Friday, April 21, 2017

Trust Someone

Trust that my awareness is on my patient's on the job

Who is the first
To get up from their chair,
When alarms are ringing
Anywhere,
This is the one
I can probably trust,
They are listening
Because we must.

To be your Nurse
Means that my awareness,
Should be totally focused
On you, in all fairness,
Because we are here
To attend to your needs,
If my attention wanders
Maybe somebody bleeds.

We are duty driven
And morally inspired,
To perform at our best
Until retired.

Thus....
Turn off your devices
When you come to work,
Check later for updates
Don't be a jerk,
Secretly viewing
When you know you shouldn't,
We could fire you
Don't think that we wouldn't,
You reviewed the policy
On your hire date,
Electronic entertainment
Is tantalizing bait,
That could lead you to
The unemployment line,
When Billy Bob is calling
In room ninety-nine.

Thursday, April 20, 2017

Seatbelt

Pretty much, auto seat belts have been a safety requirement on our American cars since 1966.
Now it is 2017, and if you choose not to wear a seat belt, and drive your car and crash, you are the fault of your injury. Don't try to pin it (to get money) on anybody else. You are the fool.


I didn't wear a seat-belt
Because I'm young and pretty,
Till I rammed that metal pole
Now, I'm one dead kitty.

I didn't wear a seat-belt
Because, what could go wrong?
Now I'm singing soprano
An angel's song.

I didn't wear a seat-belt
Because I was too busy,
Now I'm floating up in the clouds
And feeling kind of dizzy.

I didn't wear a seat-belt
Because it pushed on my breast,
And because of my stupidity
I earned eternal rest.

I didn't wear a seat-belt
Because I'm a good driver,
Now I'm up in heaven
An early arriver.


Monday, April 10, 2017

My (hopeless) Journey


MyJourney is the name of the software application that delivers the bulk of our required yearly hospital education. It is nothing like a journey, it is not a vacation, and we certainly don't get to choose the island. I discovered today, I can do it all in the safety of my home........and they better pay me for it, too.

Oh, I'm such a happy
Old fool,
Lying here
Next to the pool,
Spending the day
On MyJourney,
Wishing instead
I was an attorney.

I could bill for
Hundreds of dollars an hour,
While sipping away
On whiskey sours,
Dreaming of sugarplums
Dancing at the bank,
Instead I'm on MyJourney
In a blitzkrieg tank.

Firing away
At educational objectives,
I don't have much choice
To be very selective,
If I don't show effort
Or participation,
I'll be, persona non grata
At my nursing station.

Friday, April 07, 2017

Another Bungle


Uh, oh, rumor has it another Nursing Bundle is about to be jammed down our throats. I heard one of the ANS crew talking about it last night, and the religious fervor she exhibited while sharing the "good news" (and dismal statistics) had me running to my creative writing space, to contemplate, Nursing Bungle #2.

The Nursing Bungle requires a testament of belief
Give all of the appropriate answers to avoid any grief,
It's not an annual Revival, but they would do it if they could
Gather around the campfire boys, because the bungle is good.

This latest Nursing Bungle contains all the new thinking
Grandiose ideas to keep this ship from sinking,
And with new management in Washington you better hang on to your seat
Next time the Nursing Bungle will be delivered by tweet.

Excitement is high, at the place that I work
Unveiling the new Bungle with a wink and a smirk,
Promising wonderful top-notch Avatar Scores
Whiz-bang H-CAHPS, and C.Diff. s'mores.

Oh, I can hardly wait to travel on My Journey
After 8 hours of study, they'll transport me on a gurney,
Down to Radiology, for the implants in my brain
I'll be a Nursing Bungle Cyborg, with a built-in ball and chain.




Thursday, April 06, 2017

Out of Rhythm


Well, I caught another Rhythm interpretation screw-up and it's a doozy. From what I can see, nobody really cares, but I have fun doing the research and exposing the fraud.

Betty Lou, age 85, admitted to the hospital with nausea and vomiting. She's in mild Renal failure and her potassium really low (which got corrected). She had a history of A. Fib (paroxysmal) but was only on Coreg at home, and in Sinus Rhythm on admission. About 12 hours after admit, her heart starts to have 3 second pauses, and her heart rate drops into the 40's. Several 12-Leads were obtained, but the quality was horrid, such that neither the machine nor a person would be able to make any good call on the rhythm. Neither the RN nor the Monitor Tech (Cardiac Tele) could figure out the strip, and the nurse actually writes that in the record, along with stating that the EKG 12-lead reads "undetermined rhythm". When the patient drops to 35 and a pause, Nurse calls Hospitalist...........he says, don't give Beta blocker. When the HR dropped to 22, the Nurse charted, "Patient Asymptomatic". Finally, after a call to the Cardiologist, there is an order for Bedside Pacer Zoll, and Atropine prn. As this was Cardiac Tele, and presumably they are required to have ACLS, I would have thought the Nurse would have gotten the Zoll into the room already, without waiting for doctor's order.

