January, 2008 Archive

January 6, 2008, 3:50 pm

I’m Not Crazy, I’m Just A Little Unwell…


I always feel like I’m going off the deep end, usually around 0300 in a full department.

It passes.

Haven’t had lunch or a break in my last three shifts, and while I know it’s par for the course, and I knew it when I signed up for this profession it doesn’t make me any less grouchy.

I like to think I hide it from co-workers but I’m pretty sure a few of them have wanted to give me an attitude adjustment over the last few weeks.

According to this ad, it’s because I have cholesterol building on the artery walls of my “mental-nervous equipment”.


In that case Lipitor should be an antipsychotic!

Take a hike, Haldol!


I had a chance to catch up with all the docs on my blogroll this weekend.

Very enjoyable!

I found some broken links and some blogs that haven’t been updated, so I did a bit of housecleaning.

If your link is missing and you are still in action, please shoot me an email.


Speaking of Haldol, I ran across a post in my reading that had my jaw on the floor.

Actually, it wasn’t the post that caused mandible-vs-gravity.

It was the comments.


I suppose I should be angry, worked up, hot-under-the-collar, how-dare-you, in-your-face pissed off. (Pardon the language.)

But I’m not.

I’m just sad, and a bit concerned that there are certain antiquated attitudes toward nurses that still persist in the 21st century.

Let me say before I start, that both the post and the comments referenced are from bloggers I enjoy and respect. The post is two weeks old; if I kept up on my reading, I could have given a more timely response. Be that as it may, I really feel the need to say something.

First of all, the original post can be found at Scalpel or Sword? and is entitled “Nursing Ethics”.

If you have not read it, please do so now and then come back. Be sure to read the comments, as the problematic statements reside therein.


So, basically a nurse refused to give a patient a medication, namely Haldol, unless they were able to tell the patient what was in the injection.

Let me state right up front that, given the scenario presented by Scalpel I would have given the injection without reservation, and documented the hell out of the patient’s statements and behaviors to back it up. Been there, done that.

If I had been uncomfortable with the order, I would have talked to Scalpel and asked him to administer the medication himself.

I’ve been uncomfortable with orders before. I have never, in thirty years had to refuse an order. I’ve found errors in orders and brought them to the doctor’s attention at which point the error is rectified.

The emergency department is a very collegial environment. Usually, the doctor will listen to my concerns and either change the order to something I am comfortable with or explain the rationale behind the order, often bringing to light something I did not know.

We work together, in tandem, each approaching the patient in our unique professional capacity.

In other words, the doctor is not the enemy.

But apparently some of them think nurses are.


Scalpel was advised to “obtain nurses who will take orders from physicians”.


Nurses are autonomous practitioners who are wholly responsible for anything they do to or for a patient. If I refuse to carry out an order, I better have a damn good professional reason for doing so. If I question an order, but choose to carry it out, I will document that my concern was discussed with the physician.

Nurses do not refuse to carry out orders on a whim.

And they are not “obtained” by doctors.

One of the comments talked about a nurse being “fired for cause.”


The refusal to carry out an order that the nurse feels will injure the patient, is outside their scope of practice, or against hospital policy or the law will not be fired for cause. And being in a union has nothing to do with it. It is our right, no, it is out obligation as practitioners to not carry out an order that we feel is detrimental to the patient, and we cannot be fired for it. However, we better have a very good reason for not carrying it out

If we do carry the order out that should not have been carried out, and the patient is harmed, it is our career on the line. The buck does not stop with the physician – at least where malpractice is concerned.

One comment brought up the topic of insubordination. Another stated that medicine was a “semi-military heirarchy” and that when an order is written, they “damn well expect it to be carried out.”


Nurses do not work for doctors. Doctors do not have authority over nurses. Doctors cannot punish nurses. Doctors are not responsible for nurses. We are separate, autonomous professions that work side-by-side in caring for the patient. The physicians lay out the medical plan, the nurses carry out that plan, and the nursing care plan that compliments it using the principles of the nursing profession.

Nurses do not salute doctors.

They can, however, respect them for their education and competence.

A little reciprocity in that regard goes a long way.

To put it in terms a kid would use: Doctor, you are not the boss of me.


Somebody help me out here.

Docs, do you really see nurses like this? Even in this day and age?

Do you really look at a nurse and think “you better damn well carry out my order?”

