Monday, April 10, 2017

Odd-year blues

I'll be winding down this nursing thing in a few years.  I am looking forward to retirement but have a long way to go.  In the meantime, I still have to do all of my certifications in order to work in the ER.  Some are every two years, some every four.  There are also classes to attend in order to maintain my biannual license renewal. Add to that the annual hospital competencies, and that is a lot of stuff to repeat, same shit different….year.  Nothing much changes, yet another tick mark in the administrative Big Book of Checklists.

I just took the 2 day TNCC for about the 6th time, renewable every 4 years.  It will be the last time I have to take it before I retire.

Always stressful, I approached this recert with a true "I don't give a shit" attitude, and it served me well as I was relatively stress-free.  It helped that I knew two of the course instructors  quite well, and I was taking the course with a lot of first timers as well as a few PACU, OR and ICU nurses who were unfamiliar with a lot of the ER stuff.  Plus the kids from my own department had been ER nurses for less than 2 years.  They were a lot of fun and even insisted I join them for a drink after class.

This time around I was pulled for the clinical testing on day two by one of my fav people.  One on one with the instructor, you get a scenario, then have to go through the appropriate steps in the proper order.  Of course in an actual trauma, all these steps are accomplished simultaneously by a number of people, but it is the thought process that is important here.

She gave me the easiest scenario, since I got the pregnant trauma victim as I always do in the practice session and did it effortlessly.  The savvy instructor can tell nerves from lack of knowledge.  As I rattled off  all of the major testing points as my instructor cut off any in depth explanations (to prove I knew what I was doing), she impatiently waved me ahead to the next point with a "yep, you got it, next?",  and was out of there in under four minutes.

Since this is an odd year, I have yet to do PALS (or ENPC if I can find something before August), ACLS, and of course, BLS.  My other job back at the Bait Shoppe only requires that I have BLS because, you know, we can always just do CPR in an urgent care while we wait for EMS.  SMH.

Sunday, April 9, 2017

Name game, volume 1

Some time ago I posted a list of stupidly spellled names.  Since then I have been collecting them and sharing them with a couple of friends.  I don't see these friends much, but the magic of technology allows us to keep a running dialogue.  We shake our heads.

I get that people want their children to have names that are special and unique.  But some of  these take it to heights of stupidity, I mean, seriously?  These are names that are going to be asked the spelling for life.  LIFE.

If I do 10 at a time every week, I have enough to last months.  Or until I forget about it or get bored.  Likely the first one.  So, without any further ado, this week's list:

Deserey, and Dessert.  Both pronounce Desiree



Jammie.  Pronounced Jay Me


Taylier.  Pronounced Tyler




Alyjx.  Extra stupid.  I called "Ajax", assuming the "l" was silent

OK, more to follow

Sunday, March 12, 2017

Magic is for real

I have always believed the ER is not the place for brand new nurses to try out their wings.  Too stressful.  Way too much to learn.  Sets them up for failure.  Better to have some med-sug experience under their belt before jumping in the frying pain with both feet AND their hair on fire.

All of the new grad nurses who have started out in my  ER are on their 2nd or 3rd health-care related career.  Some have been paramedics who have gone on to nursing school.  Some are EMT's, or paramedics, LNA's, and a handful of unit coordinators who have done that job while in school.  These here are the Sacred Cows with varying levels of knowledge, hands-on training of some kind, skills not necessarily achieved in nursing school.  The "have to hires", their orientation is very, very long,  and includes months of training wheels.  It's  really an extra six months of nursing education, as they are nurtured, supported, mentored, watched, encouraged, allowed to take baby steps until they are fully mobile, upright, standing-on-their-own-two-feet nurses.  They are not merely loosely supervised and used as additional staff.  Some do well, some do well eventually.

Every once in a blue moon, though, there comes one new nurse so rare, so extraordinary you wonder if they have been reincarnated from a previous nursing existence.  The total package, equally comfortable with the providers, nurse colleagues, and patients.  Confident.  Makes good decisions and, most importantly, asks great questions.  Takes great care of patients.

