Day's going to come when you've passed your NCLEX, and gotten your first job. Sooner than you think. Once again, congratulations, and welcome to the major league.
If you thought you learned a lot before, try not to get your pants twisted too tight, but you ain't seen nothing yet. You're about to get the biggest education of your life, starting on Day One. It ends when you retire.
All your time in school, your prestigious diploma, and even that shiny new license after passing your boards document to any who care to admire them is that you are, now, certified by the state in which you live to be at least minimally qualified to do basic nursing, to the point that it's highly unlikely you'll kill anyone out of sheer ignorance, 80% of the time. And that's all it means, until you learn a whole lot more.
All three of the little epistles in this series are because all of you really are the future of nursing. I want you to succeed. Despite what you think, or how it may feel on some craptastic days (nights!), especially some in your very-near future, so do about 99% of your colleagues and co-workers.
So continuing in the spirit it's intended, a few final pointers as your embark upon the ultimate learning experience.
STAY FOCUSED
The aim of the exercise is helping people heal.
It's not getting you a bigger paycheck, lots of new friends, a date, a mate, or new toys. It isn't about stroking the doctors' egos, making your charge nurses happy, or being your co-workers' bitch. It's not even about making you better at what you do. All of those things will happen, if you do your part, and over time, more of the good ones than the bad ones. But the main one is that patients come first.
You're going to learn to hold your pee. Yes, literally. You're going to lose sleep, skip meals, stay late. You're going to be frustrated, offended, insulted, belittled, cursed, patronized, accused, and very likely even assaulted. Sometimes, all in the same day. It's a cruel world, and we're working at the nasty end of the stick. You will feel, and sometimes actually be, overwhelmed, helpless, angry, up to your eyeballs in other people's pee, poo, blood, and other body fluids that you'd really rather not care to acquaint yourself with, even by accident.
And you'll still be expected to do your job to the best of your ability, all day, every shift, forever. Welcome to the world of every one of your fellow nurses, and most of your coworkers. This is why it's called work. As Super Chicken reminded Fred, "You knew the job was tough when you took it."
The payoff, when you overcome all those additional hurdles, is that you'll get a lot of the other benefits this job isn't about. Which is still ancillary to the biggest payoff of all: your patients will get better in direct proportion to how well you do your job. And sometimes, they may, on occasion, say "Thank you."
LISTEN
People will bombard you with stuff verbally. Patients, coworkers, supervisors, families, bystanders, and busybodies. So unless you're deaf, it isn't going to be a quiet day, most any day. (And that's probably the last time you'll mention the "Q-word" within sight of your job, unless you want to find a voodoo doll with a remarkable resemblance to you, except full of pins, nailed to the staff lounge bulletin board.)
You're going to have to learn to hear it all, and separate the important stuff from the cacophony of background noise. Including from ringing phones and the callers they bring, overhead pages, dinging clanging buzzing PITA alarms, whining family members, and uncorralled children.
The biggest tip I can give is that when somebody who knows more than you tells you something, pay attention to them. It could be a doctor, another nurse, or the tech who's trying to tell you something. I repeat, pay attention to them. Listen to what they're trying to tell you. Remember that when you're just starting out, everybody knows more than you.
You've doubtless heard the phrase, "Nurses eat their young."
Uh, not so much.
There are a few soulless evil burnt-out bastards out there, and you'll learn who they are.
But mostly, nobody goes out of their way to set you up to fail, unless you go out of your way to ignore them when they try to help. Then, they'll happily watch you get crushed.
Some of them, nurses, doctors, techs, supervisors, patients, family members, and whoever else, have utterly abysmal people-skills, yet still have the patient's well-being and you doing your best well in mind. But every fish in the ocean isn't a shark, and every person you work with isn't a heartless jackhole.
Every one of YOU, however, are utter newbies, so until you aren't one, pay attention to the people who have been where you are, and know.
Grow a thicker skin if need be, and hear what they're saying to you.
ASK
The one time it's okay to run your mouth instead of your ears, when you're new, is asking.
Not questioning adversarially, but asking for information. How to do stuff, where things are, what the procedure is, the protocol, and ten million other things that you didn't have to know as a student. Because now, it's your deal.
A nurse is a computer with legs and arms.
If you're asking things, everyone knows you're thinking.
If you're asking the right things, you're thinking well.
It's also okay to ask for help. There are, of course, some unwritten rules.
Don't ask me to do something you can do yourself.
Don't ask me to give you information you could have gotten without asking. I'll tell you where to find it, and you can go look it up. If I don't know, I'll go with you, and then next time, we'll both know.
Don't ask for someone to do something like start a tough IV, or do an opposite gender cath for patient comfort, without doing something for them while they're busy doing your work.
Don't ask me how to do the same thing three times in the same week. Once is info, twice is reinforcement, and three times is you're an idiot.
Don't ask for help unless you give it at least as freely, if not more so.
Don't ask for information and then ignore it.
I, and we, all of us, want you to be the brightest and best nurse you can be, because we're going to need your help, and no one likes co-workers from the short bus. The only thing better than having a shift full of coworkers from top to bottom on the "A" team, is realizing you're on it, and earned your place there. Work with us, and we'll work with you. Screw us, and we'll screw you. Drag us down, and we'll carry you until you either learn to carry yourself, or we decide it's time to thin the herd. Believe me when I tell you that you don't want to see the bus from the underside.
REFLECT
You may be that one-in-a-million nurse who'll work at the same hospital from now until Social Security kicks in. But probably not. So get used to being the new kid on the first day of school, throughout your career. You'll change shifts, jobs, workplaces, and specialties, pretty much non-stop.
To survive and thrive that level of constant change, you're going to need at least a few people you trust.
You need at least one co-worker who's at your level, to tell you when your perceptions are dead-on, or if you're missing the forest for the trees. You're not everywhere, and neither are they, so other perspectives are going to help you fine tune your radar. And they have to be someone who you know has your back come hell or high water, like you have theirs.
You need someone at work that's older/smarter/more experienced, who you can go to for help, for wisdom and counsel, and to be a big brother/big sister/aunt/uncle. They will save your day, your career, and your sanity. Take your time, but when you think you've got one, hang on to them until hell freezes over, even if you move five states away. (In which case, find another one there, too.)
Have people who don't do anything remotely related to medical care. Someone who's a friend, who can tell you when you're not being you, or when you're in a bad place, bad mood, or bad job, without it being someone you might see at a staff meeting.
