An Extra Nurse

When they say Extra Nurse......

It's insulting to nurses everywhere.

I worked a 12 hour shift yesterday. We had 18 patients with 4 nurses. Beautiful. Staffing as it should be! But, they continually reminded us we were over-staffed. Paleez. However, with the looming possibility of 3 new admits the bean counters allowed for the 'extra' nurse.

Ha. Isn't an 'extra nurse' kinda like 'extra money'? None of my money has ever been 'extra'. The tax return is spent before I ever see it, even though it's considered 'extra'. The bonus shift I work goes to making the car payment on time as opposed to late, which would have been the case had I not worked the extra shift.

The first 8 hours of the day went off without a hitch. Everyone seemed to be really enjoying the calm. The nurses were pleasant and actually going along at a normal pace. No one was stressed, no melt downs noted, no speeding legs whipping around the place. No continuously beeping call lights, no continuously beeping IV pumps, no angry patient's or family members, no codes, nobody heading south.....etc. It was nice.

I really like days like this. I enjoy taking care of patients. I take pride in knowing they are clean, comfortable, content and that I have helped contribute some to their calm because of the attention they have received from me.

So much for the 'extra' nurse. They sent one home at 3pm. By then we received only one new admit and had one discharge. I started out with 5 patients, lost one, gained 2. Nice.

Yeah, somehow they unfailingly manage to squeeze out any possibility of nurses having a good day.

Ratios

Here's an excerpt from the article:

What Works?
Nurse-patient ratios,
professionalism, and safety
By Barbara Tone, RNPhotos by Margie PaschkeMay 3, 1999

If you’re looking for a heated and impassioned conversation, talk to hospital nurses about staffing levels on their unit. Among the many challenges confronting the profession, few cause such an intense response as the issue of staffing adequacy.
Nurses throughout the country are speaking more and more publicly about their concerns that patient safety is being jeopardized by continuing cuts in nurse staffing.

http://www.nurseweek.com/features/99-5/ratios.html

Unfortunately, the date on this is 1999 and it's still a HUGE issue for nursing in 2007.

I mean, come on, just sit there for a minute looking at the picture contemplating what it's like taking care of 8 sick folks. Even 6 patients is too much.

It's impossible to do a thorough job, feel any sense of job satisfaction or loyalty, or keep up moral with this going on. You only feel worked like a dog, unappreciated by the administration and doctors. Your best isn't good enough, your fast isn't fast enough.

Cutting your lunch break short, not using the restroom when it's necessary, staying late and any other sacrifices made are still not enough.

Punting

Work was 'okay' yesterday. I had six patients and was very busy just passing meds. I believe I was done with AM meds at 1130. I left at 2015. No one crashed and there were no issues. It would have been pure hell on earth if someone had crashed. Poor, Poor patients.

Well, there was one administrative issue. I sure seem to get those dumped in my lap a lot. But I managed to successfully punt to the Unit Secretary. The Nursing Director was within earshot so no chance of it getting thrown back in my lap from unit secretary.

It was really cool to see the issue get turfed around the room though.
I started it, it went to the US, to the Nursing Director, to Case Management (who really should be taking care of this kind of thing), back to the Unit Secretary, back to the Nursing Director, back to Me, right back to Case Management.

It's just another ridiculous story about the inefficiencies that take place in hospital land all over the country everyday.

My 'friend' Dr. A started this one. Allegedly she calls Christmas Night to the Unit and speaks with the charge nurse. Tells the charge to take a verbal: Send Mr. L to Surgeon's Office office 12/26/07 for appointment at 1130.

I have this patient on 12/26. His wife calls me that morning and says she called the surgeon's office, but the answering machine says they are out until the 27Th for Christmas Break.
We have transporters arranged to pick up the guy at 1045, but now I'm concerned the appointment isn't valid???

So, I tell the unit secretary to call the ordering Doctor and the Surgeon and figure this out. She acts like a deer in headlights. Fumbling around saying she doesn't know the surgeon's first name, and how can she blah, blah, blah. 'Yeah', I think, 'the same crap I'd have to figure out if I were the unit secretary, but I'm not, I'm a nurse, which means I have patients to take care of. So, I'm going to go down the hall and do my job, take care of my patients, thank you, while you do your job'. Do you understand that?

She attempted to wiggle out of it and throw it all back on my shoulders, but the Nurse Director was sitting there and overheard. Now, she got involved. She basically tells the unit secretary the same thing, and then says, "Hey, I'll call case management too."

So those two are now busy with figuring out whether the appointment is valid or not.

Case management comes to the floor. Apparently the ordering Doctor failed to tell the charge nurse taking the verbal order one piece of valuable information. And, that is, yes, the office is closed 12/27, however, the surgeon was coming in especially to meet with this patient even though the office is closed!!!!

I run into the case manager in the hallway and asked if she notified the wife and informed her of this. She hadn't. I asked her if she wouldn't mind doing that. duh.

Someday I hope I get to be a 'nurse'. But, for now, nursing is a hodgepodge of cast, crew, director, producer, music, accounting, etc.

JackAss & JackAss Jr.

The Jack Ass Family. Geez, trailer trash at it's finest. What I've found in my 12 years of nursing is that the wealthiest patients are sometimes the most kind. The poorer the patient, the more demanding and down right out of line they can become. This isn't always the case, but mostly I find it to be true.

Oh, forget all that categorizing. A lot of people are FUBAR, lets face it. Out of every 6 patients there's MAYBE one family/patient that function within reason(okay, maybe two). And, I'm casting a big net for 'Within Reason'. The majority are screwed up in every way. And, believe me, they pack their bags with 'crazy' and bring it along with 'em. However, they seem to leave their brains at home.... or maybe they check them at the door of the hospital before entering?? It doesn't matter. It's especially difficult when the hospital wants you to kiss their ass at all costs while they are busting the crap right out of your Rose Colored Glasses. You can't say, "Hey! Those are my glasses you're busting up there, Asshole!" That wouldn't be good customer service.

So here's a little story about the Jack Ass Family.
Where oh where to start........It makes me cringe to even have to think about this again.

Mrs. W is a patient whose landed a bed in the Unit. At one time she was, what we call a 'medical trainwreck'. She also happens to be one of those who could really progress, with a little effort on her part, however, she isn't interested.

