Regarding our EMR (again).

When we started this thing 3 years ago, there were several layers of experts, trainers and learners. I took a week of training, and became a "Super-User", because I have a bit of computer aptitude. But the guru's of training were called "Red Shirts". Most of them were cool, professionally sharing their expertise, but there was/is a rare bird, that has the obnoxious, "red-shirt egotism", that persists even to this day, now 3+ year in practice. I bumped into one of those birds today, and quite frankly, after her little bit of "teaching", my feathers were ruffled.

O.C.* Agent Three

A dressing down
By Agent Three,
She said, “I’m a red-shirt
So, do like me,
You must chart exactly
The way that I teach,
Because this is is my ocean
And I own the beach.

OK, there’s your way to teach
But seven ways to record,
All of your obsessive details
That eventually get stored,
Into this medical record
In our digital age,
But I won’t guarantee
That it’s on your favorite page.

You want Stepford nurses
Charting perfectly, O.C.?
Go looking somewhere else
Because that surely isn’t me

*O.C. = Obsessive Compulsive

Fibril_ate;
9/30/11

Back in July I wrote about a friend who had a back surgery, and 48 hours of dismal nursing care. Today, I think I wrote the last poem about the debacle. Check it out.

Condolences

They sent me condolences
Addressed to a different name,
So, was the letter truly for me?
Oh, it's such a guessing game.

After all, I was owed an apology
For some two-month old transgression,
A mismatched name to my address
Doesn't leave a good impression.

But perhaps, it's an appropriate ending
Case closed; such a messy ordeal,
I'll never step foot in that place again
And I'll tell all my friends how I feel.

Fibril_late;
9/29/11

Most of us working at big hospitals are now using some sort of EMR (electronic medical record). I am only familiar with one of them, a product from the company, Cerner.
The complexity, layers upon layers of charting, and often, processes that don't make a whole lot of sense to the end-users, are actually setting the stage for more medical errors. Of course, the buyers of such products, and the sellers of the same, would like the public to think, that every step we take in the digital world, somehow makes their precious lives safer. Not so, and you know it.

Let's take a look at one of the biggest boondoggles, "medication reconciliation".

Reconcile Redundancy

The greater the complexity
The number of steps in an equation,
The more likely a random chance
To make a mistake on any occasion.

It's an engineering problem
Mathematical in a sense,
The more steps it takes to accomplish a thing
A greater opportunity for an offense.

And that is our state of art
In the realm of medication reporting,
The repetitive steps to reconcile
Redundant, reiterative, resorting.

Take a look at our typical patient
Age 62, Diabetic and over-weight,
He has high cholesterol and gout
And he's here, to learn his cardiac fate.

He has three doctors on tap
Primary, secondary and another,
Fourteen medications and 32 pills
All organized by his dear old mother,
Maybe I'm lucky and open the chart
Finding a medication recording,
Although, just how reliable that might be
Nonetheless, it is somewhat rewarding.

Hopefully, the guy is carrying a list
Otherwise, we're totally screwed,
Because I am supposed to record all the details
From this stressed-out, forgetful dude,
When did you take it last, what day, what time
How many milligrams, sir?
Muddled he looks, then he points at his mother
Saying, “I think you better ask her”.

But here comes the crux of the problem
And it really doesn't make any sense,
His home meds will be merged with his hospital drugs
Then we toss them all, over the fence,
Each time he goes to a procedure
Every time he comes back to recover,
We have to perform another reconcile
Like trying to save an old lover.

His fourteen meds, and today's seven drugs
Keep shifting around in the bag,
What are the odds that I'll make a mistake
And select the improper tag,
Pretty damn likely, I'm telling you
When a system is built, in this way,
How many times will I reconcile
Three times, and that's just today.

With all of the hype about Patient Safety Goals
We're battered and bludgeoned with these themes,
If a problem is “solved” with a complex solution
I tell you these are only pipe-dreams,
More problems created, more mistakes out there waiting
Software written and then sold, as the best,
But the engineers writing this nonsense
Are not the ones putting it to test.

