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Friday, August 29th, 2008
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8:34 pm - EHR update
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pokygirl2001
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EHR is not going very well...
On the plus side, Dr. 1 has stopped crumpling the charge tickets and throwing them at me. He has now resorted to impaling them on the antlers of a deer head hanging from his office wall. He says he is 'collecting' them. I... am not asking. I'm not getting in between him and Billing when they find where all their missing tickets have gone.
Dr. 2 has always been hard to please, but I guess he can't decide whether he wants the nurses to enter the symptoms into the 'active problems' before he enters the room, or not, because he keeps coming out and saying 'Why did you put dysuria in there!? Now I have to take it out!" and next time saying "Why didn't you put dysuria in there!? Now I have to put it in!"
Dr. 3, I haven't worked with at all since EHR started, but apparantly he keeps leaving his notes open so he can post to them later, and doesn't enter any diagnoses. So the nurses are yanking their hair, because THEY can't enter the diagnoses because his notes are all open. And without the diagnoses they can't order any labs, so, erk.
Dr. 4 I have never worked with until today, and I had to go through all of his notes and active problems and correct them with the coding. He keeps texting in problems, like 'R eye skin lesion,' instead of putting in a code. So since all the codes want to know what and where on the skin it is, I asked him about it; his answer was 'Huh? I don't know. He told me about it, it's in his eye there somewhere, let them ('them' being the doctors doing the cataract surgery on his LEFT eye) worry about it, I don't know what it is.' THANK YOU SO FREAKING MUCH -_____- At least I could figure out and find 'sebohoric kerato', 'weeping eczema' and 'Ls Djd'.
Dr. 5 sent his nurses home bawling on Monday. I get to work with him tomorrow morning.
Dr. 6? I have no clue, but his nurses have been freaking evil witches this last couple of weeks. I can't hardly look at them without there being some snarky answer coming back @.@ He has been particularly resistive during the daily noon meetings but as for how well he's doing on the computers, I have no clue.
And every day just after noon, the ARNP calls the trainers over, reads them all the riot act, and the poor women go and hide in the lab recording office and cry -__- I feel sorry for them.
Oh! And I guess the specialists who were all supposed to go live this week had a ENORMOUS FIT during some sort of recent doctor's meeting, and the head IT person for the hospital system got fired last night. I think that miiight delay EHR there a bit more.
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(1 comment | comment on this)
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11:10 am - Math
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nancypaynter
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I just spent $90 of my hard-earned cash to renew my nurses' license for another two years.
At the current rate at which I am employed, plus or minus a few dollars and cents, and considering the amount of time involved, I figure that I just did the following.
I just helped twelve molasses speed old ladies with standard rolling walkers to the bathroom and back, for free.
I went on an average of three. . . nasty, bloody, hold-your-finger-in-the-artery type trauma codes. . . for free.
Perhaps. . . . I just assisted in three vasectomies. . . or did 25 sets of vitals. . . or emptied 80 catheters. . . or sank 16 NG tubes. . . or started 25 foley catheters or 60 IV sites or maybe I gave 240 doses or Toradol . . . FOR FREE?
Maybe I scrubbed 50 bed pans.
Nah. I haven't scrubbed a bed pan in years.
I just really think that it sucks. . . that I have to pay $45 a year, to put up with this shit.
Not fair.
current mood:  annoyed
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(10 comments | comment on this)
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7:57 pm
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| Thursday, August 28th, 2008
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10:23 pm - today was supposed to be my day off
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arijenn
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cross posted
and i was really going to enjoy sleeping in after i got the little dude off to school, doing some laundry, and messing about with some paperwork.
alas, t'was not to be.
you see, the unit manager is on vacation until the 8th of september, which means that staffing goes way down hill. of course, when the boss is away, the loosers who don't give a fig for their employment status will slack off, natch.
so my phone rang at 8am and an aide from the unit said, in a plaintive voice... "can you come in and work the floor with me today? everyone else called off."
so i said yes.
why? ( this is why... )
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(9 comments | comment on this)
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5:42 pm
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shyshutterbug
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It amuses the hell out of me when I have a pt covered head to toe in tattoos and piercings who freaks the living fuck out when I try to give her her Rhogam with a 26g.
Just sayin'.
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(12 comments | comment on this)
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| Wednesday, August 27th, 2008
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11:12 pm - Retrospective from a new RN
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not_tragedi
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"You don't work as a nurse to be safe. You're a nurse because everyday, you can do something just a little bit dangerous."
- Kate C, Nurse Practitioner
I just read an email from the 3C manager at work thanking me for helping out with the code blue on the floor today. He didn't code fully but it made us jump, run, and had me running back and forth between the nurses' station and his room to keep things in line. But I feel like I did nothing and am getting thanked for it. I mean, glucose checks and EKGs are pretty damn easy once you've tried them. And apparently, not everyone can do blood draws, catheters, aseptic technique, etc. But to be very honest, I feel everyone could do my job. It really only two years of intense, sometimes to the point of tears and actual breakdowns, training to get me here, but I'm confident most people can do this stuff without screwing it up royally.
