Best. Comment. Ever.

Blog reader “Sarah” REALLY gave me a big old can of whoop-ass when she wrote something on my blog post “The Value of Nurses” She really schooled me! So take it away “Sarah”!

Nursing is critical to patient health and recovery. Nurses are responsible for the day to day care of the patient. 

Nurses are also useful for disease prevention and chronic disease management (trust me, MD wants to go to school 12+ training in the medical model of care to tell fat Type 2 diabetics they need to stop eating pie).

That said, yes nurses know how to do all the technical things listed. Respiratory threrapists [sic] can also expertly read EKGs, blood gases, and recognize heart sounds. As can paramedics. These things alone are not rocket science.

Nurses are never trained in pathology using the medical model of care to form a differential diagnosis of disease. Otherwise they’d be unhappy underpaid junior doctors. Try calling a nurse a para doctor and see what they say. Nurses seem to forget that the nursing model of care and training is a different role from MDs.

Sure nurses save lives and do some great things providing care for patients, but many other jobs do as well. Personally, if I have a disease, I’d be putting all my money into the MD/PhD in the lab trying to cure me vs a “good” nurse. I find most nurses can provide basic care but anything advanced is rightfully over their training. Good nurses recognize their limitations, not toot their own horn. So I gave up expecting competent nurses while in the hospital.

Yay so you can recognize a cardiac cycle or a hypoglycemic attack in your patient (how did you let the patient get that way in the first place?!). That still doesn’t mean you have knowledge worth $40 hr+.

Well Sarah, you are absolutely right. I was thinking just the other day about the time me and Doreen were sitting in the Resus Room playing cribbage for a nickel a point when Greta from Admissions walked by and said to us, “Hey, that monitor had some funny pointy lines.” We looked up and yep, she was right! So we talked it over— I was five dollars and two bits ahead — and we thought since he — the patient, I mean — was maybe in ventricular tachycardia we should call in Dr. Handsome. So we did and all of a sudden there was this big fuss, Dr. Eagerpants and Dr. Contentious and Dr. Fusspot came running in and started doing IVs and xrays and EKGs and catheters and everything. It was just like that TV show, House. Then I skunked Doreen and she got mad and left without paying me my five dollars and twenty-five cents which was now eight-fifty, and also the patient died. Dr. Handsome said sadly, “If only someone knew how to do an emergency cardioversion, we could have saved him!” and pounded his first on the Resus Room desk, just like on House. Haha. What a dummy! Like nurses can do anything like that!

Then there was the time Doreen and I were painting each other’s nails in Exams, and one of those nosey housekeepers told us the guy in bed 4 was throwing a seizure or something. And despite our wet wet nails we went over and looked and Doreen said he was! Then he stopped. I found out later he died. I guess he did something called, um, sounds like asparagus but isn’t. Dr. Handsome came in, and pounded his fist on the desk again. “If only someone knew how to give a benzodiazepine and also protect his airway we could have saved him!” he said. Doreen and me just looked at each other. What??? Nurses can do that??? But anyway I had to pee. I think on reflection we fell down a little on that one and definitely didn’t earn our $40+ an hour!

There are some other things too, so yes you are right, nurses should stick to wiping bums and leave the real doctoring to doctors, though RTs and paramedics can do some doctorings too sometimes. I will toot my horn though just a little, though! I once found some old lady had a fever once! So that was awesome!

Also, I once told a fat man with the diabetes he ate too much pie. Isn’t that kewl??? It’s like we psychically share a brain! But maybe you have it this week!

Thanks for writing!

Charge Mommy

A few days ago, one of my colleagues said to me after a particularly frantic day in the ED, “You guys aren’t Charge Nurses, you’re Charge Mommies.” She is right. This is what we do:

• tell all the kids don’t fight and play nice

• fix boo-boos

• give hugs as needed, or tissue

• make sure all the kids get lunch

• find things

• repair broken toys

• clean up little “accidents”

• greet guests, and ensure they’re fed and comfortable

• make sure everyone keeps the place tidy

• assign chores

• deal with the unpleasant relatives upstairs

The one thing I don’t do is enforce discipline. No spankings or time outs. I have a Manager Mommy for that.

Epic Hitler Emergency Department Charge Nurse Rant

I never thought I’d use the words “Epic” and “Hitler” and “Emergency Department” and “Charge Nurse” and “Rant” as a blog title, but what the hell. I was bored one night and thought it would be fun to make a Hitler rant parody.

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?

