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.

Blessings

Many things we encounter in the ER makes us count our blessings.  A 45 year old who survived breast cancer & was told there was 0 chance of recurrence is now battling breast cancer (despite a double mastectomy) AND liver cancer.  Her quiet, gentle and loyal husband is sleeping at her feet, waking at the slightest noise.  A family of 5 who lives in a shelter, the most polite kids, an exhausted mother, and a polite, kind, firm father.  A 9 year old who gets panic attacks when anyone talks about her father who's in jail, and she asks the doctor to write a note to the jail telling them she needs her daddy home and she misses him very much.

Count your blessings.

A way out

A full-time position at the stand-alone ER 30 minutes away has just been posted... Hmmm... lots to think about.

It's a dog's life

EMS rolls in the door with a CPR in progress on a 70-something year old man, his furry companion in tow.  The man was walking the dog when he collapsed of a massive MI, unable to even identify the man at the time, let alone call a family member to get the dog, EMS did the best they could & brought the dog along with them.  They said he gracefully rode in the front seat, periodically turning around to look back at his friend.  He calmly walked behind the stretcher, his Great Dane head towering at the level of the stretcher, and when they all went into the trauma room he laid down in the corner of the room, staring at his friend.  Never once did he utter a sound, not a bark, not a whimper.  When the code was called and most of the people shuffled out of the room, the dog walked over to his friend and nudged his hand.  Not getting any response he nudged again and whimpered.  The cool hand confused him, he couldn't understand why his friend wouldn't acknowledge him.  He let out a long slobbery dog sigh, then leaned his front paws on the stretcher and leaned in to give his friend one last wet slobbery dog kiss.   He slowly understood; he laid down in the doorway, his head flat on the floor & stood watch over his friend's final moments while the nurses cleaned him up and packaged him up in a body bag.  And as a loyal friend, he accompanied them to the morgue, where he sat in the doorway, not moving, and watched them put away the body.
That night he went home with the nurse that took care of his friend during his last hour.  The man still hadn't been identified, and she couldn't bear to take the dog to a shelter; he had just lost his forever friend, she didn't want him to lose everything else too.  He slept at the foot of her bed, whimpering occasionally in his sleep, but easily reassured that she was nearby.