Nobody has a sense of humor anymore, especially our IT people.
We are housed in an old building. There are mice from time to time, tiny little field mice. I haven't seen any in about 3 years, but one was spotted recently by a patient who got pretty upset about it and made all kinds of stupid demands, said she wasn't paying her bill, etc., etc., etc.
I got right on it. I sent an internal request for someone to investigate our mouse problem. Just for laughs, I sent it to IT. I figured it would be a nice change from dealing with forgotten email passwords and taking turns writing about how wonderful they are on the hospital attaboy board. I checked the box that said "mouse, wireless" and sent it on over.
Memo exchange follows:
TO: EDNurseasauras
From: IT
RE: Mouse Problem
IT is only responsible for hardware issues, computer programming malfunctions, Help Desk issues, and other system issues related to electronic charting, etc. Your mouse problem does not fall under IT responsibility. Please initialize request to facilities.
TO: IT
From: EDNursesasauras
RE: Mouse Problem
That's ok, I'm more of a do-it-yourselfer. In the absence of a mouse trouble-shooting tutorial, what kind of cheese would you recommend I initialize?
TO: EDNurseasauras
From: IT
RE: Really, it's not our problem but I suppose peanut butter might work.
TO: IT
From: EDNurseasauras
RE: It is now
If I catch the mouse, should I just disable it? Would there be any point in reinstalling?
TO: EDNurseasauras
From: IT
RE: Really???
Now you're messing with me, aren't you?
Do you even have a mouse problem?
Yep. Also I know the location of the beige marketing cart. And Jimmy Hoffa.
Eventually the facilities department set traps.
More on that later.
Thursday, October 4, 2012
Wednesday, October 3, 2012
Today's Last Patient of the Night....
....was about 5 years old. He had a cough, the same cough he has had for about a week and for which he has already seen his primary care on two occasions. Nothing new about the cough and no new alarming symptoms he was just not Magically Better.
Partner in Crime brought in a child-sized gown for him to change into an mom immediately burst into tears. Not because she was fearful for her child's health or unable to pay the bill.
"Give him another gown!", she shrieked, "it has clowns on it! Take it off!"
Ohhhhkay. I'll take the red nose off, sheesh.
Partner in Crime noted that all the kids' gowns have clowns on them.
Partner in Crime brought in a child-sized gown for him to change into an mom immediately burst into tears. Not because she was fearful for her child's health or unable to pay the bill.
"Give him another gown!", she shrieked, "it has clowns on it! Take it off!"
Ohhhhkay. I'll take the red nose off, sheesh.
Partner in Crime noted that all the kids' gowns have clowns on them.
Thursday, September 27, 2012
Livin' the Dream
Often I find it necessary to take two deep breaths and force a cordial expression on my face even when I have just had a vacation. I am seeing way too many of the same faces again and again for absolutely silly reasons, merrily abusing the system. There are just too many taking the a free ride with their "hurray for me, f*ck you" attitudes. Yes they have a primary care; they just don't want to be inconvenienced.
One of the free-riders is the wife of a narcotic seeking douche bag who is now living with his mother. Or in jail or some sh*t. She has an alliterative, cutesy name so I will just call her Betty Buttz. Betty comes in to the ER regularly enough for me to know all her information and her kids by name for just stupid reasons at LEAST twice a week. She can be counted on to come in on Thursday or Friday with nebulous injury or pain and is seeking a work note, AKA "Get Out of Jail Free Card" for the weekend. She works maybe 8 hours per week at the most at a $1 store. If she has a medical issue such as sore throat, rash or dental pain (often) she can be counted on for two or three additional visits for changes in antibiotics and additional "Get Out of Jail Free Cards for Condition XX, Not Magically Better". She also regularly asks for refills for "stress and anxiety" medications. She doesn't ever get them, but that doesn't prevent Betty from asking.
Betty's birth control poster children are also seen frequently. They are easily the most klutzy, uncoordinated kids on the planet as mom's answer to every bump, bruise, ache and pain is to squeeze her fat free-care ass into her car and transport the kids to the ER. I think the school office is wall-papered with her kid's "Get Out of Gym Free" notices. These kids are obese and could use a little physical education. Last time one of the kids had a 3 or 4 day old knee boo-boo I refused to give out another pair of crutches because I know I have personally given out at least 2 sets to everyone in the family. Unless they are using them to hold up the walls of their double-wide, they can reuse a pair.