So if they come after me, because I made a mistake
I'll point an accusing finger at Cerner,
And ultimately, the exemption that I will claim
Excuse me, I'm just a slow learner.

Fibril_late;
9/28/11

We have all seen the “Companion” animals in the hospital; usually a cat or a dog. And it is becoming ever more common, to see people carrying or walking dogs, in almost any store in town. I suspect that business owners are afraid to speak up against it, because the next thing they know, the SPCA or PETA will be protesting outside their store, trumping animal rights. Fine! If it's all right for your cat or dog, it better be hotsy-totsy for my hamster.

Three Bites

Too many frickin' dogs
Wherever I go,
I've seen them at the pharmacy
And the motion-picture show,
Teacup-poodles at Costco
Handbag-bassets at Taco-Bell,
To, us cat aficionado’s
It feels like canine hell.

I plan to protest
I propose to fight back,
We cat and rat-lovers
Have to take up the slack,
And each and every one of us
Who prefer rabbits and hares,
Need to get out in public
And show that somebody cares.

If I'm ever in the hospital
I'll send my wife
To “Rent-a-Rabbit”,
Because too many dogs
Have become society's bad habit,
I'll need my helper-hare
And I want my comfort-cat,
And he wants his ever playful
Laboratory rat.

I want equality
For the animals that visit,
No more chance for discrimination
When people say, “what is it?”,
A biped, a quadruped
A uniped, who cares?
Because there once was a time
When even dogs, would bring stares,
So the future is bright
And those dogs will take a lickin',
Because after my rabbit
I'm bringing a chicken.

Canine-companion
Ain't got nothing on me,
Just wait till they see
My helper-wasp and my bee,
The Cockatoo speaks Spanish
And my Coyotes that howl,
Whenever the nurse
Brings some soap and a towel.

Some say I'm like Doolittle
But in fact, I do a lot,
Equality of animals
Is hotter than snot,
And according to the Baboons
From Animal rights,
They fully support my stance
And give it, “Three Bites”.

Fibril_late;
9/26/11

People are patients and just like all the rest of us. Sure, going to the hospital is stressful, and maybe you really are totally fubar..........but why treat your doctors, nurses and everyone who want to help you, like crap.........why cuss and swear at us? Because you are evil. It's that simple. Inside hiding, is your nasty little self.

Foul Air

I see the wholeness of people
In their most vulnerable position,
No matter how they arrived
They have a medical condition,
They are stressed, they're in pain
And sometimes angry, to boot,
Some of them will abuse their caregivers
Like hunting animals to shoot.

And the real nature of who they are
Will be revealed without blindness,
Most rise above their afflictions
With beauty and kindness,
But if they are petty and nasty inside
And lived life with a bad attitude,
No amount of pain-killer
Can make you feel better, dude.

Why take it out on us
Those persons assigned to give you care,
Why disturb the atmosphere
With your cussing, cursing air,
Why address me with foul language
Essentially I'm there, at your behest;
Your evil Karma
Is just my daily test.

The sordid nature of your soul
Beneath your beat-up bod,
The true nature of your personality
Like dirty, worn out sod,
Striking out at your caregivers
And calling them foul names,
If this is your idea of control
It is the stupidest of games.

Perhaps you always felt inferior
And now you're the superior witch,
Perhaps you always felt downtrodden
And now, you're just an angry bitch,
Perhaps you might think my language
To be foul and uncouth,
Yet, you use those same names
Toward your caregivers
Those fresh young angels of youth.

No one wants to see you
And no one wants to talk,
No one wants to hear
Your foul, angry squawk,
No one wants to care for you
But we do, because that's our job,
And really all I can say is
I feel sorry for your husband Bob.

Fibril_late;
9/22/11

Ok, so maybe I need to proceed cautiously, now that I'm in new territory; at least until they understand that I am super-nurse..............

