This young woman complained of back pain, having fallen on ice 2 days before. Her pain was 10/10 even despite the one dose of Tylenol she had taken the night before. I asked the usual questions about her significant medical history, allergies and medications. With a woman of childbearing age we ask the date of the last menstrual period, particularly if there is a possibility of needing any xrays. Her response to this question was, "oh, I don't know. A couple of months ago. I don't want any xrays, I'm really scared of them". For some reason, I begin to smell a rat; there is something just not right. However, I failed to ask the important follow up: "is there any possibility you might be pregnant?". Hey, we were busy and I did the best I could; it was some time before she got into a treatment room.
Gil, my doc of the day seemed to be in the room for a long time. He is very thorough. I had a minute to pull up a couple of past visits: only three for 2009. Not drug seeking behavior. I noticed she was seen for a possible miscarriage in July.
As I was reading this, Gil came out of the room. "Did you know she was pregnant?", he asked. "Nope. She didn't mention it, in fact she said her LMP (last menstrual period) was a couple of months ago".
"She didn't say anything to me either", Gil shook his head. "I inquired when I examined her gravid belly".
I am hearing dissonant clash of very loud warning bells now. "You know, in 30 some-odd years I have never had a gone-to-ground pregnant woman whose first words after a fall are NOT 'I'm pregnant'. Yet this one doesn't disclose it to either you or me, and hedges on the LMP by saying she's afraid of xrays and doesn't say why? I have her old record up, maybe you should have a look".
A look at a visit months ago revealed an ultrasound for a possible miscarriage; some higher math determined what the young woman didn't tell us: she was about 32 weeks pregnant.
Now I get it; it's about her, not the baby. At first I thought that this was scamming for narcotics, perhaps to sell, but she was asking for pain medicine. The fetal heart beat was fine; she had no signs of labor. Did she have an obstetrician? Nope. It had been at least 3 months (if she was being honest) since she had any prenatal care; probably none at all since her ER visit months ago. Our plan was to send her to the mother ship.
Gil didn't trust that she would show up at the downtown ER; I didn't trust her as far as I could throw her with an IV in her hand. She would go by ambulance. Must we always save people from themselves?
Her charming female companion burst out of the room, and in a voice that would melt paint off the walls demanded to know who was going to bring her home. "I had to borrow my brother in law's car because her's is crap; I can't wait around for her all day and she is freaking out about how to get home. How will she get back here?"
"Well, she could take a cab, or perhaps another family member could pick her up; that is her problem. And keep your voice down, you're disturbing others".
She was nearly apoplectic with rage, but I stared her down while she appeared to swallow her tongue. "She won't go then", charming compantion said sulkily.
"No problem, she can sign herself out AMA (Against Medical Advice). If you have any influence with her, I suggest you talk her into it. She's had a fall, basically no pre-natal care and her baby is at risk. There is an obstetrician waiting to see her. Up to you. She can talk to social services when she gets down there about comping her a cab, I don't do that here. Let me know what you decide", I said dismissively.
She went. The baby was fine. She got excellent free care even though she had little interest in the baby and no insurance. We already have socialized medicine. People who are paying for health insurance, following the rules, and working damn hard are getting the shaft. This one not only gets excellent free care but expects door to door service. Sheesh.
Some people just bring out the worst in me, more so as I get older. I am letting my annoyance show, which will likely get me into trouble. I have zero tolerance for complete idiocy and listening to bullshit, and it's not just at work. Last night at skating practice I was pretty rude myself to one completely annoying teammate; not that she didn't have it coming. She travels in her own orbit, says stupid things and never bloody shuts up. Urrgh. I have given up trying to be nice to her and can't wait for the end of the season so I will never have to see her again. Most of the time I just want to slap the ears off her head. Urrrrrhhhhgggghhhh. The point is until recently I never would have let the verbal zingers fly. Best get a handle on that.
Monday, January 18, 2010
Saturday, January 2, 2010
Today's Last Patient of the Night
Every so often there is a patient who will haunt me forever; our Last Patient of the Night is one I will think about often.
