A Nurse With Attitude

Where Dark Cynical Humor, Nursing Issues, and Politics Seem to Merge

Archive for the month “April, 2012”

(EPIC) Electronic Documentation goes live

I review current events and the news almost every day.  As a nurse,  I perk up at anything that comes across the board about the bureaucracy surrounding medical care.  Because of the enhanced government regulation of health care,  for every hour spent actually delivering care, there is an hour spent on documentation of that care.   That’s a 1:1 ratio of paperwork to patient care.

http://www.nytimes.com/2010/04/08/health/08chen.html

This is utterly ridiculous and incredibly frustrating for most nurses.  As care givers, we are paired down to only giving half of the actual care that we did only a few years ago with the same number of nurses.  Somehow our lawmakers are under the illusion that enhanced regulations add to the overall quality of the care delivered.

Did you know that there are six ICD codes specifically for water ski injuries. There are 12 codes for injuries related to parrots.  The lawmakers don’t seem to ever  do anything constructive.  Congress makes hundreds,  if not thousands of laws each session.  Do they resend any of the past laws before making new ones?  Not hardly.   How about, for once, let’s give a try with less restrictions, less regulation, less bureaucracy in health care.

Recently, Obama has mandated that all health care facilities go to “paperless documentation”.  This was sold as a way to “streamline” healthcare and make things “better and more accessible”.   At my current place of employment, I work in the operating room.  We just shifted to “EPIC  online” medical documentation.  This takes at least twice the time to do the same documentation we were struggling with doing on paper.  Well, the good news is with this system,  the billing department is said to be able to “better capture cost and expenditure.”  Unfortunately, it is horrible for all hands on caregivers that are involved.  Since the onset of EPIC, we have implemented having one extra nurse designated  as just the “documentation nurse” in each room. .. ridiculous.  This is expected to change back to only one nurse as soon as “the line nurses get comfortable with EPIC.”

The latest mandate that came out this morning… The management team has determined that EPIC is “unreliable in capturing charges.”  So, to make sure that implanted items, such as with hip, knee, spine and most all orthopedic surgeries,  are properly charged for, we are to double document the items.  Yes, we are to document all implanted  items in EPIC and on the old paper charge sheet.  This is to insure that  “all charges are captured”.  Will this insure proper charges and accurate documentation.  Not really. Most nurses are patient centered instead of budget centered. That is , when stressed and short for time to give adequate and safe care, the first thing nurses  slouch on is charging the patient for surgical items.  Nurses feel that they can’t compromise on quality care, and most patients don’t complain for a few extra free items at the end of the day.  I try very hard to make the charges correct, but when asked by my manager how it was going with the charge system.  I responded honestly, quite accidentally, and a little sarcastically.  Just like in the comic strip “Dilbert”,  managers are as far from actual physical work and hands on health care as they can possibly get.  So,  by the same token, they have practically no real understanding of  nursing issues.  Knowing that she would never really understand,  I answered her question with an old Cajun parable… “a man with one watch knows exactly what time it is all the time.  A man with two watches never really knows, for sure, the exact time.  So, with this double documentation thing… I think that this institution is ripe for a fraud investigation.  “Oh crap… did I just say that out loud?”

 

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Lunch Time

When I take my lunch break, I usually leave the building and go outside in the sunshine or somewhere I can have some quiet “alone time” to relax.  I can just sit and eat, drink my coffee, ponder my coming up weekend, read a book, whatever.  I try to not think about work, or work related problems. Lunch, to me, is like a small little island of peace,  on the storm of a chaotic day.  When I work in the main OR, lunch is at 2am.  In the outpatient realm, it can be at 11, 12 or 1pm.  Today, for whatever reason, I made my way to the community “break room” to eat my chicken sandwich.  I didn’t realize how irritable I get without my alone time worked into the schedule.  On the other hand, I might have been a little irritable all day and just now realizing it.  Anyway, when you’re not at your best, it seems to be the best time to analyze the worst of others.  Especially other staff members who insist on communication while eating.  Here’s two that are, at least for today, ranking at the very top of my annoyance list… and at the same time,  the very top of “I don’t care a whit about anything you have to say” list.

The first irritant is the crazy nurse who  does a regular “colon cleansing”  to rid herself of “harmful toxins”  Oh boy,  you  go on and on about how hungry you are, but how good you feel and that it’s totally worth it because of toxins. Awesome, could you be more specific about which toxins you’re referring to, and if you knew that they were even something that existed more than a week ago? Great. Can you go into a little more detail about the process and the stuff that comes out… especially while I’m trying to eat here.  Also, I’d really appreciate it if you continued to judge me for eating a sandwich while you shut your pie hole which is not being used for delicious pie,* but instead is being filled with pepper water, or some strange tan liquid designed to actually cause diarrhea!

