Unless you live in a cave, you have probably heard about the fungal meningitis outbreak.  A company that supplies steroids to doctors who inject them into the spine of people with back pain sold contaminated vials of medication.  Seven people have died.

So apparently these medications went all over the country. It seems state department of health agencies are in charge of notifying individuals who have had injections from these medications. So alas, they have been individually calling people in my state and asking them if they have any of a list of about 14 symptoms.  If they do, they tell them to go directly to the emergency room. Now mind you some of these people had the injections 2-3 months ago.

These patients go to pain clinics. so they have chronic pain.  What do you want to bet that they will have one of the symptoms? Oh about say 75%, lets say.  Then you have the other 25% who PANIC!!!! It doesn't matter if they have any symptoms or not.  They want to be checked. They want the doctor to tell them they DON'T have it.

And so these people trickle in, wanting expensive time consuming tests (LPs) that the majority probably don't  need. Just kill me now.

Does this ever happen to you? You are just creeped out by a patient or their family? I'm not even talking about the people who would most likely creep you out: criminals, mental health patients.
I am talking about patients and their families that are just creepy.  When you are in their room it feels like something is just off in the family, something you probably don't want to know about.  They make your skin crawl. You avoid them. You just want them to go.

I am always amazed at our ability to keep a straight face in a lot of situations and not reveal what we are feeling.  We just go along with stuff, saying...uh ...yeah ...OK...when we are really having a whole other conversation in our heads.

Are nursing an endangered species?

Healthcare is changing. In my ER we are going to PAs as  the main providers. They will be seeing all the patients except those who are critical. This will mean less doctors needed.  Now mind you, this is a decision by our doctor group to do this.  They cover 3 hospitals and its hard to find enough doctors to staff them.  These doctors are saying that the majority of our patients don't really need to be seen by a doctor.

Is this the future of medicine? I mean think about it. Overall, isn't the vast majority of medicine routine?  Couldn't most of the patients in the healthcare system be managed by PAs or NPs?  Most of it is not rocket science. I've always thought that eventually medicine will go to exactly this model. Cost will dictate the change.

Could this same thing happen to nurses? Lets face it, some of what nurses do is not rocket science either. The tasks I mean.  A lesser trained person could easily manage them.  Where the value of nursing comes in is to manage and coordinate the whole picture, to monitor the patient and catch changes,  The value of nursing is our holistic approach.  We are the ones who see all aspects of the patient as a person and address it.  We have the knowledge to know how things should look and can recognize when something is wrong.   We are the person who stands between the patient and all of those specialists focusing on their own unique area. We coordinate the care and keep the patient safe.  We're the ones there at 3 am when the patient goes down the toilet.

WIth the emphasis on costs, do nurses need to care for individual patients? Would it be more cost effective to have 2-3 nurses overseeing a unit and other people doing the tasks? Will hospital managements start to think about cutting the more expensive nurses and replacing some of them with those who cost less, leaving nurses to supervise?  With the inevitability of NPs and PAs providing the majority of primary care, will nursing go the same route, being replaced by perhaps paramedics, EMTs?

Why do I bring this up? Because I see a rapidly changing health care system in which interest groups (doctors, management) are changing the way things are done. They recognize things have to be different. And then there are the nurses.

For a long time, nurses were in the drivers seat with the nursing shortage. We got what we wanted. They wanted to make us happy to keep us. That has all changed.  There will be another nursing shortage but it will be different. Nurses are being asked to do more with less.  We already are.

The nursing profession seems to be in a state of shock right now. Things are changing rapidly.  Corporations control medicine.  Yet we as a group are not stepping up to be a voice in this new environment.  We complain and whine about what is happening (I'm really good at that), wanting it to go back to where it used to be.  It isn't going to.  Unless we step up to the plate and deal with the reality of this health care environment and advocate for our very important place in it, nurses will be replaced. We are a costly part of the system in an environment that emphasizes cost. If we don't take control of our profession and prove our worth, take our rightful place, we will be gone.