And take care of your relationships with significant others, spouses, kids, parents, and the rest of your family. They won't want to hear your awful hospital tales - that's what your co-worker friends are for. (Or, here's an idea, your blog!)
Love your family, be dedicated to your profession, loyal to your friends, a rock to your coworkers and colleagues, and a godsend to your patients.
And enjoy going to work. But don't love your job, because it'll never love you back.
Just get it done right.
You want to get to where work is work, and life outside is life outside. Both are important, for your patients, and your own sanity. Remember, no one's dying words were ever "If only I'd spent more time at work".
Do that, and before you know it, you'll be the one breaking in the rookies, and good at it.
Thursday, May 30, 2013
Wednesday, May 29, 2013
New Grads Pt. II: NCLEX, and getting a job
So now you've finished school, but there's that one last hurdle between being an AAN (Almost A Nurse) and being an RN (Real Nurse): that damned NCLEX.
I'm going to give you the best strategy I know of for dealing with it:
(1) RELAX.
Seriously, just relax. Other than doctors and lawyers, you've just completed a more stressful program and course of knowledge than most people will ever deal with. (Seriously, any whiny undergrads or grad students from other disciplines, sorry, but you come up way short. Why? Because your homework during school didn't scream at you and shit the bed, literally, so spare us your puny protests. There are math geeks, and literature geeks, but there aren't any diarrhea geeks, so just accept your lesser status on this particular totem pole.)
And if you've made it this far, after fighting to pass your pre-reqs, then to get into your program, then to keep your instructors and clinical supervisors off your back and finish all your assignments and pass your tests and classes, you've got game, or they would've shown you the door long ago.
Besides, when you're relaxed, you both learn and perform better, and you're going to need to do both.
(2) LEARN.
Get one of the NCLEX prep manuals. Ideally, one with either a CD for your computer, or a code that lets you access their website, either of which gives you the chance to take sample NCLEX tests for practice and diagnostic purposes.
Take the sample NCLEX before you spend one minute on your manual. They should score you, and tell you where your strong areas are, and your weak areas.
Once you know this, review the NCLEX and your school notes and texts on your WEAK areas. Those are the ones you can improve the easiest, and they may simply be the areas you had the longest ago, and are rusty on. Or you had a crappy instructor for that subject. Or whatever. Just focus on building up your weak areas.
After you think you've done your job studying, retake another sample test, and see how you've evened things out. Lather, rinse, repeat.
By the time you take the actual NCLEX, you'll have done at least a couple of dry runs, so it won't be a shock to you.
(3) Prepare.
The current books tell you the average breakdown of what knowledge areas each test covers, and in what proportions. Get a grasp of that.
They'll also let you know how many questions, minimum and maximum, you'll answer, and how long you have to get it done.
A word on computer-adaptive testing, which hopefully is review for you.
I was going to be one of the last years of nurses that took the bad, evil, miserable old NCLEX: two days - 14 hours, 8 on Day One, and 6 on Day Two, of old-school SAT #2 pencil bubble filling, offered twice a year, en masse, to half the graduates each year, once in February, and once in August. If you booted your attempt, you were thrown back in the waiting pool for six months for another crack.
Now, you can just try again, and take it whenever. There are mandatory waiting periods if you blow it, and max numbers in a given time period, but you can schedule it whenever, and not have to take it with 4000 other students in a giant hall like the Bataan Death March of tests. So be happy you've got it so good.
I (oops) managed to stall after graduation, and thus ended up taking the first round of adaptive tests on computer instead. And it turns out, the results were the same for passing and failing for graduates who took the torture test, or the computer test.
Read what the current NCLEX review tells you, but when it was new, it worked like this: the computer has a bank of questions, from Level A, to B, to C, to D, to F. The first three questions didn't count against you. The computer takes your answers, and based on them, decides which questions to ask. It starts with a C-level question. If you get it right, you get a B-level question. If you get it right, you get A-level. If you get the first one wrong, you get a D-level question. If you get the D-level one wrong, you move to the F-level (nurse retard) questions.
After those first three, you're live. Get a certain minimum number right, cruise along at the A-level, and it stops after something like 70-80 questions, and you aced it! Get the first three, and every other one wrong, and stay on the F-level, and blow a minimum number, and after 70-80 questions, and it shuts off, and you flunk. Bounce along from level B to C to D to C to B to C to D, and it'll keep asking questions until you either climb up and hit enough A and B level questions to pass, or you max out after 200-something, or the max time limit, and you pass. Hit max time/max questions, and stick on the D level, and you fail. Hit it just right, and get enough C-level questions right and max out on questions or time, and you may just squeak by.
Odds are, you'll be zipping through the questions, it'll shut off after the minimum, and you'll know you either aced it or flunked it.
I was astonished when my test shut down after a little over half an hour, because I didn't think I'd gotten them all wrong, but I didn't think I'd gotten them all right.
I aced it.
I talked to a dozen classmates, and we all had the same panic reaction, and we all passed.
Other important points: You may be the person who'll be bouncing along at C level. Manage your time. Figure out how long you have per question for the max number of questions. It should work out to 30-40 seconds per question, worst case. So if you hit a question, don't freeze on it and try to puzzle it out for 10 minutes. It's multiple choice. Read the question carefully. If you can whittle out two obviously wrong answers, you now have a 50-50 blind chance: make your best guess, and move along. 30-40 seconds, in reality, is a looooooong time to think about four answers. Stay relaxed, read the question, understand what answer they're looking for, and pick the most correct answer. Then move on.
You'll probably do just fine.
Some other notes: In Califrutopia at least, your initial nursing license isn't good for 2 years, it's good for up to 2 years. Your license will expire, every time, on the last day of the month, the month after your birthday, every two years, forever.
So, for example, if you were born in July, your license will expire August 31, for your first, second, twelfth, and fifty-second time renewing it. Because that's how it is.
Okay, so who cares?
You. Because if you take your NCLEX in June, your first license will go past two birthdays, and expire August 31st, in thirteen months. If you schedule your NCLEX for August 1st, your first license will also expire after two birthdays, except that'll be twenty-five months. And you'll pay the same price for that first license. And after your first license, you have to start taking CEs. So do you want a license good for a little over 1 year, or a little over 2 years? Duh.
Unless you graduate in June, and your birthday's in January, in which case you don't want to wait 8 months to take your NCLEX. But if your b-day is close after or just before graduation, you oughta to know this. The state won't tell you this, so I just did.
Now, you studied, reviewed, got a good night's sleep the day before the NCLEX, aced it, and got your results. So how do you get hired?
