Thursday, August 25, 2011

Not That it Matters, but....

I was on the other side of the health care delivery system recently, having a relatively minor surgical procedure.  Which took me just a little longer to bounce back from, but no matter.  I am on the mend and back to most of my exciting physical activities.  Except I am not allowed to lift my kayak for another week or so.

I was more than happy with the care that I received from start to finish, from checking in to the pre-op area to the next day follow up phone call.  I have to say that I did not use my own health care facility for this procedure, even though the surgeon is there more days per week than at the "other" place.  Why?

They piss me off.  For one thing, the PACU nurse manager is a moron who apparently doesn't think ER experience is enough of a critical care criterion for working in a same-day surgery unit.  For another, I just couldn't see myself as a patient where administrative types are so totally clueless they don't value or even have the ability to recognize that people are working really hard.  I am sick to death of the constant reminders and whip cracking.  That not giving 100% every second of every day is going to doom us all, given that we are experiencing layoffs and all.  The buzz word is "Strive for 5", (as in 0-5) a reference to Press-Ganey  five-point scale that patients use to grade our attentiveness and care.  They just don't get that people, especially nurses, are doing way more than the best they can.   Guess what, you are not the number one hospital and never will be because you have a lot of deadwood making stupid decisions and fail to listen to the people who make good scores happen.

Because we feel like we are always being beaten up, there are days when you just don't feel like Strivin' for  5.
It might feel like "No More Than 4"
or "Three is Fine for Me"
or "Two Will Do"
or (rarely) "One and I'm done"

It was interesting to be on the other side of the fence.  I knew that care would be good if not great because I used to work there.  I liked it well enough, certainly the ER was better organized and managed.  I took my current position because it worked out with school and all.  But, I'm no longer in school (at least, not for the moment) and it might be time for a change.

Wednesday, August 24, 2011

I Know Who I'm Gonna Call

Another night with Parvati, the usual running around. Except we had Actual EmergenciesTM. A STEMI transferred out; an 8 year old with severe reaction to bee sting;  a 10 year old with SVT.  More bee stings.  A 15 year old whose ulna and radius looked  as if he had sprouted another elbow.  Shoulder dislocation.  Yeah, busy for us with our limited resources.

Plus we had our usual contingent of dental pains and neighborhood "I had nothing better to do so I thought I'd go to the ER for this minor problem I have had for 3 months".

To add to the perfection of the evening, I also had to work with SIC.  SIC and Parvati don't like each other much.

I don't like either of them much.  So it was kind of fun to watch them sniping at each other.  For once I was Nurse Good.  Hahahahaha!

At the height of the insanity, and quite without dinner, we didn't have a single room free except the Code room, having either shipped off or discharged all Actual EmergenciesTM except for the little girl with SVT and the kid with the bee sting. We still had a boat load of others occupying rooms.

Not Cheri told us we had another triage.  "She's a little dramatic, says she cut her finger off".

Me: "Do you mean actual finger-in-a-baggie cut off, or high drama boo-boo?"

Not Cheri: "No finger in a baggie".

Second in Command went to triage her, a 24 year old well know to us for frequent visits for complaints and maladies better treated with common sense than emergency care. She was sent along with her demanding and unpleasant parent to the registration area since we didn't have a space to put her. 

Minutes later, I saw a blur as Parvati raced her back to the Code room via wheelchair and unwrapped the finger.  Call the helicopter.  Help, murder, police.  It was an avulsion from a vegetable peeler.  They may be painful, but not race-back-to-our-only-available-bed urgent.  I glanced briefly into the room and quickly lost interest.

Parvati came back to the desk, actually shamefaced: "I'm sorry, I'm sorry, her mother said she was going to pass out, I just thought she should probably lie down.  I didn't realize it was such a tiny cut".
SIC: "I know her.  She is very dramatic and stupid,and her mother is an idiot"

I witnessed this exchanged with my mouth open.  For one thing, Parvati never says "please" or "thank you", never mind "I'm sorry".  This was.....unprecedented.  For another, what was this?  Perfect SIC calling a a patient stupid and the mother an idiot??  And Parvati pushing a wheelchair? And I am well behaved??

