Don't Curse the Nurse!

Sharing support with stories & humor

Working with Smurfs

Fun moment between me and a patient this morning- Did the best I could to jot it down so I could share !

I’m facing her; putting on her monitors. She’s looking in the periphery behind me.

She says, “Did you notice that your Anesthesia doctors look like Smurfs?”

I turn and glance. “Um, what do you mean?” As soon as I say it, I understood what she was referring to. It was the designated color of their agency scrubs. The periwinkle blue matched the skin tone of the comic characters perfectly.

I place the last lead. “Well, they’re really smart Smurfs.”

She countered with, “You know Smurfs love to eat Sasparilla.”

Me, “Ours eat lazy nurses.”

She, “But I see they’re not wearing hats.”

Me, “They put a new one on every time they go back through that door on the corner.”

She, “They put on Phrygian hats?”

I pause. She’s got me there.

She. “The cartoon, it’s based on an old Belgian story. My dad was an illustrator. He talked about cartoons a lot. That’s what the hats were called.”

She had me working parts of my brain usually allowed to rest during work hours. I printed out her EKG and started to step away from the stretcher.

“Susan, who’s the Smurf coming this way?”

“That’s Papa Smurf. You don’t get to leave the pre-op mushroom until you speak with him.”
She raised her eyebrows and gave me a mischievous grin .

My last words: “He was on call last night. Don’t tell him he looks like a Smurf.”

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I Don’t Want To Share

Governor Rick Scott has appointed nine to a panel with the task of reviewing hospital outcomes. More specifically, he wants a review of hospitals receiving taxpayer funding, executive compensation, lobby funding, and advertising funding.

But, that’s not all! He wants this group, a group that includes only one medical doctor, to explore the idea of profit sharing.

Yes, the once CEO of Columbia /HCA, the company fined 1.7 billion dollars for Medicare fraud, wants us to learn how to share.

I work for a system that had layoffs last year. I’m not sure I can take Rick Scott seriously. If I did, I’d just get scared. I’ve given it some thought though. So…

My bonus last November was a 12 pound turkey. Fine — as long as I get to keep the white meat.

My manager, her office is smaller than my bathroom. Rick, I can get you in there — good luck finding room for your chair.

Our department Director, made seven trays of appetizers for the recent Nurse Week celebrations. The managers paid out of their own pocket for the remaining food. We’ll share our food. In exchange, we need the addresses for these people on the panel. They owe us dinner at least once a month.

I can do any night except Thursday.

Call me.

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No Crying On The Clock

I almost made it through Nurses week with a la-dee-da attitude until Friday when our ministry team came through surgical services.

They brought with them a rolling cart with a bowl and a pitcher of water.

They were offering to do a Blessing of the Hands.

Earlier in the week, when busy with a patient, I’d seen the same three chaplains out of the corner of my eye, coming by our area. Happy that they were back, and that I had a few minutes between cases, I headed for the back hallway (a cross path between OR and Pre-op) where they stood.

A small group gathered around the mobile set-up. Blessings went quick. Then it was my turn.

“Susan, would you like a blessing?”

“Yes.” I extended my hands over the bowl. I was 90% in the moment. 10% of me was calculating the remaining work to be done by 2:30

The chaplain’s assistance picked up the pitcher of water, and the chaplain began the blessing.

“Holy God, bless these hands to be an instrument of healing. Bless…”

I could feel a lump in my throat and fought the tears behind my eyes. It became more difficult when the chaplain was done and followed with, “Is there anything else you want to pray about right now?”

The list is long Chaplain; way too long for my five minute break.

“No, I’m good. Thanks!”

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Quote From a Mean Nursing Instructor.

My one-liner:

Do it right the first time so you don’t have to do it again.

_________

I will tell you more about her later. It’s been 29 years. Ha!  I should get it off my chest.

http://lindaghill.com/2015/05/06/one-liner-wednesday-keepin-it-simple/

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Au Natural

     “Your gown needs to be open in the back and right here is a belonging bag to put your clothes in. This blue cap… Whoa! Hold on. Let me pull the curtain and step out.”

The shirt is off and he has dropped his shorts while I was partially turned to him and pointing to the items on the bed.

     “Miss, let me just get my shoes off the floor here.”

I pulled the curtain closed a half a second before patient #2 walked by and saw my 7:00 am client from an incredibly unflattering perspective.

I don’t know what to make of the patients who see nothing unusual about disrobing before I draw the curtain. There doesn’t seem to be a thread indicating it’s a cultural thing, gender thing, or age thing. The closest I’ve come to is that it’s a surgery thing — the more surgeries they’ve had, the less they want to hear my “Welcome to Bay 4” speech.

It’s less than two minutes. It used to be three minutes long. I eliminated the “Have you had surgery here at _________ ___________ before?” I shortened the ‘It must have been difficult waking up at 4:00 am in order to get here” to “Did you sleep at all last night?”

