Happy Christmas!

What on earth are you doing here? Go drink some eggnog, or something.

Best wishes for a peaceful and happy Christmas.

Advancing the profession

I had a conversation about Advancing The Profession two days ago with a friend and colleague at work. Advancing The Profession is, for those of you who aren't nurses, a Big Thing in nursing circles. Nurses who bother to answer surveys report dissatisfaction with their careers, frustration with their practice limitations and paperwork, and anger at how they're perceived and treated by both the public and the other professionals they work with.

There are as many ideas for improvement as there are problems. Many nursing professionals want to change scope of or requirements for practice. Still others want to educate the public. Some want to raise the consciousness of those other professionals with whom nurses work.

Raising Conciousness was the focus of my colleague's and my conversation. I had spent a good part of the morning cleaning up the mess that a group of lazy, ignorant physicians had left and I was frustrated. Being sniped at by everybody and his dog is part of being a nurse, as is cleaning up loose ends that others (usually "too busy" residents) leave lying...but it gets old.

My colleague, who works ICU on the weekends and is an educator during the week, suggested that I devote a little time to Raising The Consciousness of the physicians I'd cleaned up after. And even though it was a good suggestion, I couldn't take it to heart.

Why? Because I was tired. I can see where conciousness-raising would be a brilliant idea: take a resident who's disrespectful aside and talk to him calmly about professionalism and hope for a change. But most of the time, we nurses are so frazzled, we simply don't have the energy to devote to educating the odd Neanderthal who comes in with a medical degree.

I'm lucky on a number of points. The floor where I work is well-staffed. The doctors are, for the most part, good colleagues. My specialty is such that I don't get a lot of jokes or flack about wearing short skirts and a cap. (Say "I'm in neurology" to even the most uncivilized bar patron and they back off.)

But still. Why is it *my* responsibility to educate/lecture/come down on like the crack of Doom somebody who just doesn't get it? If I have the time and the inclination, I will. Otherwise, watch out: if you're an attending physician who hasn't learned to be a decent human being by this time, I am not going to educate you. I'm gonna push back as hard as you push instead.

A group of interns made a video in our nurses' station about how to deal with sexual harassment. It wasn't focused on how to handle the nosy patient if you're a young female doctor, or how to deal with the predatory professor that occasionally crops up. It was on how to deal with a (female) predatory nurse if you're a (male) doctor.

When we (female) nurses all stopped laughing and wiped our eyes, we got into a serious discussion with the instructor of the group. Why, we asked, were the students not being taught lessons that would serve them in good stead? Sexual harassment is covered in our medical school. Being professional and working on a team is not. How not to yell at somebody simply because they're following the rules is not. I'm not implying here that sexual harassment is a chimera or overstated; it's not. What I'm saying is that the curriculum at our facility pays far too much attention to the one problem--often to the exclusion of the other.

I'm a feminist and childfree and a nurse; raising consciousness is not unfamiliar to me. What's unfamiliar is the unwillingness of other professionals with whom I work to police their own. It's left entirely to us to educate/train/police the people who technically are our superiors. At the same time, we're expected to provide good care for sick people and their families, act as gatekeepers and coordinators of care, and keep a smile on.

I once had to report a resident to his attending for being a jerk. I heard the tail end of the lecture the attending gave the resident. Just before Attending turned Resident loose to go back to work, he said, "...and don't let their hysteria get to you, okay? Most of them just aren't that tough." (Enter Crack of Doom Nurse hard on the heels of that statement.) Point being that I'm expected to Educate and Enlighten this person, but his boss will undermine me, then blame nurses for the lack of respect that his students show them.

Honestly, I have no solution for this particular problem. All I can do is keep practicing as professionally as I know how and deal with trouble when it happens. I just hope I'm not completely burned out by the time I retire.

Okay, okay, it's done.

Bidness

Whew. I got a number of new links up. My original idea was to parcel them all out nicely so that Gentle Readers would have some idea of what they were getting into (Medical? Humor? Other?), but not only do my HTML skills suck, I figured at the end of the day that I don't know what I'm getting into at any given moment; why should you?

Update the First

Coworker's Brother has had the last of four surgeries. The docs found the bleed that was giving him trouble, so he'll be medevac'ed to Europe in the next few days.

Update the Second

Troublesome Coworker is rapidly weaving rope.

Update the Third

Hemicorporectomy Guy (and don't feel bad if you've been humming "Eric the Half-A-Bee"; we all have) is doing fine.

End of Updates.

Any nurse can tell you that a number of folks will ask, when told that you're a nurse, how to improve their health, well-being, and general mood. In an attempt to head off those folks at Christmas parties this year, I present:

Nurse Jo's Tips On How To Live A Happy, Healthy Life

1. Don't be mean. That's number one for a reason. If you're mean, you make everyone around you miserable. You'll be lonely and sick and people will think you deserve it. So don't do it. Smile, smile, smile.

Or if you can't, at least fake it.

2. Shut your piehole and move. No great mystery here. The average person eats too much and moves too little. Get or borrow a dog and take it on runs. Play with your kids. Turn off the TV, or at least do crunches during the commercials.

