Thursday, September 30, 2010


I needed a little time to process and think a little before writing about this topic. Southern Cathy and I headed to San Antonio last week for the Emergency Nurses Association (ENA) annual convention. It was a first time occurrence for us both; we had heard that it was very much a carnival informative and a party atmosphere great opportunity to network with other ER nurses. Although not a Texas native, Cathy spent a few years there so she was a great resource for getting around and seeing the sights; as it turns out, we had a blast. I didn't count on the doing as much reflection on my nursing practice as I have.

We basically spent 2 full days in lectures; all were interesting, informative and provided new knowledge we otherwise would not have been exposed to. Some were clinically oriented, some were skills-based, many provided food for thought. I had an opportunity to hear about the experience of a combat nurse who had spent time in Iraq, an excellent speaker who deserved and received a standing ovation after her presentation. I wound up (quite by accident) in a class that taught us how to care for the Transgendered patient in the ER simply because I was in the wrong place at the right time, but had listened two of this nurse's previous lectures and LOVED her. There were classes about policies that supported staff against violence, how to protect yourself from lawsuits (documentation, documentation, documentation), and sudden death in young athletes. I especially liked "10 Ways Not to Get Fooled at Triage".

Cathy and I chose different classes and exchanged what we had learned about during breaks. I came out of the experience with with a somewhat new attitude towards ER nursing in general and my own practice in particular. It was empowering to be among my peers, many with fewer years of ER experience, some with many more than my 34 years. There were nurses from small ER's such as mine, and others from enormous medical centers and Level 1 trauma centers. Yet at the end of the day we were all pretty much doing the same job, had many of the same concerns, and want the same things from our managers and administrators.

The common theme among the nurses that I met will come as no surprise: nurses are nobody's priority. We, as a group, are consistently being asked to do more with less, forced to follow the agenda and direction of individuals who make the rules but have nothing to do with clinical decision-making or patient care. I dare say that if they ever knew which end of the bedpan went where, it has long since been forgotten. Nurses are at the bottom of the food chain, the first to sacrifice or be sacrificed. Yet we are at the front lines of patient care, often in spite of of administrators, managers, and individuals who have been placed erroneously in leadership positions. Yet all of the nurses that I met were committed to being better, learning more, providing top-quality care. And you know, the lecturers had a mountain of alphabet soup after their names but had great ideas for us front-line nurses. These are movers and shakers that seem to be missing in the work-a-day life of a nurse, absent from the front lines but working behind the scenes. These are nurses who are intelligent, confident and get things done; their leadership inspired me. As I listened, something struck a chord with me.

I am not a manger, but I am a leader; I can be mouthy and negative, bitching about how unloved we are when I'm frustrated, or simply caught up in small bull-shit annoyances, such as sticky notes that berate nurses for missed secretarial tasks. I can be a Pied Piper, whipping my co-workers into a frenzy of indignation, or soothing them when they are over the top and overwhelmed. I can go hog-wild with practical jokes and suck others into my vortex of lunacy. I can cajole people into doing things they might not think of or even consider doing without my encouragement.

I have encouraged some of my coworkers, mainly Mikki, to be less fearful and intimidated by one of our physicians. You know the type: the all-powerful demi-God who fails miserably as a team player and was most certainly voted Most Likely to Get the Snot Beat Out of Him in high school; generally unhappy, lacks adult social skills, etc. He's just a guy, kids. Not likable, not an especially good doctor, and not good for nursing. But get on your big girl pants and stop giving him the power to lord it over you for heaven sake!

My take-home from this conference is this: I have learned that leadership is a powerful thing, especially if it is used for good instead of evil.

Tuesday, September 28, 2010


I have been taking courses to finish my BSN for 3 years now. Since I had a busy summer planning my Alaska trip and also needed to take 2 CLEP's, I put off my final course until October.

October looms; I had a wonderful trip to Alaska with Mr. Ednurseasauras, got out in my kayak a bit, spent lots of days at the lake, and studied very little for the CLEP exams. Lazy? Maybe.