Good Advice

Sometimes the trouble
With so much experience and knowledge,
When one feels like a post-graduate
From the autonomy college,
Perhaps I was acting too loose
When the blood pressure was dropping,
“You should have called me”, said Doctor
After all, I wasn't out shopping.

I'll take that good advice
And be more careful next time,
To avoid future antagonism
And perform a little more sublime.

But ultimately
No harm was done,
The patient went home
Feeling, the happy one,
She thought that her care
Was exemplary and super,
Looking as fit as a fiddle
For a low-ejection-fraction trooper.

One might ask, were my actions
Too happenstance and loose,
Was some evil done
Or some kind of abuse?
No, none of those things
In fact, all ended well,
But I'll call the doctor in the future
So I won't catch hell.

Fibril_late;
9/16/11

Last Night

Here's what happened on the last night of work, over at the previous job.

My patient had undergone a VAT (video assisted thoracotomy), and had previously been using Oxycontin frequently at home. Post-op she had a Q-pump with a local anesthetic infusing into the rib area, she was on a basal-rate Dilaudid PCA, and popping an Oxycontin every four hours.

Apparently she was on Klonopin for an anxiety disorder; and quite obviously, this woman was on a lot of drugs at home. So I'm thinking, that when I told her she was getting her Klonopin, but really it was a Pepcid, the placebo effect was fully operational. She went right to sleep; later telling her daughter that the Klonopin really helped. Go figure!

Last Night

My last night at work
Was kind of funny,
But I'll wait a year
Before I tell you, sonny,
About the little mistake
I made with one med,
It caused no harm
And no one is dead.

In fact, I might have actually
Saved a life,
Someone's mother
Someone's wife,
When I administered Pepcid
And not Klonopin,
Was anyone hurt
By this omission, this sin?

In retrospect,
I think it was better
II didn't follow the med-profile
Exactly to the letter,
What with frequent Oxycontin
And the Q-pump for pain,
That Klonopin might have
Gone straight to her brain.

Respiratory depression
When that breathing stops,
The rhythms get whacky
And everybody hops,
To the tune of the wild rabbit
Can you think of a better name?
If she ends up on the ventilator
Tongues will wag and fingers blame.

So a Klonopin omitted
I have no sense of guilt,
She got a Pepcid swap instead
And her comfy, hand-made quilt.

8/26/11

When I interviewed, I said that I had probably seen or experienced, every possible Heart-cath disaster/dilemma that one could imagine. Although some of those events were truly scary, they were all learning experiences. I've just returned from my 7th day of new job, and here was the dreaded retro-peritoneal bleed crisis. Sure that happens now and then, but 'tis all the more dreadful when the patient is completely disoriented, suffering from severe dementia and fighting like a trapped wild animal.

Just another terrifying, true story.

Shouldn't Be Done

It wasn't criminal or negligent
But it shouldn't have been done,
Although diagnostically wonderful
Heart-caths aren't for everyone.

Fairly youngish, only sixty
But fate had struck her, many blows,
A brain tumor and severe dementia
There is nothing that she knows.

Pre-cath she wandered frequently
Amidst our busy staging scene,
Frequent searches, where did she go?
She was the rambling queen.

After her cath and clean coronaries
It was our job to pull sheaths fast,
With the application of heavy pressure
On her groin, like a bomb-blast,
She started screaming and writhing
Fighting, kicking and trying to sit,
I'm telling you, it wasn't pretty
And all hell broke loose, I admit.

Two nurses pinning her down
One giving drugs to relax,
Blood pressure dropping to sixty
Pale and diaphoretic, those are the facts,
I saw the hallmarks of bleeding
Internally, that was my thinking,
Because I've taken this boat down the river
And I know the signs when they're sinking.

IV fluids wide open for volume
A little drug to quiet this poor lady,
Tachycardia was soon our companion
Her skin was so pale and too shady,
A Rapid Response was called overhead
What the heck, have some friends drop in too,
Get a couple of other, hot opinions
We better do something, before she's blue.