Ok, so I take a look at the strips from Tele. They were monitoring Lead 2, and V3. In Lead 2, there was a broad stubby T-wave, followed by a prominent U-wave and a little pointy P-wave. So, with this heart rate of about 45, the Monitor tech, was interpreting those lumps as flutter waves, although that would have placed them at a rate of about 90, which I've never seen, no matter how many heart meds a person has been on. Now, in V3, amplitude was quite low, but there certainly was a P-wave, with a PRI first degree block of about, .38 seconds. Sometimes it even looked like there was some 2nd degree block, but all of the EKG's and strips were crappy. Over the course of about 12 hours, the strips were labeled "Undetermined, or A. Fib, or A. Flutter. The Cardiologist came in, identified the real problem as advanced Heart block, with a slow escape rhythm, and Betty Lou is getting a pacemaker today.

ps.
I am sorry to say, that the ICU nurses were calling it A. Fib too...............

Here's my report:

It bothers me
When I do see,
A misinterpreted
EKG,
I can give a pass
To untrained Docs,
Who specialize
In Chicken Pox,
But Cardiac nurses
And their monitor crew,
Should nail every rhythm
In their purview,
Because that is a skill
Required of them,
And when they blow the rhythm
I say, "Ahem"!

How could you call that strip
Atrial Flutter,
When there is a "P"
"T" and "U" wave
You're some kind of nutter,
A rhythm so slow
With a triplicate block,
'Twas not even A. Fib
You got your head in a sock.

Ah, woe is me
And Auntie Em,
Under the watchful eyes
Of the likes of them.




Friday, March 31, 2017

Infusion Pump Apocalypse


From the "New Brilliant Stuff" Department: (jokes and more)

Consider the similarities:
Q: A Creamcicle ice-cream treat and the IV tubing used for hanging a piggyback medication.
A: The Creamsicle........you suck on dairy;
      The IV tubing set is called a Secondary.

Admission Database question:
Q: Have you ever had an infectious disease?
A: No I haven't, but some people say that I have an infectious laugh.

- - - - -

Here is a retirement business (or hobby) that I am considering:
I will have a sideshow / shooting range or even a mobile unit, perhaps a repurposed mobile home. At this location, Nurses will be able to shoot the weapon of their choice (Sig Sauer, Desert Eagle, Mossberg shotgun, you name it) at old, retired IV Pumps. Heck, I'd be more than willing to pay $20 for a chance to do that. Just think of the satisfaction you could have, sending one of those infernal beeping monsters, to it's bloody grave.

Stay tuned for the Infusion Pump Apocalypse!



Incompetent


Incompetent employees exist to make all of the rest of us look really good? Now that, is an interesting theory.

The truth of the matter, is that incompetence should not be rewarded, by allowing that individual to remain in their job. Some folks never improve, and as any industry changes and moves forward, Joe Bob the Incompetent, becomes a dangerous liability. Employers should have a contract clause that states, “JB, if you don’t learn the new stuff that is expected of all employees in your department……...YOU ARE FIRED!

The Headmaster
Turns a blind eye,
Intentionally ignoring
The incompetent guy,
The one who hasn’t kept up
With the changes in Nursing,
Every day that he works
The experts are cursing.

The Assistant boss
Ponders other things instead,
Ignoring the possibility
A patient might be dead,
Under the care of
Incompetent Billie,
Boss holds the thought
Oh, that’s just too silly,
Figuring the other nurses
Will keep an eye on that punk,
But, everyone else
Would like to throw him in a trunk.

Incompetent Billie
Types with a single digit,
If you’re standing nearby
Oh surely, you will fidget,
Watching with frustration
As he searches for each letter,
He skipped typing class in High School
He never gets any better.

Perhaps Billie believed
It’s all rumor and hype,
Someday I won’t be writing
That I will have to type,
So, why should I bother
To learn any new stuff,
Patients are just people
And I know enough.

For eight years now
Billie has restated,
I don’t have enough time
And it’s so complicated,
I can’t take another patient
Because I’m too far behind,
Floundering on the keyboard
He appears to be blind.

Your career in Nursing
Exceeds twenty years,
But watching you work
Doth bring me to tears,
You don’t know jack
And you ask me every day,
“How do I chart this
They didn’t teach me, no way”.
            _  _  _  _

When I ran to the break-room
Stating, “Oh, I think I saw my son”,
I was really going to my locker
To retrieve the loaded gun,
That I keep there for emergencies
And that time has come today,
Goodbye, Billie
Let me assist you, on your way.


Saturday, March 18, 2017

No snacks.............worth eating


The graham crackers are gone from our Patient Nutrition Snack drawer. In our two ICU's and also over at Trauma and SICU where I visited last week. What's up with that? In my opinion, and I am sure, many other Nurses would agree, Graham crackers and Peanut butter have been a regular option in our Patient Nutrition area, in our "pantry"for nigh, 40 years. Now these items are gone. There was no warning and no explanation from the Dietary Dept, so I'm thinking it was a result of the "higher-ups" slashing costs, just like our knuckle-head in Chief. It's the equivalent of pulling the funding for Elderly Meals on Wheels! If I am ever in the hospital, I won't eat any darn thing on that menu. My mate (or support group) will be responsible for providing me all of my nutritional needs. I'd rather have TPN than any of that hospital garbage (meals). Only the Graham crackers would be acceptable.

Folks know that I never, ever eat anything from the cafeteria. I did it once, about 8 years ago........and very likely had food poisoning. That's 38 years of passing up hospital food.

Graham crackers are gone
What's up with that?
It's not like anyone
Was getting fat,
From a couple little packages
Maybe a one ounce portion,
Human kindness in action
Oh, what a distortion.

