And on the third day, she rested.

Saturday: fly, wait, fly. Land. Customs. Purpose here? Tourist. What do you plan to do? Be a tourist. Customs official looks irritated. Drive to the market. Taste breads and cheeses. Buy flowers and a tart. Home. Bread, cheese, beer, nap. Nuit Blanche. Art museum. Video installation, sculpture, interpretive dance installation. Breakdancing exhibition, but the line was too long. Jazz. Home. Sleep.

Sunday: bread and cheese and coffee. Vieux Montreal. Brunch of jamon et fromage crepes with maple syrup (?!)--odd but good. Lunch tab: $74. A musical piece played on ships' horns and train whistles, still attached to the ships and trains. Tugboat-as-icebreaker. Science museum. Magda's for pate and spinach pastry. Home. Oscars. Did anybody else notice that Pacino seemed drunk as a skunk? Sleep.

General: the silence at the airport, and the walk from the gate to the new terminal. Church bells on Sunday. French of a type I can barely understand, spoken at breakneck speed, and the feeling that I ought to be following it. My own fumbling attempts greeted very politely. A huge amber necklace in a shop. Very strong coffee. Green domes of churches and tall, slender windows. The mountain on Saturday, with the cross on top, and every shaggy-friendly dog in Montreal coming over to pay their doggy respects. The park with ice skaters.

In which Jo contemplates mortality

I hate flying.

Flying in an airplane is the quintessential combination of boredom and terror. Especially on two-hour flights, during which one has just enough time to get bored in between a terrifying takeoff and equally terrifying landing.

Tomorrow I get to do that, not once, but twice.

The situation's not helped by my umpteenth reading of Mary Roach's Stiff, a book about the...er...life of corpses. In it, she recounts an interview with a man whose job it is to determine what happens during and after an airliner crash--from the bodies of the victims. Not good pre-flight reading. Note, too, that this caveat is coming from someone who read Steven King's short story "The Langoliers" on a flight to Denmark.

Everything is packed save my glasses and makeup. The bed has fresh sheets on it, the laundry is done. The Boyfriend has been deputized to take care of The Cat for the week. (Sample from Cat-Care Instructions: "Under no circumstances should you attempt to impress The Cat by throwing gang signs or using such slang as 'Fo' shizzle, mah kizzle!' This will merely irritate The Cat, who will respond by bustin' a cap in yo' ass.") The folks who run this joint understand whom they are to call if the building falls down in my absence. The refrigerator is mostly free of food. I think I might just have it all covered.

Now all I have to do is wait for 4:30 a.m. to come. And dread the flight in the meantime.

Kevorkian scarf...

Link o' the day goes to Ill Will Press, home of Foamy the Squirrel.

clicky

Then click on "Kevorkian Scarf." I swear I have seen that squirrel running through my hospital. "Oooooh sad is the world...."

Also, check out Thinking Nurse. Way more intelligent and focused than I am. Really worth reading.

The downside of nursing.

There is, near as I can tell, only one real downside to nursing as a profession.

I'm not joking, people. The hours are long and the pay can be miserable, but there's always another (possibly better) job out there. Physically, it's hard work--but there's always another (possibly better) job out there. Patients and coworkers do share bugs with you now and again, but you get better. Mostly. Even the caffeine addiction can be broken, with time and careful medical management.

No, friends, the downside of which I speak is Not Being Able To Dress Oneself Any Longer.

I wear scrubs half my life. The other half I'm mostly in pajamas, unless I actually have to go out in public, in which case I'm in jeans. Packing for this trip to Canada has thrown me into a bit of a state; exactly how ugly a sweater can I wear on the streets of Montreal without being arrested for endangering the public? Are corduroys a good idea or a bad one? Should I take a belt? Do I own a belt?

Correspondent Albacore was kind enough to reassure me that Montreal isn't fashionable in the way Atlanta or Dallas is fashionable. She put it like this: it's more important to look different than to look good. Which is comforting because, while my dress is different, it's not good.

