Thursday, December 31, 2009

New Year's Rockin' Eve

New Year's Eve was fairly steady. By 7 PM we had seen a number of patients, all of whom were pleasant, polite, in real need of emergency care and in general, a pleasure.

Usually on holidays, you get the extreme version of the Sick and the Stupid.

To recap, the Sick consist of any patients who should be in the ER; that would be lacerations that require suturing, chest pains, head injuries, fractures and the like. The Stupid are those patients who should emphatically NOT be in the ER for any reason; that includes rash for 3 weeks, any chronic pain, fever of 100 degrees as the chief complaint, ear wax, or any who has a doctor's appointment the same day but just doesn't feel like waiting.

As I said, on holidays it is the extreme version; REALLY sick or REALLY stupid. This I categorize as complaints that range from Illness to Idiocy. Same rules apply.

The gentleman who should have been in the ER like yesterday for blood sugars above 600 would qualify, as well as the man who nearly severed his thumb while decapitating Mr. Thomas Turkey, AKA, New Year's day dinner, with a hatchet. Nothing like fresh poultry I guess....hmm, what is that in my stuffing? Thumbthing wicked this way comes.... Honestly, who has turkey on New Years Day?

So I was more or less prepared for trouble when one of the local regular customers strolled in. At least he waited until we had dinner. He is known for being rude, often aggressive and I have personally thrown him out at least once. He got into it with the doc in the past because the doc wouldn't write him a 'script for 120 Valium like the last doctor. WTF.

Tonight he complained of a rash, convinced it was bedbugs, or hives, or MRSA, or plague.

He is especially nasty to women, and we usually try to protect our secretaries from his bullshit because they are all really nice and don't deserve it; not that anyone does. On the other hand, he has had a run-in or two (and been thrown out) by my usual co-worker, AKA my "work husband", Dan; he is 6 foot 5 and takes no bullshit from anyone. Dan was already ramping up as soon as he caught sight of the guy so I went in to triage him. Must have been a good day for him because he gave me no trouble; asicd from failure to make eye contact, which drives me nuts.

As he passes by Dan, he mumbles to his friend "That's the guy gave me bullshit last time I was in here"; Dan rises to the occasion and returns fire, "Yep", he says, "I recall you told me to polish up my resume; I'm still here".

I cringe and resist the urge to dive! dive! dive! under the desk.

The man and his friend get all huffy so I took the higher ground. "Why don't you have a seat in the room, the doctor will be in to see you shortly; we all just need to be respectful of each other and you will get your problem taken care of" I offered.

They grumbled into the room, he got his 'script for prednisone and hydroxyzine for his itchy pseudobugs or MRSA or galloping crud, and went outside to smoke.

"His companion wants to check in too", said my doc of the eve.


The 20 year old female claimed the guy as a family friend. Her complaint was abdominal cramping; she was 4 months pregnant, having discovered this fact after taking an ambulance ride downtown to our mother ship in the last couple of weeks for the exact same problem. No prenatal care. No insurance.

She had not followed up with an OB as instructed. I quickly deduced that she wanted pre-natal vitamins and an other words a picture of her baby.

She was a little skittish. I entered the room to draw her blood, and she decided she felt really nervous and wanted to step outside for some fresh air.


"Just a few minutes, though, OK? If we need to send you downtown (for an ultrasound) we should get this show on the road"

I waited about 10 minutes and decided she needed a kick in the ass; I went out the door to discover her smoking a butt.

I coaxed her inside and prepared my various tubes and assembled equipment, and explained what I was going to do. She proceded to tell me what awful veins she had and how she was terrified of needles and how "sum nurse" dug around for her vein for over and hour trying to draw blood.

Uh huh. I love a challenge and nothing gives me more pleasure than a successful venipuncture on the first try; I rather pride myself on it, actually. I attribute my success to the countless pedi IV starts when I worked at Utopia Hospital.

But I digress. The young lady said, "I'm just really anxious about my baby, I am scared there might be something wrong with it".

