Interesting development.  The corporation I work for is offering a pretty good bonus if you recruit one of your experienced ER nurse friends to work for them.  Is this a sign that things are picking up in nurseland?

Is this the start of a shortage? I think that experienced nurses are sometimes hard to get these days. Most ERs don't want to hire non-experienced or new grads in ER.  Or ICU or other speciality areas.

Here's my take on it (hey, you knew I would have one). Nurses have not been leaving jobs because there haven't been an abundance of jobs.  We are afraid to leave a job during a recession. Some people have had their spouse laid off.

I see jobs picking up somewhat. I also know that: 1) older nurses are retiring 2) younger nurses are going back to school to be NPs and leaving  3) We are starting to see an increase in patients who are elderly (people are living into their 80's and 90's these days)

The first baby boomers are retiring. The explosion of older people and their medical problems is coming.  Obamacare is coming. You ain't seen nothing yet.

More money for us. Yeah! (rubbing my hands with glee) 

We are about to get PAs (physician assistants) in our ER.  They will staff part of the ER part of the day.  They will probably take on more of the ER as time goes on. Big change. From what I understand, this is being done because our doctor group doesn't have enough docs to staff the several hospitals they cover.

I don't like this. Seems like docs should staff ERs.  Here's the thing: You are not going to believe this but they don't give a shit what I think, here they come.  Its reality. So I will adjust and so will everybody else.

However, I wonder if by employing PAs, doctors aren't cutting their own throats. Lets face it folks, the vast majority of ER medicine is not rocket science. With a little experience, you pretty much know what the problem is. So PAs will do fine with their background. In fact, I would say that PAs and NPs could easily staff most ERs with a doc to supervise and handle the critical cases.

So really, is this what the future holds? Perhaps.  Health care costs will have to be cut.  PAs and NPs are a lot cheaper, will cost hospitals less, insurance companies and medicare/medicaid less. You can pay a PA/NP maybe $125,000 versus and ER doc $250,000, thats a lot of savings.

Like I have thought for a while, the future of general practice is PA/NP and perhaps some specialty areas too.  

Oh no. What has happened to one of my favorite blogs: Nurse in the hood?  Please, come back to me.

My ER is changing.  It is changing like all of medicine is changing.  I have been a nurse a long time. Things were different when I started. It wasn't a corporate run environment back then.   There was more of a kumbiyah feeling. 

Now it is a business. Plain and simple.  Its hard to adjust to the idea that medical care can be a business, but there it is, whether we like it or not.

The thing is nurses haven't adjusted to this new environment.  We want things to go back to what they used to be.  To a time when we had more time with our patients, where things weren't so complicated. The thing is thats not going to happen.  We will have less time with our patients and things will get more complicated.

In my ER, like most ERs these days, the bottom line is volume, patient satisfaction, in other words, money. I'm not saying we don't do great patient care, we do, but doing great patient care means nothing if nobody comes, they aren't happy and the bills don't get paid.  Its reality.

I see our doc group adjusting.  They are expanding their business to other ERs, improving their skills, trying to make the patients happy so they will come back.  They get monetary incentives to see more patients.  Everything they do, efficiency wise, is tracked.  They are adjusting to the new environment and trying to thrive within it.

There is a lot of talk in our ER among the non doc staff about how they docs don't really care  about anything but themselves. They only care about making money.  People think they treat us like task monkeys.

My thoughts: Docs have recognized that in this corporate healthcare environment, they have to look out for themselves. Nobody else will.  Nurses don't recognize that, at their own peril.  Nurse are definitely more than task monkeys,  they are the cornerstone of the healthcare environment.  IF we as a group don't start changing, promoting our profession, taking care of our own interests in this business environment, we will be gone, replaced by task monkeys.

We have to recognize that don't DESERVE anything, we have to prove our worth, change with the times, embrace change, help to create it.  The question is: Do nurses care enough about our profession to save it?

You don't realize it. Your family doesn't get it.  The doctor and I know you are not going to live past the next couple of days.

All you know is that you are having pain. Your family is in a state of shock. The things they say, the questions they ask, tell us they don't understand the seriousness of it.  The doctor ackwardly tried to explain to you and them that things most probably will get worse soon and decisions will have to be made that no one wants to make. He asks if you have talked about how much you want down regarding resuscitation, intubation. You and your spouse are old, but like most people you haven't discussed it. 

When the doctor leaves, I tell you that you are in very serious condition. Nurses do that. We feel we need to bring reality in, so you can prepare, even if it is hard.  We are the translators for what is going on.  I ask about children and tell your spouse that the needs to call your, tell him what is going on.

