King Cobra

We've been working hard and fast lately at work. Night after night, putting in 12 - 14 hours. It's a super overloaded program for those with Heart Disease. Apparently, we are not winning that "war" yet. And it surely won't happen, until people take charge of their health habits. Heck, I'm not complaining, it's job security............if I can survive the stress, that is.

Yesterday I had a 49 year old (that's young these days, remember?) nasty patient, father of two wonderful and intelligent daughters (13 & 17). He had a minor stroke last year, a single coronary stent 6 years ago, and he can still work. Of course, he has really good reasons why he is perpetually angry and why he can keep smoking two packs of cigarettes a day. He wore his victim badge, proud and strong. And he treated his children like any nasty parent does. His berating, putting-down, demanding, petty reprimands, continued all day long.

Now get this, he has some idiotic tradition, that when he has completed some "life-saving" procedure like a Heart Cath, or whatever, he wants a juicy hamburger, fries, pumpkin pie and Pepsi. I am not making this up. During his procedure, his sweet daughters went down the street where the best hamburger place is, across from the Russian doctor (just telling his daughter how to get there, was a lesson in parental nastiness, for sure) and they should have it ready when he came back.

Of course, the moment he had gotten back from the Heart Cath at 8:30 pm, he immediately demanded that I give him some food.........and proceeded to work himself into a vein popping, red-faced fit, because we no longer had any food around. His daughters brought him a good looking hamburger, thick home fries and an apple pie." What? Didn't I tell you to bring me a pumpkin pie"? "Just throw that pie away; you heard me, throw it away!"

Folks, this is why Nurses don't carry guns at work. Although some of us might need one, when we're in the parking-garage at midnight: the odds are, we would be thinning the ranks of our patient population, such that it might get the attention of Risk Management. Rules?!?! What can you do?


King Cobra

Evil moods
From this nasty man,
Make everyone suffer
That's his plan,
He's afraid to die
And too angry to live,
Two daughters need love
He has none to give.

He's angry with the hospital
He hates all the waiting,
Talking with his daughters
He's mostly berating,
Demanding their attention
"Why didn't you listen to me?"
I wanted to offer them shelter
From his toxicity.

A 49 year old cesspool
Telling me, that he's a victim,
Yes you are, sir
I won't contradict him,
A victim of his own evil
That permeates his soul,
His tentacles entrap his family
Sucking them into his hole.

Two beautiful daughters
And he treats them like dirt,
He throws off their love
Like an unwanted shirt,
They need parental emancipation
I mentioned that to him,
But he's deaf, dumb and blind;
His kids are just a phantom limb.

So touching, that he apologized
For his moods and behavior,
Falsified worthwhile excuses
Telling me I was his savior,
For sticking around
Putting up with his crap,
If I had a King Cobra
I would have dropped it in his lap.

6/30/12

Dental Dana 1

Dental Dana

Dental Dana
She has the touch,
The way she pokes my gums
Is just, too much,
In fact, I'm willing
To endure that pain,
Because her strokes are better
Than Novocaine.

Dental Dana
Can handle my condition,
She knows just what to do
To conquer inhibition,
Whether flossing or polishing
Or scraping on my teeth,
No matter what's on the surface
She knows what lies beneath.

She manipulates her tools
And rinses my gums,
There is no idle chatter
Like the rest of her chums,
And when she turns on the vacuum
To suck up my spit,
Lordy, I get a rush
I don't want her to quit.

That darling Dental Dana
She's the one for me,
Do you think if I propose
I can have dental care for free?

Fibril_late;
3/27/12

Dental Dana II

Dental Dana
Didn't do me
The last time I was there,
Was she embarrassed
With my writings
Or maybe she don't care,
Too much about my feelings
She only loves my gums,
She probably knows
That when I see her,
I envision
Juicy wild plums.

Dental Dana, what a delight
She brings pleasure, where once was affliction,
I wonder if she will do house calls
And satisfy my Dental addiction.

