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.