(4) Act like you seriously want a job.
a) Nearly everybody everywhere expects you to have an ACLS card, along with CPR. Get it. If you're going to do peds, or ER, or anywhere kids may be in your patient pool, get a PALS card too. If you'll be dealing with neonates, get NRP.
(You know which you'll need because you already asked around before you graduated, because you seriously want a job.)
b) If there's anything else you need and can get, go do it.
IV/phlebotomy, 12-lead interpretation, Bulgarian sign language, etc.
If I'm the HR person, and you've got the 5 things I know you need, and everybody else has 2 or 3 or 4, all other things being equal, guess who I'm calling back first?
c) Whatever the dominant language in your area is, besides English, learn as much of it as you can. Spanish, Tagalog, Ukranian, whatever.
If you are or can become any level of functional in it, put it on your resume. Don't BS, but if you can stumble through your Tex-Mexican Spanglish enough to do a decent assessment, let them know you can take a stab at it. If you live in NY state, FL, or within 3 states of Mexico, learn Spanish, period. I don't have time to hear how unfair it is to you (it is) or how you wish we could boot them all out (we can't); deal with reality as it is, and learn to do your job better by learning to communicate, and make sure your job applications reflect your abilities.
d) Network like a monkey on crack!
Classmates, instructors, clinical coordinators, every charge nurse you worked for in clinicals, your neighbor's cousin the doctor/nurse/tech/financial clerk/lab tech/paramedic, or whatever. Anybody who can tell you where there might be a job is your new best friend.
e) Tailor resumes for different jobs
If you'd take a job in ortho or med/surg, have resumes for ortho for hospitals with ortho openings, and resumes for med/surg for hospitals with med/surg openings, etc.
f) Get the best job you can
If you can't find what you want, take something else, and be prepared to lateral across when you've made more in-house contacts, and racked up experience. Do a great job where you are, because that supervisor is going to be your new department/hospital's first interview call. Don't sabotage yourself.
And I realize you might be making more in tips serving cocktails, but get a medical job. Show you're serious, and they'll treat you like you are. (You can always pick up waitress gigs or whatever on the side, but a great review from the night manager at TGIFridays isn't going to be worth as much as good referral from the charge nurse where they hired you as a tech while you were waiting to take the NCLEX, right?)
g) Don't give up
I hated the Catch-22 "Can't get hired without experience, can't get experience without getting hired". I also managed to graduate at the one time in 20 years they were firing nurses nationwide instead of hiring them for sign-on bonuses. Many of you now can probably relate to that.
So I papered one entire wall of my apartment with the "Thanks for your interest, we'll keep your resume on file for a year, don't call us, we'll call you" letters. Really, an entire wall. Staying a little cranky amped up my determination to get what I'd worked for. And I got the job I wanted, in the specialty I wanted, with a training program, and without working in 5 specialties I hated while I held out, and did something else in nursing to pay the bills. Tough times don't last, but tough people do. (And 2 years later, when I shopped myself around, I was the one deciding who to call back when they were begging me to take the jobs they were trying to fill. The pendulum swings both ways, sooner or later.)
h) Don't burn bridges
You could get downsized, or need an extra part-time gig, or something perfect may open up somewhere else, or just want a change of scenery. Stay cordial and connected, and the world will always be your oyster.
I'm going to give you the best strategy I know of for dealing with it:
(1) RELAX.
Seriously, just relax. Other than doctors and lawyers, you've just completed a more stressful program and course of knowledge than most people will ever deal with. (Seriously, any whiny undergrads or grad students from other disciplines, sorry, but you come up way short. Why? Because your homework during school didn't scream at you and shit the bed, literally, so spare us your puny protests. There are math geeks, and literature geeks, but there aren't any diarrhea geeks, so just accept your lesser status on this particular totem pole.)
And if you've made it this far, after fighting to pass your pre-reqs, then to get into your program, then to keep your instructors and clinical supervisors off your back and finish all your assignments and pass your tests and classes, you've got game, or they would've shown you the door long ago.
Besides, when you're relaxed, you both learn and perform better, and you're going to need to do both.
(2) LEARN.
Get one of the NCLEX prep manuals. Ideally, one with either a CD for your computer, or a code that lets you access their website, either of which gives you the chance to take sample NCLEX tests for practice and diagnostic purposes.
Take the sample NCLEX before you spend one minute on your manual. They should score you, and tell you where your strong areas are, and your weak areas.
Once you know this, review the NCLEX and your school notes and texts on your WEAK areas. Those are the ones you can improve the easiest, and they may simply be the areas you had the longest ago, and are rusty on. Or you had a crappy instructor for that subject. Or whatever. Just focus on building up your weak areas.
After you think you've done your job studying, retake another sample test, and see how you've evened things out. Lather, rinse, repeat.
By the time you take the actual NCLEX, you'll have done at least a couple of dry runs, so it won't be a shock to you.
(3) Prepare.
The current books tell you the average breakdown of what knowledge areas each test covers, and in what proportions. Get a grasp of that.
They'll also let you know how many questions, minimum and maximum, you'll answer, and how long you have to get it done.
A word on computer-adaptive testing, which hopefully is review for you.
I was going to be one of the last years of nurses that took the bad, evil, miserable old NCLEX: two days - 14 hours, 8 on Day One, and 6 on Day Two, of old-school SAT #2 pencil bubble filling, offered twice a year, en masse, to half the graduates each year, once in February, and once in August. If you booted your attempt, you were thrown back in the waiting pool for six months for another crack.
Now, you can just try again, and take it whenever. There are mandatory waiting periods if you blow it, and max numbers in a given time period, but you can schedule it whenever, and not have to take it with 4000 other students in a giant hall like the Bataan Death March of tests. So be happy you've got it so good.
I (oops) managed to stall after graduation, and thus ended up taking the first round of adaptive tests on computer instead. And it turns out, the results were the same for passing and failing for graduates who took the torture test, or the computer test.
Read what the current NCLEX review tells you, but when it was new, it worked like this: the computer has a bank of questions, from Level A, to B, to C, to D, to F. The first three questions didn't count against you. The computer takes your answers, and based on them, decides which questions to ask. It starts with a C-level question. If you get it right, you get a B-level question. If you get it right, you get A-level. If you get the first one wrong, you get a D-level question. If you get the D-level one wrong, you move to the F-level (nurse retard) questions.