Its hard to understand when you are so stable, still understanding some, talking. Its hard for you to see what is coming. 

You go up to ICU, your pain is getting worse. When you get to ICU things are starting to  deteriorate and the doctor is called and you will have immediate surgery. You will probably make it through it, but because of other medical problems you have, you won't make it much longer.  I think about what your family will go through.  You are the kind of person I am thinking about a couple of days later.
You are the person who reminds me life turns on a dime.   

Something happened the other day. I'm not quite sure if it was real. I went to work as usual, walking into the hospital wondering what shit  would rain down on me  today. As it turns out I was walking into a magical fairyland. Yes people my saggy, baggy, ratty, dirty, rundown old ER had turned into something else that day. A place I didn't even recognize. It didn't look any differnt.

Something was in the air that day. Something that I hadn't felt for years.  I didn't even realize how different that day  had been until I was in the car driving home. I was humming, feeling tired, but good.  I didn't feel that ugly, bitter, angry "I hate this motherf---king job" feeling.  I actually felt kind of good.

Wait a minute......SCREEECHHHH!!! STOP THE PRESSES!!! Yes, people I actually felt good about my day at work that day. I felt like I had accomplished something, done something worthwhile. No, I didn't sit on my butt all day because people trickled in. It was a steadily busy, post holiday type day. Lots of grandmas and grandpas.

I had sick patients, really sick patients, they might die sick type patients.  The kind of patients you are still thinking about a couple of days later, wondering what happened to them.

The point of all this?  I actually took care of  REAL emergency patients.  Patients who truly needed help.  No whiners, seekers, fools, crazies,  drunks, dopers.  It was actually like you think an ER should be. 

I doubt it will ever happen again.....in fact it may never have happened at all....maybe it was a dream.

I can save your life this Christmas.  Buy one of my bracelets on Etsy.  Everything in the shop is 15%off through Monday with the coupon code BLACKFRIDAY15 at checkout.  Click on beadnurse below pictures to go to my shop.

Just when I think I have heard it all in medicine, something else comes along to amuse, amaze and trouble...such as: I have seen this twice in the last couple of months. A doctor orders an infusion, YES I SAID INFUSION, of caffeine in order to avoid those pesky headaches from withdrawal of caffeine.  Both were given when someone was having surgery.

Okay....perhaps we should give a nicotine infusion, for smokers,an alcohol infusion, for alkies.  Maybe a chocolate infusion....the possiblities are endless.

There are four areas in my ER.

Area #1 AKA the HELLHOLE

This area is where the drunks, dopers, old lady/man weakness, suiciders, people with 89 problems and now they got another one.  Its the patient who need to be cathed, put on the commode, need every test know to man. It has 2 critical rooms, one of which is right next to the desk.
Last week I sat at the desk, across from the desk while my patient kept shouting that I was a "bitch", "aren't nurses supposed to be nice?" All this because I turned down a request that this person made which couldn't happen.  2 psych rooms.  BTW, as a general rule I AM NOT NICE.

Area #2  AKA CRAZY TOWN

This area is twice as big as area #1.  The only thing I could compare this area is times square. Sensory overload.    It is loud, chaotic.  Too many people in too small of a space There is always a dull roar.  As a nurse, sometimes its hard to find a seat here. It is the kind of area, where when it starts ramping up, it really ramps up.

Area #3 AKA HOOD RAT PLAYHOUSE

This is the area where all the local hood rats come for their boo boos, drips, pregnancy tests, womitting x 1 hr, BACK PAIN!!!,  etc.  It is supposed to be a kind of urgent care area but of course it isn't.  People often stay here longer than in the main ER because everybody has to have a "liter of saline, zofran and  Dilaudid".  You know how diners have specials?  Well, the special in HOOD RAT PLAYHOUSE is saline, zofran and dilaudid. Working there makes you want to jump off the parking ramp.

Area #4  AKA SATANS PLAYGROUND
Ah, triage, every ER nurses nightmare.  You never know whats coming next. Sometimes the devil himself shows up at the window.  There is a lot of temptation in triage.  The triage staff is tempted to slap some people silly.  My tongue is always raw and bleeding after a triage shift, because I am contantly biting it. Unbelievable things happen in triage: heads spin and green vomit spews, people roll on the floor, there is screaming, weeping, many a tooth are gnashed. Its the seventh layer of hell.

And that, my friends, is my ER in a nutshell.

This is war, people.  Stand back while we fight the almighty bed bug.

Hey I get it...the danger of spreading bed bugs throughout the land and throughout the hospital...no one likes the little critters.  But what I saw today makes me think that we have gone off the deep end.