Please understand, to me the human body is the human body. And yep, it’s true, nurses have seen a lot. But it doesn’t mean we care less about respecting privacy. And it doesn’t mean everyone in the pre-op area wants an impromptu peep show.

Word to new nurses:

Pre- op patients are rarely chatty and some don’t care about showing their wares.

Keep it short and sweet and think fast on your feet!

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Just Finished Reading

Photo via businessinsider.com

Atul Gawande is a surgeon and author who doesn’t think dying is a problem. He thinks scientific advances have turned aging and dying into medical experiences — and we in the medical world are “alarmingly unprepared for it”.

I was uncertain about reading Being Mortal, the fourth piece of work by Dr. Gawande. Fiction and memoir are genres that comfort my soul and stoke creativity. Turning fifty was my prelude to seeing his book in the OR break room, and I was just wrapping up my two week “ I’m half a century old” pity party. In other words, I was having no problem with the concept of mortality. Still, I was intrigued, so I went out and bought the book

Here’s what I liked about it: Dr. Gawande took three years of research, beautiful passages from famous philosophers, did his own footwork while keeping up with his day job, spent weeks with geriatricians and nursing home reformers, developed a rapport with large groups of seniors in order to get their thoughts, and put it all together in a book that made me feel like he was sitting next to me having a conversation.

Dr. Gawande is clear in expressing that he does not advocate speeding up death. He articulately points out all the things people need from beginning to end that you can’t treat with a prescription, a doctor’s visit, or a surgery. He reminds us at the beginning and again in the middle of the book that medical professionals are trained to concentrate on repair of health, not sustenance of soul. He can say it. He has M.D at the end of his name.

There is a quote in the book that I stopped and read twice. It’s by Bill Thomas, past director of Chase Memorial Nursing home in Upstate New York.

     “…I believe there is a fundamental human need to have a reason to live”

This book didn’t depress me. It made me take my choices more seriously.

Check it out!

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My First ODD Patient

I had a patient last week that wouldn’t listen to anything I asked him to do.

“Sir, Everything needs to come off. Here’s your gown.”

Five minute later he is in bed with a bracelet, two rings, and baseball cap still on.

“Did you take the enema at home like your surgeon ordered at your pre- op visit?”

“No” He looks at me like I’m crazy to have asked him this. He had an anal fissure, possible fistula. I gave him a break on that one and took care of it.

Twenty minutes later.

“Hey nurse, I need to use the bathroom.”

“Sure,” I say. Let me help you with the side rail and your IV. Just remember to come right back here.”

Ten minutes later I am down the hall where the bathroom is and see him off to my right, sitting with several people and chatting up a storm. I approach him and explain that we need him to stay in his stretcher. (I also point out that he has a family member back by his bed. His response sounded more like a growl.

“I’ll be back when I’m ready.”

I found his diagnosis to be quite complementary with his personality.

Image via newkidscenter.com

Oppositional Defiant Disorder is considered by the American Psychiatric Association as being a mental condition that starts in the preschool years and can go into the teen years.

I guess some people never get treatment.

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Dirty Little Secret

Although I have a passion for my work, I still sometimes walk around feeling like I have a dirty little secret. And I want to let it out.

It took me almost twenty- five years to truly love my work.

Here’s the story.

When I applied to nursing school, I didn’t care how I was going to earn my future paycheck. I just wanted a grown up job, and three close friends were applying so I thought, Why not. I had no particular interest in studying health sciences, changing bloodied dressings, or holding an emesis basin under the chin of some puking patient. In the three months prior to turning in my transcripts, my only interest had been to land my back handspring on the balance beam. My dream had always been to keep tumbling, to let my feet fly up over my head and watch the world spin around. I was never happier then when tucked into a ball, rotating on my own axis, my focus on my core and nothing else. Gymnastics was my religion, the gym — my church.

Then graduation came, teenage love turned into marriage, and my “Why not” attitude turned into a carrousel ride on the local college’s nursing track program.

There were at least three occasions I thought about quitting. Microbiology was painstakingly boring. Krebs Cycle — don’t even ask me about it. (Go talk to Victo at https://doctorly.wordpress.com.) There is at least one nursing instructor that put such a fear in me that I will remember her name with I am ninety years old.  But I made it through.

Twenty-five years to love my job.

Half of my waking hours are spent at work. So, if I choose to, I could surmise that twenty-five percent of my cumulative consciousness has been time wasted — time — a commodity I find precious. At first, it saddens me to immortalize this fact by typing it on the page.  My only consolation is having pondered my career path from its inception and now understanding why it took so long to love what I do.

In the early years I was afraid — afraid the patients wouldn’t like me, the doctors would belittle me, and the seasoned nurses would find my mistakes before I could double back and check my work. I panicked when given a new task and turned the other way when I saw a doctor coming my way. Much time passed before I was confident of my skills. I maintained a cautious reserved attitude at work, only loosening up a little when I transferred to an OB position on the night shift. The one thing I never found any value in, even after a decade of nursing, was the patient “chat time”. Being pulled to the bedside to hear a story from years gone past was, in my opinion, minutes wasted. I didn’t know what to do with all the emotional purging that transpired each time I was at the patient’s bedside. Talking was time consuming. And when it was all done, I still had as much work to do.

