The Toughest Break

My hot job is apparently being phased out. In some respects, it did look too good to be true, but I did the best that I could while I was there. I think some thought mavens have deduced, that there are some limitations to my position (I'm not supposed to take a patient assignment; just do breaks). Anyway, once I heard about it, I had to jump on the bandwagon and find something else. The tough part, is leaving the crew I have been working with, for the past 14 months. I enjoyed being a part of the team (and can only hope they will muse about the "good old days" when they had a dedicated Break-Relief Nurse).

Here is my farewell:

I enjoyed every minute
Except, just one,
It was back at the beginning
But all the rest was fun,
And do understand
I'm not leaving for that reason,
Nor was it excommunication
Or treacherous treason.

Whether rumor or fact
The position is phasing out,
I couldn't wait
Till I heard the last shout,
Nor could I accept
A return to the bedside,
In ICU; just one step
From the dead-side.

Don't take it personal
It's not about you,
But rather, the clients
The drug-addled few,
The revolving door return
Of non-fixable folks,
I think I might go postal
Attending to those blokes.

My injury risk
As a bedside punching bag,
Dead in the sights
Of some murderous nag,
Who is on the steep downslope
Of Delirium Tremens,
Like gargling with razor blades
With a chaser of lemons.

Proning and flipping
On a whim for mankind,
CRRT and ECMO
You must be outta your mind,
Level-1 transfusions
And fourteen vasopressors,
On a DNR Grandma
'Twould be better just to bless her.

Sure, it's not all that
No, sometimes it's more,
ICU nursing these days
Is a death defying chore,
In for a penny
And ten diseases for a pound,
A lot of dubious solutions
And endless problems all around.

What I will miss?
All of that stuff,
Imagining 12 hours of it
I'm not tough enough,
To maintain my poise
And my youthful good looks,
Thus, I return to the Mother ship
To drink coffee and read books.

The saving grace?
One's comrades at arms,
You are a powerful group
Defying numerous harms,
With synergy and camaraderie
Good fellowship and fun,
Working together
Like a well oiled gun.

And so on, henceforth and furthermore
Gotta go, slipping out the back door,
Fourteen months, didn’t seem like a chore
And God forbid, hope I didn’t catch a spore!

Dutch Jones Disease

Poor old Mr. Jones, always coming down, or happening to, some kind of horrid ailment. I caught up with him back in the gay old nineties. Let me tell you about it:

Mr. Jones, I gotta tell you

You have a strange disease,

You’re the first man to succumb 

To a virus that kills trees,

Your symptoms are unusual

But our data is pretty thin,

As a tree would shed its bark

We note your flaking skin.

Your gait is quite unsteady

As you stumble in your boots,

There’s a striking similarity

To a tree with rotting roots,

And like autumn leaves that change

Drifting through the air,

We notice the alarming rate

You’re losing all your hair.

Though the cause is not determined

There is but one straw that we clutch,

You share a common ancestry

The tree and you are Dutch.

Come Pliants

Apparently our metrics regarding Customer Satisfaction were abysmal again. So naturally, blame the Nurses. Everywhere in the good old USA, Nurses have to put up with this corporate BS. Essentially, management would love it if we girls would just remain easy and compliant, and always do what daddy says. I say, fuggedaboutit !!!

Come Pliants

I missed an appointment
Two times already,
The Nursing Bungle
That's the name of it, Freddy,
I guess the powers that be
Think we all need retraining,
If our profits keep dropping
They'll start again, with the caning.

Flogging us daily
A customer service reminder,
Do your hourly rounding
And always be kinder,
Remember the 4-P's
No Pass Zone and AIDET,
If I was sure there were refreshments
I probably would have made it.

I've been told I'll be paid
For this mandatory class,
But that doesn't mean
It's not a pain in the ass,
I just think we'd do better
Without our billion dollar advertising,
Invest in the employees?
The results might be surprising.

Instead, they hammer away at us
Regarding the metrics they measure,
Reports of satisfaction
Give executives pleasure,
They throw a big box of money
Focusing attention on our image,
While kicking around the employees
Like a sandlot scrimmage.

Well, I'm not so compliant
Though I am persistent,
I balk at coercion
With intent to be resistant,
When workers are badgered
Threatened and harassed,
Perhaps, that's why I forget
Until the appointment has passed.

I don't want to participate
In this customary nonsense,
Nurses are not to blame
For the usual offense,
Better to focus attention
On the business design,
Management, listen to our voices
Collectively, we decline!

