Muerte; Viva!

La Draculita esta muerta!

Viva La Rojita*!

(Yeah, I know that's a male redhead duck, but if you search on "female redhead" in Google Images, you've got to be prepared for a lot of NSFM [Not Safe For Mom] stuff. And don't even get started on how crappy my Spanish is [DAD...]; I speak medical Spanglish and that's it.)

I am DONE with the last night shift of this phase of my nursing career.

Next week I start as the first full-time day-shift neuro-exclusive nurse on the new neuro CCU.

If I do my job right, it'll mean greater autonomy for the NCCU. If I make a complete cock-up of it, it'll mean that it colors everything that will come after. No pressure, though.

The Pros: I'm very pushy about getting things done that are good for patients. I'm an experienced nurse, and I've worked with the attendings that'll be supervising the residents and nurses on the NCCU since one of them was a resident and the other was a new hire. I've seen things nobody has seen (primary meningeal melanoma, anybody?) in forty years, and taken care of a wide range of neuro patients for nearly a decade. I know what we need: a call list that's updated regularly and is dependable; a set of protocols for treatment of everything *but* occlusive strokes (that's the only thing they've gotten written yet); a set schedule for when to start everything from speech to physical to occupational therapy and beyond.

The Cons: I'm very pushy about getting things done that are good for patients. This tends to put the collective noses of the neurology residents out of joint, and for good reason: because of the lack of a dependable call schedule, one resident can find herself taking call for as many as two hundred patients stretching over three hospitals. Neuro*surgery* is more organized; they have three residents on call most days, and never fewer than two, even on holidays. The neuro intensivists just kinda figure it out as they go along, but as there are only four of them, it works out fine.

I'm on friendly terms with everybody from the housekeepers to the medical director for the hospital. This can be a bad thing, as brilliant ideas I mention as a one-off could conceivably get implemented without there being time to stop and think about them.

The attendings trust me. One of them told me, when I said I was moving to the NCCU, "Good. That means I can finally admit my patients there."

Uh. Um. Gah. Argh.

That means I can fuck up spectacularly if given the chance. And I will get the chance, I'm sure.

And, worst of all, my immediate Boss Lady offered me the job without really getting a chance to know me first. She thinks she's getting an experienced neuro nurse when what she's really letting loose onto the unit is a maniac with a crowbar and an attitude.

Because, by damn, what I want to build (even though nobody asked me to and will probably be pissed off that I took it upon myself) is a unit that *I* would want to be on when this aneurysm I'm surely cooking in my head blows.

I want a dedicated neuro unit. I want a comprehensive critical care plan that emphasizes the nurse's autonomy, and doubly-emphasizes the abilities that any patient has left. I want physical and occupational and speech therapy to start on the day of, or within twenty-four hours of, the patient's admission onto the unit. Being on a vent is no excuse; we can still do passive exercise with you so that you're not as weak as a kitten when you're extubated.

If you come in fifteen minutes past the limit after your last-known-well time with an occlusive stroke, I want the resident to be able to make the call that yes, you're still eligible for TPA. I want a protocol that allows an RN to order a stat head CT so that that scenario is possible. I want a protocol that allows an RN to start preparing a patient for that TPA after the negative CT, so that we don't lose any time.

Most importantly, I want to recapture what Sunnydale lost when it got bought out by Big Research and Academics, Inc. I want every single person who works in, gets brought to, empties the trash and scrubs the floor of, or calls the NCCU to be treated with more respect than they expect. I want "we can't do that" to be a not-uttered phrase. I want "we can't do any more" to be rarely said, and only when there are support systems in place for the people who are hearing it. I want chaplains, nurses, housekeepers, transporters, and residents on the same damn page for once, and treated with the same amount of decency and care.

Yeah. I want perfection. And I'm a dreaming socialist, with a poster of Karl Marx on the ceiling over my bed.

But, dammit, I want this unit to be the model for all the other units in Texas, not just the ones here in Bigtown.

*La Rojita sends big sloppy kisses to TGIL, who is doing some really cool stuff this weekend. You are awesome.