Wednesday, October 30, 2013

Black Hole

Management Complaint List of the Day

Daily Complaint List; choose your favorite Staff reminder

1. Why did you guys work so late last night? (more than an hour after patients departed)

It could be that we needed to catch up on charting for the patients we took care of over the past 8 hours (the charting we didn’t have time for); we cleaned all the beds and placed new linen; restocked the IV trays; made sure there were enough IV pumps; made sure that all the charts for tomorrow were present and accounted for; set-up the white-board with the clients names for tomorrow; did the billing; turned off the monitors to reboot; and left the joint tidy and neat for the 5am folks.

2. Why didn’t you get your breaks…...we assigned them to you at certain times?

Could it be that if I took my break when you assigned it, the fact that I couldn’t get my patient ready on time (and work wasn’t done while I was gone), upset the flow in the Cath Lab? Or maybe, I found myself watching 4 patients in the room, and I knew that you the Charge Nurse could not be my break nurse buddy, because you would not stay in the room while I was gone;
or I’m in EP with one other nurse and you won’t send a third nurse to cover for our breaks, and some how, you want to lay the blame on me for not taking my break, when you assigned it, but couldn’t cover it.

3. You can’t take your breaks at the end of the shift; why didn’t you take it earlier?

Well, I’m thinking that this violates Labor Law, because I can’t forfeit my breaks, merely because you, Charge Nurse, can’t figure out when we are truly understaffed, and/or, you don’t care to do anything about it.

4. Our HPPD hours were only_ _ _ _ _ _ _ _ _; what were you guys doing yesterday?

Why not ask the Elephant in the room…..Big E, do you give a rats ass about HPPD hours? No, says Big E, because I come to work to do what is best for the client….and Mr. Public doesn’t even care about your idiotic transmogrification of patient-care hours into some gobbledygook formula that tells Management whether or not the Nurses are working their asses off in a safe manner or not (make that a “responsible fiscal approach to Nursing).

5. Your shift starts at time X; you must be in the unit, exactly at that time, and working!

Wait a minute…..find me any other Nursing floor where the Nurses are expected to be doing patient-care at the very minute they walk in the door. Not likely…..and how about the issue where our breakroom, time-clock and lockers are two floors away. You say I can’t clock in more than 7 minutes early, but then you want me here on time to work instantly. Oh, and I can’t have any food or drink for me, while I’m in the unit (remember the break room? it is 2 floors distant). Nuts!

6. Why are you looking that way when I talk to you; are you reacting to something I said? You know, Billy-Bob, that is why people don’t like addressing (confronting) you when they need to talk about something important; did you know how you appear to others?

Uh, you’re kidding, right? Here is where Billy-Bob feels at a loss for words. There is no safe way out of this management confrontation; any response is a potential land-mine. Because the accuser is already convinced that you did something wrong, your response will be interpreted as being aggressive and excessive, particularly, because in reality, you are being attacked by your “leader”. Your best action is to spray some Holy Water, pull out the Crucifix, throw the garlic garland over their head and start chanting obscure Latin phrases.

_ * _ * _ * _ * _ * _ * _ * _ * _ * _ * _ *

7. Although improbable, wouldn’t it be fantastic if we came in tomorrow, and our Charge Nurse said the following:

Billy Bob and Mary Lou, thanks for taking the time last night to spiff up our humble Unit. Also, you guys are incredible, because I know how much junk you have to deal with at the end of your shift, making it ready for morning. You are so good to our late clients, because they are anxious to go home, but they need some high quality TLC and excellent discharge teaching. I’m sure that is one of the reasons we continue to receive all the “high five” Patient Satisfaction scores, you know, our whole team here totally ROCKS!

Hot Damn, we’re good!

Now, that truly would reflect DIGNITY.

But it will never happen in this universe; it got washed out 4000 rinse-cycles ago.
All that Human Kindness sucked into a black hole.

Sadie's Number

I admit it, this didn't really happen to me, but it's all about the rhyme. The Hazmat event did really happen, but it was Rob, that suffered. I was just a bystander watching the event unfold. Unfortunately, there wasn't a hot Sadie, either.

Sadie’s Number

Although it seems
Like I have written
Everything already before,
New generations of Nurses
Keep walking through the door,
And I feel I have
An obligation to inform them
Of everything that could happen,
"Wear gloves, a gown
And a face shield,
When Billy-Bob is crappen."

It was one of my
Earliest discoveries
Way back in eighty - three ,
Just how the
Nasty excrement
Could fly and fling on me,
When my attention was distracted
By Billy-Bob's teenage daughter,
When she came flouncing in the room
Wearing short-shorts
That Momma bought her.

Although, I was astounded
(Why did those idiots, just march in?),
Well their daddy was on the crapper
That oughta be a Mortal sin,
And assaulted they were
By such a horrible stench,
Mama and pretty Sadie
Collapsed upon the bench.

Young Sadie
She only managed a squeak,
As Billy Bob raised up off the crapper
Good lord, his legs were weak,
While the bottom bucket stuck
To his butt
And he staggered across the room,
His nurse reached out to support him
And that bucket, fell with a boom.

Now the laws of Physics
Somewhere state
An object subject to motion,
Will continue
In its moving way,
Whether solid, or liquid
Like lotion,
And like the monster Tsunami
Appearing so benign at sea ,
When the bucket hit the floor
The contents flew at me.