Just Another Fad

Here is a FAD you ought not to bother with.

FAD

Familial Aortic Dissection
If you don't know you have it
You have no protection,
Just when it will strike
No one really knows,
So you better be careful
What you put up your nose.

Familial ascending
Aortic dissection,
A genetic mishap
Of cosmic selection,
You better have a good surgeon
One who knows what he's doing,
It's a little more complicated
Than light bulb screwing.

After the tissues, monetary issues

Pass the Gate

It was a quick death
When he lost his breath,
A short goodbye
Because he had to die,
He hitched a ride
To the other side,
And waved his palm frond
To the great beyond,
And took a key lime pie
To that place in the sky.

St. Peter said,
Did you bring the bread?
You mean Heaven, ain't free
You gotta be kidding me,
He said, just because you died
You don't get a free ride,
If you want to pass through my gate
You better fill the collection plate.

Terminology Murder

I do break-relief in two ICU's. I read the charts of all those patients that I interact with, because I need to know what I'm dealing with for that one hour. This knowledge also allows me to contribute pertinent assessments, to assist the staff member I'm working with.

Bottom line; I read a lot of charts. I have decided to place some attention to the use of home-made Medical Terminology, those abbreviations that are not included on the standardized lists. Essentially, these are unique notations, understood by only that person who is doing the documentation. No nurse wants to end up in a court, arguing about what they were charting on that dark and stormy night; especially, when they were using unauthorized charting terminology.

Medical terminology?
We must agree,
To use the same terms
One, two, three,
To share information
Promotes understanding,
Or we’ll see you in court
And be more demanding.

GUOP, what is it?
Is it something you ate?
Might be GUacamole
On an Outdoor Plate,
And why chart it twice
How much urine amounted,
When it was entered on I & O
The running tally accounted?

Prop for sedation
Now what does that mean?,
A couple large pillows
In a stage-play scene?
When you charted it already
In the IV Drip roster,
In terms of documentation
You are an imposter.

S/W, makes me wonder
Did you mean Smith & Wesson?
What kind of a shot?
Please don’t keep us guessin’,
Because the family wants to know
How Billy-Bob died,
MDR completed, coninue poc
That’s what they cried.

Bld clt
Might have been talking
About me,
I belong to the bald cult
Check Facebook
You will see,
Might have meant
Blood culture
But it’s not our terminology,
Once again, your charting
Approaches pathology.

*  *  *  *  *  *  *  *  *  *  *

GUOP…………..good urine output
Prop…………….Propofol
S/W..................... spoke with
MDR completed, coninue poc…………(What did this convey?)
bld clt...................blood culture

One Ideal Leads to Another

Nice and proper, litigation averse charting; that's what we are taught.

Pretty Nice Terms

All of us are coached
In Nursing school class,
To say anal discomfort
Not a pain in the ass,
We say, you are combative
Not a son of a bitch,
Your wife is unruly
Not a low class witch.

Yes, we pamper our language
In pretty nice terms,
You are infected with Ascaris
Better known as worms,
You ate uncooked pork
With your fermented grain,
Acquiring Cysticercosis
Larvae in the brain.

We leave it to you
To tell your wonderful story,
Hello, Social Media
For your fame and glory,
You don’t need good looks
Just take a picture of your worm,
You’ll get millions of likes
And make everyone squirm.

Valve Job

Another moral tale: The Valves of Meth.

He was twenty nine
When he ruined his valve
And had it fixed in our garage,
Now eighteen months later
He did it again
With another
Drug fueled barrage.

He came back to the same old Surgeon
Who offered a second dance,
Declaring, you stupid young punk
After this, you get no third chance,
He is polite and innocent looking
Appearing younger than stated age,
But the drugs
Have ravaged his organs,
He is now at the 99th page.

Clearly, his Mom
Wants the best for her punk,
She thinks he is retrievable
Although he's strung out on junk,
She drove him from one hospital
And brought him to us,
We're the best Cardiac
Says the sign on the bus.

A sad, sorry story
Of a Methamphetamine user,
A slow kind of suicide
For the drug abuser,
Ingesting powerful stuff
Unknown ingredients, the issue,
Whatever strange concoction        
Wrecks your organs and tissue.

What is the likelihood
That he will get clean?
Stop snorting dirt
If you know what I mean,
The odds are not favorable
But we'll repair him just the same,
We taxpayers got it covered
Because billing is the game.

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.

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.

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.

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.

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.
.

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.

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.

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.

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.

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

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.