February, 2007 Archive

February 19, 2007, 12:39 pm

Ladies and Gentlemen, Start Your Engines! It’s NASC-ER Season!

ruralnurse

Check out rural nurse Margaret W. Durham.

They don’t make ’em like that anymore.

If this nurse said to take your Castor Oil, you took your Castor Oil and you LIKED IT!

I’m concerned that she praised three Plymouths, though. Seems like she got a new one every 166,000 miles.

I wonder if her company paid for them.

Heck, I don’t consider my car broken in until it reaches 166,000 miles!

And I keep it nice and messy so no one even thinks about stealing from it!

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kaseykahne

I am proud to report that I have resisted the pull of “American Idol” and that my two-year addiction to Simon Cowell and the top singer du jour has been broken.

I have not watched a single episode this season.

Ah, but an addiction-prone personality abhors a vacuum.

It appears I have caught the NASCAR virus.

I even bought a TrackPass.

I’ve got it bad.

In many ways it is similar to Notre Dame football:

  • It makes me yell and pound my fists on the coffee table.
  • My neighbors know when there has been a crash/touchdown because the scream from my family room emanates throughout the block.
  • It’s like I’ve been shot through with adrenaline for three hours.

And I’d like to thank my official NASCAR co-dependents for this particular addition:

  • My bestest-friend-ever-since-the-age-of-fourteen-when-our-addiction-was-the Osmond-Brothers: Ms. Kim (who got to run around a track with Dale Jarrett last year) and
  • My colleague-who-is-a-PhD-candidate who refuses to look at any newspapers delivered to the ER lest there be any info on the race she has TiVo’d at home.

The car pictured is that of Kasey Kahne. Hunk. Need I say more?

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NASCAR is very much like a shift in the Emergency Department.

Allow me to explain.

The nurses and doctors and techs are the pit crews.

The patients are the racers.

The person who starts out in the pole position (your first patient of the shift) won’t necessarily be there at the finish line. Unless of course their particular “finish line” happens to be on your shift.

If you get my drift.

While NASCAR drivers only go to the pits when absolutely necessary, patients will come into the pits/ER at any time for any reason at all.

  • They have a flat tire (broken bone).
  • The car has an illegal additive (alcohol/drug intoxication)
  • The engine is making funny noises (wheezing)
  • The engine is overheating (fever)
  • They are out of oil (need a medication refill)
  • They have a leak (laceration, vomiting, diarrhea)
  • The engine has frozen (stroke/cerebral bleed)
  • They have hit the wall (MVA)
  • The spark plugs are mis-firing (fatigue, weakness)
  • They have run out of fuel (hemorrhage)
  • They have too much gas (abdominal pain)
  • They need a non-functioning part removed (gall bladder/appendix)
  • They need a new part put in (stent, hip replacement – see flat tire)
  • They don’t like the way the car is handling but they just can’t put their finger on it (chest pressure/heart attack)

And, just like in NASCAR, some racers will head out back onto the “track” of their lives and others will have to go straight to the “garage” to be admitted for repairs.

If life is a race, the Emergency Department is Pit Row.

Ladies and Gentlemen, Start Your Engines!

Read »

February 17, 2007, 12:53 pm

Why, In Dem Ol’ Days We Walked To Work in the Snow and We LIKED IT!

nurse

Meet Miss Eunice Lenz, Director of Nursing Service.

She is so professional that when she has a disagreement with a doctor, she takes them up to the roof to yell at them.

I know I want the Chicago skyline in the backdrop when I yell at a doctor!

Obviously it’s her day off because she’s in street clothes.

Now that’s what I call a professional!

(Oh, by the way, at the top of the payscale on the day shift, a full-time RN at this time in this hospital was making $2.68 per hour. What was minimum wage, negative 75 cents?)

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

It had been a rough night and I had a pile of charts to finish.

Being the social animal that I am, I retired to the break room to write so as not to be tempted into conversation.

Presently the night supervisor came in for a cup of coffee and sat down at the table.

Rough night for her, too. She had five sick calls to fill and no one had called her back.

We started talking about “the old days”. She’s been a nurse a little longer than I, but not much.

We remember the “old days”.

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In the old days, you didn’t worry about claiming overtime if it took an extra fifteen minutes to finish your shift because you knew that on the days when it was quiet you could leave twenty minutes early.

If you had a chance to eat something, even if it was only for fifteen minutes, you didn’t mind. It balanced out the nights where we’d put on a full pot luck dinner in the lounge and munch all night. Coffee breaks? There were times we wouldn’t have known a coffee break if it came up and bit us on the butt.

Then again, there were shifts with low census where you could sit with the paper or watch a TV show with a patient.

If there were nights when you had to “take one for the team” you did it without bitching.

In the old days, you didn’t play “tit-for-tat”. You were all a part of the team. You felt as though you were the facility. You worked until the work was done and when you took advantage of the quieter times, the administration didn’t mind.

And you sure as hell didn’t punch a clock.

*****

Fast forward to today.

Instead of documenting their hours on paper, nurses punch a clock, at least in my facility.

Professionals do not punch a clock. Never met a doctor who did. I know lawyers don’t. In fact, I don’t think police officers, paramedics or firefighters punch a clock. I’ll go as far to say that I’m pretty sure my garbage collectors don’t punch a clock.

We are required to take a lunch, by law, and we are paid penalty pay if we don’t get one. Breaks, too. This sounds like a good thing on the surface.

But…we are not allowed to punch in early, even if we happen to get to the unit ten minutes before the shift. And we can’t punch out early without our pay getting docked. Even if there are no patients in the department.

