Exhaustion.

I’m done.  Stick a fork in me.  Cooked.  Tired.  Knackered.  Straight up worn out.

Y’know how I know?  Every little bug knocks me down.  I want to sleep but can’t.  I wake up more than I’m asleep it seems.  Even with chemicals.

That said, I’m taking the rest of the year off.  I get on a plane tomorrow and head for Arizona hoping to recuperate and recharge and maybe stem the bleeding that is my will to continue as a nurse.  Burnout is a terrible thing.  So I’m going to enjoy a white Christmas in the White Mountains with my family.

Hope everyone has a wonderful Christmas and a great New Year.  I’ll be seeing you in 2012.  Promise.

 

Image via Wikipedia

 

What’s Wrong with Health Care?

Image via Wikipedia

Customer service.

We’ve turned taking care of the sick and injured into fucking Burger King. Everyone wants it “their” way. Sorry folks, life isn’t like that especially in my house. When we turn patients into consumers, they begin to expect to treated like customers and hence have no skin in the game. This leads to unrealistic expectations and our administrative “leaders” play up that we are in the business of providing customer service instead of healing. That then becomes our problems on the floors and our “customers” think that “their” way is the only way.

Yes, I will be disturbing you at midnight to check your vitals and then doing it again at 4am.

Yes, you will have blood drawn, probably several times through the day and night.

No, you can’t have your hydrmorphodemerolepam every hour, even if that’s how you take it at home – which is probably what got you here in the first place.

No, burger and fries are not part of your heart healthy diet to help treat your congestive heart failure.

Yes, lasix makes you pee. And, yes, I will be giving you a dose tonight, as the doctor ordered, every 8 hours so that you can breath and not have a hugely swollen scrotum.

Yes, it would be nice for your family to come in to learn wound care techniques so they can care for you at home.

No, not all of them can stay the night with you in a double room.

No, you can’t go out to smoke, even just for a minute. And I’m definitely not giving you an oxygen tank and wheelchair to do it.

Yes, you are more than welcome to leave AMA because we’re all racist assholes who won’t give you IV narcotics every hour, please just sign this form.

No, you don’t get a cab voucher, discharge prescriptions or fresh clothes if you do leave AMA. Sorry.

Yes, Dr. First-Year Intern, they just left AMA after threatening the entire staff, but you might catch them by the ED if you hurry. I’d bring Security with you though.

I will be polite and respectful, but I will not fawn over ingrates, feed into those with unreasonable expectations or take the crap from the dis-respectful. I refuse to be turned into a cashier clerk at the local fast food joint or a Pez dispenser of Oxycontin. There is difference between customer service and letting the public run wild in our house.

It’s time to take it back.

To set expectations.

To educate our patients.

To let the world know that we are not there to be exploited, abused and disrespected.

It’s a long journey, but it starts with a single step, for nurses and other health-care providers to stand up and say, “NO MORE!” and start to expect our patients to be active and involved, to care about their health, to put some skin in the game and start behaving like responsible adults.

But that will never happen. Sad.

Meetings: Not a Prioirty

To: Unit Manager

From: Wanderer, overworked charge nurse

Subject: Monday’s Meeting

I guess one of the included functions in the Managerion™ 2000 automated management toolset randomly creates meetings and requires our attendance.  This would explain relative randomness and recurring frequency of such meetings and their lack of cogent concept or agenda.  Having meetings just to have meetings about meetings is pointless and a waste of all of our time.

In the last 4 meetings we have decided absolutely nothing, but keep referring to later meetings to “work out the details”.  Would it be so hard to make a decision?  Yes, you have multiple units that these decisions will affect, but sometimes you need to throw caution to the wind and make a decision – call it an executive mandate.  There is something to that y’know?

This said, I won’t be coming to any more meetings.  I’m not going to spend an hour each way commuting in to work for a meeting that lasts 45-60minutes and decides nothing.  It is not as easy as some might think.  Whether I drive or not it is at least 45 minutes in rush hour traffic and if I use transit it is even longer.  Now if we were going to decide something or the  meeting was going to last 2 hours, things might be different.  Also if I didn’t have to come back to work the night shift at 1900 it might be different as well.  But the last 4 meetings have done nothing of the sort.

I realize that it is part of your annual review to see how many meetings you presided over, ran or otherwise were engaged in, and I know management is in agreement that meeting indices are not quite what they should be for this fiscal quarter, but please, enough already.