An emergency call to the Cath-Lab
Where her doctor is working on some other guy,
Ya, sure, take her down for a CAT-scan
That sounds like a good thing to try,
With the nurses running out the door
Racing that gurney down the hall,
Sure enough, she was sure bleeding
She won the ICU bed after all.

It wasn't criminal or negligent
But it shouldn't have been done,
Heart-caths are clearly, quite dangerous
Not frivolous exercises for fun.

Fibril_late;
9/9/11

There's nothing wrong with busy...........it keeps nurses off their phones, off Facebook, and makes the time fly. But sometimes if you look in on it, chaos will be your impression. The new job is a bit of all that

The Wild Magician

It's a dance, it's the rhumba
It's some crazy samba, my friend,
In the middle of the day
It's seems like there is no end,
At five in the morning
You might think you know these folks,
But they're just passing through
With all of their nervous jokes.

Let's take a moment to examine
To summarize the outpatient condition,
They are told to arrive two hours early
So we can prepare their admission,
Hopefully, they arrive promptly
To give us time to do their prep,
In theory, we're a well oiled machine
With everything going step-by-step.

Unfortunately, in real time
We dance to the tune of the wild magician,
From the doorway, it looks more like chaos
Combustible and approaching ignition,
Patients are waiting beyond the time
There were informed regarding appointment,
Because of an emergency with Billy Bob Borko
Extreme Unction, consecration and anointment.

But eventually this day shall pass
The most that need be done is achieved,
And as long as they continue to pay us
No one shall be aggrieved.

Fibril_late;
9/4/11

Why My Care is Better

Many people know this, but here is a reminder of how ridiculous health-care has become.

"Tying Medicare and Medicaid reimbursements to patient satisfaction was a component of the Patient Protection and Affordable Care Act, and will go into effect in October 2012."

That leaves us nurses with but one choice; time to start bribing our patients and families.

Better

I bribed my patient
To write a thank-you letter,
To describe my patient-care as great
Like yours, but mine is better.

But why, all the fuss
About these letters of thanks?,
Because these notes are like money
Into the hospital banks.

Don't call me cynical
When I know this is true,
Uncle Sam will pay us more
If patient-satisfaction grew,
Greater than our last tally
In the previous fiscal quarter,
Because these satisfaction quotients
Are the brick and the mortar,
Of the second-tier reimbursements
When private-insurance halts,
My patient's love me, baby
Because I bring them chocolate malts.

I pose to them a question
“If you could have anything tonight,
What is your desire
Just name it, in lights”
Because I have the power
To the kingdom, (and the keys),
To make your night easier
And surely, everyone agrees,
That a happy, satisfied patient
Writes the best, post-hospital letter,
And although, your care is good
That's why mine is better.

Fibril_late;
8/26/11

What the Hell?

This is a long one, but is my last opportunity to comment on a local memo, before I head down the road.

Nursing - What the Hell

I’m thinking of instituting a new Blog / Forum titled:
“Nursing – What The Hell?”

Don’t get me wrong, we nurses keep the world turning, but golly-gee, our leaders have the craziest ideas.

For example, the hot topic on the Staff-bathroom wall is the memo that includes the following paragraphs, outlining the latest “What the hell” idea; read along, and see if you agree. I have made special comments, as denoted by the asterisks.

Quote: “As we continue to provide the best care for our patients, we must improve our documentation accordingly. (In regard of Patient Turning Protocol)  H, D and L reviewed what was taught to the nursing staff regarding documentation of patient turns. We feel that documenting every shift that the patient was turned every two hours is inadequate. We would like for all of you to begin documenting the individual turns that are being made. For instance, if at 8am, you turn the patient to the right, you will need to document in the I-view, that the patient was turned to the right and so on…..

”We appreciate the care that you give our patients every day.(*1) We want to be able to acknowledge that care, by having you document it in the medical record.(**2) The nursing department managers will be auditing your charting and coaching you as needed.(***3) The data gathered in these audits will be reported back to you, as well as being presented to the hospital leadership team.(****4) It is our desire to see the documentation of patient turns to reach the 100% goal."(*****5) Closed-Quote.

