Archive for category I'd Better Feel Sorry for Myself 'Cause No One Else Will

Nursing Week Ain’t What It Used to Be

My Nurses Week joy was shattered last night when the son of a patient reamed me out for discussing the patient’s condition and treatment plan — wait for it — with the patient. He thought his father, who was a rather elderly but very independent and shrewd man who still lived in his own house and putted around in a low-mileage 1992 K-car, might be disturbed and upset. I thought the son was a controlling little freakazoid, but didn’t say so. Not very nurse-like, I know, but your humble writer smiled and nodded and went on, curiously enough, to validate and affirm the son’s distress even as the son was proceeding merrily along with the aforesaid ream spree.  Then I promptly charted the conversation because, as all nurses know, these things come back for endless amounts of arse-biting. My life as a nurse: Florence, eat your heart out.

Management Approaches with Nurses Week Greetings

Also, Acme Regional’s annual Token of Sincere Appreciation, a.k.a. the Swag Bag, has evidently been cancelled. So in other words they are replacing crap with no crap at all which, when I come to think about it, represents a net gain.

Hurrah.

Anyway, EDNurseasauras and I seem to be on the same page when it comes to Nurses Week. After listing all the cruddy, oddly depressing, and inevitably unattendable Nurses Week festivities at her workplace, she writes:

Bobo, our medical director and somewhat socially challenged on his best days has actually paid out of his own pocket for some nurses day gift (I think his wife is a nurse).  In the past we have received lunch bags, t shirts, and coffee mugs.  But slogans like “Nurses Call the Shots”,  “Love a Nurse PRN”, “Nurses Rock” and other silliness goes right to the bottom of the charity bag for me.  Let me say that I truly appreciate that he has taken the time and effort to do this.  I really do. But I actually hate that more than the company logo.
At my nursing school graduation 35 years ago, one speaker exhorted us as newly minted nurses never to condone slogans that exploit us as men and women in health care, perpetuate stereotypes, and fail to present nurses as professionals.  Big boobs, thigh highs and stilettos, giant syringes…..you know what I’m talking about.  I have a few Emergency Nurses Association coffee mugs from a former boss that are tasteful, but other than that I say NO to silly slogans.
The only Nurses Week recognition I’m looking for is just a little sincere appreciation for the job I do from my employer.  Sincerity is not one of their strong points, so hopefully my boss will come through with the ice cream.

Ungrateful wench! At least she might get ice cream.

So how is your Nurses Week going?

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Asking for Drugs

In the Emergency Department, part of a nurse’s job in discharging patients is to figure out if they are good to go home, because in part it’s good nursing practice, but mostly you don’t want to have them bouncing back in a few hours because they didn’t understand something, or have a question. So you eyeball them, do some health teaching, review their prescriptions and follow-up, tell them when and if to come back —  and assess their pain. This past week I’ve had five patients — all male, incidentally — who needed scripts for stronger analgesia than what is sold over-the-counter. The doc had overlooked this aspect of their care of them were reluctant to ask for good analgesia directly from the physician. They didn’t want to be seen as being unable to handle the pain. They all ended up with scripts after I advocated for them.

A few days ago, I had a very minor, but enormously painful procedure performed for a notoriously uncomfortable condition in my local (but not my) ED. I got handed a script, and when I was leaving when I noticed the physician neglected to prescribe any analgesia. Percocets or even Tylenol 3 would have been appropriate.

I pondered, briefly, whether I should ask for painkillers. I decided no. I was embarrassed to ask. I didn’t want to be labelled as drug-seeking. The sequel is now I am taking far too many 222s (ASA, codeine and caffeine) and Tylenol 1 than is really good for me (both of which can be gotten over-the-counter in Canada) and also Advil than is really good for me, and I still don’t have good pain control. Though I am feeling pretty spinny from all the caffeine in the 222s and T1s.

Barrier to care, anyone?

