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.

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.

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.

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.

Keeper

Subject: New (to me) nursing blog

Title: Florence Is Dead

Instructions:
Go.
Read.
Repeat.

Florence kicks @$$.
Made my day. Added to the Bloglist--->.
MOAR please!

(h/t to Shrtstormtrooper, and her bloglist )