First  of all, apparently there is a 15 page explanation of the hospital bed bug policy, which is very complex and intricate in a binder.  Who knew? 

Whats funny is that apparently we are now supposed to wear a disposible paper jumpsuit.  Yes, I said jumpsuit, a la Elvis or some shit. I mean that is how serious this has all become.  Here's the thing because the paper "jumpsuit" could not be found, someone brought hazmat disposable suits to wear. 
So registration goes in wearing a hazmat suit with hood up over their head.  They also had a mask on due to droplet precautions. I tell ya, what we go through to get insurance information these days.

So there is registration making their way into the room for those signatures.  Following them  lab, with same get up and hood and mask.  They look like they are entering some chemically contaminated scene.  It was bizarre to say the least.

I wish I had a camera..

Only in  this insane place that I live can you go from 60 degrees (which in November here is miraculous,) to an evening thunderstorm, to 30 degrees and snow in the space of 24 hours...

BTW, honor the veterans today and make a donation to Fisher House.

Top ten reasons why nursing is such complete bullshit:

1) In what other job are you expected be okay with being verbally abused? 

2) In what other job, is the leadership so bad? 

3) In what other job are you expected to go hours without a break and be okay with it? 

4) In what other job are you asked to give dope to a junkie? 

5) In what other job are you supposed to try and understand and empathize with someone who is threatening you? 

6) In what other job do you get 2 dollars more an hour to be in charge of a place where peoples lives can be on the line?

7) In what other job are you physically, emotionally, mentally exhausted at the end of most days?

8) In what other job could you get a life threatening disease but are given no raise for a year? 

9) In what other job are you exposed to junkies, criminals, sex offenders, psychotics, neurotics on a daily basis but you only hear from the management what you do forgot to chart some piece of bullshit?

10) In what other job do the mediocre advance to leadership positions? (see 2)

And that my friends is why nursing is such complete bullshit. The end. 

Sincerely, 

Highest number of people waiting in the lobby to get in today: 22

Highest number of people in line at the triage window at one time: 10

Highest number of people in the ER at one time today: 52

Longest length of time someone waited: 3 hours

Most members of one family triaged today: 3

Longest time someone had a symptom they were being seen for: 2 years

Shortest time someone had a symptom they were being seen for: 1/2 hour

Percentage of people who didn't really need to be there: 90%

Dumbest reason to come to the ER: "I want to be seen for an std, I have no symptoms but something doesn't feel right".

Smartest reason to come to ER today: severe chest pain for 3 days

Amount of time left in the shift when I got dinner: 1 hour

Amount of times I felt like running screaming from the ER while working in triage: 12 - at least twice an hour

Once upon a time there was a rocket scientist. Now this rocket scientist did not go to the dentist on a regular basis, who knows why. Well one day rocket scientist has a toothache. Now toothaches suck as we all know.

Well of course rocket scientist does not have a dentist, not using such services on a regular basis. Didn't think of going to the drug store to get something. Eventually rocket scientist decides that this toothache requires emergency intervention. So rocket scientist calls an ambulance. Yes, an ambulance. Now Mr/Ms. paramedic are obligated by regulation to take rocket scientist to the ER, code 58 (if we get stuck in traffic we don't care). Paramedics walk rocket scientist into ER triage. Rocket scientist is put in the lobby after triage. Eventually they are taken back to the fast track and put in a room. Within 5 minutes rocket scientist is on the light asking for pain meds.

And so the story goes on....Act 11 scent 28...enter stage left - nurse practicioner. Nurse practicioner won't give narcs for toothaches, bless her heart. When Nancy nurse goes in to discharge rocket scientist they are no where to be found. They have left without instructions, realizing no narcs are forthcoming.

Your tax dollars at work.
Fade to black....

Hey I'm sorry if your life is shit, but that doesn't give you the right to become so enraged that you tear the reciever off the wall phone and throw it across the room hitting the wall. The wrath of madness will be upon you. You endangered us and we don't like that.

Hey I'm sorry you are a pathetic drug addict who told us you are suicidal. That doesn't give you the right to make a run for it. You are fast, but we are faster. It is our security's pleasure to tackle you out in triage. They live for that shit.

Hey, I am sorry that your life has gone badly, but that doesn't give you the right to light up a cigarette in the patient bathroom. That does not endear you to the staff or the other patients. The tenor of your visit has now changed. Not in a good direction.

How was your Friday?

Now news today of NYC Bellevue hospital having to be completely evacuated.  I wonder how the rest of the hospitals in the city are absorbing hundreds of patients.  I think of how tight beds often are among the hospitals in my city.

