MD vs. Dr.

Has the term Doctor become too generic? Having worked in several health care facilities, I have noticed more doctors are identifying themselves as MD’s on their documentation and even how they are identified by the hospital or clinic.

Here is what I’m thinking. When I was a kid and went to the doctor, it meant sticking my tongue out and saying "Ahh". Followed by some booster shot or needle for whatever was going around. I did not think of the doctor as anything other than medical in nature. Now every time you turn on the news or some talk show there is a doctor of something.

True that anyone with a PhD can call himself or herself a doctor, and I do not take anything away from that accomplishment, because they worked damn hard to get it. However, I don’t associate the PhD doctors of botany, astrophysics, zoology and business with the term doctor I grew up with and recognize.

Yes, maybe Dr. Seuss confused me as a little kid, and I still don't know who he is, but it seems different in how the word doctor is used today. Besides those with a PhD being able to call themselves doctor, in 5 minutes I could think of Dr. Dre, Dr. Oz, Dr. Drew, Dr. Laura, Dr. Phil, Dr. Scholl’s, Dr. Pepper, Dr. Dolittle and the Rug Doctor. Isn’t Dr. Oz the only real medical doctor in this bunch?

Along with that Nurse Practitioners will have to have a PhD starting in 2015. I think I will be happy to just be an NP, even if I get a PhD.

"The Best Laid Plans of Mice and Men"

When school ended, I thought I would be smart and make myself available whenever they needed me to pick up as many shifts as possible. I knew that once school resumed in September the last thing I would feel like doing is working most weekends.

Well the idea might have sounded good two months ago, but now they are calling almost every day. In most situations this would be fine, however, now I’m tired of working with patients. Well, it’s not so much the patients, because only a few are the ones who suck your motivation and energy, like the government has sucked the confidence out of the American people. It is more the unit politics and certain staff that make for difficult shifts. You learn quickly who the team players are; they jump in and help when it’s needed. While some are never available, that is unless they need you.

The money helps, but being burned out before school and clinicals even start is not a good idea. So how much is the lottery up to?

Gratuitous cute mouse picture 

How to Blog

A friend will be starting nursing school this fall and after reading about so many other people's journeys back into school. I thought she should document hers as well. So what kind of advice would you give a new blogger, or an old blogger for that matter?

Let’s face it school, work and life can be stressful. Some bloggers including myself believe blogging is beneficial to relieving some of that stress and providing a way to process all of the positive and negative emotions. Reading other people’s experiences and insight may also help because they have been through it.

Personally, I would say there is no right or wrong way to blog, just start writing and your style will develop. Everyone is different in what they like to read, so at first write for yourself and not what you think other people want to read. You are not writing an academic paper to be graded, so enjoy yourself. Although, I have noticed that bloggers seem to have better writing skills than most. ( Maybe not mine)

Some people want others to read their blog, while others do not care because they are writing for themselves. There is a follower’s widget and by following someone, they may follow you. However, the best advice I can give to gain followers is not my own, you have to click here and read this older post by Red Means Go. She is a fun read and does not take herself too seriously. With over 2200 followers, she understands that followers do not equal readers.


The blog roll is something I’m indecisive about and always changing mine and playing around. However, it is good to look at other people’s blog links and click on them, because you might find other blogs that you really like.

People can be very creative with their blog templates, while others like mine are somewhat boring. I really need a change. So play around with the backgrounds and layouts.

Then she needs to decide whether to be anonymous or use her real name. Privacy is a big thing in health care and if you make accusations, bitch or say something negative about a patient, staff member or the facility, it can come back to bite you.

Any other ideas or advice?

Dead bodies and Recipes



As nurses you become desensitized to a lot, but once in a while a wtf moment hits you.

Yesterday, because of sick calls they had me helping in the cardiovascular ICU. Halfway into the shift an elderly Asian gentleman passed away; it was not unexpected as most of the family had been called and were at the bedside.

After he passed, the family wanted to spend more time with him and have their 6-year-old granddaughter come into the room to say goodbye. The patient had been on a ventilator with lines and tubes inserted into every possible orifice and extremity. It would have been a scary site to most, but why subject a 6 year old to this?