No graham crackers
No peanut butter too?,
The whole world is not allergic
Probably not even you,
Plus, the sorbet is missing
Along with ice cream,
Our human kindness menu
Will make you want to scream.

Yep, we're going out of our way
To satisfy your appetite,
When you want a little snack
In the middle of the night,
And all we have to offer
Is pudding and jello.
Plus, an old turkey sandwich
Its color, chrome yellow.



More Items Branded


Our Big Brother agency, is still placing their colors, branding, kindness logo's on everything, except.............the vomit bags. Everybody in the worker force now has their own special color and we are "given" a number of outfits (uniforms) per year, so at least that might be a perk. But wait, there's more; I bet you haven't heard about the Human Kindness Underwear !!!!...........Look for them soon at Ross.

Magical Frog

Diggity branding messages
Even on the soap,
Back when we were CHW
We had soapy Pope-on-a-rope;

But the Pope was excommunicated
And now the suds are alcohol,
With gentle soft emollients
But friends, that isn't all......
Now, you can get two more
With a nail brush, that's no jive,
Six dollars shipping and handling
For nineteen ninety-five.

And if you call right away
You're one lucky dog,
Within sixty minutes
You'll get a magical frog,
But that's not all
We have more to share,
Are you ready for the latest?
Human kindness underwear.

Tuesday, March 14, 2017

Gourmet Thrombus


Do remember, when travelling in planes, trains or automobiles, to stop now and then for a simple walk. Wear support hose, and maybe even take a baby aspirin
(ask your Dr., of course).

Another big story
About a very large man,
How truck driver Bob
Just sits on his can,
Hundreds of hours
Week after week,
He eats far too much
He's an overweight freak.

A heavy tobacco user
He breathes his own second-hand smoke,
Driving the long haul
It's a wonder he doesn't choke,
With the windows rolled up
Like he's afraid of fresh air,
He has nicotine stained fingers
And tar in his hair.

Science has taught us
That long periods of sitting,
Are about as physically demanding
As a knitter at knitting,
In that sit down position
On an airline or a bus,
You have a high risk to develop
A Pulmonary embolus.

One thirty five kilos
Driver Bob, is pretty big.
He stops at the trucker diners
And eats like a pig,
These are not gourmet restaurants
They use the cheapest ingredients,
Lard, salt and sugar
Because it's expedient.

For sure, it satisfies cravings
Big men in 18-wheelers,
I'm not saying their work is easy
But these are heart attack dealers,
Stopping at Cafe' Cholesterol
Fill up their bellies, and refuel the truck,
And if they happen to get sick?
Just call it dumb luck.

Truck driver Bob, had pain
Man, he was aching,
In his legs and his loins
He was practically shaking,
Like that place on his flank
When he had that kidney stone,
But then he waited two weeks
Before he picked up the phone.

He went to Emergency
The man was in dire straits,
His thinking was all messed up
Couldn't remember any dates,
About what exactly happened
And when did it start,
All he knows, he kept on driving
He was in denial; not very smart.

The Cat scan did show
A massive venous clot,
From Inferior Vena Cava
To the Femoral shot,
His legs and his scrotum
Swelled up like balloons,
Plus, he was already built
Like a giant pontoon.

Did I mention that he weighs
One hundred thirty five K,
That's three hundred pounds
In the middle of the day,
About the size of three
Asian, new Grad nurses,
Who are mumbling
Into their iPhone's,
Obesity Curses.

TPA and Heparin drips
In bilateral Femoral lines,
Trying to dissolve big thrombus
Without infarcting his spine,
Absolute bed-rest
Be observant for emboli,
If they migrate to his lungs
Trucker Bob, could easily die.

That would be a memorable
CPR,
Like doing chest compressions
On a Mini-Cooper car,
Rarely successful
Even in the ICU setting,
Odds makers in Jersey
Are already betting.






Thursday, March 09, 2017

Fake News


Fake news, Part 2. Sure, we in the public have been beat to a pulp with this non-news story of fake news. It has always been around, but now, the concept is being used as a tool for harm.

Consider this "news" that isn't:
I graduated from an accredited California Nursing school, in 1983. The school diploma did not specify that it was in Nursing, but rather just an AA degree.

Imagine my surprise, when some dweeb from Corporate, the one who looks at Point of Care device authorization, apparently caught sight of my nondenominational AA degree, and said to himself, "Hmm, this guy didn't go to Nursing school". After a couple more dull moments, he must have thought, "I gotta inform someone". He fires an alarming email off to HR, my ICU Manager, and a couple others who might care. And finally, a copy came to me, but not from the Dweeb himself. I mean, why bother to ask me in the first place, when I might be the guy who has qualifiable supporting documentation that I am really an RN, that went to a real Nursing school.

Here is a story
Of epic distortion,
How the facts of the tale
Were bent out of proportion,
To present a version of truth
With no hint that it is factual,
We call this false news
And present it as actual.
_ - -

I'm not letting this one slide.

Signed,

Faked out in Fargo



Saturday, March 04, 2017

Clean Out


GoLytely, is not lyte! They should have called it, "Drink Soap and Crapalot"
Well, times have changed, and for the better.


Clean Out

There will come a day
When you need to empty out,
Well, I discovered a remedy
I could publish and shout,
But, if I were to do that
I would certainly lose my edge,
And the next thing you know
I could be hiding under a hedge.