So unless the next meeting will actually accomplish something, or is held in a local pub during happy hour, I won’t even be phoning it in.  I am a nurse, I take care of patients.  I am not a paper-pusher, drone, meeting junkie or have any aspirations to management  so just let me do what I’m good at – no more meetings.

Thanks!

Wanderer, overworked charge nurse

First of a Thousand Words

I’m learning that there is only so much that you can write about on a daily/weekly/bi-weekly basis without getting into things like religion, money and politics – all subjects I learned long ago to steer clear from while at work and the dinner table.  Thees are things that I wish I could write intelligently about and eloquently enough to make a valid argument, but I have neither the time or the inclination to deal with the kooks that would stream from under the rocks if I did.  So instead, every time I get the urge to blather on about the inequities of tax policy, over-reach of global multinational, invasion of privacy, the corruption of our government and political process among other things, I will just post a picture.  It works for me.

Nursing Shortage? Not in Some Eyes.

I know this rant has been making the rounds on Twitter.  It is full of rage, a touch of woe is me and the grim reality of the situation we place so many new grads in.  A quote (shield your eyes if easily offended…)

Image via Wikipedia: They got jobs.

Well, after a year of getting rejected I have finally decided to give nursing the bird. FUCK YOU NURSING FIELD! Too bad the schools and media are still insisting that people go to RN school. Believe me THERE IS NO FUCKING SHORTAGE! New grads are considered garbage. On top of that, the degree serves no purpose in any other setting. BSN is a complete waste of time and money.   …And it is not just the economy. Hospitals turning huge profits stopped new grad programs and hire foreigners.

Wow.  The rest continues on in a rant that she (assuming a she) will never get a job, never put her degree to use and that she wasted 6 years of her life.

First gut reaction:  she’s right.  It sucks to be told there is a ready market of jobs just waiting for new grads.  Read too many job requirements of  “at least 2 years experience” and raged at the screen saying, “How am I supposed to get experience if I can’t get a job?  WTF?!”  I know many, many grads who have cycled through our unit for practicum who have yet to find jobs.  We have nurses on our unit who jumped at the first offer (methadone clinic anyone?) but persevered and got the jobs they wanted.  In fact that was me.  I got lucky.  I can empathize.  The betrayal of it all is painful, kind of like when you realized Santa was not real, or your girlfriend was banging your best friend.

Second reaction:  buh-bye.  Maybe we’re (as a profession) better off not having this person in our ranks.  Nursing is not easy…what happens the first time they get a difficult assignment?  Or have “one of those days”?  Run out?  Quit?  Nothing in this profession is given to you, one has to work for it.  Take for example NurseXY, who landed his dream job in a world-class CVICU.  Seriously, go read his stuff, he worked his ass off for it.  Nothing was easy.  No one ever promised (at least anymore) that a job would be waiting right when you passed NCLEX – and if they did you should make sure they aren’t selling a pile of hooey.  Just because there is a nursing shortage does nothing to guarantee you a job just because you passed the boards.  Anyone who degrades their education to this degree and doesn’t realize that sometimes sacrifice is a needed part of our job has no place being a nurse.

Final reaction:  no seriously, buh-bye.  If you want to work as a nurse enough to devote 6 years and thousand of dollars to do so, giving up isn’t an option.  She never says that she looked out of state for jobs, into different avenues than the traditional hospital based nurse or for other ways to be a nurse.  Our system interviewed over 500 grads for spots in our residency program and they came from all over the Northwest.  They tried to make it work.  There is nothing to say she did this, just a whiny, “why isn’t it given to me!” rant.  We have too many toxic personalities in nursing and truly don’t need anymore.

I know this is harsh.  Maybe this person is a amazing nurse, top notch clinical skills with empathy to boot, is driven far beyond belief and tried EVERY avenue to make things work, but based on what I’m reading, what they posted onto the internet for everyone to read, I doubt it.  And with this rant, I doubt any but the most desperate, worst, idiot recruiter would ever even consider asking for a resume.  I know it sucks, but maybe it’s for the better.

Is Protecting Yourself a Joint Commission Violation? | WhiteCoat’s Call Room

When are you guys going to learn? When a patient is choking the life out of you, you HAVE to offer them milk and cookies then tell them to go to a secluded room before you try to defend yourself. Those are the rules. If they have their hands around your windpipe and you can’t breathe, then just point emphatically to the secluded area.

via Is Protecting Yourself a Joint Commission Violation? | WhiteCoat’s Call Room.