Anyway we had the family go to the waiting room as we fully gowned and masked up. Because of his condition we knew there would be extensive body fluids everywhere; also bathing and turning a dead patient requires a lot of contact.

The air in the room smelled horrible as we started pulling lines, tubes and clean up the man's body. Then the two nurses with me started exchanging recipes for some type of bread pudding dish.
I laughed a little and found it is sad, because while cleaning up that poor dead man's smelly fluids, their talk actually made me hungry.

Stereotypes

Frequently patients or family members think I'm a doctor as I walk in the room at the beginning of the shift, or they ask if I'm doing this until I go to medical school. Maybe it's because males are less than 10% of nurses or it could be my boring blue scrubs and demeanor. Face it women nurses tend to wear happy scrubs with lots of colors and patterns. Yes, that is a stereotype and that's my point. As a male nurse we are stereotyped a lot.

Everybody stereotypes or jumps to conclusions about something or someone, its human nature. We do it with individual people, races, cultures, communities and even whole countries, and of course the occupational stereotypes.

Teaching is still a women dominated profession and we keep hearing about the ones getting caught doing a little extra curricular activities with their students.

Is there anybody who doesn't know a lawyer joke or have something positve to say?

Body building and steroid use equals small testicles. Does anybody outside of bodybuilders think this is a profession?

Doctors have that God complex. Personally, I notice this trait more in the Neurosurgeons.

Try not to stereotype a secretary, cop, construction worker, flight attendant, cook, trucker, librarian, farmer or architect. They are all noble professions, but it seems every occupation can bring up some stereotypes so don't go postal on me.

If you are offended or agree then good, because nurses still have the worst stereotype. Look at this ad I found in the Vegas phone book a while back.

For every one person who associates Florence Nightingale with nurses, one hundred think of this stereotype.



Shift Report

As a new grad nurse shift reports were one of those nerve racking parts of the job, but over time like everything else it becomes routine. You have your nurses who expect you to tell them everything about the patient, even as far as doing their whole shift assessment. Then you have the veteran nurses who just like you to hit the abnormalities.

Last shift I was taking over for a nurse who just worked 16 hours and I told her hit the highlights and go home. Her report for the first patient was short and sweet as he was a fresh heart cath, then she started with the second patient saying he was a 55-year-old morbidly obese Hispanic male who was crossing the border when he ate a burrito and experienced an MI, but he's fine.

I looked up from my paper because what I just visualized a Chris Farley comedy moment.

She may have been tired but this was too good to let go. I look at her and said, you just told me that an overweight Mexican was crossing the border when he ate a burrito and had a heart attack. I let her think for a minute before she had the same visual I did and laughed.

Nurses have a warped sense of humor and this patient is fine, but sometimes you need to take care of your co-workers and if you can lighten the moment then do it.

Later I looked at the doctors H&P and saw that three days ago he was crossing the border with some friends in a truck and had eaten a burrito while waiting. He then started experiencing some chest pain, and after three days of this intermittent chest pain he decided it was a good idea to go the hospital.

Borderline

I have the specialty I want, but sometimes I think I should have applied for a nurse practitioner in psychiatric and mental health care.
It just seems to be that more and more patients are presenting with mental illness and it's not limited to any specific floor. I float everywhere; oncology, cardiac, step-down or the surgical unit, and I receive patients with mental health issues. These are not dementia or certified psych patients just those borderline cases. Having worked with this population before becoming a nurse I take it in stride, but it can be funny watching how they manipulate some of the staff including doctors.
I actually kind of enjoy most of them, but then again some might say I am borderline.

Sea Salt

Sea Salt has been around for a while, well almost since the beginning of this planet anyway, then as a natural preservative of foods for our ancestors, along with smoking and dehydrating.  However, once again leave it to companies wanting to make a profit to turn it into something that it is not.
For months now Wendy's has been advertising their french fries with sea salt, and last night I saw Campbell's advertising that their soups were now made with sea salt. The commercials give you the impression that it is better tasting and better for you in general.