Albacore also mentions in the same email that there are great places to snowshoe and cross-country ski in the area. This frightens me. Longtime readers might recall last summer's trip to Banff, during which I was hauled gasping up and down mountains by my fit pals Joey and Magda. I just know that Joey and Magda will now strap me into a pair of snowshoes (or worse, skis) and take me out so that I can watch Joey's grace, Magda and Jhave's impressive fitness, and be instructed, German-Border-Guard-Style, by Joey's boyfriend Arek in how to ski. Or snowshoe. Just like he taught me to play pool.

Right now I'm packed. Down to the long underwear and pajamas. Things may change in the next 72 hours, but for now, it's done.

Be warned, Montreal: the world's worst dresser is headed your way.

Housekeeping

You will notice new links to the right. I encourage you all to click on them all, in series, and marvel at how much better all of those folks are than I am at writing.

Also, comments are now enabled. You know what to do and how to do it.

I am so tired.

I am tired, so very tired, of being sick.

First the flu. Then, just as I thought my immune system would be somehow cranked and ready to deal with any kind of little buggy-wug, a cold. (And yes, as I said to the doctor yesterday, "I *know* the immune system's more specific than that, but I can dream, can't I?")

And the cold turned, as it so often/always does, into a sinus infection.

Which means I called in sick this morning. I really thought I'd be able to make it, but simply sitting upright is taxing. Which makes me feel like a complete wimp/sellout/let-down.

Please reassure me that working sick is not a good thing to do. Please tell me that if I show up drugged and uncomprehending, it's not good for my patients. Please remind me of all the times I worked during a short-staffed shift and how it turned out fine and dandy.

The worst thing, at this point, is not the coughing or the facial pain (though that sucks). It's the guilt for calling in. Working sick is such a normal part of being a nurse that your whole metric for illness changes: "Okay, well, I've only vomited once this morning, so if I eat crackers and Sprite all day I'll be fine." "I only have a fever of 100. That means I can go in." "I can't forget to pick up a mask."

Of course, it's other people working sick that got me into this situation...but I still feel guilty for not going in and helping out.

Funny thing is this: in the other jobs I've had, ones with horrible deadlines (getting 18,000 pounds of books out of a warehouse by Wednesday) or ones where I Was It (the only waitress in the diner), I didn't ever feel guilty if I were well and truly sick. And now that I'm well and truly sick--flourescent mucus, crushing head pain, not having slept in two nights--all I feel is guilt, guilt, guilt.

If I had my way, new nurses would be fitted with a third arm and a pair of eyes in the backs of their heads rather than this Ubiquitous Guilt Chip they apparently stuck into my neck when I graduated.

Holy kamole.

Here's an object lesson for everybody: Before you leave the examining room, ask your doctor what she plans to prescribe for your condition.

I don't like narcotics. They make me sleepy and sick and fuzzy-headed, so I prefer not to take them whenever possible. I have made this clear and asked that it be noted in my chart at every doc I see.

Today I went to the usual place for a sinus infection. While I was there, seeing an MD that I don't normally see, I mentioned that the cough that went with my URI was keeping me up at night. He told me he'd give me something to calm the cough.

He gave me Flutuss HC. I had to Google it, having never heard of it before. It's promethazine (Phenergan) and codeine. Narcotic, yes. Combination of two drugs that will guarantee sleep, no joke. I've had patients on both drugs who came close to not breathing any more. Fuzzy-head-making and quease-inducing? You bet.

It may be time to dig out the Tessalon Perles (it knocks me out, but it's relatively short-acting in my system) and just go with that.

Meanwhile, I have a bottle of stuff I can't use. If I'd just asked a simple question or two, or reconfirmed that I don't like narcotics, I could've saved both my insurance company and myself some dough.

Beautiful.

Harriet McBryde Johnson's piece on disability rights and debating Peter Singer. (Addendum: I have tried eight times now to get that link to work correctly; it won't. try this:

http://community-2.webtv.net/@HH!80!A2!2134BF518044/stigmanet/HarrietMcByrde/

Shout-out to Alas, A Blog for linking to this in the comments section.

Pseudephedrine-induced silliness....

Part One:

I'm thinking of changing the tagline of this blog. It's gone from "Adventures of a dilettante in neuroscience: this won't hurt a bit" to "Brains. Spines. Goo." (a little underdescriptive) to "This won't hurt a bit."

Candidates:

"What do I do with this thing, exactly?"

