Thursday, October 13, 2016

Thought For The Day

If you come to the ER and you remember me, you've been here two times.
If you come to the ER and I remember you, you've been here too many times.

Nurses Eat Their Young - Busted

Pretty much calling bullsh*t on that one.

Do all of us, as nurses, run into people that try to pee on our heads and make life hell?
Hell yes!
Do some nurses wimp out and quit?
Does that mean everyone everywhere is there to jump you into the gang?
Hell no!

How do I know this? Because when I started out, it was at a great teaching hospital, unfortunately cursed with some of the most godawful bitter rotten bitches and bastards on the planet, stewing in their own little toxic cesspool. I got tough, and then I got out. And having seen it once, I can spot it in about 0.2 seconds, and don't put up with it.

Everybody, in every job or experience, has probably been hazed a bit (mostly in good fun, and just as a momentary prank). Some people get it far harsher, because you're working with a bunch of bitter, twisted douchenozzles. If your work environment is pissing you off after a month, it's Option B, every time, whether you're new, or you've been doing this for years. If so, GTFO.

I bring this up, because I'm currently somewhere they have a constant stream of new staff, between registry, travelers, new grads, residents, etc. ad infinitum. That was true at the first place I broke in too. What's different is that here, what's missing are the bitter old hags who think they were beknighted by Florence Nightengale personally (and honestly, some of them were old enough to credibly make that claim, but I digress), and they're metaphysically certain that their feces produces no odor. The only reason they wished nursing caps would come back was so that they could wear a tiara to work.

There's none of that here, nor most places. In fact, there's seldom more than a couple of nurses who try it nowadays, and they're usually the petty supervisors who substitute attitude for actual bedside skills. The ones who should retire, to save their own lives, and their patients'.

The reason it doesn't thrive so much anymore is that everyone knows we need the fresh blood, because we need the help period, and secondly, the days of the supervisor who can't help at the bedside are blissfully numbered as I speak. Anybody still pulling their weight knows that can't-hack-it supervisors are dead weight, and that includes their bosses, and their administrators. And much like the military, a constant stream of non-returning new hires points rather inevitably to crappy leaders and preceptors, and that metric comes up at annual raise and retention bonus time, in a big way.

Here, I'm seeing experienced nurses precept the hell out of new grads, and getting double-checked on it, so that once the training wheels are off, the new grads cruise, instead of crash. Better for them, better for us, better for patients, better for the hospital, better for the hospital's bottom line.

If you're one of the perennially bitchy nurses that can't stand new grads, don't let the door hit you in the ass on your way to retirement. In fact, why wait? Quit right now, and save even more lives than if you stayed. And if you're a new nurse, feeling like a cat toy for the experienced nurses, you either need to change you profession, or even more likely, change your work address. The nursing shortage is going nowhere, and all you'll get for trying a greener pasture somewhere else is a better night's sleep, and lower blood pressure. And the Queen Snottypants nurses at Jacked Up Hospital will be stuck where they were without you, doing the work themselves, because they suck.

Anybody can have a rough shift.
If you're having a rough trimester, on the other hand, either do some serious soul-searching, or update your resume, and start web-surfing.
Don't be afraid to ask for help, but if it isn't forthcoming when you ask, start making plans to bloom elsewhere. There are no reward points for being a workplace martyr.
You may be a victim, but you don't have to be a volunteer.

Monday, October 3, 2016

Car 54, Where Are You?

Drunk is not a medical emergency.

Note I am not referring to drug ODs, nor to intoxication to the point of cessation of breathing.
It is solely in reference to plain old intoxication. Something which used to occasion a visit to the local constabulary's drunk tank. Which, long and short of it, is where the problem reared its ugly head.

Because, gentle reader, despite a multiplicity of job skills, police officers, sheriff's deputies, and whatnot are many things, and jacks of a host of trades. But "licensed medical practitioner" is not any of them (and I'm okay with that, and about to tell you why).