When we go on our meal breaks we have to take a timer because if we take longer than 30 minutes, the pay gets docked.

So now you have a scene that makes my blood boil every time I see it.

Nurses standing around a time clock waiting for the exact minute when they can punch out – a group of professional men and women standing at the mercy of a machine in order to get their pay.

The result of this mechanization? This subtle “deprofessionalization” of nursing?

A different attitude..

No more “taking one for the team”. No more sense of “oneness” with the facility.

If I work ten minutes over the end of my shift, I will damn well get paid for it.

I used to write it off as helping out the next shift.

Nights where I don’t quite get dinner, the ones that used to be chalked up to the nature of the profession?

No more. I don’t eat, I will damn well get paid for it.

I used to write it off as par for the course on a busy night.

I would love to see how much more money the facility is paying in penalties and overtime now that the nurses are forced to punch a clock.

It’s not just my facility, by the way. I see this whenever and wherever nurses are “punching” in and out.

What these hospitals have gained in expediting their payroll, they have lost in the sense of “oneness” nurses used to feel with their hospital.

And my facility is the Taj Mahal of hospitals!

I can’t even imagine what it’s like in lesser facilities.

*****

Speaking of quiet times, when the census was down….

In the old days the staff showed up every day as usual. If it was slow, someone might have to float.

That was never fun, but we took turns and I’d always volunteer if it was the OB/GYN floor. (In the old days, the babies were on one side and the gyn surgeries on the other side of the wing.)

Even better was that you could take an “EA” day – excused absence and actually take a day off! If you wanted to get paid, you took a vacation day and if you didn’t, no big deal. We took turns with those, too!

On the floors, if the census was down, you’d actually have less patients per nurse and more time to spend with each one of them.

Today, if the census drops you are either canceled (if you are a per diem) or you are sent home in the middle of the shift.

Yes, we have nurse/patient ratios here in California, but instead of ever being able to have an easy night on the floors/telemetry when the census is down, they simply drop the number of nurses to the exact ratio required.

I’m an ER nurse. We admit patients 24/7. In the old days, you staffed for potential admissions. You know, left a little leeway just in case.

Not today.

*****

I’m actually going to work in an hour; someone called in sick and I’m covering a few hours.

You could call it taking one for the team, but I will be paid handsomely for coming in on a day off and on a weekend, too.

But something tells me I should be signing my charts as “T. Rex, RN”.

Because even though they weren’t perfect,

I miss the old days.

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February 14, 2007, 6:29 pm

Maybe, Just Maybe It Can Work!

twinnurses

Hey! The Doublemint Twins became nurses!

This must be their “How to make a wrinkle in a bedsheet class!”

Either that or they made hospital corners every twelve inches back then!

What’s with the dark cuffs and shoulder insignia?

Some sort of military uniform?

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

Back in January, I wrote a piece entitled “Health Care is NOT an Entitlement“.

I still believe that.

But I have found a proposal for a national plan that might actually work.

It isn’t socialized medicine and while it is a national health care insurance, it is administered at the state and local level and not by a government agency.

I was looking for references for my issue paper: Health Care: Commodity or Right. I was looking for something that would support my position that national health insurance would never work in the United States.

I believe that health care is a commodity in that it must be paid for. But, there may be a way to actually do it and cover everybody.

And that means everybody.

With free choice of provider, hospital, medications and tests. With health care where it belongs, between the doctor (or nurse practitioner) and the patient. Period.

What happened to make me hopeful?

I found the website for Physicians for a National Health Program (PNHP).

I would suggest you check out the following pages if you are new to their proposal:

  • New To Single Payer? This gives a very succinct overview of what they consider to be important in a single-payer plan.
  • Then check out Frequently Asked Questions. Everything you could want to know, from what is covered to what will happen to salaries to how it will be paid for is addressed.

And answered.

But I wondered. What about nurses?

So I wrote a letter to the PNHP and asked about the projected effect on nursing salaries. PNHP staff member Dave Howell responded to my inquiry promptly.

This proposal has been out there for many years. Dave quotes from the 1989 proposal:

  • “Each hospital would receive an annual lump-sum payment to cover all operating expenses – a “global” budget. The amount of this payment would be negotiated with the state national health program payment board and would be based on past expenditures, previous financial and clinical performance, projected changes in levels of services, wages and other costs, and proposed new and innovative programs.”

Dave assures me that nursing salaries are a priority in this program. He also notes, again from the 1989 proposal, the effect on health care workers in general under this program.

  • Nurses and other health care personnel would enjoy a more humane and efficient clinical milieu. The burdens of paperwork associated with billing would be lightened. The jobs of many administrative and insurance employees would be eliminated, necessitating a major effort at job placement and retraining. We advocate that many of these displaced workers be deployed in expanded programs of public health, health promotion and education, and home care and as support personnel to free nurses for clinical tasks.”

Less administrative duties and more time for patient care.

Works for me.

And while I differ politically on many issues with the California Nurses Association/National Nurses Organizing Committee, they are the reason the salaries and the working conditions here in California are among the best in the nation.

They are working with the PNHP to get this proposal off the ground, and they would not allow nurses to get the short shrift.

This proposal was enough to make me look at my preconceptions.

I believe this program would work.

There is too much information for me to add here in one blog post.

Visit the site.

Check out the pages I have linked to.

Tell me what you think.

It made this hard core private-insurance supporter believe medical coverage for everyone is not only possible, but affordable.

You may be very surprised.

Read »

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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