When getting report from the night nurse I wanted to run screaming to my car and leave. The family sounded scarey. It made shivers go up my spine. I didn't think I was up for the mental gymnastics. Would I be able to keep my mouth shut? I mean getting 'In Trouble' for poor 'Customer Service' and then losing my job, etc. is not something I wanted to accomplish that day. However, I was on pins and needles knowing at any minute my abuser could walk in that door and start making my day hell.....and I was just going to have to take it for customer service sake.

Theses situations are where a good nurse find themselves in really big trouble. Because it's kinda like a car accident, but it's a people accident. You are just full speed ahead doing your nurse thing, minding your own nurse business, and then BAM! Abusing Family member walks in. It happens oh, so fast. Out of nowhere. It's all blurry. You black out. When you come-to you vaguely remember what happened, trying to piece things together.
You're thinking, 'I must have done something', but you are not sure what. Then you notice you're in the Director's Office. The Director comes into focus, sitting in front of you talking. You can't really understand what she's saying, it's all garbled and she's fading in and out of focus. You're still dazed. "Is there anything else?" you hear her say......"Well, okay then, just sign here." Not really sure why you are signing. You just sign.

The good news is, however, grace is on our side and warns us in report. You know what I'm talking about..... It says, "You have an extremely High Probability of getting into a People Accident within the next 12 hours with this family.....Speak SLOWLY & CAREFULLY."

And, I'm terrible at this. Whatever is there comes flying out. I try, I really, really try. One of my major flaws is saying shit when I shouldn't.

One of the stories I heard while getting report had taken place the night before. Allegedly the day nurse was sitting at the desk finishing up her charting. It was almost 8pm. She was approached by the lunatic husband of this patient. He said, "Her curtain is pulled, what are they doing behind there?" The day nurse said something to the effect of, "Oh, well, the night nurse is probably in there doing her assessment." He says, "Probably? So you don't know is what you are saying." "Well, the night nurse is in there and she is Probably doing her assessment," said the nurse. This lunatic walks in the room, comes right back out and says, "They are in there doing a bath. What...you don't know the difference between a bath and an assessment.....because there's a big difference between giving a bath and doing an assessment!" The day nurse said to the lunatic, "Sir, please don't speak to me like that, I know the difference between a bath and an assessment." He says, "I can talk to you anyway I want because you're an employee." "No, Sir, You can't speak to me anyway you want just because I'm an employee here," she says. He continued to stand his ground, abusing her, and went on to say how the nurses working in this hospital are worthless and don't know anything.......

Not Pretty. So, yeah, I was seriously apprehensive about taking the patient.

Nervous as I was, the day went off without a glitch. The family was pleasant and didn't show their Arkansas Roots for me (oopsie, that wasn't nice).

Well, the other day I had to take the patient again, it was my turn in the rotation. We were at the point of rotating her out because of the family. Nurses were wearing thin, tongues almost severed from biting them for so long. The daily beat down was taking it's toll on everyone. And, it was my due turn of 'getting it' from the husband.

I worked with her a lot that morning. Cleaning her from head to toe. Talking to her like she is human. Turning her, putting lotion on her, cleaning up the room, etc. All this stuff you get to do when you actually have time to do it.

At 1100 am the patient is calling (again) for her phenergan. God knows why she is nauseated. That's been a mystery to us for quite some time. We've done everything to figure it out. At this point we figure it's just her drug of choice because it knocks her out so she doesn't have to deal with us pleading for her to participate in her own recovery. Or, maybe she knows when her husband is on his way to the hospital and times it accordingly?

She is now trached and can use the speaking valve, but refuses to use it for very long. She would rather you play charades with her.

At noon lunch was brought in. We advanced her from pureed to mechanical soft. This is the first M.Soft diet she's eaten since she's been in the Unit. I sat the tray up and requested she put the spoon full of chopped meat in her mouth. I even guide her hand and try baby talking her through it. Well, she can't, so she says. Of course, I ended up feeding her, like all the other nurses and techs before me. Why? Cuz, she is not interested in participating in her own recovery. That's why. Well, that was part of the reason. The other reason is she was very sleepy from the phenergan and all she wanted to do now was zonk out.

After a 45 minute session of poking her shoulder telling her to swallow, chew, or wake up or whatever, I finally gave up and just let her sleep. I kept her up in the bed because I didn't want her aspirating.

About 5 minutes pass. I was garbing up to help a fellow nurse in another patient's room. I see the husband of my patient coming from her room out into the hall, screaming , to no one in particular, about how this hospital is the worst he's ever been at, that all the nurses play around all day instead of taking care of his wife, that he can hear everything that is said in the nurses station, that there should be a unit secretary, that there is never anyone available to answer the call light, that his wife has food in her mouth. 'Oh, shit,' I think. 'She could have some food in her mouth..... I didn't see him come in, how the heck did he get past me'?

I approach him in the hall and tell him I am the nurse for his wife. (I mean, he liked me? ...last time, right?... And he knows I take good care of his wife, right?). In fact, this day I did a lot more for her than I did the last time, because I actually had time to do it.

I walk back towards the room with him, filling him in on her day and how she is doing. I tell him her labs are all WNL's, that she is was on T-collar all night and the doctor seemed pleased with her progress. I tell him she had her last dose of abx. I cheerfully tell him about her first mech. soft diet for lunch and that she was sleepy because of the phenergan and that it was hard to keep her awake and blah, blah, blah...... He didn't care. He was there to bitch-slap and that was that.

He pulls open a Kleenex from his hand, shoves it up to my face, saying, "See this! This is what I removed from her mouth! You don't do mouth care on her? Have you seen her teeth? They are dark, how do you suppose that's happened? She already has dental problems, she's going to get a mouth infection because of the care here. It's unacceptable........" He went on and on and on and on and on and on and on.

I'm thinking about how the teeth are just more evidence she really is a product of Arkansas. She already has a mouth of missing teeth. And, the ones remaining are nasty, dark, stained teeth. That, my friend, happened before she came to the hospital. The food in the Kleenex he was showing me (gross) was the size of a sesame seed, I had to really look for whatever it was he was showing me. And, not only did I do oral care on her that morning, but so did the RT. The RT's always do oral care on patients with vents and with trachs.

I don't know if my Nursing Director heard this man or just happened to come to the unit at this time. But, whatever, she intercepted. The guy says, "We need to discuss the way you operate this place because the care here is horrible and I'm tired of it. You don't have enough staff, and blah, blah, blah, blah....." My nursing director told him she would really like to speak with him too, but to come to her office so they can have the discussion there.