"Scotch: It's what's for dinner." (Sister's Boyfriend, the one who fell off the ladder, sent me a dozen tiny bottles [5 centiliter] of odd single-malts for my birthday. Lest anyone think his middle initial is E-for-Enabler, 70 centiliters of Scotch will keep me drunk for 70 months. We're going through it *very* slowly. But still.)

"Will drain CSF for food."

Part Two:

I'm trying to decide what to take to Canada. That is, I'm trying to decide how many pairs of long underwear, how many pairs of wool socks, and how many long-sleeved shirts and sweaters I can fit in one duffle bag and still have room for the bottle of tequila that Pal Joey has requested. Apparently the liquor-store employees in Montreal are all on strike. (???)

You cannot buy, for any price, a wool sweater in this part of the country, regardless of the time of year. It doesn't get that cold. I managed to find a couple of wool "blends" (angora, cat hair, rayon, steel wool, asbestos) at 75% off the other day, and so picked up those. One is black; the other is the ugliest shade of green I've ever seen. It's so completely misbegotten that it looks marvelous with a pair of brown corduroy pants.

I'm also wondering how easy it would be to cook a Tex-Mex dinner for my Polish and Canadian friends, some of whom are vegan and others of whom are scarily fit. Perhaps I should make room for sopapillas and tortillas in my luggage. I really, *really* want to teach the Artistic Canadian Man With His Own Website how to do tequila shots the right way (lick coarse salt off hand, shoot tequila, suck lime), but I'm not sure I can get limes in Quebec in February for under CN $400.

And should I wear the stitched black cowboy boots with tooth-picker toes that I have, or pack them? And will my new jeans arrive in time? (Having lost some weight, hoorah, I find I now have to buy size 12s to get the properly baggy Midstate Hippie Look.)

Part Three, in which our heroine attempts to forestall the inevitable:

I bought some of that Neutrogena Dangerous Face Resurfacing Stuff the other day. You know what I mean: 1.7 ounces comes in 45 pounds of packaging, but the contents of the jar are supposed to Turn Back The Clock when it comes to facial skin.

I was desperate. I would say "I was drunk" but a) it was 1:30 in the afternoon, and b) I don't *get* drunk; I get sick. So I was full of pizza and fears of looking my age.

(Note: I notice now that when I say "I'm 35" or "I got fat" nobody corrects me or protests at either one. Oh, dear.)

So I get this jar of stuff. I slather it on, let it dry for ten minutes, then use my fingertips, moistened with warm water, to buff it off my face.

I will not lie to you, sisters. My skin looked and felt like absolute shit after I was done.

However....the next day, I got many compliments on my skin. The pebbly texture that I've grown used to, the signal of PMS-under-skin-zits, was gone. Fine lines were Honest-to-Frog Diminished. Makeup went on more smoothly. There was nary a sign of redness.

One of my patients (given, he was on Ativan at the time) said, "You look so innocent."

Part Four:

I'm honestly, no-joking-here worried about how long I can keep up this work. Neuro nursing is notoriously hard on the body; you have to lift people who have no idea that they have a right/left side. Lately, I've started noticing that I creak interestingly when I turn over in bed (I need a new mattress anyhow, but this is on top of that), that I can't check my blind spot as easily as I used to, that I get out of a low chair without pain.

Having lived with chronic pain in the past, I'm in no hurry to do it again. I'm looking hard at leaving the high-control, high-prestige world of University Nursing and going to the Community Scary Hospital About To Open In The Spring in the hopes that I'll have some variety.

Any input is welcome. Click on "Speak".

The name is "Jo". Not "Job", *JO*.

This is ridiculous. I thought, after dealing with The Real, Live Flu, that my immune system would be fully cranked and happy. I was wrong.

Thanks to the vagaries of viruses, I now have a head cold. (See why I blog? I can whine to thousands of readers [actually both of you] about this and spare my family and friends.)

Yesterday I woke up with one of those horrible sore throats that makes one unenthusiastic about swallowing. I also had no voice. None. Not even a croak, squeak, or growl. I'm not sure where the voice went; in twenty years of singing with choirs and on my own, I've only lost my voice that completely once before--and that was when I coughed it out with bronchitis.

Anyhow, no voice. Sore throat. Vaguely stuffy head. Gotta go to work anyhow. So what does a nurse with no voice do?