You know how many times I have been going to ACLS classes every two years? A whole helluva lot of times. I have seen epi doses range from 58 mg every 10 seconds to .00000001 every hour. Back when I started there were no such things as defibrillators.  If someone arrested we just stuck their finger in a socket.....bada bing!

In other words, I dread and hate this q2 year obligation to keep working in the ER. I wait until the last minute to renew. I avoid the book til the last couple of days.  The renewal is always fun.  They jam all the shit into 8 hours, including BLS. 

CPR has become too much of a workout for this old gal. I mean 100/min, hard etc?! One cycle in and I called for a switch.  I mean I didn't want to have a stroke in class. (Although everyone would have know what to do...)

Then there are all of these numbers swirling around in my half demented brain: 30:2, every 6-8 seconds, 1mg, 300 mg, 2-10 mcg, 15:2, 300 jules, 100/min.....its too much.

The worst thing about ACLS is that every time you go, you think you will fail and humiliate yourself.  You picture yourself going back to the educator at work and telling her you failed and you have to take it again.  It never happens, but there is still that stupid fear, no matter how many times you take it.

I passed it. Like I always do. I'm traumatized, like I always am.

The worst thing? I have PALS next week 

OK, whose scathingly brilliant idea was it to put ER wait times on  hospital web sites?  There are apparently enough morons out there that go there and check them.

MESSAGE TO THE PUBLIC:

If you have time, if you are thinking about this before you even come, YOU ARE NOT HAVING AN EMEGENCY. REPEAT YOU ARE NOT HAVING AN EMERGENCY.

So I am sitting at the triage desk with the usual snarl on my face (sort of a get the the hell away from here presentation) and a person comes up to discuss on the wait time that was on the web site. The conversation went a little something like this:

MORON: The web site said the wait was 15 minutes and we have been waiting 30 minutes.

ME: Those wait times are usually not acurate.  ER situations can change minute to minute.

MORON: But, your hospital operator told me the wait was fifteen minutes...

ME: They shouldn't have told you that. Things change quickly.

MORON: Well who can I talk to about this. This is public information and it is not correct.  BLAHBLAH BLAH.  LALALA.

Now mind you it is Monday.  There are 58 people in the waiting room who have been waiting for hours. There is a line of people behind this guy. I gave them the ER managers home phone number and encouraged them to call  and have a long talk about the fraud being committed by the hospital in regard to ER wait times.  I told them the manager won't be home until midnight and doesn't mind being called that late.

The bain of our existence: charting.  More and more required charting, to the point where it will drive us all insane.  In the interest of collegeiality here are some abbreviations that might help you:     AQR - Ain't Quite Right Call Button Jockey - patient that uses call button, every few minutes  for no good reason SALT Same as last time CTS - Crazier than shit DQ - Drama Queen ETOH - Extremely Trashed or Hammered FMPS - Fluff My Pillow Syndrome (attention/sympathy seeker), like Call Button Jockey FOS - Full Of Shit GOK God only knows Gomergram - Ordering all available tests because the person is unable to explain what is wrong with them JPS - Just Plain Stupid PRATFO - Patient Reassured And Told to Fuck Off LGFD - looks good from door (but not closely examined, possibly an obnoxious patient) OBS - Obvious bullshit Urban Outdoorsman - Homeless person MFC measure for coffin SWAG scientific wild ass guess   Additions anyone?