Number two is the nurse who, despite all of my protests, she insists on telling me all about her dream she had.  I have ADD and I have a tough time anyway,  trying to pay attention to even entertaining things… but this, whew.  I knew I was in trouble  the  moment she start talking and I looked around the room.  I realized that everything  she was saying was being met with blank stares, polite nods, and dead eyes.  That’s probably the exact reaction to every dream any person has ever gotten when attempting  to force-explain it to someone on their lunch break. If you had a dream about suddenly realizing your at level – 10, on the annoyance scale,  and suddenly shut up , perhaps I would be interested in hearing about this one.  Oh no, my time is up and I’ve got to get back to my room.  Lunch was entirely too short.  No matter what happens, tomorrow, I will go outside and visit my little island.

What’s the SS doing when not chasing hookers?

     I’ve no doubt that you not heard about the Secret Service and how they are in deep trouble.  They were suppose to be guarding Obama on his visit to  Columbia.  Instead, they slipped out and got a whole party of Columbian hookers to party the night away.  They’ve stirred up an official Congressional investigation and everything.  What are they doing when not chasing after Columbian hookers?  Why they are watching over rocker Ted Nugent.  The ridiculousness continues.

I have been quite about this whole story,  I mean really,  “boys will be boys.”  I don’t blame them.  I blame the administration and the people that hire these agents for their misbehavior.  What eventually got me stirred about this story was the Congressional committee and their solution.  They said that there writing a bunch of “new rules” for the Secret Service.  All agents are forbidden to drink any type of alcohol ten hours prior to reporting to duty.   All agents are forbidden to frequent any disreputable establishment such as bars and brothels…. and on and on ad nauseam.   When will they learn.  No matter how you try, you simply cannot legislate morality.  To get and keep dependable and honorable Secret Service agents, you must recruit only dependable and honorable people to the job.

When my son went to West Point, he told me of  “the code of West Point”.  This mysterious code doesn’t have thousands of special rules, tenants and standards to memorize and abide  by.  It is simply one phrase that they all live by.  “We will not lie, cheat or steal, nor will we tolerate anyone who does.”   It is impossible to recruit honest and honorable people even at West Point.  If anyone fails to live by this simple rule, he is immediately discharged from the school.  It’s amazing, but at the end of the four year school cycle,  anyone that is dishonorable has been purged.  The graduates are the best, most honorable possible.

The Secret Service is no different.  If they wanted to actually have honorable and honest people in the agency, they could adapt this one simple rule.  Any one that was caught, witnessed or found breaking this one rule would be immediately purged from the agency with no retirement, or compensation.  This and this alone would make the Secret Service a reputable agency.   Congress still doesn’t get it.

Obama has fixed illegal immigration!

His economy is so bad Mexicans have stopped coming and are now leaving.

Who would have thunk it?  Obama had a plan all along.  He didn’t fix the porous border.  He didn’t make new anti-immigration laws.  He didn’t even allow the border patrol to do their job, which they were willing to do.  He simply made this country have a crappier economy than that ofMexico.  I read this article in the Washington Post.  it was so sad and ridiculous it made me laugh.  Apparently a four-decade tidal wave of Mexican immigration to theUnited Stateshas receded, causing a historic shift in migration patterns as more Mexicans appear to be leaving theUnited StatesforMexicothan the other way around, according to a report from the Pew Hispanic Center.  Ha!  take that Republican hate mongers.

I’ll bet that when Romney takes office, he’ll claim that Romney has undone all that he has accomplished.

A Comment on Nurse Managers

 A Nurse Manager who wears scrubs to work = Nice
A Nurse Manager who will step in and take patients when things are crazy = Priceless

I worked with two of my favorite surgeons this week. On Monday was Dr. Bee.  He is the chair of the neurosurgery department. He has clinic two days a week, does chairmanship stuff two days and then surgery the other two with a day left over for Synagogue.  The other was Dr. Yee, the chair of the orthopedic department.  His schedule is much the same. My question:  surgeons, doctors, medical practitioners all seem to maintain a toehold in their practice.  No matter how high or how involved they get in administration or hospital politics, they still do patient care.  Why is this not the same for Nurses? Once nurses make the transition into administration, they drop patient care and never look back.  Today, most nursing managers couldn’t do hands on care if they had to.  I think that this is horribly wrong for any licensed nurse.  I personally believe in leadership by example, and you can’t expect to be a credible leader if you don’t have any idea what is going on in the trenches.

 

It would seem that a nurse manager that has the skills to manage and has the ability to jump in and do patient care when things get bad are as rare as unicorns.