She communicates in squeaks and growls to her patients and with sign language and flashcards to her co-workers. This was, of course, a source of endless amusement for said co-workers, especially as the ol' speechbox started to rev up about 1100 but wasn't totally reliable 'till about 1500.

I managed to trade off a patient assignment with a coworker, too. Although I'd had him the day before, there was no way I could take him back yesterday--he's stone deaf. And his wife takes his hearing aids with him whenever she leaves. (Side note: why do family members do this? I understand that there's a problem with dentures, glasses, or hearing aids getting lost or stolen in healthcare facilities, but you'd think that the risk of that would be outweighed by the benefit of Grampa or Grandma being able to eat, hear, and see while you're not in the room.)

(Speaking of which, I had a patient whose daughter used to take his top denture plate with her when she left, but not his lower one. This meant that for about eight hours of the day, he was reduced to "grphmmrrr fffllllrrrp ggg rrrphlllllllmmmm" instead of actual speech, and that he couldn't eat. What's up with that?)

Anyway. I was getting ready to discharge one very understanding and amused patient at about noon. Walked into the room with all the requisite paperwork and Soforth and So-on, and she asked, "How on earth are you going to do this if you can't talk?" By that time, I had a sort of Eartha Kitt/Katharine Hepburn growl going, so I just said, "I'll do an interpretive dance about how to take care of your incision."

I'm off for three days, Thank Frogs. That'll give me time to go from Really Supremely Congested to Unbelievably Gross and Snotty, catch up on some other blogs, and maybe do some grocery shopping (chicken soup with rice. Chicken soup with noodles. Chicken soup with vegetables. Chicken soup with roasted garlic. Chicken soup with mushrooms).

How much Mucinex can one person take before they start to rattle? Stay tuned.

Free association

So my beloved sister mentions in an email that her boyfriend fell off a ladder.

Not, as she put it, by slithering and grasping, but by becoming completely airborne, backwards, off the top of a six-foot stepladder. He apparently brought down the ladder, the bookshelves, and a computer desk with him as he fell. The boyfriend, incidentally, is in his fifties. Sister said the impact noises that his limbs made as he tumbled down were quite impressive.

I had a patient two weeks ago in his fifties who became a quadriplegic through missing his chair and sitting down hard on the floor, then whacking his head on the desk. And Sister's Boyfriend does a credible imitation of the Jamaican Bobsled Team and is okay.

Which leads me to pondering this: could it be that he's from India that contributed to his relative lack of injury? Bear with me here.

Sister and I are Northern European. Fair skinned, blue-eyed, red and blond hair. We break easily. We scar easily. Toss one of us off the top of a six-foot ladder (I have done this, in college) and we're lucky if we break only a few ribs (as I did). If we'd tossed our father off a ladder at age 50, he'd likely have ended up like my chair-missing, floor-sitting patient.

Now, then. You can maintain as much as you like that we're all brothers under the skin, but a quick study of comparative anatomy will reassure you that it simply ain't so. African-American leg bones have a different ratio and thickness than Caucasian-American leg bones. In the same vein, African-American women are much less likely to suffer from osteoporosis than their brunette, brown-eyed Caucasian sisters, who in turn are luckier than their Scandanavian relatives in that department. It's a matter of bone density that relates to ethnic background.

I hear tell from my pals in the ED and the labor unit that they hate to see redheads coming; the rumor being (although I have no clue if this is true) that we carrot-tops have less collagen in our skins than others and are therefore more likely to scar/rip/wrinkle/you name it.

There's a movement afoot in the African-American community nationally to raise awareness of the need for donor organs--especially kidneys. Again, although non-Black and Black donors and recipients share a good number of characteristics, there's something about the differences in donated organs which (as I understand what little I know) makes it easier to cross-match all the zillion factors when the donor and recipient are of the same ethnicity.

This all sounds like the worst racist hooey if you aren't careful. Still, I wonder. Could Sister's Boyfriend's lack of injury--aside from a few bruises--be partly attributable to some difference in bone density between his ethnic group and ours that I'm not aware of? Or is it just that his top is made out of rubber and his bottom is made out of springs?

Anybody got any nice studies they'd like to pass along?

