January, 2007 Archive

January 20, 2007, 1:10 am

Hitting the Nail on the Head: Nurse Meets Evidence Based Medicine

This post first appeared on Emergiblog back in March of 2006. Given that the theme of Grand Rounds this week is “Evidence Based Medicine”, I thought I would submit this post as a perfect example of how EBM affected my practice (and my personal life!).


Well, here it is!

The health coverage we’ve been waiting for!

$540 for hospital expenses for sickness or accident!

That just about covers your first hour.

$135 to your doctor!

This covers the first telephone consult with the hospitalist. Thank goodness! Your own doctor won’t be caring for you so it has to go to somebody!

Loss of work is up to $300! Well, for a nurse in the San Francisco Bay Area, that is a whole six hours! Ah….peace of mind!

And your life is worth $1000. Wow – I thought mine was valued at around $689.99.

It is not available for those over 70. Because you have, like, ten seconds to live.

War coverage is available.

Nah, I get that free on TV.


I am a compulsive nail biter.

When other babies were sucking their thumbs in the womb, I was bitting my nails off.

I’m not talkin’ itty bitty nibbles now and then. I’m talking down to the very last morsel and then peeling the rest to the cuticle, making sure it’s even, without any curves or stray pieces to distract me. My nails grow so fast, there is always something for me to “groom”.

I am sure this behavior is listed somewhere in the DSM-IV (or is it V now?) as an obsessive, compulsive, neurotic behavior with sociopathic overtones.

(Stay with me, this is going somewhere….)

And then I discovered the greatest invention of all time.

Acrylic nails.


I am the only person on the face of the earth who got acrylic nails just to have their nails reach the end of their fingers.

There were times when my own nail remnant was so small they were glued onto the nailbed itself.

Finally, I had, dare I say it…..pretty hands! They grew so fast I actually had to have them redone once a week!

I was cured!

Then I blew it.

I opened my mouth to “Nurse Nasty”.


She trained under Florence Nightengale.

She was there in the Garden when Adam and Eve caught the first virus known to man.

She treated Fred Flintstone for gout.

Michael Crighton used her as a technical consultant when he wrote “Jurassic Park”.


One early morning after a horrifically busy shift in a horrifically busy ER known as “County Hospital Wannabe”, Nurse Nasty approached me with an ongoing issue. I was off the clock, but I had been Charge Nurse that night and my input was needed.

We had been working with a registry nurse who had fingernails two inches long from the end of her fingers. Two long, curved inches.

I’m sure she paid good money for them, but they looked obscene and how she managed to do patient care was a concern.

Nurse Nasty thought it would be best if Nurse Long-Nails didn’t return to the ER as long as she had what looked like ten lethal weapons on her hands. I agreed.

And then I made the fatal mistake.

I had to open my mouth.

I held out my hands with their tiny stubs of acrylics that just reached the ends of my fingers and said, “It will be a cold day in hell before I ever give up my nails.”

No one realized I had acrylics on my stubby fingers.

She wrote me up. Just for making the comment.

Off the clock, one woman to another.

She wanted my manager to know about my “insubordination” regarding the “new nail policy”.

I didn’t even know we had a nail policy!


The “new nail policy” was that acrylic nails were no longer allowed in hospitals.

I was more than angry.

I decided to research what was behind the policy.

I discovered that infection control officers in various hospitals around the country had traced groups of nosocomial infections to nurses with acrylic nails. Specifically, a pseudomonas outbreak in a nursery and a fungal infection in post-op bypass incisions.

Serious stuff.


I was allowed two weeks to let my acrylics grow out so that I could remove them.

And I did.

You can’t really argue with policies derived from evidence based medicine.

I’m pretty sure I could put them on again without anyone knowing now that I no longer work in that ER.

But I won’t.

I don’t want to be passing infections to my patients – the danger is bad enough without having ten bacterial incubation chambers on my hands.


…the very day I retire, you’ll find me in a nail salon, getting a full set of stubby little acrylic nails. Then again, I may even add an eighth of an inch, just for fun.

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January 18, 2007, 9:23 am

If You Don’t Have the Answer, Why You Still Standin’ Here?


Oh my!

And I thought flying suppositories in via paper airplane was funny!

It’s starting to look like “tampon” week at Emergiblog…

This must have been pre-suppository times because they are referred to as “sphenoids”.

Again, for female nether regions.

I can’t say their marketing ploy of showing the sphenoid being rammed into a tree trunk is very subtle!

And that’s all I got to say ’bout that!


Do you hate nursing?

Have you ever thought about leaving it?


You’re overworked, your manager doesn’t manage, your co-workers don’t work, you hate your shift and the “Three B’s of Nursing” (Bitching, Backstabbing and Bickering) are alive and well on your unit.



No, don’t quit nursing!

Quit your job!

Nurses are in demand. Unless they are two years from retiring, there is absolutely no reason for a nurse to stay in a toxic environment.

There are better jobs out there. Hospitals with administrations that actually support nursing – yes, they exist. Units with nurses who are motivated and empowered. Smaller/larger facilities that can offer a change of pace.

Or a change of specialty.


What if you are the one who is “toxic”? Burned out. Apathy so thick you can cut it with a butter knife. Not exactly fun to be around.

It may be time to take stock of your career and change its course.

By getting a different job.


The best ER I’ve ever worked in is the one I’m working in right now.

And I have worked in some nice ERs in my time!

But…I’ve also worked in some not-so-nice departments, too.