After those first three, you're live. Get a certain minimum number right, cruise along at the A-level, and it stops after something like 70-80 questions, and you aced it! Get the first three, and every other one wrong, and stay on the F-level, and blow a minimum number, and after 70-80 questions, and it shuts off, and you flunk. Bounce along from level B to C to D to C to B to C to D, and it'll keep asking questions until you either climb up and hit enough A and B level questions to pass, or you max out after 200-something, or the max time limit, and you pass. Hit max time/max questions, and stick on the D level, and you fail. Hit it just right, and get enough C-level questions right and max out on questions or time, and you may just squeak by.
Odds are, you'll be zipping through the questions, it'll shut off after the minimum, and you'll know you either aced it or flunked it.
I was astonished when my test shut down after a little over half an hour, because I didn't think I'd gotten them all wrong, but I didn't think I'd gotten them all right.
I aced it.
I talked to a dozen classmates, and we all had the same panic reaction, and we all passed.
Other important points: You may be the person who'll be bouncing along at C level. Manage your time. Figure out how long you have per question for the max number of questions. It should work out to 30-40 seconds per question, worst case. So if you hit a question, don't freeze on it and try to puzzle it out for 10 minutes. It's multiple choice. Read the question carefully. If you can whittle out two obviously wrong answers, you now have a 50-50 blind chance: make your best guess, and move along. 30-40 seconds, in reality, is a looooooong time to think about four answers. Stay relaxed, read the question, understand what answer they're looking for, and pick the most correct answer. Then move on.
You'll probably do just fine.
Some other notes: In Califrutopia at least, your initial nursing license isn't good for 2 years, it's good for up to 2 years. Your license will expire, every time, on the last day of the month, the month after your birthday, every two years, forever.
So, for example, if you were born in July, your license will expire August 31, for your first, second, twelfth, and fifty-second time renewing it. Because that's how it is.
Okay, so who cares?
You. Because if you take your NCLEX in June, your first license will go past two birthdays, and expire August 31st, in thirteen months. If you schedule your NCLEX for August 1st, your first license will also expire after two birthdays, except that'll be twenty-five months. And you'll pay the same price for that first license. And after your first license, you have to start taking CEs. So do you want a license good for a little over 1 year, or a little over 2 years? Duh.
Unless you graduate in June, and your birthday's in January, in which case you don't want to wait 8 months to take your NCLEX. But if your b-day is close after or just before graduation, you oughta to know this. The state won't tell you this, so I just did.
Now, you studied, reviewed, got a good night's sleep the day before the NCLEX, aced it, and got your results. So how do you get hired?
(4) Act like you seriously want a job.
a) Nearly everybody everywhere expects you to have an ACLS card, along with CPR. Get it. If you're going to do peds, or ER, or anywhere kids may be in your patient pool, get a PALS card too. If you'll be dealing with neonates, get NRP.
(You know which you'll need because you already asked around before you graduated, because you seriously want a job.)
b) If there's anything else you need and can get, go do it.
IV/phlebotomy, 12-lead interpretation, Bulgarian sign language, etc.
If I'm the HR person, and you've got the 5 things I know you need, and everybody else has 2 or 3 or 4, all other things being equal, guess who I'm calling back first?
c) Whatever the dominant language in your area is, besides English, learn as much of it as you can. Spanish, Tagalog, Ukranian, whatever.
If you are or can become any level of functional in it, put it on your resume. Don't BS, but if you can stumble through your Tex-Mexican Spanglish enough to do a decent assessment, let them know you can take a stab at it. If you live in NY state, FL, or within 3 states of Mexico, learn Spanish, period. I don't have time to hear how unfair it is to you (it is) or how you wish we could boot them all out (we can't); deal with reality as it is, and learn to do your job better by learning to communicate, and make sure your job applications reflect your abilities.
d) Network like a monkey on crack!
Classmates, instructors, clinical coordinators, every charge nurse you worked for in clinicals, your neighbor's cousin the doctor/nurse/tech/financial clerk/lab tech/paramedic, or whatever. Anybody who can tell you where there might be a job is your new best friend.
e) Tailor resumes for different jobs
If you'd take a job in ortho or med/surg, have resumes for ortho for hospitals with ortho openings, and resumes for med/surg for hospitals with med/surg openings, etc.
f) Get the best job you can
If you can't find what you want, take something else, and be prepared to lateral across when you've made more in-house contacts, and racked up experience. Do a great job where you are, because that supervisor is going to be your new department/hospital's first interview call. Don't sabotage yourself.
And I realize you might be making more in tips serving cocktails, but get a medical job. Show you're serious, and they'll treat you like you are. (You can always pick up waitress gigs or whatever on the side, but a great review from the night manager at TGIFridays isn't going to be worth as much as good referral from the charge nurse where they hired you as a tech while you were waiting to take the NCLEX, right?)
g) Don't give up
I hated the Catch-22 "Can't get hired without experience, can't get experience without getting hired". I also managed to graduate at the one time in 20 years they were firing nurses nationwide instead of hiring them for sign-on bonuses. Many of you now can probably relate to that.
So I papered one entire wall of my apartment with the "Thanks for your interest, we'll keep your resume on file for a year, don't call us, we'll call you" letters. Really, an entire wall. Staying a little cranky amped up my determination to get what I'd worked for. And I got the job I wanted, in the specialty I wanted, with a training program, and without working in 5 specialties I hated while I held out, and did something else in nursing to pay the bills. Tough times don't last, but tough people do. (And 2 years later, when I shopped myself around, I was the one deciding who to call back when they were begging me to take the jobs they were trying to fill. The pendulum swings both ways, sooner or later.)
h) Don't burn bridges
You could get downsized, or need an extra part-time gig, or something perfect may open up somewhere else, or just want a change of scenery. Stay cordial and connected, and the world will always be your oyster.
Tuesday, May 28, 2013
New Grads Pt. I : Commencement
Today's missive, the first of three, is directed at those of you just-minted or imminently about to be so shiny new nurses.
First of all, congratulations on all your hard work. I know what you've gone through, and sacrificed, to get to this point. Pat yourselves on the back. You've definitely earned it.
For those of you not there yet, but approaching your turn: hang in there. Your day will come. And for frick's sake, hurry up! We can use the help!
Those of you about to be spawned as larval nurses, into whatever specialty, are going to need to know some things. Doubtless, you've heard them before, but in case I have any influence anywhere, you need to hear them again.
I titled this "Commencement", because you are at the bare beginning of nursing. In other words, despite a looming appointment with the NCLEX, and 2-4 years or more of pre-reqs, classes, clinicals, and drinking from a firehose of medical knowledge pointed at you since you began, in terms of your lifespan as a nurse, you're only now just coming out of your cocoon.