I could spend the next week studying like mad, and probably pass both CLEP's so that I could start my course the first week of October and then graduate in December.

I just can't face it. I'll take the CLEP's then start the last course in January!

Monday, September 20, 2010


"I just remembered that I am allergic to oxycodone; could I get Percocet instead?"*

*same thing

Sunday, September 19, 2010

Beginning of Flu Season?

Since last week, between a local epidemic of Salmonella and perceived flu-like symptoms, I have washed my hands 7,542 times (they are ready to fall off). I have lost one really nice pen thanks to the assbag who sneezed on it while she signed her discharge instructions; now I religiously use hand sanitizer on my pen after anyone uses it. If they are really grubby individuals I use another pen and throw it away. If I don't even want them to touch the pen at all, I scribble something indecipherable myself in lieu of their signature and hand them the copy. Yeah.

I have also de-bugged my stethoscope and shoes (don't ask) approximately 3345 times, had to chaperone too many pelvic exams to count for STD's, and collected several stool cultures. Therefore, I am so not looking forward to mining flu swabs once it is determined that the flu season has officially begun. How does one collect a flu swab? I'm glad you ask. Please keep this in mind before running to the ER with a cough and sniffles.

We wear a mask, of course, and gloves. Then we take a slim Q-tippy apparatus on a very narrow bendy wire and PLUNGE it deeeeeeeeeeeeeeeeeeeeeep into the nostril where it stays for about a minute. It sucks big time, although I will say most women tolerate it better than men for some reason.

Everyone is far less afraid of Swine flu, or more accurately, the H1N1 flu (thanks to the pork industry and their SWHIning) than they were last year. CVS has advertised the availability of flu vaccines in their stores for about a month now, way ahead of the primary care offices; who knows when they will begin booking appointments for that. I think it is still too hot out for people to worry about flu in this neck of the woods, but come the first lighting of the wood stove the onslaught will begin with a vengeance.

Yes, it's nasty. Yes, people feel lousy. For the most part it is not the end of the world; regardless of how much you feel like you are dying, the odds are good that you won't.

We've had a number of patients with fever, cough, sore throat. None sick enough to be seen by their PCP, and certainly not sick enough to go to the ER to be told to rest, take Ibuprofen, and drink fluids 'til you are better.

So we put a mask on all the coughers, and have resurrected the Altar. Gotta protect our secretaries.

Thursday, September 16, 2010

Today's Last Patient of the Night

At 10:41 PM, a 20-something female wanders in to be seen.

1. Cold symtoms 2. Foul vaginal discharge, and 3. Sore tatoo

She had no primary care provider, no insurance, and no driver's license or other identification.

Pick one, please; "Have it Your Way ER" closes at 11:00 PM

Tuesday, September 14, 2010

Second in Command (SIC) has some issues. She has no authority over anyone except by virtue of being the boss's best friend. Lisa, Mikki and I can't stand her. Lisa has a tendency to make snide comments about the number of "love notes" SIC leaves for everyone. WTF? There are 10 nurses who work here. There is absolutely no need for most of these idiot notes.

I don't mind an occasional reminder if I've forgotten something, but you can usually count on SIC to leave a mountain of notices; they are never about clinical issues, but about the myriad busy work/ non-clinical/ secretarial-type tasks that have been simply forgotten. Believe me, none of these things are terribly important, at least when you compare them to taking good care of the patients and getting that part right.

My typical I-don't-give-a-shit attitude occasionally gets me into trouble. After finding about 1/2 dozen notices one day, I started leaving little notices of my own; I pretty much went postal with Post-It Notes.

On a memo: "who writes this shit?"

On a notice reminding people not to clock in before 5 minutes prior to the start of shift (we have two, day shift and evening shift mind you): "if the day shift insists on clocking out at ten minutes of 3, I will be clocking in to take report. Thanks again for withholding raises this year".