This little jaunt down memory lane comes in part because next Monday I will start working as an RN at a hospital. And really, this whole entry boils down to the fact that I feel that sometimes things in nursing are so simple to do and perform that I don't know why I need a degree to do them. Or why people think this job is hard. I'm starting to feel those looming edges of negativity that emerge as a result of me moving on to something new. Like, to me, if I can do this job, anyone can. I mean, I can barely remember the classes of drugs let alone their major side effects. And pre-op check lists? Follow-up post-op procedure? I actually do need the forms for that.
Then I read through the entries over here at and as I've been paging through them this evening, I realize it's not that it's easy. Not even close to easy. I might not be cracking atoms or saving the world with new energy sources. But I know what to do if someone has ruptured a major artery or is seizing from detoxing off of alcohol. I can tell you that MAOI inhibitors are horribly complicated drugs and that you better have a buddy with you when you start Paxil. I can touch urine, vomit, mucus, stick my finger up someone's butt for digital removal and clean a stage four decube on someone's sacrum, wash my hands everytime, and go have lunch. And though I didn't go through all the time and cost of med school, I can say with quite some assurance that you will be less likely to get a UTI from me putting in your catheter than most urologists doing so instead.
This is a weird and creepy feeling for me. That I actually know and understand something is pretty amazing, just short of miraculous. And maybe I just needed to type out this so that I could have some sort of physical evidence when I start to feel insecure again. Call it quasi-gloating if you will but I'm half scared out of my mind right now. So, I'm not saving the world or even extra money on an electric bill. But I have to say, thinking on it now, I'm going to be responsible for another human's life soon. Several human lives. Everyday. And I've been prepared for it and obviously, at some point or another, people who have been doing this for years and years believed that I was competent and confident enough to do this out there in the big ol' world on my own.
I think I'm just trying to get used to the fact that I might actually be ready for this.
current mood:  quixotic
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(6 comments | comment on this)
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10:39 pm - More nursing books
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jensternal
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Sorry to spam the community, but I have one more book to go--this one I am selling, because it's a textbook that I just got prior to leaving the ICU.
Pass CCRN! 3rd Ed
New for $53, selling for $30 plus shipping, never used, no markings, CD included.
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(2 comments | comment on this)
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8:27 am - Was there a transient full moon last night?
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4:49 pm
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ebolacola
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Calling Nurses of Canada!
Not specifically cynical nurse.. so sorry if this breaks any rules :/
BUT, who are the big recruitment agencies in Toronto? Do any of you know how an overseas RN goes about working in your baeautiful country?
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(2 comments | comment on this)
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| Tuesday, August 26th, 2008
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10:10 am - Aide woes
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nursemae
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Dear, dear night comrades,
I know you're busy. I'm busy. We're all busy! We've got some lazy-ass folks on our shift, and more on days that we have to follow/clean up after.
However, we also don't have many aides. For some reason, they keep quitting. Maybe it's the crappy pay (whee, $7/hr when they can make $9 at McD's and not wipe ass!). Maybe it's the workload (often 24 patients/1 aide). Maybe it's a combination of these facts added to the biggest problem of all.
You're being twatwaffles.
Seriously, would you take on a 24-patient load, never get help to clean or turn patients, and put up with twatwaffle attitude for $7/hour? Hell, I wouldn't put up with much of that for $70/hour!
I expect them to work as hard as we do. However, that doesn't mean they should run ragged and don't even pee while you have time to read a magazine. And talk to your boyfriend. And take an hour lunch break. It's even MORE awesome when you do all that and then snap at her to get coffee for someone, or to take them a clean gown, or empty their urinal.
You're the same folks that are the most vocal and angry when we don't HAVE an aide and "OMGWTF-are-we-going-to-DO?!?!?!" on and on when you have to figure out how to take your own vital signs and blood sugars on your patients.
Try not to run off all the new hires quite so quickly this time, would you? I'd really appreciate it. I actually like working WITH them instead of lording over them all working "for me".
Too tired to type anymore,
Your Friendly Nursemae
(*Why yes, that is my new favorite Intarweb word, why do you ask?)
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(16 comments | comment on this)
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| Wednesday, August 27th, 2008
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1:12 am - New Zealand Nurse..
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ebolacola
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Hola!
I'm at work at the moment, in what I guess is a semi-busy acute medical ward. Obviously not so busy if I'm sitting here typing away!
Are there nurses that you simply hate getting or giving a handover to?