I learned to listen when my daughter reached middle school and became socially active. Now, my hearing didn’t improve because she and I were becoming best buddies. That was hardly the case. I went into case management to accommodate her new schedule (and my additional responsibilities as a single parent). The job involved hours of telephonic work. Listening, patience, and asking the right questions accounted for fifty percent of the time.

My little princess, she grew up and I went back to clinical nursing.

Enough time had passed and with the changes in healthcare, I essentially had to start over. Relearn everything.  Yes, I was nervous at first, several years had passed. One thing is different. I am excited every day I go to work. Knowing I have an opportunity to listen, connect, and be there for someone else, it means everything to me. So in summary, this is what I think happened:

I fell in love with nursing when I was mature enough to love the profession like a woman loves a man, unconditionally, cherishing the moments of synchronicity and enduring the trials that test the relationship. Nursing is not a job for people that don’t want to grow up. Nor is it a job for those that might be considered heavy in the “self-focus” department.

The career crush happens when you can connect with your patients. The connection with the patients comes when you’ve experienced the same sense of vulnerability you see in the eyes of your patients, when you realize you are no different than them…when you know what it means to be human.

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Unions – Merit – Safety

Every now and then, I get all highbrow and actually read the professional nursing journals that come in the mail. I think it compensates for the moments when I’m doing something so mundane at work and think to myself, “Geez, I can’t believe they pay me for this.”

So, I’m sitting on the couch after work, feet up, debating on blogging something personal versus something “nursey”, and there in the middle of reading magazine number two, there is a small sidebar about union activity. (Remember last year, I posted twice about Union reps stalking our hospital perimeter.)

Anyhow…

In a place I have visited, even rode the hilly streets, there is discord between nurses and the ever so mischaracterized management, Washington State. Oh my.

I didn’t know nurses had unions in Washington State.

The magazine blurb was small: After six months of negotiation, contract talks between Providence Regional Medical Center Everett (a hospital in the Puget Sound area) and 1,400 registered nurses remain deadlocked.

I did a little looking up of stuff since I don’t know much about Washington State’s economy, unemployment rate, minimum wage, etc…This is an interested tidbit I found.

Under Washington’s current law, the minimum wage goes up every January with inflation. The Employment Security Department said this year’s minimum wage hike affected more than 67,000 workers.

Here in good old Central Florida, we have merit raises. That’s it.

*****

I don’t know what to think about this. I looked up more online about the situation at Providence. I read nurses’ comments about the nurse patient ratio in Critical care being 3:1, about people being held in the ER for 24 hours because there are no beds. Yikes!

I am sitting upright and saying to the computer “Yes, yes, get your voice heard, more staff, more safety!”

Then I remember dabbling in management, the headaches, the pressure that comes from way up there, somewhere, I don’t know, and I understand that everyone is frustrated.

So I’m going to blame POTUS and ObamaCare. It’s probably childish, but I’m going to do it anyway.

I’m going to bed early so I get a good night’s sleep before work tomorrow.

Our department is leading the board when it comes to overtime.

It’s been crazy.

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The Honeymoon is Over

rings

The honeymoon is over.

Like the couple who has reached the six month mark — each party starting to add stuff to the mental checklist of habits they find annoying, I’m doing the same with my job.

Don’t get me wrong, it was a great transfer, much needed. There is ten times more diversity in my current role.  It’s just that the job, like the gigantic wedding cake, tasted sooooooo good at first, but after you’ve had three pieces and leftovers, the thrill factor takes a vacation.

I know which doctors bring their H&P’s the morning of surgery – which ones use the dictation system only forty minutes earlier and give me the stink eye when it’s not on the chart. I know which nurses avoid picking up post-op patients, which OR teams get along —which ones only tolerate each other. I know which pharmacy tech doesn’t need a faxed order to fill our supply of Ancef syringes, which one needs to be reminded that we go through thirty syringes a day.

The ballet of preparing a patient who’s about to have a total knee or hip replacement, I’ve got it down pat. The Tramadol/Lyrica/Celebrex cocktail on one certain surgeon’s order sheet — I’m holding the pill cup in my left hand and with my right, putting a big “yes” on the affected joint. And while I’m that close to the patient, I’m checking to see just where I want to put that IV.

I’m not the new girl anymore (ah, it was such a sweet thing to fall back) but now I have to do the grown up thing and strengthen my commitment to my new family and my new home. I am going to start by deciding which battles I want to get involved in, or as my Dad would say, “Decide which mountain you want to die on.” I’m also going to find out exactly why our silly little hospital has farmed out the dictation services to a business in another time zone. The people here that don’t get along, it’ll be fun blogging material.

I didn’t make the change with the expectation that the job would be better.  I made the change thinking that the job would make me a better nurse.

So far, so good.

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