I'm really pissed

I drove through my subdivision the other day, there was house after house sitting empty that the owners had lost due to foreclosure. Many of the other homes have for sale signs, most of those houses are newer and the owners will either take a huge loss on the sale or end up in foreclosure.

I'm really pissed that our government gave BILLIONS of dollars to corporate swindlers that used the money to line their own pockets.

I'm really pissed that we are going to give money to the automobile makers who are bankrupt because they mismanage their companies.

I'm really pissed that the taxpayers are paying for all this while we lose our jobs and homes, our neighborhoods are full of vacant homes with dead landscapes, broken windows and graffiti which drive our property taxes even further down the toilet.

I'm really pissed at our stupid government. If you are worried about the automobile industry, give all the tax payers enough money to buy a new car, that will stimulate the industry and be far, far cheaper.

Instead of giving all that money to corporate shills what should have been done is to give it back to the tax payers to pay off their mortgages which would have saved the mortgage industry. Which would have been far, far cheaper.

Instead, we gave billions of dollars so that the CEO's which mismanaged their companies could take millions of dollars in bonuses, trips and other perks while the working class get to have higher taxes, higher unemployment, foreclosure, bankruptcy, and homelessness.

If anyone out there thinks that our government is 'For the People' you are idiots. Get on the Internet, find out who your government representatives are and write them and tell them what you think. DO IT NOW! Or you'll just get more of the same.

A Notice to Information Systems Help Desk

If I am calling you because I was inputting my patients 27 medications and the computer crashed causing me to lose what I have put in so far........


DON'T ASK ME IF I'VE REBOOTED THE COMPUTER OR I MIGHT HAVE TO COME DOWN AND 'BOOT' YOU!

Merry Christmas to You and Yours

A Holiday Wish

Once again it's Christmas. The tree is lit, the packages wrapped, the Christmas cookies are baked at last.

The candles are lit, the family is here and so my friends I wish you the best of Christmas cheer....But:

Please don't get drunk and slice your hand open with the carving knife.

Please don't get drunk and stab your wife.

Please don't get drunk and fall down the front stairs while fooling around, quadriplegia is a terrible Christmas gift.

Please don't pass out drunk and leave candles burning, the resulting fire will ruin many of your co-tenants holiday also.

Please don't get drunk and stagger into the glass patio door nearly killing yourself from blood loss.

Please don't get drunk and beat your loved ones. Ho Ho Ho, Merry Christmas indeed.

Please for one day see if you can avoid lying, cheating, stealing, assaulting, raping, torturing or killing anyone.

I'm working Christmas day and don't wish to see any of you in the ER, my friends the police would like to enjoy the holiday also.

If you think this is an exageration just ask any ER nurse if it is true, sadly it is.

And if I may God, just one small prayer: 'Please no Codes this year until the holiday is safely over.' There is nothing worse than to have to tell a family that a loved one has died on Christmas knowing that, for them, Christmas will be ruined forever.

Good Leadership is the Key

I read this post and it made me nod my head, YES - YES - YES!!!!

I have a vision in my head that to me is the ideal. This does not pertain only to the CEO but all upper management, for instance at my current hospital I wouldn't even know the Chief Nursing Officer - think I may have seen her from a distance once, maybe.

Every morning come in through the ER doors, spend time greeting the doctors and staff. Then start a walking rounds, look in on every patient on every floor. Depending on the size of your facility, you may need to split up the floors among the CEO, CNO, COO etc. Also during the day each department manager should round on and spend time with each patient and their family. This is a simple thing to do and makes a huge impact on the patient, makes them think we actually care about them, not just their wallet.

Pretend like you actually care about your employees. I'm sorry that you are too dense to realize that skilled employees are your finest resource but believe me, deep down most patients can tell the difference between a good nurse, Xray tech, patient care tech etc. and a bad one. They won't want to return to a place where they never saw their nurse or the Xray tech was surly or they rang their call bell for hours without anyone answering it. How to show you care? Get to know them by name, send them a birthday card, give them something at Christmas. If they are busy or short staffed get off your ASSES and get out there and help them. This especially should pertain to department managers, back in the day when I was a baby nurse they were called Head Nurses and if there were staffing problems they were expected to come in and work. Yes work the floors, night, weekends or what ever.