Fibril_late;
6/6/12

Hot off the presses at Medscape:

May 29, 2012 — Exercise or physical therapy, along with vitamin D supplementation, are the best medicine for fall prevention among older adults, according to a report by the US Preventive Services Task Force (USPSTF). The new clinical guideline was published online May 28 in the Annals of Internal Medicine.


Falls

In the hospital
We could easily prevent falls
If we secured everyone in bed,
No more busted hips
Fractured elbows
Or dented heads,

Or.......

We could float them all in water
They couldn't fall, nor harm their skin,
If only I could patent this
I'd be more famous
Than Wilhelm Karl Grimm.

Fibril_late;
6/6/12

Never Say Dye

I went into the hospital
To have my vessels scraped,
I reacted to the dye, and now
My kidneys have been raped,
I admit, the doctor warned me
About some complication,
But he minimized the maximum
And now I've lost my urination.

The Renal kidneyologists
Are studying my case,
I haven't peed for seven days
And I'm turning yellow in the face,
There's talk about a catheter
They could place into a vein,
To suck out all the poisons
And sudsydize my brain,
But frankly, I'll be honest
I don't trust this deadly trick,
So, I'm checking out tomorrow
Because I'm safer being sick.

1992

At work we have a myriad of cabinets, but really, not enough. Several cabinets full of bins, where Central Supply personnel are supposed to keep us stocked with all the disposable stuff that we need. 

For a few weeks, we have been running out of supplies over and over, and we just couldn’t figure it out. The Tech would come by, use his barcode reader on the supply bins, and leave. It turns out, the labels on the bins had barcodes, but the device had been programmed to something entirely different, and thus, we were not resupplied at all. They were probably happy down in the Supply department, because we required fewer deliveries. I suspect a conspiracy of cost-cutting measures going on.

Bed Sheets and Pencils

We ain't got nothin'
Of anything today,
No decent supplies
For a comfortable stay,
No linens in the closet
No bed sheets on the gurneys,
God forbid, let’s do no procedures
On the slip-and-fall Attorneys.

The pens and the pencils
The erasers and the papers,
If this goes on much longer
We will all be sniffing the vapors,
And speaking of relief
Our food and water has been removed,
Just who is running this shop?
Who allowed all of this to be approved?

Well, I’m not worried
We have a new building going up,
We are led to believe
It’s going to be one sweet cup,
Overflowing with amenities
Flowers and pictures
And walls painted with stencils,
And we’ll still be short on linen
Papers and erasers
Bed sheets and pencils.

Fibril_late;
5/22/12

A meddling mid-manager dropped in the other day, and informed us that we couldn't keep any personal beverages (water) or snacks. Some rule /law/regulation, disallows hospital personnel from having edibles in a patient care area. I did have a few carefully chosen words which I expressed, but it only produced some chest-thumping animosity, from mini-boss....................

Angel Cake

Dear Allison, I beseech you
I need to take a break,
My manager is on vacation
And I thought of you, my angel cake,
After all, 'twas you that mentioned
That my manager was my source,
To call for the need to take a break
Thus, you're the closest horse,
To pull the cart, to win the race
When I'm at the stable resting,
You were the one who suggested this
Surely, you weren't jesting?

Dear Allison, I am wondering
Has our relationship become jaded?
The last time I bumped into you
You flashed a smile, and then it faded,
Perhaps my uppity comment
Regarding food and drink at work,
Reminded you that truthfully
I'm just an elderly nursing jerk.

Dear Allison, I implore you
I know you have a sweeter side,
If we had never crossed these paths
I think you could have been my bride,
With your ever winning smile and humor
Your relaxed and soothing demeanor,
Now, every time you see me
You're probably thinking, "what a weiner".

Thank God, you're not my manager
It's just too bad that we are peers,
But if this was two thousand years ago
We would talk with swords and spears,
Those days of good old sportsmanship
Are long past, but not forgotten,
So keep away from our cupboard, dear
Even if it's smelling rotten.