This Author responds:

1* This is the sweet, feel-good stroke, before we’re slammed with the message

2** How exactly do they “acknowledge” our care, when we are documenting something? That doesn’t make a lick of sense.

3*** Now we’re going to be audited (to make sure we behave) and coach us if necessary. Oh boy, I love coaching! Perhaps it will be like my High School PE teacher screaming four-letter words during football practice. “Turn the G-D patient, you f**khead, or else I'm going to give you a jalapeno enema!”

4**** Oh boy #2, audit us and then tell the hospital leadership team; maybe they can coach us also.

5***** Look, if you want 100% compliance, we can all continue to lie about it in our charting (as usual).

6****** H, D & L = Huey, Duey and Luey.

It makes me laugh, how our whole frickin' management society in this country, want “100%” compliance. Nothing in nature will ever achieve 100% compliance. How about that cardiogenic-shock patient that will die if we turn him; the morbidly obese patient that fills the bed, and can not be turned; the need for three or four nurses to be available to turn a patient, when there are no nursing assistants; the patient that wiggles out of position within five minutes of just turning them; and so on. This directive is ludicrous.

There is a severe nursing shortage in America (if one believes the media) and for some reason management doesn't get a clue: we, your valuable, and supposedly appreciated assets, do not feel happy when we are threatened with “audits and coaching, to achieve compliance”.

It all comes down to one thing, you know you are truly valued and appreciated, when the Capo di tutti capi are threatening you. Booyah!

Fibril_late;
8/22/11
* * * * * * * *

When I posted my pseudo-flier on the wall in the Staff-bathroom (see flier below), some persons actually thought it was true, until they noticed the silly poem at the bottom. Ain't that something? We are so inured (hardened, accustomed) by these types of directives, as to be accepting anything (no matter how ludicrous) that comes our way. That must be the sign of a "true" professional.

Breaking News! Breaking News!

From the

Breaking News Department
Beginning September 1st:

Q2 Turns will require a Witness

And,

Coming soon!!!

XOXO Hospital, is opening a new RN position

Finally, at last;

Witness Nurse

Now, let’s all sing together:

Turn them to the left
Turn them to the right,
Turn ’em supine,
And say, nighty-night.

Turn them around
Forward and back,
Get a witness while you’re at it
It’s the Q2-turn attack,

(Repeat)

Turn to the left
Turn to the right,
Stand up, sit down
Fight, fight, fight,
Turn them on their side
Thirty degrees, on the angle,
Have a witness to prove it
It’s the latest fandangle.

Fibril_late;
8/22/11

_________________        __________________

I'm sorry to say but the Management did finally demand that we have a 2nd nurse as witness, to the actual turning of the patient. PATHETIC.

Hunt and Hess

Attached to our computer monitors where we chart, are a variety of laminated "prompts" to help us know stuff. I spotted this one last night, because we're a Neuro Unit now. One more reason I'm glad I'm moving on. But, the name of the thing caught my eye, because it had a nice rhythm to it. "Hunt and Hess Assessment Tool".

Hunt and Hess

If you really
Want to impress,
Use the scale
From Hunt and Hess,
For non-traumatic
Sub-arachnoid bleed,
Know your hemispheres
And who they feed.

Fibril_late;
8/22/11

The term, "evidence-based" always bugs me. It is supposed to be so cutting-edge. But that's this year; what about 5 years from now, when we debunk the whole thing? When there is new evidence, that we were just running around in circles (as usual)? I guess after we implement, nobody will give a rat's ass anyways. Well, out in the hayfield, there is always room for just one more.................

Sacred Cow

I could have written more
And maybe I will,
Could you get me some water
To swallow that pill?

You see, I'm feeling kind of dry
Parched mind, and not enough to think,
Just get me a glass of water
And give me some time to drink.

There is a lot to be said
And in time, I will say it,
I'll write the usual words
Like a dragon, I will slay it.