Y'see, back in the day, Ofcrs. Reed and Malloy used to load drunks in the back of the squad car, and tote them to the drunk tank. Which was fine for drunks. The problem arose because people with head injuries after car crashes, and people having strokes, and people with diabetic-induced blood sugars of 20 all look exactly like drunks when apprehended. But unlike garden variety drunkaholics, they unhelpfully tend to die a lot overnight when placed in a large drunk tank holding cell. This causes consternation for the officers, annoyance for their families, runaway profits for said families' personal injury attorneys, and great aggravation and heartburn at the offices of the legally responsible municipalities concerned.

So the word has gone out, from city council to city attorney to chief of police to watch commander to desk sergeant to every Ofcr. Reed and Malloy and Deputy Fife:

Take all drunks to the E.R.

And I get that, boys and girls, I truly do. You don't have a CT scanner in your car, nor any medical training but the barest state minimums, so to preclude killing people by mistake, you bring them to those of us qualified to tell a drunk from a guy who took too much insulin and not enough dinner before he plowed into 3 cars and staggered into your arms.

Well and good it is, dulce et decorum.

But where all of you ministers of street justice screw the pooch, is that once you leave the few medical emergencies, and the overwhelming vastness of public wastrels, in our hands, or handed off to us by way of the local fire guys, whom you also had to wake up and drag into this mess, is that you, having happily washed your hands legally of them, don't return and take them to jail, nor even issue a summons for public intoxication, once it's medically certain they're simply drunken @$$holes in desperate need of a stay in the Greybar Motel.

Let me make it clear, lest I put it too mildly, that in every ED I've worked in, and on every night of every year of this century, that amounts to between 2 and 20 m*****f*****s every shift, in perpetuity. I'm sure you don't miss dealing with them, having happily palmed their vomiting, urinating, diarrhea, abusive and obnoxious behavior, and even their assaultive escapades, onto mainly a bunch of overworked nurses, techs, and doctors in scrubs. I'm sure your desk sergeants and watch commanders think that's a splendid thing. I'm sure your city minders don't miss the wrongful death lawsuits. And I know for goddamned certain (ask me how, I triple dog dare you) that the sonofabitches in the city attorney's office have never criminally prosecuted so much as one intoxicated drunk for any of the literal dozens to hundreds of techs, nurses, or doctors that are assaulted and battered daily and nightly in any place hereabouts, just like they don't statewide, or probably in any state.

And as another monumental douchebag opined in a similar vein, "What difference, at this point, does it make?"

Well Sparky, it means that sooner or later, you or yours is going to come in the door with your wife, or kid, or parent, having a heart attack or stroke (or, if God is just, it'll be you yourself, and better yet, your chief), and I'll just be too busy to get to you right away, because I and ten or twelve of my colleagues, without bulletproof vests, batons, tasers, or pepper spray, are doing the wild hog rodeo with some out-of-control 300-visit-a-year @$$hole that should have been doing six months in county for multiple arrests for intoxication that you never bothered to make, because policy; or because the loss of $500K per offender, year in and year out for this happy horseshit caused staff members to burn out and leave, and budget cuts due to those ongoing financial losses have left filling the job impossible.

And then your kid, your wife, your parent, or you, are going to sit in the waiting room, and maybe even die. Sucks to be you on that day, huh?

Or, long before it gets to that point, some one of you with two wits to rub together, could be proactive, and start taking the repeat offenders off the menu, and let some judge set them to filling potholes in the summer, and shoveling snow in the winter, for six months at a stretch, and while we might see them once in six months, after a couple such bed-and-breakfast arrangements with the county, either they'd decide on another life trajectory, or we'd have the best-maintained roads in decades.

Maybe think about that the next time you're sure we'll have time for you when you crash your unit, or take a bullet fighting crime. It'd be a real shame to find out the last bed in the ED was filled by Roscoe the Sterno Bum, for the 200th time this year so far, a half an hour before you rolled in on a stretcher, wouldn't it?

Think it over, and do the right thing.