He was small for a 4 year old, a beautiful blue eyed blond little boy. He was whimpering strangely in the arms of a woman whom I assumed was his mother, also blond and blue eyed. They were accompanied by two little girls, probably 8 to 10 years old. They were silent.
"He's an orphan", said the mom. "We're his host family for the holidays, and we have a folder of his medical records. He burned his finger tips when he touched the glass screen of the fireplace".
I took a look at the little boy's fingers; the 2nd, 3rd, and 4th fingers of his left hand had a blister on the pads where they had come into contact with the blistering heat. He was alternately putting his hand on the ice covered in a wet paper towel, and removing them and sobbing, clenching his fists with pain. These types of burns usually do fine, but are excruciatingly painful for the first few hours.
The mother went on, "He's from Latvia, and he's deaf. He's from a program where orphans spend time with families for the holidays; we would like to adopt him".
"We love him", the youngest of the little girls said simply.
Normally immune to such situations, my heart melted on the spot.
His records were, uselessly, in Latvian. We tried some numbing medicine on the burns, gave him some Tylenol with codeine and tried to make him comfortable. I got a sterile cup, filled it with room temperature saline and had him dip his little fingers in it. Immediately he stopped crying. After several seconds, he lifted his fingers out of the cup experimentally; his face crumpled with pain, and he howled like a wounded animal. I gestured to him to put his fingers back in the water and was rewarded with a surprised grin. He put his head on the mother's shoulder and sighed contentedly.
I really didn't want to pry, but I asked, "Does he have to go back to Latvia after the holidays?"
"Yes, and that's going to be so hard. He's such a precious boy; he never cries, well, at least until he hurt his fingers. I wonder, do you think it's because he's deaf?"
"It's an orphan thing", explained the older of the two little girls sagely. I was astonished at her insight.
"Does he sign at all?", I asked. I vaguely recalled that American Sign Language (ASL) is not universal; most countries have their own sign language and their own rules. From some deep, forgotten part of my brain I recalled some signs I had learned years and years ago when my friend Geri and I took 2 semesters of an evening school sign language course.
The little boy had started to shiver; I balled both my hands into fists with the thumbs sticking out between the index and middle fingers. Shaking my hands in front of my I said, "Cold".
No reaction from the little boy, but the mom was interested. "What's the sign for 'hot'?"
I just couldn't remember. I remembered "play", "mom", "girl and boy", "friend". The two little girls quickly picked up on the few signs I could remember. One final sign popped into the front of my brain; I made a motion as if to pull at the visor of a ball cap, followed by touching my lips with the fingertips of my hand and then touching my other hand with both palms up.
"Good boy". Such a good, sweet boy; this family was in love.
" I know how to say 'I love you'", offered the youngest little girl, as she extend her thumb, index and pinky finger and held her palm side out; "That's the most important sign of all".
They were ready to go home. The two little girls wordlessly gathered up their coats, the mom's purse and car keys. The oldest gently put the little boy's hat on his head and softly kissed his flushed, tear stained cheek. They went out into the snowy night.
My New Year's wish is the hope, with all of my heart, that this lovely family will be able to make the little guy a permanent part of their family. They all deserve a happily ever after ending.
He was small for a 4 year old, a beautiful blue eyed blond little boy. He was whimpering strangely in the arms of a woman whom I assumed was his mother, also blond and blue eyed. They were accompanied by two little girls, probably 8 to 10 years old. They were silent.
"He's an orphan", said the mom. "We're his host family for the holidays, and we have a folder of his medical records. He burned his finger tips when he touched the glass screen of the fireplace".
I took a look at the little boy's fingers; the 2nd, 3rd, and 4th fingers of his left hand had a blister on the pads where they had come into contact with the blistering heat. He was alternately putting his hand on the ice covered in a wet paper towel, and removing them and sobbing, clenching his fists with pain. These types of burns usually do fine, but are excruciatingly painful for the first few hours.
The mother went on, "He's from Latvia, and he's deaf. He's from a program where orphans spend time with families for the holidays; we would like to adopt him".
"We love him", the youngest of the little girls said simply.
Normally immune to such situations, my heart melted on the spot.