The further Sissification of the American warrior

    Yesterday I saw on the front page of the Oregonian was the story of a group of US soldiers taking a picture with a dead enemy soldier.  They went on and on about the investigation blah, blah.  Reading this made my blood boil.  It is a soldier’s job to kill insurgents… that’s what they do.  These people are the enemy. They are a threat. For soldiers, it is kill or be killed. When a warrior is successful, he will often count coup. It is a tradition as old as the ages. It’s an endorphin dump to say “Whew,  Hey, I’m still alive.” The warriors in the story counted coup by posing for photos with the mangled bodies of enemy insurgents who, shortly before the photos were snapped, were trying very hard to kill them.  In the post-modern world of moral relativity and political correctness, this is totally unacceptable.

Evidently the goal of the government, the culture and the military is to remove every last ounce of warrior instinct and tradition from American soldiers. Until the American fighting man has the same sensibilities and feelings as the occupants of a California elementary school faculty lounge, they must be continuously molded and engineered. The goal, evidently, is to make the members of the American Military gentle, politically correct, effete, witnesses to war. Nothing more.

The Pentagon on Wednesday condemned a report thatU.S.troops posed for pictures with the mangled bodies of insurgents in Afghanistan.

The Los Angeles Times released the purported images Wednesday morning, and reported that they showed soldiers with the 82nd Airborne Division in 2010. One photo showed what appeared to be U.S.troops, some smiling, holding up a pair of severed legs.

The military said Wednesday it has already launched an investigation of these zealots’.

Life Magazine, May 22, 1944…

…When he said goodbye  two years ago to Natalie Nickerson, 20, a war worker of Phoenix,Ariz., a big, handsome Navy lieutenant promised her a Jap. Last week Natalie received a human skull, autographed by her lieutenant and 13 friends.

Give the Doctor a Scalpel

    I work with surgeons every day.  Just a little warning about these guys, you can never make them happy,  or they can never be satisfied.  They all seem to be a little self centered with the emotional and temperamental development of a twelve year old.  Well, it’s like working with a really smart twelve year old, except with ADHD.

If you give a surgeon a scalpel, he’s also going to want a pick-up. “I’ll need that to be a Cushing pickup… no I want a DeBakey…   no I’ll have a…  Oh wait a minute…”  then he’ll remember that he always operates better with some music.
“Nurse, Can you put on the radio please, or some music. Do you have an I-pod connection?”
“Certainly, Doctor Bla-Bla. Do you want Rock?”
“No.”
“Classical?”
“No.”
“Easy Listening?”
“No.”
“Country?”
“Oh, God, no.”

Then he’ll suddenly remember that he has a Frank Sinatra CD in his car. He’ll want you to page the PA and ask him to run down and get it.
While you’re waiting, he’ll hum a few bars and show off a few dance moves to the scrub nurse. “Yes sir! I used to really cut the rug in my day.” He’ll say as he gives the nineteen year old scrub a wink.

While he’s dancing and flirting with (and distracting) your scrub, he’ll remember that he’s parked illegally. “Oh yea,  nurse… can  you page the PA again and see if he can move my car while he’s down there… I think I’m in a handicapped space”.
Suddenly, the first year resident makes a comment about being hungry. A spirited discussion takes off on where’s the best place for lunch.
“Chinese?”
“No.”
“Thai?”
“No.”
“Italian?”
“No, I had pizza yesterday.

Sandwiches?”

“Blah”

The surgeon will remember a Mediterranean restaurant that he likes… “Hey Nurse, you’ll have to page the PA again”… while he talks about the great hummus and vegetables. “Wait! I want brownies, too! Tell him to get brownies!”
To fill in the time, he’ll tell a story about the time he vacationed in Greece and lost the keys to the rental car on the beach and they had to walk 2 miles back to their hotel room and his wife was so mad she didn’t speak to him all day.

You get a call from the front desk.  It’s the PA finally back with 5 Frank Sinatra CD’s, the keys to his car, one pint of hummus, a carton of vegetables, 6 gyros, a 2 liter bottle of soda (it was a special), an extra pita,  and two types of brownies.  The charge nurse is wondering when your room will be finishing up.  As you discuss the events with the charge nurse, the Surgeon says…

“Hmmm. Now what was I going to do?”
The anesthesiologist looks out from behind his paperback and coughs, “Ahem”.
“Oh, yes. I was going to ask for a scalpel.”

 

 

Best E-Mail of the Week

 Doctors:

(a) The number of doctors in theUSis 700,000

(b) Accidental deaths caused by physicians per year are 120,000

(c) Accidental deaths per physician is 0.17

Guns:

(a) The number of gun owners in theUSis 80,000,000

(b) Accidental gun deaths per year is 1,500

(c) Accidental deaths per gun owner is 0.000019

So, statistically, doctors are approximately 9,000 times more dangerous than gun owners.

Remember: Guns don’t kill people; doctors do.

Not everyone has a gun, but almost everyone has a doctor.

Please alert your friends to this alarming threat. Doctors should be banned, or at least more strictly controlled, before this gets more out of hand.

