Tuesday, June 05, 2018

Inspired


Well, what nurse has never gotten tangled up in wires, tubes, drains, etc? That would be the nurse that never worked at bedside. One time I tripped on a long IV tubing that had draped to the floor. Next moment, I was on the floor, and the IV was still intact. That wasn't even my patient. Another time, working over at the University, Dr. X, had just placed a temporary, transvenous pacemaker, via subclavian. As he turned away from the table, somehow his gown snagged that same wire, and whoopsy, the pacemaker wire went in reverse. It was an epic fail, that's for sure. At that time, Joe-Bob the patient was somewhat unstable, with a severe bradycardia, and the Doc's had to hustle placing pacemaker wire #2.

Yesterday, after being the most awesome recovery nurse, for our third TAVR of the day, Betty Lou, with me and the Transporter, were beginning to launch out of our Recovery bay. I was 100% certain, I had successfully cleared all the monitor wires, cables, no-longer-running IV bag and tubing, ditched the IV pump, secured the Foley, and eye-balled the pacer wire coming out of the Right IJ introducer sheath.
Ready, set, go........then Betty Lou shreiked. I hit the brakes, yelled for transport to STOP!
Oops, somehow the TV controller, which I had parked below the heart monitor, had the neck IV tubing tangled in it. Yikes.........epic fail on my part. Still, aside from a serious tug on her neck, no harm was done; no bleeding, pacer wire secure. Of course, Betty Lou gave me some serious evil eye and her daughter fussed a bunch too.

Pulled on her neck
Oh man, something got tangled,
After a great afternoon
Things took a different angle,
Where she got to thinking
Maybe I am a fraud,
And this sweet old lady
Is now, one angry broad.


No harm done
Other than that serious yank,
On the pacemaker sheath
Let’s be perfectly frank,
It shouldn’t have happened
But sometimes it do,
Regardless of preparation
Even you could do it too.


Luckily my rep
From the previous four hours,
Laid a balanced foundation
Despite bitters and sours,
And I’ll be more careful
To  clear the tubes and wires,
Nothing like a total screw up
Oh, how that inspires!


Friday, June 01, 2018

The End is Nigh


I have made the decision..........12/31/18........I step into Pension #2. Now that does not mean that I will completely stop working, but it will mean, I don't have to continue, buckled on a daily basis, with the current job. But you don't care, do you? Didn't expect you to.

The real problem is that I haven't written much lately.

An anti-glut with writing
Idea fish aren't biting,
The bait I use
It has no taste,
The pond I visit
Is in a state of waste.

Still, the fisherman
Is lazy,
Talks only to himself
That's crazy,
So this might be
The perfect time,
To pull the plug
On hospital slime.

If I'm not slimed
Can I write about it?
If I'm not employed
It might be safer to shout it,
Less chance of lawsuit
And public blushing,
Let go of my nightmares
With literary flushing.

Like all the Code Blues
That didn't end well,
Depends on opinion
Regarding heaven and hell,
Because many of us
Have seen the face of evil,
Some folks are lower
Than a New York weevil.

How about
All those EKG's,
Counted in thousands
And no one said "Cheese",
Just taking a picture
Of your rhythm, babe,
In the old days we did it
With an astrolabe.

All the bottoms wiped
And the dangles adjusted,
Reliable coworkers
And others not trusted,
Trying to figure it out
In a cluster disaster,
The only solution?
Just do it damn faster.

Ya, I think I'll keep writing
To cleanse my mind
So to speak,
Don't expect me to quit
I won't go out with a squeak,
Because others will follow
Down these same old trails,
Through the bloodiest splatters
And interrupted fails.

Tuesday, May 15, 2018

Squirrel


This is not remotely related to anything medical, or nursing, or what? However, as I was at work last evening with my pals, I received a text/photo from my daughter. The photo appeared to show a squirrel in a toilet, and quite frankly I was aghast, while assuming it a prank. Well, it turned out to be true, and I wish I had been there, or not.

Squirrel in the toilet
How did that happen?
Thank the Lord I wasn't sitting
And having a crappen,
That would have scared my pants off
But they already were,
A squirrel in the toilet
Crap! How did that occur?

Squirrel in the toilet
Doing the backstroke?
Diving for dollars?
Man, this is no joke,
Must have fallen from the ceiling
The H-VAC vent beckoned,
Took a swan dive in the toilet
That's what I reckoned.

Squirrel in the toilet
Is a crazy event,
A picture, not precious
Luckily, no scent,
Looked like a monster
Glaring up from the bottom,
Had he been sitting on the bed
I probly woulda shot him.


Saturday, April 28, 2018

Employee Survey: Anonymous?


I'm pretty sure that everyone working at a hospital in the USA, is presented on a yearly basis, the Employee Survey. At our system, we are told, that our responses are completely anonymous. Well, I don't believe that for a minute, nor do I care. Heck, I'm probably going to retire in a year, so what does it matter? Still, I thought I might share with you the final Q&A, 3 top questions (and my responses), at the end of the survey.

Please provide one suggestion on how to improve the Employee Experience here at XYZ Health.