If I am giving a handover to someone that I don't really trust to do what needs to be done, I find that I take on 'primary school teacher' tone. Where I tell them things, and then repeat the essentials at the end. Like, IV antibiotic at FOUR PM, needs REGULAR nebs.
I remember one handover I got:
Came onto morning shift, bright and early - first one, so didn't know any of the patients.
Handover: "Mr S is a 81 year old, came in with decreased level of consciousness, we have done hourly GCS overnight, his GCS is 3, and has been stable."
".. wait, what? A GCS of THREE?"
"Yeah, but it's been 3 all night, it's stable"
".. is he for codes?!"
"Yeah, full codes"
".. and he has a GCS of 3 - was he seen by anyone over night???"
"No, he's been stable"
".. uhm, is he alive?"
"Yeah, he's fine"
".. what??"
I look at the GCS chart, and there it is, every hour this nurse was doing a GCS assessment, marking him as 3/15 and doing NOTHING about it. On an actual assessment his GCS is 9 - but we have the old addage here 'GCS less than 8? Intubate!'. So I code him, he's taken up to Critical Care for his compromised airway.
I was just a bit shocked that someone could in clear mind document that someone had a GCS of 3 - which technically means non-responsive, hell, unconscious, and do nothing about it! What is the point checking every hour if you're not even going to do anything about it?
PS - Are any of you working in or around London? I would love to get in touch to find out what it is like nursing over there. I'm currently in NZ, and am planning on moving to London for a couple of years!
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(11 comments | comment on this)
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| Monday, August 25th, 2008
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10:11 pm - Charting Errors...
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jeribearrn
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I love reading narrative notes. It tells me what happened with my patient and I can pass it onto the doc and it's a great day. What I love more is typos in narrative notes. I had to share these two with you because they just...they were awesome. Anyway, on with the show.
Chart was supposed to read: Patient vomited and got choked. Suction applied. No signs/symptoms of aspiration evident at this time.
Chart read: Patient vomited and got cocked. Suction applied....etc.
Yeah. He had really good insurance.
Chart was supposed to read: Patient talked with physician. Consent form signed.
Chart read: Patient toked with physician.
Apparently, in my hospital you can get cocked and toked if you have good insurance. Does anyone else have any funnies?
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(14 comments | comment on this)
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8:46 pm - Dumb order of the day, found in an actual patient chart.
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| Sunday, August 24th, 2008
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11:12 am - Nursing books
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jensternal
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I'm moving, and thus getting rid of some books. Not selling them--they just need to go. If you can chip in a few bucks for shipping, that'd be nice.
MedSurg Notes(nurses clinical pocket guide)--never used.
Critical Care Assessment Handbook (Murray/White)--this is a library book that I paid for, I promise!
Tarascon Adult Emergency Pocketbook (Rothrock)
Diagnosis and Management of Pneumonia and other Respiratory Infections, 2nd Ed.
Diagnosis and Management of Type 2 Diabetes
Critical Care Nursing Secrets, 2nd ed (Schnell/Puntillo)--corners of the cover are a bit chewed on, pages are intact.
Save the First Dance for You, the complete nurse's guide to serving your profession, your patients, and yourself (Young)
Your first year as a nurse(cardillo) 2 copies.
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(2 comments | comment on this)
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| Saturday, August 23rd, 2008
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10:42 pm - A night where things went right
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catshovel
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I'm in north Florida, and was scheduled to work Thursday evening at a LTC facility. Thursday was when the tropical storm was supposed to be at its worst, so I was expecting a clusterfuck of epic proportions. Anyone who's ever worked when some kind of natural disaster was looming/happening knows what I mean.
All I can say is that I must have worked off a ton of bad karma, because I had a hall full of pleasant, coherent patients- none of whom crashed or fell or even had so much as a cough. One lady asked for a clean washcloth and apologized for "bothering" me for that. My coworkers were equally pleasant and helpful. The only thing that went less-than-optimal was that my relief was an hour late, but several bridges had been closed at that point so I'm amazed she got there at all. In fact, in my entire experience as a nurse, I don't think I've ever had such an uneventful shift anywhere besides a group home.
Oy. I mean...oy. I couldn't believe it. I guess you get one of those every ten years, huh?
current mood:  content
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(5 comments | comment on this)
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9:37 pm - Lock Down: Part Deux
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yurtgirl
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So, as i posted yesterday we had an issue. We spent today with locked doors and screening everyone who came in and actually had a security guard on our unit from 2:30 pm for the rest of the afternoon. I wonder where they were yesterday when the guy said he had guns?
whatever.
I'm home alive and that's all there is.
I go back in tomorrow.
thanks for listening.
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(4 comments | comment on this)
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| Tuesday, September 23rd, 2008
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1:49 pm - Needing some reassurance...
