Tuesday, December 04, 2018

Writer of Notes


I am crazy about writing nursing note narratives. It's not really a lost art, but rather a form of communication / documentation that has been cast to the wayside, because our Over-Lords have fashioned an easy out  (Computer charting). Nurse got lazy! That's all it is.

I write, as if I am going to find myself in court, about 3 years from now. Those who read my notes, would agree to my statement. I write a narrative journal in a sense, on each patient I have that day. I have done that from the beginning of my career, until now, 35 years later.

Anybody who wants to know what happened on Tuesday, at 5pm, when Oscar (me) was that nurse, only needs to go to "Notes and Transcriptions"...........Nursing Progress Notes...........and you will find out, what procedural sheath of 22 French, was in what Femoral artery, and if it bled and how long, and what Doctor was called,  and who the Echo Tech was and so on.........................that's how it still needs to be done!

Note Writer

I'm a nursing note writer
That's my declaration,
Like I'm writing to the Jury
Describing fact and causation,
Every single interaction
For the patient I observe,
In the final court of law
I didn't drive off the curve.

Go ahead, read my notes
You'll know what happened each time,
When Joe-Bob got up
And slipped on his slime,
And I called the Doctor
And the Doctor said:
For Gods sake, keep Joe Bob
Tied down in his bed!

Or something like that
Back in the day, when we could do it,
When Joe Bob broke his leathers
After all, he could chew it,
Whereas, you can be sure
I documented it all.........
You might try to sue me
But I won't take the fall.

In these EMR days
Half the Nurses, they don't write,
They check boxes and forms
And read their phones half the night,
But three years down the line
When Joe Bob's case comes up in court,
They won't remember a damn thing
They'll just shake, whimper and snort.

Yes, Nursing is very demanding
But I write, for each one,
My job is to tell their story
Everything that was done,
During my short contract
Their events, my responsibility,
And if I am questioned later
My notes are my utility.


12/4/18


Charge Nurse Approach


At my first Nursing job, which lasted one year, I don't recall being in Charge; but we all had to be Monitor Tech now and then for our 8-hour shift. Maybe, I did that more often, because I had actually had a one semester class of Basic EKG previously, when I was a Respiratory Therapist. I was an early-adopter, even back then.

Moving on to my next 3-year Nursing job, at a prestigious Burbank institution, known for open-heart surgery, sure enough, within one year I was playing, quite frequently, Relief Charge Nurse. This role was often revisited at all of my subsequent Nursing positions.

So, what's the point? As a Charge Nurse, I don't prognosticate. I don't call the ER to see if they are expecting to send us people; I don't harass the Nurse Supervisor, to see if we are getting any possible patients. What I do, is keep an eye on my show, keep apprised of what all our patient's need, or what the next two hours of care might look like, and I try to make sure, that patients get out exactly, at their appointed time. That's what drives patient satisfaction.

This poem is about my philosophy in life, and at this chosen career:

Planning

Things that I plan
They rarely turn out,
Whereas, things that I don't plan
Get a high-five and shout,
Because I reserve a place for
Change and spontaneity,
Unconventional outcomes?
I'm filled with gaiety.

Henceforth, I don't plan much
In fact, it produces anxiety,
I want to run to a waterway
To practice silence and piety,
I don't need that type of stress
I'm just a momentary guy, 
Right now, I'll do this thing
And when I do it, you'll know why.

When big decisions come
I gather knowledge and ponder,
Consider multiple outcomes
That could occur down yonder,
But, don't presume that is planning
I'm just collecting information,
Until I whip out the knives
And delare: Captivation!

I work with all kinds of planners
They are good at what they do, 
I know it isn't me
But it just might be you,
I admire the energy
You throw at all situations,
I'm happy to stand to the side
While you collect your ovations.

I don't want any part of that
Yet, we share the same desire,
To reach the end of the road
Without pain or funeral pyres,
And I believe we can achieve that
In our own unique ways,
How about, I take the nights
And you take the days.