Fibril_late;
5/16/12

I went to a pretty interesting Cardiology seminar last week. But.......(there's always a but, it seems), when it was time for the "Nursing" perspective talk, it was a sleeper. I've made it a habit to obtain my license-required Continuing Education hours, by going to seminars that are targeted to doctors, because in general, nursing education is a bore. I'm interested in science, not "Creating Person-Centered Care through the Five Core Principle", or, “Fostering and Sustaining Family Involvement “. And anything pertaining to “empowerment”, I would surely avoid, along with “nursing leadership and management”, too.

Nursing is a tough business, so why in the heck are those educators, trying to put everybody to sleep at their seminars? Here's a winner: “A Closer Look at Practice Guidelines: A Focus on Evidence”. As you may have figured out already (if you've been a reader at this blog), I'm a bit stymied with all of this emphasis on “evidenced-based practice”. It makes me feel like we want to bring attention to the fact, that for all the years previous, we were just doing our Nursing stuff on some arbitrary whim. Well sure, maybe we were, but why advertise that to the world? It's like were saying, “we were idiots before, but now we're smarter”.

So there I am, with my longest-knowing nursing pal, trying to keep up with the latest in Interventional Cardiology, and now it's 2 hours post-lunch, and a “nursing practice” topic is presented; Time to press the snooze alarm!

Swoon

Not dynamic
Not exciting,
Like fishing, when
The fish aren't biting,
Coffee can not
Conquer this war,
I surrender
It's a crashing bore.

I think our presenter
Read from a guide,
A preprinted syllabus
All the words are supplied,
And delivered in a manner
Without vocal inflection,
And for the fee that I paid
This doesn't pass inspection.

I suspect it's just filler
For the late afternoon,
But if it goes on much longer
The audience will swoon.

Fibril_late;
5/11/12

Now, just about every nurse in this big old country of ours, has been subjected to the pain and sorrow, of migrating to an Electronic Medical Documentation model or system. Please, don't think of me as some kind of Luddite, a person that abhors change and keeping up with technological change............no, I'm not that. But not one of you who has been encumbered by this digitalized record, can admit completely smooth sailing. After all, in the past our paper charting didn't “crash”; did it?

So when a big hospital system like ours, decides to do some kind of “upgrade”, well then, it involves a colossal hassle for all participants. There is the whole, charting on “down-time” forms, and more. Like how we are supposed to chart on paper when the computer is down, and then transfer all that stuff back to the computer, three hours from now. Come on! Get real! This is where imaginary vital signs find a place to seed and go forth.

Here, at a “we-use-Cerner” hospital, we have identified our “super-duper-users” as Red-Shirts. This group of advisers, releases a “Tips and Tricks” document, to guide us through the horrors of computer-downtime-upgrades. Look, that alone gives me nightmares, and really, which one of us busy-bee workers has time to slog through all that handy, not so-helpful literature, when, if we don't get our butts in gear, we'll be behind for the rest of the day. In my opinion (and I'm full of them), “Tips and Tricks” handouts, are best ingested, out on the veranda during the Siesta (of which, we never have time for).

Downtime

Downtime, is like summertime
Just take it easy,
All the fuss and falderal
Is overdone and cheezy,
Who, really has the time
To read the tips and tricks?
When we're sipping Frappaccino's
Down by Highway Sixty-Six

Fibril_late;
5/3/12

ps:
Thanks to my pals over at MSJMC........your note was very heartwarming.


_ _ _ _ _


Also, more.........


Redundant Reentry

Oh sure, the E.M.R.
Has made work.........a piece of cake,
While paper documentation
Makes us shudder and shake,
But, only because a computer collapse
Forces our data upon paper,
Then later, we must re-chart it all
In this redundant, reentry caper.

Fibril_late;
5/3/12

A bit of a ramble here, but often, I just go where the good rhymes take me.