Another way to show you care is to make sure there is enough staff. My hospital went through a lay-off recently and you know who they laid off? The techs. The people who make $14 an hour. Yep, that will save us. We still have administrators, administrative assistants, secretaries to the assistants, directors, assistant directors, secretaries to the directors and enough clip-board nurses to have one for every two patients almost. BULLSHIT! Let's eliminate two or three of the people that make over $100K a year and keep the people who help take care of the patients, which - in case you have forgotten - is WHY THE HOSPITAL IS HERE YOU BLOOMING IDIOTS.

Do not sneak into work through the door down in the administrative wing and never come out of your office. Do not wear 4" spike heels to work, come prepared to throw on a lab coat and get your hands dirty.

Don't preach customer service to me unless you are practicing it yourself.

And yes, shovel snow if you have to.

Ten Ladies Dancing

Medblog addict is hosting the 'Twelve Days of Christmas' feature, check me out - I'm day number 10! And that's my real picture too, ha ha ha!

A Christmas Caution

Holiday Season Calls for Special Precautions to Prevent Poisonings

(Alexandria, VA): The holiday season requires special precautions to prevent poisonings, according to the American Association of Poison Control Centers (AAPCC).

AAPCC Board Member Edward Krenzelok, PharmD, director of the Pittsburgh Poison Center and Drug Information Center at the University of Pennsylvania Medical Center and professor of pharmacy and pediatrics at the University of Pittsburgh, offers the following safety tips.

• Children are at greatest risk for alcohol poisoning during the holidays. Do not leave beverage glasses where children can easily reach them. A child’s natural desire to imitate partying grown-ups requires special vigilance on the part of drinking adults.

• Never leave gifts of perfume or cologne, which also contain alcohol, under the Christmas tree where a curious child might find them.

• Keep hot foods hot at 140 degrees or above and cold foods below 40 degrees to reduce the likelihood of food poisoning,

• Wash your hands before and after food preparation to prevent the spread of food-borne illness. Washing is especially important before and after handling raw meat.

• While most holiday plants are relatively safe, always keep them out of the reach of children and pets.

• Cherished old family ornaments may be decorated with paint that contains lead. Store them away if the ornaments are peeling or in poor condition and children or pets live with you.

• If you have holiday visitors or are visiting another residence, make sure that all medications and other potential poisons, such as household cleaning products, are out of the reach of children.

If you have questions about poisons or if you think that someone (a child, adult or pet) may have been exposed to something poisonous, call 1-800-222-1222 immediately. America’s poison control centers are staffed by specialists who are available to assist you 24 hours per day, seven days a week -- even on your favorite holiday.

“Poisonings never take a holiday and neither do we,” explains Dr. Krenzelok.

AAPCC is a nonprofit association representing America's 61 Poison Control Centers (PCC), their staff and affiliated toxicologists.

For more information on poisoning prevention visit the AAPCC’s website at http://www.aapcc.org.