Tuesday, November 27, 2018

Germy makes me squirmy


When travelling, the good advice is to drink bottled or boiled water. Also cooked meals, and for us Westerners, remember to carry TP and hand-cleaner, wherever you go.

TP Tourist   

The modern world tourist
Expects toilet paper,
Unlike the locals
Who use their hand as a scraper,
Thus, why we avoid
Handshakes at all,
We wai, with respect
Because your skin
Does surely crawl,
With 17 million
Pathogenic germs,
And probably some eggs
Of your favorite worms.

If you are travelling
Don’t drink the water,
Especially if skinny dipping
With the shopkeeper's daughter,
Consider the potential
Of life-threatening danger,
Instead buy bottled water
From a reliable stranger.

Do peel all the vegetables
The fruit and the goats,
Boil when cooking
Even your steel cut oats,
Served every morning
With slices of Mango,
Remember, don’t eat that skin
It’s not fun, like the Tango.

Just because it is spicy
Doesn’t mean it is safe,
Montezuma’s revenge
May cause serious chafe,
Wiping down yonder
For 24 hours,
Next time, avoid the water
Drink only, whiskey-sours.

Thursday, November 15, 2018

Retirement Security


If you have read anything I have posted over the past 10 years, you know I find bureaucracy to be a total mind-melter. Well, proof of this, is how difficult it is, to actually arrange to stop working and begin receiving any kind of future benefits. I almost wish I was an illegal, and then I could get some hot looking young social conscious do-gooder to help me navigate this quagmire of nonsense.
But instead, I am just an over-educated, short tempered, sarcastic retiring Nurse...........

Unplanned

Social Security office
Makes retirement look hard,
It might look like an inch
But it's really a yard,
To jump through the hoops
Without blowing your top,
I thought working was tough
But it's harder to stop.

Folks there were seeking
Their first SS Card,
Others getting payments going
So they can sit in their yard,
Watching the world go by
As they allocate each nickel,
Wondering why they didn't save
'Cuz now, they're in a pickle.

Grandma Moses
Had a five year old, for show,
She talked to him like he was two
In baby-talk, you know,
Telling him something about school
Study hard, and get a job,
But did she even bring a book for him?
Not a chance; the lazy slob.

In fact, no one had a book
Not even me,
Although I read my journal abstracts
On Medscape, for free,
Thus I know a lot more stuff
About cardiac innovations,
A new pacemaker, for the neonate
For those rhythm aberrations.

Does it, really seem
That I am ready to retire?
No, it doesn't feel that way
My mind is still on fire,
To learn the most I want
In the time I still command,
Life will show me what to do;
The guy that never planned.


Wednesday, November 14, 2018

Train to be Violent


By now, I expect that every healthcare organization all the way out to Timbuktu, has offered free, workplace-violence response training, to all and everyone. At our mega-medical entity, this endeavor seems way over the top intensive, no doubt costs millions, but looks good on paper for the public to read about. But what do I really think?

All the excitement:

What is the latest, hot button topic
For all the people in our nation?
Active-shooter situations
Expounded via oration,
And our own organization
Is spending gobs of money,
Learning to defend ourselves
When some jerk calls you "Honey",
While pointing a weapon
Or threatening you harm,
Got his arm around your neck
His favorite method of charm,
And a blade at your throat
While you gouge, scratch and bite,
Crush his instep with your heel
And kiss him goodnight.

At the Class:

We all learned the blade-stance
Where it looks like you're praying,
Shuffle forward and backward
Keep focused, no swaying,
Yell, scream; don't beg
While showing power, no fear,
Startle that mofo
Then bust a cap in his rear.

Another option:

Or........just arm us with guns
With a weapon I.D.
I can hide it in my scrub pants
A Glock 43,
I'm ready for whatever.........
Oh shit, now he sees us!
But, I'm not really worried
He's about to meet Jesus.