I have seen stories about "bucket brigades" of people passing cans of oil up 12 flights of stairs to fuel generators on upper floors and this has been going on for more than 24 hours.  Also bringing patients down more than 12 floors to be evacuated by ambulance. Imagine bringing a critically ill patient and all their equipment down that many stairs...I can't imagine it. Makes you think about something similar happening in your own hospital.

Then there is the fact that there are now 2 less hospitals in a city of millions including a trauma center. Another thought I had was with the terrible traffic jams there, how are emergency vehicles getting through?

I wish them well

Donate to the Red Cross.

Speaking of evacuations ... I once worked at the county hospital. I was in orientation to the stabilization room.  We had just received a patient.  They were either DOA or died shortly after arrival.

There was a bomb threat. The ER was quickly evacuated. I don't even know where they sent the patients. All I know was that it was done quickly and efficiently. The dead patient stayed in the stab   room.  We all went out on a corner by the hospital until it was all over.

Some hospitals are just set up to respond to disaster. Then there are those who aren't...

Watching on TV  NYU hospital in New York City being evacuated right now due to power failure and back up generator failure.

I can't imagine that happening. All the lights go out, all the power goes off, including the power that runs the ventilators.  I don't know if vents have battery power, never had to think about it. Lots of modern medical technology depends on electricity.  Lots of very complex technology that makes my stomach hurt to think about going out. I hope everybody survives.

This is every hospitals, every nurses and doctors nightmare come to life. I pray for them and their patients.

So a friend  of mine who works in a smaller hospital in the suburbs was telling me about a JCAHO visit a couple of months ago...

It seems that JCAHO was someplace and happened to glance at a sprinkler on the ceiling and noted some dust on  it. Well a message went throughout the land about this.  Soon managers and their supervisors and their supervisors were sending messages all over the hospital to promptly clean the sprinkler heads in each department.

In my  friends department a man was seen, compressed air bottle in hand going from sprinkler to sprinkler blowing invisible dust off each head.  And that, my friend, is how ridiculous things have become in health care.             

It seems at a small suburban ER, patients go to great lengths to smoke a cigarette.

There is a hospital where a gas station is across the street.  Apparently quite often patients will walk over there in their patient gown to get a pack of cigarettes, butt flapping in the wind, steering an IV pole.

One guy actually drove over there with his IV pole out the window next to the drivers seat, one hand steering the pole and one hand steering the car. The lengths that addicts will go to....

You know its going to be a bad day when your first patient calls you a "motherf----r" and says "get out of my room, I'm not lettin' any of you do anything to me", as her alcohol tinged breath wafts across the room.    Okay.....it's 9:15 and I have 11 hours and 45 minutes to go. Among the other patients was someone in for mental health because their grown son had just been sent to prison for life.    Then there is the 55 year woman who has been fighting cancer for 10 years (and looks it) and this will be her last day of life. She will not go out quietly. Death isn't pretty a lot of the time. It involves noisy breathing that tortures family members. It can go on for a while.    There is the young man found staggering around a local mall and when the doctor asks what's going on with him, he gives her the finger. OK then....   There is the crack/pot abuser in her early 30's with seven children whose family brought her in because they don't know what to do with her anymore.    There is the man from another country with both cancer and tuberculosis who is dying. Sometimes I just feel weary of the suffering and troubles. I'm human.

Here's something I've never heard of. Giving an IV piggyback of caffeine for possible withdrawal from caffeine that can give you a headache...

This is unbelieveable.  I am perfectly aware that caffeine can be part of medication that is used for migraines.  Nothing wrong with that.  But using it because you don't want to have a headache from not having your daily coffee or pop t, seems ludicrious to me.  I mean is this what this country has come to? 

Your poor little puddy tat, let me get your caffeine fix for you....I don't want you to suffer.  Oh my no.  Having any kind of discomfort whatsoever is completely unacceptable in this riduculous country of ours.  I'm a daily jelly donut user, can I get a jelly donut infusion?  How about chocolate?

Funniest tweet about the 3rd presidential debate:


"President Obama has that "I have Bin Laden's head in a bag beneath the desk." look in his eyes."

Lately there has been an explosion of ER hoppers in our ER. What are ER hoppers? They are those patients who yesterday, two days ago or whatever went to another ER but felt the need to come to our ER this time. They have various reasons for doing such an idiotic thing. The seven deadly sins. Among them:

1) I didn't get any pain meds for my neck injury from an MVA 2 weeks ago at the other hospital and I'm hoping you will be nicer.
2) I had surgery last week at another hospital, now I am having problems, and your hospital is closer.
3) I didn't like the way they treated me at XYZ hospital.
4) The wait was way too long at the other place
5) I want a second opinion.
6) They didn't do anything for me over there.
7) Family is not happy with care of other doctor, hospital, etc.