Now, I wasn't in on the conversation they had, I had other stuff to do. But, I heard about it and the whole thing is almost comical. Apparently the guy tells her she has a nasty, inappropriate attitude. He basically sat there and told her nurses are in the unit fooling around on the Internet, that his wife's room is a mess, that this place needs to find a whole new administration to come in and fix the problems and so on. He must have left the hospital because I didn't see him after this. His son, Jack Ass Junior, showed up for scene 2 and his behavior was even more aggregious.

Scene 2

I headed out for lunch. I see this guy standing at the Med Surg nursing station asking the unit secretary to find the Nursing Director cuz, he wanted to talk to her! I thought for a moment, wondering was he the son in this lunatic trio? I couldn't quite place him. But, for some reason I was thinking it had to be the son. Maybe the pissy tone of his voice?

I get back from lunch and the Nursing Director asks me to come to her office. She says, "Well, I had a long talk with the son of your patient Mrs. W. And, he thinks we need to drug test you." I'm like, duh, "WHAT!?" I couldn't help but laugh. My Director went on to tell me all the stuff they talked about.

Jr. Jackass said stuff like, '... this place is just like his Dad told him',..... 'that he was going to call the media on us, they would like to hear about this'. He also said, 'he would like to call Richard BlahBlah, cuz he would Really like to hear about this too'. My Director asked who Richard BlahBlah is. Jr. Jackass says he's a restaurant critic. My Director asked him why he would want to call a restaurant critic. Jr. Jackass says, "Well, I would if he were still alive, but he died."

Anyway, I think you get the drift.

I walked back to the unit after listening to all this stuff from my director. I could see the son was sitting in his mother's room. I hated having to go in there. My director told me to be polite and attempted to coach me on how to behave. She told me to say nothing if the man starts ragging on me. So, basically what she said was this, "You are going to be abused and you will take it with a smile on your face." I resent that. These people are obviously not worth arguing with, but come on......tell them to shape up and STOP IT or we will get transfer papers ready and have transporters here at 0730 sharp to send you people to another facility you might like better. What's wrong with saying that? We already know we are dealing with crazy here. We already know THEY are not going to change. The more we bend over, the more abusive they become.

Unfortunately, I did have to go into the room. Now, this is where I go from exceptional care, extra mile, over and above care to C-. These type of people don't understand that their behavior = standard care. I do what I have to do without all the froufrou. I don't connect, don't try to. No eye contact, no communication other than what I have to, no encouragement, no updates. And, that is sad, because, I really believe and know, that the connection you have with your patient helps them heal.

Anyway, Jackass Junior starts in on me. I don't know what he was saying because I wasn't listening. I went into my own little world and did my job. When I was done with what I 'had' to do I took off all my garb, chucked it in the garbage and left. All the while the fricking nut-job is still yapping.

Later, around dinner time, the Nut Job, Jack Ass Junior comes to the nurses station requesting permission to eat the rest of his mother's tray. I didn't help her eat this time. She is perfectly capable of feeding herself. And, because the son was in there I figured he could do it. So, here dumb ass is standing in front of me like the fricking idiot he is.........wanting my approval to eat the rest of the food on his mom's dinner tray.

I say to him, "Um, well, that's probably not a good idea and I don't recommend it because your mother has MRSA which is a communicable disease." He's only been coming up here for a month and is fully aware of his mother having this. It's dumb assess like him who spread it to the community, because neither he, nor his screwed up father, garb up when in the room.

His reply was just as stupid as he is. "I have been working around people with diseases for 9 years and I don't have anything." I'm thinking to myself.......'You're a F*&^%g Idiot'! But then my sinister side thought, 'Please Eat that Shit and Die you Stupid MF.....We need LESS of your types in this world'. I just shrugged my shoulders, turned around and walked off. I left him standing there to grapple with his own dumb ass question. He ate the food.

As my evening was coming to an end, I was spent emotionally, mentally, physically. These people and these ridiculous issues just drain a person. Jack Ass Junior shows up at the Nurses Station again saying his mother wants her 'stomach medicine'. I was in another room so the other nurse sticks her head in and tells me. I told her I would be out of the room in just a few minutes and would get Mrs. W her 'stomach medicine', phenergan.

It took me about 3 minutes to get out of the room and to the pharmacy. I'm drawing up the phenergan when the nurse sticks her head in the door of the pharmacy telling me he ( I knew who she was talking about) is at the nurses station being belligerent, saying 'he asked for the stomach medicine for his mother and nobody has brought it to her yet....what's wrong with you people, doesn't anyone work around here, blah, blah'. I would like to take the needle I'm working with and shove it up his...
I walk to the patients room. Son is just bitching away. I give her the shot and leave, not acknowledging him at all.

I gave report to the oncoming nurse about Mrs. W and the events of the day with the family. Nobody is surprised at these stories anymore because we have rotated just about every nurse we can through that room because of the toll it takes on people. I had to talk over Jack Ass Junior though. He was sitting in his mother's room, singing at the top of his lungs, along with a Christmas TV Program. He had turned the volume up as loud as it can go and is obviously oblivious that his mother is falling asleep after taking her shot of phenergan. Hmm.....Phenergan use seems to correlate with Family Members visiting. I think I found the reason for the nausea.

Issues Issues Isssues

Most issues that occur take me away from patient care. I spend more time attending to Issues then dealing with or caring for a patient. To give a couple of examples:

Issue Numero Uno:
A few weeks back I worked the HOU (High Observation Unit). Thank God I only had two patients. One requiring a lot of nursing care and another requiring a lot of mickey mouse, administrative care.

I was told in report that Mr. H is going for a CT Scan to r/o a PE. We don't have a Scanner so the patient needs to be sent out. The Xray tech is the one that schedules this px with the other hospital, but because this is Monday morning it hasn't been scheduled d/t the weekend.

So, first thing, I march down to where I can find the Xray tech, hand off the patient's folder to her. She gets back to me around 0930. The appointment is now scheduled for 1100, but the patient needs to be there at 1030. She also hands me a phone number and tells me to call the CT Tech and give report. In the meantime, she is asking the Unit Secretary to schedule a transfer via Ambulance.