I can't tell you how many times I heard from older, experienced nurses, how long it would take me to know what the hell I was doing, and I would struggle to express how much it sincerely and royally pissed me off when they did that, but I can tell you all right now exactly how many times each incident pissed me off: that would be "twice".
Once when they told me so, and once when I found out they were right.
It really blows, IMHO, that we build up so much into getting potential nurses amped up about graduation. To me, it's like if we told Olympic high divers that the biggest day was the day they got to climb onto the ladder.
Because really, despite how much time, and mental and physical energy you've invested to get to where you are, that's where you are. You've studied the physics of diving, played on the trampoline, memorized the moves, done your exercises, splashed around in the shallow end of the pool with a lifeguard or ten nearby, but that's really all it amounts to.
You don't really learn how to do high dives until you jump off the board, and start doing the moves yourself.
You don't learn how to be a nurse until you jump off the board, and start doing the moves yourself either.
And from that first jump, if you pay attention to what you've been taught, and what you learn in the next few months, in order to actually start doing what you've set out to do, it's going to take every one of you, on average, at least one solid full-time year, and as much as two years, on your own, to be fully what you think of when you think of nurse.
If you aren't palm-sweaty scared shitless about that prospect, somewhere inside, whether you talk about it or not, you're a moron. Fear of screwing up, of killing your patient, or harming them, or just being a crap-headed idiot, is healthy, to a point. The point when it isn't is when it so rules your every waking thought that you can't function. Don't be that person.
But, as my brethren of the military persuasion say, "Embrace the suck". You're going to get help, and precepting, and watched, and managed. Some very well, and some of you, criminally poorly. I can't help you with that, because life isn't fair.
But even if you get the best preceptors in the world, who make sure you're competent at everything, and you check every box on every training sheet for everything they want you to know, they're all, sooner or later, going to reach the decision that it's time to push you out of the nest, and make you take a crack at flying on your own. And it's going to make you sweat, palpitate, hyperventilate, and maybe even shake and spaz out.
Welcome to the club.
If you aren't uncomfortable with what you're doing, you aren't learning anything. And for your first year-plus, you're going to be a sponge. And it's going to be just as hard on Day Two, and Day Twelve, and Day Two Hundred and Forty Three. Some of you may not make it past that. You'll quit. I wish you the best of luck with your future endeavors. And I really mean that. Think it over long and carefully beforehand, but if that's the answer, you have to make the right decision.
Some of you will decide, despite all you've endured, that nursing isn't what you want to do. To you, I want you to know something: if you really know that's true, and you get out of nursing, you are some of the bravest people I've ever met, and I salute you. And I mean that with every fiber of my being. I know what making that choice will cost you, but please believe me when I say that you're saving lives by making that choice, and saving your own soul. The people who stay in nursing long after they should have moved on are the biggest problem in the profession, bar none. Take what you've learned, and put it to good use somewhere else, and remember the people you learned with and worked with, and go with all my blessings. If you don't want to do this job, there's no paycheck on the planet that will ever keep you from being a bitter, miserable, pitiful excuse for a human being, and by not staying you're saving yourself, your coworkers, and your patients from ever having to deal with your evil twin. Vaya con Dios!
But most of you, the vast majority, will get through the tough times at the beginning, and the seemingly endless days (or, let's get serious newbies, nights) and somewhere down the road, you're going to wake up for your shift, and somewhere between rolling out of bed, putting on your scrubs, driving in, or getting report, you're going to realize, "Hey, after last week, there's nothing I can't deal with. I don't know it all, but I've got this!"
You're still going to be learning stuff, and you may occasionally get dropped in the deep end and be dog-paddling yourself to exhaustion, but you aren't going to wake up thinking you're going to wet your pants at work anymore, or wondering whether your co-workers will discover you're just a poser.
But the first step on your new journey, is coming to grips with the reality of that truth.
You, your instructors, your textbooks, and all the work you put into sucking the last drop of knowledge out them all, haven't made you, on this occasion, Nurse Badass.
But you've worked hard, you've trained hard, and you've learned well. You're like all those guys in the landing craft on D-Day, headed for a distant shore, as prepared as anyone could make you to that point, but there comes a point where the only thing to do for you is put you on the boats and head in.
So enjoy your graduation events, have fun as your family and friends hold their celebrations, and look forward with some pride at the paychecks you're about to get, because believe me when I tell you, you're going to earn every penny, every day.
And start psyching yourself up, because very very soon, it's time to hit the beach.
First of all, congratulations on all your hard work. I know what you've gone through, and sacrificed, to get to this point. Pat yourselves on the back. You've definitely earned it.
For those of you not there yet, but approaching your turn: hang in there. Your day will come. And for frick's sake, hurry up! We can use the help!
Those of you about to be spawned as larval nurses, into whatever specialty, are going to need to know some things. Doubtless, you've heard them before, but in case I have any influence anywhere, you need to hear them again.
I titled this "Commencement", because you are at the bare beginning of nursing. In other words, despite a looming appointment with the NCLEX, and 2-4 years or more of pre-reqs, classes, clinicals, and drinking from a firehose of medical knowledge pointed at you since you began, in terms of your lifespan as a nurse, you're only now just coming out of your cocoon.
I can't tell you how many times I heard from older, experienced nurses, how long it would take me to know what the hell I was doing, and I would struggle to express how much it sincerely and royally pissed me off when they did that, but I can tell you all right now exactly how many times each incident pissed me off: that would be "twice".
Once when they told me so, and once when I found out they were right.
It really blows, IMHO, that we build up so much into getting potential nurses amped up about graduation. To me, it's like if we told Olympic high divers that the biggest day was the day they got to climb onto the ladder.
Because really, despite how much time, and mental and physical energy you've invested to get to where you are, that's where you are. You've studied the physics of diving, played on the trampoline, memorized the moves, done your exercises, splashed around in the shallow end of the pool with a lifeguard or ten nearby, but that's really all it amounts to.
You don't really learn how to do high dives until you jump off the board, and start doing the moves yourself.
You don't learn how to be a nurse until you jump off the board, and start doing the moves yourself either.
And from that first jump, if you pay attention to what you've been taught, and what you learn in the next few months, in order to actually start doing what you've set out to do, it's going to take every one of you, on average, at least one solid full-time year, and as much as two years, on your own, to be fully what you think of when you think of nurse.