Retrospective analysis
Why, that's our bread and butter,
You know, I get all excited
Evidence-based, set's my heart a'flutter,
Then we can all run around
Thumping our chests, stomping our feet,
When we proclaim, we're “evidenced-based”
Why, good golly, that's so neat.

But don't inquire too much
About what we did before,
Why in the hell we did things, that way
How come, we chose the crooked door,
And then again, ten years in the future
When again, we look back to now,
What we think is evidence-based
Will be just another sacred cow.

By golly, I did write more
As if I was appointed, yay, it was my duty,
Now, if you love that evidenced-based stuff
Come on down, and shake your booty.

Fibril_late;
8/16/11

Goodbye; I'm leaving Timbuktu.

Timbuktu

Goodbye to all
Farewell, to thee,
I’m heading off
To Mercy-G,
It’s been a helluva
Wild ride,
But I’m crossing over
To the other side.

‘Tis like a family
Here at McAuley,
Just hanging out
With Mabel and Wally,
Their cousins and nephews
And grandchildren too,
Like a relative revival
In Timbuktu.

You know I won’t miss
All the crap that we do,
I’ll only miss
Mabel, Wally and you.

Fibril_late;
8/12/11

Feel The Ouch

I haven't written much about Diabetes
The old, the young, the grumpy, the sweeties,
A collection of persons
Everyday, on my path,
They have one thing in common............
At night, they get a bath.

Blood sugar samples
Every six hours
Or more often,
If the crisis is acute
Fingertips scar
They don't soften,
And if blood pressure is low
Maybe a repeat poke
A couple of times,
Even I, feel the ouch
In the midst of my rhymes.

Fibril_late;
8/5/11

It's official: I applied for a different hospital position, interviewed, was offered the job on the spot (seniority/experience) and accepted. I'll be moving across town to another subsidiary of this same system, and I'll be able to walk the one-mile to work. But what will I miss from my old job, when I switch over?

Won’t Miss

Nightly bath’s
And cranial drains,
Insulin drips
And hemorrhaged brains,
Delirium tremens
And the overdosed,
The suicides
That meet the holy ghost.

Respiratory failure
And the bundled VAP,
GI Bleeds
With smelly crap,
Gaping wounds
That just won’t heal
Because none of this
Has sex appeal.

Oral-care, and
Q-2 rules,
Turn and baste
And lifting tools,
High-tech equipment
Not ergonomic,
Break-room size?
Sub-atomic.

HAPU-this and
John Hopkins, that,
Acronym’s for everything
Like, who fell flat,
When the family demanded
Elmer, should ambulate,
After 3 months in bed
It’s too damn late.

Patient satisfaction
Driven,
Screw that up
You’re not forgiven,
Then top-end bosses
Will stomp and snort,
About that juicy
Government support.

Thoracot
Colectomies,
Post-op surgicals
Delivered free,
Into this
Convoluted place,
We cover all specialties
Of the human race.

The flier was on the wall
But I had to squint,
The matches were missing
And I had to use flint,
But when I lit up that paper
And followed the ink,
I found a position
That caused me to think,
And ponder the option
A most excellent adventure,
Could I apply in time?
That was the clencher.

I’m moving on
And heading back,
To Billybob
With his heart-attack,
The heart-failure group
And the E-P ablations,
Pacemaker placements
And aberrations,
Bypass and valvular
Heart repairs,
I’ll advise them on diet
And climbing stairs,
Take all of your Plavix
Your Aspirin and Statin,
And if you want to live
You better unfatten.

Can this old dog
Learn a few new tricks?,
I'm betting yes
In a couple of clicks,
And the walk to work
Is one heck of a bonus,
And surely, I won't miss
That pseudomas!

Fibril_late;
7/30/11

Back on April 19, I wrote about how our ICU was to be designated as the "go-to" Acute Neuro Unit. I know these things are decided up in lofty offices, and the community at large will benefit, but this addition of yet one more service under our belt, has caused a lot of anxiety and discontent amongst the nursing staff. There have been a number of classes and on-line educations available, and the "official" starting date, was August 1st. I've gone to those classes, and here is my take-away:

Neuro Class

Locked-in State
That's how I feel,
Becoming a Neuro-nurse
Makes me want to squeal;

My reticular activation
Is clearly in doubt,
Psychogenic unresponsiveness
Is my way out.