Things that bug me

I'm not normally a pessimistic person. Yesterday, though, I forgot to take my usual allergy medication. I ended up grumpy and snotty by about 1700 and so made a list of Things That Bug Me About My Job.

Abusive patients and patients' family members top the list. For some reason, it's seen as okay, in the hospital world, for patients or relatives to shout at, curse, or insult nurses. I've been told in the last week that I'm incompetent, that I'm robotic and lack a sense of humor (okay, that was from a woman who was clearly off her nut, so I'm ignoring it), that the patient in question could get better care at Podunk General. Given that Podunk General was the facility where that particular person had a completely jacked-up surgery she didn't need, I doubt that last.

What do you do when this happens? In nursing school, there's a lot of talk about "setting limits", "defining boundaries", and "therapeutic communication." Sometimes that simply doesn't work and you have to get out of the room. Other times, setting limits with a patient is harder than you think.

For instance, I once had a guy who was a professional curmudgeon in for knee surgery. He complained about *everything*--the way the bed was made, the sex and size of the physical therapists (both small, wiry females), the food, the nurses. I finally rested my arms on his bedside table and we had this exchange:

Me: "Sir, have we done anything since you've been here that is up to your expectations?"

Him: "Oh, you can't take my complaining seriously. It's just my personality; the way I am."

Me: "Well, I've had it up to my moustache with your personality. Something has to change, and change *now*. There is nobody except me who is willing to walk into this room. Be nice."

No, that communication wasn't therapeutic. But it worked.

Second on the list comes the Insulting Doctor. Be he resident or attending, some of these folks (both male and female) think it's cute to call nurses dumb. Two examples, the first from two days ago and the second from yesterday:

Male resident: "Can you tell me something about Patient A?"

Me: reels off pertinent history, recent vitals and chem results, and general information of interest.

Male resident: "Gee, that's a whole lot better than a nurse's usual reaction of (screws up face, shrugs shoulders) 'I dunno'".

Me, with blank stare: "Well, you know, we're just here to train you guys."

Which, though sad, is often true. I get asked at least once a day what to do with a patient with intractable pain or a low Dilantin level.

How about....

Female attending: "God, it's cold up here. Why don't you people turn down the air conditioner?"

Me: "Because we're comfortable."

Female attending: "Turn it down right now. I'm cold."

Me: "No."

Female attending, switching tacks: "Where's my patient who was in 24?"

Me: "We moved her to the pulmonary unit."

Female attending: "Oh, you guys didn't *like* her? (sneering)"

Me: "No, she's a pulmonary patient. She never should've been admitted to this floor in the first place."

Granted, I'm fond of this attending, and she, in her cold-hearted and snippy way, is fond of (or at least amused by) me. I was able to ask her later when she changed sticks. You know, the one you usually keep up your ass. It seems bigger this week.

Third on the list is management. Hospitals are the only places, I think, where you'll find managers who haven't done the work in question in years. Okay, maybe car companies are the same way, or large manufacturing concerns. But this is a hospital we're talking about--most of the folks coming up with Brilliant New Ideas have never worked in direct patient care, or haven't done so in years and years.

Middle Manager: "Here's our new piece of extra paperwork. It's brilliant! All you have to do at the end of every shift is fill out this two-page form on each of your..."

Me, breaking in: "No."

Middle Manager: "But this is brilliant! It breaks down the..."

Second Nurse, interrupting again: "No."

Middle Manager, looking confused: "No?"

Third Nurse: "All of this information is reproduced in the chart here, and here, and here. There's no need to transfer it at the end of every shift to yet another piece of paperwork."

Middle Manager: "... ... ..."

Me: "No. It won't fly. It's a bad idea."

Blessings be upon the head of this particular Middle Manager, who realized that we were right in our protests. MM looked at the chart, realized that what we were saying was true, and scrapped the idea.

Things that comfort me, post-shift:

The sound of my cat drinking out of her water glass (she's finicky; doesn't like bowls): she's the loudest drinker on the planet.

Getting a Valentine's day present so tacky, so over the top, for my boyfriend that he screamed and threw it across the bar. Perfect.

Opening the file folder of thank-you notes and props I've gotten from patients over the years and rereading them.

The scariest thing anybody's ever said to me

Came today from a neurology attending at work.