Management in some Nursing areas, talk DAILY about budget, HPPD hours, and so on, to the staff nurses, as if those nurses have some influence over the patient census and procedural scheduling. We don't have any influence, on how many patients come on any single day, and thus, all of this kind of talk is petty and short-sighted. The nurse at the bedside, is working as hard and fast as possible, so, instead of being reprimanded by managers, those bedside nurses should be praised and thanked every single day for their diligence and hard work.


What do you like best about your Employee Experience at XYZ Health?

The opportunity to work with other highly competent and trusted work companions.


What is one thing XYZ Health could do to create a more inclusive culture?

Sure, it's great that our color and branding slogan, tells the world that we care about a Load of Kindness; heck, it's brilliant. After all, that's what healthcare workers the world over, have always been doing; putting others needs ahead of their own. So face it, this is not a new idea. Let's have XYZ cut the branding budget in half, and spend that other half exclusively and inclusively, inside of these hospitals in a direct way, that impacts employees. This will make workers happy; they will tell their friends to come work at XYZ and truly encourage people in the community, to seek medical care at our hospitals.......much more effectively than tv commercials about whales, lame deer, drowning dogs, and elderly women crossing the road.


Saturday, April 14, 2018

The Old Guard


If you've worked anywhere, and found some way to survive your less-than-perfect work place, bravo to you. Why? Because we're all human and no job is perfect. We all have to put up with all kinds of convoluted nonsense in healthcare, and usually somewhere in your career, you will have worked at the best place for you.

And then, there is the "new" employee, with some kind of stupid crusader attitude. They come to the job, and think the place is super dysfunctional (and it might very well be), and figure all it needs is their insight, and "how we did it back home" and they begin to raise complaints, regarding all the stuff that the rest of us know, that are almost impossible to change. The outcome is very predictable......our place of work, spits out that irritating rotten little bit of noise (sooner than later).
The betting pool is warming up on how long that will take...............

Newly hired employees
Arriving at deeply entrenched places,
May try to change the old guard
Make big statements and hard faces,
While ruffling a lot of feathers
And raising up dander,
Eventually this mess
Will lift the hackles of the Commander.

With your prodding and complaining
How this place of work is busted,
Your turmoil is so toxic
That you can't be trusted,
Thus, the outcome is usually
New employee will implode,
Sonny, you can't beat the system
Get the message? Hit the road!


Saturday, March 31, 2018

Unplanned Descent to Stupidity


Sometimes, I'm behind the times. Apparently back in 2009, some genius came up with the definition of a "Fall", as: An Unplanned Descent to the Floor".Yep, that was pure genius, and how did I miss such a gem as that. Things like that drive me to research, and I won't bore you with the details. But, here is my poetic rendition and assessment.

I am not sure how I missed
The definition of the year, in oh-nine,
Back when someone redefined "Fall"
They must have drank too much wine,
After all, who could possibly imagine
This would be the slogan at the door,
Nurses, be on the lookout for:
An; "Unplanned descent to the floor".

It must have been a Nursing Educator
That came up with that,
Any sensible staff nurse
Would keep it stuffed in their hat,
To utter something so stupid
When Billy Bob slipped on his pee,
"Hey, stop your unplanned descent to the floor
Weren't you listening to me?"

Now, Nurse Suzy has to call Risk Management
Fill out an IVOS, to explain the score,
Was the Unplanned descent to the floor
Truly unplanned, or was Bluto helping with the chores,
Trying to mop up his mess
As mentioned in stanza # two,
This was a "PLANNED descent to the floor
He was just trying to help you.

As usual uppity-mucks and big associations
Are driving up costs, and pushing down nurses,
They don't see it that way
Because it does line their purses,
To create all kind of surveys
Along with metrics and tools,
And when you call a Fall
An unplanned descent to the floor,
We nurses know, we are guided by fools.

Friday, March 30, 2018

Titration Dedication


Historical background:

In my current job arena, I rarely encounter any kind of vasoactive "IV drip"; why would I, we're just a prep & recovery joint. Only rarely, a TAVR recovery might be on a Cardene drip, or maybe someone with acute bradycardia or heart block, might be on Isuprel or dopamine, but that's it.

I was thinking back to the old days (actually still the new days), and how drip-titration, in the setting of a profound state of shock, is a delicate and risky endeavor. I remember with my early forays into the ICU setting, titrating vasoactive solutions, was like some mysterious science only understood by the Gods. Well, after a lot of critical care classes (Thank you! Deborah Tuggle), countless hours reading medical journals, textbooks, going to symposia, on and on (still to this day) I'm pretty sure I got the hang of it.

Titration of chemicals
Is a fine and delicate art,
As a critical care nurse
It requires education
and practice, in part,
To learn the subtle nuances
Regarding properties of drugs,
Factor in the complexity of illness
For now; leave out the hugs.

Only dedicated clinicians
Willing to study, practice, and improve,
Should be allowed into this realm
It requires more than moxy and groove,
Where vitality of life shifts delicately
'Tis a risky balancing act,
And if I'm your Boss, and see you on the cell-phone
Billy Bob, your bags are packed.