Secret of Excellence

All Managers desire
Conformity and compliance,
That's why they have the MBA
With their Bachelor's of Science,
And that's why I can not
Do that sort of thing,
I have acquired my education
Like a coffee-shop fling.

I dropped out of college
And then, attended seven more,
I didn't get scholarships
I chose the lower cost door,
But my secret of excellence
Lies in my ongoing search,
To consume vast stores of knowledge
Like some orthodox church.

I'm an incognito manager
A multitasking scholar,
I can clean up a problem
And take a disaster by the collar,
In the midst of a tempest
During an earthquake hurricane,
That is Nursing in a nutshell
Through hail, sleet and rain.

Fibril_late;
4/25/12

Yesterday, I received a 30 year old patient, transferred from an ICU at another hospital, for our Angiogram. This fellow was using his phone and texting almost continuously, while also stating that he had continuous chest pain. He was able to walk around without any difficulty, and truly exhibited no evidence of classic Cardiac disease. Sure enough, his heart-cath was normal, and what he needed to do, was drop one-hundred pounds.

Why the story? He shouldn't have been in an ICU, because that classified him as “critical”, and thus, needed an ICU nurse. It was a waste of resources.

Much later in the day, we received another patient from another hospital. She was a train-wreck. A classic, little-old-lady, previously very active, had fallen five days back and fractured her Humerus. She went to the Emergency Room of her hospital, whereupon they sent her home with an immobilizer sling, and told her, come back next week, and we'll fix that thing.

After being home for four days, where she probably slowly and unknowingly bled from her fracture, she had chest pain, and after quite a few hours, finally returned to her hospital. She had previously been diagnosed with stable cardiac disease, but never had undergone an angiogram. So, really it is no surprise to me, when her Troponin levels were quite high, and sure enough, she had suffered a heart attack, secondary to blood loss and the trauma associated with a little-old-lady falling down, and not being properly treated.

And did you know, that critical thinking, trumps protocols? Apparently, over at hospital -X, they follow protocols; in particular, the one where you place the person with a non-STEMI on a Heparin drip, Plavix and Aspirin. I know that sounds like a good idea, but not for the senior citizen with the broken arm, who is already anemic! This lady needed an emergency blood transfusion, before she could be rushed to the Cath Lab. She was clearly critical, needed an ICU, but had not been classified as such, at her home hospital. For us, this created a potential resource crisis, because now we needed two nurses to do the rapid-prep, to get her ready for her angiogram, and our staffing level was at its lowest point of the day. 


And to top it all off, a system-wide (as in multi-hospital and across several States), computer crash occurred. Nobody could chart a flippin' thing, or even check Labs or Diagnostic studies. Yessiree-Bob, how we love our EMR!

I saw this patient head out the door to the Cath-Lab, and soon after, I departed for home. If an ambulance crew ever tries to take me to hospital-X, I'll stun-gun the EMT driver.

Don't Go Back There

Hospital horror stories
Patient's will relate,
And we're the last in line
To invest in their fate.

A week spent elsewhere
Almost killed this fellow,
He's severely anemic
With skin bruised and yellow.

So we're documenting like crazy
To prove we didn't do it,
Taking pictures and tissue samples
Short fix?; we'll fish-glue it.

And casually, I'll suggest
If there is ever a future day,
Where you need to use a hospital
Don't go back there, no way.

Fibril_late
4/25/12

For the past 30 years our Heparin infusions have been measured in "units per hour". Recently, this has been changed to a weight based method of prescribing, and it all seems to be tied to the "Anti-XA" method of measuring something, to quantify the anti-clotting effect. But really, the drug didn't change, the purpose of infusion did not change, the adjustment protocols changed a bit (and are far more convoluted and confusing, from a Nurses perspective), and to my simple attention, this is all bad.

Lab Scientists and probably the ISMP and JCAH, all think this has to be "simplifying"...........whereas, in our practice as "those who must follow the Protocol", this new methodology is totally FUBAR. It is mucked up, bucked up, totally frickin' crazy.

