Sunday, March 20, 2005

That's a new one on me.

Just when you think you've seen everything, your patient brings a homeless person back to the hospital to share her room.

There are a number of things wrong with that sentence. See if you can list them. I'll give you a few minutes.

In other news, management is apparently still concerned with our customer service skills. In addition to initiating formal charge nurse rounds (not the sort you think, hang on), we have a new script to follow and a new set of guidelines on how to provide good customer service. The new formal charge nurse rounds, rather than being the usual CN rounds, are focused on customer service. Instead of rounding on each patient to make sure the CN knows what's going on and what sorts of issues the patients have, CNs now have to round to make sure that the patients know their nurse's name and that they're happy with their interpersonal interactions with the nurse.

Never mind that we're dealing primarily with people who have pretty massive brain injuries. Only two of my five patients could possibly remember my name; the others think they're either in Paris or being held hostage by the FBI. Or they're faking neurological problems in order to get more drugs and so won't cooperate anyhow. I forsee a number of problems with this new customer service focus.

Okay, pencils down. What's wrong with a patient bringing a homeless person back to her room?

Well, first thing, you really ought not to be leaving the floor right after brain surgery. You ought not to be going outside to smoke, that's for sure. Probably striking up a conversation with a random person in this neighborhood isn't the best idea, nor is bumming a cigarette off of them. You just don't know what you're getting. Finally, bringing said random person back to your room will present problems for both the nurses and (when they get involved) the security staff.

Of course, this was the same patient who tried to fake neurological deficits in order to get both more attention and more hydromorphone (Dilaudid). My morning started like this:

*ring ring ring*

Doctor: "Yes, this is Doctor Unpronounceable."

Jo: "Doc? That patient in 33? She's complaining of new numbness and pain. And speaking like Yoda, she is."

Doctor: *slightly hysterical laughter* "Okay. I'll be up in a sec."

It's amazing how fast those embellished neurological symptoms disappear when you tell the patient that the surgeon is coming up to tap her shunt, after which she'll be going for a long and probably uncomfortable series of tests. I dunno, they're probably going to have to do a lumbar puncture too, so I'd better start about four more IVs.

Yes, this is sadistic and manipulative. However, the sort of behavior that woman exhibited is a prime example of Shit I Don't Have Time For. I have actual, real, live, *sick* people to take care of; don't waste my time because you like your narcotics a little too much. Besides, if you start faking new symptoms, we'll figure it out--you simply don't know that much about neurology. And if we're unsure, we'll take you off the narcotics completely to see if the symptoms resolve.

So there, too. I'm fairly sure my customer service rating will dip on that one.


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Janie Claypool said...

The "customer service" rounds sounds like some of the ideas that have been put in place at my hospital and probably work to some degree everywhere except our dementia unit. LOL