"If you are really concerned about your baby, you should quit smoking immediately".

"Well, I've really cut down since I found out I was pregnant".

"Your baby doesn't know from cutting down. You are at risk for having a low birth weight baby. Do you know what that means?"

"Having a small baby? Wouldn't that be better for delivery?"

Arrgh. This kid is doomed.

As the festivities began to wind down we were hopeful that we might get out at 11PM, our usual closing time. I triaged a sore throat at 10:20 PM, then a febrile, inconsolable, wheezing 8 month old who was afebrile, sleeping and had no wheezing. But did have an ear infection and didn't wake up during the exam or when I put Oticaine in followed by a cotton ball.

At 10:40 PM local EMS was toned out for a lethargic 4 year old with special needs, not otherwise specified. We know most of the medically fragile kids in the area and the address we heard over the scanner was unfamiliar. Moments later, we heard that CPR was n progress.

"Should we stick around to see if they need to come here?" I wondered aloud.

"They know what time we close", offered the secretary.

"I know, but a pedi code is anxiety provoking, they won't be thinking about it in the field", I responded.

I asked our doc who was an ex Greatest EMT in the history of the world, before he went on to become World's Greatest Paramedic before he got kicked out of the Air Force Academy for being a big mouth, followed by the designation of Most Intellectual ED Doc in the Universe. But good to work with when we can keep him focused.

"Wait and see".

By 11:05 PM we had heard nothing. "We're closed" said our doc. I wasn't sure, but it was his call. Still, we knew he would sit in the parking lot for a few minutes.

Since we nurses and other lower life forms park out back in a lower parking lot, Lisa and I made our way down the back elevator, alarmed the building and went outside into gently falling snow. We had gone a half a dozen steps across the lot when we heard the siren. Lisa and I froze in our tracks. The ambulance approached, got closer and louder. I fumbled in my coat pocket for the key and tried to remember how to disarm the system to get back inside as I listened.

We held our breath. One block away. Outside our ER.

And continued toward the city.

Wednesday, December 23, 2009

It's Magnetic

"Have you looked at this?" asked my husband, Mr. Ednurseasauras

"What?", I asked, busy warming my hands in front of the pellet stove.

"This discount card from your hospital. You can go online and print discount coupons and look for deals at a bunch of different stores and restaurants. It says 'Perks Card' ", he said

Like what?", I asked, becoming interested. I hardly ever read anything that comes from my hospital.

"Well, let's see: Dougie's House of Onions, Sally's Books 'n Toasters, Elemental, Lamps, Socket Wrenches and Diapers's, ... and Arby's".

"Big Whoop. I never heard of any of those except for Arby's, and I don't think there's one of those for 50 miles...why would I even bother?"

"I thought you might be pleased since the hospital cut your educational reimbursement by 50% and your shift differential fifty cents an hour", my husband replied, not without a note of sarcasm.

Ah, I thought, he's baiting me.

"OK, I see where you're going with this. For one thing, it is no skin off their teeth if they give discounts to obscure places that nobody ever goes to; in fact, I find it insulting. You can put a turd on bread and call it lunch, but it's still a turd".

"Good analogy".

It's still a big old stinking turd.

I'm still pissed that Scary Catholic Medical Center did both of those things as well as completely cutting the employer contributions to the 401K. These occurred after the Magnet Survey in August


Magnet Recognition is a designation bestowed on any hospital that works hard enough to jump through the necessary hoops. It is given by the American Nurses Credentialing Center (ANCC) , a wholly owned subsidiary of the American Nurses Association (ANA). Magnet Recognition is given to a hospital that "satisfies a set of criteria designed to measure the strength and quality of their nursing. A Magnet hospital is stated to be one where nursing delivers excellent patient outcomes, where nurses have a high level of job satisfaction, and where there is a low staff nurse turnover rate and appropriate grievance resolution. Magnet status is also said to indicate nursing involvement in data collection and decision-making in patient care delivery. The idea is that Magnet nursing leaders value staff nurses, involve them in shaping research-based nursing practice, and encourage and reward them for advancing in nursing practice. Magnet hospitals are supposed to have open communication between nurses and other members of the health care team, and an appropriate personnel mix to attain the best patient outcomes and staff work environment". (From the Center for Nursing Advocacy).