Here are the top ten things stolen from our emergency room:

1) syringes - before drawers were locked

2) linen - sheets, towels and wash cloths

3) phones off the wall

4) fetal doppler

5) lap top

6) bandaids, bandages

7) box lunches

8) gowns

9) oximeter

10) staff purse


Extra added bonus points:

thermometers

ornaments off Christmas tree in lobby

***PUBIC SERVICE ANNOUNCEMENT***

Attention all citizens:

The following are not emergencies:

1) bug bites - unless it have swollen to the size of a baseball

2) the fact that you cannot control your teenage daughter or son

3) you are fatigued or can't sleep

4) you want your son, daughter, brother, sister, etc. to get chemical dependency treatment

5) the condom broke

6) you are hungover

7) G tube not working

8) the cut is less than 1"

9) any kind of medication refill

10) menstrual cramps

Thank you,

your neighborhood ER

If you come into the ER with a stubbed toe, you could go out with ten diagnosis' on your visit record.  If you are admitted there will probably be twenty.  Everything that has ever been wrong with you will be noted as part of your discharge or admission diagnosis. Depending on which doctor you get, it will be more or less.

Knowing this, when I saw an article in the New York Times a couple of days ago (September 24: "Medicare Warning to Hospitals on Medicare Abuse"),  I was fascinated.  It talks about how the government isn't going to tolerate hospitals that try to "game the system".  In a statement, government officials were quoted in the following:

 “There are also reports that some hospitals may be using electronic health records to facilitate ‘upcoding’ of the intensity of care or severity of patients’ condition as a means to profit with no commensurate improvement in the quality of care".

The article also states:  
 

"Much of the higher billing is taking place in hospital emergency rooms, where hospitals are classifying many more patients as sicker and needing more care". 

Oh my goodness, ya think?????!!!  ER nurses have been talking about this for YEARS.  The fact that people are being way overtreated. There are very few people who come into the ER who don't have an IV started, aren't given IV medications, lab tests, xrays, etc.  It has gotten to the point of ridiculousness.  If you have a virus or a tummy ache you get all of this shit.

Doing all of this allows doctors to up the level of care and CHARGE MORE MONEY, and therefore MAKE MORE MONEY.  It is nothing less than fraud.  Now doctors try to justify all of this by whining about "liability", "patient satisfaction",  etc.  Bullshit. This is called greed folks.

It is done for all patients, not only medicare patients - espescially patients with insurance. Your chance of getting an MRI or a CT ANGIO increase in direct proportion to what kind of insurance you have.

Lets hope the government truly cracks down on this shameful practice of medicine.

 

 

 

TO: Mitt Romney

FROM: Madness the nurse

RE:  care of  uninsured in the emergency room

Dear Mr. Romney:

Regarding your comments on a recent 60 minutes program in which you stated that the 50 million uninsured can get care in the emergency room. You referenced somebody having a heart attack and their ability to call 911 and then be taken to the ER for care.

Mr. Romney, I wonder if you realize that the reason why that uninsured person ends up in the emergency room is because they have untreated heart disease, high blood pressure, diabetes, etc.
All of these things are UNTREATED because this person does not have a regular doctor that  can monitor those problems.  Mr. Romney, why do you think these people don't have a regular doctor? BECAUSE THEY DON'T HAVE HEALTH INSURANCE.

This kind of uncompensated care runs up millions and millions of dollars every year in hospitals throughout the country.  Hospital eat the cost.  Meanwhile, reimbursement for medicare/private insurance/medicaid keeps decreasing.  The health care system is headed for collapse.

Surely, someone like you, knows these facts, right?  RIGHT?! Maybe not. No doubt you have what is commonly referred to as "concierge medicine".  This is care for wealthy people like yourself in which you pay lets say 20,000 a year to have a doctor at your beck and call.

I can only conclude you are a CLUELESS BASTARD. 

Affectionately yours,

Madness the nurse

Bad week in ER #3

You are finally getting used to this parenting thing. The shock has worn off. The baby is smiling and cooing and life is great.

You start having some trouble though. No big deal, off to the doctor you go. The doctor sends you to the hospital for an expensive test just to make sure there is nothing going on. Turns out there is something going on.  And the results aren't good. In an instant your prospects for a future are dimmer.

Your life has now completely changed. It will never be the same. Your childs life will never be the same. How will you get through this? What if you don't get through this? Who will take care of the baby?

