They forgot my birthday!

This may seem trivial, and I probably shouldn't let it bother me so much but I can't help it: it's day 3 (I guess, business day 2) of Emergency Nurses Week and so far we've received ONE half-hearted e-mail with cheesy stock photos from the Nurse Educator (read Non-Clinical Nurse Nazi)...  Not a word from our director, our manager, the administration of the hospital, other departments, or the other EDs in the health system.  Again, I probably shouldn't let it bother me so, but it still sucks.  I hear from 10 different people when I fail to submit my TPS reports, but I can't get a goddamn sincere "Thank You" one fucking time in a year?!  This is a nationwide week of recognition, and quite frankly I'm not accepting any excuses.  Tonight I'm going to work & I'm going to keep my head up high and proud, like the expert emergency medicine professional that I am.

Never mind the fact that I just spent 3 hours looking for other jobs.

Light duty

I absolutely object to direct-care nurses coming to work on "light duty" and "attempting" to do clinical work.  I say attempting because light duty in the hospital means you're on the schedule as a full nurse but in reality you can't do certain crucial aspects of your job.  This scheduling gimmick is often used by managers, but hurts the fully-functioning direct care nurses (image a nurse that only works triage and refuses to work another assignment, or a tech who only works the desk as a secretary despite the fact that the job description is Tech-Secretary).  You either do your job 100% or don't show up at all.  However, I think there should be a light duty option for clinical nurses (staff education, unit administrative work, patient call-backs) to come back & earn a living while recovering.  Perhaps at a reduced wage (as arranged through proper legal channels), but still working and earning money and earning PTO time.  Over the last few years I personally knew (and donated money/time to) several nurses and paramedics that suffered a tragic accident or a debilitating illness and couldn't return to work due to new limitations or trivial documentation that makes them seem unfit for duty.  All honest, hard-working, great people that would give you the coat off their back even if they had nothing of their own.  And except for some sporadic donations, we as a profession, tend to forget and ignore our friends when they need us the most.  I've had nurses tell me that all their friends abandoned them and they hardly talk to anyone at work anymore.  We must do better than this, and we can do better than this.  No matter how busy our own lives are, never forget your blessings and be humbled by the lives of your co-workers and friends who may be fighting a very hard battle.  Reach out and say a kind word, donate some time, money or services to them (could be as simple as driving them to the grocery store or running their kids to practice).

Cross your "t"s and dot your "i"s

I actually feel like my eyes are crossed now... Sent and re-sent my application for Walden University multiples times (4, 5? I've lost count), all times getting daily phone calls from the mysterious Admissions Recruiter who first told me to elaborate regarding my work experience (and this conversation required 10 days of phone tag), then told me my addendum page elaborating my work experience was unacceptable and that I have to fit it all on the application page (thank goodness for editable PDFs).  Sorry for the run-on sentence but this is extremely frustrating!  Out of frustration I looked up Walden on allnurses.com and quite a few posts question it's validity and discuss whether or it it's just a diploma mill.  Currently it's between Walden & Drexel for the AGACNP track.  Walden is 100% online, starts December 1st, but seems not very reputable.  Drexel is all online except for 3 required campus visits for "clinical lab", starts next fall, but also is a much more reputable school.  We'll see what happens, I still need to submit a potential clinical sites selection form for Walden & then I'll have an admission decision.

At the same time, my disgruntled, burned-out self is questioning if I should even pursue an NP track, or get out of nursing all-together.  My blindly hopeful & optimistic self is making plans about how I can do house-calls to retirement communities for physician groups, work in ICUs as a Critical Care NP, work as a nurse consultant (see previous post about pimping myself out), or any other healthcare career tracks.

This is the Stuff Nightmares are made of

Nurses are very stubborn creatures by nature.  We claim that we adapt to change easily and can work in the ever-changing environment, but when you tell us you're starting some non-sensical evaluation tool like HCAPS in the ED setting and then tying ED provider reimbursement to the HCAPS you bet we're gonna be angry.  I'm debating how long to stay at the bedside.  My lofty aspirations continue to draw me to Flight Nursing.  In-hospital, I'd like to do PACU or maybe OR.  Completely non-bedside I would seriously consider Legal Nurse Consultant, Clinical Toxicology Specialist, or simply Nurse Consultant.  I could pimp myself out to patients and families agreeing to visit them in the hospital and review their care with them to make sure that the care they receive is appropriate and actually indicated, not just care that the doctor wants to give or the care that the government mandates.