"The best time I ever had scuba diving" he said, "was out in the kelp forests off Monterrey. You can find these big bunches of sea hares [large sea slugs with long eyestalks] and they're all copulating, you know, 'cause they're hermaphroditic, and then you grab a great big starfish [here he used the scientific name, which I do not know and do not want to Google], and drop it on 'em, and they're all, like, yanking their various bits back and inking all over the place, trying to get away. It's fun with invertebrates!"

A Compleat Guide To Tonight's Dinner

You will need:

About a pound of fresh asparagus, as thick as your thumb at the base
Half a pound of whatever mushroom is cheapest this week
A generous handful of oil-cured black olives
Half a ball of fresh mozzerella
Two handsful of cherry tomatoes
Five cloves of garlic
A serving or two of linguine
A couple of shots of good single-malt Scotch
Nickel Creek's "This Side" CD

1. Put on the CD. Put asparagus into a preheated 400* oven with salt, pepper, and maybe a little oil. All on a baking sheet, of course.

2. Slice mushrooms thickish. This should take you all of "Smoothie Song".

3. Pit olives (if they're not already). Slice garlic thinly.

4. Rinse olives under hot water in a colander to remove excess oil. You should be well into "Speak" at this point.

5. Heat olive oil in a large skillet over high heat. Shake the asparagus, then put it back in the oven.

6. Toss sliced 'shrooms in there. You want them to brown around the edges, not sweat out their juices. You should be doing a little hip-shake to "Should've Known Better."

7. Pour a generous dollop of your favorite single-malt and sing along with "Hanging By a Thread". Start water to boil for linguine.

8. Add olives and garlic to mushrooms, turn heat down to low. Slice tomatoes in half. Dice cheese.

9. Sing along to "Green and Gray."

10. Toss linguine into boiling water. It should boil about the time you hear the line "notebook and Discman for friends."

11. Finish first dollop of Scotch and send a mental shout-out to Rob.

12. Now we're into the home stretch, with "Beauty and the Mess". Quit blogging and go drain linguine. Toss tomatoes with cooked mushrooms and olives and garlic, then pour over pasta.

13. Add cheese. Watch as it melts.

14. Yank asparagus out of the oven. Arrange asparagus and pasta attractively on a plate.

15. Eat.

Total unapologetic fluff

Things you wouldn't know about me unless we worked together:

1. I wear thematic socks and sushi-print scrub tops on a regular basis.

2. I once performed the part of Rizzo in a stage production of "Grease". My rendition of "Sandra Dee" still brings down the house.

3. I have a bad attitude and a really foul mouth.

4. I have no automatic respect for doctors.

5. My air-guitar version of The Knack's "My Sharona", performed in absolute silence, is a huge hit with nursing students.

6. I walk 4.5 mph at work.

7. I'm incredibly clumsy. The physical med & rehab docs nicknamed me "Grace" after I walked into a room, tripped over the floor, bounced off a wall and two pieces of equipment, and ended up in the MD's lap.

8. I have learned to cuss in Greek, Russian, Armenian, and Italian in the last three years.

9. I will eat almost anything from the hospital cafeteria. (This alone ought to inspire both awe and fear.)

10. After three years, I'm still not proficient with the computerized order-entry system.

Dammit.

The new line from management to the community is "Patient care is our first priority."

The new line from management to us on the floor is "If you have a bed, we'll put a patient in it, even if you don't have a nurse."

Yesterday I started with five patients. One of them was way-high-acuity (a fresh neck dissection without a trach tube). I discharged three and got two in. Then I closed charts on all four of those and picked up two ICU overflows.

If you're still with me, that means I opened, assessed, and closed on nine patients in seven hours. The last five hours were spent with those two ICU overflows.

For five hours, I said things like "You must turn off that cell phone in this room" to one patient's wife and "Don't try to stab yourself with that butter knife, dammit" to the other patient.

Still.....one postop patient who was mostly intact and one patient with EEG monitoring beats SEVEN patients per nurse, which is what the rest of the floor had. Seven. Patients. Seven high-acuity neurosurgery and neurology patients. People on seizure precautions and confused people. Per nurse.

Oh, my God. We've turned into Enormo County Hospital Lite.