I called this guy named Dale, the CT Tech. Dale asks me all sorts of questions regarding the patient. I give him the patients dx, all the info you give in report, etc. He even asks me for the BUN/Creatinine. Then he says he's faxing me a questionnaire to go through with the patient.

I call the patient's son at home and tell him what we are doing and what we are suspecting. He agrees with the CT Scan and says his Dad can sign his own consent and has been signing all of his own papers. I was told in morning report that the patient can't sign his own consent and that the son should do it..........?

I then take the consent and the questionnaire to the patients room and begin filling it out. The patient is severely HOH so my voice and ego were about shot at the end of this. Everyone on the unit can hear me screaming at the patient, "Are your Bowels moving? Do you have any sexual dysfunctions or sexually transmitted diseases? .....Nah, I'm kidding..... I wasn't really asking him those questions. I might as well have been. I felt violated after leaving the room. Hey, where's privacy for the nurses? And, what's this privacy for the patient bit if everyone on the unit can hear our conversation because the old geez is mostly deaf? Well, anyway.......

The Xray tech comes to the unit to inform me the transporters can't pick the patient up until 1045. Which means I get to call Dale the CT guy, again, and inform him. He was a little concerned the Radiologist wouldn't stick around to read the scan. I guess the Radiologist reads reports of CT's that were done at 1100 and that's it.

So, Dale, checks with the Radiologist, calls me back (yet another phone call) and tells me to send the patient on.

I call Dale at 1050 and tell him the transporters are not there. He said they won't be able to do the scan if the patient isn't there at 1100 so we will need to cancel it. Damn!!! So, now I am stuck holding the ball and I will be the one to get bitch-slapped when calling the doctor.....Not anyone else. And, how exactly is this my fault again?

I inform my charge nurse and then call the ordering physician. But, before I leave my message with the doc, the transporters are rolling in the door (approx 1110). I immediately call Dale back. He said he would check with the radiologist, because at this point it's up to him/her whether the patient gets the CT Scan done and read. Apparently, the radiologist said to send the patient, that he/she would be there for awhile and would be able to read the scan.

Whew! That's over. What a pain in the ass to get all that worked out.... All that extracurricular work paying off.....See that's why I am a nurse, right? Extracurricular work. I've always liked extracurricular activities. Is this the same thing? Whatever, it's over, taken care of and that feels good. I wish my superiors would've seen all the hard work I did (outside of patient care) to make that happen. Maybe I'll go get some coffee and contemplate why I'm a nurse......Maybe my superiors would be less willing to write nurses up over stupid shit if they grasped exactly what part the system plays in helping us screw up.........could extracurricular BS have anything to do with it....? Could the doctors themselves actually be held accountable for some of the mistakes nurses make?.......hmm.....Oops, I have patients to care for....what am I thinking? Forget that coffee. I'm already behind with AM Meds and Care so I won't be having coffee this AM.

And, it gets better!!!

Soon after the transporters are wheeling Mr. H out on a stretcher, they are soon wheeling him right back to his bed. I'm getting a phone call from Dale. He is telling me they can't do the CT Scan because the GFR is up and the dye would mess up this guys kidneys.
Ya don't say? F#%*@!!!!!!!
Could ya not have not calculated that PRIOR to all of this? DO THEY THINK I JUST SIT AROUND WAITING FOR S*#T TO DO. COULD SOMEONE NOT HAVE SAID SOMETHING BEFORE GOING THROUGH ALL OF THIS????? WTF DOES IT TAKE HERE? ALL OF THAT TIME TAKEN AWAY FROM DOING BASIC CARE FOR MY PATIENTS.

Now if the Dr's are so Gosh Darn smart, shouldn't the Ordering Physician have checked this out before writing the order? Oh, No, wait, I am sure somewhere it's written in the legalese that it's the nurses responsibility, just like everything else. I beg to differ. I have been sending people to CT Scans for years and the responsibility of whether the patient is stable enough to receive one has NEVER been placed on my shoulders. This is NOT the nurses responsibility to make that call. If it were we wouldn't need the GD doctors. Actually, maybe I should have made that call and let the doctor deal with the consent, the phone calls, the transporters, the questionnaire...maybe, just maybe, that would work???? Nah.

Just because making the call on the GFR calculation isn't in our scope today, doesn't mean it won't be. Watch, just watch, somehow this will eventually be made the nurses responsibility in the years to come. I gave the guy the Creatinine and BUN and they were both within normal limits. I didn't give him the GFR. I don't even know how to calculate it. Should I? Was I supposed to? I don't inject the dye. I only gave the guy the information he was asking me about. My patient doesn't have anything written regarding his kidney function. I didn't know he had kidney issues and he doesn't as far as the chart information was concerned. How can I know this? Lick his pee? The BUN and Creatinine were WNL.

But, somehow this inefficiency is always the Nurses Fault. Or maybe it's just me. Maybe I feel like it's my fault because I have put so much work into making it Work and then it falls apart, no matter how hard you try. And how can you be angry at this inanimate object, The System? The system fails you.....every time. But, nobody in administration blames systems. They blame nurses.

If this one little fu*&^%d up thing is enough to take me away from the bedside(basically caring for my patients), consider having several of those things occur in one day. It's not pretty. And this type of thing makes for some very snarly nurses.

There is always something lurking in the shadows to put icing on the cake for you. As a Nurse our best just isn't enough. Nurse are constantly put in positions to fail and that sucks.

Numero Due'.....Can you take more?
Okay, this issue happened one Regular workday.
I get report on this patient who is said to have Herpes Encephalopathy. The night nurse giving me report tells me the doctor has been waiting and wanting this lab result from a spinal tap taken a week or more ago. She said, "The Results Are on The Chart!"

I look on the chart. The order isn't there because this was ordered while the patient was at another hospital, however, I am seeing the doctor requesting us to get lab results for the HSV-PCR on the chart. I look at the lab result now on the chart. It says HSV-Enterococcus. Not a HSV-PCR result. Hmmm, I think to myself, Is this the lab the doc wants or is this something else? I don't really know for sure. I've never had to deal with either one.

Round bout this time Dr. A comes into the unit. She is relatively pleasant, still being a new doctor. It's only a matter of time though. But, the best thing is, she likes me. She calls me 'her friend'.

I point the lab result out to her. She says it's not the correct result. She wants the HSV-PCR. Okay, I will personally call the lab and get the result. So, I do. They don't have the patient in their system. Great!