Hedge fund managers
Would be chasing after me,
They want to tap into my secret
Regarding this intestinal evacuee,
It's a multi-million dollar
Investment cycle milieu,
There is a lot of shit to spread around
And it all begins with YOU.


Some things are very sensitive
One can't inform the general population,
After all, I could really profit
From bowel medicine exploitation,
No more Golytely preps
With that vague citrus taste,
Whereby, most prescribed users
Will lie about, how much they waste.


It might seem drastic
Regarding what you do,
When you need to promote
Digestive doo-doo,
It's a method and a madness
And it really works, you'll see,
If you want to know about it
Step right up, and pay the fee.


Switch back and forth
A cup of tea, a cup of beer,
After four rounds of that
The toilet you will fear,
And after seven sit-downs
Take a glass of purple wine,
Your day will be complete
When you're flowing loose and fine.


There is one more ingredient
It can not be mentioned here,
It may foment religious commotion
And rile folks, with fear,
So, if you want the complete remedy
Just send me twenty dollars,
You will receive the secret Mojo
Known to very few scholars.


We take all major credit cards
Anything debit, that’s for sure,
Food stamps, cash, aluminum cans
Any questions?, read the brochure,
Anything recyclable
Goes to a local buyer,
Together we're custodians
Our Environment, Doth Inspire!


Your G.I. Doc, will recommend
GoLYTELY, for purification,
Please think of us, consumer
For a clean-out kind of vacation,
It won't seem as crazy stupid
As drinking a gallon of soap, 
Plus, you'll get a little buzz
Along with a pleasant sense of hope.


Friday, February 24, 2017

Intra-aortic vs. Intra-erotic


Well, the title tells it all; so be careful with terminology.

Intra-aortic vs. Intra-erotic
A swap of one letter
And timing dicrotic,
Both involving position
Of a foreign body,
Regarding cardiac output
Or your favorite hottie.

Key factors, stroke work
Performance and action,
Attention is paramount
There should be no distraction,
You will achieve the best results
If  you control your design,
Those intra-aortic-erotics
Then, everything will be fine.

Tuesday, February 21, 2017

Bad Investment Part I


Bad Investment

What a classic case
Of non-compliance,
Stupidity
Disguised as defiance,
Anxious, stressed out
About the whole crazy scene,
When his girlfriend came to visit
She brought amphetamine.

Two days pre-op
Aortic valve repair,
This surgeon will cut anyone
That seems to be moving air,
Active drug user?
Sure, that's OK,
Used drugs while in the hospital?
Hope ya had a nice day.

Lives in the bushes by the river
Ya, he's a great candidate,
Cut him open tomorrow
There's no reason to wait,
Are we worried about follow-up?
Well, just a little bit,
He promises to take his medicines
Each time he takes a hit,
With amphetamine, marijuana
And cigarette smoking,
Does this doctor have ethics?
Come on, you must be joking.

He says, I am a surgeon
And that's what I do,
He offered a two week tuneup
Before he cut on you,
Saying that is enough for
A good surgical choice,
No one wants to argue
When he raises his voice.

Some might say
Well, who am I to judge,
That I don't like this doctor
And perhaps I hold a grudge,
But this is public medicine
And all of us are paying,
Take care, this is an investment
That's all that I'm saying.

Bad Investment Part II


Reason for admission? Benzo & amphetamine overdose. Lives on the streets, chronic drug user, and by chance a routine chest x-ray identifies a bulge at his aortic arch. Health insurance? heck no! A CT Angio reveals an Aortic Aneurism at the critical stage........Once the dude gets off the ventilator, becomes somewhat lucid, the multi-disciplinary team (lacking discipline, if you were to ask me) get together with Joe Bob and have the big discussion. Something like this:

Team: Joe Bob, we saved your life and we want to do it again, how about it?
JB:   Uh, ok. Hey, can you get me some dope first?
Team: No, Joe Bob, you're done with that stuff now, forever.
JB:   Uh, ok.........but, can't you just let me roll a doobie now, so I can think it over?
Team:  No, Joe Bob. What we are going to do is let you get clean for a couple of weeks, then we're thinking of sawing your sternum in half, rip open your aorta and put it back together with wires and staples and other shit, and then you'll be all better in about 9 months.
JB: Hmm, sounds crazy. You know, I need to go to the powder room right now.

Over the next two weeks, Joe Bob goes to the parking lot about 4 times, to clear his head. Right; how about for a little snort of Meth!

And that's why he was the winner of an Aortic Valve repair.

Monday, February 20, 2017

Age-Weight Score


Another way to measure up.

Twenty-eight years old
Weighing twenty kilos,
She weighs about as much as
Two boxes of pillows,
Which isn’t enough
To sustain prolonged life,
Hopefully a husband
Didn’t starve his wife.

Whether kilos or pounds
It rarely works out,
If it’s the same as your age
There is reason to shout,
Something is wrong
Almost all of the time,
Forty kilos at age forty
Isn’t optimum prime.


Ninety kilos at ninety
Or maybe, ninety pounds,
In this day and age
Where too much abounds,
Either unit of measurement
Gives cause to investigate,
What is Aunt Betty eating
How much is on her plate?




Protege 2


Here is the sick and twisted sequel to the original "Protege" (December, 2016). This story is pure fiction, but would make for a great hospital whodunit.