Thank You

The embers glowed softly, and in their dim light,
I gazed round the room and I cherished the sight.
My wife was asleep, her head on my chest,
My daughter beside me, angelic in rest.
Outside the snow fell, a blanket of white,
Transforming the yard to a winter delight.
The sparkling lights in the tree I believe,
Completed the magic that was Christmas Eve..
My eyelids were heavy, my breathing was deep,
Secure and surrounded by love I would sleep.
In perfect contentment, or so it would seem,
So I slumbered, perhaps I started to dream.
The sound wasn't loud, and it wasn't too near,
But I opened my eyes when it tickled my ear.
Perhaps just a cough, I didn't quite know,
Then the sure sound of footsteps outside in the snow.
My soul gave a tremble, I struggled to hear,
And I crept to the door just to see who was near.
Standing out in the cold and the dark of the night,
A lone figure stood, his face weary and tight.
A soldier, I puzzled, some twenty years old,
Perhaps a Marine, huddled here in the cold.
Alone in the dark, he looked up and smiled,
Standing watch over me, and my wife and my child.
"What are you doing?" I asked without fear,
"Come in this moment, it's freezing out here!
Put down your pack, brush the snow from your sleeve,
You should be at home on a cold Christmas Eve!"
For barely a moment I saw his eyes shift,
Away from the cold and the snow blown in drifts..
To the window that danced with a warm fire's light
Then he sighed and he said "Its really all right,
I'm out here by choice. I'm here every night."
"It's my duty to stand at the front of the line,
That separates you from the darkest of times.
No one had to ask or beg or implore me,
I'm proud to stand here like my fathers before me.
My Gramps died at ' Pearl on a day in December,"
Then he sighed, "That's a Christmas 'Gram always remembers."
My dad stood his watch in the jungles of ' Nam
And now it is my turn and so, here I am.
I've not seen my own son in more than a while,
But my wife sends me pictures, he's sure got her smile.
Then he bent and he carefully pulled from his bag,
The red, white, and blue... an American flag.
I can live through the cold and the being alone,
Away from my family, my house and my home.
I can stand at my post through the rain and the sleet,
I can sleep in a foxhole with little to eat.
I can carry the weight of killing another,
Or lay down my life with my sister and brother..
Who stand at the front against any and all,
To ensure for all time that this flag will not fall."
"So go back inside," he said, "harbor no fright,
Your family is waiting and I'll be all right."
"But isn't there something I can do, at the least,
"Give you money," I asked, "or prepare you a feast?
It seems all too little for all that you've done,
For being away from your wife and your son."
Then his eye welled a tear that held no regret,
"Just tell us you love us, and never forget.
To fight for our rights back at home while we're gone,
To stand your own watch, no matter how long.
For when we come home, either standing or dead,
To know you remember we fought and we bled.
Is payment enough, and with that we will trust,
That we mattered to you as you mattered to us."

A long and painful day

My whole day went like this:

Patient arrives and is triaged. Sits in room for over an hour before being seen. Half an hour after being seen orders are finally entered for IV, labs, EKG, cath UA, orthostatic vital signs (a basically useless way to check for dehydration by taking pulse and blood pressure lying, sitting and standing. Since it is rarely done correctly the information is basically useless) and multiple IV med's. An hour and a half later all the labs are back and the chart is flagged for recheck. An hour later is still not rechecked and patient is getting mad. Doctor is nagged and finally picks up chart, orders either A)an oral prep CT which takes several hours to prep the patient, get the test done and get the radiologist to wake up and read it or B)an ultrasound which takes several hours to wake the tech up to answer the page, get them to arrive and do the test and then get the radiologist to wake up and read it. 7.5% of the patients that signed in today left before being seen by the doctor after waiting an average of 3 hours in the lobby. All 9 of the patients I had in my twelve hour shift ended up being admitted after an average stay of 7 hours. I knew they would all be admitted when they arrived.

With most of our docs everything flows well and is quick and efficient.

With others it does not. Guess who was working today?

No We Do Not Remove Warts!

Sunday night, 3:17am and a 22 year-old male signs in to have a wart removed from his index finger.

Said wart had been present for about six months. It had not gotten larger, more painful, redder or had any drainage. He had not tried any over the counter medications or seen his doctor for the wart.

So what in the world made it an emergency Sunday at 3:17? Well you know, I had to ask that very question. And you know the answer?

"I just got tired of it."

Image credit

It's all in how you present the options

Nursing school 1983 - the nursing students are being taught how to deal with the difficult patient - the patient is difficult because they have lost their autonomy, help them cope by giving them choices to make, for instance "do you want your bath now or in an hour?"

Present day ER - The seasoned ER RN is attempting to triage a medical clearance patient brought in hog-tied by the police. The patient has refused to speak to the police or the jail personnel so apparently that makes him 'medically unstable' and in need of clearance so he can be booked. The nurse is attempting to get a temperature and the patient is pretending she isn't there. The nurse realizes that the patient is being difficult because he has lost his autonomy so to help him she gives him choices.

"Do you want to open your mouth so I can take your temperature or do you want me to take it in your butt? I don't care either way but I am busy and we ARE going to get this done."

The patient opened his mouth.

It may be not so much about giving choices but in how you present them.