Its too much to take in. You are in a daze. Your spouse is in a daze. As you go up to your hospital room, all we can do is say a little prayer for you.

Bad week in the ER #2

You and your family are living your life. Going along, as families do, working, going to school, having dinner together, la de dah. You all love each other, mom, dad, 2.2 kids, living an ordinary all American life.

Family member develops a symptom, goes to local ER. Family member doesn't do well at local ER, almost dies. Local ER decides to transfer family member to big time fancy smancy ER.

Family member arrives to big time fancy smancy ER, not in good shape. Family member is unstable. They are never stable again. They die. A couple of times, and are brought back, then die again permanently.

Family member is parent. Parent has children, old enough to know whats what. Children arrive and are in a state of shock. This isn't supposed to happen to parent. Son says: "Tell Dad to wake up". We hear you crying. It brings tears to our eyes.

Everyone's life is changed forever. Yesterday everything was OK.

Sometimes trauma sneaks up on you. Somebody arrives by ambulance. It seems fairly straightforward. Blah blah blah. No big deal. Then it becomes more complicated. What seemed simple is now much more involved than originally thought. Tests are ordered. More fractures are found that didn't seem obvious at first. Suddenly its a whole new ball game. This person is severely injured. Most people would be yelling in this situation, but not this one. They refuse pain meds, stating that if they don't move they are fine. I don't usually encourage pain meds, but I tell them its OK to take them. They still refuse. Wow. I know that this person, with the extent of their injuries will have months of recovery. They may never be the same. Their life has changed. What started out as a beautiful sunny day for them, enjoying themselves, has morphed into tragedy.

This is me in triage:

before triage:
during triage:
After triage:

You know it's a bad day when a drunk guy and a mental health patient are bonding around their unhappiness with the ER. They are out in the hall egging each other on.

The drunk is not one of those people who happily sleeps it off. This person is wide awake and unhappy. They just can't understand why they can't just leave. IT MUST BE THAT pint of vodka you chose to partake in earlier today and then proceeded to pass out on the grass around the corner from the hospital. Then some good Samaritan called 911 and the medics were obligated to bring you in. When they gave me report they said you were, "a nice guy". The niceness didn't last very long.

First sign of trouble: you peed in your pants. Then you came out of your room demanding to use the phone, where you proceeded to rant about us, the unfairness of life (with a few MFers thrown in). You plead with the "girlfriend" to come and get you. Of course she won't. She's fed up.
I had you change into a gown to get you out of the wet clothes, but you couldn't seem to get the concept of CHANGE YOUR CLOTHES...When you did get them changed, you had the wet ones back on in a couple of minutes. I gave you food to try to speed up the sober up process - ended up on the floor, a milk puddle on the chair, which you proceeded to sit in. Okay now we got pee and milk going on the clothes.

Of course detox, had no beds. Does detox ever have any beds?!!! So you were ours until you got a ride or sobered up enough to go.

You got louder and louder, wanting to use the phone over and over, getting mad at security for watching you. At one point you shouted at security: "I just got out of the penitentiary. I don't need nobody watchin' me".

A couple of visitors response to your antics: "I'm just enjoying the show". "You need to call the police".

Meanwhile while you waste everyones time, a guy down the hall is not doing well with a GI bleed, a man a couple doors down is gasping for breath, someone is having a heart attack, a woman has metastatic cancer.

There is nothing we can do about people like you. In our city public drunkenness is not a crime. If it was the jails would be filled So your local ER acts as a detox center to the tune of tens of thousands of dollars a year. Ever wonder why your insurance is so high? This is part of it.

If the walls of the med room and supply room could talk they would have some interesting things to say. This is where the nurses go to say out loud what a fucking idiot someone is. It is where we say out loud that we hate this place and this job. It is a place to blow off steam.

If we didn't blow off steam in these places sometimes, somebody would go postal during the shift. Nobody wants that right? It would be really messy, involve a lot of paperwork, etc.

So we go in there and talk and yell at the walls and walk out able to deal with all of the shit once again.