His records were, uselessly, in Latvian. We tried some numbing medicine on the burns, gave him some Tylenol with codeine and tried to make him comfortable. I got a sterile cup, filled it with room temperature saline and had him dip his little fingers in it. Immediately he stopped crying. After several seconds, he lifted his fingers out of the cup experimentally; his face crumpled with pain, and he howled like a wounded animal. I gestured to him to put his fingers back in the water and was rewarded with a surprised grin. He put his head on the mother's shoulder and sighed contentedly.
I really didn't want to pry, but I asked, "Does he have to go back to Latvia after the holidays?"
"Yes, and that's going to be so hard. He's such a precious boy; he never cries, well, at least until he hurt his fingers. I wonder, do you think it's because he's deaf?"
"It's an orphan thing", explained the older of the two little girls sagely. I was astonished at her insight.
"Does he sign at all?", I asked. I vaguely recalled that American Sign Language (ASL) is not universal; most countries have their own sign language and their own rules. From some deep, forgotten part of my brain I recalled some signs I had learned years and years ago when my friend Geri and I took 2 semesters of an evening school sign language course.
The little boy had started to shiver; I balled both my hands into fists with the thumbs sticking out between the index and middle fingers. Shaking my hands in front of my I said, "Cold".
No reaction from the little boy, but the mom was interested. "What's the sign for 'hot'?"
I just couldn't remember. I remembered "play", "mom", "girl and boy", "friend". The two little girls quickly picked up on the few signs I could remember. One final sign popped into the front of my brain; I made a motion as if to pull at the visor of a ball cap, followed by touching my lips with the fingertips of my hand and then touching my other hand with both palms up.
"Good boy". Such a good, sweet boy; this family was in love.
" I know how to say 'I love you'", offered the youngest little girl, as she extend her thumb, index and pinky finger and held her palm side out; "That's the most important sign of all".
They were ready to go home. The two little girls wordlessly gathered up their coats, the mom's purse and car keys. The oldest gently put the little boy's hat on his head and softly kissed his flushed, tear stained cheek. They went out into the snowy night.
My New Year's wish is the hope, with all of my heart, that this lovely family will be able to make the little guy a permanent part of their family. They all deserve a happily ever after ending.
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.
Frig.
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 ultrasound...in 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.
OK.
"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.
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.
Frig.
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 ultrasound...in 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.
OK.
"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 Crankshaft...um, 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
Bastards.
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.
Bull.
Shit.
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.
Huh?
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.
"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 Crankshaft...um, 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
Bastards.
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.
Bull.
Shit.
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.
Huh?
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.
Wednesday, November 4, 2009
Bite Me
It is absolutely essential that I have a laugh at work. For that matter, I pretty much have to laugh wherever I go. I have been called witty, but when I'm together with my brothers the zingers fly. It is nice that my two adult children have the confidence to step into that arena now. They are both VERY funny; my son J is dry as a bone. K, my daughter also has a great sense of humor. We do laugh a lot together.
The ER is just ripe for funny stuff. Not that we are laughing at the patients, but sometimes the stuff that comes out of people's mouths, well, you just have to laugh.
I often say whatever is on my mind, and I like to make the patients laugh a little when I can. I am a big Monty Python fan, and frequently I will throw out a line just to see if anyone will bite. A patient came in with a hamster bite, and I asked if the the little ratly creature was prone to such behavior or this was an aberration. As I swabbed the puncture I mumbled running commentary along the lines of "It's only a harmless hamster" (note Holy Grail reference) and the guy picked right up on it and responded in kind. Before you know it, we were bantering lines back and forth and laughing like idiots. Good thing it wasn't busy. Spam, spam, spam, spam...
Another animal bite victim comes in, this time a dog bite. We heard a dog barking from somewhere in the neighborhood; "Did they bring in the dog?" asked Cathy, my Southern nurse accomplice
"Nope. Just the head", I kidded. "Wanna know his name"?
"Ok, what is the dog's name" she said, bracing for impact.
"John the Baptist".
Ouch.
Dog bites are epidemic, and we get another one. This one had a chunk of skin missing from the space between the thumb and forefinger. This one struck for "no reason".