Sad to say, nurses and physicians in the Emergency Department still tend to manage pain like every patient is drug-seeking, or will become addicted or else is exaggerating their pain to so they get the “good stuff”; we eschew measurements like self-reported pain scales, instead relying on our highly subjective and unreliable judgment about whether the patient is actually in pain or about the patient’s relative worth. (I have witnessed physicians withholding narcotics from drug-addicts with large bone fractures. Ha ha, take that, you addict! I have also seen orders for morphine 1-2mg q4h for sickle-cell crisis — which, to my mind, manages to be racist, bad practice and plain awful, all at the same time. ) We disbelieve reports of chronic pain. We laugh when a patient presents with back pain and is taking Lyrica. We believe deeply as a culture that suffering somehow ennobles, but in reality only thing suffering does is make people suffer.*

It strikes me that even after years decades of education about pain management, we still don’t really get it about pain control. If a crusty old emergency nurse like me worries about being labelled as DSI* for asking for ten Percs, do you think there might be something seriously wrong with our approach to pain management?

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*I have yet to meet the patient whom overwhelming pain has made into a better person.3.

**Drug-seeking individual.

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In Which I Swear, Repeatedly, or, TorontoEmerg Gets Bullied

I write this blog for a number of reasons: my own amusement, to educate, to share various random thoughts, to tell stories, to stimulate discussion on topics important to nursing, to provoke thought beyond the superficial, to challenge assumptions, and lastly, to rant.

Today I am going to rant.

Those of you with delicate sensibilities may want to get out. I am going to use some earthy language. Repeatedly.

So, to begin: I love my colleagues with the generous love I share with my family, but like some of family, they can be gaping assholes.

I’ve been seconded again for more administrivia duties. Since part of what I’m doing will have focus on improving quality of nursing work life, I am very excited and eager to do this. I believe making our work places better for nurses will, in the end, save nursing as a profession.

For this work, I needed to buy some markers. With the manager’s permission I (innocently) ordered a pack of multi-coloured, fine point Sharpies, which with the wholesaler’s discount came to $6.35 (six dollars and thirty-five cents) plus HST, and charged them to the departmental budget.

The markers arrived on my day off.

Then the nattering started, which (from reports) quickly escalated from a simple “why were these markers ordered?” to attacks on my integrity, discussions about my worth as nurse, and lurid suggestions I was dogging it.

From the reaction, you might have thought I was running a child prostitution ring in the Resus Room, and was using departmental petty cash for start-up costs. It was that bad.

One of my colleagues, a woman I previously thought as an ally, was incredibly hostile. “Why” she asked, “couldn’t you buy your own?” Of course, her anger left me slack-jawed and stupid and the correct answer escaped me at the moment: for the same reason I don’t buy my own kidney basins and bath flannels.

Yes, it was bullying, and afterwards, I reflected on the irony that so soon after writing on the subject I should become a victim of it myself.

So, it was hurtful.  But mostly it really, deeply pissed me off. Remember, I’ve been working with some of these nurses for ten years or more.

I know I’m a damn good nurse, and you’re lucky to have me, so fuck off.

I’m working hard to make your lives easier as nurses, so again, fuck off.

And yeah, I know about horizontal violence and the rest of that, but the bottom line: you are responsible for your behaviour. Stop being a high school gossip queen — and for some of you, you’re closer to retirement than your senior prom — and start being a nurse. Because when you undermine me or anyone of your nurse-colleagues, you’re really undermining yourself.

Another colleague, far more sympathetic, suggested that nurses have been doing it to each since Florence was beating the carpets at Scutari, and we are never going to stop acting, collectively, jerks.

I fear she may be right.

So I say again to those nurses who found it fun and interesting to shred my character in a few minutes time: um, fuck off. And fuck you. You aren’t worth my time.

End of rant. Thank you for your attention.

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15 Comments

Pee-new-moe-knee-a

That’s right. Bilateral even.

I was having this funky back pain radiating around to my chest for a couple of weeks and a really strange shortness of breath that left me inexplicably gasping, so I went to my local ED to get it checked out. Got the full cardiac work-up, blood work, chest x-ray, ECG. Nil acute, nothing wrong, rien, diagnosed with musculoskeletal pain, patted me on the hand, and sent on my way. That was two weeks ago.