Just to give you some idea, I also:

cleaned two rooms
discharged one patient, including a fifteen-minute wait for the taxi
called over an interpreter twice for a patient who spoke no language I speak
dealt with post-lithium tremors in a patient
thwarted one case of suicidal gesturing
answered phones for a half hour
missed lunch
drank four pots of coffee in short order

*sigh*

Sometimes I wonder: A Rant.

So we have this new management team at work.

About a year and a half ago, there were massive layoffs at my facility. A consulting group was brought in, at huge expense and with great trepidation, to tell us how to fix our hospital. They came, they saw, they left reams of paperwork in their wake.

(All of this, by the way, was occasioned by something so silly I can't even blog about it lest my head explode again.)

So in comes the new management team, right? They're all nurses and doctors who've left active practice in favor of management. And they have great ideas about Improving Customer Service. Yes, that's how they put it.

I had to sign a form at my last employee review that said the following things about Good Customer Service:

1. The nurse will introduce herself at the beginning of the shift to each patient in her care. (Check.)

2. The nurse will perform a complete head-to-toe assessment of each patient at least once a shift and more often as circumstances dictate. (Assessment? Like I don't already do that?)

3. The nurse will outline, with the patient, goals for treatment for that shift. (Check.)

4. The nurse will answer questions to the best of his or her ability. (Duh.)

Point being, I already do all that. It's called basic nursing care, not good customer service.

I really believe that anybody who has a medical or nursing degree who's in management should be required to work, or at least follow a nurse, for an entire shift before making recommendations like these.

That way, they'd see that the layoffs of nuts-and-bolts staff like cleaning folks and transporters have occasioned such things as nurses cleaning rooms and running patients across the medical complex (thus leaving their other patients un-nursed). They'd understand that those Four Bullet Points are things that we do anyway. They'd see the difficulty of working a shift when you don't have enough urinals, or NG tubes, or wheelchairs, or Lortab, and are constantly having to steal said items from another unit.

Another fun case in point:

A Highly-Placed Member of the Management Team showed up unexpectedly on the floor the other week. She was exercised to see that there were five people in the breakroom eating lunch at once.

Here's the breakdown: Two were unit secretaries, one not from our unit. One was a transporter, also not from our unit. One was a nurse's aide, not from our unit. One was a nurse from our unit.

It was two o'clock in the afternoon. We had had an almost-complete turnover of patients that morning, with fifteen discharges and fifteen admissions before noon. The folks in the breakroom were the first to eat lunch that day; the other nurses were attending patients.

There was one nurse (the charge) at the desk, answering call bells and trying to chart on her own patients. (Note that we are a high-acuity unit, yet our charge nurse still gets stuck with one to three patients daily as a result of staffing changes recommended by management.) A patient called for help with a bedpan, and apparently the charge nurse didn't move fast enough away from the desk to help the patient.

The Highly-Placed Member of the Management Team Went Ballistic.

Without assessing the situation, without asking why there was only one person at the desk, without discovering what on earth could induce a nurse to eat at two pip emma, the HPMMT stormed off to the floor manager and hollered about our not caring for our patients.

At that point, the Credibility Meter in my head goes past zero and the Bullshit Meter is pegged on redline.

We already have five-liter capacity bladders. We already work sick, hungry, dehydrated, underslept, and injured. And we've got a good floor with almost enough staffing to handle the patients.

Here's a person who's been at the facility a matter of weeks, who walks on the unit and makes assumptions about the quality of care based on three minutes' observation. That's their right, I suppose, but it's equally our right to inform them that their assumptions aren't valid. Instead of then trying to find out why a nurse had to scare up help for a patient with a bedpan, the person then got very upset and made *further* assumptions about the quality of care on our unit.

(For what it's worth, the charge nurse estimates that it took her two minutes to wrap up a phone call, deal with two other call bells, and get into the room.)

I would love to invite that particular manager to come follow me for a day. If the manager's license is up-to-date, I'd even invite them to come work with me for a day. I think--no, I know, having been one myself--that managers tend to forget what it's like to work on the floor every day.

The trick is not to blow a gasket and theorize ahead of your data. If you do that, not only are your management skills suspect, but nobody will listen to you.

Our manager's solution to the Enormous Lack Of Concern For Patients On Our Unit, as seen by the HPMMT?

Close the breakroom door.