Oh protege
Look what you did,
You killed that guy
And then you hid,
But worry not
Listen to your mentor,
When the blame is cast
I will be the dissenter.

I will show you how
To make them look,
Somewhere else
In another book,
To obscure the trail
Of evidence and blame,
This is not the time
To ruin your fame.

Now, there is a pittance
A fee to pay,
So your good reputation
Doesn't fade away,
So early on
In your distinguished career,
Just pay it once
At the beginning of each year.

You won't tell
And neither will I,
What caused Billy Bob
To die,
It seemed natural enough
And it was kind of expected,
But, going out of the window
As if ejected?
That was a tough sell
And you gotta be thankful,
So, pay your fee each year
To keep my bank full.

Oh protege
I knew at the start,
He's the cream of the crop
Clever and smart,
With career potential
Clearly off the charts,
And if you do as I say
You'll be the Master of Arts.






Bye Bye MERSA


Oh boy, finally we don't have to play dress up in bio-hazard yellow, when we enter the room of the patient with MRSA. Sure, of course, we practice Universal Precautions, cuz that's what we do for everything (especially when eating in the hospital cafeteria). Since I be the achey-breaky nurse, anytime I'm helping with cleanup, I'll wear yellow, because I visit a lot of different patients during my six hours, and thus, I'm a highly developed fomite under power, so to speak.

But here's the real news, once again:

MERSA used to be the thing
Everyone had it, tra-la-ling,
We did isolate and wear the garb
And we poked your nose with a mini-barb,
But now the latest directorate
Says, oh why bother, to protectorate,
If everyone has it, then so do you
Goodbye MERSA, so long, boo hoo.

What this all means, we need a new adversary
To don the gowns and gloves, and act kind of wary,
Until we know the enemy and develop our tools
And someday our descendants will call us fools.


Thursday, February 16, 2017

Dental Dana 58


Apparently an old dog, may not learn new tricks.........

Dental Dana
Prepares for duty,
She straightens her hair
And shakes her booty,
For a memorable entrance
Walking into the room,
And every time she does it
My heart goes boom.

DD took an oath
To perform at her best,
In the eye of the storm
No matter what the test,
Because dealing with the public
In a service role,
Requires finesse
And a sharp pronged pole.

Every single appointment
Is unique and fairly risky,
I try to be good
But I always get frisky,
I just claim that I’m weak
In the presence of a goddess,
(But it surely doesn’t help)
When I sneak a peak
Beneath her bodice.

Wednesday, February 15, 2017

Hot Diggity Outsourcing


For some reason, not shared with the general regular employees, the hospital is now undergoing a very deep cleaning. So deep, the job has been outsourced to a group of blue garbed, female tape-scrapers. Can you imagine the very unsafety of their job, that a person would employ a razor-blade window scraper, to remove tape and other sticky substances from hard / smooth hospital surfaces? Even in the Laboratory?!? I'm wondering if there is a special clause in their contract (probably denying them compensation) should one of them accidentally perform a finger laceration with a blade carrying 42 layers of resistant bacteria, when they were cleaning the Laboratory two weeks ago.
Once again folks, I am not creating fake news; this is real-time reporting!

It is super-hospital-cleaning week
Five contracted specialists
Down on the floors take a peek,
At all nooks and crannies
Including the chairs,
Deep cleaning the swivels
I ask you, who really cares?

It’s another hotdog diggity
Delirious decision,
Five cleaners at a time
An eight hour vision,
Of scraping and wiping
Tape removal and more,
I figure at twenty per hour
This is one expensive chore.

Night after night
An outsourced cleaning crew,
They didn't query me
And they didn't ask you,
If this was a sound
Clear-headed decision,
Yet, these are the ways
Of hot diggity vision.




Monday, February 06, 2017

Pain from the RASS


I am a little late writing about this, as it has been in use for a few years now. But thanks to somebody, I have now given it my attention.

Here is another Audit-glory Tool; allow me to present to you the:

Richmond Agitation-Sedation Scale.
Never, in any Nurse-to-Nurse report did Betty Lou say to me, Billybob has a RASS of minus two, positive. Instead what they probably reported; Billybob is totally whacked out, slugging and spitting at his caregivers between bouts of profound somnolence. And incidentally, I told the Doctor the same thing. So why is there a RASS? To audit us, of course, you fool! It probably fits in somewhere, on that down-home favorite, the APACHE score.

RASS

Remember
Acquire
Stupid
Stuff,
As if we didn’t
Have to do enough.

Always remember
To do that RASS, mutt,
Or some invisible Auditor
Will kick your butt.

At first there was AIDET
And then there was NO PASS,
Ask any honest nurse
They’re all a pain in the ass,
And don’t forget that Apache Score
One more shackle
To grapple with on your shift,
I doubt the CEO must do it
Do you get my drift?

Is Management forced
To use precious time,
To pull up Apache
And make everything rhyme,
A non-productive part
Amidst every day duty?
Makes me feel like calling
Death Cab For Cutie.


Atrial Chatter


Question: "What do you call it when a couple of Atria are hanging out, and he says:

"Hey Miss Atria, you are looking finer than fine tonight in your new mini-skirt".

And she replies:

"Well, Rockstar, you are pretty fine, yourself. Your appendage is looking really awesome!"

Answer:
Atrial Flatter.

