Friday, July 15, 2016

Plus ca change...




Two lifeflight traumas, three psych patients, an ICU admit whose AICD kept firing in the ED, and two obnoxious drunks. Not a bad first orientation shift on a new assignment.

Nice to be back home.

Monday, July 11, 2016

"How the hell do you not get burnt out doing this?"




I really, really enjoy my job.  (When I get to do it. The three dozen things a shift that have jack and squat to do with actually caring for patients still suck my soul out.)

There's always bad shifts, even bad weeks, but when I catch myself getting overly grumpy about it, I make a mental game out of kicking its @$$.

Life really is 10% what happens to you, and 90% how you decide to feel about it. I realized it's a lot more fun going through life as the cat than as the litter box.

And when it's time for time off, GTHO and have fun. (Also, if you never go away, they never miss you. Really.) At least one county away by car is great; if it involves a plane ride somewhere else, so much the better. This year I'm picking off the 27 states I've never been to - and probably finally getting the (online, now!) BSN they swore I couldn't live without as a nurse - by 1995 (snort!). Next year, I'm either doing countries, or destinations. I want to see what a full passport looks like.

But after a week, 10-14 days tops, I start getting twitchy to get back to work. I've never not had a job (except during part of college) since I was 13.  That's mumblemumble an awfully long time, so force of habit there as much as anything else I suppose. Total days, lifetime, on any sort of state unemployment, zero. Trabajo. Period.

BTW, assuming someone does 3x12hr shifts weekly, if you pick up 1 extra shift/wk at a different facility, you network, see how other people do things, have a fallback job when your main gig craps out on you (and they will!), and you have about 20-25% after taxes of your annual pay in your hand as your Better Life slush fund if you simply put it in a jar every payday. I highly recommend it for anyone with 5+ yrs. experience. That's vacation, retirement, a down payment on a mortgage, or a new car, in return for one extra set of clean scrubs every laundry day. Times the rest of your career, that's one helluva better place to be in. Wish I'd started doing it ten years sooner.


One other thing: if you have an ounce of discipline, keep a shift log.
E.g., I'm about to embark on a 13-week contract. Or, 39 shifts. Potentially, as many as 65. Whatever.
But if you'd like to put what you do in perspective, start a little tally:
Say, something like : 4 GSWs, 19 MVCs, 42 MIs, 23 CVAs, 37 hot appys, 59 fractures, 107 psychs, 317 FDGBs, 81 peds, 126 admits, and a little boy with a toy soldier up his nose.
1423 doctor's orders implemented, 917 meds passed with no errors, 182 IVs started, 12 NG tubes, 56 foley caths, 918 phone calls, and 2 teddy bears successfully returned home with their smiling owners.
It lets you see just what an actual difference you make, and it's a metric fuckton more persuasive than the jacked up ratings on annual evaluations if you want to point out what you've actually done for your facility, if you're there long enough for an annual evaluation and raise discussion.
Trust me on that.

Like that slush fund, consider the tally another way of paying yourself first.

Tuesday, June 28, 2016

Glutton For Punishment




Working ten to fifteen consecutive shifts consistently just wasn't challenging enough (no, really). So for even more greenbacks, I'm picking up a contract at a county teaching hospital/trauma center. In July. Just after the fresh residents have hit the floor. The phone interview, where they told me they love registry and travelers because they use so many, and that there are always plenty of overtime shifts to pick up, tells me that they're either stupid, or don't realize what that means to me is that most of their staff is new/short-term/swamped, so I'll pretty much be on my own once they take off my training wheels. Otherwise they wouldn't be glad to get people, and paying top dollar to make it happen.

Except unlike the last time I did this, this time with fluent Spanish and nearly 15 years of ED experience. (Note: never start a new ED job on 9/11/01, or amidst any other world-changing terrorist attack, if you can help it. Just saying.) This should keep me ahead of the residents. But I'll probably renew the contract a time or two if things work out. Because seriously, every time I start a new one, the 16-hour marathon of compliance modules on the computer, either there or here at home, is a total buzzkill.  If there were an option that would let me skip the modules and substitute just being punched in the junk for half an hour while being tazed, I'd really have to think about which way to lean.

