Head Shrinkers

The phone menu at the head shrinker's officer seriously sounds something like this:

Hello and welcome to the mental health hot-line

If you are Obsessive Compulsive , press 1 repeatedly.

If you are Co-dependent, please ask someone to press 2 for you.

If you have Multiple Personalities, press 3, 4, 5 & 6.

If you are Paranoid, we know who you are and what you want.  Stay on the line so we can trace your call.

If you are Delusional, press 7, and you call will be transferred to the Mother Ship.

If you are Schizophrenic, listen carefully and a small voice will tell you which number to press.

If you are Dyslexic, press 96969696969696.

If you have a Nervous Disorder, please fidget with the hash key until a representative comes on the line.

If you have Amnesia, press 8 and state your name, address, phone number, date of birth, social security number and your mother's and grandmothers' maiden names.

If you have Post-traumatic Stress Disorder, slowly and carefully press 000.

If you have Bi-polar Disorder, please leave a message after the beep. 

Or before the beep.  Or after the beep.  Please wait for the beep.

If you have Short Term Memory Loss, please try your call again later.

If you have Low Self Esteem, please hang up.  All our operators are far too busy to talk to you.

Wait times

ER wait times across the country have been out of control.  People are waiting hours in the ED for an in-patient bed, not to mention hours in the waiting room just to get into the magical roller-coaster land of E.D.  5.5hrs at 05:15am on a Tuesday?  Seriously?  It's depressing to see that on my nights off, because this trend will probably continue all week.  Since February I had 1 (count 'em, ONE!) slow night, the night of July 3rd (going into the 4th, when everyone was relaxing).  What is it about all the other days & nights that makes people come out of the woodwork & en-masse travel to their local ER?  I understand we are the only hospital  in a county of 165K+ people, and that our sister hospital is in the adjoining county and maybe the doctor doesn't admit there or your mother/father/brother/aunt doesn't want to drive there... But seriously?  When is this going to let up just a little bit?  I'm waiting for the giant healthcare bubble to burst, and the purulent pus that will come out will affect people at all levels, nationwide, as well as local community health systems.  I'm actually nauseous and I don't have to go to work for another 13 hours.  Time to call the head shrinker today.

Another One Bites The Dust

So today we got some rather shocking news: our manager, who had been with us for barely a year (but has already accomplished so much, and brought the department so far forward) is leaving for a director position.  It's heart-breaking to lose her so soon, to see her cry and stop halfway as she says she's leaving.  It feels like losing a super cool aunt, and knowing the date that she's leaving, makes it that much harder.  Looks like I need to embrace a new slogan if I continue working in medicine: "The only constant is change"; but that doesn't make the situation any easier to accept or deal with.  We'll see what the next few weeks will bring, I can only wish her the best and along with everyone else support her on her new journey.

Duty to Report

Got my notice in the mail to renew my state nursing license, with the usual reminder letter about a duty to report (seems like it's mandatory to report everything from child & elder abuse/neglect to rare & exotic new diseases to fraud to dangerous co-workers).  The last paragraph got me thinking: "Duty to report unsafe working practices", which mainly seems to pertain to reporting other healthcare providers (individuals) that are, for example, intoxicated at work or are performing jobs outside their scope of practice.  What about reporting corporations/organizations?  How do we as nurses complain to an authority about unsafe working conditions?  And I don't mean the time when the patient calls you a "fucking whore" for not giving him Dilaudid and tosses a urinal at you, no that's easy to remedy.  I mean the times when you have 3 intubated patients, 2 strokes, 1 non-STEMI and a chest tube in just the critical-care side of the ER, you've asked to go on divert and were denied that request.  How much and how far are nurses expected to stretch themselves?  And having been in the charge nurse shoes, I'm sick and tired of the "Talk to your charge nurse about your concerns" answer, they're only human, just like you, and most nights they already have a patient care assignment, on top of everything else that's going on.  Upper management & shareholders need to come to each unit (dayshift and nightshift) and shadow a nurse for a single, busy shift; and guess what, if the nurse doesn't get a pee break for 12 hours, neither do you, if the nurse doesn't get a drink of water (which sometimes helps during the "no pee breaks" situations) neither do you.  And please don't come to me saying how "well you chose this career" or "you knew what you were getting into".  Yes, yes I did choose this career.  However, it's inhumane to expect a person to work their ass off for 12+ hours without a pee break, snack break, lunch break, ANY break, while tolerating nasty attitudes from patients, family members, visitors, doctors, co-workers and do it all with efficiency  proficiency and a great big smile on their face because benchmarks and patient satisfaction is all that matters.

Untitled

There really is no appropriate title I can think of for a blog entry like this one. 

It's been a mix of weather lately, so even though it's almost May tonight proved to be a brisk night, probably in the 40s, and people coming into triage had their jackets & sweatshirts on.  I thought nothing of the scrawny 14-year old (who looked more like he was 11) when he limped in with his grandfather.  The child was complaining of generalized abdominal pain, holding his stomach and appearing all around uncomfortable and in pain.  Nothing unusual.  While I changed out the adult for the pediatric blood pressure cuff he pulled up his sleeve and stretched his arm out towards me.  My jaw almost hit the floor.  What's that, black-blue veins along the forearm and A/C region?  Perhaps noticing my hesitation the grandfather chimes in "He's Hep C positive, he did Heroin, he just got out of inpatient psych today".  I don't know how many more times I stuttered through the triage questions, but I did not think it was possible for my tongue to turn to ask a 14-year old "when was the last time you used, what did you use, and have you used anything else".  

Unapproacheable

So a couple of months back I had a conversation with the boss where she described some concerns the other staff had brought up to her.  Specifically I was called tough, unapproachable, and had a my-way-or-no-way attitude.  I was not given specific situations that generated these complaints, nor was I told who the people making complaints were.  Needless to say I was upset that my own co-workers couldn't come to talk to me, defensive because I was called unapproachable, and confused about how I was supposed to be responsible for the safety of all the patients in the department without delegating proper assignments to the staff.  On the nights in questions we had high-volume, high-acuity nights, and at times nurses ended up with 5 patient assignments, however I was constantly rounding and never asked nurses to do something I wouldn't.  I'm now channeling my energy of disappointment and frustration at finding my next career path in medicine, trying to decide if I want to stay at the bedside.  Ideally I would want solitary, independent work that involves high-tech, high-expertise skills: so currently it's a toss-up between an NP program or an MSN in Toxicology or Forensics or Legal Nurse Consultant.  Still have a dream to fly.  We'll see where this road leads.

Morale

Morale is at an all-time low since I've started.  Excellent experienced nurses and great new nurses with lots of potential to grow & develop are leaving, for multiple reasons: staffing, patient load, attitudes, drama, pay, HR issues.  It's sad to see staffing get tighter and tighter with nurses leaving twice as fast as they are coming in.  It's a concerning trend that our "customers" are blind to: from our point of view, "if you only knew what we're dealing with back here", and from management's point of view "you are not allowed to discuss any staffing details with patients and families, including answering how many doctors are on duty".  My motivation to work is still the fact that I get to learn about the human body, how it can turn on you and save you in one day, and the science behind medical treatments; as well as the several projects I have going on at work - Disaster Preparedness, Pediatric Operational Committee, and relief Charge Nurse.  Yep, that's right, I haven't been here 6 months and they've asked me to take on PRN Charge Nurse shifts.  I'm scared out of my mind, even more so, given how many nurses are bailing out.  We'll see what happens a few months down the road... I sure hope this is the bottom before things start getting better & it doesn't get much worse.