After some poking around, I find Mrs. C comes from another hospital, not the hospital we usually get patients from. So, I conclude, the result must be at that hospital.
I can't get the attention of the Unit Secretary. She is too damn busy being ugly to people. I can't find the Coveted Rolodex where I might actually find the phone number to this other hospital, so I call Directory Assistance. They give me a number which rings and rings and rings and rings. Don't worry about me, I don't have anything to do!!

So, once I get the attention of Ms. Nasty-I Got Issues, Unit Secretary, she gives me an entirely different number to this hospital and also some lip service about how the Lab Results are already on the Chart.......she had them faxed the day before.....blahblah, blahblah (sure it is I think to myself....I don't care to explain much to her, cuz basically, 'SHOULDN'T YOU BEING DOING THIS'? is what I was thinking).

I call the hospital and get some girl in the lab who was familiar with our request of the lab results. Maybe Ms. Nasty US spoke with her the day before and she's still feeling the burn?
She goes on to tell me(Just like the US)they already faxed the labs and we should have them on the chart. "Yeah?", I tell her, the "Wrong lab." "Oh", she says.

Anyway, Ms. Lab Chickie tells me to hold while she gets her supervisor. Hmmm, Supervisor huh? This is interesting. Supervisor was apologetic and tries to pull the same crap saying we already have the results. REALLY? Cuz, I don't see them! However, after explaining to her the difference (like I know) between the HSV-Enteroccocus and the HSV-PCR she conceded and said she would investigate further and call me back cuz she couldn't seem to find results for the HSV-PCR.

About an hour later the Lab Supervisor calls back. And, please, Don't worry about me, I have nothing to do, my patients can take care of themselves. If they want to get stronger and get better they will have to learn to fend for themselves dammit.......I've got more important things to take care of ..........

She said she didn't find the results and that she had already made a call the night before to the infectious disease doctor, leaving a long message for him regarding this. ( I guess she forgot to tell me that in the first conversation?).

Now comes the brutal question of 'who fucked up'? Since she wasn't very willing to give up the information without point blank interrogation, I gave her multiple choice. I asked her: A) The Lab Was Never Ordered? or B) The Lab Was Ordered, But Your Lab Failed to request this test when you sent off the cerebral spinal fluid? I mean, come on....I need to report back to the Dr. A, because the ball is dropped in my lap, unfortunately, and I need to tell her something.

The lab was ordered by the Doctor, as I figured. So, now I had to tell Dr. A the lab wasn't done.
This totally sucks because it's SPINAL FLUID for God's Sake. How do you get spinal fluid? It's not like just drawing up some fricking blood and sending it off!!! So, guess what? If the Doctor wants that Lab bad enough, the patient is going to have to undergo another Spinal Tap. This is just so wrong. Ineffective, Inefficiency, Just plain "Fucked Up". Oh, yeah, I have patients to go take care of now.........., ooops, yet another interception has occurred, can no do......

Once telling Dr. A the bad news, she now wants me to call the Infectious Disease Doctor and tell him about the error, plus ask him what we need to do..... That's just fricking great cuz now I'm the first one in line to get bitch-slapped by the ID doctor. And, how exactly is this my fault again? Damn, nursing sucks at times.

Dr.Klein and Inefficiencies

I was speaking with a girlfriend on the phone this a.m. discussing my Mom's recent experience with LabCore and a Cardiologist. Pretty soon I am spewing out issues that arise in the hospital setting too. There are sooooo many fricking issues. I would be here for a decade if I wrote about them all. Mainly it boils down to INEFFICIENCIES, UNDERSTAFFING, NO ADMINISTRATIVE OR ANCILLARY STAFF ASSISTANCE AND DROPPING THE BALL..

A few hospital mishaps do come to mind that occurred recently and are noteworthy. I am thinking that the NNOC can maybe incorporate this type of issue into their legislation come Jan 2009...? Nah, let's just start with Ratios. That would be victory enough.

But, First, I must reveal the many mishaps from my Mother's visit to Dr. Klein:

My mom was having blood pressure issues. And, because her Primary Care Physician was ineffective at controlling it, I encouraged her to see a cardiologist for further evaluation and to rule in/out any cardiac issues.

Through some advertisement she found Dr. Klein in. She saw him on 11/29/07 where he did an Echo and sent her for Labs at Labcore. She was told the Echo was fine, but two weeks went by and she never heard a thing regarding the labs.

I called the Dr's office and was told the computer malfunctioned and they couldn't pull her up. They also reported they didn't have lab results on her chart. I called Labcore where the labs were drawn and they couldn't find her in their system. After several phone calls Labcore tracked her down. They had her last name spelled incorrectly. We requested Labcore fax a copy to Klein's office. We then called Klein's office and asked the receptionist to look on their fax machine for the results and fax them to us.

Dr. Klein didn't even have or know the results!

Also, Klein ordered a Cortisol level which Labcore failed to draw, and he obviously wasn't aware of this either. I discovered this error, not Klein. However, since my Mom was going to have to go back and get redrawn for the Cortisol, I requested Klein's office add a PTH level to the draw because the Calcium did come back a little high and she does have a knot on the right side of her throat/neck.

After my mom went for the second go around of labs she got a phone call from Klein's receptionist stating the Labs were all normal. This isn't true.The cortisol was within normal limits, but the PTH was high. That, with the high Calcium, can spell endocrine issues or possibly even some sort of adrenal gland issue. I don't know , I am not a doctor. What I do know is that Dr. Klein saw this as NOT being a cardiac issue and never followed up with her or her care AT ALL. I'm glad and we are relieved it's not cardiac, but come on.....some f/u or summary, suggestions, referral, guidance, something!

So, do I recommend a Dr. that fails to follow up? Absolutely NOT. He didn't have any, NOT ONE, follow up conversation with her AT ALL. This is unacceptable. I don't know if the man is too busy or what, but something is amiss.

What's Unsafe About it?

I met with Mandi today with the NNOC. Really enjoyed that. Learned a lot and feel like this may be a place for me to actually make a difference. Let's face it, I have another 20 years of doing this sh%^ and if I can help in anyway to make it more palatable, I will give it my best.

I remembered something that occurred several years ago when I worked for The Rehabilitation Hospital. This was my second clue that something was amiss in Nurseland.