Yes.  Yes it is.

This is the inherent problem of large regulatory bodies like the Joint Commission:  they do not operate in reality.  They exist in a perfect fantasy land where falls never happen, infections are impossible and ED (and all patients) are well behaved.  They do NOT understand the complex and dangerous reality that is modern health care.  Like managers, they should be required to spend an amount, say a week a year, of time where they are the primary surveyors.  Your primary survey (management) area is ED?  You get to spend a week in the trenches.   The people who are writing the rules NEED to be intimately familiar with the true consequences of their actions.  Handing down edicts from on high isn’t as easy when you know what it means to the actual providers.

Of course that is just a fantasy because like most bureaucrats, they got into this line of work to avoid (or couldn’t hack it) just this sort of thing.  Actual patient contact?  Ewww.

Obviously the Public Still Doesn’t Get It

Trouble is that patients still seem to think that nurses are not real people. I would be angry if nobody cared about my safety from an institutional standpoint, as was the case in my previous post, but that does not apply in my current position. The issue that steams me lately is the apparently novel idea that nurses are not waitresses, punching bags, ignorant children, maids, or housekeepers. I’m tired not only of being punched and kicked, but also of being ordered around (“go get me some water”) and even of, eg, being belched on. Would you burp on someone anywhere else and blow it in her face? No! So why is it OK when it’s a nurse? Where is it written that normal rules of adult engagement are off when one party is a nurse?

via Commentary on “Hospital staff sick of violent drunks” | Not Nurse Ratched.

There must be a magical aura around hospitals where behavior that is unacceptable ANYWHERE else is suddenly acceptable.  Nurses get the brunt of it.  Sorry, getting hit, spit on, yelled at and generally treated like shit is nowhere in my job description.  Really, I’ve looked and read my job description.  Not there, sorry.

Unorganized Thoughts

This last week beat the snot out of me.  I really want to write a resounding “Fuck yeah!” and a post related to some great nursing writing by Not Nurse Ratched and  Those Emergency Blues, but I don’t have it.  I’m running on empty from a worse week than normal.  If we weren’t getting screwed by the patients, the ED, docs and our fellow nurses there was a general feeling of being under a bad moon.  I feel like I saw the future of my floor this week:  it wasn’t pretty.  I want to say more, but can’t formulate coherent logical thoughts.  Believe me, I’ve been trying.  Nothing seems to flow right.  I have some snippets put down, but can’t seem to make them go anywhere.

Go read these posts.  They’re beyond good and in many ways capture what I’m thinking better than I can.

Dark Times by Not Nurse Ratched

Response to Dark Times by Not Nurse Ratched

Nursing Malaise by Those Emergency Blues.

I have this feeling of impending doom regarding my unit.  What they write about is evolving on my unit and I am scared to death about it.  I feel that even though my manager wants our input, doing so would make me (and every other charge nurse) complicit in the same destructive behavior described above.  I don’t want any of it.

Don’t worry I’ll find my flow again.

 

Head for the Polls

Tomorrow our great nation performs the ritual that makes it great:  voting.  We go to select leaders who we feel will best support our views, fulfill our needs and add to the prosperity of our nation.  It is a noble thing to serve one’s constituents, putting the needs of the many above the needs of the one.

I feel that in our country today, torn by negativity, bias, hateful rhetoric on both sides should have to take a day to step back, forget all of the nonsense, all of the bullshit, all of the false misleading ads, all of the things politicians say to get and stay elected and have a rational discussion of what is best for our country.  What is best for the whole?  How can we affect the greater good with our decisions?  This year we’re voting out of anger.  We place the blame and misfortune of years of mismanagement squarely on the heads of our current leaders forgetting that it took years to get us to this place…and it will take years to get us out.  You have to think about the issues rationally, try to sort through the bias that both sides spew to find the truth.  Realize the your decisions tomorrow can and will make a difference, good or bad, for the next several years.

So go to the polls tomorrow.  Don’t go angry, go with a clear head, a rational head and think what ramifications your vote might bring for the next 2, 4, or more years.  Choose the best candidate, not the one who has spent the most, slung the most mud, told the most half-truths and lies to win your vote.  Choose the ones that will benefit your district and your country.  Division will get us nowhere, rationality should win the day and unity will lead us on.

Culture of Coddling vs Eating Young

Not all that long ago I was a fresh-faced new grad, eager to explore the great wide world of nursing.  School was done, externship was over and I had passed the dreaded NCLEX on the first try.  I was ready.