As if these bi-and tri-weekly visits didn't suck enough empathy out of me, Betty Buttz has started to accompany Crayzee Cutter Friend as a mouthpiece / advocate for her regular field trips to the ER for her self-inflicted suture-requiring transfer-to-tertiary-care-psych-eval. Crayzee Cutter Friend's medical history, multiple allergies and psych meds are also well known to me. Betty Buttz is always helpful during Crayzee Cutter Friend's visits by routinely updating her Facebook status and texting their numerous friends and family who also never accompany her to the ER.
Crayzee Cutter Friend predictably gets a ride by Big Taxi with the Flashy Lights (again) to a complimentary psych evaluation (again) so Betty is pretty much at loose ends for the rest of the night (again).
"Where are the kids today, Betty?" I asked conversationally, like I cared. Probably off playing in dumpsters and inhaling toxic fumes judging from their usual choice of activities.
"With their father".
"Isn't it nice you have an evening out?", I observed brightly.
Betty took the opportunity, as long as she was there, to get herself checked out in the ER (again).
One of the free-riders is the wife of a narcotic seeking douche bag who is now living with his mother. Or in jail or some sh*t. She has an alliterative, cutesy name so I will just call her Betty Buttz. Betty comes in to the ER regularly enough for me to know all her information and her kids by name for just stupid reasons at LEAST twice a week. She can be counted on to come in on Thursday or Friday with nebulous injury or pain and is seeking a work note, AKA "Get Out of Jail Free Card" for the weekend. She works maybe 8 hours per week at the most at a $1 store. If she has a medical issue such as sore throat, rash or dental pain (often) she can be counted on for two or three additional visits for changes in antibiotics and additional "Get Out of Jail Free Cards for Condition XX, Not Magically Better". She also regularly asks for refills for "stress and anxiety" medications. She doesn't ever get them, but that doesn't prevent Betty from asking.
Betty's birth control poster children are also seen frequently. They are easily the most klutzy, uncoordinated kids on the planet as mom's answer to every bump, bruise, ache and pain is to squeeze her fat free-care ass into her car and transport the kids to the ER. I think the school office is wall-papered with her kid's "Get Out of Gym Free" notices. These kids are obese and could use a little physical education. Last time one of the kids had a 3 or 4 day old knee boo-boo I refused to give out another pair of crutches because I know I have personally given out at least 2 sets to everyone in the family. Unless they are using them to hold up the walls of their double-wide, they can reuse a pair.
As if these bi-and tri-weekly visits didn't suck enough empathy out of me, Betty Buttz has started to accompany Crayzee Cutter Friend as a mouthpiece / advocate for her regular field trips to the ER for her self-inflicted suture-requiring transfer-to-tertiary-care-psych-eval. Crayzee Cutter Friend's medical history, multiple allergies and psych meds are also well known to me. Betty Buttz is always helpful during Crayzee Cutter Friend's visits by routinely updating her Facebook status and texting their numerous friends and family who also never accompany her to the ER.
Crayzee Cutter Friend predictably gets a ride by Big Taxi with the Flashy Lights (again) to a complimentary psych evaluation (again) so Betty is pretty much at loose ends for the rest of the night (again).
"Where are the kids today, Betty?" I asked conversationally, like I cared. Probably off playing in dumpsters and inhaling toxic fumes judging from their usual choice of activities.
"With their father".
"Isn't it nice you have an evening out?", I observed brightly.
Betty took the opportunity, as long as she was there, to get herself checked out in the ER (again).
