August, 2008 Archive

August 30, 2008, 11:19 am

Chopped Liver to the ER, STAT

Oh, this is hilarious!

It is so obviously not a real hospital room!

The solid white backdrop – no oxygen, no light fixtures, no code button, no intercom.

Okay, so maybe they didn’t have those back in the day.

It’s hard to see, but there is a piece of tape on the glass bottle that says “Saline”. It looks like the tubing coming from the IV is rubber and about the size of a garden hose.

Is there anyone out there who has been in nursing long enough to remember rubber tubing?  I’m embarrassed to say that glass bottles were still in use when I started (and no pleurivacs, either – just three glass bottle water seal drainge!)

It seems that they practiced make-up application and used hair arranging as a therapeutic intervention.  That patient looks really sick, doesn’t she?

Heck, I don’t look that good and I’m healthy!

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

I have a problem.  With nursing.  WTF have we accomplished in the last 30 years?

Awhile back I handed a chart to our unit clerk.  On the chart, I had checked the standard blood tests required for a patient presenting with chest pain.  I then turned to tell the doctor about the patient.

Before, I had a chance to say a word, the clerk swiveled in her chair, put the chart in front of the doctor and asked, “Is it okay if I order these?”.

After I picked my jaw up off the desk, I said jokingly,  “Betty, are you questioning my author-i-tay?”.

Then I heard something even more astounding.  Betty told me that one of the doctors instructed her to run any and all nurse initiated orders by him first.  So, in order not to get in trouble, she did that with all the doctors.

WTF?  This is wrong on so many levels.

  • First of all, every nurse in my department is a seasoned veteran.  Together we have over a millennium of nursing experience.  I’m serious.  We don’t frivolously order labs or x-rays on a whim, we have the education and experience to know what needs to be ordered when.  Particularly with chest pain patients.  Especially with chest pain patients!
  • Then, to top that off, we have a very substantial nursing protocol for us to use on patients presenting with numerous chief complaints that covers us for the very thing I was trying to order.
  • The doctor in question has never, EVER said anything to the nurses about not ordering tests.  I find having the unit clerk question the order to be surreptitious.

Let’s make it clear here.  I’m not perfect.

But I’m also not talking major radiological, invasive studies.  I’m talking labs and extremity x-rays.

Which brings me to my next issue.

**********

The supervisor on duty that night (a good manager and someone I respect very highly), was astounded that we were “allowed” to order anything!  That we were treading on thin ice.

My response?

“Julie, are you telling me that an experienced, educated, professional registered nurse is out of line ordering x-rays for obvious fractures or initiating a cardiac workup when a patient obviously requires it?”

That was exactly what she was telling me.

Oh dear Lord.

That could explain why a very esteemed colleague of mine stood in the very same facility and watched her father die while the telemetry floor nurses would not get an EKG, order a chest x-ray, call respiratory therapy or draw blood work because “the doctor would be coming in”.

Shouldn’t we, as nurses, have those things ready when the doctor shows up?  Isn’t that the point of working in the hospital, to facilitate the care of our patients, to intervene when they go critical, to be prepared for the unexpected?  Especially in the emergency department, of all places, especially in an emergency department that prides itself on door to dilatation times that are so fast they can give you vertigo?

Am I nuts here?

What the hell are we nurses these days?  Chopped liver?

HELL NO!

*****

How can we fight for our professionalism when our own nurse leaders at the grass roots level don’t support it?

How are we really being perceived when doctors pay lip service to us one minute and then have the unit clerks run our basic protocol-driven nursing actions by them before initiation?

What the hell is going on with my profession?

*****

Please excuse the language, but I am pissed off.

This profession needs to get its you-know-what together if we are ever going to be taken seriously by anybody.  We can differ, but we have to present a solid front to the public, our community and to the medical profession.

And that front needs to be, say it with me….professsional! I don’t care if you spend your shift emptying bedpans or writing national nursing policy.

Nursing is an autonomous, distinct profession with it’s own research and evidence-based practice.  How long before we start to get treated like it.

Nurses, we had better take the reigns here because no one else seems to (a) want us to do it or (b) even think we might actually KNOW something.

How the hell do we ever expect it to change if we don’t do it from the grassroots up?

Even if it means taking it one person, one institution at a time.

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August 26, 2008, 10:41 am

Alas, Grand Rounds; I Know Them Well

Doubt thou the stars are fire;
Doubt that the sun doth move;
Doubt truth to be a liar;
But never doubt Grand Rounds.

I hope Will shall pardon my paraphrase of Hamlet’s words in Act II, scene ii.

Hamlet totally rocks, as does Teresa at Rural Doctoring for the Shakespeare theme of this week’s Grand Rounds!

And just for the record, Lawrence Olivier gives the best performance of Hamlet I’ve ever seen ( with all due respect to Kenneth Branagh), although the critics of Olivier’s time disagree with me.

I wonder what Zippy thinks?

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Rima from The Doctor Blogger has submitted a proposal called The 3G Project to the American Express Members Project. The projects that get the most votes will be funded. Rima does not receive the money, but the institution administering the project does.

In fact, here is a bit about what the project hopes to accomplish:

Teach health ed to pre-school age kids living in disadvantaged homes while parents and/or grandparents are present to also learn in a non-threatening setting. Kids hear the information early and all generations can work together to make healthy choices. Use a digital web based approach to “Teach the Teacher” what to say and how to say it.

Right now, Rima is around #27 and needs to make the top 25.

She can do it if we go to the site and nominate the project. I have put in my nomination. It costs nothing and takes a few keystrokes to accomplish. You do not have to have an AmEx card to vote.

Preliminary votes must be in by September 1st.

Good luck to Rima and The 3G Project! Be sure to keep us posted!

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

This is so exciting!

Emergiblog advertiser/sponsor and nursing community allnurses.com has reached their 300,000th member!

That is not a typo – that is an amazing accomplishment!

Congratulations to allnurses.com! Here’s to continued growth and a deep “thank you” for your support of Emergiblog.

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Another round of thanks to all who have volunteered to host Change of Shift! We are up into January dates now! Holy cow – I’m going to have to put up dates way into 2009!

Of course, the next edition is being held at the newly renovated Nurse Ratched’s Place, so be sure to send your links in via Blog Carnival or to “motherjonesrn at yahoo dot com”

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August 25, 2008, 8:01 am

Urgent!!! Help/Supplies Needed

UPDATE: I HAVE JUST LEARNED VIA EMAIL (8/27/08) THAT THE CLINIC WILL BE CLOSING AT THE END OF THE MONTH SO THEY CANNOT ACCEPT ANY MORE DONATIONS. HAVE NO INFO ON WHY THE CLINIC IS CLOSING, BUT WILL KEEP YOU POSTED IF I LEARN MORE.

This is a quick post to let you know what I found on Healthcare Today.

You really need to see this.

The 73rd Calvary in Iraq working in a convoy support center are running a burn unit!

These are non-medical guys, they work on trucks, but they are seeing/treating about 40 kids a day with burn injuries.

Why?

They volunteered. The Iraqis built a primitive but effective triage center and our guys are working to help these kids heal.

These are not war-related burns – there is a high incidence of domestic burns secondary to boiling water and oil from cooking.

Because they are not war-related, the guys of the 73rd cannot use Army supplies to treat the burns (a rules-of-engagement thing).

They need donations of physical supplies (not money or checks).

Lots of them.

I found bulk gauze rolls and non-adherent dressings on overstock.com, but they need other supplies as well.

Read the post.

Watch the videos.

And then donate.

How could I not?

And if you can find bulk supplies of Medihoney, please let me know – they need that really bad!

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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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