Yeah right.

My first year was brutal.  Trial by fire, eating of the young, stress migraines and an overwhelming urge to run screaming as fast as possible away from my job and go work at McDonalds, that encompassed the first 6-8 months.  Then as if by magic, I realized I wasn’t struggling, I wasn’t hating work, I didn’t get sick on the way to work and people were asking ME for answers instead of the other way around.  I couldn’t tell you when it happened, just that it did.  Having been through it I know that it made me a better nurse.  That hell I went through toughened me up, made me become organized as a survival technique, taught me how to juggle the needs of my patients with the duties I needed to perform whilst maintaining a sembalnce of sanity.  And it worked.  It was kind of like boot camp:  break you down to build you up.

Since then I’ve precepted new grads, been a mentor of sorts to them and tried to make their first year a little less harrowing, but still instilling the fire they need to survive.  I don’t practice eating of the young, it’s counter-productive and will drive promising new nurses right out of nursing, or at least off of your unit leaving you back where you started: short handed.  But I do believe a little bit of “tough love” is needed.  Our job is not easy and the sooner you accept that it isn’t all candy and rainbows the sooner we can build you into a competent nurse.  Not saying that you’re crying on the way home everyday, but not shielding from the rough days either.

Our system just bought into the Versant Residency Solution, which is a systematic residency program intended to rapidly prepare new nurses.   “After only 18 weeks, trained observers report that Versant RN Residency graduates achieve Nursing Skills Competency ratings that are slightly above new graduate comparison groups who have been in professional practice for nearly a year and a half (17.1 months).”  Sounds awesome.  Wish we had something like that when I was starting out.  That would have made my first year a little bit better.  Or is it just delaying the inevitable?

Our RN Resident is with us for 18 weeks.  18 weeks of being precepted before they are on their own.  2 days a week in classes, 2 days a week on the floor.  It’s a tough schedule, worse for those that drew a night shift slot.  But in our over-saturated market many new grads were willing to sign over their first and second born to get a nursing job.  For 50 something slots, over 500 newly graduated nurses applied.  It’s that desperate here.  Truly these are the cream of the crop.  But for 18 weeks they are coddled into nursing on the floor.  I had 12 shifts with a preceptor, and was told straight out that by shift 9 or so I would be taking a full load with the preceptor merely supplying help when needed.  Our poor resident is struggling still to take 2-3 patients a night and they are already past day 12 and those running the program have told the preceptors that the residents aren’t expected to take a full load until the final weeks of the residency, if even then.  For 18 weeks we expect less, are allowed to expect less and not to push as hard as we might have before.  We’re coddling.

Do I expect new nurses to go through the same shit I did?  It sounds like it.  But I truly believe that there comes a point where you can no longer hold their hands, no longer allow them to sit idly by, skimming along with help from their preceptor:  it’s time to fly!  The 18 weeks is doing a dis-service as it is not making them fly on their own.  What made me a competent and efficient nurse?  Stress.  Pain.  Being kicked out of the nest and having no choice but to fly.  Did it suck?  Yeah, but I know that I’m stronger for it.  This coddling aspect is so ingrained in our culture, from the “everyone wins” school of thought in sports, to getting a 4.3 GPA on a 4.0 scale,  to overprotective parents, that we can’t just let people go and see how they function on their own.

Since I started on my floor, it has changed drastically.  The old battle axe nurses have moved on, now you’re more likely to get help when you ask  rather than a dirty look or eye roll and generally it’s a better place.  Being let fly here is far less daunting than it was when I started, there is support whereas previously you really were on your own.  But, due to the rules of the program we can’t let our residents fly on their own.

I know that people will ask, “So, are you doing anything to help the resident?”  Yes, the preceptors (there are three of them) and a couple of the charge nurses have talked about ways to help them.  We don’t want them to fail, but we don’t want the end of the 18 weeks to be a huge issue either, where all of a sudden you’re flying free and haven’t developed the skills to keep aloft.  Who knows, maybe this idea is great and it will produce incredible results – that’s at least what the program developers say.  But I have one lingering question:  how can you be as good as a 18 month nurse at 18 weeks when you’re only spent 12 of those weeks actually caring for patients?  Book learning is great, but it means nothing until you get to use it.  It is the actual act of caring for the patients that brings the book knowledge into focus as Ricky Gervais said, “Without application, knowledge is pointless.”  We’ll see how it end in about 3 months.