It has been about 16 years since I recognized a brand new nurse with such excellence.  She was an EMT, then  paramedic, to RN.  Got her BSN, MSN and is now working on her PhD in nursing.  She was a great nurse right out of the box.

Now, in my department, I have met such a Unicorn.  Marvel at the beauty.

Saturday, March 11, 2017

That's all I have to say about that

I was invited out to dinner with some folks from the department, including a couple of nurses and one of the resident low-level paper pushers who is also a nurse.  She is a nice person, but has more interest in paper pushing.   Plus yelling at all of us when our BLS is about to expire.  I call her Bean, short for Beancounter.  Every day there is another directive or rule change.  Or a new "checklist.

Bean was bemoaning the fact that people were not compliant using the newest checklist devised for stroke patients.  I found stacks of them placed in specially labeled folders at each triage desk, in the critical rooms, and at every single computer in the department.  Yet nurses were not using them consistently and Bean was frustrated.

"What can I do to get people to use these checklists?" Bean asked plaintively.

Ok, since you asked:

"It's another stupid thing, Bean.  Just another thing to do that takes the focus off the patient places it on the paperwork".

Bean (horrified):  "But these are so important, like doing neuro checks every 15 minutes!"

Me: "Bean, seriously?  Do you really think these things aren't being done for the patient?  Do you think we aren't assessing continuously?  Shouldn't the focus be on the what's going on with the patient and not simply writing it down and wrapping it up pretty?"

Bean (piously): "If it isn't documented, it isn't done".

Me:  "Right.  I've seen you doing the postmortems on all these checklists, and never in recent memory can I recall anyone being told that they have done a good job, either with the patient or on the checklists.  Each time we get a STEMI, stroke, trauma in which the paperwork is more of an issue than the care of the patient, we grab the paperwork and say "yep, wonder how long it will take for someone to yell at me for what I did wrong, or I get a nastygram from administration".  See, we're damned if we do and damned if we don't.  There is little motivation to get the paperwork done to order.  We're beat up with this shit, Bean".

Bean: (stunned): "You don't understand with pressure we get from above…"

Oh, please.  Boo fucking hoo.

Me: "I get that you take heat from admin, and then you have to torture us.  I do.  It's a suck job I wouldn't want, but you asked how to get people to fill out your checklist;  I've merely told you we do the best we can.  But what you haven't asked is how to help us be in two places at once, doing paperwork in real time and being at the bedside.  That's all"

Since I appeared to be ready to get on the table and jump up and down, one of the other nurses agreed with me then promptly changed the subject.

Probably won't be invited to dinner again.

Friday, March 10, 2017

On prioritizing

As we all know, cubicle-dwellers at the semi-administrative level generally have little in common with us clinical-types.  Jean spends a lot of her time in the office, although she spends a significant allotment of her day sitting at the desk in the clinical area.  Taking up space.  About 7 feet from most patient rooms.   Which is kind of scary when you consider that she is responsible for educating the young'uns about policy, procedures, and definitive form completion.  Aside from an occasional couple of hours in triage, I haven't ever seen her actually commit any patient care.

The other day Jean gestured for me to come over to her as she sat at the desk.  It was apparently not clear that I was busy, I guess I appeared to be loafing as I stood warily watching a ranting heroin overdose who was, through the miracle of Narcan, now insisting on leaving, unfazed by his brief episode of death and "had things to do".  Security was in the room trying to reason with him, I was poised to run, or at least yell for back up.

I indicated to Jean with a terse shake of my head while giving the 2 finger "I'm watching" sign.  She stood up, walked over to the adjacent med room door, which connected with the room I was in, and locked both, effectively cutting off any alternative emergency exit.  WTF.

"If the patient decides to go into the med room, now he can't get in"

Me: "So what?"

Jean: "Well, the med room would be safe"

Me:  "Did you consider that it might be necessary for ME to have another way to get out of the room?"