Wednesday, September 26, 2012
Call a Toe Truck Please
Ms. Toe Fetish was in for her 3rd visit of the week for a toe infection; she had been seen about 5 other times in the past year for problems with every part of her body from the ankles down. See, she has this thing about messing with her feet, picks at them, cuts skin, monkeys with them in weird ways. She was all drama and har har about how disgusting it was, and how much it hurt, and how much "trouble" she was going to be in for not following pretty much any of her discharge instructions."It hurts really bad, it looks gross. I can't bear to look at it"
For all her penchant for picking at her peds, I don't think she had washed it since last time she was in the ER, nor had she cleaned and dress it as instructed. Her foot was filthy, and I mean disgustingly filthy. I'm talking walk in mud, then step in an oil spill, then run through newly cut grass that smells like seaweed. How much trouble is it to actually soak you foot in a basin of water? She had on the same flaky old black nail polish on as well. Ack.
She was also told to wear actual shoes, which she also did not do. She did, however, have plenty of time to take photos of it and send it to her friends. Double ack.
"Is it the same doctor? If it is he's going to yell at me, haha. I hope it's not the same doctor (who by the way, didn't give her any narcotics). Oh good, it isn't the same doctor. Am I going to get a needle? I'm really scared of needles. Did I mention that this is really the most pain I've ever had in my life? If most people say their worst pain is 10/10, then my pain has to be at least a 15 and maybe even 20/10" (also note she had about 6 piercings and 2 full sleeves of tattoos).
Really? I had a sick baby to transfer so I sat her fat ass in the waiting room along with another lady who "just took Phenergan and it makes me sleepy so I need to have my microscopic laceration seen as soon as possible because I drove myself", which guaranteed that it would be at least 90 minutes, sorry.
When Ms. Toe Fetish was eventually seen (Phenergan lady left in a huff; it doesn't help to cop an attitude with the staff) she had the inevitable injection in her toe. She went on for some time about that, actually getting up off of her bed of exquisite pain and opening the door to the room so we could hear her predict how painful it was going to be later. "Yeah, this is really going to hurt later, huh?", "I can almost feel how bad this is going to be when the shot wears off", "This hurt before the shot, it is going to be twice as painful when it wears off I'll bet".
She proceeded to ignore the actual discharge instructions and reinvent them.
"Now, I should come right back if it hurts and to have the dressing changed tomorrow, right?"
Sherry: "Oh, no. You don't have to come back, there's no need. Just soak it, wear shoes, put a bandaid on tomorrow and have your own doctor see it. Remember that soap and water are you friends, please take this complimentary basin home". Like it says in the instructions that we have so nicely written out for you at a 6th grade reading level. Sherry always sounds so nice when she gives people the hard truth.
Tuesday, September 25, 2012
Nursing Manglement
Nursing: a career in which the more education one receives, the less likely one is to actually know how to do the job.
I thought when I got my degree I would "get" why nurses in management were such dicks to non-management nurses, the nurses who are on the front lines and caring for patients, the nurses who get dumped on with ever-increasing paper work and bullish*t.
Guess what. My expensive high quality education has ill-prepared me for insightful revelations into the though processes of management: I don't get it.
There seems to be several types of nursing management that I have had the dubious pleasure to work with:
1. Did the job for a long time. Can't do it now, but respects nurses who do; does whatever possible to make the job run more smoothly.
My most-favorite boss/leadership mentor of all time was my manager in a big ER where I was a clinical leader. She gave me the best advice ever: listen. Sometimes it's the only thing you can do. The second best piece of advice was one she often used, offer "What can I do to help?" She did actual nursing for some portion of almost every day, even if it was only holding a kid long enough for someone to stick an IV in. This is a nurse who not only had all my respect, but someone whose respect I wanted in return.
2. Has limited clinical experience. Has lots of education. Couldn't do the job terribly well and now can't do the job at all. Ineffective.
At one hospital, some upper management brainiac decided to promote the horrible ICU nurse manager and make her ER nurse manager as well. Great idea. All the ICU nurses hated her. She didn't know a balloon pump from a water balloon. She never worked a single shift in the ER and had no understanding of how ER nurses work. Or how our department was run. In fact that small hospital was the only place she had ever worked from the time she passed her boards. Miserable human being, she was eventually canned because 10 people quit, including me.