3. Vegetables: the green things at one end of the grocery store. Vegetables are fun. Really. They're interesting. You should eat them occasionally.

4. Relax. There's nothing worth getting *that* upset over.

5. Drink if you like, smoke if you must. Just don't be a self-righteous twerp. See Point Number One. Self-righteous twerpiness goes right along with meanness in shortening your life. I don't care what you do as long as you're a reasonable human being. If your choices are smoke crack or be a twerp, let me get you a lighter.

6. Water. Your body is 70% water, not 70% Diet Coke.

7. Find what you like to do, then do it. This relates both to work and non-work situations. If you passion is basket-weaving, then by all means, weave baskets. The point is to have at least one thing in which you can lose yourself on a weekly if not daily basis. Which brings me to:

8. Get out of your own head. It ain't all about you, so find something that helps you remember that.

9. Act. Whatever gods are running the Universe don't care what you *think*, they care what you *do*.

10. Recognize that life really *is* that funny and ridiculous.

I have hinty bazillion links to put up

And will do it on Wednesday or Thursday, I promise.

Too close to home

A coworker's brother was shot halfway to hell in Fallujah today. (Yesterday? I don't know the time difference.)

His squad was marching down the street when a car bomb was detonated next to them. The guy behind him died, but in doing so, sprayed my coworker's brother with bullets. He (the brother) also has some nasty shrapnel wounds.

Thanks be to the Army medics who got there first. They're still working on him in a field hospital in Iraq, trying to find the internal bleeding that's keeping him in critical condition. After they do, he'll be airlifted to Europe for further surgery.

When the Red Cross called her as she was on her way to work, all the person could tell her was that her brother'd been shot. They had no details. Wouldn't you hate to have that job?

Any prayers on her behalf, on behalf of her brother, and on behalf of her two siblings--also in the Army, also near or in Fallujah--would be gratefully accepted.

Any political emails will be tossed back to the senders so hard that the electrons bounce. I'm too upset by her upset-ness to be rational.

Odds and Ends and Drama

From Correspondent Tim, somewhere out there in the Worldwideinternetwebland, comes this very funny list of do's and don'ts for patients. Tim says "all of these would've come in handy had I known to tell my patients beforehand."

Some generalized advice for patients

Dos
1) ...ask if the large puddle of blood pooling under your disconnected IV is normal.
2) ...ask for help reinserting foley catheters if you pull them out.
3) ...use short chairs instead of tall barstools if you drink too much and have osteoporosis.
4) ...ask for help if you wish to amputate a body part BEFORE you start cutting.

Don'ts
1) ... tell the hospital policeman that you need to go get your gun.
2) ... steal the laptop computer I use to sign out your medications.
3) ... slam the Pleurevac in the door of the cab as you leave AMA.
4) ... barf on the nurse. (the biggie)

*snork*

It finally happened

"It" being Nurse Jo coming down on another nurse like the crack of doom. "Goddammit" was probably an ill-advised thing to say. "Fuck" was certainly unprofessional. The screaming will surely be discussed and embellished in rumor for weeks to come...but the only thing I feel bad about is the fact that I'll have a whopping big meeting with the floor manager on Thursday.

There's something about being a nurse that makes other people think they can yell at you. I got yelled at yesterday seven times before noon--that's more than once an hour if you're keeping track, which I certainly was after Yell Number Three. The reason I was getting yelled at and complained to was the attitude and shoddy people skills of the nurse whose patients I got yesterday morning.

A very nice paraplegic guy was upset because he wasn't given enough in-and-out catheters to use all night. Given that he gets dysreflexic if there's more than about 200 ccs of urine in his bladder, catheters are important. He also didn't get antispasmodic medication (very important for spinal-cord-injury patients; the limbs don't just lie there, they spasm) or pain medication for most of the night. There were other problems too minor to go into here...but they add up.

Another patient's husband was upset about the lack of communication on the nurse's part vis a vis what was happening with his wife. The doctor on the case was upset by her lack of help. The doctors on the consulting team were unhappy that the patient had gotten a large enough dose of sedative to leave her obtunded for hours and still zonked the next afternoon.

And all this came down on me. I ran around for several hours making nice, trying to wake my patient up, and generally picking up the pieces. The nurse who left me with this basket of rabid weasels is a technically excellent nurse. She's the shit when it comes to starting IVs and doing paperwork, but her attitude toward any patient who doesn't sleep peacefully all night sucks.

I'd finally had it. After she'd started complaining once again about how big a pain in her ass the obtunded patient had been, I went into Screaming Harpy Mode and yelled. For about ten seconds, at which time I realized it was pointless. Any nurse who responds to the suggestion that she might've oversedated a patient just a *leeeetle* bit with the words "I have to give what the doctor orders, that's my job" is a nincompoop.

I should've used the word "nincompoop" rather than "idiot". I should've moderated my tone and spoken to her in a calm, professional manner outside of the tension of the report room. I should've taken into account what had happened to her that night to make her personality even more wretched than usual.