Which will be inevitably followed by more hours of orientation, that mostly just provides rent for the people in HR who lead orientation. But somewhere I have a book on Korean War POWs resisting brainwashing sessions, so I'll be brushing up on those tips beforehand, and working on keeping a slightly bemused look on my face, just to be ready for the first day of school before I hit the department.

Life should always be an adventure.

Wednesday, May 11, 2016

Good Times




Just minding my own business, and been working my @$$ off.

A few random notes to self:

I really like my job. Not to get all Pollyanna and all, but most days, it's a fantastic reason to get up in the morning (although my morning is usually 5PM-ish).

I can work 10-day weeks. That's either stamina, or psycho-neuropathy.
The youngsters ask "How can you work so many days?"
Try unemployment for a stretch, kid. Overwork beats underwork by a country mile, and it's one helluva lot more fun when you visit the bank.

Time off is even better. Usually I've had time and no money, or money and no time.
Having time and money at the same time is positively fabulous.
I highly recommend this option.

It really cuts down on the BS at work when you're at work 2-3x more often than anyone on staff.

It also cuts down on the whining from other people about how hard their life is.

When you take some days off after a marathon stretch at work, they're just magically better.

A special bonus is that when you take those off days, they realize how much you've been doing.
If you don't go away once in awhile, they can't miss you.

Always remember, you can like your job.
But NEVER love your job.
Because it will never love you back.

Also remember that the way employers tell employees that they like them is in your paycheck. Balloons and cupcakes for Nurse Week don't pay your rent, or buy your tickets to Hawaii, Vegas, or Disneyworld. Money does that. If your employer isn't paying you whatever top dollar is in your area, all protestations to the contrary notwithstanding, they don't like you.

If you think you're indispensable to your employer, check your assignment list ten minutes after you're fired, laid off, or have your days cut.

Always have a spare job in your back pocket that you can expand into a full-time substitute gig until things settle down. For the same reason you should have a spare tire in your trunk, and a fire extinguisher in your kitchen. You want to have it, but you hope you never need it. Until you really need it, right now. Don't wait until it's too late to find that out.

A work-at-home thing that generates cash flow isn't a bad idea either.

Always have at least one entire month's expenses squirreled away, in cash, somewhere you can get to 24/7/365. "In the bank" doesn't count: banks close, earthquakes and hurricanes knock power out to ATMs, etc. etc. That wad should be sitting in a fire safe under the bed, or rolled up in a ziplok baggie inside mayo jar in your pantry or buried in the rose garden, or somesuch.
Where you can get it if you have to hit the road at 3AM, or your employer shuts down with no notice, or the transmission falls out on the freeway, or whatever.
With a handy lump of greenback cash where you can lay your mitts on it now, without fail, you can solve small to moderate problems, or buy yourself time to think your way out of an emergency, and keep it from becoming a catastrophe.

Go places you haven't been, do things you haven't done, and talk to people you wouldn't normally talk to. (Not in a babbling homeless schizophrenic off his meds kind of way.) But be sociable, and explorative, and the world stays new, while your brain grows.
The alternative is dragging same-old same-old tracks in your daily rut, getting Alzheimer's, and then sitting in the same-old same-old forever, and just thinking you're going new places and meeting new people. Because one day your mind got bored and left town without you.
Option A is vastly more fun than Option B.

That's enough musing for the moment. I need to get some sleep, because I've got another busy day playing in the sun planned again for tomorrow.

Wednesday, April 13, 2016

PSA For Societal Miscreants

 

Two helpful bits of advice:

1) You can run from the cops, you can try to run from the police helicopter, but you cannot run away from the police dog.
Some cops are truly donut magnets, there are some places helicopters can't fly, but anywhere you can run, a dog can run faster.
He is more agile than Officer Friendly, he cannot be reasoned with, and in 100% of cases, if you're fleeing when he catches you, he's gonna bite your ass, multiple times, which hurts a lot.
And then, he'll get a Scooby Snack for his efforts from Officer Friendly.

