The Republican candidate....

Gotta say, McCain is not impressing me by asking Big Pharma and Big Insurance to do all it can to reduce health care costs for the average America citizen.



Really, Senator McCain? Come on. Really?

Does that BSN really matter?

My hospital got new name badges printed this week. I work for a big hospital system.

I do not yet have my CCRN certification, but I do have my BSN. I want my name on my name badge to read: JustCallMeJo, RN, BSN

I was assured that this would be the case. It's not. When my colleagues and I received our new name badges, we were all just RN. Nobody's certifications, nobody's educational degrees (and a handful of us in the ICU are master's prepared, too.) (Yes, bedside nurses with master's degrees. Smart practitioners who actually want to take direct care of patients. Whaddya know.)

I emailed the CNO. I was hot. My CNO is doctoral prepared. I said I hoped they'd gotten her badge right; and that I'm sure that I'm preaching to the choir on this issue, will you please fix it? I'm only asking for ONE of my bachelor's degrees to be printed on the badge. Just three letters, not six.

My CNO told me and the rest of Nurse Practice Council on Monday that certifications will be printed, not educational degrees. I thanked her for responding to my concerns first. Then I asked why. "Because with the font size, the names will be too small."

Now she knows as well as I do that the pompous Hospital Mission Statement is printed in fine-ish (9 point) print on every single fscking name badge.

But the font would be too small if 'BSN' or 'BSN, MSN' were added.

Because. The font would be too small.




....

Ask me, now, why I don't trust upper management? Why I don't think they have any CLUE what is important to me as a clinician?

I am simply....RN. A nurse is a nurse is a nurse, right?




Take your Magnet and cram it with a Flexiseal.

p.s. And why the hell do the exam certifications get the corrected dispensation and the 4- or 6- degrees do not?

I'm back.

Hi all (if anybody's out there). I'd taken a bit of a hiatus from blogging over here on Sinus. Some life stuff was more important. You understand.

But I'm back. I've fixed some broken links to other bloggers who've had life take precedence over blogging, and have found some bloggers new to me that I'd like to add to my blogroll.

I also am looking for recommendations on a blog reader that people like. I think I'd blog more, read more, if I didn't need to click everywhere and forget to bounce to other places I like to read. Suggestions, anyone? (Assuming there isn't a big fat echo out there....which is likely....)

/jo

Beer does this.

Dear patient,

Your husband wanted to take a picture of this room today.

What would that photo have showed? You are lying in a hospital bed, with your wrists tied down. Pillows are stuffed under your back because I turn you side to side all night.

There is a blue tube as thick as my middle finger down your throat. It is connected to a machine, 4 feet tall, that breathes for you. From those tubes are two very fat tubes, a white one and a blue one. For air going in and air coming out. Also, a thin wire attaches to the knot at the end of your endotracheal tube and goes to the monitor, so that I can watch numbers that are relevant to keeping your body's pH balance stable.





You have five electrodes attached to your chest, which is attached then to a tv screen over your bed. It shows me your heart rate and rhythm. Another cord goes to the blood pressure cuff on your arm.

You have a thin tube down your nose. This tube goes into your intestine, and comes up and out and is connected to a small pump, which is connected to large bags that are giving you amino acids and sugars. The box tells me that it has milk proteins, sunflower oil, medium chain triglycerides, cellulose gel (insert 34 other chemical substances), and corn syrup and vanilla flavoring. It smells like soymilk with fake vanilla sweeter. Which, I suppose it almost is.



There is a much larger tube going down your throat and into your stomach (you have two tubes in your mouth, see). This one is suctioning out the acid. Green crap is coming out intermittently.

You have a foley catheter in your bladder.










There are two photographs here of the same thing because you needed all six loaded with different medications, programmed differently by med, by how that med is measured (mcg/kg/min and ml/hr and units/hr, etc).
You have an iv line with what we call a "chicken foot" on it. That means we don't have enough iv ports for all the meds you need. I am pumping phosphate, magnesium, heparin (a blood thinner), and an ungodly amount of sedation and pain medication.

You also have a gigantic 2-tube catheter going into your jugular. EACH of the two is almost the diameter of my pen. One of those tubes is slurping all your blood into it and pulling it into a dialysis machine larger than my dishwasher, but smaller than my fridge. This is scrubbing your blood with acid and base baths, respectively. The waste is going through several pipes thick as my big toe (all of them), and dumping it through that huge port in the wall. God only knows where it goes there.

This dialysis machine requires that I count every milliliter of fluid I am pumping into you (however it gets there), and every milliliter that I take out to try and meet the goal of fluid we're trying to take out. Every hour on the dot I flush this machine with saline so that you don't throw a blood clot and the machine doesn't clot off.

You require constant 1 to 1 care of an ACLS-certified specialty trained registered nurse 24 hours a day. And I do mean every moment of the day. There are exactly three nurses on this floor right now who are able to relieve me when I need to go to the bathroom. I eat here, at my computer on wheels. Lucky for me you have no cooties.