If you aren't palm-sweaty scared shitless about that prospect, somewhere inside, whether you talk about it or not, you're a moron. Fear of screwing up, of killing your patient, or harming them, or just being a crap-headed idiot, is healthy, to a point. The point when it isn't is when it so rules your every waking thought that you can't function. Don't be that person.
But, as my brethren of the military persuasion say, "Embrace the suck". You're going to get help, and precepting, and watched, and managed. Some very well, and some of you, criminally poorly. I can't help you with that, because life isn't fair.
But even if you get the best preceptors in the world, who make sure you're competent at everything, and you check every box on every training sheet for everything they want you to know, they're all, sooner or later, going to reach the decision that it's time to push you out of the nest, and make you take a crack at flying on your own. And it's going to make you sweat, palpitate, hyperventilate, and maybe even shake and spaz out.
Welcome to the club.
If you aren't uncomfortable with what you're doing, you aren't learning anything. And for your first year-plus, you're going to be a sponge. And it's going to be just as hard on Day Two, and Day Twelve, and Day Two Hundred and Forty Three. Some of you may not make it past that. You'll quit. I wish you the best of luck with your future endeavors. And I really mean that. Think it over long and carefully beforehand, but if that's the answer, you have to make the right decision.
Some of you will decide, despite all you've endured, that nursing isn't what you want to do. To you, I want you to know something: if you really know that's true, and you get out of nursing, you are some of the bravest people I've ever met, and I salute you. And I mean that with every fiber of my being. I know what making that choice will cost you, but please believe me when I say that you're saving lives by making that choice, and saving your own soul. The people who stay in nursing long after they should have moved on are the biggest problem in the profession, bar none. Take what you've learned, and put it to good use somewhere else, and remember the people you learned with and worked with, and go with all my blessings. If you don't want to do this job, there's no paycheck on the planet that will ever keep you from being a bitter, miserable, pitiful excuse for a human being, and by not staying you're saving yourself, your coworkers, and your patients from ever having to deal with your evil twin. Vaya con Dios!
But most of you, the vast majority, will get through the tough times at the beginning, and the seemingly endless days (or, let's get serious newbies, nights) and somewhere down the road, you're going to wake up for your shift, and somewhere between rolling out of bed, putting on your scrubs, driving in, or getting report, you're going to realize, "Hey, after last week, there's nothing I can't deal with. I don't know it all, but I've got this!"
You're still going to be learning stuff, and you may occasionally get dropped in the deep end and be dog-paddling yourself to exhaustion, but you aren't going to wake up thinking you're going to wet your pants at work anymore, or wondering whether your co-workers will discover you're just a poser.
But the first step on your new journey, is coming to grips with the reality of that truth.
You, your instructors, your textbooks, and all the work you put into sucking the last drop of knowledge out them all, haven't made you, on this occasion, Nurse Badass.
But you've worked hard, you've trained hard, and you've learned well. You're like all those guys in the landing craft on D-Day, headed for a distant shore, as prepared as anyone could make you to that point, but there comes a point where the only thing to do for you is put you on the boats and head in.
So enjoy your graduation events, have fun as your family and friends hold their celebrations, and look forward with some pride at the paychecks you're about to get, because believe me when I tell you, you're going to earn every penny, every day.
And start psyching yourself up, because very very soon, it's time to hit the beach.
Sunday, May 26, 2013
Diagnosis Of the Week
Here you are, 24/7/365.
What you have is a shiny, red, painful, growing-like-a-goldfish-in-a-Doctor-Seuss-story bump, somewhere on your body. Your neck, arm, armpit, or some less public region.
What you think you have is how you sign in: "Spider bite".
What the doctor will tell you have is an "Abscess".
Thus, the correct diagnosis can only be "MRSA Spider bite".
Regular spider bites are relatively fairly rare.
For the entomologically tutored, the only venoumous spiders on the North American continent at least, are two:
Black Widows (lactrodectus mactans), and
Brown Recluses (loxosceles reclusa).
So unless you physically sighted one of the two above-named species at the scene of the crime, tiptoeing off with a guilty look on his or her multi-eyed face, and furthermore have, now and in your body, the signs and symptoms of insectoid envenomization with arachnid neurotoxin, please, stop blaming your little problems on spiders.
MRSA, carried not by the imaginary MRSA Spider, on the other hand, is a particularly disease-resistant strain of the bacterium Staph aureus, which someone you've come into contact with has given to or deposited upon you, and which may even now have colonized your body. We know this because you've been seen here for three other "spider bites" in the last six months. Laymen not medically trained often refer to this little factoid as a "clue", not a license to impugn the motives and culpability of every arachnoid in your world.
There's a way around this. Actually several.
1) Wash your nasty ass, ideally daily, and using not only fairly warm water, but also a decent scrub brush or cloth, and any number of personal hygiene products hitherto strange to you, most specifically soap. Lather, rinse, repeat.
2) Encourage the unheard of approach of similar behavior amongst your spawn, your clan, and your significant others.
3) Get a prescription for the antibiotics to kill the MRSA, and actually follow the directions and take the pills, on schedule, until they're all finished. I know how hard this is, but make an effort.
4) Do the same for every one of your spawn, clan, and significant others who have a similar history of recurrent "spider bites".
5) Scour your nasty hovel, with any number of bacteriocidic products, like Lysol, Pinesol, etc. Going as far as to actually burn your shanty to the ground is a bit extreme, but as I haven't seen your living conditions, I'm not going to rule it out immediately, sight unseen. Desperate circumstances may indeed demand desperate measures.
6) While you're at it, avail yourself of such radical notions as sweeping, vacuuming, throwing away garbage, and killing all bugs, rodents, and other vermin in your hovel. Clean out the places they live, and deprive them of the food they eat.
I know how hard it is to not live like a hobo in a third world roach motel, but think of it this way: an hour with a mop and a bucket of warm water, followed by a long hot shower, hurts a lot less than having our P.A. slash into that big nasty welt on your butt and dig around to get all the pus out. Your efforts, unlike ours, won't usually make you let out blood-curdling screams, and housework seldom, if ever, leaves lasting scars. Unlike an I&D.
It's your hide, and so is the choice.
But the needles and scalpels are all us, baby.
What you have is a shiny, red, painful, growing-like-a-goldfish-in-a-Doctor-Seuss-story bump, somewhere on your body. Your neck, arm, armpit, or some less public region.
What you think you have is how you sign in: "Spider bite".
What the doctor will tell you have is an "Abscess".
Thus, the correct diagnosis can only be "MRSA Spider bite".
Regular spider bites are relatively fairly rare.