My partner loves dogs and just had to have a conversation about English sheep dogs. Dog bites to the hand are usually not sutured; risk of infection.
The other day a woman was out in her yard hanging laundry and minding her own when she was attacked by a woodchuck who tried to take a chunk out of her leg. No, they didn't catch it. My neighbor had one living under her front porch, and I tell you, they are mean. I was walking my dog and the thing sat brazenly on the front steps in the middle of the afternoon and screamed at us. Good thing the dog was on leash or she could have been killed. Scary damn creatures.
Sometimes people just go looking for Trouble. I mean, they practically out and out take an ad in the Lost and Found section of the paper they want Trouble so bad. The think about Trouble, if you go looking for it you can generally find it quite easily in Plain Sight. Here is an excellent example.
One guy came in with a farily nasty bite on his hand because he tried to PET A FERAL CAT.
He told us all about his rescue attempt of a SKUNK WHO HAD BEEN HIT BY A CAR.
Are you kidding?
"Yeah", he said, "That thing scratched me up pretty good, but as soon as I put it in my car the thing SPRAYED me!"
We really aren't supposed to say "What th fu*k?", it's not too professional. I couldn't help but ask "Um, what did you have in mind when you put that wild creature into your car?" to which he replied. "Well if we had called animal control, they would have just killed it".
Oh, of course I completely understand now.
I live in a semi-rural area; I'm not talking Allagash here, but the houses on my street are at least 3 acres apart and is bordered by woods. One of my neighbors who lives at the end of my cul-de-sac- was attacked by some sort of 4 legged critter--in broad daylight. It was first thought to be a fox, then a coyote, then a fisher cat, then a wolf. Whatever it was, it was going after their horses; they are beautiful draft horses, and let me tell you they are BIG. The family also has some unidentifiable large dog the size of a pony, but they kept that in the house. The woman went out with a stick and started yelling at it while one of the kids called 911. Whatever it was, the animal turned on her and latched on just above the elbow; she was literally beating at it with the stick but it wouldn't let go. She finall managed to pick up a rock and bashed it in the nose; it let go and ran off. She said it couldn't have been more than 15 seconds, but it seemed like hours. The whole time she was afraid one of her kids would come out to join the fracas. We cleaned her up, did some xrays, updated her tetanus, and started the rabies series. A few days later when she came back for her next dose she was a mass of bruises. And, she said, the critter had returned but they had managed to scare it off with a BB gun and her son's slingshot, but from the back porch. Whatever works I guess.
The ER is just ripe for funny stuff. Not that we are laughing at the patients, but sometimes the stuff that comes out of people's mouths, well, you just have to laugh.
I often say whatever is on my mind, and I like to make the patients laugh a little when I can. I am a big Monty Python fan, and frequently I will throw out a line just to see if anyone will bite. A patient came in with a hamster bite, and I asked if the the little ratly creature was prone to such behavior or this was an aberration. As I swabbed the puncture I mumbled running commentary along the lines of "It's only a harmless hamster" (note Holy Grail reference) and the guy picked right up on it and responded in kind. Before you know it, we were bantering lines back and forth and laughing like idiots. Good thing it wasn't busy. Spam, spam, spam, spam...
Another animal bite victim comes in, this time a dog bite. We heard a dog barking from somewhere in the neighborhood; "Did they bring in the dog?" asked Cathy, my Southern nurse accomplice
"Nope. Just the head", I kidded. "Wanna know his name"?
"Ok, what is the dog's name" she said, bracing for impact.
"John the Baptist".
Ouch.
Dog bites are epidemic, and we get another one. This one had a chunk of skin missing from the space between the thumb and forefinger. This one struck for "no reason".
My partner loves dogs and just had to have a conversation about English sheep dogs. Dog bites to the hand are usually not sutured; risk of infection.
The other day a woman was out in her yard hanging laundry and minding her own when she was attacked by a woodchuck who tried to take a chunk out of her leg. No, they didn't catch it. My neighbor had one living under her front porch, and I tell you, they are mean. I was walking my dog and the thing sat brazenly on the front steps in the middle of the afternoon and screamed at us. Good thing the dog was on leash or she could have been killed. Scary damn creatures.