Last Thursday a colleague told me I looked “haggard” after a twelve-hour day.

Friday my GP left me a message on my voicemail asking me to follow-up because the radiologist’s report showed “an abnormality” on the chest x-ray. Here we go, I thought. I’m a reformed smoker.

After having a small meltdown, and making many phone calls trying to figure what exactly the radiologists report said, it was determined I only have pneumonia. Undiagnosed for a couple of weeks or more. The term of art for this is “missed finding”: the ED doc literally missed it on the x-ray — or forgot to look.

I haven’t felt exactly unwell: just sort of run-down, which I attributed to the weather and the season. Ibuprofen took care of the back and chest pain. I only started feeling really sick on Friday before I got the call. Since then it’s been hit or miss. Saturday I felt fine, Sunday I was intermittently febrile, and yesterday and this morning— just general malaise. Thankfully, I have a few off to lounge around the house.

Needless to say, all of this is far better than the alternative. It’s funny, though, how a phone call can transform you from “well” to “sick” in a matter of seconds. One moment I was perfectly okay, if a little under the weather; the next I was afflicted with a semi-serious illness, and thinking I needed all the prerogatives and privileges of the sick: warm blankets, ginger ale, chicken soup and general pampering. None of that has happened this far: no one quite believes me! For this, oddly enough, I’m grateful.

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Good News from Kansas after a Spectacularly Awful Day

Your humble charge nurse had an awesomely bad day, in a week of similarly nasty days, so crappy in fact that I’m too tired and fed up even for my usual upper-management-idiocy snarkiness. The only slight consolation is that I understand nearly every hospital in the Greater Toronto region has been overwhelmed with patients. Superior Hills General, our bigger neighbour down the road, I’m told, had an 36 admitted patients boarding the ED, and an unbelievable 61 patients held for consult.

The good news is that a judge has ruled against Johnson Community College in the placenta Facebook case. To say the court spanked the College would be an understatement. Some more details on the events leading to the expulsion:

Byrnes said the picture was on her Facebook profile for about 3 hours, until Delphia [Byrnes’ lab instructor] called her and requested she remove it, which she did. Byrnes says Delphia told her she wasn’t in trouble during the conversation.

But the next day, Byrnes said, Johnson County Community College Nursing Director Jeanne Walsh blasted her and the other students by screaming and crying at them.

“During the meeting, Director Walsh’s emotional conduct precluded the students from defending themselves and adequately explaining the reasons for engaging in the conduct in question,” the complaint states.

“Director Walsh summarily dismissed Plaintiff Byrnes and three other members of the lab group from the nursing program, and exclaimed, ‘I don’t know if I would want you back.'”

Is this how we want nurse educators to act? I don’t want to flog a dead horse, but again it strikes me the true professionals were the students, not the Nursing Director. In its press release, JCCC was typically gracious towards the students in admitting defeat, as it has been in this whole process. Okay, maybe not so much.

“We are disappointed with the court’s decision today,” said Terry Calaway, JCCC president. “Of course we’ll abide by the judge’s decision and readmit the student to the nursing program.

“The JCCC nursing program is widely known and respected for the quality of its instruction and its graduates. Sensitivity to patients and confidentiality of patient care is at the heart of what we teach. We took what we believed to be appropriate action, but the court saw the situation differently, so the student will be readmitted to the program.”

The students who took the photos were never expelled from the college, as has been reported, but were temporarily dismissed from the program.

Three other students who had been dismissed from the program will also be readmitted.

Classy to the bitter end, eh? (See, I’m so tired even my sarcasm bone is exhausted.)

To Doyle Bynes and colleagues: congratulations and well done. You do us proud, and you’re a credit to our profession.

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*JCCC needs to give up on the “temporarily dismissed not expelled” spin. It’s a distinction without a difference, and it’s silly.

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Seeing the Back End of 2010

You might have noticed I was a little scarce after the holidays. Because I fell.