For the entomologically tutored, the only venoumous spiders on the North American continent at least, are two:
Black Widows (lactrodectus mactans), and
Brown Recluses (loxosceles reclusa).
So unless you physically sighted one of the two above-named species at the scene of the crime, tiptoeing off with a guilty look on his or her multi-eyed face, and furthermore have, now and in your body, the signs and symptoms of insectoid envenomization with arachnid neurotoxin, please, stop blaming your little problems on spiders.
MRSA, carried not by the imaginary MRSA Spider, on the other hand, is a particularly disease-resistant strain of the bacterium Staph aureus, which someone you've come into contact with has given to or deposited upon you, and which may even now have colonized your body. We know this because you've been seen here for three other "spider bites" in the last six months. Laymen not medically trained often refer to this little factoid as a "clue", not a license to impugn the motives and culpability of every arachnoid in your world.
There's a way around this. Actually several.
1) Wash your nasty ass, ideally daily, and using not only fairly warm water, but also a decent scrub brush or cloth, and any number of personal hygiene products hitherto strange to you, most specifically soap. Lather, rinse, repeat.
2) Encourage the unheard of approach of similar behavior amongst your spawn, your clan, and your significant others.
3) Get a prescription for the antibiotics to kill the MRSA, and actually follow the directions and take the pills, on schedule, until they're all finished. I know how hard this is, but make an effort.
4) Do the same for every one of your spawn, clan, and significant others who have a similar history of recurrent "spider bites".
5) Scour your nasty hovel, with any number of bacteriocidic products, like Lysol, Pinesol, etc. Going as far as to actually burn your shanty to the ground is a bit extreme, but as I haven't seen your living conditions, I'm not going to rule it out immediately, sight unseen. Desperate circumstances may indeed demand desperate measures.
6) While you're at it, avail yourself of such radical notions as sweeping, vacuuming, throwing away garbage, and killing all bugs, rodents, and other vermin in your hovel. Clean out the places they live, and deprive them of the food they eat.
I know how hard it is to not live like a hobo in a third world roach motel, but think of it this way: an hour with a mop and a bucket of warm water, followed by a long hot shower, hurts a lot less than having our P.A. slash into that big nasty welt on your butt and dig around to get all the pus out. Your efforts, unlike ours, won't usually make you let out blood-curdling screams, and housework seldom, if ever, leaves lasting scars. Unlike an I&D.
It's your hide, and so is the choice.
But the needles and scalpels are all us, baby.
Monday, May 13, 2013
Mrs. Brown
Believe it when I tell you that when your pending ambulance run patient is preceded to the ER by a waiting police officer, it isn't going to be a good thing.
And police officers, not frequently given to exaggeration, will seldom capture the full magnitude of the situation with the short form of the story. Only the pain of actual experience will bring appreciation to you like the dawning of the sun. And by then, it's too late to run away. With years of experience, I've worked it out. And sometimes, I still wish I'd tried to run.
Mrs. Brown was absolutely one of those times.
Officer Taciturn's opening line, before her arrival, was attention-getting in its own right:
"When I opened the driver's door, the funk wave drove me back, and nearly knocked me unconscious."
And no, he wasn't referring to her George Clinton CD.
Then he backed up.
"I pulled her over when she blew through a red light. She was pulling out of a drive-through fast food place. So when I got up to the car, I was totally unprepared for the experience. She didn't have a license or registration. But she'd been living in her car for, she said, three years. Apparently, without leaving the driver's seat ever in that time. I mean living in her car."
Which was apparently the cue for the paramedics to arrive, along with a light task force, all eight of them maneuvering 500 pounds of woman into the ER, and to my open room.
I couldn't tell much about her, because they'd wrapped her in two of the big vinyl/Tyvek yellow hazmat patient blankets, and a couple of them were taking hits of air off their SCBAs as they trundled her along.
I can say that the wave of miasma emanating from her gurney cleared a path from the door to my zone.
The firefighters tenderly shifted her off the backboards they'd used, and slid the entire delivery onto our bed, with touching delicacy.
Then I found out it was because they didn't want to disturb any of the...contents, of the package.
The lead paramedic, a gentleman of long acquaintance, apologized for bringing her to us, and specifically to me. "I'm really sorry guy, but here she is. Mrs. Brown, chief complaint of sitting in her car for three years, unable to walk, and sitting in, as best as we could determine, over three years of fast food wrappers and mounded feces. Her welfare checks and whathaveyou are apparently direct deposit, and she goes to the only full-service gas station for miles to fill the tank, and eats every fast food drive up on the planet, so she never has to get out of the car. We would've done a more thorough exam, but she's AOX4, and our eyes were burning out of their sockets, so we just loaded her up and came in, once we got the extra help."
"Don't feel too bad, bud," chimed in Officer Taciturn, "the guys at the Impound Yard still have to inventory the vehicle contents. They're going to die when they see inside her car."
My tech came out, the patient's arms being accessible for BP and other vital signs. He was on the verge of launching his dinner, and excused himself quickly with the muttered benediction "Good luck!"
"Hey Maverick, what was that truck-driving school on TV? Truckmaster?"
I proactively gowned up, face-shielded up, and mentally made my peace with God before entering to do a head-to-toe physical assessment. She did, in fact, have toes, somewhere, in what can only be described as pounds and pounds of her own compost.
The doc, sight unseen, ordered baseline labs and a 12-lead EKG, which I drew. Then I started marshaling my resources for the inevitable decontamination this was going to require while the EKG tech had her turn in the pit.
The charge nurse, in a fabulously understanding act of compassion, discharged one of my patients for me, and moved the others to nurses with other assignments. And our chest pain nurse for the evening was underutilized, and rather than ducking it, selflessly elected to help me on my mission. Usually you don't see that kind of bravery outside of combat.
We arranged piles of towels, washcloths, and basins, and a separate linen and trash bin apiece, and made a deal with the tech I shared: he could stay outside, as long as he brought us all the basins of warm water we requested, until we finished. He said "Deal!" so fast I almost made sure I'd heard him by asking him to repeat it. Too late, because he'd already scampered off to the utility sink with a cart and half a box of empty wash basins. Normally I never delegate "Code Browns" to techs, but I will share them. But clearly, this wasn't normally. Now there was nothing left for it but wait for the chest pain nurse to gown up with me, and head back inside.
Into the Valley of Death rode the six hundred. Or actually, the two.
