Tuesday, July 29, 2008

You Are All In My Book...No, Really

Most of my colleagues think I am either A) Shitting them, (not) or B) Scared shitless (you should be, especially you, Dr. Dewshe Bagghe) that I am writing a book about the ER and they are all in it. It has become such a joke that when someone is observed doing or saying something funny or idiotic, or we have an especially interesting night, I get "well, that's a chapter for your book right there!". Indeed, some people could be an entire chapter. There are a few patients who could be a complete book; nay, an encyclopedia. Here is a chapter or two:
Medical Mysteries
"I swear I have no idea how that device became lodged in my rectum!"

"There is no way in hell I could be pregnant" (32 weeks of 15 year old not pregnant)


60 year old man, father of 3 and grandfather of 8 becomes pedestrian vs. auto casualty and dies 7 days after being struck by an unlicensed man having a seizure while behind the wheel because he chose not to take his anti-seizure medication.

"Why the hell should I wear a motorcycle helmet? This is New Hampshire"
(no helmet laws+ idiots= head injury)

Sick vs. Stupid
"I fell down and laid on the floor for three hours. Then I got up and called the ambulance because I didn't have any way to get to the hospital to pick up my Klonopine prescription"

Exemplary Patients
Shocking tales of patients who say please, thank you, and don't piss on the floor. Ok,there aren't many of these.

The Cheeto's Challenge
Clinical studies show that 16 year old's with abdominal pain and vomiting improve spontaneously by ingesting Cheetos in the wating room.

(Not) Catering to the Surgeon's Neighbor....
who gets to wait in the waiting room with sore ankle that she has had for 2 weeks. "If you truly believe your condition is worse than I have assessed and warrents more immediate attention, I will put your chart in the main ER. FYI, fast track is running 2 hours behind, the main ER is 4 hours behind. Have a nice day, and lose the attitude"

Tales from Chicken Little School of Nursing Management "The Sky is Falling, The Sky is Falling!!" Many tales of charge nurses who are willing to go on diversion because there are 15 people in the waiting room. Decisions based on quantity, not quality...erm, acuity.

I can't take credit for this one, but one of the nurses at work suggested a chapter How Nurses Are Stupid to Other Nurses by including some of the moronic incident reports by individuals with a vendetta and poison pen. Usually ICU nurses.

...oh, and in the Idiocy at the Top section, read about the medical CEO whom I encountered on a day when there were NO empty beds on the floors, I couldn't place the 5 boarding telemetry patients who eventually stressed and went home from the ER, as well as 6 post-ops, 1 Remicaid infusion and 2 blood transfusions; she thought that one solution to getting bodies out of the ER so we could get the 20 or so out of the waiting room was to ask pedi to take the demented 90 year old with pneumonia and MRSA. Sure!! Great idea!! I'm sure the little tykes and their parents would really benefit from that experience, not to mention the moms and babies there who overflowed from post partum. Sheesh.

************************************************************************************* I could do several chapters on Leadership.
Even though I have assimilated at Pseudocity Med Center, and the folks at Scary Catholic Medical Center satellite often beg me to come work for them, I continue to think often (and fondly) of my people at my last job. I had the best boss, truly a leader. She may not have done a ton of patient care, but she was out of her office and on the floor several times a day. She almost always knew what was going on, how long people had been waiting in the waiting room or in the treatment areas. It was a big ER, 35 beds and many staff, but she knew the strengths and weaknesses of every nurse, tech, unit coordinator, paramedic and even the docs. I haven't had a lot of mentoring in my career, but Jane was an inspiration to me. She encouraged me to take on more responsibility, and helped me to find my way as a leader.

I guess coming from such a, well, nurturing environment makes it that much harder to flounder around sans leadership. Yeah, the current boss is an RN with an MBA which is impressive; but I find the emphasis is more on the MBA portion. Don't get me wrong, she is a lovely person, and the business prepared nurse is, in my opinion, the future of nursing management. How else to be able to swim with the big fish and not get eaten by the sharks? It must be hard to have taken this path, there can't be a ton of RN's with MBA'a out there to mentor others.

However, without strong leadership from a nurse manager I can see the entire department slowly going to hell in a handbasket. Poor retention, call-outs, no shows.....some days it is downright painful to go to work. A recent nursing course had me write a "Dream Job Description" for a project. I wrote about my current job, with all the things I liked about my last job. That is a no brainer, cause I like my actual job, but wish there was more support for nursing to actually do the job. Is everybody stretched this thin?

I may never get the book off the ground, but it is fun to think about it. The next best thing is blogging. When the interesting/challenging/funny/ unbelievable/shocking/horrifying/ disgusting/exhilarating occurs at work, it pops into my mind "oh, I need to remember that". It's addictive, really, and a great stress reliever. It also occasionally helps to put things into perspective, which is more than I can usually hope for when I get home at night and Mr. EDNurseasauras is asleep and not available for debriefing. It sucks that most of my friends are now working the 3P to 3A shift and aren't available for 'Rita Rounds anymore, but my liver is certainly in a happier place; and, I'm sure the Pseudocity Police who would prefer seeing me working in the ER as opposed to being a patient.