phone, I was unable to complete the mountain of computer entries (about 500 for one ICU admission) so I could transfer my patient to her Comfy Bed.  This sucked because I had timed it perfectly to coincide with my expected arrival time in the unit according to the Gospel of BWOM Admission Policies, Procedures, Unwritten and Implied Codes of Behavior, Safety and Floor Nurses Lunch Schedules.

The procedure is to fax the report, 10 minutes later the ER nurse would call to confirm receipt of said fax and give the receiving nurse the opportunity to ask questions or for clarification.  After 30 minutes the patient goes away.

I started this nonsense 1 hour prior to the end of my shift.  Plenty of time to get my patient transferred to the floor within 30 minutes of faxing the SBAR, right?   Figure 10 minutes to bring the patient to the floor,  return to the ER, 10 minutes to tidy the room, give report to the oncoming nurse, pee, and boogie home.  60 minutes.


NOPE.  The SBAR report that I had faxed to the floor 30 minutes prior to my expected arrival time was, as usual "not received" by the ICU nurse.  Re-faxed, which resets the 30 minute window.  This window is not in effect for 90 minutes around the change of shift at any time because the floor nurses are getting report and making rounds.  Fair enough.  Which means two hours, generally.  Also another 90 minutes during the middle of the shift for lunch.  Not that we ever get lunch in the ER.  

So 10 minutes after I re-faxed the report that I had written out I gave a FULL, DETAILED VERBAL REPORT to the ICU nurse,  regardless of the fact that the information is readily available in the computer.  This is where my extremely detailed and copies notes may found about my patient assessments, IV infusions, meds, labs, cultures, vital signs, I&O's, pretty much everything the astute nurse needs to know about the patient they are about to receive.  More wasted time and effort, documenting in 2 places and giving verbal report as well.  Brilliant system.

At 20 minutes before the end of my shift  I spent about 10 minutes looking for the pieces to the rarely used portable monitor and throw a few curses to the computer because NOW I CANNOT FINISH THE COMPUTER ENTRY THAT HAS TO BE MADE BEFORE THE PATIENT LEAVES THE DEPARTMENT.

I proclaimed loudly "Well, I can't fix this".
Boss Lady ran by enroute to another important meeting throwing a " yes you can!" over her shoulder as she raced by,  as if I merely need encouragement instead of a cudgel or someone who can actually fix the problem.  It wasn't happening as the Tech types were also at lunch.

At 10 minutes past the end of my shift,  I brought the patient to the ICU by myself, because there was nobody to help as usual.  The ICU nurse futzed about with the patient's bed weight that she couldn't quite figure out (you need to zero the bed first, honey),  fluffing, figuring out which monitor leads are mine and which are hers, chatting pleasantly with the patient, answering phones, putting on a different sheet, and blocked my egress from the room by holding me hostage with the patient still on my ER stretcher.

At 30 minutes past the end of my shift I returned to the ER  to find two more patients in my rooms, but the relieving nurse, having been 10 minutes late arriving for the day, had condescended to take responsibility for them.  Unfortunately, she had not as yet received report on my remaining patient and busied herself caring for the two new patients, one of which was a kid who needed stitches.  I could not, in good conscience, drag her away from that.

At 90 minutes past the end of my shift I left the hospital, forgetting to pee, and with a 35 minute drive home.

And the charge nurse went to lunch.

Tuesday, April 22, 2014

He Said It

ER tech was carefully mining for a vein in an old dude with multiple co-morbidities with shortness of breath.  In CHF. Who refused to take his hat off.

Old Dude: (between gasps for breath) "I.  Have.  Really.  Bad. ……Veins.  Go.  Ahead and.  Slap it"
ER tech: (therapeutically conversational, but focused on the task and milking arm veins): "Well, I really just kind of think that massaging it seems to work better.  I'm more of a stroker than a slapper"

Snerk.

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.  



Friday, February 7, 2014

Oooh, That Smell

Repost, with an update.  Because I'm bored.

I have one hard and fast rule from which I never, ever deviate.  No matter how compelling or earnest the entreaty or convincing the argument, I refuse to be swayed.

When someone asks me to "Smell this"?  I. Will.  Not.  Do. It.

In fact, when I go to work I will spend 8 hours (or more) breathing through my mouth.  Only when I am safely in my car will I take a deep breath through my nose.

I hate foul smells almost as much as I hate raw chicken.  I can't help it, but I'd rather deal with most of the guts, gore and bodily fluids from any orifice, natural or man-made, than handle raw chicken.

I don't know when it started, but if I have to cut up chicken I can't eat it.  These days I can't tolerate any chicken I buy unless it is already cooked.  Oh, I like chicken well enough and I don't have any problem with eggs.  There is just something sooooooooo gross to me about slimy, nasty raw chicken in a package.

Things I would rather do than handle raw chicken:

gut fish
put live lobsters in a pot of boiling water
put worms on a hook
ladle chum
(can you tell I grew up on the ocean?)

I have a point, I promise.

Given my phobia of raw chicken and intense dislike of foul smells, you can probably understand why I went just a little apeshit when Mr. Ednursasauras took a package of chicken out of the fridge and said,
"Smell this"

Nope.

Except it seems to be getting worse, this, this….bad smell thing.  I have been googling brain tumors and such because it seems I am always smelling the odor of years of cigarette smoke and unwashed human, even it it has been days since I have been closeted in a phone-booth sized triage cubicle with same.

The most recent olfactory assault has been the aroma of some kind of perfume.  Could be conditioner or hairspray.  It's sickly sweet and just WAFTS, this heavy cloying scent.  Not sure what it is, but I was trying to explain it to Mr. Ednurseasauras yesterday while we were wandering around the grocery store.
Naturally I immediately smelled it and surreptitiously pointed out the offender.

Me:  "There it is.  It's awful, walk behind that woman in the black coat and zebra boots.  The one with the really bad hair cut, see, she's taking down a box of oatmeal.  Go smell it and tell me what you think.  It's like that BO episode of Seinfeld; it's like an entity"

Mr. Ednurseasuras: "I'm not going to follow around some lady to smell her.  I will just have to take your word for it"

OK, fine.  I see your point.  Later while we were waiting in the pharmacy for a prescription I decided to smell all of the hair products to determine which brand smelled the most like Shampoo and Death.