Top 10 Lists Nurses Probably Should NOT Publish on their Blogs

The Top Ten:

1. Top 10 Reasons I Should Be Reported to My Professional Regulatory Agency

2. Top 10 Medications Errors I Have Made (and How to Avoid Them)

3. Top 10 Funny Things to Call Patients

4. Top 10 Narcotics and Their Side Effects: Using Personal Experience to Enhance Your Practice

5. Top 10 Reasons Why My Criminal Record Should Be Expunged

6. Top 10 Sick Call Excuses to Give Your Manager

7. Top 10 Ways to Frighten Children on in an Emergency Situation 

8. Top 10 Buttons to Push on a Defibrillator

9. Top 10 Ways to Fake Arrhythmia Analysis

10. Top 10 Things to Talk about During a Code Blue

My own personal list. Feel free to add.

In Which TorontoEmerg is So Busted, or, Welcome, Jean Hill

A few weeks ago, I was talking with a colleague, whom I will call Jean Hill, and by-the-by the conversation fell to nurse bloggers. Several prominent ones were mentioned, like Crass-Pollination and Emergiblog and Nerdy Nurse.

“Oh,” said Jean Hill innocently. “I wish I could write like these guys.”

At which point your humble blogger’s eyes began to sparkle rather a cat’s contemplating a mouse. Come in my parlour, said the spider to the fly, I thought. You see, dear readers, I have been contemplating the addition of a co-blogger for some time. *

Nurse Jean Hill. (Dramatic reconstruction. Not intended to be an actual image.)

But how to lure the prey?

I told Jean Hill to meet me in the ambulance bay after shift. I told her portentously I had something I needed to ask her.

So later, in the ambulance bay, I told Jean Hill about this blog, my anonymity and whether or not she would like to come aboard the Good Ship Those Emergency Blues as a co-blogger.

She would, she said. She would be pleased. She had, she said, been reading the blog for a long time.

“So you knew about Those Emergency Blues?” I asked, secretly very pleased that someone from Acme Regional was reading it.

“Oh yes,” she replied. “And, you know, I knew it was you all the time.”

Oh crap. “Really?”

“Well, you sometimes talk like the blog, so I figured it out.”

By which, I suppose, she means I speak in a pedantic, self-important, pompous manner, but was too kind to say so. At any rate, I am very pleased Jean Hill has come to write here. I think she will be writing once or twice a week (hopefully more!) beginning in a few days on topics which interest her. Since this is her first time publicly writing a few small words of encouragement will be welcome.

__________

*For mostly selfish reasons, i.e. to ensure there is more content consistently posted, to free up time so I can write better for this blog, to work on some other writing projects, etc.

Insert Snark Here

What this patient did not have

Mr. CD, 88, took a little tumble at the nursing home when he slipped on a loose rug (or something, the details are a little vague here), obtained for his trouble a scalp laceration the length of Q-tip on his temple, bled like a stuck pig, transported by EMS, triaged, assessed by both MD and RN, x-rayed, CT’d, declared medically cleared and fit to go home, deblooded, stapled, tetanus’d, acquired a head dressing worthy of a maharajah, and finally sent back to the nursing via a private ambulance and their ill-paid yet (hopefully) competent attendants.

Whereupon the RPN (i.e. LPN for you out of province types) or whoever was minding the door of the nursing home refused to take the patient back.

“Oh my God, he needs to go back the emerg,” she said, eyeing, perhaps, the overwrought head bandage. “He has a skull fracture! I can tell!” And promptly sent him back, alert, oriented x 3 — and bemused.

I have only two possible explanations for her extraordinary statement: she either is wasting her time at the nursing home and depriving humanity of a set of assessment skill so exquisite she can, using her psychic x-ray powers, detect a skull fracture under approximately twenty layers of clean, white 4 x 4 sponges and tape gauze, or else she thinks despite all the assessments and investigations, we are complete boobs. ( Admittedly, I have a sneaking sympathy at times for the second possibility.)

There is actually a third possibility, but I am far too polite to mention it.

That’s all I got. Feel free to insert your own snark.

How to Make a Myocardial Infarction Funny

A very droll short video featuring Elizabeth Banks having a heart attack. Part of the American Heart Association’s Go Red for Women campaign.

Not too edgy, but undoubtedly some will be officially ooffended/hurt/annoyed by the light treatment of a very serious subject.

*Shrug*

Labour Day and the Toronto Sun: An Annotation

Public sector workers are lazy and overpaid parasites sucking at the taxpayer teat. Or something. Please remember to tell us this when we’re doing ACLS on your sorry ass.

Happy Labour Day.

Love,

TorontoEmerg

The Hockey Season Cometh

Overheard in Fast Track:

Grandmother: (pointing to hat on child with a Canadiens emblem) Who are they? Who’s your favourite hockey team?

3-year-old child: Habs!

Some other patient: Losers!

I tell you, she had some nerve, that child. In Toronto, no less.