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alliecat1224
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Yesterday I had a case go from simple and straight-forward to all-out cluster fuck. I'm hoping someone can ease my mind.
We had an 85 year old man come in for a carotid endarterectomy. Everything is fine, we move in the room, patient goes to sleep. I start to insert a foley and meet resistance. Doesn't feel like just a stricture, so I STOP (this will be important later). I push on the bladder just to see if I can get any return and get bloody urine. My doc is standing next to me so I point it out and tell him I'm not going to do anything, we need a urologist. Take out the foley, more blood. I call the desk to see if we have any urologists in the OR. Lucky me, the only one there is the biggest douche bag on the planet. He comes in and immediately starts yelling at everyone. We scramble to get everything he asks for and he starts working on the patient. He starts jamming in dilators and catheter guides, blood is really starting to flow. He calls for a cystoscope. When he takes a look he says, "Well, he's got a hole where there shouldn't be!" He puts in a foley, then looks around and says, "Who did this? Who put that foley in?" I speak up and say, "I did, but when I met resistence I stopped." His reply, "Like hell you did!" Then stomps off disgusted.
For some reason, even though my scrub techs and my surgeon were right there and backed me up, I feel awful. I'm 99% sure HE was the one that caused the problem, considering that he poked long pieces of metal down the entire length of the penis, and roughly to boot, whereas I stopped after an inch and a half. But there's this annoying little voice in the back of my head that keeps saying, "What if it WAS your fault?"
Gah! Any thoughts? Words of wisdom?
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(8 comments | comment on this)
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| Friday, August 22nd, 2008
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10:41 pm - Yep, it was Friday..............
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yurtgirl
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We get a call today from an area hospital saying a patient was on her way to our facility. We had no idea this person was coming, for one, and two the family was requesting security to meet them at the door because her estranged son threatened to bring his guns and shoot everybody.
Huh?
Okay, calm down.
page manager, page admission nurse and ask politely what the fuck is going on?
nurse calls back and acts like its no big deal, says manager should have told us what time patient was coming. manager calls and said nurse should have told us. whatever the patient is rolling in the door. we have no orders, no DNR, no signed consents, nada but an H&P from previous hospital. We don't even know whats wrong other than she's unresponsive.
Long story short her son was upset she wasn't going to his hospital of choice and got mad enough to threaten everyone. The story we got much later was that he was going home to get his guns. Then we heard he had handcuffed himself to his bed. whatever.
So, we had a lock down. I paged admission nurse again to bring orders so we know how to treat person in distress. and dont' forget the DNR.
Nurse shows up acting all nonchalant. I held my tongue and just took the paper work. Finally I couldn't stand it anymore and asked her if she knew about the patient and the family history yesterday which she said she did, why did she wait till we had to page her to get info that patient was coming and little bit of family background would be nice. She said blah, blah, blah. I told her it would have been nice to know in advance as we are not an icu or trauma unit.
We are a hospice floor. She just looked at me as I told her how this interferes w/ the patient's treatment not to mention the other patients and families who know have to get security to escort them out to their cars. AND how it causes stress for the staff and interferes with other patient care. Security showed up and parked a cruiser in front to deter any would be homicidal maniacs and said they'd come to the unit more often.
manager finally comes down all cool and gives us a name and a color picture to look at. We have no idea what to do if/when he makes his way into the building but to call our security. They gave us panic buttons that are hooked up to their alert systems.
i'm so fucking tired an stressed out about it. the manager fucked up and didn't call us to confirm pateint was coming, admission nurse didn't call to give us a heads up on the family situation and releasing hospital nurse didn't call w / any report.
Believe it or not we are having more and more acute cases coming in and we don't even hae a crash cart for those occaisional full codes we end up with.
i'm calling legal to see if our management knew about this man's threats prior to the patient being transported. if so, i believe they put the patient before staff safety and if that is the case shit is hitting the fan and it won't be mine.
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(6 comments | comment on this)
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| Thursday, August 21st, 2008
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9:09 pm - Nursing...
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| Wednesday, August 20th, 2008
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7:11 pm
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anodetonoone
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We've had a lovely collection of pts the past month.
My favorite is the guy who was masturbating and decided to enhance the stimulation by sticking a pen in his urethra. The pen cap got stuck in the tissue and he was unable to get it out. Waited around @ home...I'm not sure for what. Then went to the ER...they couldn't get it out, so he had to have general surgery. This isn't the first time he's inserted things into his urethra. O.O
My 2nd favorite is my guy from last night who was 33 and had 6 or so GRANDkids. He's a busy, busy guy, but he got beaten upside the head with a metal bat the other week and therefore, had to miss the birth of the 6th granddaughter yesterday. He goes to me, "people don't even think I look like I have grandkids!" I had to stifle a laugh.
=).
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(7 comments | comment on this)
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cynical_nurse
sleepy