This is the type of clinical needs you have. You may be independently wealthy, I don't know. ICU nurses don't come cheap. Let's not even mention the drugs you're receiving. Drugs, narcotics, sedatives I am dumping into your veins like they're on sale. Or even just having a bed here on the unit. Or the three MD groups following your case. That little foley catheter costs fifty bucks.

Every four hours, I draw blood from you (from one of the several tubes), send it to the lab, and based on the results, adjust your medications. I constantly evaluate your heart rhythm and blood pressure, which has a habit of tanking. I keep your mechanical kidney working properly, and I sit here at your bedside because if those fat tubes disconnect for any reason, you can exsanguinate in a matter of 5 seconds unless someone is here to stop it. But don't worry. I have three huge clamps, several emergency meds, an ambu bag, two additional suction tubes all in neat piles in various places in this room in case you need it.

Tonight, I also plan to give you a bath. Your hair's in a braid (well...dreadlock), and I will try to attend to that, too. I can't lower your head to wash your hair or you'll aspirate the tube feeding and potentially pop a lung. But we'll see how creative I can get with the hairwashing. You outweigh me by 75 lbs. And as you went into respiratory failure, you were fighting the nurses and no less than seven RNs (three of them men) had to hold you down so that we could maintain an airway for you. You kept trying to yank everything out. You would have died without that tube. So I'm sorry about the restraints, but they're stayin.

The irony is that you came in with a bellyache to the ED a week ago. What they found is that you have a disease caused by alcohol. It will take months for you to get over this disease. It will be painful. I have never seen a patient with this disease not leave the hospital setting without an Oxycontin addiction that an MD manages with the patient. Be honest with whoever that MD is, by the way. It'll go better.

Your husband asked me if you'd remember "any of this." I assured him, no that, I'm doing everything I can to keep you out of pain and oblivious to this horror we're doing to you. But then he thought about it, and thought maybe he should take a picture to get you to stop drinkin, or at least 'cut down', cos some alcohol is worse than others, right?

No, sir. Alcoholics cannot 'cut down'. There is stop and there is off the wagon, period. She cannot ever drink anything again. And alcohol is alcohol. "But sometimes she only drinks beer." Beer is alcohol. Beer does this. Many alcoholics eventually maintain their alcoholism with Nyquil, sir. It makes no difference.

Patient, since I can't take an actual picture of you, I painted you a word picture.

So you should know, dear patient. Beer did this to you. Beer killed you, except that some doctors and nurses brought you back. To this snapshot.

Your nurse,
/jo

This photo is obviously not my patient. But I see ventilators, CRRT, monitors, an NG tube and some fluids running. The only thing missing are the two triple channels. So, patient? You looked a lot like this.

Go read this:

The Happy Hospitalist took a picture worth 1000 words.

What I'm sure you canNOT see in that picture is the ventilator, and possibly the CRRT machine and monitors which are probably on the right.

Welcome to ICU in America.

Crazy old bat stole my car keys.

The other day, some crazy old bat stole my keys. My housekeys, carkeys. Fortunately for me, I have a spare flat carkey in my wallet and my sister's got a copy of my housekeys.

How do I know she stole them? I don't for sure. I can tell you what happened, though.

I know that this crazy woman had to be tied down by yours truly to prevent her from ripping out two fat flank chest tubes, her peripheral iv, and her epidural catheter. She scratched me up. As I tried to get her changed out of her bloody hospital gown and into a clean one, I and my charge RN, Rita had to restrain her from crawlin out of bed naked and screaming. We got the blood cleaned up, the chest tube dressing reinforced, and her body and then eventually her hands tied down so she'd quit yankin on stuff placed for good reason into her body.

I know she tried to take the epidural keys, which I'd set on the bed as I fiddled with changing the epidural med (to something less likely to make her barking mad and paranoid). I noticed and asked, What are you doing? I don't think I listened to the answer, I just took the keys back out of where she was trying to bury them.

My keys were found two days later in the laundry bag. The laundry bags that are changed qshift. The ones that, had the keys been in there originally because I may have accidentally dropped them there, would have been either found on my shift or sent to the facility laundry several days ago, when I actually took care of the patient. But they were found yesterday by housekeeping. In the laundry basket. Nobody knows how they got there, two days after I'd lost them. One of my very kind and considerate colleagues locked them up in her locker.

Crazy ol bat.

I know I'm supposed to feel this well of compassion for this frail elderly woman who is medically complex, and confused, and going through a great deal of mental anguish not to mention that chest tubes HURT. I recall the moments when she said, after begging me to untie her, and me explaining it is not safe for her to do so...."I'm very disappointed in my daughter that she's allowing this to happen to me." It genuinely broke my heart. That frail old woman was absolutely aware that I'd tied her down; she felt shame and humiliation and at that moment, absolutely blamed her daughter for it. And she was disappointed. She was incapable of cognitively reasoning that she cannot pull out the tubes lodged into her chest, because she was utterly convinced that we were trying to kill her. At least, that's what the police officer said when he called the unit to tell us a Mrs. So and So had called 911 on us. (Thank you, Officer, no. Yes. I'll keep the phone out of reach until she's more oriented. Sorry to trouble you, thank you. Yes, good night.)

