September, 2006 Archive

September 4, 2006, 3:25 pm

Dear Pediatric Patient,


That poor kid on the right!

What kind of traction is that?

Elevate the knee but drop the distal extremity?

And then let her watch while the other kid gets to color and she doesn’t?

Pull the freakin’ curtain!


Blue Cross may say they pay 14 million dollars to their members, but what they don’t tell you is that amounts to fifty cents per member.

And none of it to the doctor.


Dear Pediatric Patient,

Yes, honey, you with the 3/4 inch laceration to your chin.

I’m your ER nurse!

I’m sorry you fell off the monkey bars.

I know you are scared because you are hurt and afraid of stitches.

And I know that you are doing as well as can be expected and trying to cope with what has happened.

I am doing my best to try and distract you and gain your trust, so that we can make this as easy for you as possible.

But I am watching you, and although you are older, you are behaving as though you are two years old. Someone your age should be able to process a bit more and not scream demands at your mother and the ER staff.

But wait, now I see what the problem is.

Your parent is acting as though they are two years old. Sobbing and speaking to you in baby talk. Giving into your every demand.

Repetitively crying out, “Oh my GOD! Oh my GOD! My poor BABY!”

And calling all four of your grandparents to come at once.

Not to mention your father who comes barreling in the department and begins pacing in your room. How could your mother allow this to happen? It never would have happened if you had been in his custody.

Mom is flailing about the room screaming how she just can’t take this and won’t we please help her BABY and what is taking so long and she can’t STAND the sight of blood and oh, she is going to faint!

Geeze, you would think it was her chin that was lacerated.

I see why you are screaming at the top of your lungs.

You have to fight with your parents for attention.

But finally all four grandparents arrive and they fawn over you.

Well, two of them do.

The others are busy comforting mom who is hysterically leaning with her head in her hands over the sink.

But wait! Here comes Auntie!

Auntie gets to help hold you down with the other five staff members so you can have your chin laceration glued while Mom wails five feet away in the distance behind the curtain while every one else comforts her.

You get lots of attention then. And when you screamed for your band-aid immediately and wouldn’t stop until you got one, even though I was in the middle of getting your discharge instructions, it was hard for me to realize that you were an absolute spoiled brat.

It’s not your fault, though.

You see, this was all about your parents and not you.

Your parents modeled the behavior. You took your cues from them.

It’s hard to fight for attention when two adults seem to be taking it all.

Yes, grown-ups can be very scared and upset when something happens to their child. They may even cry.

This is normal and the nurses try to support them, too.

But you should have been the focus of their concern and no matter how upset they were, they owed it to you to be strong and help you get through it.

At least Auntie was able to do that for you.

But your hysterical, demanding behavior reveals a spoiled, pampered child of overcompensating parents.

This is your family dynamics.

I’m sorry to say your parents did you no favors that day.

You didn’t learn strength or courage.

You learned that screaming and acting out was the way to get everyone riveted to you and to get exactly what you want.

I hope you don’t grow up to be a demanding, screaming adult patient.

Those are called “wimps”.

When you are a big boy, you might want to join the Marine Corps. They have an excellent program in self-discipline.

Lord knows you won’t learn any from your parents.


Your ER Nurse

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12:46 pm

And While We’re On the Subject….


Death by Constipation.

Sounds like a James Bond movie.

I wonder who would sing the theme?

Instead of “Live and Let Die” it could be “Strain and Let Go”.

Or maybe: “The Ex-Lax Who Loved Me.”

According to this learned document, nearly 75% of all illness can be traced to constipation.

In fact, did you know that constipation causes diabetes?

Well, blow me over! We don’t need metformin or insulin, we need Milk of Magnesia or the biggie: GoLytely!

I’ll be right back, I have to call the ADA!

All these deaths and diabilities.

All cured by: lubrication!

Wow – rectal WD40.

I wonder if Tom Cruise is anti-laxative.

Of all the people who could use one…


Labor Day morning.

Starbucks. House Blend. Venti. Room for cream.

Sam Cooke’s Greatest Hits on the speakers.

