NurseMart.........just another .99 Cent Store

 

I am a multi-decade ICU nurse and retired from the hospital for three years. Yes folks, I do miss it and I cringe at the reports of what current nurses are experiencing. I know what you know; one of the primary reasons regarding staffing shortages (as are reported today) has to do with the sucky treatment of nurses by hospital administrations. The following is what I wrote in 2008 (and probably ten years earlier too).

If only we were in the business
Like the local grocery store,
We'd earn a flat percentage
For every pill and chore,
Every spoken word of teaching
Every gesture of compassion,
There'd be seasonal variations
Like the latest winter fashions.
 
For special big events
There could be a bonus format,
It would beat the present system
Where we're treated like a doormat,
For example, we could compensate
Events like CPR,
If you succeed and bring them back
You win the big cigar.
 
Your patient was combative
He tried to stab the Candy-Striper,
She’s the daughter of the CEO
You win the keys to his Dodge Viper,
Or you work an extra night shift
Like it’s really no big deal,
Seven patients with infections
Every one of them with difficele,
By morning you’re exhausted
And finally feeling old,
Your boss comes in, says, “Way to go”
And hands you coins of gold.
  
There would be no nursing shortage
If these silly thoughts were true,
Pay us like celebrities
It is long way overdue!

2008

Careful with those words, Boss

I am a certain kind of writer because I pay attention to the usage of words and terms. During my 40+ years in healthcare I paid close attention to the things that were being communicated to me. As a result, I have laughed a lot.

If you work in the hospital you must know about the Johns Hopkins Appraisal Tool for Fall Risk Assessment. At the most recent facility I worked at, it was identified as the Johns Hopkins Tool. If you are a warm blooded adult, you may be aware that there are alternative definitions for the term "tool". Sometimes I wonder who is sitting on the panel of professionals, when they all agree on the naming of something. It reminds me of the acronym of SBAR (Situation, Background, Assessment, Recommendation); now consider what FUBAR alludes to: Effed Up Beyond All Repair. 

Johns Hopkins Tool

I don't think I want to know
About Johns Hopkins tool,
I may be a Nurse
But I'm not a fool,
To be poking around
In his business that way,
I'd rather read a report
Than see that tool, any day.
 
I really don't care
About Johns Hopkins tool,
I learned all about that stuff
Way back in school,
And if he wanted us to know
Don'tcha think he'd send a letter,
Nope, I don't want to see it
'Cuz it don't get any better.
 
You see, I don't understand
How seeing Johns Hopkins tool,
Will make me any smarter
And I'm already cool,
So what could be the point
Of this mandatory class?
It better not be something
About Johns Hopkins ass!

New Poem - Old Problem

 

Bullying, harassment, threatening behaviors definitely do occur in the Tribe of Nursing. There were numerous times over the years where I experienced bullying and/or harassment. Most of those times I blatantly ignored it and went on my way. My method to deal with it was to become better qualified and more valuable, such that I received a more favorable status. 

Now, I can put up with harassment about three times and then, I fight back. The event described in the poem below did result in a conference with my Nurse Manager and Charge-nurse regarding my outburst of aberrant behavior. Fortunately, my nurse adversary was just acting the way she frequently did with other persons. I was the catalyst for her soon-to-be, future departure.

I was better than some
No worse than others
Perhaps the same as a mythical creature,
All the tools that I owned
I brought to the table,
Some complained about a singular feature,
I might propose, a better solution
And offer it up with a question,
Apparently that ruffled 
A couple chicks feathers
Upsetting their delicate digestion.

After absorbing a singular attack
From a colleague at work one night,
I silently decided enough is enough
The next time I will openly fight,
And sure as sure in a couple more weeks 
During night-to-dayshift-report,
Bianca the weirdo demanded details unneeded
I exploded like a gun at the fort.