And not to put too fine a point on it, please check yourself, especially guys, and notice exactly which of your bodily appendages are conveniently the exact same height off the ground as the teeth of the average police dog. And ponder the several hundred pounds of pressure that jaw and those sharp teeth will put onto your giblets. Srsly.
Enough said?

So, if the dog comes out, stay very, very still, and do exactly what they tell you.


2) In the ED, we have a really neat way of carefully medically removing those taser darts that get shot into your ass, according to the latest standards of care.
We take a set of Craftsman needlenose pliers, grab the dart(s), and yank them straight out as hard as possible.
And nota bene, those darts have opposing reverse barbs on them, like fishhooks, designed to make that rip hurt. A lot. (At least, judging solely by the high-pitched screams of your colleagues in similar circumstances.)
And then we put betadine and a Band-Aid on your boo-boos.
And I promise you, the cops will be laughing at you when you cry like a girl, almost as hard as they were laughing at you when they were tazing you, bro.
And, truth be told, it is pretty funny, for everyone who's not you.

So once again, maybe consider the benefits of not being an obnoxious jackass, fight the wisdom flowing upstream to your head from all those alcohol molecules, and avoid getting things ripped out of you, or stitches put into you.

If only for the sheer novelty of not doing the exact opposite of common sense, like you've probably done the entire rest of your life.

Oh, and it wouldn't hurt to maybe also keep your tetanus booster up to date, kids.

Saturday, January 30, 2016

Why Doesn't This Happen As A Policy? Everywhere?

(I mean, besides the fact that none of the suit-and-tie wearers or lab-coated clipboard commandos of "higher" practice thought of it.)

The sitch is that E.D. is frequently slammed. (I know, who knew, right?) Like, multiple ambulance gurneys in a conga line out the door and down the ramp to the street. No, for real, not just in blog-perbole. We literally have fire engines blocking the street because they can't get in to park when I get to work.

So one night I'm coming in to sign in, knowing it's going to be a special slice of heaven already, and Staffing is telling a perfectly good ICU nurse "Hey sorry, we tried to call you off before you came, we don't need you." So I jumped over the counter and started pummeling him with a fire extinguisher because we were already four nurses short on a ten-nurse shift suggested to him that they send the "extra" ICU nurse to the critically overloaded and understaffed E.D. for the night, instead of telling him to go home, make no money, and leaving us (and 100 patients) hanging. Because mothereffing DUH. We don't expect him to chart, or fully take over care, with zero departmental indoc, but for cripesakes he gets the same patients we send upstairs all friggin' night, so it's not like working the E.D. would kick his ass. (And I'm the outsider here, not a staffer. I just work there more days and hours than the full-time staff do.) And lo and behold, Staffing does it! So we made him the extra float nurse for the whole department.

And this dude kicked ASS! He was a friggin' rockstar for twelve solid hours!

The nurse I was paired with, who was also a float from our step-down Tele floor, who we'd love to steal permanently from them if he wasn't too smart to do it, takes Awesome ICU nurse under his wing, gives him the ten-cent tour, and then we turn him loose for the entire shift.
He passes meds when any given nurse is busy with other patients, and he starts, by actual count, 23 IVs that night. He transports 75% of the tele-monitored patients upstairs, which leaves the regular E.D. nurses free to stay and get sh*t done in the E.D., and we can drag in an empty gurney and turn over a room in 60 seconds instead of 15 minutes, and the nurse doesn't walk into a crapstorm with an unstable patient who's been sitting there untouched while he/she was gone. Which cleans out triage and ambulance overflow in a few hours, instead of the hospital lingering on ambulance diversion all night long.

So now Rockstar has a blast, only charts the care he renders (starting IVs, giving meds, etc.), and if he gets a chance, he wants to come back. And he has a whole new perspective on what E.D. is like, and why, when someone says "I need to give you report on this patient now" they really mean "I'm up to my ass in alligators here and someone tied pork chops around my neck! Hook a brother up and take this patient NOW!" without him being beaten over the head about it.

And he'll pass that perspective on to his co-workers who've never set foot down here.