Dog Joke


Picture this:

Sven, an honorable Animal Breeder, he raises dogs, Dachshund specifically. One might say, he is in love with these sturdy little fellows. At some point, there is a litter of identical twin brothers, which he names Huey and Louie. They are so cute, playful, fun and spirited, they become the joy of his life.

Now, they are a couple years old, and at his side day and night. One morning at breakfast, his two pals walk into the dining room, greet their owner, and then keel over together, unresponsive. Sven races to their side, and no matter what he does, Huey and Louie don’t wake up.

Sven bundles them into a blanket, and races to the Veterinary office. He yells, “Dr. Mergatroyd, something terrible has happened to Huey and Louie, what is it?”

Dr. M performs a thorough, albeit quick examination, and suddenly declares;
“Eureka, this is Pulseless Pair’o Dachsunds!”

Inflammatory


Q: What is the commonality when comparing Sepsis, and, a Nursing Staff Meeting?

A: They are both an Inflammatory Process.

Sunday, February 05, 2017

Clorox Showers



Flexiseal
What a fabulous invention,
It works pretty good
For the stuff we don’t mention,
At Thanksgiving dinner
Though, it looks like gravy,
Occasionally chunky
And usually wavy.


Flexiseal drainage
Is now incontinence control,
Placing a tube
In your nether-hole,
So the drippy and runny
Won’t mess up the bed,
And the toxic smell
Won’t make us all dead.


Flexiseal
Part of your go-to-kit,
When Billy Bob Boomer
Has another shit,
For the 17th time
In the last eleven hours,
Earning you the right
For Clorox showers.

Hospital Acquired Pressure Ulcer


CRAPU

If you give me a HAPU
I’m gonna SLAPU,
Oh, don’t make such a FLAPU
It’s all because of your CRAPU.


Sunday, January 22, 2017

Phones: I See You


No commentary required.

Phones: I See You

I went into the ICU;
Five nurses sat
With smartphone view,
Movie watching
Texting and games,
Would they notice
Smoke and flames?

Sure, times have changed
But I have not,
I remember what
Instructors taught,
While on the job
Please pay attention,
Reduce distractions
Honorable mention,
Spare time? study
Expand your knowledge,
Especially if
You're not in college.

In the courtroom
There is a no-phone rule,
If the Judge should catch you
Contempt, you fool!
Why don't our hospitals
Enforce, the same,
I don't know why
But it's a losers game.


Tuesday, January 17, 2017

Cumin Kindness


Not all health-care entities blast their branding, all over the USA, but some do. It's a little embarrassing to the employees, but what can we do? Actually, we're supposed to following our leaders, and spout the slogans too.

Anyway, Curry Bob's Taxi Service, has apparently jumped on the advertising bus too; take a look.

Cumin Kindness

At Curry Bob's Taxi
They have a new motto,
Hello Cumin Kindness
Is displayed on every auto,
We care about you
And every living being,
They spend a fortune on ads
It's all the public is seeing.

The taxi's are plush
With fake mohair velour,
It hides the dirt and debris
For the duration of your tour,
And don't even bother
To ask about pricing,
If we ever told you
It would not be enticing.

There is a passenger mini-bar
Just enter the code,
Fresh Turkey sandwiches
And pie a la mode,
With a 3-day expiration
Preservative enhanced,
Like our cutting edge attention
We are truly advanced.

No matter, your destination
You will get there, guaranteed,
For the satisfied customer
We have everything you need,
But, please fill out the survey
And give us some praise,
Hello Cumin Kindness
To the end of your days.

Sunday, January 15, 2017

News Under Pressure


Lately, there has been an uproar in the news, regarding "Fake News". I am of the opinion, that ya can't trust anything on TV or the Internet, unless you dig deep. You must know where to look.
But I think there is a bigger issue at hand; news that is held back, all together. When major industries spout platitudes about how "transparent" they are, the very fact that they are bragging about, is usually an indicator, that they have been lying for years!......and will continue to do so.
\
How does Diggity
Squash the stories in the press?
Not a peep is ever written
Regarding any mess,
Now, if there is a chance for bragging
Then, we're all over the papers,
But write articles
About problems?
You must be sniffing the vapors

'Twas like a rainstorm at midnight
In Mother's caboose,
When those pipes in the ceiling
Finally broke loose,
Back in 2013
When the sprinkler system busted,
You know, old infrastructure
It just can not be trusted.

Little catch-all pans
Trying to corral every drip,
When it all busted loose
They had to abandon ship,
Water leaking down
To the Pharmacy floor,
Shouldn't the public know this?
Bad news, is locked behind a door.

And did that ever make the papers?
Why, certainly not,
Money must have crossed palms
On a story that hot,
Or how about the time
With the new ATM,
Was it stolen by us?
No, it was taken by them,
Right there in the lobby
Two men with a dolly,
A couple boys showing off
For their Aunt Polly.

Serial thieves
A family, one might say,
Although, no one was arrested
Now that's a Payday!

1/15/17

Thursday, January 12, 2017

Dental Dana 56


Dental Dana is still driving me crazy!

Dental Dana
Performs such magic,
Still, every appointment
Seems to turn out tragic,
I have wondered about that
And here's what I think,
I always seem to say something
That raises a stink.

She is always
So sweet and kind,
I must be stupid
And completely blind,
Well, apparently not
As I'm always trying to touch,
Some part of her
That I like very much.