Below are just some of the articles that explain why those of us that work at the bedside think that patient satisfaction is a bad metric:

http://www.kevinmd.com/blog/2014/03/patient-satisfaction-hospitals-car-dealerships.html

http://archinte.jamanetwork.com/article.aspx?articleid=1108766

http://www.forbes.com/sites/kaifalkenberg/2013/01/02/why-rating-your-doctor-is-bad-for-your-health/

http://www.kevinmd.com/blog/2014/06/patient-satisfaction-surveys-riddled-problems.html

http://www.kevinmd.com/blog/2014/06/hold-patient-satisfaction-scores-done-right.html

http://www.kevinmd.com/blog/2013/06/doctor-guilty-fraud-great-patient-satisfaction-scores.html

http://archsurg.jamanetwork.com/article.aspx?articleid=1679648

http://www.kevinmd.com/blog/2012/02/patient-satisfaction-kill.html

http://www.kevinmd.com/blog/2010/04/oped-patient-satisfaction-medical-care.html

Mad Skillz

2 for 2 with U/S guided IV access tonight, one sickle cell, and one pancreatitis.  Difficult veins: 0, Allie: 2.  Love trying out new things at work.  #easiertoaskforforgivenessthanpermission

Wit, wisdom & wonderfulness

Oh. My. God. I'm in a work-related heaven. Turns out ImpactedNurse continues to blog!! Many a time when I was ready to quit nursing (many, many a time!) I turned to his informative, humorous, RAW and REAL writing to turn myself around & cultivate a new love of the profession. The 3 free e-Books listed here http://www.impactednurse.com/?p=549 are what got me through.

New job at Milford is going great!  Less drama, more sanity, awesome experienced nurses who are calm, cool & collected, talking about how they used to smoke at the nurses station.  Doctors who are fast, smart, polite but firm and set limits with their patients immediately.  Not to mention only have to run 16 beds instead of 40.  Should have done this long ago.

Less attitude, More gratitude

Home early & sick.  Thank goodness for low census.  Had I stayed the full 12 hours I would have (1) strangled some people, (2) been completely useless to my patients seeing as I can't breathe & my head is about to explode.  Shift started out easy, my assignment was empty from day shift due to low census, so I had the luxury of checking all my rooms, cleaning up & stocking.  No sooner than I'm done in my last room the nasty charge nurse comes over and says I'm actually taking over the other side of the pod (where 1 patient awaited me) - I say to her "Well I've got 1 patient on my side and I'll take 1 patient from that side, but all my rooms are stocked and checked." -- "Yea well it's just easier for me to move your 1 patient instead."  Muttering under my breath I move my patient and begin my cleaning/stocking saga all over again in 4 new rooms.  I mutter some more as I take over the patient with a clear-cut (no pun intended) post-op infection with absolutely no pre-emptive orders done; the off-going nurse put his orders in an hour ago for labs & a line, but then he sat there for an hour and didn't do anything.  My LPN drops a line & I give the poor patient some pain medication.  While I do that EMS rolls in next door with a patient, whom I was initially, and in a rather nasty tone, told was not coming for 1-2 hours (which is a little bizarre for an ER patient, but whatever).  I get on the radio and ask for the charge nurse or the float nurse to come & triage my patient.  No answer.  Get on the radio twice more while I push Dilaudid on my post-op patient; still no answer, crickets chirping.  I finish the Dilaudid & step out to meet EMS who is now roasting marshmallows in the hallway (aka camping out waiting to give report).  I profusely apologize that no one has come to take report, and get a quick report from him.  My patient is pleasant, anxious, but very nice.  Multiple more times throughout the shift I get on the radio to either ask for help or ask who is on the phone, and multiple times I'm met with either silence or attitude.  I'm too sick to put up a fight with anyone.  I get all my patients settled, and discharge the possible miscarriage.  Only to get the mid-forty's mother who's battling breast cancer a second time after being told she has a 0% of getting it again; so much for 0%.  We last met 9/29/13, and she looks about the same: trying to be brave for her family, but completely overcome with pain.  She's a quivering mess of pain, fear, sadness; yet she continues to apologize for coming in and says "Please don't give me too much Dilaudid, I don't handle pain medication well, I just want something for nausea."  Her teenage daughter sits quietly in the room, and her attentive, exhausted husband sits too, soft-spoken, calm and caring, he provides information.  I access her port & very slowly give her Dilaudid & Zofran; she is immediately relaxed, drowsy & calm; I don't leave her side because of her previous problems with getting Dilaudid, I call out 6(!) times for someone to bring me a lab cart before the blood in the syringe clots.  Crickets.  I finally get Tammy (my favorite LPN & work BFF) on the radio & she brings the cart over.   Again, too sick to fight with anyone, and now emotionally drained after meeting my unfortunate patient and her daughter.

Decision made: time to leave and accept the job at South Base.  Had a great interview there 2 days ago, peer interview went well, staff likes me from the 2 shifts I've worked, Nurse Manager is excited to get an experienced (me? experienced?!) nurse on board.  She was quite appalled by hearing how some of  the staff talk to each other at Hood Hospital.  I'm tired of the drama, tired of the cliques, tired of rudeness.  Apparently I'm unapproachable and bossy, but everyone else is allowed to get away with their behavior.  I will not tolerate it anymore, I cannot seem to change it in any way, so to save my sanity & career I'm moving on.  Resignation letter is typed up, will go & speak with the Interim Nurse Manager tomorrow about leaving.  Did I mention the Director is quitting as well?  Leadership is falling apart at Hood Hospital, and it only lets more bad behavior go unchecked, and people with poor attitudes continue to get away with their bad behavior.  It's time to leave.