This never-angry professional nurse
Was now a Hazmat disaster,
Wishing he could fly away
Like Superman, but faster,
But when he left the room
Everything was fresh and neat,
And he managed to acquire
Sadie's number,
For a weekend retreat.



High class, technical Cardiac Care is here and has become commonplace. So much so, that the public awareness of "easy and accessible", makes our hotsy-totsy procedures seem as simple as a short trip to the Nail Salon. When we inform people after their Cardiac Cath that they now have 6 hours of bedrest, some of them nearly flip out, and as the hours creep by, some of them do. They just don't understand the whole bleeding thing..........."like, how bad could it be, dude?" Since we are the major referral center for a territory reaching 100+ plus miles out, driving home at 2300, with the potential for bleeding, is not something to take lightly...............but many of them do.


Call me a Journalist
In truth, I'm a Historian,
I used to drive a Geo
But wished for a DeLorean,
So, fantasy plays a part
Between reality and desire,
I write this diary from experience
To educate and inspire.

Each line is a message
Defined by you, the reader,
In my kind of work
We must stop the bleeder,
Or we mess up the linen
So just imagine your car,
You say you need to drive to Redding
Good lord, that's too far.

We did an expensive procedure
But someone's covering the cost,
Your GPS doesn't work
And you might become lost,
You barely know the way home
But you have to drive there tonight?
How many brain cells do you have
Oh, I forgot, its Boxing night.

You pre-paid for the match
Mayweather, and Duran,
We forgot to include that
In your Ablation plan,
Because clearly we didn't calculate
Desire vs need,
And if you drive 200 miles
Well surely, you could bleed.

We may have saved your life
But you care most, about a fight?
Millionaire thugs on pay-per-view
Don't care if you bleed tonight,
To us, that seems so stupid
But you're the non-paying consumer,
Please don't bother to call us
When you get that brain tumor.


Tuesday, October 29, 2013

Breath of Death

Breath of Death

I feel calmer now
After venting, to a friend or two,
To those of us in health-care
You must be one too,
I can’t discuss it with my neighbor
And not my wife, at all,
They don’t understand, life-threatening
Or the Grim Reapers call.

I have been with death
Hundreds of times,
I know him in every culture
And understand his rhymes,
I have walked the pathway
That parallels life and death,
And you can’t understand it
If  you have never felt its breath.


Seal of Approval

Last night...........

Seal of Approval

Cardiogenic shock
In its earliest throes,
Shallow, labored breaths
Pale and clammy to their toes,
Restless and demanding
Disorganized thought,
Classic signs of pump failure
Are those things I was taught.

Reduced urine output
A narrowed pulse pressure,
Sinus Tachycardia
We’re heading for the thresher,
Multifocal PVC’s
With Bundle Branch block,
More classic signs of
Cardiogenic shock.

Why didn’t they insert
An I A B P,
Impella in the ventricle
If it was up to me,
But no, he was sent
To our unit, for sheath removal,
Yo, Doctor, I’m not impressed
You didn’t earn, the seal of approval.




This is hard, hard work we do
Sometimes it bothers me tomorrow,
When yesterday’s catastrophe
Brings on hidden reams of sorrow,
By many other names,
Is a difficult tunnel to walk thru
The most treacherous of games.

To just say that we had a bad night yesterday, is a gross understatement. We had a wild and hairy, completely unsafe three hour period, where patient’s could have died, because we were woefully understaffed. There were three nurses, covering six patients. Sounds Ok, right?

  1. One had a continuous groin bleed. (1:1)
  2. One was post Cerebral Angiogram and he was completely bonkers, requiring four other persons to hold him down for safety reasons (requiring a Code Gray response = out of control). 4:1
  3. One was a General Anesthesia recovery (supposed to be a 1:1, for at least 30 minutes)
  4. One was a guy with the early signs of Cardiogenic Shock, and I was doing the Femoral sheath-pull, and he had received Plavix, Aspirin, Heparin and had an Integrilin drip. 1:1

But wait, you may notice that I mentioned earlier that we were only 3 nurses. There’s more to say, but why bother!

In the past week, each one of us has had “the worst day ever” kind of feeling. But we’re the healthy ones; the patient’s suffer too, when we don’t have the staff to give them the high-quality attention that they need.

Revision: Those were three highly experienced, GREAT Nurses.

Little Yellow Bus

I can barely
The daily frustration
Regarding our fate,
Attempting to satisfy
The demands of our work,
Where our leaders remove
Any kind of a perk.

To us, a perk would be
The right number of nurses,
Supportive managers
Who don't focus on the purses,
In such a manner of ways
As to believe our overtime,
We don't stay late on a whim
But we're punished for the crime.

Just play nurse for a day
And do exactly what we do,
Perform as fast as the best of us
Just to get another view,
Watch six patients with three nurses
At a moment, 4 one-to-ones,
Do the numbers, little Miss Management
When Mr. Danger, is loading the guns.

One of them a MAC Recovery
One of them was bleeding,
One of them was a sheath-pull
And one confused and needing,
Two others that were stable
But still belong to us,
This was not safe patient care
On the little yellow bus.

And tomorrow, rest assured
The question posed at first,
Why did you stay so late, girls
Our budget almost burst.