Nuchal rigidity
That's Viagra of the neck,
Who took the fun out of fundoscopy
Oh my, I'm a nervous wreck,
Then, there is “gaze preference”
Like when I'm lunching at O'Grady's,
My eyes are roaming the room
Looking at all of the ladies,
While Uncle Herniation, snickers in the corner
I'm checking his accomodation,
He has pathological reflexes
And a sociopathic fixation.

They're giving Imhotep
A dose of Nimotop,
Buried alive and resurrected two times
His headache, just won't stop,
It's a neurological emergency
Mummification, just didn't suit him,
Probably the only recourse we have
Is to take him out back, and just shoot him.

GPS vs. GCS
What the two of those are
I don't know, I'm under duress,
Global position system, and
Glascow coma scale,
Search and seizure, I'd rather avoid
The thrill of it is beginning to pale

So, Monster Jobs
Is calling to me,
My motor activity
Will set me free,
Jump in my car
Put my foot to the floor,
Take a look at my “run sheet”
As I'm racing out the door.

Fibril_late;
8/3/11

My best of all friends had a “global” spinal fusion a couple of days ago. The surgery was perfect and the care sucked. It's true, and if you could know all of the transgressions, you too, would be shocked.

My friend is a highly experienced critical-care nurse, like myself. Nine out of ten of her visitors were from the same crowd. Did that make a difference? Not really, but we were there as her witnesses, journal-persons, and safety-net. She went home a day earlier than expected. Why? Because every hour longer that she stayed in that hospital, was one more hour that somebody could screw up.

To an outsider, that may seem harsh. But, in truth, it was reality. I know, because I was there to witness the debacle. I'm sorry to say, that I work for the same employer, across town at a different facility.

There was an old saying, like a kind of prayer, that went like this: “Lord, have mercy on us/me”. Unfortunately, my best friend was a recipient of that mercy-style care. Ouch!

Un-Care

Diagnosed you were, indeed
With a surgery, to boot,
Unintentionally, under-medicated
You were primed, and ready to shoot,
Just name the perpetrators
The participants in this crime,
More focused on a policy
Than patient-advocate time.

Just forty-eight hours duration
Is more than enough, when care is lacking,
When you want to run home, screaming
And send those care-givers packing,
To be ignored, and accused, and betrayed
By fellow nurses, who treat you like dirt,
Unwilling to accept that their errors
Are at least half of your feelings of hurt.

Who is to blame, and what is the problem
I'm embarrassed, because this is my employer,
Where mercy should be doled out to everyone
But now we're looking for one good lawyer,
To right the wrongs that were experienced
To prevent future scenario's like this,
So that persons who follow beyond us
Might be protected from this careless abyss.

Fibril_late:
7/22/11
_ _ _ _ _ _ _ _ _

A Guiding Principle

A common surgery
With the best doctor,
Turned out to be a gamble
In the absence of a proctor,
A guiding principle
Of good care and compassion,
Instead, you were abused
In the worst fashion.

The surgical intent?
To alleviate pain,
In the post-op period
It was a ball and chain,
Dragging you under
While caregivers watched,
Their morals and ethics
Completely debauched.

How can that be
In this day and age,
We have been counseled
That pain, is front-page,
And nurses stand by
As guardian's at your side,
Instead, you were assigned to
Beelzebub's* bride.

How could they, not act
To alleviate your pain,
Stand up for your needs
Isn't this their domain?
To act as an advocate
For those persons in their care,
Instead, you were trapped
Within the dragon's lair.

We sat there and witnessed
And I have written, what I know,
Guiding principles were lacking
Nursing was absent at your show.