If you're keeping score at home, I think that's win-win-win-win-win-win-win-win.

So all I want to know is why, in the name of heaven, they can't make a policy for full-time staff that EVERY RN in the hospital will pull a blazing one whole shift in a department that they either get patients from, or send them to, each calendar year. And every year has to be someplace they haven't been before, until they've been everywhere. Where they'll then gain a little 'walk a mile in my shoes" appreciation, insight, and empathy for the people they barely interact with from other floors and departments. Maybe even get to know a few of them a little.

It wouldn't break the bank, it wouldn't cause mass chaos, no patients would be harmed, and people from the back door to the top floor would probably start to feel like they were kind of all on the same team. (What a concept, right?)

We'll forget about the fact that people who move up to management would have multi-department skillz and contacts built in, and everybody would get a free taste of other departments and practice areas, and thus maybe transfer within the hospital, rather than just bail, and leave the clueless monkeys in HR wondering where to find another round peg for the newly empty hole, at a per-hire search cost of $50K, on average. (It's scary, almost like I've thought about this or something, as if it made sense on multiple levels.)

And when I note the specific experience on one shift, the management I tell about it are all smiles. When I suggest they do it as an annual experiment staff-wide, apparently it's like my Invisibility Cloak has descended, and they suddenly have an urge to go to the bathroom, do a bedpan inventory, or something equally urgent.

So now, as I drag myself off to more education, remind me why management with BSNs and advanced degrees means a better-run hospital. Because I need some ibuprofen, or a softer wall to bang my head against.

Friday, January 15, 2016

Refugees, Take Two

Apparently, according to one response, because I'm not culturally suicidal, I'm nasty and embittered (Moi? Mai non!) towards "Syrian refugees". And fail to recognize that some of them are really nice people.

I'll happily stipulate that some of them are.
And note that much like the guy who turned into the car in front of me last month, he missed most of the oncoming traffic. Care to speculate how that turned out for him and his passengers?
Or the people in the other car(s)?

We could cast about no further than these two happy folks, one a State-Department-vetted legal immigrant, and the other the son of same; not refugees at all, in fact being both well-paid professionals:

Or we could ask the relatives of these fourteen folks:


I said relatives, rather than direct questioning, because the first two happy additions to the American melting pot killed the other bunch of actual Americans (and shot another two dozen who luckily didn't die). Because Diversity!
(And just between you and me, I wouldn't trade an ocean liner full of the first two for any one of the other fourteen. But then, I'm nasty and embittered.)
.
Or we could just note, as I replied,
It isn’t the “nice ones” that concern me.
Sorry, I couldn’t hear the rest of your argument over the gunfire from San Bernardino, just down the road from here.
Our own director of the FBI – an Obama appointee – has flat-out stated that we have no way to ever adequately or properly vet such refugees, and that any claims to the contrary are simply outright fabulism. So this isn’t a D/R thing, it’s a wise/foolish thing 
If you feel inclined to send them aid over there, then yes, by all means do. Even with my tax dollars. I’ll even kick in extra on top of what I already send, just for that.
But failing to strain out the problem children, as we certainly will, with the guarantee that incidents like the San Bernardino Christmas bloodbath will become a regular occurrence here, is a lose-lose deal. If those refugees want to get in line behind the 93 million unemployed Americans already here, who need no such importing, and us with a government debt increasing by trillions and trillions, we can talk about how many more outsiders we can afford to carry piggyback. 
And nota bene in the pic above [in the original post -A.], the strange preponderance of fit, healthy, well-fed military-age males in that picture, and the utter dearth of starving women and children. Perhaps the latter wasted away entirely before the photographer could get a snap of them?
If all they wanted was regular meals and a roof over their heads, there are a dozen or more countries between here and Syria where they share a common culture, language, and religion. Not to mention identical culinary preferences. 
So I find it breathtakingly disingenuous to pretend that this is anything Maslowian in action, rather than acknowledging the obvious facts that it’s driven simply and entirely by a desire to feed at the deepest trough to which they can make their way, aided and abetted by quisling leaders who would gladly throw their daughters to rape mobs to curry the favor of people who would happily cheer the throat-slittings of Westerners to come afterwards, as they already do now. 
If room can’t be made for them in Jordan, Iraq, Turkey, or Lebanon, let alone anywhere from Morocco to Pakistan, they have no special claim on our favor to re-locate here, and if they have the means to move 10,000 miles away from home in the first place, they’re hardly incapable of finding someplace two continents closer to their ancestral home than this country, where we have all this annoying freedom. Our women get to freely express their views on the Internet, run around without sacks on from head to toe, and without being molested en masse every New Years’, nor be mutilated by their patriarchs, or slaughtered in family honor killings. 
I’m kind of a fan of importing people with a higher quotient of freedom toleration from the get-go, rather than bringing folks here whose traditional cultural method of settling differences starts and ends with bloodshed.  
If they have that much time and energy, they might more profitably occupy themselves with overthrowing Assad, and setting their own nation’s house in order, rather than clamoring that the Great Satan of Nations welcome them with open arms and clutch them to our national breast as long-lost cousins. 
In fact, when last I looked, there was nothing in the US Constitution forbidding other countries from adopting it wholesale and reaping its benefits, if that’s all they have in mind in the first place. We could certainly use some more like-minded friends over there. 
Nurses meet people in need every day.
We don’t bring them home with us.
If things are so slow where anyone works that they don’t have enough people right in front of them that could use further efforts and assistance, I suggest what’s needed isn’t a refugee visa program, but rather perhaps a closer look around – within driving distance. 
But if, despite all that, you still want to buy the world a Coke, please do it with your nickel, and invite them to live in your house at your expense first, before you kindly sign the rest of us up for the privilege.
The problem with socialism is that eventually you run out of other peoples’ money.
Sorry, but that's not nasty or embittered at all.
And I don't despise Syrian refugees (or the other 98% that make up the hordes descending on the rest of the Western world pretending to be refugees, or Syrian, and/or both.)
I just have an extremely low threshold tolerance for simplistic bullshit.
And when you walk into metaphorical thorns up to your neck, on the Internet, the best thing to do is probably to back out quietly, with a minimum of whinging, rather than doubling down on it.

I anyone wants to talk about what we "owe" the rest of the world, have at it.
I'm not isolationist by any stretch, but it seems to me there are about a metric fuckton of American graves filled with our sons sacrificed on behalf of the rest of the world, in contrast with two statues of foreigners here who ever did anything notable for us.
(I'm not discounting any of the individual sacrifices on our nation's behalf by literal hordes of foreign people - who were, in the truest sense, simply Americans in their souls who were born somewhere else - just noting the dearth of any official response by other nations as such since Lafayette & Co. landed here in the thirteen colonies.)

Y'all give a holler when Syria, or any other twenty nations combined, hits the shores here to save us from tyranny. Let alone sends us so much as a fruitcake at Christmas, because they like us.

That'll be the day.

Thursday, December 31, 2015

Gift Wrapped

You had a heart attack a couple of years back.
Undeterred, you're still smoking every day.

But you had chest pain the other night.
So you came to the ED.
No, not by paramedic ambulance called to your house, with all the latest technology and pharmaceutical wonders at their fingertips right there in your in your living room.
(Too easy, right?)
Instead, you waited a few hours - to make sure this was really something - then had your wife run a few red lights driving you in to see us.
Then you came in, went to the bathroom, and then waited to register to be seen.
Without telling anyone why you were here.

Of course, your full arrest in the waiting room a minute later kind of let the cat out of the bag.
Lucky for you it was late at night, during the slow time, and we all came running.
And somebody jumped on chest compressions for you in about 10 seconds.
And kept on doing it until we got you onto a gurney and into the code room.

And you were in V-fib, of course.
So we zapped you a couple of times, cranked on your rib cage for a few cycles in between, and pumped you full of code drugs, sunk an ET tube on the first try, and got a pulse back.
(Did it sting? Do you remember any of this now? Just wondering...)

And then we shipped you off to the cath lab, and then they sent you to the ICU.
Who fixed you, and sent you home again.