What, am I in Bizarro World?  UP is DOWN, BLACK is WHITE, NIGHT is DAY?  What's next, human sacrifice, dogs and cats living together... mass hysteria?  This could be either very good or very bad;  I will go to the experts for an opinion. since I'm fuzzy on the whole good/bad thing. What do you mean, "bad"?

Dr. Egon Spengler: Try to imagine all life as you know it stopping instantaneously and every molecule in your body exploding at the speed of light.

Dr. Ray Stantz: Total protonic reversal.

Dr. Peter Venkman: Right. That's bad. Okay. All right. Important safety tip. Thanks, Egon.

Saturday, August 13, 2011

On Not Feeding the Monkeys

I discovered that irrepressible Kate, my newest partner in crime had created the latest time wasting activity (in addition to coming up with songs for my "ER Complaint Soundtrack", more on that another day).  It was a list of bogus initials to use when we input EKG's.  It should be entertaining when the EKG wench calls to berate us for somehow managing to screw up and make all kinds of work for her.  The list includes:
Doing EKG's is kind of time consuming because there is lots and lots of important patient information that has to be typed in.  In an actual emergency, it is possible just to put "911 chest pain" in and edit the particulars later.  Because there are two different sets of 9 and 11 digit identifiers, on occasion there might be an error.  Or a misplaced letter when we type it in (no scanners here).  We make every effort to be accurate with these, but what can I say: we are human.  Instead of merely making the changes in the EKG department where each study is wirelessly received (the wonders of modern technology!) the evil EKG troll has a hissy fit, way down in the EKG cave where she resides.  I don't thing she sees daylight, or humans, that often.  She will frequently file an error report and/or call us.  She lacks adult social skills big time, and has a tendency to screech.  I handle this type of rude telephone behavior with my usual professional skill.  I simply hang up. 

"This is EDNurseasauras, how can I help you?"
"Call me back when you are calm and can speak to me like a professional".  Click.

Kate: "Did you hang up on EKG again?"
Me: "Yep.  She still hasn't learned, but I remain hopeful"
Ellen, 30 seconds later: " EKG is on the phone.  She wants to talk to whoever hung up on her.  She didn't sound happy"
Me: "Ellen, was she rude to you?  Seriously??" (I get really pissed when people are rude to Ellen)
Ellen: "Oh, well, heh heh.  She was a little....high strung I guess"
Me: "This is EDNurseasauras.  I will not tolerate your  rudeness to me OR my staff.  If you can lower your voice and communicate respectfully I'm happy to hear your complaint.  "


Me: "Look, I'd love to chat with you about the logistics of your job, but mine involves actual patient care.  In fact, I'm going to do CPR right now since my partner is signalling me to get off the phone.  Have a nice day".

Kate (grinning and shaking her head): "Lady, you do love to poke that bear in the cage, don't you?"
Me: "That's no bear, it's hardly a trained monkey. But she does have opposable thumbs....I think".

The next call was from the nursing supervisor. 

Supervisor: "EKG troll called me to complain that you keep hanging up on her"
Me: "Yes, that's true, but only twice today.  Let me ask you: she was shouting, wasn't she? How long did it take you to calm her down so that you could get the story out of her?"
Supervisor:" Um..."
Me: "That's what I thought.  I was perfectly polite to her, but she continued to use a raised voice and unprofessional communication technique.  So I terminated the conversation.  I will be happy to talk to her if she acts like a big girl.  Please have her read her telephone manners guide.  She needs to calm down before she pops an artery or something"
Supervisor: "Hahahahaha!"

I understand that her job doesn't involve much actual communication with people, but you would think that someone who has been working in this place for 10 years would be better trained.  Perhaps the Clip Boards simply throw her a piece of raw meat every once in awhile, who knows.

So, getting back to the initials.  Today I just used "SOB".  I think EKG troll would agree with that.