(I said to Carmen, an RN I know with a light heart & humor, "She called the cops on us." "Cool! Did they come?" It got me to giggle after all the blood and paranoia and stupid sturm and drang.)

And it's her daughter's fault, and she was very disappointed.

I'd been on the phone with same daughter many, many times that night to update her on her mother's condition, and the daughter explained the family history of dementia and odd bursts of paranoia, and how this happened on her mother's previous surgery. I could hear the daughter wring her hands, and ask what she should do, should she come down there? Would that help her?

I reassured the daughter that her mother appeared to be suffering from some confusion related to the recent anesthesia. How it would be easier on both of them for the mother to be angry at me. How there's nothing to be done but keep her mother from hurting herself and wait for it to clear. How the physicians were all aware of what was happening, and their plan was simply to wait and let it clear. How she should try and rest and come in the next morning.

And the mother, I'm sure, shot some stinging accusation at her daughter the next morning. Stinging words she thinks she means right now, and the daughter will really feel. I feel awful for them both because of that.

I know all these things. And I did feel genuine compassion at the time.

Then I realized the old bitch stole my keys.

Is it okay to be annoyed?

I loved this:

From Head Nurse.

I updated my resume tonight to toss it in the pile to be considered for the weekend option. The differential is roughly 40% of my base. I hear I don't have to be "oriented to hearts" yet, either.

("Oriented to hearts" is something of a sensible gatekeeping thing to prevent newer ICU people from getting a patient they cannot handle, with a mixture of bullshit mother-hen pecking order alpha-queen-bee-old-nurse doctor-coddling thing on my unit.) (Some other time, maybe I'll post about it.)

So. I'm tossing my resume in. I know there are others in the pile already, and the due date is 4/15. Shall see what happens.

Updating your resume tends to get you thinking hard about how much or little you love your job. Which is it for me?

Um. Five...?

Head Nurse's words were good to hear. My answer to whether or not my job is still 5. But now, I'm thinkin this is an okay answer today. Tomorrow might be a resounding yes, love my job.

Today, I don't have my car keys back in my hot little hands yet. (See post above.) So today's probably not the best day to cast a vote. I liked Head Nurse's words.

I am contagion. I called in to work. I feel no guilt.

I cluster my workdays together, so I had a stretch off. Took a few days in Moab with a girlfriend, and her best friend from Germany (now, my new friend) and the dog, Miko. Our friend from Deutschland caught something on the flight over and was flu-y for four days. We came home a day early.

Then I got it. Hacky coughy achy chills. I'd gotten the flu shot, so this was either nasty quick cold or a milder version of the flu.

Calling in Thursday and Friday nights wasn't a problem. Genie was very sympathetic; Katie told me to feel better soon. Saturday's call-in was the problem. I talked to a nurse I like quite a lot, and who I believe is sensible.

I don't REALLY have to give you a rationale as to why an ICU RN should not report to work coughing her head off, spewing viral particles over intubated and immunocompromised patients right?

I mean.

For real. Right?

You're not one of those mad people who believes those little yellow paper masks does the trick, right? Or thinks a person having trouble breathing due to crud in their bronchial tract is gonna keep that thing on for over 13 hours straight right?

On Saturday, I got an icy "Wow. Okay. Talk to you later."

And the hellovit is, I do not feel guilt for calling in. I'm sure they were short Saturday night, because they are ALWAYS SHORT SATURDAY NIGHTS. And if I had come it and brought the spring flu from Deutschland, the whole unit would get it and everybody'd be calling in this week.

I just don't get this thing that nurses do. I grew up in a different field, and when you were sick, you called in. Remorse? What remorse. You sat your butt at home, on your couch or on your bed. You drink orange juice and water and soup. You crawl out of bed once to go to Blockbuster and load up on movies. You nap. Often.

This is what I've done for the past four days. I have gotten maybe an hour of productive quilting in. Made one productive phone call to a bank. Yesterday, I felt better and played a video game, which I haven't done since October of last year. (Quite possibly the last time I was home sick with a cold.)

Tomorrow I go back to work. The chills and aches are gone, the coughing is better by a large margin and no sneezing. Aren't my patients gonna be glad I didn't slime them with my virus?

I just don't feel the guilt. I don't get why we have a culture that seems so badly to want to require it.

Um....I'm here for a paycheck. I like to help people, yes. But, uh....I'm a lazy buddhist and there are no great martyrs among lazy people, and the handful of Buddhist martyrs had something really important to say that had nothing to do with flu symptoms.

*scratching head*