September 29, 2006, 8:42 am

It’s Never Enough. Ever.

or

A better chance to live….

Tomorrow?

Then why on earth is this guy having his surgery today?

And the ad is for Electric Furnace Steel!

What? Are they going to melt him?

It looks like he was abducted by aliens and their resident Scotty is ready to beam him up!

Either that or there’s a buffet lunch on that gurney and everyone is standing at the table to partake of the dry croissant sandwhiches, wilted lettuce with french dressing, bottled water and dry chocolate chip cookies.

Hey, that’s what nurses get for a sponsored lunch!

Paid for, of course, by the Electric Furnace Steel sales rep!

******************************

I have been immunized.

I received a DTaP shot.

Just like a baby.

I didn’t cry like a baby, but someone has decided that those of us who did not have, and survive, Pertussis (Whooping Cough), should be reimmunized as adults as our immunity from previous immunizations cannot be guaranteed.

And they are finding cases of it in the community. Hey! Thanks to all you folks who decided not to immunize your kid! Now I’m getting immunized so YOU don’t have to!

Being a grown up, I got the shot in my arm.

And that is where the difference ends.

My arm hurt, I went off my bottle and was cranky for four days.

Of course my “bottle” was Diet Pepsi, but you get the idea.

No wonder these little tykes get so fussy.

I am not, however, showing signs of autism.

Oh…wait, wasn’t that the MMR?

Hah! Been there and had every single one of them!

I’m from the generation who believed in immunity by active infection…..

******************************

I actually decided to post after a very busy four-hour shift.

During the 240 minutes I was working, I spent 25 minutes on two Medication Reconcilliation Forms while triaging.

Ten-percent of my workday was spent on these two pieces of paper.

Both patients knew their meds, but they had to think of the doses and when they last took them.

Both patients were on, I kid you not, ten medications each.

And of course every medication came with an explanation. It’s not like Sgt. Friday on Dragnet. The questioning is succinct, but the answers aren’t.

Of course, we are no longer allowed to write just the name of the medication down on the sheet, even if there is no chance the patient will be admitted.

We must fill out the dosage, the instructions, and time last taken.

On everybody.

And we have to ask because if they don’t know, we actually have to write “DNK” for “Does Not Know” everytime they don’t know.

Now, we nurses are an adapatable bunch. We simply took our med list off the triage notes so we would not have to double chart.

Fair enough.

But now, if every single box isn’t full with either a number or “DNK”, we don’t get full “credit” for doing it.

I’ll say it before and I’ll say it again: it is the admitting doctor’s responsibility to ascertain the dosages of the patient and write the appropriate orders.

Instead, they can simply write a check mark next to the list that the nurses compile and that constitutes an order.

Oh, they love those of us who do those medication reconcilliation forms nice and neat and precise.

Because they don’t have to.

As I’ve noted before, I often feel like a scrubbing bubble in the toilet bowl of health care.

Only what I do is never enough.

When it comes to finding a way to frustrate, over-work and add ridiculous amounts of paperwork to the nurses,

They (JACHO?) will always find a way.

And we will continue to jump through the hoops.

Because we will get “dinged” if we don’t.

******************************

On a lighter note, my 94-year-old patient kissed me on the cheek before getting into her taxi.

How I can be so frustrated by my job and love it so much at the same time is amazing.

Thank god for the patients.

They make it all worth it.

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12 Comments

  • Kelly
    Kelly

    September 29, 2006 at 2:09 pm

    There’s still a generation that believes in active infection……

    And I’m pretty sure they’re the ones who’s DTaP shot didn’t do any good when whooping cough came around.

    I could be wrong though.


  • Peggy
    Peggy

    September 29, 2006 at 2:55 pm

    Parents who are not getting vaccinations for their children should have to watch videos of babies slowly strangling to death with whooping cough. So many parents watched their own babes dying in such a horrific way….until the vaccines. My mother and aunts were R.N.s and made themselves available any time to give vaccinations for anyone who asked. That, of course, was ‘back when’. I wonder if nurses still can do that for neighbors?


  • Mel
    Mel

    September 29, 2006 at 4:16 pm

    I have an autistic kid. He has Asperger’s Syndrome. I blame it on his genes because I’m a pretty classic case myself, except I’m a girl. I don’t blame it on his MMR vaccine because AS was described in children long before there was such a thing, but even if I did believe it was caused by the vaccine, I’d rather have a really smart, great kid with AS than a kid dead of a preventable disease.


  • Sid Schwab
    Sid Schwab

    September 29, 2006 at 8:09 pm

    It’s all about the chart. Long as the boxes are checked, nothing else matters


  • Julie
    Julie

    September 29, 2006 at 10:08 pm

    …a scrubbing bubble in the toilet bowl of healthcare I love it! And amen to everything you have said. Med recs. Bleh. :-)
    Hoping you have an enjoyable weekend. On the bottle. heh heh


  • Alice
    Alice

    September 29, 2006 at 10:09 pm

    Do you actually fill in all that stuff? The nurses here just fill in as much as they can get readily. The “last taken” (which is a really dumb and unnecessary question; for the few patients for whom it matters, it won’t hurt the doctors to ask) is usually blank, and the dosage doesn’t always make it on, and no one bothers to write “DNK.” Try slacking off a bit; I bet JCAHO is too bored by their own forms to notice particularly. Our hospital is surviving, so far. :)


  • Candy
    Candy

    September 30, 2006 at 7:58 am

    My guess is that SMF requires the form to be filled out as a CYA move…and to keep the docs happy.

    I wish there were more moms like Mel out there who understand prevention and the horrible end result when preventive measures are ignored — or outright avoided.


  • Annemiek
    Annemiek

    September 30, 2006 at 3:28 pm

    We are not allowed to fill in DNK, but have to find other ways of getting the dosages and names of the drugs; calling the patient’s pharmacy or MD office if we have to. Way too much time consuming. Thanks JCAHO.


  • Azygos
    Azygos

    September 30, 2006 at 3:43 pm

    I’m guessing you actually got the Tdap (reduced dose) as a childs dose of the D and P componet could make an adult ill. When I worked in family practice I would always look for cuts and scrapes on my patients just so I could get them a Td that was paid for by the insurance company.


  • Jo
    Jo

    October 1, 2006 at 12:15 pm

    I got a DTAP during a fingerstick a couple of years ago. No harm, no foul.
    Someone’s gotta do it.
    I think it’s weird though that I haven’t met a kid with Chicken pox in over 15 years.
    Maybe those things do work.


  • Tatiana, RN
    Tatiana, RN

    October 2, 2006 at 7:34 am

    I prefer the patients who come in with 2 bags of medications in tow. Full info on the bottle label. Then you have to sort through the medications they are taking and no longer taking becuase they cleaned out the entire medication cabinet.


  • Bridget Corcoran
    Bridget Corcoran

    December 19, 2006 at 10:10 am

    Hey, I just found this, I love it. I am also a RN with 28 (this year) years experiance. Did Newborn ICU, Adult ICU, ER, and peds tele advice. This is so funny about the immunizations. Isn’t so right about those not getting imm, and that we get to suffer. I found this by looking for med reconcilliation site. we are starting this at a clinic, but did this before in our ER and ICU. What a mess!! How to take a 20 min job, and expand it to 1 hour/per patient. Well keep up the good work. Bridget


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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