I slammed the chart on the table
‘Twas like a gunshot in a crowded mall,
All heads turned in our direction
As if waiting for the bodies to fall,
And fall they did, when I demanded 
"Bianca, just take my report",
I felt a silent collective agreement
Bianca’s harassment did abruptly abort.

When DNR is revoked for a few hours

 
Many times I witnessed this sorry state of affairs; the person who is identified as DNR and then, he or she is not allowed to die. Yes, it is true. A DNR designated patient is coerced / urged / guided to undergo some kind of safe surgery and the surgeon declares that the DNR designation is "suspended" during the surgical procedure. This is where doctors think they are gods; where nothing could possibly go wrong that they can't handle. Oops, Mr. Billy coded on the table and the team can't possibly let him die. Well, the primary reason for that has to do with the Physician, the medical practice and the hospital reputation status. It doesn't look good when patients die during surgery. And there you go, Mr. DNR was not allowed to die and quite likely his QOL is now worse than it was preop. In fact, he might suffer fifty times more on the way to his natural death.

Free Resuscitation

When I got too old
To drive my car,
My doctor made me
A DNR,
But when I went in
For my surgery,
They offered resuscitation
Completely free.

That's a heck of a deal
The surgeon said,
If you crump on the table
We'll bring you back from the dead,
Because we don't want people dying
In our operation room,
It's bad for our reputation
It's a flippin', dollar doom.

But worry not, sir
There ain't nobody better,
We operate by the book
Down to the last letter,
And the gist of all this talk
Is about risks and regulations,
You'll come through with flying colors
And standing ovations.

So you did poorly, after surgery
Well, it's clearly not our fault,
We performed what we promised
And you didn't tell us to halt,
When you had the opportunity
Before morbidity and mortality,
Would get the upper hand
And you'd become a fatality.

You should have put your foot down
And stayed a DNR,
Before you let that doctor
Be the driver in your car.

RASS Revisited

 
As the years go by every medical worker must go to hospital orientations or get introduced to new solutions, blah, blah, blah. Man, a huge amount of money is blown on these things and no matter who you work for they will sell it like it's a new pathway to Jesus. 

The one and only………..(no, I’m joking, there are at least fifty of these ridiculous acronym directives that are jammed down our throats). And believe me when I tell you, the primary objective is to audit your performance, while the secondary objective is to guide a metric for billing. 

Here is one of my all-time despised directives:

Richmond Agitation-Sedation Scale.

Never in my career, in any Nurse-to-Nurse report did Betty Lou say to me, Patient Billybob has a RASS of minus two, positive. Instead, I was told that; Billybob is totally whacked out, slugging and spitting at his caregivers between bouts of profound somnolence and manic, murderous mayhem. 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.

2007.......2021

The Family

 

Here it is 2022 and I will admit that end-of-life decision making algorithms and comfort-care medical orders have laid the path to reduced suffering. However, sometimes there is family baggage, dysfunction and outright animosity toward the poor dude that is at death's door. I have witnessed on numerous occasions, family members fighting over what they will "get" when Daddy dies, all the while Daddy is over there in the bed heavily sedated and on life-support devices. 

A dying patient's family, can
Do more harm than good, I assure you, man,
While contesting the contents of his will
They're hovering closer for the kill.

They may be harboring hidden guilt
About the time the milk was spilt,
Then clutch at every thread of life
And claim it's for his loving wife.

When life-support, becomes death denial
He feels like he's been put on trial,
He wonders what his crime must be
The poor fool had a family!

(1992)

A High Stakes Game

 

Dang, I wrote this back in 1991..........and the same game is on.

High Stakes Game

We keep them here for days on end
And try to make their organs mend,
We attack their cells with mighty drugs
To try to kill all sorts of bugs,
That naturally were acquired here
This ain’t no place for the sick, I fear.

Pardon me, I was only rambling
About life and death, it’s just like gambling,
In a high stakes game for those that dare,
Who bet their lives in Critical care.

Flashbacks of Bleeding

 

If you ever stop here to read my writings, you may have noticed that I have been revisiting my past a bit since I divorced the Hospital in 2019. I'm not finished with Nursing, because I still teach about Heart Rhythms.