I got a lot of pet peeves in triage. The biggest one is that people keep showing up at the window. Bada bing. Here are my top ten pet peeves in triage:

1) I am finding out what is wrong with someone at the window. You are waving your arms to get my attention. YOU ARE A RUDE PIECE OF CRAP.

2) I wish I had a dime for every time a relative/friend asks if they go out the triage door, will we let them back in? I seriously doubt it. ONCE YOU LEAVE, YOU ARE NEVER COMING BACK IN...

3) You come and ask to see Franco. No last name. Just Franco. Or the other scenario, you can't spell their last name. I am supposed to find them in the hospital for you. NOT.

4) You come up to the window and ask for so and so. They are not in the ER. They are not in the hospital. You argue with me to the point of getting pissed off that I can't find them. Here's the thing: WE ARE HIDING THEM. YOU CAN'T EVER SEE THEM.

5) I am in the triage bay. You can see me triaging somebody. You yell: "HELLO HELLO!! or know on the window. GRRRRRRRR..

6) You are here to be seen, you have brought your six kids under six with you at 9 pm. There is no one else with you. JUST KILL ME NOW.

7) You are:
- a doctor
- a doctors nurse
- a doctors receptionist
- a home health nurse
- a nursing home
- etc etc etc

You call to give a courtesy "heads up" about a patient coming in. DON'T CARE. WASTING MY TIME.

8) You want me to make a decision about whether you should be seen. I WILL ALWAYS ADVISE NOOOOOOO.

9) You:
-kneel dramatically at the window
-hang your head through the window
-talk so softly I can't hear you

DRAMA = YOU PROBABLY DON"T REALLY NEED TO BE SEEN.

10) Ask if we have an urgent care. WHAT DOES THE SIGN OUTSIDE SAY? DOES IT SAY URGENT CARE?! YOU SEE, WE DO HAVE A VERY TINY URGENT CARE THAT IS STAFFED BY ELVES AND FAIRIES THAT WE LIKE TO KEEP A SECRET.....

I got a lot of pet peeves in triage. The biggest one is that people keep showing up at the window. Bada bing. Here are my top ten pet peeves in triage:

1) I am finding out what is wrong with someone at the window. You are waving your arms to get my attention. YOU ARE A RUDE PIECE OF CRAP.

2) I wish I had a dime for every time a relative/friend asks if they go out the triage door, will we let them back in? I seriously doubt it. ONCE YOU LEAVE, YOU ARE NEVER COMING BACK IN...

3) You come and ask to see Franco. No last name. Just Franco. Or the other scenario, you can't spell their last name. I am supposed to find them in the hospital for you. NOT.

4) You come up to the window and ask for so and so. They are not in the ER. They are not in the hospital. You argue with me to the point of getting pissed off that I can't find them. Here's the thing: WE ARE HIDING THEM. YOU CAN'T EVER SEE THEM.

5) I am in the triage bay. You can see me triaging somebody. You yell: "HELLO HELLO!! or know on the window. GRRRRRRRR..

6) You are here to be seen, you have brought your six kids under six with you at 9 pm. There is no one else with you. JUST KILL ME NOW.

7) You are:
- a doctor
- a doctors nurse
- a doctors receptionist
- a home health nurse
- a nursing home
- etc etc etc

You call to give a courtesy "heads up" about a patient coming in. DON'T CARE. WASTING MY TIME.

8) You want me to make a decision about whether you should be seen. I WILL ALWAYS ADVISE NOOOOOOO.

9) You:
-kneel dramatically at the window
-hang your head through the window
-talk so softly I can't hear you

DRAMA = YOU PROBABLY DON"T REALLY NEED TO BE SEEN.

10) Ask if we have an urgent care. WHAT DOES THE SIGN OUTSIDE SAY? DOES IT SAY URGENT CARE?! YOU SEE, WE DO HAVE A VERY TINY URGENT CARE THAT IS STAFFED BY ELVES AND FAIRIES THAT WE LIKE TO KEEP A SECRET.....