Sometimes people just go looking for Trouble. I mean, they practically out and out take an ad in the Lost and Found section of the paper they want Trouble so bad. The think about Trouble, if you go looking for it you can generally find it quite easily in Plain Sight. Here is an excellent example.
One guy came in with a farily nasty bite on his hand because he tried to PET A FERAL CAT.
He told us all about his rescue attempt of a SKUNK WHO HAD BEEN HIT BY A CAR.
Are you kidding?
"Yeah", he said, "That thing scratched me up pretty good, but as soon as I put it in my car the thing SPRAYED me!"
We really aren't supposed to say "What th fu*k?", it's not too professional. I couldn't help but ask "Um, what did you have in mind when you put that wild creature into your car?" to which he replied. "Well if we had called animal control, they would have just killed it".
Oh, of course I completely understand now.
I live in a semi-rural area; I'm not talking Allagash here, but the houses on my street are at least 3 acres apart and is bordered by woods. One of my neighbors who lives at the end of my cul-de-sac- was attacked by some sort of 4 legged critter--in broad daylight. It was first thought to be a fox, then a coyote, then a fisher cat, then a wolf. Whatever it was, it was going after their horses; they are beautiful draft horses, and let me tell you they are BIG. The family also has some unidentifiable large dog the size of a pony, but they kept that in the house. The woman went out with a stick and started yelling at it while one of the kids called 911. Whatever it was, the animal turned on her and latched on just above the elbow; she was literally beating at it with the stick but it wouldn't let go. She finall managed to pick up a rock and bashed it in the nose; it let go and ran off. She said it couldn't have been more than 15 seconds, but it seemed like hours. The whole time she was afraid one of her kids would come out to join the fracas. We cleaned her up, did some xrays, updated her tetanus, and started the rabies series. A few days later when she came back for her next dose she was a mass of bruises. And, she said, the critter had returned but they had managed to scare it off with a BB gun and her son's slingshot, but from the back porch. Whatever works I guess.
Speaking of biting critters, one of my co-workers, Sherry, goes to Alaska every summer to canoe down random wilderness rivers above the arctic circle. She and her husband are gone weeks at a time. They eat a lot of jerky and soup because they neither fish nor hunt; they are very concerned about their carbon footprint. Sherry and hubby have done these trips for years, loving peace and solitude, the beauty of their surroundings and usuallythe abundance of wildlife.
They have never had the kind of chilling close encounters with grizzly bears they experienced this year. Apparently there was some kind of grizzly bear convention because this year, not only were the bears present in unprecidented numbers but they were very curious; one might even say they were stalking my friends. This went on for days; they would make camp and bears would always be nearby. One even started running her way, far enough but still too close for comfort. Apparently, because they were without any kind of weapon except Grizzly Bear Spray in a can for REALLY close encounters, they largely deterred these creatures with a whistle or shouts. I wouldn't have closed my eyes. Ever.
"How can you go into the wilderness without a gun?" I asked.
Sherry was so completely unnerved by the memory of charging grizzlies that she told her husband that she didn't think she could do the trip next summer. Her husband thought it would be a good idea if they brought a gun next year because he really wants Sherry to go and feel comfortable. He even said he would learn how to shoott.
"Well, you need to learn too!", I exclaimed.
"Oh, I grew up around guns. My Dad still hunts. I know how to shoot", she replied. Yikes. Apparently her husband is the pacifist, and was begining to see the danger inherent in this situation in a new light.
I thought that as the weeks and months went by Sherry and her husband would take a more assertive approach to procuring a firearm. Unfortunately, the epiphany was short lived and her husband is backing off and losing his resolve. Sherry, on the other hand, just bought a can of pepper spray, which you don't need a permit to carry in this Shoot Pepper Spray and Live Free or Die state. Today pepper spray, tomorrow protection against grizzlies.
Good luck Sherry! Guess your husband will simply have to continue to use harsh language voicing his extreme displeasure in unequivocal terms while taking care not to damage the self esteem of the native ursus arctos horibilis.
Read to the bottom for full hilarious effect. Love it!
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