Thrice.

As in three times, all slipping on ice. After the third time, the husband started holding me — annoyingly — by the elbow, like he was doting on his ancient and frail gran. No serious injuries fortunately, but enough to cause some weird back-spasming thing and some exquisite pain in my left trapezius (I think). So not functioning too well, these last couple of days.

So to sum up this year:

Wretched back.

Badly sprained ankle.

Assaulted.

Ear infection and perf’d tympanum.

Gastro.

Enough, I said, is enough after the falls. I was angry enough to spit, and frustrated enough to cry.

But then I remembered this:

We spent a delightful Christmas Day with an old friend, who, by-the-by, has some fairly troublesome and significant medical problems. She insisted this year on cooking us Christmas dinner deluxe — complete with turkey and tortière and homemade pickles. It pretty well wiped her out. Afterwards, we had our usual perfunctory discussion about her well-being — she dislikes talking about it — and at the end, gazing at knuckles contorted by rheumatoid arthritis, she said, “Well, it beats the hell out of the alternative.”

And also I remembered this:

We spent a delightful Boxing Day with another old friend who cooks in the firm belief that too much is certainly not enough, so dinner began with cold shrimp, hot hors d’oeuvres and a  meat and cheese tray, wine, and processed merrily along through bread, mashed potatoes, gravy, stuffing, Caesar salad, broccoli with cheese sauce, wine, wine, wine, coffee by the gallon, cheesecake and ice cream. Her marriage is as at the edge of a cliff, and has been for the better part of a year. I fear the fall to the abyss will be rapid. She presided happily over the cheerfully chaotic — and loving — theatre of her family: this Boxing Day, for her, was a good one. It may have been the best five hours I have ever spent with her, watching her watch her family in her cramped kitchen.

It’s all a matter of perspective.

I have a home.

A happy marriage.

Good health.

A full pantry.

A garden.

An interesting and well-paying job.

Money in the bank.

A reliable vehicle.

Friends.

Love.

It’s better than the alternative. Much better.

So, no more whingeing and whining. But still, the end of 2010 won’t come fast enough.

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Those Crockpot Blues

Today I am not going to delve into any heavy-heavy nursing issues, or talk about cholera (though you may see an update later). There is only so much this nurse can give, and my brain is tired. Instead, I am going to rant about a crockpot. The one we bought a couple of weeks ago.

It’s a Hamilton Beach Model # 33723C. Why, o why, you might ask, did buy a crockpot, the curse of church suppers and mid-week dinners? Well, because, frying eggs taxes Mister Man’s culinary skills, I loathe having to cook after getting home from a busy day of playing charge-nursey, and yes, I am cursed by the occasional church supper.

We didn’t intend to buy it. We were at Zellers. For my American readers Zellers is a low-rent department store that really wants to be the Canadian version of Target but usually ends up looking like a slightly tacky Walmart. Anyway, we had to get something at Zellers — some fancy lightbulb evidently something exclusively available at Zellers — and when we went through the check-out the girl there said “You have enough Club Z points for sixty dollar gift certificate!” (It took us twenty years of shopping to accumulate enough points, incidentally.) Oddly, just that morning I had said to the husband, “We should by a crockpot.” Some things are meant to be.

Anyway, it’s not goumet cooking, but I am reasonably satisfied with it. Stew and soup and such are credible. It makes a tolerable bœuf à la bourguignonne, believe it not. Pot roast not so much, or maybe I’m not doing it right: it’s strangely flavourless. Midweek stew and church potlucks, that about sums it up.

None of which is the real reason for this post. The point is that after two weeks of using the crockpot maybe five times, the little writing on the temperature control dial, which tells me “High”, “Low”, “Warm”, and “Off” have worn off completely. It’s not like I’m using some weird concoction of bleach, ammonia and oven cleaner to wipe the thing down. Yet the happy sticker on the side, which tells me I have bought a lovely Hamilton Beach Crockpot with Travel Case in the event I forget, remains stubbornly stuck on despite repeated assaults. It’s not that I need to know where “High” is. It’s the principal of the thing. Why should something which I paid fifty bucks for develop a defect after two weeks?  So yesterday, I emailed the company:

The defective crockpot. Note the sticker on the side.

