June, 2008 Archive

June 6, 2008, 9:08 am

Stuck in the Middle With You

Just what annoying troubles do you get from harsh toilet tissue?

A sore rear end?

Unless this prim and proper patient is wiping with bark, she should probably spend her money on a more gentle tissue.

She certainly looks like she can afford it.

The nurse is thinking, “What a loony toon!”


One of the nice things about my job is the flexibility of scheduling. Each shift does their own schedules, and the nurse responsible for my shift is a freaking miracle worker.

I need one night off for a Jeff Scott Soto concert (okay, two nights) and she arranges an entire week off around the dates!

No request is too big, no length of time is too long…you ask, you get!

I love it.

And that is why I am now in the middle of a six night stretch, including a 12 hour shift tonight.

It’s hard to say “no” to someone who never says “no” to you!

Can’t say I’ll be very pleasant to work with by Monday night, but I will be there!


As an emergency department nurse, I am many things to many people.

I am a counselor, a pain-reliever, a consultant, a giver of advice, a dispenser of reassurance.

But there is one thing I am tired of being.

A rectal roto-rooter.


I’m sorry, but constipation is NOT, never HAS been and never WILL be a freakin’ emergency.

A soap-suds enema is not a life sustaining procedure and is most certainly not part of any Advanced Cardiac Life Support class I’ve ever taken (yet).

My vast experience tells me that if you can take a soap suds enema, you don’t NEED a soap-suds enema.


There are two types of constipatees in the ER. One type will present with abdominal pain or cramping, not knowing what the problem is. They will receive labs, fluids and really good pain medications while they get their abdominal cat scans that will confirm the now very expensive diagnosis of…


The second type comes in with the complaint of “I’m constipated.” Usually they haven’t had a bowel movement in 36 hours. Oh boy, call the code team!

And do you know why they show up at the ER with that complaint? Because their internist/general practitioner/family medicine physician or the advice nurse on duty TELLS them to come in! At 3:00 am.

A pox on all your houses!


I could go into a detailed explanation of what a soap-suds enema entails, of how it exhausts the patient, of how the soapy water shoots out faster than you can instill it, of how the entire procedure is useless, messy, smelly and time consuming.

But I won’t.

Let me go on record as saying IF you are truly diagnosed as being “FOS” (use your imagination) and there is nothing else seriously wrong, then a good bottle of nice, tasty Mag Citrate is what you need.

Yummy. Tastes just like 7-UP. And you won’t have to worry about NOT having a bowel movement for 36 hours as you will proceed to have a bowel movement that LASTS 36 hours.

MIssion accomplished.


I’d also like to point out that the next doctor who orders this ridiculous treatment in the ER while I am on duty may just wind up being the recipient of the same.

Think I’m joking?

Try me.

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June 3, 2008, 12:57 pm

Eyes Without A Face

Ha! This doctor won’t get away with poor auscultation skills!

Not if Nurse Sour Expression has her way!

Have you ever seen a doctor auscultate a chest without putting the earpieces in? Raise your hand, don’t be shy!

Now, how many of you have done the same thing?

I have. I thought I had gone deaf from too many rock concerts. Turns out the stethoscope was around my neck.

Speaking of stethoscopes, I have a beautiful “electronic” Littmann stethoscope that amplifies sound. I thought it ran on an AA battery, but it turns out it needs an AAA battery, so I have had to use my regular Cardiology II.

Guess what? I hear just fine. I guess I’m not going deaf after all. One more NASCAR race and I might be, though. The loudest band in the world has got nothin’ on a race car!


Wondering where Grunt Doc has gone? Have no fear, he’s with his family and away from his computer. He’s getting lots of worried emails, and asked me to pass this along!

Whatever it is you are doing, Allen, have fun! Then get back to work, we’re having withdrawls!


I’ve written before on how wrong I think it is for nurses to evaluate doctors (and vice versa), especially when it is anonymous. It isn’t easy, but as professionals I think we are obligated to talk out our differences of opinion regarding patient care.

And the only thing that really matters is the patient.

Well, now this topic has hit close to home. I was given an evaluation tool that had all our doctors listed on it.

I refused to fill it out.


Never mind that I had reservations about why the survey/evaluation was being conducted.

It was what they were asking and the way they were asking it that caused me to raise an eyebrow.

It was touted as a way for the nurses to give anonymous feedback to doctors. It even said “Nursing Evaluation” on the top.

But it was given to non-nursing personnel. Apparently, non-nursing personnel have the insight and education to evaluate physicians on the same level, using the same criteria as professional registered nurses.


If the concern is how well the doctors work with others, wouldn’t you think the non-nursing personnel would have different issues to address other than say, how physicians treat patients?


The questions were geared toward evaluating the doctor’s personality as opposed to medical expertise. One of the questions was actually “Which doctor makes you excited to come to work when you see his name on the schedule?”


How, exactly, is that professional?

I’ve been in ER nursing since 1991. There have been doctors whose very names have made me cringe, let alone work with them. Are they any less competent as physicians because I don’t like their personality or the way they practice medicine?

Or how about the question regarding whether or not a doctor moves a patient efficiently through the system?

Well, some doctors work fast and some work slow. I’m supposed to evaluate their pace? God help the doctor who tells me I’m not working fast enough for his/her taste.

Ah, but I don’t tell the doctor anything. You see, this is an anonymous survey. We give specific grades to specific doctors and they get the “feedback” with no way of addressing any problems with the nurse who has the problem with them.

Hate a doctor? Now is your chance to blow them out of the water with no accountability. For example: say that you are a physician and I don’t like you. You practice safe medicine, and you are relatively efficient. But I think you are one step above an amoeba in terms of your personality and I want you out.

Well, I would have two words for you: Bye-bye! Except I would not have to say those words to you. I could just evaluate you at the bottom of all categories and skew your evaluation so that it looks like you are a detriment to the department.

But I wouldn’t do that.



Because I don’t care if you are Marcus Welby, Hawkeye Pierce or Dr. House. I don’t care if you are Grumpy the Dwarf for as funny as Robin Williams. I may get frustrated with how fast you (don’t) move, but that doesn’t matter.

Every single one of us as have quirks, idiosyncrasies and unique personalities. As professionals we work with (and sometimes around) these qualities so that together we provide decent patient care. A doctor can hate my guts (and some have) or I can think they are the biggest ass on the face of the earth (and I have) but when the focus is the patient, none of that makes any difference.

I may get angry, frustrated or tired of getting screamed at by surgeons some physicians, but my patients are taken care of both by myself and the doctor. Interfere with safe patient care and I’ll be all up in your business, but at least you will know who is accusing you.

It beats having a bunch of eyes watching you without knowing whose faces they belong to.

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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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