February, 2008 Archive

February 12, 2008, 12:23 pm

Putting the “Heart” in Grand Rounds


I’ve been a bad blogger.

I have neglected linkage duties for a week!

So without further ado, David at HealthBlawg is hosting this week’s Grand Rounds. The theme? Valentine’s Day!

Hence this photo from Cookies by Design.

I want this for Valentines Day. No way will my husband by them for me. He’ll say they are bad for my heart. I’ll say it’s because he is cheap frugal.

I’d pout, but after thirty years, that doesn’t work anymore!



Last week, Grand Rounds was hosted by Amy over at Diabetes Mine.

If you missed it (and I did!) be sure to check it out!

I’d put up the permalink, but can’t seem to get my brower to show it.

Also check out Amy’s take on the ACCORD research results.

Sure threw us for a loop!



You know it’s bad when I forget to link to Change of Shift!

Especially when I hosted it! The difference is that is is actually over at Nursing Voices this time.

Next CoS will be hosted by emily at crzegrl.net and submissions can be sent through Blog Carnival or to emily directly at “emily at crzegrl dot net”.

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10:29 am

Attitude Adjustment Required


What the hell is going on here?

The one on the left has to be a nurse because she is wearing a cap (that looks like a two-gallon Stetson, definitely a -1/10 on the Emergiblog Cap Rating Scale!)…

…and holding a Darth Vader mask in front of her face.

Given the hair, it might be Gene Wilder behind that mask.

(I swear we have “hats” for measuring urine in a commode that look exactly like that cap.)

Looks like something you might don for a “code brown”, lord knows I’ve had patients with what I swear was flammable excrement.

I don’t remember ever having to orient to a welding unit, and metal shop wasn’t a required class in my nursing education. Maybe it’s a graduate course…


I need an attitude adjustment.

Frankly, I think the entire world of emergency medicine needs an attitude adjustment.

But, since I only have the ability to work on my own attitude, I’ll start there.


Work has just sucked lately. Major league suckage.

I’m not sure what phase of the moon or what evolutionary phase humanity is undergoing at the moment, but for some reason we have a new paradigm on the night shift.

It’s called the “0400 Rush Hour”.

Somewhere between 0330 when the “third nurse” leaves the department and 0400, they start pouring in. All ages, all sexes.

And they are sick. Really sick. As in drop-the-blood pressure, rupture-the-viscous, call-the-cath-lab-stat, vag-hemorrhage-from-hell sick.

As in what do you mean there are no beds and we have to keep this patient for four hours? sick.

As in what-the-hell-are-you-thinking-this-patient-is critical and why-don’t-you-give-a-damn? sick.


Yeah, I’m tired.

I snapped at a co-worker this week. It wasn’t the straw that broke the camel’s back, either. Just came out of the blue – BAM! Not exactly the epitome of professionalism.

ER nurses are not supposed to do that. We are supposed to see the whole picture, function efficiently and if we are hungry, have to pee, have a headache or are just plain pissed off we keep it to ourselves and don’t not take it out on each other.

It’s not about me.


But it is about the patients. And I’m finding it harder and harder to give what I consider good nursing care in an emergency department.

We know what needs to be done for our patients. But from the patient’s perspective, it’s the less critical aspects that make all the difference.

And I’m not talking patient satisfaction scores here. I’m talking about making sure our patients are comfortable because we care how they feel, no matter what their chief complaint or how demanding they may be.

Caring. As a nurse I am supposed to be “caring” for the entire patient. That’s hard to do when you work in a department that by definition is a “medical-model”, as the ER is (and should be!). After all people don’t come to the ER to have their chakras realigned. They come in because they believe they have, and often do have a medical emergency.

So what’s my issue?


Well, this week I had someone tell me how to do a fingerstick glucose. A family member of a patient. I responded cordially, agreeing with exactly what they were saying and even adding a little theory as to why we do it the way they described.


You see the disconnect? There’s no harmony between how I feel and what I actually do. I’m acting. I’m acting professional.

The person who felt the need to give me an inservice in finger-stick blood sugars was scared. Didn’t look it, but they were. And the only way they could deal with a frightening situation was to feel as though they had some control over what was happening to their relative.

I know that. And I responded appropriately to them.

Then I went and snapped at my co-worker for absolutely nothing.


And while I’m ventilating, let me state for the record that patients are not stupid, jerks, little-old-ladies, asses, gomers, druggies, “alkies”, twits, hysterical, wimps, whiners or babies.

(Unless you are under 1 year of age and then you are a baby…)

And if I feel something is necessary to report, I am really tired of hearing “I couldn’t care less” or “we aren’t dealing with that now” or “I don’t want to hear it.”

Because it will be mentioned and it will be heard, whether or not action is required. And if I feel it’s germain to the care of the patient, I’ll document that I mentioned it.


