Friday, November 21, 2014

patients are products on a corporate medicine assembly line

OK its official. I am overwhelmed. I have been an ER nurse for 25 years. If your arm was dangling by a thread from your shoulder, I would calmly take you back to the stab room. If you unexpectantly go into v fib, I would have the patches on so fast, your head would spin even though you are dead. In other words, I have seen a lot of stuff and can remain calm under lots of stress.

However, I am getting to the point of no return with the amount of information and job requirements there are these days.

I work in a large inner city ER in a hospital which does all kinds of fancy-dancy shit: LVADS, ECMO, CRT, interventional radiology, robotic surgery. You name the complicated medical condition and we probably do it. My point? Our ER is filled with complicated chronically ill patients on a daily basis. These patients are not your ankle sprains, lacerations, appys. They are people who are quadriplegics on dialysis with complicated heart histories. Those patients make up a good proportion of our patients.

The other population we serve is the neighborhood hood rat element. They use us as a clinic. They bring their dysfunctional lives into the ER with them. We serve a large immigrant population. We see many, many mental health patients.

In other words, our ER population is heavy duty. So we are already running around like banshees trying to keep it under control.

Now add to that the 20 emails I get daily about different changes to policies, procedures. Add to that the 10-15 education classes I am supposed to complete every quarter, preferably during my shift. Add on being preparing for various organizations that come every couple of months to certify the hospital in one thing or another: LVAD, magnet, bariatric care, stroke management, chest pain, etc. Add on to that a new drug dispensing system that has been put in place in the last month. Add on to that BLS, ACLS, PALS, TNCC. Add on to that the ebola scare and preparing for that. Add on to that JCAHO, CMS, Department of Health visits.  Add on to that monthly staff meeting, quarterly charge nurse meetings.

How much more can nurses take, seriously? In all of this ridiculous frenzy of information and certification, interaction with the patient seems to be the last thing on anybodys mind. The patients have become products on an assembly line of corporate medicine. The human element of todays corporate medicine, the nurse, has no time to talk, empathize with, care for, the patient. They are too busy trying to keep up with all the certification/regulatory bullshit.

Wednesday, November 19, 2014

31 uses for duct tape in the ER

Its an oldie but goodie....

1)IV pole broke: Tape the IV bag to any nearby surface: the monitor, the wall, the patients relative, etc.

2) Demented Donald trying to get out of bed? Duct tape will keep him in bed.

3) Duct tape that irritating drunks mouth shut.

4) No security available to watch your suicidal patient? Duct tape will keeep them in bed and SAFE.

4) Out of arm slings? Fashion one out of a piece of cardboard and tape.

5) Patient hairy and need to put him on the monitor? Duct tape will remove that hair for lead placement.

6) Backboards all in use? Take the sliding board, some rolled towels and tape and fashion your own version of spine stablization.

7) Duct tape your manager to a chair.

8) Low on suture or staples: A quick and easy laceration repair.

9) Tape patients gown together for trip to bathroom.

10) Out of adult diapers: use towel and duct tape substitute.

11) Tape NG, ET tube, foley in place.

12) Tape patients wig or toupee in place.

13) Never lose it again: tape you pen, scissors, roll of tape, stethoscope to yourself.

14) Make letters RN on uniform so patients will know you are their nurse. You know how everybody gets confused...

15) Afraid your patient might wander off? Put their name on it, room number and attach to gown.

16) Cheap shoulder immobilizer.

17) Confused grandma will never pull out her IV again.

18) Tape your nostrils together for that smelly clean up

19) Cheap eye patch.

20)  Patient has hyperactive kid that keeps running around.  Tape to wall (see picture).

21) Duct tape educator to chair - no more of those irritating online quarterly education classes.

22) Patient keeps coughing in your face, won't cover their mouth - use as a mask.  Hey relax...they can still breathe out of their nose...

23) Doctor order an enema?  Duct tape them out at the triage window.

24)  Never get lunch? Tape a snack to yourself.  Tape a water bottle to yourself.

25) Tape the ER entrance shut when you get too busy.

26) Tape the annoying family member/friend to their chair so they won't stand at the door looking annoyed when the visit drags on and on....

27) Cheap alternative to restraints.

28) Tape OCD/candy man/overordering  doctor to chair. 

29)  Tape the clipboard carriers into their cubicles sans computer so they can't come up with more annoying new policies.

30) Cheap hazmat suit.

31) Hold JCAHO/CMS/Department of Health, chest pain/stroke/magnet/any assinine certifier hostage at least til the end of your shift...

Your thoughts?

Saturday, November 15, 2014

California mandates full body suits and respirators for HCWs taking care of ebola patients

Here's an interesting development: The state of California has mandated new regulations about ebola training and PPE gear for hospitals.

It requires full body protective suits that leave no skin exposed or unprotected. It also requires respirators. It is mandatory for hospitals along with training.

This is quite an accomplishment for the California nurses union.  Last week 18,000 nurses in California were on strike around contract negotiations as well as what they said were inadequate equipment to care for potential ebola patients.

Actually the respirator part of this makes a lot of sense. It actually could prevent HCWs from getting ebola.  If you don't have to wear a mask but instead have a respirator, it will be a lot more comfortable. You will be able to spend a lot more time in the suit. This would mean less nurses rotating into the room and having to don and doff the equipment. With the current equipment, wearing the mask and all the other stuff, I don't see how you could do this for more than an hour or two, requiring multiple donning and doffing in a shift and more potential for contamination.

What people don't realize is that the four hospitals with biocontainment units in the US use this equipment to care for any patients they have. Supposedly these people are experts in this area.  So why the disparity between what they wear and what an average nurse in the US is supposed to wear?

I can guarantee you that most hospitals will not adopt this. Too expensive. They will play the odds that they will never get an ebola patient.

One other thing California has included in the regulation is a whisteblower section. It guarantees that health care workers won't lose their jobs if they report non compliance. Employers are VERY sensitive about their preparations for ebola. I have found that if you bring up any kind of concern about their preparation, they immediately jump on it and go to lengths to explain why you are wrong.