Out of concern for general public safety, there should be no statistics published about lawyers for fear the shock would cause people to panic and seek a doctor’s assistance.

A Little History Question

Guess who I am.

My father was born in another country.

I was not his only child.

He fathered several children with numerous women.

I became very close to my mother as my father showed no interest in me.

My mother died at an early age from cancer.

Although my father deserted me and my mother raised me, I later wrote a book idolizing my father not my mother.

Later in life, questions arose over my real name.

My birth records were sketchy.

No one was able to produce a legitimate, reliable birth certificate.

I grew up practicing one faith but converted to Christianity, as it was widely accepted in my new country, but I practiced non- traditional beliefs and didn’t follow Christianity, except in the public eye under scrutiny.

I worked and lived among lower-class people as a young adult, disguising myself as someone who really cared about them.

That was before I decided it was time to get serious about my life and embarked on a new career.

I wrote a book about my struggles growing up.

It was clear to those who read my memoirs, that I had difficulties accepting that my father abandoned me as a child.

I became active in local politics in my 30′s then, with help behind the scenes, I literally burst onto the scene as a candidate for national office in my 40s.

They said I had a golden tongue and could talk anyone into anything.

I had a virtually non-existent resume’, little work history, and no experience in leading a single organization.

Yet I was a powerful speaker and citizens were drawn to me, as though I were a magnet and they were small roofing tacks.

I drew incredibly large crowds during my public appearances. This bolstered my ego.

At first, my political campaign focused on my country’s foreign policy…

I was very critical of my country in the last war, and seized every opportunity to bash my country.

But what launched my rise to national prominence were my views on the country’s economy.

I pretended to have a really good plan on how we could do better, and every poor person would be fed and housed for free.

I knew which group was responsible for getting us into this mess.

It was the free market, banks and corporations.

I decided to start making citizens hate them and, if they became envious of others who did well, the plan was clinched tight.

I called mine “A People’s Campaign”. That sounded good to all people.

I was the surprise candidate because I emerged from outside the traditional path of politics and was able to gain widespread popular support.

I knew that, if I merely offered the people ‘hope’, together we could change our country and the world.

So, I started to make my speeches sound like they were on behalf of the downtrodden, poor, ignorant to include “persecuted minorities”.

My true views were not widely known and I kept them unknown, until after I became my nation’s leader.

I had to carefully guard reality, as anybody could have easily found out what I really believed, if they had simply read my writings and examined those people associated with. I’m glad they didn’t.

Then I became the most powerful man in the world… And the world learned the truth.

Who am I?…  My name is  ADOLPH HITLER.

This is no direct comparison to anyone we know, It’s simply a coincidence … and simply an observation on my part… on this day – April 20, 1889

Four Hours!

That’s how long it takes to get the smell of c-diff out of your nostrils after you’ve left the room.    C-diff is a powerful little bug. Kinda like Slimer, from Ghostbusters.  It just stays with you.
I scrubbed on an “exploratory lap” case last night.  It was a 61 year old nursing home patient who had vague abdominal pains. The general surgeon said, “lets do it… I’ll need a basic major, a bookwalter, T and C for two units of blood, then we will bring him down from the ER.”  I said, “wait, what’s wrong with him?”  Surgeon, “I don’t know, that’s why we’re doing an exploratory lap.”  Long story short,  we were elbow deep into this case within the next thirty minutes.

The case went well, all the way through to the end.  As I expected, we didn’t find anything out of the ordinary except a large amount of poo.  Maybe he was just constipated… I don’t know.  But, lets just say that this guy’s “abdominal pain” will be a lot worse for several days to come, now that we took a four hour look-see into his abdominal cavity.

Once we finished the last stitch, the circulating nurse called report to the ICU, and I rapidly cleaned up to assisted with the transport.  From the time we opened the guy up, the smell was pretty bad.  I smell some pretty smelly smells in surgery, but this smell, smelled pretty smelly. I figured that the smell would dissipate as soon as we departed the OR suite… I was wrong.  The old guy was a fifty-pack-year smoker and his lungs weren’t in the best of shape.  The anesthesia team wanted to extubate him in the unit with an “overnight stay” just for safety sake.  We transported to 7A ICU with no incident.  Once I got back and sank into the couch to watch some TV, I smelled that same smell.  I looked around for some of that poo.  The first two hours was  spent repeatedly checking my shoes, scrubs, back of my arms, etc, to make sure that I don’t have any of it on me, because I was sure that the smell is coming from something that I missed.  After all, I  spent four hours elbow deep in the stuff.  It had to have gotten on me somewhere, right? Those gowns are only paper, after all.   But alas, it is coming from my own abused little olfactory cells. The cells that hate me now. The cells that will make everything I eat in that 4 1/2 hours taste like c-diff, too.

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