Monday, November 05, 2018

Warm Blanket


Planting a Seed

I changed my mind
Withdrew my prior writing,
I had a good run
No need to be indicting,
We work in a tough business
Life, death and worse,
No need to be remembered
As the disgruntled Nurse.

Work is damn stressful
Till we rise above it all,
Do what we do best
And answer the call,
To comfort those in pain
Some are worried and more,
It might be their own loved one
Or their own, gruesome score.

Expertise is important
So also, is a warm blanket,
Like that Model T Ford
Won't run unless you crank it,
And so does our care
Meet the want where it is needed,
Should we all work together
Our best results are exceeded.

Sure, there are times
When we protest for change,
It is difficult for a system
To work outside a range,
That has been predetermined
Not in a democratic way,
Inhibiting improvement
It won't happen in a day.

In the meantime we care
For those with greater need,
Helping brother and sister;
Is but planting a seed.







Tuesday, October 30, 2018

Mini-moles


This is the fifth, post-symposia revelation; and I wonder, does anyone else doodle in words like I do?
likely not. It is amusement and part memory method. So here is the latest nonsense.

Mini-moles
Very small rodents
Seemingly important, they say,
Something regarding
Umbilical LDL
Not seeing the light of day,

Supposedly at birth
Your U-LDL
Resides at a measure below 50,
But that's kind of silly
You never have eaten
Ya, extraneous data is shifty.

The Cholesteral-HDL ratio
Is a predictor of some kind of risk,
Particular with folks of Diabetes
Don't ask me, but something is brisk,
That's just about where the after-lunch dude
Was guiding us all into sleep,
I suspect he has earned a favorable rating
As we awakened; man, that nap was so deep!

For Giving, that's who we are


End of days ponderings:

I feel kind of alone
Going to classes and such,
It's just one of those things
That I enjoyed very much,
Sharing moments of learning
Perhaps I'm just such a geek,
Feeling a need for expansion
If only just a peek.

Rubbing shoulders with colleagues
Over the years,
We all got a little older
And shed a few tears,
As we all are wont to do
On this human path of living,
And hopefully we have acquired
More capacity for giving.

The Best New Drugs


Every year at one conference or another, a presenter will regale us regarding the use of Wonder drug Q, and all the great stuff, which is in the cue. Some of those drugs disappear, never to be listed, because the side effects began to show up after 300,000 people had been tested against placebo. Maybe their toes began to fall off, or there were too many folks dying from long thumb disease, or whatnot.

The Best New Drugs

Death eliminates all risk
LDL reduction is very brisk,
Approaching zero, as the heart stops beating
After that, no worries about eating.

Sodium reduction has a lot of hype
Not sodium sensitive? you're not the type,
Regarding all that worry, about retaining fluids
No need to join the low sodium Druids.

Sodium-glucose Cotransporter-2 Inhibitors
If you can say that, you're clearly an exhibitor,
But they never talk about
Those incidental amputations,
Or how Fournier's gangrene
Can ruin a reputation.

Beware, dear public
About the newest, latest drugs,
Testing on rabbits, rats and pigs
May not eliminate all the bugs,
Lurking in the background
Glossed over by slick advertising,
If you should get Angioedema
Death may be very surprising.

10/30/18

Price versus Advice


More nuggets of information, from the symposium. If Joe Bob can drop a kilogram of weight (2.2 lb)
this may lower his Systolic BP, by an average of 5 mm of mercury. This alone, can be an organ saver.
But, there is the topic of compliance, isn't there?

If you drop your weight
By one kilogram,
2.2 pounds
It will be favorable, M'am,
To bring your systolic
Down five millimeters,
That might save you a kidney
Unless you're one of those cheaters,
That puts the weight back on
After you leave the Clinic,
You loved all that praise
But you're just a cynic,
Not believing a bit
About all that good advice,
You don't worry about pounds
You only ask about the price.

10/30/18

Syncope Slide


I went to our local Cardiology Electrophysiology Symposium two weeks ago, and learned some good stuff. Man, those physicians love to strut their stuff regarding favorite topics, but there are usually some good nuggets of information.

