A Happy Hospitalist: What Happened To The Nursing Profession?

A Happy Hospitalist: What Happened To The Nursing Profession?

….I was going to write a bitter polemic about this, but realized that it would just fuel Happy’s ego.  It’s bad enough that I’m linking to it, but I had to say something about it.  So here goes:

1.  More often than not as nurses, we’re not allowed to exercise our critical thinking and judgment thanks to rules, regulations and policies.  Even when we know that it is not necessary to call (thanks to our experience, training and critical thinking), we still have to call, or if nothing more, document why we didn’t.

2.  Some nurses are better/more experienced/better educated/have more common sense than others.  Same goes for doctors.  ‘Nuff said.

3.  We’re not always sure the doctors are aware of the situation (many times they aren’t…) so we call to inform them of it.

4.  Us night shift nurses really love nothing more than to call up a sleeping hospitalist at 3am to report a critical value (that really isn’t, see point #1).  It’s almost as much fun as having to call a cardiologist at that un-godly hour.

Just my view.

Ugh.

I just finished working 6 out of the last 7 nights.  It’s kicked my ass, but in the end was worth it.  One of the shifts was overtime, which never happens anymore so I had to take advantage of it.  I feel like I should be more tired, went to bed at 9am and woke up at  feeling fine.  I no longer understand my body’s sleep patterns, they’ve gotten too screwed up.  Now I just sleep when I feel like it and hope for the best.

Luckily I have a week off and in spite of having to take ACLS tomorrow (and the next day) it should be enjoyable.  But alas, it is Spring in Oregon and there is nothing but clouds and rain in the forecast.  We had one day of bright sunshine this week and it was wonderful.  I felt alive again, at least for awhile.  Considering the previous evening I was riding through downpours on the way to work it was a nice change.

Here’s a couple of funnies from the week:

Chief Complaint 1:  Suicidal Stomach
(actually suicidal, stomach pain, panic attack, but our system only shows the first 20 or so characters of the complaint.)

Chief Complaint 2:  Penis Lac
(in comments to the side “S.O. w/tongue piercing.)  That’s sexy…nothing like the feel of steel on your…uh, nevermind.

Rumors

Of my demise, once again, have been greatly exaggerated.  Between Comcast, near-eviction, a psychotic landlord, 2 near Codes, a root canal, 2 weeks of antibiotics, a sick wife and a busted rear wheel, blogging has not been at the forefront of my mind.  I am still alive, kind of.

Taking the beak though, further crystallized for me why I write:  I like it.  It is one of my creative outlets that requires no more money than I already put out, which is a good thing!  I’m energized and happy to be back on the horse.  But of course I have to work.  OK, well maybe later this week….

Bill would make cyclists pay to use & maintain roads.

Bill would make cyclists pay to use & maintain roads | Local News | kgw.com

This pisses me off on so many levels that I’m seeing red just thining about it.  I can understand why the reps involved in this want to pick on a visible minority, hell, we’re not always the best of stewards (us cyclists).  But this is just an out and out attack.

I went through the commentson this article and the most common one is, “Good!  Make them pay for using the roads too!”  Nothing could be farther from the truth.  I pay property taxes, state and federal income taxes, I register all three of my cars (including the restoration project) and the family does drive nearly every day thereby consuming gas and adding to the gas tax fund.  Who’s telling me that I don’t pay me own way?

It’s just bullshit.  By bicycle commuting I take a car off the road, thereby reducing my carbon output and reducing congestion, plus I’m doing something healthy for myself that will reduce my draw on the health systems down the road.  Besides, the fee will not even pay for the administration of the program, much less contribute to actual upkeep of the roads.

You better believe that I’m going to involved in getting this bill killed!

medical-esque posting to resume shortly…

EKG of the Week #1

click for larger view

Pretty classic example of failure to sense and failure to capture.

As you can see, the pacer is firing but there is no response from the heart.  No P-waves, no QRS complexes, just lone pacer spikes hanging out.  This is classic failure to capture.  Possible causes of this can be a fractured or dislodged lead, battery failure or electrolyte abnormalities among others.  Luckily in this case the patient has an intrinsic rhythm that is probably perfusing them.

The second item shown is failure to sense.  Notable for this is the pacer spikes in the ST-segments.  Failure to sense is exactly what is says, the pacer is failing to sense the cardiac cycle and inappropriately pacing.  Again, luckily in this case the pacer is not capturing so the inappropriate pacing is not causing issues.  The biggest problem with this failure is inappropriate firing when the heart is not quite yet refractory possibly initiating ventricular arrhythmias.  Causes of failure to sense include lead issues (dislodgement, fracture or poor positioning) or sensitivity issues requires a change to sensitivity.

In this particular case, it appears the patient is in atrial fibrillation, which may be causing issues with both capture and sensitivity.  The erratic electrical signals emanating from the atria may be throwing off the pacer, but many times they are programmed with this in mind.  For nurses the important things to remember is to check on the patient when the pacer is acting up and ensure they are stable.  Past that, with permanent pacemakers, we need to get the cardiolosit involved.  If it the nurse who is running a temporary pacer at the bedside, adjustments to both output and sensitivity may be required to ensure adequate sensitivity and capture (but that’s a whole other ball-game!).

Here’s what a pacer strip should look like:

av_ekg

Each spike has a corresponding activity, just like it should.