There was no good reason to switch the dosing from "units per hour" to this new-fangled stuff. And thus, I guarantee, there will be more mistakes.

The Felicity of Complexity

Listen to the Engineers
They ought to know,
Make a process more complicated
New problems will show,
It's the nature of those men
And the machines they will build,
They don't do simplicity
In the Complexity Guild.

When you're looking for safety
In the delivery of medication,
Don't increase the complexity
And then describe with obfuscation,
Because, you must surely consider
The audience you serve,
If you have 12 different lingo's
Complexity will throw a curve.

Take Heparin, for example
It was dosed units-per-hour,
Now there is a weight based formula
But it still has Heparin's power,
The drug didn't change
Only the method of defining,
It went from simple to complex
And that's why I'm whining.

The dosing nomagram
Is super confusing,
Preprinted for Nurses
By a Doctor's order, for infusing,
And although it's his duty
To deal with this stuff,
We are supposed to make adjustments
Which is more than enough.

While the recipient can't tell
That units-per-kilogram-per-hour,
Is like electricity from the wind
How it's different from solar power,
Which, forces the question
Why change the method, how we dose,
Complexity drives mistakes
Eureka!, I diagnose.

Fibril_late;
4/23/12

The Joint Commission is at it again. Get a load of this new idea and  read the quote found in a “Pharmacy Communication” that was sent to all Nurses at our Facility.

“Effective Wednesday, April 18, pharmacy will dispense exact doses by splitting tablets and repacking them for each dose. It is required by TJC and recommended by ISMP that a patient specific unit dose should be prepared by the pharmacy and available for nurse for administration, negating any manipulation. “

As I read it, the Joint Commission is accusing we Nurses of  “manipulating” medication delivery. And of course, that means something like that would never be done in the Pharmacy. Actually, it probably means that Pharmacy Techs, will now become the Pill-Cutters. How’s that for a job title. “Dude,  tell me about your new job?” “Well, Bill, it’s like crazy, like I chop frickin’ pills all day!


Pill-Cutters

They are dismissing our pill-cutters
Man, that’s hard to believe,
Now Pharmacists, will get the task
So, why do I grieve?
Because it’s just too damn stupid
The reasons they list,
A Joint Commission directive
I guess somebody’s pissed,
And they wanted to take-away
Something else, we Nurses do,
Chopping up pills
Was too risky for you,
The patient-consumer
Might get an improper dose,
And the Pharmacy chops pills
Statistically more close,
Than any Nurse could achieve
Even thirty years on the job,
Screw it, let them do it
Take it on, Pharmacy Bob!

Fibril_late;
4/18/12


_ _ _ _ _ _ _ _



My Editorial on the above topic:


I realize I represent a tiny voice in the shadows of mighty decisions, but hear me out on this concept of Pharmacy Pill cutting. I am aware that this idea comes from other big agency thinkers, but I believe it violates sensible Nursing practice We have both been Nurses a long time, yet I haven't forgotten the teachings of "The 5 Rights of Medication Administration", nor have you.




the right patient
the right drug
the right dose
the right route
the right time


One of my concerns is this: many pills look similar, but may have distinctive markings. Now, someone in Pharmacy is going to chop a pill in half, and I won't be there to see what pill they chose. And when that chopped pill comes to me, in its own little package, I may not be able to identify that pill, because I did not see it in its original shape, appearance, and perhaps some unique markings have now been obliterated. In fact, that was one of the purposes of Unit-Dosing, one pill, clearly marked, I open it, and I chop it.


Now, I am expected to administer a medication, that quite likely, I can not identify. How does this make for a more safe situation? We are taking away the "Right Drug" step of the process.


And if a patient has an adverse reaction (because, just maybe, the wrong pill was grabbed in Pharmacy), the Nurse will be blamed, because they administered it! This policy, although adding a "new and improved" layer of safety, is actually eliminating the step where the Nurse, can truly check the validity of what they are administering. This is not progress.


