Monday, May 14, 2018

On not receiving coffee, chocolates

Working the evening and overnight shifts in the ER is a lot like being the unfavored child.

The darlings of the day shift enjoy things like adequate staffing.  A call out for the day shift?  Immediate urgent ping to all staff!  Come in and work for double time!  Crazy busy!  Boarding 6!

They have a charge nurse and a manager on the floor in addition to the department nurse director.   None of them take patients.   Day staff enjoys perks like breaks, and many free drug-rep sponsored lunches.  Baked goods, candy, treats all arrive on day shift.  Recipients of various "awards" (photo ops) devised by clipboard commandoes are all day shift divas.  They have transport volunteers so they never have to lift a finger to transport their patients.  The urgent care part of the ER opens at 9 AM, so they stack potentials in the waiting room starting about an hour prior, then fill those beds up all at once.  Heaven forbid they see urgent care patients.

Which brings me to Nurses' Week, the favored Hallmark holiday for administrators with plenty of time on their hands.  This year, there were no shitty water bottles.  No umbrellas, pens, or other 35 cent items for mass distribution.  No "lottery" for a beach basket with everything a person needs to have a fun day by the ocean.  No wine basket.  No reiki in the break room.

There was a giant cake, courtesy of our buds at the local ambulance service.  Very delicious.

Some of the docs were cool, springing for  pizzas, a favorite meal from a local chicken place, ice cream with all the fixings,  much appreciated and  meant more to those of us working the off-shifts than the formal annual pomp and ceremony photo-op "gathering" for nurses week.  A selection of ice cream (chocolate and vanilla, from what I heard) and some sprinkles to announce the Big Kahuna's pick for the nurse of the year award, who was a non-clinical administrative Quality darling.  Everyone knows Quality is Satan.   The sundae bar soiree was held in the middle of the afternoon in the hospital cafe.  Bear in mind most staff work 12 hour shifts.  Floor nurses are busy with patients, meds, and discharges in addition to the mid-afternoon admission rush.  These guys hardly get a pee break and rarely get to lunch, let alone leave the floor en masse to listen to know- nothing admins make speeches.   I boycott these "celebrations" on principle, and ya'll can stick your ice cream buffet.

You want happy employees?  Send us some damn help on the off-shifts.

Saturday, May 12, 2018

Head smacking moment

I spent a loooong shift at the old stomping grounds Medde Center with some of my old crew.  Good times, like, I mean, before The Apocalypse.

But it's urgent care.  I complain about how hard it is at Pseudocity,  how busy it is, and how punishing it is on my aging body.  However, I have come to the conclusion that I would rather poke hot, sharp, steel needles in both of my eyes than go back to a steady diet of stupid and have finally figured out why.

At Pseudocity, we do see the same patients.  Rash.  Boo Boos.  Back pain.  Sore throat.  Colds.  Lots of silly nonsense sometimes.  However, those patients are low priority and often sit in the waiting room for a long time.  They won't be seen sooner than chest pains or strokes.  They eventually get seen, but they are kind of out of sight and out of mind.  Sometimes they get bored and leave.  They can actually see the chaos that trumps their non-urgent complaint which tends to put things in perspective for most people with even minimally functioning common sense.  But at the MEdde Center, they are promptly registered, roomed and triaged.  On days when there are two providers, they are in and out.  Actual urgent care, and it can be a little faster paced and somewhat fun.  But when they are already roomed, they are RIGHT THERE in your face.  There is no privacy, and sitting at the computer, making phone calls and conducting business is seen as ignoring their low priority problem and they don't like it.

Today, only one provider and she was slow.  I should say methodical, actually, because she's always been careful and conscientious, but that does slow the process.  When patients wait in a tiny room for about an hour, they get testy and threaten to leave.  Here are the three that stand out.

1.  Leg boo boo, 30 minutes in:  "I have groceries in the car, how much longer will I have to wait?  Everything is melting".

2.  7 year old with recess wrist injury: (given a fun sling by the school nurse), 35 minutes in and pending X-ray which she doesn't need and everyone knows it "Does she really need to wait? She's moving it just fine now she's been here so long.  Do you have any crayons?".

3.  54 year old with atraumatic neck pain for a week: (yelled from the doorway) "I've been here for two hours (one, actually), and I"m in terrible pain! (note: did not take any OTC analgesics, use ice or heat, or  call her own doctor) "Next time I'm going to Mega Hospital, and I'm writing a bad review on Google".

Bye Felicia.  You can threaten to leave all you want, I'm not gonna beg you to stay.

So, back to  my epiphany.   Right now the prospect of a permanent urgent care job is not enticing.   The constancy and sheer boredom of routine office-type complaints and entitled attitudes would turn my brain to mush.  I'm not saying the job is without challenges, but there simply is not enough challenge for me.  I've fought to regain my critical care skills, it is not time to put them on the shelf forever.