On a sign up sheet for a hospital sponsored community health day (thank you, marketing) on a Saturday: "do we get paid for this fiesta? and will that include weekend differential?". The response was an exasperated "YES!" by my boss.

On a reminder for a UAC (Unit Advisory Meeting, more Magnet bullshit):
"boycotting UAC's until raises are reinstated".

On a note reminding nurses to keep the blanket warmer filled: "sorry, we ran out of blankets so we just filled it with paper towels; hope it helped!"

On the Wall of Death (there have been a number of deaths of staff and relatives in the last couple of years; some of which I have written about in previous posts. All the death notices and pictures of the deceased are on a bulletin board in the kitchen, which is macabre and depressing. I made Dan promise me that if anything happened to me that he would prevent any posting on the Wall of Death, but the bastard quit): "please, this place is depressing enough. It is time to remove this memorial"

Note: the Wall of Death was dismantled. In its place is now the "Circle of Life", which has graduation pictures of some of our staff and kids. Much better.

One Saturday when SIC was off, Sherry and Mikki surprised me with a GINORMOUS sign, decorated with stickers and art work "EDnurseasauras, please sign the narcotic sheet! Thank You! Love, Mikki and Sherry. This was clearly a case of ragging on SIC.

I laughed for 10 minutes, I thought it was hysterical. Mikki and Sherry were a little nervous that I would be offended. Me?, Nah. In fact, i told them that we should leave it up except for the fact that it was covering the opening to two cabinets. Too bad!

Friday, September 10, 2010

Douche Baggage and Luggagegate

Mr. Ednurseasauras and I were en route home from a fabulous vacation in Alaska and waiting in Seattle for the second leg of our flight homw. We were slaphappy from lack of sleep as we observed the antics of a full flight of dip shits as they try to weasel out of paying the baggage fee on Continental with their over sized, overfilled, truly non-regulation sized "carry-on" bags.

First of all, I just have to say that every airline that charges a fee for baggage sucks; if they also charge for carry-on bags, they suck doubly.

Mr. Ednursesauras and I are flying on Continental, which deserves the "Profiles in Customer Disservice" award; the so-called customer service representative directed a woman with a cane to go AROUND the podium and into the cattle chute instead of letting her save a few steps and cutting across. Booooo! You get an F for that.

The other gate keeper announced that since the flight was full, EVERY carry on suitcase would be required to be properly sized in the, well, sizing thingy.

Mr. EdN and I amused ourselves by predicting which bags would get the heave-ho into the dungeon of checked baggage.

Seriously? Some of the bags were TWICE the legal size; no way was it fair to have them stuffed into the overhead. Yet people were actually ARGUING about, which is when it got really funny. To us, of course.

One woman had a purple trapezoid shaped bag; yep, I said trapezoid. She kept insisting, "but really, see? It's squishy, it'll fit!". This was after she had removed a computer and some dirty laundry from the bag.

Lady,no matter if you put brought that bag into the cabin empty, the base is STILL too wide to fit. NEXT!

"Oh, look. This next one is huge! No way that gets in. I think it weighs about 50 pounds."

"I think it probably contains frozen fish; what if it melts and starts stinking?"

"What is wrong with these people?"

It occurred to me that these are probably the same self-centered and needy people who frequent ER's, and that it would probably be fun to compare notes with some of these airline people. Over cocktails, of course.

The pseudo-sick public sucks. The traveling public sucks equally. I think, though, that because flight/gate attendants have the final say on who gets on and who doesn't they might have the advantage over ER nurses. At least they are being evaluated on customer service, not nursing care which has somehow been lumped into customer service. Not to mention the advantage of having air marshalls who REALLY have the last word. It is no wonder that a veteran flight attendant, after a verbal altercation with a passenger that should have been ejected/arrested/flogged, made a public farewell announcement, grabbed a couple of beers, and fled down the emergency chute. He deserves a fecking medal.