For example, about 50% of folks who take blood pressure meds for hypertension, still have lousy control, and as such, remain at high risk for deadly complications. We were informed, that better success is achieved if two different medications are working together, rather than just doubling the dose of a singular drug. However, the discussion did not address the added risk of additional side-effects that might come along with those secondary medications.

Anyway, life itself is risky...........and doctors are averse to blame.

Slide


Lowered your BP
But still you died,
When you busted your hip
Doing the Electric Slide,
Thanks to your doctor
Adding another medication;
The plaque on his door reads:
"Your health, is my dedication".


He’s a BP control freak
He studies all the trials,
And as a result
You should see all the vials,
Stacked on the counter
At Billy Bob’s house,
16 plastic bottles
Between him and his spouse.


Meanwhile, the doctor
Basks in recognition,
Writing books on medicine
The latest rendition,
On BP control
All the methods he has tried,
But nowhere will you find
Just how many have died.


He had no hand in that
Never takes any blame,
P-value significance
Is the name of the game,
Statistical variants
Like a bolt of lightning,
Impossible to predict
And that’s what’s so frightening.


Syncope
Is what happened to you,
Your blood pressure crashed
As its likely to do,
After that fourth medication
Was added to your list,
Now that you busted your head
You will be sorely missed.


We’ll get your pressure down
The doctor had reassured,
You’ll feel a whole lot better
The hypertension cured,
You can fulfill your dream
To learn the Electric Slide,
Yes, I fixed you, old man
But still you died.



Sunday, October 28, 2018

Gunning for Retirement


Gunning for Retirement

Another great plan
For when I retire,
An alarming inspiration
Truly did inspire,
For me to think of a way
Where nurses can blow up their stress,
Come to Billy Bob's shooting gallery
It won't matter how you dress,
Because you get to choose
Your favorite cannon,
Please, let me explain
Just what I am plannin'.

I have endured enough
Of every kind of alarm,
My psyche is maimed
With significant harm,
My ears ring incessantly
I dream beeps and sirens,
That's not what I call peace
In any environs,
So, my plan is a shooting range
To vent your frustrations,
Blast those infernal machines
To hell and damnations.

I figure a five minute session
Ten shots in all,
Pick any weapon you like
It's absolutely your call,
The lockers are stuffed
With every kind of gun,
From small stinger missiles
Or some desert eagle fun,
It's all a part of stress relief
Cutting loose with a scream,
Blow up that IV Pump
Like you did in that dream.

The worse flippin' alarm
That I ever heard,
Is on that CRRT machine
Like a foghorn, my word,
So that is my target
With a shotgun to blast,
10 gauge for sure
Nice and slow, meant to last,
Ten shots in all
To damage and maim,
Twenty bucks admission
Come on, play this game!

Can't Remember


I was talking with one of those young nurses of the day, bright as an atomic bomb, and probably the type I'd want on hand if I was in the ICU. She noticed I kept a small note/list on my phone that covered some of the common IV drip mixes and calculations, and it prompted a discussion of this thing.

Hence, I wrote this:

It's the middle of the night
And you can't remember,
The drip calculation
You learned last September,
And it's really important
Because you're at the Code Blue,
It seems like everyone is staring
And waiting for you.

You reach for your phone
It's in one of your pockets,
In your deluxe cargo pants
That hold 42 sockets,
When you suddenly realize
The smartphone is gone,
When you were rushing to work
It fell on the lawn.

Joe Bob the victim gasps
"You can use mine",
Look up Cardiac Arrest
Dial 249,
Ask for Betty Lou Johnson
Also known as my wife,
First ask her opinion
If you should save my life.

The moral of the story?
Keep your tools close at hand,
Know those drug concentrations
For those moments on demand,
When you're on the spot
And Joe is circling the drain,
In those crazy, clutch moments
You gotta trust your old brain.