ER hoppers are sometimes dumb enough to tell us they were at another hospital. Then there are those who don't. They think we won't find out. But BEWARE, these days we can see if you have been to another hospital in our system. We are also connected to other hospitals as part of a network that shares info, with your kind permission of course.

When I ask people why they didn't go back to the hospital that treated them before, did surgery on them, they are often offended, like I shouldn't ask that. It should be okay to come to a hospital that has no records of your surgery, history, etc. Sorry if I think thats stupid.

How to make nurses happy:

1) Eliminate rotating shifts.  There is no reason for rotating shifts.  Pay people more money and benefits to work straight off shits.

2) Make sure that nurses get their lunch break and other breaks.  This is not that difficult. It is required by law.  Insist nurses take their breaks.  Everyone needs a break, espescially from this stressful job.

3)  Make it policy that nurses have control over their practice.  If something is going to affect nurses talk to them about their opinion about it.  Nurses are not unwilling to accomodate change, they just want to have a say in it.  They will no doubt have some great ideas.  Eliminate bullshit committees that do nothing.

4) If healthcare is a business, bring in people with business degress at the middle management level.  People who have been to school in how to MANAGE people, hold people accountable.  Promoting nurses to management posiitons, without a business background is a mistake, in my opinion.  They make awful managers. 

5)  Put policies in place that make verbal and physical abuse by patients unacceptable.  Take this so seriously, that the patient who has been medically cleared or is stable is either discharged or transferred to another facility.

6) Put policies in place that are serious about unacceptable behavior  by doctors (or anyone else for that matter). Fire them if it doesn't change.

7) Here's a controversial one: eliminate 10 and 12 hour shifts.  No one should work that long in such a stressful job.  It is unsafe.

8) Pay people with more skills and more responsiblity such as those in critical care more money.  It makes common sense.

9) Allow nurses to take an LOAs, say every five years, for a short time to rest body and soul if they choose to.

10) Pay monetary incentives to nurses around defineable goals. Managers and administrators are not the only people who should get money for achieving goals.

Any thoughts?

10) poop, vomit, blood, snot,  etc. 'nuff said.

9)  borderline personalities

8) inept management - Is there a good nurse manager/supervisor/administrater anywhere?????

7) rotating shifts

6) the growing number of obese people

5) exposure to disease

4) jerk doctors

3) working holidays

2) lack of appreciation

1) impossibility of completing required tasks, charting, etc.

Your thoughts?

I know bed bugs are no laughing matter, but geez.....it is getting out of control how we deal with them.

I pity the poor housekeeping staff, who have apparently gone through a detailed class on how to identify and COLLECT, yes I said COLLECT, said bed bug in a speical BED BUG container.  Apparently we are now collecting specimens.  I bet the housekeepers are saying: "HEY I DIDN"T SIGN UP FOR THIS SHIT WHEN I WAS HIRED!" My question is: what if they are still alive? Do they expect the housekeeper to chase them around the room and trap them under the specimen container? What do they put them in the cup with? Tweezers? Special bed bug catching instruments?  Shit its enough to give them nightmares.

After they catch Bob the Bedbug, then they call in the BIG TIME inspectors from some other department that has been specially formed to deal with these problems.  I hear they have shirts that say BEDBUG INSPECTOR.   After that they can clean the room.

Now all of this takes up to two hours.  If you can believe that.  A room out of commission for two hours because of the possibility that a bedbug has set up shop in the room. 

Here's my idea, I think I'll report that I saw a bed bug in a couple of rooms on a routine basis so that we have those rooms out of commission and there will be less patients brought back...

Well, its that time of year again. Its a little bit cooler and people start to go indoors and spread disease among themselves.  First up in the season: vomitting, diarrhea.  With this in my I present the following:

DEAR MR/MRS JOHN/JANE Q. PUBLIC:

If you have vomitting or diarrhea or combination of the two and are somebody who is in a normal state of health,  IT IS NOT AN EMERGENCY.  REPEAT, IT IS NOT AN EMERGENCY.  It is most likely a virus you have picked up in your travels through the world.

DO NOT COME TO THE EMERGENCY ROOM. WE DON"T WANT TO SEE YOU.  You clog up the system, fill the chairs in the waiting room, spreading your virus to others.  You take beds from people having an MI, a dissecting aorta, a stroke, a major trauma. 

Your day or two or even three or four of vomitting or diarrhea  will not kill you.  You will recover. It takes time. 

MAN UP.  Wash your hands.

with affection,

Madness the nurse