And I still write new stuff!

Flashbacks of bleeding 
No, never my own,
Billy Bob and Esther
Patient's I have known,
Was it ever my fault?
Yes, a couple of times,
Caught my foot on an Art-line
Was one of the crimes.

ICU is a tangled place of
Wires, tubing's and clutter,
Careful maneuvering advised
But what if your patient is a nutter?
Delirium in progress
Thrashing and flailing,
I was kicked in the head once
And I went sailing.

Nightmares of bleeding 
Have followed me into retirement,
This burden of dreams seems like
Some kind of payback requirement,
But I know better than that
This is called PTSD,
Repetitive traumatic experiences
If you’re a hospital nurse, it will happen to thee.

Figure it out early on
Find a pal to listen to your stories,
No reason to brag
All about you and your glories,
No, just unload all the crap
The pain, the suffering and more,
Maybe twenty years from now
PTSD won’t knock on your door.

Crazy Function

 

I graduated Nursing school in 1983 and immediately began working on Cardiac Care units and within a year I was working in all manner of ICU's. My interest in heart rhythm's began before Nursing school, during my career as a Respiratory Therapist, when I took a semester class for basic EKG in Fall of 1978 (Pierce College in Los Angeles). As a novice RT working in the Cardiac Surgery ICU, I figured I better be able to read a Heart Monitor while I was screwing around with the ventilators. 

Anyway, my fascination with EKG rhythm's goes a long ways back and with my current historical review of writings I am getting reacquainted with quite a number of cardiac poems I forgot about.

Crazy Function   (1992)

I have some crazy function
Down in my AV Junction,
The impulse is forgotten
Because the path is getting rotten,
At last a beat gets through
I’m unsure, what it will do,
Aberrancy or retrograde
If refractory, it just might fade,
Back into covert hiding
Until my AV-Node is more abiding.

A Spirit of Visions

 

An old favorite of mine regarding the Tribe of Nursing.

The camaraderie of nurses
That I mentioned once before,
Is like the glue that binds the book seams
And the hinges on a door.

Like the sands of ancient deserts
And the waves of mighty seas,
The gale force winds of a hurricane
And a forest of time tested trees.

It draws from a source of great power
It plays host to a spirit of visions,
It shoulders the pain of all brotherhood
While bearing the weight of decisions.

There’s a loneliness shared by its members
As the givers and takers of pain,
It rests on the heart with a heaviness
We bleed life, in a bottomless drain.

But the law of abundance sustains us
The cup that we pour is refilled,
After quenching the thirst of so many
There’s enough left for us, that we’ve spilled.

1992

Save Your Skin

 

Just as an auto mechanic would believe that there must be something wrong with any car and that they can fix it, I suspect that surgeons feel the same way; there is always something that needs repairing.

Mr. Customer, can't you see
We think you need a surgery,
You’ve got some parts about to fail
And your skin is looking awful pale,
Well, that's a sign of some disease
Don't ask us how we know it, please.

Our surgeons would like to look within
They'll do anything to save your skin,
And frankly, sir, that's all you've got
In our opinion, the rest is shot,
So sell the house, the bonds, the stocks
And give the cash to all of your doc's,
You'll receive a card of heartfelt thanks
From all of our respective banks.

Disaster Relief

 

There were quite a number of incidents over the years when the Doctor in charge of writing orders was hesitant to do so. The cause could be stress, lack of confidence, lack of knowledge in a certain area, or a combination of all three. When a patient is in dire circumstances and near the threshold of a cardiac or respiratory arrest, if the "boss" is frozen and unable to make a decision, he or she should listen to the experts in the room; 

The Wizards of the Badlands.

Can you tell what's real
Do you know what's not,
Can you determine from 50 yards
If it's sputum or snot?
Does a jacked up CO2
Of one-twenty-five,
Give you any indication
About the odds if he's alive?