As myself and another nurse were taking morning report, the Charge Nurse, D. M, came in and told us we would be taking 11 and 12 patients, respectively. I don't think I said a word because I was too shocked to say anything. Apparently some nurses called in??? Not really sure, but nonetheless, the thought of so many patients was surreal. Sarah, the other nurse, said to the Charge, "That's unsafe!" The Charge Nurse said,....and God is my Witness, "What's Unsafe about it?" I don't remember how it turned out. Poor patients on that day, huh?

What happens with the people who are your co-workers turned management? Where does their sound mind go. Where do their memories of horrible days on the floor go? How can they 'Just Forget'? I see it all the time. It's gotta have something to do with making a name for themselves or creating a paragraph on their resume for future purposes. Regardless, they sellout and they sellout quick. I'm not sure, but this is a phenomena I have seen over and over.

Dr. St came in the unit the other day. He is this good looking, renal doc. The last time I had an encounter with him he was bitch-slapping me. I remember that vividly:

On Monday I was asked, No, Wait, Begged by the Charge to work the following day (my day off and my day to prepare for a mini-vacation I had planned for Wednesday). I didn't want to, but caved when another nurse said she would split the shift and I was told I would get the same patients. So, Tuesday I come in on the second part of the shift and boy did I pick the shitty end of the stick....I mean shift.

First, I get 3 patients in the HOU. Two of whom I don't know. Secondly, I had to go into a Bronch procedure and sedate this guy. Third, this guy coughs sh^%$ up through his trach and it hits the side of my face, all over my gown, etc. Nasty, nasty, nasty. The Pulmonary Doc is a dick. He looks like Howdy Doody and is arrogant as hell. Just not a nice fella at all.

I get out of the bronch and go check on my other two patients. Here is where Dr. St comes in. He and I have always had very friendly conversations and a good rapport. He is fairly new to our facility having recently moved from another state. I think he is a new MD as well.

Anyway, he starts quizzing me on I&O's and Wt's on this one particular patient. I explain our paperwork to him so he knows where to find information. But, then he starts freaking on me because the Wt's are inaccurate, the I&O's are added incorrectly, etc. It was bad. He had a fricking meltdown on me! After he left my colleagues were coming up telling me how bad they felt for me because they saw how brutal he was!! Now, you know it's bad when that happens.

I was pretty shocked that this guy who I thought was really nice was now in the Dr. Jekyll/Mr. Hyde category. I will have to remember to give him the evil eye and cold shoulder from now on.

He really walloped me good. The night nurses are the one's that add the I&O's for 24 hours, I only take care of my shift.....and I am pretty damn anal when it comes to that, because I know how important it is for a renal patient. I also do not do the wt's. Night shift does this and obviously the CNA's don't look back on the last Wt to see if there are significant changes.

Dr. St comes in the other day all bubbly, talking to me....."Ah, Ms. So and So looks Great, doesn't she!!" I said, "I guess so, Whatever you think." He's like, "What's that supposed to mean, You don't think so?" I said, "I don't want to answer one way or another, because I really don't want to have an argument with you." He was like....dah, dah, dah......"I'm not sure I understand." I said, "The last time I saw you, you basically "Bitch-Slapped me." And, I said it just like that!

He says things like, 'no he didn't, he didn't mean for me to take that personal, that he knew I was trying to help him, that I've always helped him and have been friendly and in NO Way was that personal or directed towards me, that he knows I was not the one calculating, blah, blah, blah.......'

Ya know, It's just not Okay to speak with people the way he spoke to me and then expect it to be okay. It's not okay, it never will be okay...... Because, "We rarely remember what someone says, But we always remember how they made us feel." And, I won't forget. It's etched in my cells, nothing I can do about it. Nothing he can do to change it. Even his genuine attempt to smooth it over with me....No, it's just not okay. Goodbye Dr. St.

EEG & The NNOC

After 3-12's in a row, I'm at home and finally able to drink some coffee. I'm recovering from lack of sleep and the nonstop stimuli of the hospital routine. I like my peace and quiet on my days off. It usually takes a day or two to recover fully.

First of all, Bloated, Fat Bastard is still alive. Well, we are the ones keeping him alive. Because why? Because 'We are making Progress'.

I'm not an EEG machine. Don't really want to be. However, my keen eye can see this guy isn't with us any longer. His wife, on the other hand, is believing something directly opposite to common sense.

Mr. BFB had his dialysis today. Wife is sitting in there glaring at me and everything I do. She is also writing notes. That would be nice if it were thank you notes to all of us keeping fat bastard alive, but it's not nice notes. She is coming from the angle as though WE are doing something wrong. Do people ever consider the fact that Not taking care of their own health might have contributed to their condition? I wasn't there while fat, bastard shoved food down his pie hole. I wasn't there while fat bastard sat around all day doing nothing, gaining 400lbs.

It's frustrating that you can't just say, "Hey lady, he's dead, can't you see that? What about that do you not see? Also, Lady, can't you see I have recruited 4 others to help roll him because he's so fricking big and now I have my head up your fat husbands ass trying to clean up his shit? For that, I would like a little appreciation.... AND NO NOTE TAKING."

What's equally frustrating is that there are many people who are dying because of a bad disease of some sort. Those are the ones I feel for. But, people who contribute to their own death, Nah, I have no sympathy, nor desire for magical powers to fix em.... Especially when you have a wife sitting there behaving as though it's my fault BFB is in the condition he is in. I am sorry that she has to experience loss. We all have to. And, It's not my fault.

The NNOC. Well, I am venturing into a new arena. I made a commitment in the past few weeks to get involved in something I really believe in. The NNOC may be it. After 12 years of nursing, 12 years of bitching, 12 years of being a GD doormat, I am done. I am ready to do whatever it takes to change nursing. I have to be in this profession for the next 20 years if I care to eat and keep a roof over my head. I will blog more about this later, but for now I am having my first meeting with one of the Paid Employees of the NNOC today at 3:00. She is not a nurse, her background is unions. I am excited. I know nothing about the Pros and Cons of Unionizing, but I am making it my mission to find out all I can.

Resiliency

Some days are better then others. Today I worked in the HOU. It was pretty do-able. We had an admit from the floor. Some guy with a huge pneumothorax. The pulmonary doc came in.
I watched as he gouged a hole in the side of this guy's chest, rooted around for a second, then plunged a tube down into the lung. He gave a mini in service on the plura-vac, so that was cool. It wasn't like a 'You stupid idiots' in service. It was genuine. And, appreciated. Thank you Dr. P.

