Thursday, June 19, 2014


The term "LOL",  before gaining widespread popularity as an acronym for responding to text messages and emails for which we are too lazy to write a proper response,  had another meaning   LOL= Little Old Lady.  At least in health care.  Of which there is an abundance at BWOM, a distinctly aged population, this hospital.  On any given shift the department will have a uniformly unhealthy selection of patients in their late 80's, 90's or even a scattered centenarian awaiting admission or transfer.  There are a lot of nursing homes and somewhat upscale assisted living joints.  There are lots of gravitationally challenged elders.  Lots.  Everyone sports yellow socks, yellow bracelets, and cute little yellow "falling stars" on the doors of the rooms for fall risk.  "Yellow socks for LOL's cause they will fall"

One LOL was brought by the usual contingent of  Entitled Concerned Family Members having become increasingly weak at home.   She had taken a fall several days earlier and evaluated at the ER (not ours) and sent home with family.  She did not do well.  She refused to eat or drink, take the pain medication, or participate in her care.  I don't know how the Entitled Concerned Family Members got her into the car, but it was necessary to lift her bodily out of the front seat by one of my heftier co-workers and was marked for admission within the first 3 seconds of her visit.  

As previously mentioned, the admission ritual is pointlessly lengthy.  There are also two issues that make the process just that much more difficult: the layout of the department and the happy bunny concierge service that management insists we must provide, even it if means that actual stuff we're supposed to do is not done in a  timely fashion, let alone properly documented.  I have many times stayed hours after my shift to document.  It's crap.  But I get paid overtime. Don't bother complain, Boss Lady.

It is often necessary to work around all the Entitled Concerned Family members who hang out in the room and think nothing of coming out to the desk and asking for everything they can think of under the sun.  The physical lay-out of the department is moronic.  Juice.  Crackers.  Pillows.  Warm blankets.  5 more warm blankets.  Reposition.  Toilet.  Toilet.  More juice.  Cardiac monitor beeping.  Concerns about BP.  Concerns about o2 Sats.  When will she go upstairs.  Can she have pain meds.  Can she have blood pressure meds.  Can she have tylenol. Will you recheck her temp.  It is a constant barrage; nothing gets done and woe if I have other patients to take care of with equally demanding Entitled Concerned Family.

The two nursing stations are placed back to back, but with the doc's dictation room and pyxis / med room in the middle.  You can't communicate well with the secretary.  The problem with the placement is the proximity to the doors of patient rooms which is less than 8 feet.  It looks like a bank, but with low counters and no bullet proof glass.  It is not possible to have a private conversation, speak on the phone, communicate with providers, or in any way follow any patient privacy policies.  Like all nurses,  I usually have a couple of  situations going at one time.  Consider juggling three bowling balls and a chain saw.  It is exhausting.  The desk placement makes the nurses sitting ducks for anyone with a questions or request;  ALL  the Entitled Concerned Family members  think nothing of coming over to the counter and asking for everything they can think of under the sun.

 It is NOT OKAY to interrupt constantly.

Herewith, my open letter to same.

Dear Entitled Concerned Family Members:

Let me just make a comment about why I am sitting ever so briefly at the desk.  It is not for your convenience.  It is not the check-out counter at the market.  It does not say INFORMATION in bold neon letters about my head, nor does it say HANG OUT HERE.

Please note that there is a computer, a centralized monitoring system, and a phone.  There are other personnel with whom I may be speaking about other patients; what she and I are speaking about is not only none of your damn business, but a violation of the privacy rights of other people.  We do not have the Cone of Silence.

What I want you to know is that while I would love to spend each and every moment of my evening with your loved one, you and your family members are rapidly sucking the life right out of me, as well as every ounce of empathy.  Your very nice but markedly demented grandma has been toileted 4 times in the last hour (3 of them needlessly because you keep asking her if she needs to go.  She's demented.  She says yes).  Turned her.  Given her water, juice, and a snack.  I have acceded to your requests for warm blankets and more pillows.  I have put all of the chairs into the room that are appropriate for the 2 allowed visitors even though there are 5-6 and I am stepping around them.  I have been into the room to address each and every variation of blood pressure or heart rate that has concerned you and reassured the lot of you that I am indeed keeping an eye on it and there has been nothing dangerous or even noteworthy about these variations.  I have relayed each of your requests, comments, concerns to the treating physician.  I would love to get her medication for pain but THAT ORDER IS IN THE COMPUTER AND I NEED TO SIT AT MY DESK IN ORDER TO ACCESS IT.  I also need some consideration for figuring her dosing and you keep distracting me.  It is dangerous.  I think she needs those packed cells more than another warm blanket.

I do not know when the floor will be ready to accept grandma.  Again, addressing that situation requires me to be away from the bedside for more than 30 seconds at a time while you dream up yet another inane request. Before I can consider giving report, I must call the pharmacy to get a complete list of her medications because you didn't bring one, assuming that "we have it in the computer".  We do not.

 I am sorry grandma is not feeling well and you have had to sit by her side for the last four hours, but really, I have this.  You guys apparently did a shitty job of taking care of her needs at home, why don't you all just go away now and let me have a crack at her.  You are so busy making sure that all the bases are covered that you are not letting her rest.  Now, beat it.

Yours Truly,