They may not know how or why to appropriately access an emergency department. They may or may not have the means to pay for their medical care. They may be talking on a cell phone and listening to their iPods while decrying their inability to pay for the two-hundred dollar antibiotic they just got the prescription for.

Some may knowingly abuse the system.

Most don’t realize they are doing it.

But if we can’t at least try keep a non-judgmental attitude, we are going to eat ourselves up inside with anger, disgust and tension.

It’s happening to me – I’m the only one I can speak for, really.

And I’m going to work on stopping it from going any farther.

Anybody wanna join me?

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February 6, 2008, 11:33 pm

I Have Enough Water Bottles, Thank You


Margaret Kissack is in a million ads – always with the same expression.

Here, she explains how to use the “indispensible” rubber water bottle.

For periodic pain, no less.

First of all, it isn’t a bottle, it’s a “bladder”.

If your patient can’t figure out that you put water in the bag and then put the stopper in the hole, you have your work cut out for you as a nurse educator.

It amazes me how nurses were trusted figures of authority in advertisements…

But expected to give doctors their seat on the wards.


Soon it will be time for Nurse’s Week and we all know what that means.

Yes, I’ll wear my cap.

But it also means that all over the country, nurses will be receiving key chains and water bottles and tote bags and T-shirts touting their facility’s love for their nursing staff.

Either that or the company logo.

Ever wonder where they get that stuff?

Well! I found a catalog at the nurses’ station last week that is a veritable cornucopia of gifty goodies for nurses (and other groups that don’t get paid much and work their butts off, including volunteers).

Actually the merchandise looks pretty nice as long as your hospital is willing to pay for more than a key chain or a water bottle.

But it was what was attached to the catalog that had me falling off my chair laughing.


It was an “Event Planning Guide” for Nurses Week activities.

Let me share some of them with you!

I’m not making these up.

  • Fun On Wheels – “Organize a wheelchair relay race in a parking lot or in a wide hallway. Set up a ‘race track’ and on the day of the race, divide up the nurses into teams. Use a clipboard or ruler as a baton. Provide each participant with a…water bottle and give winners….insulated lunch bags.”

Yep, nothing says “Professional Nursing” like the site of a bunch of RNs rolling down the hill of the parking lot in wheelchairs!

  • Think Outside the Box – “Challenge your nursing staff to come up with silly uses for everyday equipment…get them to create a list of 101 ways to use a bedpan….at the end of the week, gather them around and read the lists aloud so everyone can have a chuckle…pass out (wait for it….)…water bottles or deluxe lunch bags to all nursing staff present.”

Oh yes, I want so much to have a chuckle at work. Tee-hee and ho-ho. Silly, silly nurses! How about we list 101 things that would make our jobs more rewarding and administration actually listens. Hard to put the logo on that ……

  • Out of Character – “Let them [nurses] dress up at the end of the week…nurses won’t be able to wear any outfit that’s too crazy so, at the start of the week, give each nurse a…scrub top. Require them to wear this shirt on dress up day, but to be sure not to wear anything that will hinder their ability to work. Hold a costume contest and allow them to vote for their three favorites. Give winners…red microfleece blankets.”

Criminy, that’s what I want to see if I’m a patient. Nurses in costumes. I love the attitude…let them, require them, allow them. How about I let you staff my unit correctly while requiring you to pay me adequately and allow you to kiss my derriere in the process?

  • Cajun Celebration – “…purchase inexpensive stings of beads and give out one to each nurse for every day worked during the week….pass out buttons….to spice up their scrubs…serve a Louisiana-style luncheon…provide nurses with [notice the new twist on water bottles] motivational message tumblers to drink beverages out of during the meal.”

Yeah, and get Emeril Lagasse to cook the lunch. Do I have to flash my boobs upper region to get the beads? Why not have the patients just throw them at us? It’s about the same level of dignity. I don’t need any logo-bearing buttons to spice up my scrubs, either. I find that blood, stool, urine and emesis – you know, the stuff that I deal with as I do professional nursing care?- is pretty much all the “spice” I need, thank you.

  • Handy Work – “Using notepad paper, have patients or residents make outlines of their hands…have them write their names and a message of thanks…when all of the hand drawings are complete, hang them in a common area…along with a …poster…give each nurse a stationery set of his or her own.”

Where the hell do we work, at a freakin’ preschool? Handprints? From adults? A bunch of adult-sized handprints hanging on the wall? Forget the stationery. The only paper I need from my place of employment is the paper that has my check printed on it.

Oh, there’s a few more, but I’m disgusted with the four examples I gave.

Ask yourself this: have you ever heard of these type of suggestions made to honor doctors?

I didn’t think so.

We have a loooong way to go.

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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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