Friday, August 12, 2011

No Soup for You

An 18 year old male came in with a finger laceration, doing the drama dance.  "It burns!  It burns!  The pain!  I think I cut it to the bone!".  I glanced at this monstrous wound to find a tiny little laceration on the pad of his finger after unwrapping it from within its nest of  1/2 of a cut off tube sock,  and some blue string.  It was a nothing injury, not even bleeding.

Next, he handed me some pharmacy labels.  "I had a car accident and my back is really messed up.  My doctor is on vacation, so can I get a prescription for these too?".

I don't know who would ever put an 18 year old on oxycodone, but my triage note read:

"1.  Laceration.  2.  Requests narcotic refill". 

Most of the docs know that when I number the triage complaints there is probably a much longer story behind it.  The most I have ever had was 6 sequentially insignificant complaints.

Parvati didn't even put glue on his booboo.  But she did ask me to call the provider who was supposedly on vacation.  Guess what?  He wasn't.  The office manager was kind enough to share with me that the patient had called their office only this morning with a similar request for meds, but gee, he had  just been given a 'script only 5 days ago.  He was told he would have to make an appointment since that was way too soon to be thinking about a refill.  Did I still want to speak to the doctor?

Nope.  You can just go ahead and make a notation in his medical record before he automatically gets the report of his patient's ER visit.  Just another little service that we provide. 

I put a bandaid on and prepared to kick him to the curb.    But I did tell him that I had contacted his doctor, who now knows he is on the scam for more oxy.  "I'm only sorry I can't call your mother since you are over 18", I said.

"Oh, that's not good", he said, hanging his head.  He simply turned around and left, and I doubt he will be back...this week.

Thank you, Medicaid, for providing this young man with free doctor's visits, no-cost ER visits, and  the means for an 18 year old to earn some cash this summer.


Thursday, August 11, 2011

"Heeeeere's Johnny!

I am ready for some R&R after the last 5 day stretch, seeing 23, 24 patients per shift.  This wouldn't have been so bad if it hadn't been an endless parade of IV's, EKG's transfers, and nothing simple.  What made my last few shifts unbearable was the presence of Parvati.  The ex-surgeon in her likes to do her own dressings, but she is pretty helpless when it comes to actually finding anything:
"Where is the gauze?"
"Where is the bacitracin?"
"Where is lidocaine?"
"Where is the tape?"
"Where is the extra saline?"
Anxiety=cardiac workup, EKG, labs, etc.
Chronic migraines=IV fluids, narcotics, sometimes Toradol and then narcotics, anti-emetics and tying up a room for 3 hours.  And a prescription for Percocet.
The "I need a refill of my Percocet" crowd usually goes away empty handed for some reason.

I usually ignore Parvati's rapid-fire verbal orders which annoys her; then she asks the other nurse, who also ignores her.  This is not simply to be a pain, but she will frequently change her mind, which just makes work for me, inconveniences the patient with additional veinipunctures and makes me cranky.  Ignoring her really amounts to saying, "Just go ahead and write the orders, I am doing the other 4,000 tasks you asked me to do; remember, there is only the two of us to do everything.  It takes you two minutes to do the exam, but it takes us a lot longer to do these things.  You need to be patient.  Why don't you go eat dinner (and get out of my way?)".

Hilariously, Parvati hasn't complained about me yet.  She did complain to our boss about Second in Command, who in her desperate attempt to appear competent and all-knowing comes across as be a little overbearing with new doctors.  She will argue or give them her 2 cents about what they need, second guesses them and makes herself seem indispensable.  I never argue unless I have a damn good reason so I
don't come off as a squeaky wheel.  It's not time to argue until it's time to argue, a corollary to It's not time to panic until it's time to panic.  That way, if  tell a doc I am worried about this or that they actually listen to me.  Parvati, though...doubt she listens to anyone since she makes way too much noise to hear anything anyway.

After three of the longest shifts of my life with Parvatti for ALL THREE SHIFTS I was feeling a tad....homicidal. Which accounted for my mutterings


I suddenly have the urge to re-read "The Shining".  And maybe buy an axe.