Donkey Portions

I would like to get this in a velcro patch or perhaps a bumper sticker that I can forcefully apply to coworkers to drive my point home:

If I wanted the work to be done half-assed I would have asked ________ (insert name of your least favorite co-worker here).

I'm not saying we all need to be perfectionists and stars at what we do.  But we do have to be competent.   I don't think "competent" is too much to ask for when a 61 y/o male tells you he has back pain, hurts all over, sharp chest pain, and you note wheezing, I don't think it's too much to ask for to order a chest pain protocol and at least 1 DuoNeb.   No, telling me that "he's not in distress" isn't good enough.  No, telling me that you've ordered a chest XRay because of the wheezing isn't good enough; last time I checked, radiation doesn't fix wheezing.  But a DuoNeb just might.  And I'm sure that in the 90 minutes that patient has sat in the ED core you could have figured that one out.  This isn't rocket science.   But obviously this was not happening inside your skull:

No, no, it's alright.  I'll totally work-up the 61 y/o with hx of angina for his chest pain & back pain.  And yes I'll totally admit him for groundglass infiltrates PNA.  And I'll even draw the blood cultures prior to his ABX even though the doc forgot to order them.

So, please, today, when the doctor that I wouldn't trust with my dead goldfish is working, please, take your fucking head out of the goddamn bubblegum factory and for once in your fucking life THINK like an ER NURSE.  Which sometimes means, yes, you have to think like a DOCTOR.  It doesn't really matter to me what you call it, I just call it CRITICAL THINKING.  And in a busy ED, it is CRITICAL.  Otherwise please expect a thorough ass chewing from me.  I hope you taste good with Nutella.

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.