Still, she has such patience
And magnificent poise,
She gets me to behave
With very little noise,
With a sensitive jab
Of her green-Laser pen,
Which seems to work very well
On rambunctious men.

Denial and Death


The holidays are over, so I can write a depressing story. Yes, of course it's true (with a few embellishments), and took a month for me to regurgitate.

Denial and Death

The Christmas Holiday season
Is such a special time of the year,
This is where good old Uncle Bob
Will play out his dying fear,
He has a history of heart failure
And has angina every day,
Now he's faced with Christmas dinner
Fat, salt and sugar heading his way.

He's a tough old Russian Teamster
He could pull a tractor with his teeth,
But now his chest hurts a little
He's short of breath, just hanging the wreath,
Mamma says, Daddy, your face is purple
He replies, Don't worry, it's kinda cold out,
Whispering silently to himself
No reason to scream and shout.

A silent M.I, in action
Myocardial damage, during dinner,
Everybody joking about how
Uncle Bob, used to be thinner,
Then, in the family room, later
A rousing toast to a wonderful life,
Everybody bragging
About great kids and the good wife;

Then suddenly,
Down goes Uncle Bob,
And ten year old Joey
Does a miraculous job,
Performing Cub Scout CPR,
Until the Paramedics arrive
In their siren-shrieking car.

Three days later
It's a forgone conclusion,
That Uncle Bobs brain
Has undergone fusion,
Of white matter
Sulci and neurons,
About as dense as the muck
At the bottom of Lake Huron.

But that's not what his wife sees
When Uncle Bob wiggles and twitches,
It reminds her of those times
When he stumbled into the ditches,
Out on the steppes of old Russia
Drinking potato whiskey,
She sheds a nostalgic tear
Back then, he was so frisky.

This is the new world
Sorrowful last fable,
Where no medical options
Are left on the table,
Leaving old fashioned hope
Amidst old time religion,
Sending desperate prayers to Jesus
Strapped to a messenger pigeon.

We do our best
To provide logic with sensitivity,
While this family prays Psalms
Focusing on Nativity,
A miraculous rebirth
For Uncle Bob, in all His Glory,
And as the weeks drag on
Hubby, becomes a laboratory;
Bacteria, of virulent strains
Take over in his G.I. tract,
Like a festering Petri dish
Drug resistance, in fact.

Rotting away
Such an uncouth term,
Especially the morning
When a festive brain worm,
Was seen escaping
Uncle Bob's Left ear,
Erupting suddenly
With a burst of cheer,
Singing, "Oh, we're having a party
Up in Uncle Bob's brain,
Giggling insanely
Repeating the refrain.

Finally, a consensus
Uncle Bob, can be a DNR,
But no, not Comfort Care
That would be going too far,
Thus, another month drags on
While, this body decays,
A desperate, trapped soul
Silently screaming for 100 days.

Until he died.

A pigeon pooped on Mamma's car that day
A message from Uncle, as if to say:
Goodbye.

Wednesday, January 11, 2017

Take a Break


Doing Break-Relief Nurse for nine months now, and my satisfaction score is pretty high; here are some of the reasons.

Break-relief nurse
There’s a lot to like,
Nearly as simple as
Riding a bike,
After competing for years
In the Tour de France,
Having earned the right
To wear the jersey and pants.

Take your break, Nurse
What do you need me to do?
Start an IV
On old Betty Lou,
Carry tubes to the Lab
Then, hang some plasma,
Titrate the Levophed
And monitor Bob’s asthma.

Set up a room
For that overdosed giant,
Keep an eye on his restraints
He’s completely non-compliant,
Assist with 3 bed-baths
On the super-sized folks,
While gasping for air
And still telling jokes.

Answer the call-lights
Attend to machines,
Troubleshoot problems
Without making a scene,
Offer suggestions
Be a team player,
Ready to offer a hand
To the dragon-slayer.

A six hour shift?
Now, that’s a relief,
Don’t have to deal with
All that charting grief,
But I must read the notes
‘Cuz, each patient is a mystery,
Please, don’t be offended
If I know more about their history.

There are a couple things
That I can’t do,
Continuous Renal therapy
That’s up to you,
If there’s a Code or a crisis
Or say, a new Open-Heart,
I’ll be your assistant
I play the little part;
Then, we’ll get stuff done
More efficient and speedy,
Don’t worry about me
I’m not the least bit needy.

When I leave at Six
Finally, I take a break,
Silently, I depart
Having earned a piece of cake.

Thursday, January 05, 2017

Generations


I may seem like the grumpy old Expert curmudgeon at times, but that's what you expect from old people, right? We elder nurses who care, find satisfaction in sharing with younger generations; those Great Nurses who will follow in our footsteps. That doesn't mean I think I'm some kind of superior nurse; it only means I'm a veteran, rabble-rousing individual that expects perfection, or the closest thing to it.

Generations

It may look like
I am picking on a younger generation,
Of new nurses practicing
In our good old federation,
But, don't take me wrong
I seek the best of practice in our profession,
I like to mentor........
Just step in and make your confession.

Sure, things have changed
No doubt about it,
Thank goodness for change
I'll be the first to shout it,
No more confusion now
When doctor's write orders,
I don't have to decipher handwriting
And scribbles on the borders.