We are consistently more busy then we have been. The "budgeted" census has been blown to hell. At least a couple of times a week there are 15-20 people in the lobby.

Our local EMS system does not like ERs going on divert. It used to be you could go on divert for 4 hours. It is now down to 2 hours and, ideally, the plan is to eliminate the ability to close. What are we supposed to do if the place is completely out of control and we have 3 or 4 criticals at once? Your guess is as good as mine. Run out the door perhaps?

Anyway, we rarely close anyway these days. The frequent 15-20 people in the lobby are usually people who use the ER as a clinic. Toothache, sore throat, female abdominal pain, UTIs, lacerations, etc etc etc. I am always amazed at how long people will wait for this shit.

My point? More and more people seem to be using our ER as a clinic. Those populations have exploded this summer. Why? I don't know. Can't get an appointment? The county hospital down the street wait is too long? Aliens are speaking telepathically and telling people to come to the ER?

I just can't wait until EVERYBODY has insurance, can't get doctors appointments and come to the ER BECAUSE THEY CAN.. I'm totally in favor of Obamacare, as far as I'm concerned the government should take over the whole damn thing, blow it up and start over again.

We are consistently more busy then we have been. The "budgeted" census has been blown to hell. At least a couple of times a week there are 15-20 people in the lobby.

Our local EMS system does not like ERs going on divert. It used to be you could go on divert for 4 hours. It is now down to 2 hours and, ideally, the plan is to eliminate the ability to close. What are we supposed to do if the place is completely out of control and we have 3 or 4 criticals at once? Your guess is as good as mine. Run out the door perhaps?

Anyway, we rarely close anyway these days. The frequent 15-20 people in the lobby are usually people who use the ER as a clinic. Toothache, sore throat, female abdominal pain, UTIs, lacerations, etc etc etc. I am always amazed at how long people will wait for this shit.

My point? More and more people seem to be using our ER as a clinic. Those populations have exploded this summer. Why? I don't know. Can't get an appointment? The county hospital down the street wait is too long? Aliens are speaking telepathically and telling people to come to the ER?

I just can't wait until EVERYBODY has insurance, can't get doctors appointments and come to the ER BECAUSE THEY CAN.. I'm totally in favor of Obamacare, as far as I'm concerned the government should take over the whole damn thing, blow it up and start over again.

I'm thinking about starting a new local ER website. As a service to humanity.

On this site would be listings of every ER in the city and the waiting times on their websites. Listed in order of least waiting time to most. Length of typical visit.

In the interest of serving the community, there would be a list of whether the ER has:

1) box or bag lunches and their contents and rotation
2) types of (cold, icy) juice and selection of crackers
3) whether they supply warm, cuddly, toasty blankets.
4) footie availability and color selection
5) whether they have TV (with HDTV cable or DVD availibility)
6) probability of getting a cab voucher or bus token
7) probability of you scoring a script for percocet
8) probability of you taking an ambulance in for a sore throat and getting back to a room versus being put in the lobby
9) comfort of chairs in lobby and presence of TV, fish tank, vending machines (quality of snacks, selection of sodas), play area
10) whether your car can be valet parked on arrival

There would be a comment section in which you could name names about which docs at which ERs were Dr Feelgoods.

Oh the fun that could be had! The comments section could be entertaining in and of itself.

Hey...its a competitive world out there and patient satisfaction is the goal of every single solitary person in the ER, including of course, yours truly, thus the web site...

I'm thinking about starting a new local ER website. As a service to humanity.

On this site would be listings of every ER in the city and the waiting times on their websites. Listed in order of least waiting time to most. Length of typical visit.

