Thursday, April 30, 2015

Hey, I just met you, and this is crazy,

. . .but I have the sudden urge to smack you over and over and over with a shovel across the back of the head, so could you sit down?


I am like Grumpy Cat: my life is empty without someone to hate.

After a rough period in December, when it seemed every nurse in Texas had disappeared without leaving so much as a shoelace behind, things are good in the CCU. We're staffed well. There's Kitty, who has sold her soul to the Devil in exchange for the ability to do a razor-sharp wing with liquid eyeliner *every* *time*. There's Marcie, who is good and beautiful and brilliant and so sweet I dread having to tell her that there is no Easter Bunny. And she's been a nurse for ten years, too, so this is not something that's going away. There's the night crew, who refer to themselves collectively as Team Awesome, and who are not overstating things. And there's Keith.

Keith (not his real name; if they pick me up for murder, they can't prove it) is the smartest nurse ever. He already has a master's under his belt at the age of 30, he's working on his DNP in adult acute care? Or critical care? Or something? He knows every policy and procedure in the manual. HIPAA is an open book. He can, he assured me on day one, run a code by himself. He is a fucking genius. He has been a nurse for five years.

He does not know how to set up a suction rig. He does not know what angioedema looks like. He does not understand how swallowing works, and that silent aspiration is a thing. He does not, in fact, know how to run a code at all, let alone by himself.

Now, I'm willing to excuse all of that and more in a new nurse. Contrary to how I might sound on here, I am the preceptor you want. I'll entertain any question without making you feel like a moron, because even supposedly stupid questions usually have logical backing. I'll show you cool shit and get you into the transplant OR and pull strings so you, too, can hold a heart as it beats outside somebody's body. You can practice IVs on me.

However. If you're a supposedly experienced nurse, who's worked four places in five years (wtf is up with that it's not like the economy has been great why did that not trigger anybody's warning bells oh my GOD), and you make a critical medication error, giving five times the dose of an opiate to an opiate-naive patient, and then turn your back on them in order to futz with the computer, and *then* try to blame the error on *me,* I will cut you.

If you try to pin something on Marcie that she did not do, then boy, your life as you know it just got a whole lot worse.

Keith's head and me, May 2015

Can I get an A-men.

For the time being, we have appealed to Wonderful Boss as a group, and Keith is going down to the bowels of Holy Kamole in order to train with Betty in Interventional Radiology. Betty is sixty. Betty is a dedicated Crossfitter and member of a motorcycle club. Betty runs a six-minute mile, faster than she did when she was an Army nurse. Betty is two years away from retirement and takes even less shit than she used to.

Keith will know, if he knows nothing else, how to dose people for conscious sedation. And what to do if he fucks up. And he'll know exactly why it's a bad idea to try to bully the people he works with.

I feel alive again. I feel like I'm no longer wasting my time, if there's an ego to destroy and dreams to crush.

Or maybe that's the double-bacon cheeseburger I ate for lunch talking.


gela said...

Ahmen :)

Silliyak said...

Elle said...

Oh, I've missed you! Sometimes I need to know there are other people out there who would hold a person like Keith while I b*tch-slap him to Albuquerque and back.

Anonymous said...

Head Nurse is back, bitches!

This was a pleasure to read-glad things are looking up at work.

cowango said...

Oh I have been needing this. And it is a pleasure to hear that someone's staffing is good. Ours is in the dregs. We await reinforcements. Keith sounds like a charming idiot. Hopefully Betty can knock some sense (and humility?) into him.

Aviana said...

Nursing would be better served if the profession was modeled on the same type of program that exists for physicians. After education, then internship. After more education, then residency. This would help hospitals with staffing, allow easy recognition of the level of education for each person and would aid in "fixing" whatever is lacking from the educational process. Having worked in hospitals with interns and residents, the system worked to improve care and weed out incompetents.

whoFilets said...

Love it. Go on, Betty!

ktb said...

Oh, HN, how many Keiths are there?! Mine was taking PALS while still in orientation in an adult ICU and was a bit shocked that he wouldn't get paid for his time to do so. He also gave 40 mEq KCl IVPB over 15 min through a peripheral, when I thought he was hanging zosyn and we were long past the point that I should have had to touch every med he gave to confirm that they were correct. If the patient hasn't been a gcs of 5, they would've been screaming. When I told him that he needed to go eat something and take a break, LIKE I HAD SUGGESTED TWO HOURS EARLIER BEFORE THE POST OP CRANI ROLLED IN, he actually shook me off at first. I felt like Kevin Costner in Bull Durham, and parked him at the nursing station for the rest of the shift. Sadly, the NeverusefulManager and Director felt it was not serious enough to get bent out shape about, and let him out to cowboy around on the unit for eleven months until he got into CRNA school. Good luck with that, Keith. Glad to hear yours was dealt with appropriately!

JG said...

Ouch, ktb. Just....OUCH.

So glad you're back, and woohoo for good staffing! Ours has been improving, but still iffy at times. I work cardiac progressive care, but it ends up being mostly med-surg, and I need my critical care fix in a bad way. I hate to leave my team, though (I work with a night-shift Team Awesome, too). If I could just get CC patients and keep my coworkers and awesome boss, I'd have the perfect job.

RehabRN said...


I did not work with Betty, but I have with some of her Navy friends, and let me tell you!

That 4'11" nursing clinical instructor I had could cradle babies so tenderly and strike down a 6+ foot pain in the patooty doctor in nothing flat with a look that would freeze the Arctic.

She also liked to describe how she kept patients entertained on evac flights from war zones.

If he's stupid enough to f*&k with an old Army nurse, he may as well prepare for walking on a land mine.

Glad he's far away from you, 'cause it won't be pretty.

Anonymous said...

Precepting is like a box of chocolates you never know what you got until you bite into it to see what oozes out. My Keiths are usually Rhondas who are newbies who fear EVERYTHING. They cannot start a line, hang a drug or tell me what any of the medicines do. They all want to be CRNAs (cause of the money) and they can actually be just as dangerous as an Intern.

They bounce in on day one with 5 pounds of makeup, cute little grey anatomy scrubs and flirt with any physician under the age of 40. They lie to patients and talk all sorts of shit to families and by the end of the day I have been eye rolling so much my eyes get stuck.

I have to admit I do love it when they crash and burn. When the day comes that being cute is not gonna cut it. The day where the doc they have been flirting with tells her off because she almost killed a patient. Then Rhondas go away...and life returns to normal...

Oldfoolrn said...

I feel your pain. I have a "Profiles in Nursing Leadership" post on my blog about some of the characters I've had to put up with over the years.