January, 2009 Archive

January 9, 2009, 3:06 pm

Pain, Potty and Position Protocol for the Professional Peon

Wow – that is a mega cap!

There must be 2.5 inches between the black stripe and the top of that thing.

Too much space there. I give it a 8.75 on the Emergiblog Cap Rating Scale.

I see this nurse is making sure the doctor does all his documentation.

Some things never change.

If I had a nickel for every time I was told, as a nurse, to put the appropriate order form in front of the doctor’s face if he wasn’t using it, I’d be flying to every Nascar race this season.

Don’t know ’bout you, but the doctors I work with are professional men and women who can take responsibility for their own charting and ordering protocols.

I’m a Registered Nurse. I raised my kids. I don’t need to be babysitting doctors.

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

It has been my belief that the ER technician is the unsung hero of the department.

Doctors and nurses come and go, but a solid ER tech (along with a solid unit secretary) are the foundations of a smooth running department.

One would think that management would understand and appreciate the never-ending work of the emergency department technician.

One would think.

Let’s examine this in a hypothetical situation and see if we can draw any conclusions.

*****

Pretend you are an ER tech in a medium-sized community hospital; we’ll call it Hotel Get-Well. You work 12-hour shifts.

Your duties? As varied as the patients you care for. You transport them to x-ray and you run their blood to the lab.

Some days, every bedpan and commode are filled just for you to specimize and measure the contents thereof. Those colorful suction canisters are changed by your gloved hands, the same ones that just helped change the diaper of a patient old enough to be Lincoln’s grandfather on his mother’s side.

*****

Every single ER patient is transported up to their room by you, and we don’t have the technology of beaming them up. Every single patient in the entire hospital who receives a Celestial Discharge is taken to the heavenly holding area. By you.

IF you are not busy (!), you are expected to help other departments take their patients to CT or go with the house supervisor to take a patient to the MRI.

“No!” is not an option, btw.

These expeditions can take up to 1-2 hours, during which time the ER is short-staffed.

To make it worse, sometimes you are asked to run and get medical records because it is scary down there and you’re a guy and the supervisor is female and, well, you won’t get raped/maimed/murdered or abducted by the the Homicidal HIPAA Hell-Cat.

Oh, and did I mention that you are not the house “orderly”? This isn’t even in your job description.

*****

You clean every ER room after discharge, you re-vital patients on a regular basis and you never rehydrate yourself because there is no time to pee anyway.

If any stock is low, it’s probably (sarcasm) your fault (/sarcasm) because you did not order it and either way you have to run to Central Supply and pick it up. And while you are on the way, you might as well take down all the instruments that you have cleaned and prepped for sterilization.

You are responsible for stocking every single 2 x 2 and every packet of Surgilube. God forbid you forget to do the QC on the One Touch.

*****

You dress wounds, you apply splints, you do crutch training and you act as the go-fer when the doctor is suturing. You run out with wheelchairs to help people who can’t possibly get out of their cars, even though they managed to walk to them and sit down on their own power.

You hold cricoid pressure and you knew the appropriate rhythm of chest compressions long before the Bee Gees became the poster boys of CPR.

At any given time you answer to one secretary, four nurses, a physician’s assistant and a doctor.

Simultaneously.

*****

Pretty intense job description, eh?

It gets better.

Now, in the name of patient satisfaction, you have been told it is your job to round on every patient every hour, including those in the waiting room.

Of course, you must document all of this.

Welcome to the “Pain, Potty and Position Protocol”.

And while our hospital, techs and all others discussed in this post are hypothetical, that title is not.

I wish I had made it up.

*****

When the hell are you supposed to do all this? If our hypothetical ER was the size of the Daytona International Speedway {second superfluous Nascar reference} , this could be an issue.

But it’s not.

The hypothetical managers, when faced with the hypothetical red-faced-spittle-producing anger of this new hypothetical protocol say, “Now, now.  It’s just a nice thing to do when you aren’t busy.”

When you are not busy.

Some folks just don’t have a clue.

*****

So on behalf of all those hypothetical ER techs at the Hotel Get-Well, allow me to join you as we hypothetically hurl.

Should the term “Joint Commission” come up in relation to this new program of patient satisfaction, I swear I’m going to become a Nascar groupie or a Starbucks Barista.

Just when you though you’ve heard it all, the inane garbage continues to spew forth from the Powers That Be.

Why not just let us be?

Read »

January 4, 2009, 11:04 am

Primary Care: Profit is not a Dirty Word

Okay, who made the mistake of asking Dr. OSoloMio what he sang for his “Idol” audition?

I bet is was that guy right behind him. Doesn’t he just look like a trouble maker?

I swear that is “Frasier” to his right.

Here, at the annual luncheon of the Clean Plate Club Specialists, our medical colleagues are discussing profit in healthcare, which just happens to be the theme of this week’s “Grand Rounds”.

Unfortunately, this led Dr. Vince McVocal to belt out a rousing rendition of Donna Summer’s “…they work hard for the money; so hard for you honey! They work hard for the money so you better treat ’em right!”

It could have been worse. They could have been discussing gastrointestinal disorders, leading to that top-of-the-chart musical number: “Heartburn, nausea, indigestion, upset stomach, diarrhea, Pepto Bismol!”

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

There is one aspect of health care I will never comprehend, and that is the unwillingness to pay primary care providers what they are worth.