Man, it doesn’t get any better than this!


A comment on this recent post started me thinking about the other side of nursing education.

One of my commentors, an RN (who blogs about her experiences as an RN whose spouse suffers from multiple myeloma) began her comment with this sentence:

“I apologize for being one of those nurses with all the initials after her name…”

Uh oh.

Not the impression I was trying to give regarding higher education within the profession.


All comments come into my email and in my response to my fellow nursing blogger, I mentioned that I didn’t want anyone to feel they had to apologize for their education, but that I just didn’t want to have to of defend my lack of letters!

We need nurses who have BSNs, MSNs and PhDs. We need nursing instructors and leaders in the profession.

And we need them badly.

They are responsible for producing the bedside nurses that make up the bulk of our profession.

To do that well, they need to have the theory, the background and the gift of teaching/leadership.


I have the utmost respect for those nurses who chose an upper level degree, whether they choose it as their entry-level or work their way up as they practice.

I work with a PhD candidate in the ER who fascinates me with her knowledge of areas of nursing that I would never think of exploring. She provides a perspective of nursing that gets me excited to be doing what I do.

She does it not for the money, I doubt academia pays anywhere near what bedside nursing does and that is what she is doing now. Bedside nursing.

She loves the theory of nursing.

And it almost makes me want to go back for a BSN! So you know her enthusiasm is infectious!

And she gave me her entire Cherry Ames collection, so, basically she just rocks anyway!


But what these nursing leaders do not understand is that everytime they advocate for the BSN to be the entry level of nursing, they put down me and every other ADN graduate, even as people clamor to enroll in ADN programs.

I might not be able to discuss five different theories of nursing, but I can tell you about Sister Calista Roy’s adaptation model.

I may not know anything about leadership qualities or how to be a good manager, but I can advocate for my patient.

No, I have not written a thesis on the history of the nursing diagnosis, but I can work my butt off for twelve hours and actually place my hands on patients and make an immediate difference in how they feel.

I don’t sit at a desk, in fact I often work up to ten hours without a single break, but I can tell you more about how a patient is responding than anyone sitting in a suit in their office.

Those basic tasks of care are hiding the most important aspect of nursing, the nursing assessment. Seeing and responding to subtle changes in temperament, nutritional status and knowing what they mean.

Seeing lab results and understanding what they represent.

Not finding fancy ways to document them.


Oh, I can write very pretty nursing plans using nursing diagnoses.

You could frame my care plans and put them on the wall.

I’ve gotten more compliments in three decades than I can count.

And all it means is that I can write legibly and spit out what all the accreditation bodies want to see.

They don’t affect my patient care at all because they aren’t written or designed with the actual NURSE and PATIENT in mind.

They are written because someone who probably hasn’t been anywhere near an actual patient in years has decided that nursing must mimic other professions instead of blazing a trail as the unique profession it truly is.


So don’t tell me that the BSN should be the entry level into nursing.

It insults me and negates almost 30 years of professional practice to “technical” status.

In our profession you can begin with an ADN.

Hell, for that matter you could begin from a diploma program if they hadn’t made those obsolete.

Get the nurses at the bedside doing what 99% of all nurses do!

And maybe, for oh, say, one month out of the year, those who sit happily in their offices should be required to get back to the bedside and re-connect with what they are supposed to be promoting and advancing.


I respect those who have chosen to advance in their nursing education.

I have chosen to advance mine at the bedside.

With my ADN.

And all I’m asking is for a little respect…

Just a little bit.

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September 3, 2006, 10:45 pm

Goodbye, Mate….

steveI can’t believe this happened.

Steve Irwin is dead.

“The Crocodile Hunter” was a guilty pleasure of mine and I am sick in my heart, just sick.

I’m sick for Terri and their two babies.

And for all his dangerous work with crocodiles, he’s killed by a sting ray barb to the heart.

I supposed it’s silly to be so touched by someone you don’t know, but I enjoyed him so much. I learned so much about Australia.

This is definitely a man who can never be replaced. A true character in every sense of the word.

(The photo is from the Sydney Morning Herald.)

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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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