Well, maybe for a while
But I wouldn't place any bets,
I think it's time to call your markers
And pay off any debts,
Because arguments at this time
Are pointless and invalidated,
Just get the flippin' ventilator
Before you're excommunicated.

Now don't take this personal
We're all hired hands,
But some of us call the shots
While other's holler from the stands,
With an opinion here and there
About what ought-to-be,
And at this very moment
You should be listening to me,
Because this dude is going south
He needs an endotracheal tube,
Please don't stand there arguing
Like some existential rube,
Quoting laboratory data
And his history of CO2,
We're the Wizards of the Badlands
And we know much more than you.

We don't want to code this sucker
We don't want a Rapid Response,
We don't want to toast his remains
With a sterling-silver sconce,
No, all we want to do
Is the best right thing, right now,
And that my friend is to intubate
Before I have a cow!

My, How Time Flies

 

The Underside of Nursing is now forty years old. 
Here is a poem from 1982 when I was halfway through Nursing school.

Lovely Young Lady

Your hospital stay
Is like a kick from a mule,
You’re stuck on your back
Like you’ve run out of fuel,
It seems just like yesterday
You were running around,
Now you’re in this strange place
Without a friend to be found.

You can’t close your eyes
In the middle of the night,
You know, if you were home
It would be a breeze to sleep tight,
Until finally, you doze off
How peaceful it seems,
When someone is shaking you
They’ve shattered your dreams.

You awaken in anger
Looking around for the kill,
There’s a lovely young lady
And she hands you a pill,
Then gives you some water
She wants to know if you’re dead,
With a glint in your eye
You pull her into the bed.

It’s like a dream come true
She has such a nice tan,
Then she’s back on her feet
Screaming, “You dirty old man”,
Then the room becomes light
And you open your eyes,
It was a dream after all
Oh my, how time flies.

We Are All Inventors

I know most of us come up with ideas and schemes that look like a surefire way to do something better and then somebody else comes up with it and makes a fortune. I invented a new disorder eleven years ago and my internet search reveals it hasn't been discovered yet in 2021. Wow! I nailed it.

Hypertension Deficit Disorder

I have named a new disorder
According to my think,
We were discussing low blood pressure
And it came to me in a blink,
As if a cursor were brightly flashing
Within the deepest recess of my mind,
Several concepts were bouncing around
When all at once it was clearly defined.

Rarely do we ever examine
That hypotensive son of a gun,
There are a lot of good reasons a BP is low
Like the planets revolving the sun,
But more commonly our major statistics
Are driven by those hypertensive fools,
Yes, we know these bloody freaks so well
They're the drivers for all of our tools.

And as a result, the naming
Of this barely known uncommon disease,
Has gone for eons without its own title
It's more like a sniffle than a sneeze,
So let it be known upon this day
October twelve in the year twenty-ten,
Hypertension Deficit Disorder
Has now been transcribed by this pen.

Wielded by this one very author
And posted on this world-wide-web place,
If you wish to hijack this naming
I'll throw my copyright into your face,
You see I need to rake in some royalties
My autumn years will come quickly to hand,
I'm open to grandiose ideas and schemes
It's a part of the future I've planned.

Hypertension Deficit Disorder
Is a well-defined disease to a few,
In the many long years of this nurse
I remember just a couple I knew,
Who were prescribed high-salt in their diet
And proposed to render higher emotions,
Because we know in retrospective analysis
These are evidenced and reliable potions.

I am thinking of publishing my data
Though it's a narrow, small selection research,
I'll set up a booth and a table
On Sunday outside of your church,
When it's one-hundred degrees beneath the shade tree
The parishioners will be dropping like flies,
Hypertension Deficit Disorder
Will be easily proven, no surprise.

10/12/2010

 

Under Attack

 

There have been a number of newspaper articles lately highlighting increasing levels of violence and threats against medical personnel. Folks, this is not a new phenomena; we have been under attack for years, lets call it forever.  As a matter of note, I can recall three injuries I suffered requiring time off for my own recovery.