Your co-workers can make all the difference. I had a few minutes to actually chit-chat today. That was fun. I like to be able to get to know some of my coworkers during work. A few of the girls/guys are pretty funny. You want your colleagues to be on your side, you want them to support you when you are losing it, you want them for resources. You want to support them when they are losing it. You want to like them and visa versa. Not always the case, but nonetheless, it helps when you are having a bad, nay, nay, day to have that going on.

I had time to look up Calcium Gluconate online before injecting someone with it. I haven't ever pushed this particular drug. Heard about it with all the hyped High Alert Med stuff, but actually I think that's calcium phosphate??? Anyway, it's ordered Q6hrs. Spoke with Pharm, Chg Nse, IM Doc and nobody knows why I am giving this guy the drug. Pulmonary ordered it.
I noticed the guys blood pressure did come up somewhat and remain stable. Of course, the levophed he's on is helping too. This is one of the guys that crashed last week. Today, one of his middle toes is turning colors baby! Yep, he's been on levophed since last Mon or Wed, I think. His wife is of the belief that he still has hope, because, "We are making progress." Who in the hell told her that? Progress!? Dental floss strength is his only hope right now, cuz that's all he's hanging by. He traded in his more expensive floss for the cheap one last week when he coded, again.

The Pulmonary Doctor came in. Said the Ca Gluconate order was taken off wrong or written wrong. It should be Q6hr X2. Great! We've been giving it for maybe 4 days now. He also went on to rant about whoever he gave the verbal order to must have written it incorrectly...... I'm thinking "Really?... Cuz YOU WROTE IT" I wanted so badly to grab the chart from him, flip back a few pages and point out that HE is the one who wrote the order. I didn't though. I really like him and didn't want to punish him even though I could have. He has very legible handwriting so there's no way around it.....definitely....Q6hrs IVP...period, plain and clear. Oh, I found out from him I was giving it for a low calcium. Geez. This patient is on deaths door, literally, and during the last code You, Mr. Pulmonologist, found it important to write an order to correct his calcium which was not out of range anyway???? I don't get it. And, from speaking with the colleagues, they didn't get it either. K+ was fine also.

What's up with people not being able to let go? So many people....Bloated, uncontrolled diabetes, kidney failure, unresponsive, bottoming out blood pressures, vented, MRSA, C-Diff, Tube feedings or TPN, etc........And, we keep them alive for as long as we possibly can.....for what? Because, he's making progress.....:-( No, it's so wrong. Our health care system could take an immediate turn for the better financially if we would stop this nonsense of keeping dead people alive.

We forget, in the middle of our storms, that we have this incredible thing called resiliency. Whether it's a 'get your ass kicked day' at work or a loved one dying, Somehow we make it.

I hope the family of this 'dead' guy will soon admit to themselves that he is not coming back, no matter what they see on the monitors. He is brain dead, rotting flesh, inside to out. We are pumping his lungs for him, we are supplying his GI tract with nutrients, and infusing him with lethal drugs so we can remotely detect a blood pressure. It's ridiculous. Let the man go.
News Flash! He left you a long time ago and what you are doing is almost sick and cruel. At this point you are not doing anything for him, you are doing it for yourselves.

Doing the Right Thing

Okay, here goes....I have a problem with being put in the position to fail. My gripe is this:

All these patients and all these issues....I am trying like hell to situate these patients and issues. The 07:30, 08:00 and 09:00 meds don't get passed until between 10 and 12ish.

Say I have a 07:30 Reglan due and a 11:30 Reglan due, but can't even get to the med dispense system until 1100 am to start pulling meds. I am basically forced into a med error. Technically it's a med error because the 0730 reglan wasn't given, and ya can't give both at the same time. That's not right. Nor is it right that I should sit down and chart why the Reglan wasn't given at 07:30 even though that's policy. Nor am I going to call a doctor just to tell him the 0730 reglan wasn't given because I was too busy trying to keep sick people from crashing. How can I document it wasn't given and that it wasn't given because I was busy? You can't chart that.

After doing this gig for years and seeing this happen over and over.......I just wonder what other nurses really do.

Bad, Bad, Nay, Nay, Day

My psyche is still recovering from having my ass blistered several days in a row. It's getting tougher and tougher to keep up a good attitude and 'care'. The hospital has beat the 'care' right out of me. What I 'care' about has come down to basics; not killing anyone, leaving my shift on time, and covering my ass at all costs.

I work the 7a-7p shift on a med/surg unit. I graduated from Nursing School in '95 with a BSN, got a GN job at a well known rehabilitation hospital and worked there for several years. The first week on the floor as a new grad, I sensed something in nurseland was amiss. It's like this huge,white elephant in the room nobody speaks about. I think the reason nobody speaks about IT is because IT is so huge, where does one start?

A Wednesday I'm still recovering from:
Show up at 7am, get report on 6 patients. Making rounds, here is what I find:

Patient A:

Patient is suffering from Herpes Encephalopathy....or something....we don't quite know for sure what's going on. She is forgetful, belligerent, angry, confused. Husband is a wound up wreck.

As I introduce myself and inform them I will be their nurse for the day, I am told to move the IV pole to the other side of the bed. So much for introductions. Then I'm told to get her gear so she can brush her teeth, because she can't eat breakfast until she washes up and gets her teeth brushed. In the middle of this she decides she is getting up to go to the bathroom. I was also told they didn't have a 'tech' the day before. I go to the laundry cart while she is on the toilet to grab some washcloths, there aren't any. I now have to trail blaze down the long hall, through the building to get some washcloths from the clean laundry room.

Once I get her settled she complains that the breakfast is cold and she can't eat it. She wants cold cereal. I go get her cold cereal and milk. She doesn't drink regular milk because she is lactose intolerant and needs lactose free milk! Fine! Just Fine! I go back to the nutrition room where there ISN'T any lactose free milk. I make my way out to the nurses station and ask the smart mouthed unit secretary to call dietary for lactose free milk. Because the secretary is taking her sweet time I call the dietary department myself. I was told that, "'We' don't have any, the milkman hasn't made his delivery yet." The speech therapist walks by at this time and happens to overhear me ranting. She said she will get in her car and drive to the grocery store and get some lactose-free milk for the patient.