As much fun as we had, we hope next time you'll call 9-1-1. First.
And not risk your wife plowing into a vanload of innocents when she's running red lights on the way to the ED.
Or you arresting in the passenger seat 10 minutes away.
Or dropping somewhere between the cars in the farthest reaches of the parking lot, and us playing hide-and-seek in the dark after your wife runs inside and tells us about it.

So maybe it's time to lose 50 pounds and ditch the Marlboros for good, eh?
Because you did nearly everything wrong, and evidently God's not done with you. Yet.
Congrats, man.

Happy New Year.
Enjoy it.
Oh, and you're welcome.

Thursday, December 3, 2015

Refugees, Politics, and an instructive fable


In reference to the most recent post at Florence Is Dead, regarding the thought that 2,290 Syrian refugees here since 2011 is not enough, the following:

We currently accept around 1,000,000 immigrants per year to the U.S., and that's just the ones who come here legally. (We can ignore the other 10-20 million here illegally we're currently supporting every day for another discussion another time.)
That's more than the sum total of legal immigration for all other countries combined, on the entire planet, and has been so for decades, year in and year out.

So given that the "refugees" in question are some 5,000-10,000 miles away (depending on where in the US we're talking about), and have to pass over any two of three continents, or over two complete oceans between them, to arrive here in this hemisphere, skipping past any 40-50 other countries en route, the correct number of Syrian refugees we ought to be accommodating here is therefore right around zero.

If you can find any of them who relish individual liberty, representative government by democratic republic, long for the benefits of our Constitution and Bill of Rights, the blessings of (mostly) free market capitalism, and eschew enforcing religious tyranny on all others at the point of a sword, and they have a working knowledge of English and our American history, by all means, send them - to get in line behind everyone else seeking a better life.
Just because 8 billion people want to move here (or to Europe) as part of the Free Sh*t Army doesn't nor should it grant them any claim to American citizenship, nor even to legal immigration status. Which is precisely the reason most of Europe is calling up troops and building fences to keep their hordes out, and why the governments there who ignore that are about to find themselves ousted. Or worse.
(That's the best event, assuming another couple of Paris-style incidents don't push the entire continent to the cattle trains and barbed-wire camps stage, which is hardly a new or surprising thing over there, historically speaking.)

But importing hordes of people to this nation from Third World poverty, without any marketable skills, and saddled with an allegiance to a repressive theocracy which authors the most brutal forms of repression, torture, and slaughter against women, gays, and every other religious faith is right up their with someone wondering what would happen if a person shoved a grenade up their tailpipe with the pin pulled out.

The two clearest examples of what that looks like for real need be gathered from no further back in history than Beirut in the 1980s, and Sarajevo in the 1990s. Anyone in any doubt should vacation there, and report back to the group on the experience.

And the enclaves of precisely the second generation economic refugees in Europe already admitted in better times (from Syria, Lebanon, Algeria, etc. - all former French colonial leftovers), and now without prospects, plus bearing no love for the country that sustains them, were the precise breeding grounds for those who conducted the Paris attacks. The correct term for those who kill their hosts isn't "refugees", it's "parasites". So let's be scientifically and pathologically accurate, shall we?

If someone is feeling the call to help Syrian refugees (who comprise some single-digit fractional percentage of the hordes now descending on Europe - the rest are from anywhere and everywhere other than Syria), then by all means, send as much of your personal resources as you'd like: to help them survive and make their way on their own continent, ideally in some safe enclave in their own country, or at worst nearby and geographically much closer. They belong in a place where they have some reasonable hope of someday returning to their own native homes, and staying alive in the meantime without resorting to trying to float to Europe on a raft made of floating debris, or walking on foot to the countries with the best welfare payments.

Better for them, better for us.

Anything else is tongue-kissing syphilitic lepers, and doing mouth-to-mouth on drug resistant TB patients, because compassion without cogitation.

Nursing is about using our heads along with our hearts to help people.
My namesake's fable about The Scorpion and The Frog comes to mind.
 
Bonus points for bravery/stupidity: putting this question to nurses at Loma Linda UMC in San Bernardino, today.