I think it would have been appropriate to address this issue, prior to having it "suddenly announced", and expecting us to incorporate it into our practice. 

Why reprint old stuff? Just to prove that history keeps repeating over and over. The same old problems are just repackaged, and let’s see if anyone notices. It’s fun to say mercy and dignity, all in one breath, and then whoops and oops, you lost your job. Hmmph.

You Can’t See Your Victims

We’re not laying off
We’re just redistributing,
You can’t see your victims
In a drive-by shooting,
We have an abundance of projects
In a construction based facility;
Victimized by seniority
And not by ability.

Budgetary cuts
In lean fiscal years,
Administrative decisions
Fulfill common fears,
Hysterical restructuring
In an arena of fright,
Cut the ranks, save the salaries
Relinquish the light.

Apologies abound
In administrative meetings,
“We did what we could
Now, please take your beatings”,
A community leader?
Clearly setting the tone,
Denying the basic tenet
“Take care of your own”.

Fibril-late;
1994

** See what I mean?...............nothing has changed. Of course, back then I was working at the big house, and now it's another ship in the storm.

I work in a great place, but a patient visit/encounter, can be quite taxing to that individual. We have them come in two to three hours in advance, so we can start the IV, send the Labs, sort the Documentation, verify the Doctors entries are up to date, and so on. But we have no way to predict how many drop in emergencies, or equipment breakdowns, or know-shows, or a procedure lasted three times as long as expected, and so on. These hungry, anxious, waiting people, get bored, and more, hungry, anxious, and then angry, when they find themselves in a seemingly perpetual holding pattern.
That's what I don't like.

We Are the Levers

The waiting
That’s the toughest part of this job,
We hurry up to get our clients ready,
And then we all stand around
Like an unemployed slob,
Looking for the Doctors; Tom, Dick and Freddy.

Here’s a typical dilemma
An over-rated disaster,
“My patient got here on time
Why can’t you go faster?”
But we’re just pawns on the chessboard
Of Cardiac endeavors,
They are the fulcrums
And we are the levers.

Fibril_late;
4/13/12

Lately, almost every week, there have been Regulators, Dignitaries, Law-Enforcers, and other wandering eyeballs, that we need to impress, over at yonder healthcare system. Every department wants to look as neat as a pin, and then to top it off, all those wonderful visitors get the best of all meals, and what budget does that come out of, I wonder?

These two poems touch upon financial impact and all of that.

Sisters Charm

Sure, I realize
There’s a tough crunch,
Matching dollars to nursing time
But what about that lunch?

Where visiting dignitaries
Chew the fat and shoot the bull,
Who pays for all of that?
Waiting till all those suckers are full,
With our special gourmet
We catered for you, kind of dinner,
Now please, if you all would score us
As your favorite winner,
In the lottery of favorable comments
On the Who’s-Who list of Hospitals Best,
Come on; just give us a good score
This is not a quiz, exam or a test.

And it’s not about our Surgeries
Or Cancer-Care, or Robotic Arm,
No, it’s all about the catering
And Sister Euphemia’s charm.

Fibril_late;
4/13/12

Like Sheep

Writings twenty years old
Do they still have some funny?
If I publish them, what are the odds
That I’ll make any money,
Pretty low, I estimate
But that’s not the point,
I wrote then, about issues
That I needed to anoint.

Human habits change very little
Despite our technological advances,
I wrote about missed opportunities
And precarious chances.

Since that time, not much has changed
With ethics, morals and actions,
Although I’m inclined to believe
That the Hospital-as-a-business-model
Has led to an impaction,
Where good care and cost-cutting
Have nearly reached a critical-mass,
Where a gentle mercy and kind dignity
Won’t be allowed to pass………..

No matter how many feel-good, call-back
Phone calls are made
Cost-cutting will surely, bury those deep,
Even while our leaders and administrators
Chase Medicare dollars in their slumber…………..
Like runaway proverbial sheep.

Fibril_late;
4/13/12