The foundation of health in this country is primary care.

And that is what is wrong with our system.

The foundation is crumbling.

*****

Health care is not a “right”. Health care is a necessity. It isn’t free. Never has been. Never will be.

But we are going about it the wrong way.

We are spending money “downstream” – after health issues have turned into major complications, and after the patients have fallen into the rapids.

But if we keep patients out of the water by putting the focus on health and the prevention, in other words, spending our money “upstream”, we get more bang-for-the-healthcare-buck.

And that bang-for-the-buck translates into primary care for everyone.

Equally.

*****

Primary care is not about disease, it is about health. The maintenance of health.

A relationship with a primary care provider who knows you, your family, your issues, your concerns.

This is what every American should have.

And no, I do not live in a “Marcus Welby, MD” fantasy world.

We can have this.

And I would recommend the steps listed by the Physicians for a National Health Plan to put it in place.

*****

Let me quote the following from the PNHP site (all emphasis is mine).

Here is how the plan would be funded:

A universal public system would be financed in the following way: The public funds already funneled to Medicare and Medicaid would be retained. The difference, or the gap between current public funding and what we would need for a universal health care system, would be financed by a payroll tax on employers (about 7%) and an income tax on individuals (about 2%). The payroll tax would replace all other employer expenses for employees’ health care, which would be eliminated. The income tax would take the place of all current insurance premiums, co-pays, deductibles, and other out-of-pocket payments. For the vast majority of people, a 2% income tax is less than what they now pay for insurance premiums and out-of-pocket payments such as co-pays and deductibles, particularly if a family member has a serious illness. It is also a fair and sustainable contribution.

Here is what would be covered:

All medically necessary care would be funded through the single payer, including doctor visits, hospital care, prescriptions, mental health services, nursing home care, rehab, home care, eye care and dental care. We also advocate a sharp increase in public health funding.

Here is how it would be run:

There is a myth that with national health insurance the government will make the medical decisions…In a public system, the public has a say in how it’s run. Cost containment measures are publicly managed at the state level by elected and appointed agencies that represent the public. This agency decides on the benefit package and negotiates doctor fees and hospital budgets. It also is responsible for health planning and the distribution of expensive technology. Thus, the total budget for health care is set through a public, democratic process. But clinical decisions remain a private matter between doctor and patient.

(PS: For staff nurses, this is where we come in.  Our negotiated salaries would be included in the total budget allocated to our hospital, per PNHP.)

Here is why we all need to be covered under the same plan:

Whenever we allow the wealthy to buy better care or jump the queue, health care for the rest of us suffers. If the wealthy are forced to rely on the same health system as the poor, they will use their political power to assure that the health system is well funded. Conversely, programs for the poor become poor programs. For instance, because Medicaid doesn’t serve the wealthy, the payment rates are low and many physicians refuse to see Medicaid patients. Calls to improve Medicaid fall on deaf ears because the beneficiaries are not considered politically important.

(All quotes are from Single-Payor FAQ/Physicans for a National Health Plan)

*****

I’m not a doctor.

I don’t even play one on TV.

And I realize I have not even addressed the use of advance practice nurses in primary care.

But I see doctors everyday. From ER specialists to family practitioners to neurosurgeons .

There isn’t enough money in the world to compensate them for the awesome responsibility they take on when they earn that MD.

And so no, it isn’t wrong for them to want to make a decent living, or a profit, if you will.

The altruism that leads them to choose medicine is becoming smothered by the bureaucracy and capriciousness of our current system of compensation.

If we can change that through a single-payor plan; if we can make it easier to actually practice medicine, we will see an increase in the number of doctors who choose to be primary care specialists.

And we will all profit from that.

Read »

12:22 am

Meet Hannah “Fontana”!

Meet Miss Hannah.

Artist, reader and the greatest big sister in the world!

Hannah is also a patient.

Right this minute she is in the hospital with aplastic anemia.

I’ve never met Hannah, but I met her friend, Jason, through Twitter (@jseliskar).

*****

Now it seems that Hannah loves to get mail.

Snail-mail, that is.

Good old fashioned cards and letters and pictures from other kids and…well, you get the idea!

*****

Hannah’s mom, Debbie, is working on scrapbook pages while she is with Hannah in the hospital.

That’s where I got this photo.

Now, I’ve never met Debbie, either, but she has a great blog called “Our Journey to China for Hannah’s Little Sister, Hope”.

Now the blog chronicles the miracle of Hope (literally!) and the results of hopes and prayers for Hannah’s recovery from aplastic anemia.

*****

So, what if we all sent a card, or a letter or a picture to Hannah?

Not money, or gifts, but a wonderful envelope full of warm wishes and prayers.

There’s a little girl out there who would love to receive them!

Send your cards and letters to:

Miss Hannah “Fontana” Eriksen

c/o The Law Offices of James Eriksen

PO BOX 4257

Rancho Cucamonga, CA

91729-4257

And don’t ever doubt the power of a 140 character post; it can literally brighten someone’s life.

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...

Continue reading »

Find Me On...
Twitter     Technorati

Subscribe to Emergiblog

Office of the National Nurse

Zippy Was Here


Healthcare Blogger Code of Ethics

  • Perspective
  • Confidentiality
  • Disclosure
  • Reliability
  • Courtesy

medbloggercode.com