I’ve done med/surg, CCU, ICU, telemetry, psych and pediatrics.

Which is why I can appreciate the job I have now.

I’ve made changes. Sometimes major changes.

I know what’s out there.


Why would a nurse stay in a stressful, toxic environment?

  • Seniority.
    • Switch facilities in the same network. If you work for a health care “system” like Sutter Health or Catholic Healthcare West or Kaiser Permanente, you can switch facilities and keep your seniority/benefits without a break.
    • Switch units in the same hospital. The bigger facilities often offer training programs in specialties like neonatal or intensive care. Expand your horizons.
    • Sit down and figure out just what that “senority” means to you in terms of pay or benefits. Is it worth sacrificing your mental health for the often nebulous perks of “senority”?
  • Fear
    • They’ve never worked anywhere else and change is scary.
    • They don’t know that another job/facility/unit could be totally different. They assume that what they are experiencing is “nursing” as it is everywhere. These are the nurses we lose within a few years of graduation!
  • Family responsibilities
    • There is often a waiting period between the beginning of a job and the start of the medical/dental benefits, although this seems to be decreasing. There are low-cost interim insurance policies that can be purchased to cover the family for the few weeks before the benefits kick in. Being responsible for the health benefits, I took advantage of this every time I changed facilities.
    • There may be jobs with hours that fit your family’s needs much better than your current job. I was once able to move to a facility offering four-hour shifts in the evening – with benefits! Dad was home, no childcare needed! You have to look – I found this job as a tiny ad in the San Francisco Chronicle!
    • There is sometimes a slight drop in pay if the new facility starts you out at a different “step” than your current facility is paying you. I notice that experienced nurses are being paid higher on the pay scale these days. Again, you have to ask yourself if keeping your current pay is worth your mental health! Here is where moving within a facility or within a network is advantageous.
  • Burnout
    • This one is dangerous because the hallmarks of burnout are apathy and depression. The ability to see that you need to make a change can be impaired. The will to make any change is virtually absent.
    • Usually at this point, even if you don’t want to switch jobs, you at least need a break from nursing, period. If you have vacation saved up, take it. All of it. Use it between jobs to give yourself some breathing room. Discuss it with your manager, not your co-workers.

So, how do you get out of the mire of your current position?

    • Find out what is available in your area. Check your local paper, too. Usually on a Sunday.
    • Don’t get blown away by fancy brochures and nurse recruiters. Ask to see the department in action. If it’s under a collective bargaining contract with the RNs, get a copy of the contract. Look it over.
  • The biggest names aren’t always the best places to work. I live near a World Famous Medical Center with World Famous Medical School and they have the oldest, most crowded, least staffed, most hectic, least flexible ER I’ve ever worked in. Blech. I stayed ten weeks. (In all fairness I hear they added more staff.)
  • Give smaller community hospitals a chance. In the ten weeks I stayed at the teaching facility I never saw an x-ray and could hardly get my hands on lab work because it was all geared toward the interns and residents. You will have more responsibility and actually get more experience in a smaller unit, IMHO. Unless you get off on pure adrenaline, then go for the biggest of the big!
  • Afraid to cut the ties of the old job altogether? Stay per diem at the old job until you make sure the new one works out. Sometimes you actually have to work the department to know the department.
  • Or…do the opposite. Go per diem at the facility you are trying out and make sure it’s a good fit.

Maybe it’s my personality, but I was never afraid to make a switch when I felt it was in my best interest or if I wanted to try a new department.

Look at it this way, we are nurses! Facilities are begging for our skills and talents! We don’t have to “settle” for second (or third) best. We can write our ticket to the jobs we want!

I found one of the best because I was willing to make a change.

Ask yourself:

Do you work for your job or does your job work for YOU.

If you don’t have the answer, why you still standin’ there?

Just walk away….

To the right job for you.

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January 16, 2007, 7:34 pm

The Heat Is On!



What then is “phylogistine”?

This is for inflammation in the female nether regions, either superficial or deep-seated.

In other words, it was for Victorian yeast infections.

Apparently it is administered as a vaginal tampon.

That is one mega tampon!

She looks like she is holding a paper airplane.

That’s one hell of a delivery system!

Put the patient in the stirrups and throw it in from the door!


Two momentous events have/will occur today that will affect my life in dramatic ways.

  • I discovered “You Tube”.

I mean, I knew it existed, but I never realized there are about a bazillion hours of Journey/Steve Perry videos on it! I spent two hours today just soaking it all up!

How am I supposed to function in the activities of daily living when there might be a video I’ve never seen hiding in the wings???

It boggles the mind.

  • American Idol begins Season Six tonight.

I cannot even hear the opening notes of the theme song or I will be addicted once again for five months, doomed to power vote for two solid hours every Tuesday night even if it means forgoing sleep prior to my night shift.

I’m not kidding. I still fight the urge to grab a phone when I see Kelly, Ruben, Fantasia, Clay, Bo or Taylor Hicks.

I have asked my family for help, as we only have one television and if they do not watch it, I will not be tempted.

They have declined to assist me in this endeavor.

Actually, when asked to give up this AI season for my greater good they said, in unison “Hell no!”

Alas, I have done my best.


I checked out the syllabus for my Leadership and Management class online today.

Five papers!

In APA format!

When I was last in school, there were no “formats”. You had a title page and then you wrote paragraphs, and added a bibliography at the end of the paper.

I wouldn’t know APA from MLA from a CPA.

I guess I’m going to have to learn.


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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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