It's a lot of documentation, and sounds like it should be a good thing. I guess it is except that the astute nurse recognizes it as window dressing. Nurses are largely brain washed into into thinking that a Magnet designation is anything other than a marketing tool. Those nurses are then lined up, questioned by the representatives of the ANCC who are convinced that the candidate hospital is the Best in the Entire World in attracting and retaining the World's Best Nurses because the hospital cares deeply and passionately about Nursing Issues.


I was forced by my nurse manager to attend a Magnet Dinner; there were about 12 of us with 4 Magnet Representatives. After we finished rubber lasagna, wilted salad, soggy garlic bread, and soda, the examiners went around the room and asked each of us; where we worked, what projects we were involved in, what educational or leadership expertise the administration had encouraged us to participate in and what UAC's we were involved in.


Let me put it this way; I go to work to earn enough money to pay for my expenses. After 33 years, I feel pretty much as if I've done my time with Unit Advisory Committees. Waste of time. I have all I can do to do my assigned hours, attend an occasional staff meeting, be a mover and shaker behind the scenes and scramble to complete my BSN before I chuck the entire plan and follow my friend Anne into hair dressing. Really. Or learn to play the drums, whatever.

To the Magnet representative I spoke about my years of nursing experience in the ER at various levels from staff to leadership positions, went on at length about completing my nursing education and plan for grad school and ultimately teach nursing in some capacity. I spewed some lie about working on a nursing assessment form that pretty much everyone had worked on as well; I recognized a nice young ER nurse from our mother ship and dragged her under the bus with me as I said, "Erin, you probably had lots of input in that too, didn't you?".

Erin grabbed at the lifeline as she clearly had no UAC commitment either and rambled her own bull shit. I silently flung the bird at my nurse manager for putting me in this position.

Two weeks before the hospital got its Magnet designation, the aforementioned budgetary cuts were made; all affected clinical nurses. While merit raises were cut, no management positions were cut, reduced or eliminated. No administrative positions were eliminated. No administrators took a pay cut. This is a demonstration of how much a Magnet Hospital values its nurses.

Magnet my ass. Use the nurses for gaining some sort of marketing edge and then, in this economy cut tuition reimbursement and pay. Yikes.

I can't wait for the Magnet Peeple to come back, but that will be a few years.

The hospital is, however, required to conduct satisfaction surveys either once a year, or once every two years. They can pretty much depend on me to lower their satisfaction scores.

I just love surveys. The first couple of surveys I completed I complained about the crucifixes in every treatment room; that and the joining of hands, being forced to pray and sing Kumbaya at the conclusion of orientation. I though this was offensive in a facility that seemed to pride itself on cultural diversity. How does this welcome members of other cultures and religions while ramming their ideals down someone else's throat?

Within 2 weeks the crucifixes disappeared. Interesting.

Bring on that Magnet satisfaction survey; unless our tuition reimbursement is fully restored, along with shift differential and merit raises. And, while you're at it Scary Medical Center, fire 50% of your administrators and other dead weight. I want the CEO right here tonight. I want him brought from his happy holiday slumber over there on Melody Lane with all the other rich people and I want him brought right here, with a big ribbon on his head, and I want to look him straight in the eye and I want to tell him what a cheap, lying, no-good, rotten, four-flushing, low-life, snake-licking, dirt-eating, inbred, overstuffed, ignorant, blood-sucking, dog-kissing, brainless, dickless, hopeless, heartless, fat-ass, bug-eyed, stiff-legged, spotty-lipped, worm-headed sack of monkey shit he is! Hallelujah! Holy shit! Where's the Tylenol? *

Me, bitter? Nah.

*Thank you Clark Griswold, although I stole this from Jules.