Do you really see nurses as subordinate to you? Particularly in the ER? Anywhere?

What are you taught in medical school?

I guess I’m shocked that these attitudes are still floating out there. I work in a great ER where the docs and the nurses have good communication. They trust each other but have no problems confronting or questioning when necessary.

It’s called team work, and to read the opinions expressed in response to Scalpel’s post was like getting slapped upside the head.

I would have expected those comments twenty years ago, but not today.

Can I be that naive after thirty years of nursing?


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January 3, 2008, 11:43 am

Hey Corporate Know-It-All, What Do You Recommend?


Well, blow my nose!

The key to fighting a cold is a laxative!

Instead of cleansing the nasal passages, you cleanse the intestinal tract!

And, you combat acidity!

Apparently, the acidic life is not worth living.

Up with alkalinity! Get up wit’ yo’ bad pH!

This is false advertising, anyway.

The husband is waiting on the wife? Yeah, right. In the Twilight Zone, maybe.

Sal Hepatica. Sounds like salty liver.

And to think, I thought Afrin was my best friend when I was sick!


Press Ganey.

I’ll wait until you get over your nausea.

Okay….take a deep breath…..

I thought I’d check out their website and I found this blurb:

How do patients size up your health care environment? Find out with Press Ganey’s Patient Satisfaction Surveys and discover how to target your improvement efforts where they matter most.

Target improvement efforts where they matter most.

Well, what does matter most to patients who visit the ER?

Based on what I’ve read in various “questionnaires”, it seems there is only one real complaint:

  • Patients don’t like to wait.

For anything.

Let’s use “rooming” as an example.

They want to go to a room on arrival, therefore we are now required to perform “immediate bedding”.

For everyone.

And lord forbid that we take them to the triage room first and then put them in a room.

That doesn’t count. Then we hear at the staff meeting that the doctors don’t think we are bedding immediately enough.

After all, there was a bed open!

And somebody had to……tell me it isn’t true……….actually wait for a few minutes before being escorted back to the treatment area.

Oh, the horror!


Call me crazy, but we are an ER.

Geeze, we’re one of the (if not THE) premier heart facility in the damn state and now they are trying to make us a stroke center, both of which require emergent, as in FREAKIN’ STAT! implementation of specific protocols.

Wouldn’t it be prudent to leave a monitored bed available for these extremely serious patients?

Just one?


Tis nobler in the mind to suffer the slings and arrows of frantically moving patients in an emergency than to keep someone waiting.

Press Ganey is not pleased when patients wait.

And when Press Ganey is not happy…

Well then it must be the nurses’ fault.


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January 2, 2008, 10:04 am

Submitted For Your Approval: A Happy New Year!


This is how I spend my New Year’s Eve.

Just me, my husband, this book and the Twilight Zone marathon on the Sci Fi channel.

And this totally cool drink made up of smooshed limes, sugar and vodka. I’ve had one. A big one. I may have another.

As soon as this one wears off.

I have never posted under the influence before! I shall have to read this verrrry carefully to make sure I don’t make any typos!

Seriously, it’s actually a tradition for me to spend New Year’s watching the marathon.

I can’t believe my husband is actually watching it with me. Whether or not he makes it to midnight is another story! I shouldn’t gripe – he is going to see “I Am Legend” with me tomorrow. It will be my third time. It’s that good.


UPDATE: I fell asleep at 2340. Missed the whole shebang – the neighbors said things were quite noisy. While Burgess Meredith looked for his glasses in a post-apocalyptic world in the Twilight Zone and the real world celebrated the arrival of 2008, I was sound asleep.

And the booze had nothing to do with it – I had been up for 26 hours straight by that point.

Hubby thought “I am Legend” was “eh – okay”. Gave it a 5/10. That movie is at least a 9/10.

Humph. Men.


So here’s to a healthy, happy and wonderful 2008 to all.

I, for one, am happy to see 2007 go bye-bye: weddings and funerals, trauma and joy, loss and recovery, stress and accomplishment.

(And a hug from Jeff Scott Soto!)

No resolutions for 2008 – I’ll just take life as it comes and enjoy family, work, school and blogging.

To quote REO Speedwagon, I’ll just “roll with the changes” and a la Sheryl Crow “I’m gonna tell everyone to lighten up…..”

Especially me.

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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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