Change, ushers in new ideas
Along with new situations,
That we didn't encounter before
Thus, more regulations,
Where, some will try to find
Workarounds and shortcuts,
That is all good and well
But makes Administrators go nuts.

This is hacking in its purest sense
Like the automotive pioneers in 1910,
Where many of us dream about
Those silly days way back when,
Your great-grandmother, worried
About great changes in her world,
And here we are, one hundred years later
Having our genetic code curled,
Down at the Salon
While choosing our next baby,
The current generation of new Nurses
Is always poised to say, "Well, maybe".


Wednesday, January 04, 2017

No more sounds of silence


Smartphones are now ubiquitous in every hospital in America (probably everywhere else, too). With over 500,000 phone applications already available, and many of them being useful in the practice of  medicine, these babies are not going away. As their technical prowess increases with every new generation of operating system, human behaviors are going off the rails, in terms of phone abuse. The careless habits of "professional" phone users (and the inability of Hospitals to enforce rules), place our patients and their families at risk.

When an employee is on break, go for it dude, whip out the phone and be entertained! Just stop doing it when your attention should be on your patient in Room X, Y & Z.

Earplug Attention

Earplug attention
Dude is unaware,
He deserves a notorious mention
Because his patient slipped out of the chair,
His mind is on his music
A mantra and a movie,
The patient had a cardiac arrest
He didn’t notice, ain’t that groovy?

Smartphone distractions
In the midst of Intensive Care,
If this one be your nurse
It’s like playing double-dare,
With his earpiece blocking sound
Your survival is in doubt,
I have noticed he’s doesn’t hear
I practically have to shout.

Smartphone abuse is out of control
In two thousand seventeen,
You can call me Mr. Grumpy Nurse
And say I’m being mean,
But with thirty years experience
I know listening, is a specialized skill,
If you don’t hear what goes on around you
You’re not worth a two dollar bill.

Monday, January 02, 2017

Chip in the Head


She talked of this incessantly, "there's a chip in my Head". According to this delusional person, it was placed in her head when she was two years old, down in South Carolina. Well, that was 50 years ago, and there were no chips, other than potato chips, (which is what is in my head, I think).

I tried some internet research on the topic because it sounds like something right out of L. Ron Hubbard, a lesser known science fiction writer. And considering the wacky ways of his legacy (Scientology), I don't doubt for a minute, that he had several in his head.

She has a chip in her head
That’s what she claimed,
They’re trying to kill me
They abused me, I’m shamed,
It happened
When I was a baby, she said,
And ever since then
They have wanted me dead.

An “accidental” overdose
Not intentional, says her daughter,
But this was number five
So, let’s call it MySlaughter,
Trying to end her life
And that demon in her head,
A self-fulfilling prophecy
After all, they want her dead.

Squeegee


Certain topics, are covered often because they are so visceral in their presentation. And honestly, each time it's old and yet reveals some unique nuance that I just have to cover. But first, I cover my clothing and my nose.

Covered in stool
It never is pretty,
Back, butt, arms and legs
It's downright shitty,
At first look, it overwhelms
"How can I possibly clean, that?"
Run to the linen cart
Grab a bunch of towels
Call the cleanup crew, STAT!

Take a careful moment to notice
Is it flowing off the bed?
That detail is so important
So you don't slip and slide onto your head,
If it's on the floor, get some shoe covers
So the crap doesn't walk home with you,
Although it doesn't smell as bad
It is way worse than dog poo.

Now, I was unsure what to do
So I consulted my weegee,
It spelled out, forty wash-cloths
And a high-pressure squeegee,
Yes, that did the trick
BB, was slick as a whistle;
Just another chapter
In the crapola epistle.

Sunday, January 01, 2017

BillyBobinator


First poem of 2017:

I don't like trauma
I'll tell you why,
All those broken bones
They make me cry,
The busted heads
With swelling brains,
And a myriad
Of other pains.

A lot of trauma victims
Have drug-seeking behavior,
And they are expecting me
To be their savior,
But I am not
That kind of guy,
I can say, No
And let them cry.

Half of these folks
Did stupid crap,
Like spilling hot coffee
Into their lap,
While driving
Their brand new Maserati,
And looking out the window
At some teenage hottie.

Swerved, they did
Into a giant Oak,
Blew up that Maserati
And that's no joke,
Two hundred and fifty
Flying pieces,
Including Billy Bob
And his two nieces,
Going off in
Different directions,
Seat belts still on
But no other protections.

Where once were three
There now is one,
Put back together
With a hot glue gun,
A hodgepodge collection
Of many pieces,
Something from Billy Bob
And both of his nieces.

A Frankenstein creature
An amalgam of parts,
One head, two arms
And three beating hearts,
The rest is a mix
Of tissue and bones,
And inside the head
Two, iPhones.

We call him BillyBobinator
The first hybrid man,
Kind of weird looking
But that was the plan,
When the trauma surgeons
Looked at that box of parts,
Retrieved from the accident
In fits and starts.

He has a little girl's voice
He got that from Trixie,
She was the cutest thing
Looked just like a pixie,
Her sister Madeline
Was a gymnast extraordinaire,
Now, BillyBobinator
Keeps flipping into the air.

He's a handful
That's for sure,
But we're a Trauma Unit
With a guaranteed cure,
Where everyone leaves
Sooner or later,
Including this hybrid
BillyBobinator.