I tell the patient and her husband the milk will be there shortly. Now they want me to get them some ice water. Of course, I run back up the hall and fill their water pitcher. So, after an hour of doing ridiculous tech duties I'm ready to get on with being a Nurse!



Patient B:

I go to the nursing station to check on the morning blood sugars, now that I am an hour behind on giving insulin. I see one of my patients name on the list. 'That's funny', I think to myself, I wasn't told by the night nurse in report this guy is a diabetic. Hmmmm, he has a DFS of 549! Great! I checked his chart and yep, he's a DFS. I decided to recheck the blood sugar before covering him so I head off, down the hall, with the DFS monitor. Of course, I had to go through the hoop of testing the machine first!!!!

The fingerstick is 107. Glad I didn't cover him with 15units of insulin!!!

In addition to the DFS, what I find in the bed is a semi-confused, obese, bloated man, with nasty, black toes ready to fall off and serious respiratory issues going on. His upper extremities are so bloated they are weeping fluid onto his sheets and gown. The PICC line drsg in his upper right arm is saturated with fluid and loosely covering the insertion site. I make a mental note that I better check his labs, his vital signs and change that drsg. However, he has crapped the bed and is screaming bloody murder to get cleaned up. I can't even assess his lungs because he won't stop demanding we clean him up immediately. Usually sick people don't talk. Not him.

First things first. Nursing can wait! I called for my tech and attempted to recruit others. Not that I mind cleaning up someone, it comes with the territory. I had some seriously ill patients and issues that needed dealt with (his condition included), and although I felt an obligation to help this man with his bowel issues, my priority was to make sure he would live to let us clean him up. It's a damned if you do, damned if you don't scenario. I can't always depend on the techs to get right to something. They were busy passing out breakfast trays, taking people to the bathroom and doing what techs do. But, this guy wasn't waiting.

People can deteriorate quickly. I hesitated over wasting time worrying about getting him cleaned up or going up to the nurses station to see what I could find out about him, the condition he's been in and what's going on, cuz he just wasn't presenting well at all.
I have a million things spinning through my head that needed to be done, 30 minutes ago.
It feels like its a real disservice to myself and to my patients when I don't have the proper time to do what REALLY needs to be done so someone doesn't crash and die.

I call for the tech so we can clean him up. It took an army to move this man because he was so big. The whole time he is yelling at us to 'take it easy', 'just hold on', don't 'move me so fast', 'that hurts', 'don't grab me there'............ Once we got him turned and there were enough people to handle it without me, I took off. The Respiratory Therapy Guy was there working on him too, so I felt a little more comfortable leaving. I found the Charge Nurse and filled him in on what I found. I asked him to get a head start on assessing the situation, because I still have 4 other patients yet to see.

Some are more fun than others. After getting clean up underway with Mr. B, I walk into Mr. C's room. Jesus-God. Can someone tell me WHY I WENT INTO NURSING!!!!

Patient C:

This nut-job is up, holding onto the chair, holding onto the bed, weaving all over the place, wrapped up in his IV tubing and foley bag. He's talking nonstop, rambling about having to pee and he can't do it sitting down(he's got a frickin foley in), rambling about his hernia and how nobody gave him any pain meds all night long, they just left him lay there in pain. He is going on and on......... My first thought is safety! This dude is large, obese and will make a hell of a dent if he goes to ground.
I get him situated and safe. He is still yapping on about stuff. He wants his Nitro for hernia pain, (not kidding), He wants his little 'blue' pain pill, He wants his Maalox before breakfast. I tell him I will get him his pain medicine and mylanta. He said, "They've been giving me Maalox." I said, "It's the same thing." He starts freaking out cuz he wants MAALOX and "That's What They've Been Giving Me!" I think, " Okay, okay, Maalox it is..... :-) would ya just chill?"

This guy has oxygen on, but can hardly breath. He is taking short, quick, shallow breaths. I'm concerned that he is much more confused and out of control then normal. He's barely moving air in his lower lobes and has some serious ronchi. I don't have a pulse ox with me, so I call the front desk and ask the oh, so pleasant, unit secretary to call RT in for an eval. and treatment stat.
I go on to the next room.

Patient D:

Issues, issues, issues. Little Ms. Patient D is confused as hell. Having never had her before I am not sure what her baseline mental status is. I was paged to the front desk for a phone call. It's her daughter concerned about her mother's considerable confusion. "Worse today than normal". she says. Of course it's worse today than normal, because everyone of my patients are worse today than normal!
I pull the ladies chart and there have been no labs drawn on her for a week. I make a page to the Doctor and low and behold he answers the phone! Miracle. Must be a miracle. He said he knows she is confused and to go ahead and get labs.

I gather up my supplies to draw her labs and head back down the hall to her room. She has a PICC line, but it doesn't draw. Now you would think the night nurses, because they draw the am labs, would be more proactive with getting cathflow orders, and making sure the lines flush, but they don't. They just do peripheral sticks if the lines don't draw and never say a fskg word. I have supplies for a PICC LINE DRAW, NOT A PERIPHERAL DRAW. So, now I have to walk back up the long hallway and root around for peripheral stick stuff. Obviously nobody has been flushing her catheter or we would know you can't draw from the ports. Talk about waste and inefficiency.

After writing this for awhile I feel like I am reliving the stress of that day. It's so frustrating. Can you feel the frustration? I have more from that particular day to write about, but I have some Christmas Stuff to get done and plus, it's pissing me off the more I stay in it.

This day's craziness didn't get any better. Patient B's BP was bottoming out and respiration's just got worse, he's a real mess. Patient C has a Sat of 80% and his pulse is 156, great way to start the morning. In the meantime, I need to pass AM meds. I probably started passing my morning meds at 9:30 or 10:00. Which means it was around 12:30 before I was done. Which means in the middle of all the gymnastics I get to start right in on noon meds. That sucks. I remember getting to lunch at 5:30. That sucks.

Oh, and the two geezers that can't breath, crash on me. Both ended up at the High Observation Unit before that night was over. Of course the doctors wait all day long to send them. So they didn't go on my shift, they went on the night shift! I was hanging 3, 5 and 6pm IV abx's at 7:30pm because of being so busy with these sick ones. One little old lady who couldn't do jack for herself was seen by me ONE TIME to shove crushed up meds mixed in applesauce down her throat. For that I feel awful. However, what can I do? She was the only so called 'stable' one of the bunch. She didn't get any care from me, that's all. This is wrong and it needs to change.