Fibril_late;
7/24/11

Beelzebub* = Satan
__ __ __ __ __ __ __ __ __ __

A Transgression – No Compassion

A transgression, a crime
Perpetrated upon you,
Oh, where was your error
Just what did you do,
You chose to have surgery
In a well known place of healing,
But the care you received
Was absent of feeling.

Is that a crime in the courts?
Probably not, but I suggest,
That nurses, who choose this profession
Should be offered a test,
Where they imagine their child in bed
Suffering life-threatening pain,
Will they stand around and argue policy
Or get on the phone with Dr. Humane?

We test Nurses on experience
And we test them for knowledge,
We check their credentials
And we applaud them for college,
We welcome them readily
When they come from afar,
But we don't test them for compassion
And that would reveal who they are.

This “calling” of Nursing
Is legitimate and true,
We're seeking a few good souls
Who'll take the best care of you,
And hopefully, we'll be watching
For the weeds, yes, pluck them out,
Because Caring is an advocacy*
That's what Nursing is all about.

Fibril_late:
7/26/11

*Advocate: Noun: person who pleads for a cause or propounds an idea
Verb: speak, plead, or argue in favor of

On The Bottom

Over many years, I've seen a metamorphosis and evolution of skin dressings, protective barriers, wound packing’s, etc. These are used to either promote healing, protect skin, and now days, prevent the formation of bedsores. Sure, those breakdowns have some fancy name like HAPU, but it's the same old story, as usual. Ya gotta see the humor; one of our computer charting Plan of Care selections reads, “At Risk For Skin Integrity”. I'm not kidding. How about that for a typo? Whoa there, I better be careful, my patient might develop integrity of his skin; I better leave him on the bedpan for a few hours.

The latest new product we are using is a dressing for the sacrum, to be used on all patients who are on a ventilator, and any one else who might get a HAPU. Last night one of the patients had his Mepilex dressing changed four times, because he had a CRAPU! By golly, we really got to the bottom of that problem, right away.

On The Bottom

Mepilex, oh Mepilex
Advertised as
“Butt Protects”,
Use it on
Your infant too,
A cover-up
For baby poo.

Mepilex, oh Mepilex
For the kitchen floor
And redwood decks,
Water proof
And rot resistant,
Placed properly
With one assistant.

Mepilex, oh Mepilex
We employ it often
Like a hex,
To ward off bedsores
On the bottom,
We don't care
If you already got'em.

Mepilex, oh Mepilex
For on-line dating
And couples connects,
Way better
Than those churchy meetings,
Though I don't know
About Twitter tweetings.

Mepilex, oh Mepilex
There are special versions
For rated, “X”,
Check our website
Adults section,
Then left-click right
For that selection.

Mepilex, oh Mepilex
The best protection
For having sex,
Self adhesive
And hydrophylic,
Try it out
'Tis life idyllic.

Fibril_late;
7/12/11

Sure, we always do a Skin Assessment when we admit someone, (and of course 2 nurses sign on it), but now, Sister Euphemia wants us to do a Sin Assessment!?! Can you believe it?

Sin Assessment

Down at Sister Euphemia's place
Everyone working has a happy face;

You might think it's natural
But the water is tainted,
One day I drank so much
I almost fainted,
Swooned, I did
With ever-expanding joy,
I gotta be thankful
Because they do employ,
All sorts of us heathens
That follow a different path,
Sister Euphemia states;
Just give a good bath.

When a new patient arrives
We assess them head to toe,
Using all of our five senses
And technology for the show,
Charting hundreds of check-marks
On many drop-down lists,
If something is wrong
We have to see if it exists.

Now, since this is a Holy
Hospital place,
We evaluate the sins
Of the human race,
And then we'll formulate a care-plan
To wipe clean your dirty deeds,
Medicare demands it
Stating, “address all of their needs”.

Who can argue with that?
And Sister is paying,
We always do what she says
If we want to be staying,
At this heavenly job
Hell, it's Paradise, after all,
If you need to be employed
Why, just give us a call.

Fibril_late;
6/9/11