I should've ripped her arm off and beaten her to death with it there on the spot.

Addendum: I came home to find a message on my machine from this same nurse, asking me to call her so she could clarify something with me. "If you can't, it's no big deal" she said. So I didn't. It's three a.m. If anybody says word uno to me about my not calling back, I'll point out that I too have been dragged into the 20th century and own a cell phone. Call me on that.

Ooooooohhhh, I am *so* not looking forward to Thursday.

Blog O' The Mornin' To Ye!

I love this woman. She writes and thinks the way I want to.

Mouse Words

All I want for Christmas

The tree is up, the frost is on the goose, the pumpkin is getting fat.

Or something like that. The tree (a nice Fraser fir) is indeed up, all six feet of Seuss-inspired silliness of it. I went to a local Walgetmartorama to look at artificial trees and came away unutterably depressed, so I broke all the apartment complex's rules today with my Fresh Cut Tree! Hooray!

The cat is disturbed by the presence of a tree in the living room, but she'll live.

What I want for Christmas, the non-commercial version:

1. To be listed under "Nursing Staff" on Cut to Cure.

2. To get a submission accepted for Grand Rounds. Note that I haven't actually submitted anything yet, primarily because the people who are listed are, like, geniuses. And I feel like an idiot. A neurologically-focused idiot, but a moe-ron nonetheless.

3. Three or four days off in a row with nobody calling me to see if I want an extra shift, or if I'd be willing to be on call. Everybody's been sick lately, what with induced labors and broken backs and the flu.

4. A comic strip that is as unironic and simply beautiful as the old "Peanuts" was.

5. Six more residents like Dario, Mia, Christos, and Jay. Another attending like Kevin: "I went to the Kellogg School of Management so I could manage cornflakes more effectively." Another surgeon like Duke or Bruce.

6. Failing that, no more like Dr. Chucklehead.

Wired, tired, and done, oh my.

I am finished wrapping Christmas presents. That is, I'm done wrapping the ones I have to mail to my family. I'm not done wrapping the ones I bought for The Boy, nor have I even finished assembling the present for a Secret Pal I have through an online forum. But the majority of Christmas present-wrapping is done, which gives me great pride. Even more than that, none of the presents look as though they've been wrapped by a mentally-deficient orangutan with Tourette's. This is unusual for me.

Yesterday was one of those days that every nurse dreads. Nobody coded; nobody had intractable pain...but nothing happened all day.

Nothing, that is, until about an hour and a half before the shift ended, at which point we got eight admissions. That sort of day will make you crazy: You start out well, get into your groove of planning and assessing and running around, then hit a wall. You sit for eight hours with absolutely nada to do, and then all hell breaks loose in the middle of your nap.

I got home so wired I didn't get to bed until after midnight. That's twenty hours out of twenty-four that I was up. It's no surprise I took a two-hour nap today.

Following is an opinion I sent to a pal via email today, included because I'm too damned lazy to think of anything new to write:


I have a BA in music and sociology (double major) and an ADN myself.
Unless you want to teach, research, or be an NP, don't get an MSN. MSNs
are highly specialized and focus on management (ugh) or specific areas
of practice like oncology or family practice or women's health etc.
MSNs are a waste of time for the average floor nurse (which is what I
am) and not a great idea for anybody who wants to stop at, say,
midlevel management. Even for upper-level management in a hospital or
community health setting, an MBA would be a better choice.

BSNs are fine and dandy, but I think they're overrated by the nursing
establishment. The amount of clinical experience you get with a BSN
compared with an ADN is about the same; the major difference is (again)
in the focus on management and decision-making skills. What the
proponents of BSN over ADN fail to recognize in my experience, though,
is that the majority of people getting ADNs are doing so because
they've either already got a degree or three in something else or
because they're 45 and changing careers. Both of those things reduce
the need for extra courses on prioritization, law, and management. We
been there, done that.

My advice, which costs what it's worth, is this: get the ADN. It'll
come near to killing you if you pick a good program, but you'll get
more knowledge in less time than you would if you did it any other way.
After that, work in a clinical setting of some sort for a year or two.
(Everybody says that and I've become a believer myself; there's just
something about knowing what works in real life versus what the books
say.) After *that*, make a decision on what to do with the rest of your
brain. You might decide that eine kleine floor nurse is what you want
to be, or you might have found some specialty that sparks a need to go
further in school.

A word about specialties: everybody ("everybody" being nursing
professors, nursing consultants, and others who haven't worked in the
field for years) says to work med-surg for a couple of years to "build
your skills" before you specialize. Bullshit, in a word. People coming
into hospitals are so sick now, and have so much going on in terms of
different systemic involvements, that even a specialty is broad enough
in practice to learn things. I deal every day with cardiac involvement,
diabetes, arthritis, women of reproductive age...you name it. And I
work in an environment that I lot of people would consider progressive
care rather than an acute care floor.

That, in long, is my sermon to anybody considering starting a nursing career after doing something else.

Can't Do Better Than This 'Un...

Courtesy of Geena.