3. RN with an MBA.
If you are going to run with the big dogs, and all that. Yes, she dealt effectively with upper management so probably didn't spend much time with bullsh*t nursing theory classes, of which I swear I will never take another the rest of my life. What good is nursing theory when it ill prepares a manager to deal with other managers? This boss said every day she could not do our job clinically, although she was lavish with praise for jobs well done, as well as a bang-up customer service rep. However, the only time I ever actually saw her was if there was a problem. She was great for committees. Have a suggestion or an idea? "Great! Get a committee together and let me know what you come up with!" Shared governance really just means "let's have a meeting or 10 about that. Then, management will do whatever they wanted to do anyway".
4. The hands-on clinical leader vs. the hands-off clinical leader.
This type of boss may or may not have the education. They are really good at either doing the job OR sitting on his/her ass and delegating. Being a clinical leader is definitely the type of job that can be characterized as "Lead, Follow, or Get the Hell Out of My Way". Clinical nurses can tell in about 5 minutes which ones are lazy and which ones support the nurses they work with by actually helping; some examples are supporting their staff by yelling at the floors to take patients, or bullying the nursing supervisors to get off their asses and have THEM yell at the floors to take patients. They have little tolerance for lazy nurses and just don't put up with nurses who insist on riding the LNA's like My Little Ponies while they put their feet up and update their Facebook status. My favorites love to put out fires; my least favorites run through the ward screaming "FIRE!" while it just gets hotter and the flames spread.
I thought when I got my degree I would "get" why nurses in management were such dicks to non-management nurses, the nurses who are on the front lines and caring for patients, the nurses who get dumped on with ever-increasing paper work and bullish*t.
Guess what. My expensive high quality education has ill-prepared me for insightful revelations into the though processes of management: I don't get it.
There seems to be several types of nursing management that I have had the dubious pleasure to work with:
1. Did the job for a long time. Can't do it now, but respects nurses who do; does whatever possible to make the job run more smoothly.
My most-favorite boss/leadership mentor of all time was my manager in a big ER where I was a clinical leader. She gave me the best advice ever: listen. Sometimes it's the only thing you can do. The second best piece of advice was one she often used, offer "What can I do to help?" She did actual nursing for some portion of almost every day, even if it was only holding a kid long enough for someone to stick an IV in. This is a nurse who not only had all my respect, but someone whose respect I wanted in return.
2. Has limited clinical experience. Has lots of education. Couldn't do the job terribly well and now can't do the job at all. Ineffective.
At one hospital, some upper management brainiac decided to promote the horrible ICU nurse manager and make her ER nurse manager as well. Great idea. All the ICU nurses hated her. She didn't know a balloon pump from a water balloon. She never worked a single shift in the ER and had no understanding of how ER nurses work. Or how our department was run. In fact that small hospital was the only place she had ever worked from the time she passed her boards. Miserable human being, she was eventually canned because 10 people quit, including me.
3. RN with an MBA.
If you are going to run with the big dogs, and all that. Yes, she dealt effectively with upper management so probably didn't spend much time with bullsh*t nursing theory classes, of which I swear I will never take another the rest of my life. What good is nursing theory when it ill prepares a manager to deal with other managers? This boss said every day she could not do our job clinically, although she was lavish with praise for jobs well done, as well as a bang-up customer service rep. However, the only time I ever actually saw her was if there was a problem. She was great for committees. Have a suggestion or an idea? "Great! Get a committee together and let me know what you come up with!" Shared governance really just means "let's have a meeting or 10 about that. Then, management will do whatever they wanted to do anyway".
4. The hands-on clinical leader vs. the hands-off clinical leader.
This type of boss may or may not have the education. They are really good at either doing the job OR sitting on his/her ass and delegating. Being a clinical leader is definitely the type of job that can be characterized as "Lead, Follow, or Get the Hell Out of My Way". Clinical nurses can tell in about 5 minutes which ones are lazy and which ones support the nurses they work with by actually helping; some examples are supporting their staff by yelling at the floors to take patients, or bullying the nursing supervisors to get off their asses and have THEM yell at the floors to take patients. They have little tolerance for lazy nurses and just don't put up with nurses who insist on riding the LNA's like My Little Ponies while they put their feet up and update their Facebook status. My favorites love to put out fires; my least favorites run through the ward screaming "FIRE!" while it just gets hotter and the flames spread.
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