About two weeks ago I bought a crockpot at Zellers, the fancy one with the travel case. I am very pleased with it, except, the markings on the temperature dial have already worn of. Ironically, I cannot get the promotional sticker on the side of the pot off. Can you please send me another dial, and instructions how to replace it? Also, how do I remove the sticker?

Thanks
[redacted]

I have not received a reply, perhaps because of my faintly sarcastic tone. (I am constitutional unable to write to anyone in authority without being faintly or obviously sarcastic.) But then I remembered something about the concept of “quality control.” Most people believe “quality control” means making something the best way possible. It actually means making something to the cheapest, most minimal quality standard possible that will sell to an ignorant and apathetic public. Hamilton Beach obviously strongly believes in quality control. The company also knows it can save ten cents a unit on dial labelling because few people will complain about such a triviality, and if they do bitch, they can be safely ignored, because we won’t do anything about it. (Customer service essentially has the same definition as quality control. Bell Canada has elevated customer service to an art, for example.)

So I feel cheap and used. By a corporation. I know, take a number, and stand in line.

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No Snark Here

Up again at 0430, ear throbbing, after a restless night of fever and confused dreams. A comfortable cup of strong coffee, some pain meds, a dose of antibiotics, and one can begin to size up the world.

Bleh. Hardly doing anything that required more than thirty seconds of focussed attention. As for writing — God help us all, I’m not even up to snark, even ripe and ready for the picking.

At any rate, thanks for all the kind messages and advice. If there’s no improvement by tonight (which will be 72 hours of antibiotics), I’ll go get checked out again.

Me and the cat and my drippy ear are going back to bed.

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Perf

Judging from the outer ear canal crust this morning, I gather the infection and the pressure perforated my eardrum overnight. Frankly, I don’t know when I’ve felt so lousy. No post today, obviously, but a few autumnal garden photos.

Incidentally, does anyone have an opinion when I should get further attention? The treatment seems to be antibiotics (which I’m on) and time, but the ongoing pain, the hearing loss and general crapitudiness is a bit alarming.

Symphyotrichum novae-angliae (syn. Aster novae-angliae) 'Alma Potschke'. Who says fall gardens have to be dull?

More beneath the fold. Read the rest of this entry »

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An Earful

I’ve had this annoying little head cold for the past five or six days, but on Friday morning I began having sharp intermittent left ear pain which became more or less constant and severe by Sunday night. Ibuprofen and Tylenol #1 did nothing. I was waiting to see if would go away: I knew the vast majority of ear infections are viral (and won’t of course respond to antibiotics) and would resolve in any case on their own; also I didn’t want to be a bother, one of those people who runs to Emerg for trivial complaints.

But after a sleepless, pain-filled night enough was enough. I called my family doctor — no hope of an appointment today. So I had no choice: we trundled over to the local Emergency (Hi L.!), was mistriaged (of course), and waited three hours to see the physician.

My conversation with the doc went like this:

Me: I have a left ear infection, and the pain is so severe I can’t close my mouth.

Physician: It’s not likely you have an ear infection. I don’t like writing unnecessary prescriptions for antibiotics.

Me: The pain is ten out of ten.

Physician: (looks in ear) Why, it’s all red and very swollen!

Me: (to self) Well, duh. (to physician) I haven’t slept in two days, the pain is so bad.

Physician: (defensively) Ear infections are rare in adults.

Me: Can you give me something for pain?

Physician: (writes script) Oh, just keep taking ibuprofen. (Leaves.)

Me: Gnarl slah grrr  mutter roplph slnarl jackass.

All of which is a long way of saying that posts for the next few days may be erratic and/or non-existent while I de-distend my tympanic membrane and load up on Tylenol #1 (which, incidentally is OTC in Canada). Also, listening to your patients is a good thing.

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