In the interest of serving the community, there would be a list of whether the ER has:

1) box or bag lunches and their contents and rotation
2) types of (cold, icy) juice and selection of crackers
3) whether they supply warm, cuddly, toasty blankets.
4) footie availability and color selection
5) whether they have TV (with HDTV cable or DVD availibility)
6) probability of getting a cab voucher or bus token
7) probability of you scoring a script for percocet
8) probability of you taking an ambulance in for a sore throat and getting back to a room versus being put in the lobby
9) comfort of chairs in lobby and presence of TV, fish tank, vending machines (quality of snacks, selection of sodas), play area
10) whether your car can be valet parked on arrival

There would be a comment section in which you could name names about which docs at which ERs were Dr Feelgoods.

Oh the fun that could be had! The comments section could be entertaining in and of itself.

Hey...its a competitive world out there and patient satisfaction is the goal of every single solitary person in the ER, including of course, yours truly, thus the web site...

I'm out of my ER next spring one way or the other. Can't take it any more.

To say that the morale in my department is in the toilet is to vastly understate it. The negativity is out of control and makes it a miserable place to work.

It is rundown, way too small. The hospital doesn't give a shit. All the other hospital in our "corporate system" have been redone. Ours, that sits in the middle the ghetto ER has not (no accident there - poor folks don't need a nice ER). I don't see it happening anytime soon.

My ER is an embarassment. Walls with paint scraped off. Ceiling tiles with big round wet brown spots on them. Looks dirty. Is dirty. Equipment that is an embarassment. Whatever. Been like that for many years.

Now the straw that broke the camels back. There has been a decision made that our ER will be staffed by physician assistants. They will see the vast majority of our patients, except the criticals apparently. I admire NPs. I admire PAs. I think they are great. I work with NPs. They see our urgent care patients. They don't belong in the main ER. Sorry.

I don't think ER patients, other than urgent care patients, should be seen by anyone other than an ER doc. Apparently the PAs will "present" these patients to the docs. Not good enough. No doubt will greatly slow the process.

Here's my thought about the whole process personally: When I, or my relative, come to an ER, we EXPECT to be seen by a DOCTOR. We pay insurance to be seen by a DOCTOR. I won't bring myself or my relative, needs to be seen for an EMERGENCY, to an ER where chances are they will not be seen by a doctor. I will choose to go to another ER where they will be seen by a DOCTOR. I will also choose to work at an ER that employs DOCTORs to see patients.

I'm out of my ER next spring one way or the other. Can't take it any more.

To say that the morale in my department is in the toilet is to vastly understate it. The negativity is out of control and makes it a miserable place to work.

It is rundown, way too small. The hospital doesn't give a shit. All the other hospital in our "corporate system" have been redone. Ours, that sits in the middle the ghetto ER has not (no accident there - poor folks don't need a nice ER). I don't see it happening anytime soon.

My ER is an embarassment. Walls with paint scraped off. Ceiling tiles with big round wet brown spots on them. Looks dirty. Is dirty. Equipment that is an embarassment. Whatever. Been like that for many years.

Now the straw that broke the camels back. There has been a decision made that our ER will be staffed by physician assistants. They will see the vast majority of our patients, except the criticals apparently. I admire NPs. I admire PAs. I think they are great. I work with NPs. They see our urgent care patients. They don't belong in the main ER. Sorry.

I don't think ER patients, other than urgent care patients, should be seen by anyone other than an ER doc. Apparently the PAs will "present" these patients to the docs. Not good enough. No doubt will greatly slow the process.

Here's my thought about the whole process personally: When I, or my relative, come to an ER, we EXPECT to be seen by a DOCTOR. We pay insurance to be seen by a DOCTOR. I won't bring myself or my relative, needs to be seen for an EMERGENCY, to an ER where chances are they will not be seen by a doctor. I will choose to go to another ER where they will be seen by a DOCTOR. I will also choose to work at an ER that employs DOCTORs to see patients.

I work for this big healthcare system that has a few hospitals. So with the "standardization" of all the hospitals, decisions come from on high that are implemented at all the hospitals. They don't always implement it at the same time. Like we are going to bedside barcoding, meaning scanning the wristband and the medication before giving meds. La la la. Patient safety blah blah blah.