What made the most sense was to start at the head and work down each side to the knees, then do the other side, and finally tackle the lower legs and feet. I'm not Catholic, but if purgatory exists, the CP nurse and I each worked off at least twenty years' apiece for what we suffered during the next hour. We washed, rinsed, soaked, scrubbed, scraped, and chiseled excrement off that lady, from places on the human body I didn't think you could get poop into, until she was as clean as human hands could make her. We piled the discards, the original sheets, her shreds of clothes, and anything else into not the laundry hamper, but the hazmat burn bags.
Then had three different custodians and the night maintenance supervisor bring all the room freshener they could get. Each one questioned us in turn before entering, then went in, then wordlessly emerged and went straight to the wallphone to ask for more backup, which is how the super ended up showing up with a case of the stuff, and additional cleaning supplies.
Over an hour later, during which time happily nothing more serious showed up (or it did, but no one, and I mean no one, was going to disturb us for something as petty as a mere Code Blue), like the man in The Rime of the Ancient Mariner we emerged, sadder but wiser. And shortly afterwards, so did Mrs. Brown, smelling the closest to roses she had in three years, complete with sores and abscesses, but no longer encrusted to the hips in her own filth.
Report to the floor was a special treat, and the ward charge nurse brought us candy after they saw what they got, versus what they expected.
And yeah, it happened during Nurse Week of that particular year, too.
Tell me again what a wonderful, easy job we have, and that fabulous pay for what we have to do.
And police officers, not frequently given to exaggeration, will seldom capture the full magnitude of the situation with the short form of the story. Only the pain of actual experience will bring appreciation to you like the dawning of the sun. And by then, it's too late to run away. With years of experience, I've worked it out. And sometimes, I still wish I'd tried to run.
Mrs. Brown was absolutely one of those times.
Officer Taciturn's opening line, before her arrival, was attention-getting in its own right:
"When I opened the driver's door, the funk wave drove me back, and nearly knocked me unconscious."
And no, he wasn't referring to her George Clinton CD.
Then he backed up.
"I pulled her over when she blew through a red light. She was pulling out of a drive-through fast food place. So when I got up to the car, I was totally unprepared for the experience. She didn't have a license or registration. But she'd been living in her car for, she said, three years. Apparently, without leaving the driver's seat ever in that time. I mean living in her car."
Which was apparently the cue for the paramedics to arrive, along with a light task force, all eight of them maneuvering 500 pounds of woman into the ER, and to my open room.
I couldn't tell much about her, because they'd wrapped her in two of the big vinyl/Tyvek yellow hazmat patient blankets, and a couple of them were taking hits of air off their SCBAs as they trundled her along.
I can say that the wave of miasma emanating from her gurney cleared a path from the door to my zone.
The firefighters tenderly shifted her off the backboards they'd used, and slid the entire delivery onto our bed, with touching delicacy.
Then I found out it was because they didn't want to disturb any of the...contents, of the package.
The lead paramedic, a gentleman of long acquaintance, apologized for bringing her to us, and specifically to me. "I'm really sorry guy, but here she is. Mrs. Brown, chief complaint of sitting in her car for three years, unable to walk, and sitting in, as best as we could determine, over three years of fast food wrappers and mounded feces. Her welfare checks and whathaveyou are apparently direct deposit, and she goes to the only full-service gas station for miles to fill the tank, and eats every fast food drive up on the planet, so she never has to get out of the car. We would've done a more thorough exam, but she's AOX4, and our eyes were burning out of their sockets, so we just loaded her up and came in, once we got the extra help."
"Don't feel too bad, bud," chimed in Officer Taciturn, "the guys at the Impound Yard still have to inventory the vehicle contents. They're going to die when they see inside her car."
My tech came out, the patient's arms being accessible for BP and other vital signs. He was on the verge of launching his dinner, and excused himself quickly with the muttered benediction "Good luck!"
"Hey Maverick, what was that truck-driving school on TV? Truckmaster?"
I proactively gowned up, face-shielded up, and mentally made my peace with God before entering to do a head-to-toe physical assessment. She did, in fact, have toes, somewhere, in what can only be described as pounds and pounds of her own compost.
The doc, sight unseen, ordered baseline labs and a 12-lead EKG, which I drew. Then I started marshaling my resources for the inevitable decontamination this was going to require while the EKG tech had her turn in the pit.
The charge nurse, in a fabulously understanding act of compassion, discharged one of my patients for me, and moved the others to nurses with other assignments. And our chest pain nurse for the evening was underutilized, and rather than ducking it, selflessly elected to help me on my mission. Usually you don't see that kind of bravery outside of combat.
We arranged piles of towels, washcloths, and basins, and a separate linen and trash bin apiece, and made a deal with the tech I shared: he could stay outside, as long as he brought us all the basins of warm water we requested, until we finished. He said "Deal!" so fast I almost made sure I'd heard him by asking him to repeat it. Too late, because he'd already scampered off to the utility sink with a cart and half a box of empty wash basins. Normally I never delegate "Code Browns" to techs, but I will share them. But clearly, this wasn't normally. Now there was nothing left for it but wait for the chest pain nurse to gown up with me, and head back inside.
Into the Valley of Death rode the six hundred. Or actually, the two.
What made the most sense was to start at the head and work down each side to the knees, then do the other side, and finally tackle the lower legs and feet. I'm not Catholic, but if purgatory exists, the CP nurse and I each worked off at least twenty years' apiece for what we suffered during the next hour. We washed, rinsed, soaked, scrubbed, scraped, and chiseled excrement off that lady, from places on the human body I didn't think you could get poop into, until she was as clean as human hands could make her. We piled the discards, the original sheets, her shreds of clothes, and anything else into not the laundry hamper, but the hazmat burn bags.
Then had three different custodians and the night maintenance supervisor bring all the room freshener they could get. Each one questioned us in turn before entering, then went in, then wordlessly emerged and went straight to the wallphone to ask for more backup, which is how the super ended up showing up with a case of the stuff, and additional cleaning supplies.
Over an hour later, during which time happily nothing more serious showed up (or it did, but no one, and I mean no one, was going to disturb us for something as petty as a mere Code Blue), like the man in The Rime of the Ancient Mariner we emerged, sadder but wiser. And shortly afterwards, so did Mrs. Brown, smelling the closest to roses she had in three years, complete with sores and abscesses, but no longer encrusted to the hips in her own filth.
Report to the floor was a special treat, and the ward charge nurse brought us candy after they saw what they got, versus what they expected.
And yeah, it happened during Nurse Week of that particular year, too.
Tell me again what a wonderful, easy job we have, and that fabulous pay for what we have to do.
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