The following poem reviews a Post-anesthesia recovery I partook in seven years ago.

Fist

You tried to punch me with your fist
To do me harm,
With your Mike Tyson grip
You bruised her arm,
And sure, you "got better"
We can blame the anesthesia,
Conveniently, you won't remember
Claiming you seem to have amnesia.

But I know better
After thirty years of Nursing, 
The drugs tear down the curtains
That hide the violence and cursing,
The evil one inside of you
That you rarely let out,
People who live with you, they know 
It's not something they talk about. 

Your faithful wife stands up for you
Asking me, "Sir, are you having a bad day",
Implying that I am the aggressive one
In the midst of this violent parlay,
Where our whole intent is his safety
In this setting of saving his life,
But we're dealing with his hidden demons
And his ever-supportive wife.

Violence in the workplace
This is it folks, it isn't fun,
Potential career-ending injuries
Are the proverbial loaded gun,
Whether intentional or not
It hardly matters when harm is done,
And defensive family members
Probably helped to load that gun.

9/30/14

Repair Shop

 
I think every nurse will think sometime, that all we are doing is working in a repair shop for humans. 

I just unearthed this poem from 2014 that I had not correctly archived.

Nothing terribly exciting to report
It’s life as usual
Down at the Suck & Snort,
The regulars remain
And entertain themselves,
Some have stayed so long
They belong on the shelves.

Imagine working
At only one job,
Frankly, I can’t
I would feel like a blob,
Of secure confined knowledge
Sheltered in place,
Afraid to step out of
My comfortable base.

We’re a mixed up bunch
From all manner of beginnings,
Some days we are losing
And others we’re winning,
In an unpredictable business
The repair shop for humanity,
Surely, you can understand why;
We’re on the brink of insanity.

The owner is a typical
Miserly cheapskate,
Paying his workers
The lowest damn rate,
Cutting corners on service
Supplies and whatever,
All the while advertising
We are the best and most clever.

Yes, it was a standard good day
And now I’m kicking off my shoe,
The bartender has delivered
It’s time to quaff a good brew.

PTSD - All Over Again

 

While reviewing older year posts, I discovered I could trigger a version of PTSD; in this case, getting angry all over again. It is regarding one of the more common complaints of workers; bad managers.

Leadership Fail

When I reported my injury
The Assistant manager said,
“You should have called for help”
“Well I could have done that, but then he’d be dead,
Mr. Demon couldn't wait
For any handy lift device,
Gasping, cussing and fighting
And we paid the price.

What kind of leadership person
Points a finger, as if to blame,
Not showing concern for the injured
What kind of dysfunctional game?
Causes a person to harp on and on
About why I had 30 minutes of overtime,
Two days ago on the day I was injured....
Her management skills aren't worth a dime.

I love my job
But this Assistant Manager is an ass,
The worst I have ever encountered
Thirty years, since Nursing class,
And this will never be resolved
As long as she remains on the job,
It's laughable, that she believes
She is a worthy leader for our mob.

In hindsight, she said
You could have used the right tools,
Me: I thought the guy was going to code
Then they would have called us fools,
For calling a Transporter to find equipment
While the devil's heartbeat raced over 150,
It's not like the equipment we need is on hand
Oh, to work in such a dream hospital, sure would be nifty.

I think the right tools would include
Captains, who care about their team,
I have a wonderful job
And a sergeant that makes me scream.

Omicron, Omicron

 

This one you all know by now

Omicron, Omicron
That name is a winner,
Everybody is talking about it
At breakfast, lunch and dinner,
We're not blaming it on China
No, Africa instead,
Still, we have already imported it
Along with wine, cheese and bread.

Merry Christmas North America
Let's party like 1969,
Back when we laughed about pandemics
And everything was fine,
And now we have a new guest
He is a party animal for sure,
Omicron is the name
And it's kind of catchy, that's for sure.