We were the last ER and last department in all the hospitals to get the training. They installed the nifty barcode readers a month ago. They kind of look like a laser gun. When you push a button on it a red light comes on, there is a red cross that appears that you are supposed to put in the middle of the scan dealybob on the wristband and medication.

Well it seems that the local ghetto geniuses who frequent our ER, decided to see what the hell this new fangled thing is. Oh cool its like a laser gun. I can put a red cross in the middle of your forehead!! So what did they do? They took four of them before we even started the whole barcoding thing. $500 a pop.

The genuises who come up with these fancy new doodads don't get that we are in a ghetto where a lot of people have sticky fingers. They take things that are worthless to them, but take them nonetheless.

Another day in paradise.

I work for this big healthcare system that has a few hospitals. So with the "standardization" of all the hospitals, decisions come from on high that are implemented at all the hospitals. They don't always implement it at the same time. Like we are going to bedside barcoding, meaning scanning the wristband and the medication before giving meds. La la la. Patient safety blah blah blah.

We were the last ER and last department in all the hospitals to get the training. They installed the nifty barcode readers a month ago. They kind of look like a laser gun. When you push a button on it a red light comes on, there is a red cross that appears that you are supposed to put in the middle of the scan dealybob on the wristband and medication.

Well it seems that the local ghetto geniuses who frequent our ER, decided to see what the hell this new fangled thing is. Oh cool its like a laser gun. I can put a red cross in the middle of your forehead!! So what did they do? They took four of them before we even started the whole barcoding thing. $500 a pop.

The genuises who come up with these fancy new doodads don't get that we are in a ghetto where a lot of people have sticky fingers. They take things that are worthless to them, but take them nonetheless.

Another day in paradise.

Are nurses going insane? Has the pressure become too much?

Recently a nurse through a kidney that was supposed to be transplanted into the garbage. I guess I wonder how that would happen. Did she/he mean to throw away the kidney that was removed? Is that what they do with the old kidney? Who knows....

Another 68 year old nurse set like 17 fires because she had taken care of people all of her life, no one paid any attention to her or cared about her. Well I guess everybodys paying attention to you now...

I hate when nurses are in the news for bad stuff. Makes the rest of us look bad.

Are nurses going insane? Has the pressure become too much?

Recently a nurse through a kidney that was supposed to be transplanted into the garbage. I guess I wonder how that would happen. Did she/he mean to throw away the kidney that was removed? Is that what they do with the old kidney? Who knows....

Another 68 year old nurse set like 17 fires because she had taken care of people all of her life, no one paid any attention to her or cared about her. Well I guess everybodys paying attention to you now...

I hate when nurses are in the news for bad stuff. Makes the rest of us look bad.

Dear Mr/Mrs John/Jane Q. Public:

******A HANGOVER IS NOT AN EMERGENCY*****

REPEAT

******A HANGOVER IS NOT AN EMERGENCY*****

Your tummy upset is not our problem. I don't care if you literally puke your guts out. Do not come to your local emergency room. If you do, here is what will happen:

We will talk about you. The staff will talk amongst themselves about what an idiot you are.

If you take an ambulance into the ER for this you will go to the top of the moron list that we keep in a drawer in triage.

*****THAT IS ALL*****

Go about your business. Nothing to see here.

Dear Mr/Mrs John/Jane Q. Public:

******A HANGOVER IS NOT AN EMERGENCY*****

REPEAT

******A HANGOVER IS NOT AN EMERGENCY*****

Your tummy upset is not our problem. I don't care if you literally puke your guts out. Do not come to your local emergency room. If you do, here is what will happen:

We will talk about you. The staff will talk amongst themselves about what an idiot you are.

If you take an ambulance into the ER for this you will go to the top of the moron list that we keep in a drawer in triage.

*****THAT IS ALL*****

Go about your business. Nothing to see here.