Sunday, June 13, 2010

Really and truly. It's very simple.

(The return of the grouchy nurse vent!)

Nurses do not have "cred". This "cred" of which you speak can be found in the ICU, on fixed-wing and whirly aircraft, and in the trauma ED. I do not have "cred", I do not need "cred"; in a pinch, I am a neuro nurse and I know where to hit you.

If you capitalize "Me" and "Myself" in your Facebook entries, you will not get friended by lower-case me. You are from Oklahoma, not Dusseldorf.

You are the resident on call. As such, I expect you to know something, no matter how minimal, about the patient you're about to see. Do not confuse Mrs. Westheimer, who is 88 and female and here from a LTC facility, with Mr. Gonzales, who is male and 50 and speaks no English.

If you tell me I have the freedom to move back and forth between the various steps of a protocol depending on lab results, please do not write me up when I do so. I've already entered your verbal order as, well, a verbal order.

Likewise, if you tell me to call you with any change, understand that I will call you with any change that warrants calling you. A blood sugar over five fucking hundred is one of those. Don't shout; the telephone reception is fine.

And really: I hate to pull rank, and I hardly ever do it, but understand this: Your attending has worked with me for eight years. We have pulled each others' asses out of so many fires you'd never believe. Therefore, if there's a question of practice, he's probably going to side with me first. This is no reflection on your brilliance; he's only worked with you for three weeks and has no idea how you think. Muttering "cunt" on your way out the door effectively seals your fate.

I do not want to date your grandson. I don't care how cute he is. Because he is 28 and your grandson, and I am 40, no matter how young I look.

If I ask you to please take a moment when you're not busy and refill the paper towels, please take a moment and refill the fucking paper towels.

Doctor Dracul, this one is for you: don't order six tests that are send-outs to Mayo and JH three days in a row, then come in on day four and yell at me, messing up my 'do, for not having test results back yet. I will respond in a pleasant, calm, straightforward manner and make you feel like a donkey's ass. No offers of coffee and cream cakes will make your shame go away.

*** **** *****

We need real monitors; the sort that don't shut off when you unplug them for travel.

We need beds with scales that work.

We need important paperwork to be translated into Spanish, Chinese, Korean, and Arabic.

We need a list of send-out tests for which results take a minimum of 96 hours (I'm starting on that on Tuesday; don't worry).

We need an updated call list, a list of acceptable protocols (do we use the insulin protocol for critical care or the one for acute care, or the one you just made up?).

We need enough pumps.

We need dedicated vents, so if a patient has to be intubated, I don't have to beg a vent from the guys down in the basement (that was a very near thing indeed).

We need propofol in the machines.

We need.... ..... .....damn. We need so much on this stupid unit, with only four beds and two nurses and a floater. I'm having to spend so much time on the absolutely critical that I no longer have time for the merely urgent.

*** **** *****

I remember once in the last eight years when I said something akin to "I have been here for X amount of time, therefore you need to listen to ME".

I'm hoping that I've built up some credit with everybody else in the hospital, because I'm about to start using that line a LOT. As in, throwing my weight around, pulling rank, calling in favors. The only way I was able to get a working travel monitor today was by reminding the dude in central supply about the time......well. That doesn't bear mentioning here.

The trouble is this: Manglement is hoping they can vamp 'till ready on this unit, and then somehow have it spring fully-fledged from somebody's (my?) forehead in January. That's not going to happen, but try to convince a bunch of desk-bound paper-shufflers of the need for, oh, equipment that won't actually kill people, and you fight a losing battle.

*** **** *****

That said, D0c Dracul is kind of cute, in an underfed, Eastern-European, I've-gotta-look-that-country-up-on-Wikipedia sort of way. His offer of cream puffs and chocolate, though, left me unmoved. Show me the Cheetos and Scotch, boy!


messymimi said...

You are right. It is simple.

It's a shame you have to point these things out.

Alpine, R.N. said...

Now if he offered creampuffs AND scotch? Mmmm...future husband material.

H said...

A-fracking-men to the resident on call/call me with any changes issue. Jesus H. Christ I get tired of their bitching. You are the resident on *call*, therefore, don't be surprised/pissy when I *call* you in the middle of the night for a Hg of 5.9. If you want a job where you don't get those kinds of calls at those kinds of times... sorry hon, doctorin' ain't it.