This ties into work because a few weeks ago while doing patient teaching about HTN a woman asked about sea salt and she wondered if it was any better for her?
Because of all the advertising lately I had actually thought of this subject before, so I calmly said to her, it might taste a little different, but think about cigarettes. One may taste different than the others, but the effects on the body and the outcomes are the same.
We just looked at each other for a second then continued with the rest of the teaching.

Only difference is they mine it by the sea

Nurses and Food



Did I gain weight during the past few weeks? Yes.

It was not only from family and friends sending me gift baskets and home baked cookies (those are the best). No, it is from work and the horrible nurses and nursing assistants.
All year long there is food to be found in hospital break rooms across this country, and I have seen it of from the east coast to west coast. This time of year it is doubly bad with all the sweets and baked goods.

But like I said nurses are horrible, year around they use any excuse to bring in some kind of unhealthy food. A birthday, holiday or special occasion is fine, but sometimes people bring in things just because they cleaned out their fridge or they wanted to bake, but not eat it.
See that homeless man on the freeway ramp, give it to him.

OK, I'm bitching because I'm weak!
Plus, this past year I've eaten more Filipino and Vietnamese food found in the staff break-rooms than I have in the last ten years.
I thought it was good working in the float pool, but now I realize that just means different staff telling me to eat. Every time I walk-in someone is encourage me to try something they made, I don't want to make them feel bad and so I eat.
There is no getting around it that Filipino food is not healthy, and definitely not how my co-workers make it. They basically fry everything and use various meats products in numerous combinations. 
Now off to eat more with family and friends over the next few days.

I made the mistake of telling staffing that school would be finishing December 15, and I would be able to work when they needed me. That was a stupid mistake or early onset dementia, either way they said OK and booked me every day for the rest of the schedule. I quickly told them to take me off for a few days around Christmas, then I will also take a week off to re-energize before classes start again in January.

Need to finish getting my paperwork together for the graduate part of the program and prepare for my Mom's visit in a few weeks, I just want to make sure she has a good time and hopefully it quits raining. If it ever got cold enough to snow here we would have had about 10 feet this past week.

Compassion

I love and hate getting floated to the oncology floor.

I have worked in the area and at this hospital long enough to know several of the patients who come and go on a regular basis. These are not the Frequent Flyer's all hospital staff roll their eyes at, these are the patients who are dying, yes I suppose we are all dying, but they just have a better idea when.

It's a goal of mine to have fun with my patients and if I can make them or their family laugh a little all the better. Of course the situation dictates how you treat them, because some will being going home for the holidays and some won't. And the ones who don't have any family or visitors really rip at my heart, you want to know why, but it is not important at this point, they are human.

It is better that I float to oncology instead of work there all the time, because I don't want to become jaded. Most nurses are wonderful on that floor, although sometimes you can tell the ones who have been there too long and have lost compassion.

We are all allowed bad days at work, but for some nurses and doctors it has gone beyond that and into an autopilot, robotic, watch the clock, wait for my 401K to recover so I can retire mentality.  

Fake sick calls equal fake crisis

Being in school full-time I work per diem with just one hospital and on a schedule that is mine, and everything works out well. However, every so often I get these calls from the agency begging me to come in because the hospital is extremely busy and they need everybody they can get.

The actual translation is that more staff than normal called in sick. Today it was because it has been raining for the past 12 hours, it is so predictable when this is going to happen. Halloween fell on the weekend this year so all the parties were Friday and Saturday nights, so why was it a surprise to have numerous calls both Saturday and Sunday morning.

Pretty soon more holidays and school will be out for the little kids, so will they prepare knowing sick calls will be going up, probably not. This is not a crisis, this is a staff problem. The weather is bad and people call in sick, staff wants to extend their vacation for a day or two and they call in sick, hangovers from holiday parties equal sick calls. The only ones hard to predict are the real sick calls.

Please float me back

I do not float to the critical care units very often, but it happened this past weekend. Maybe it was karma after complaining about being sick of work and needing a change. I'm not ICU trained, but working in the float pool you go where they tell you. It was low census so they probably could have sent me home, but instead gave their nurses an extra set of hands.
No direct patient care, okay so actually I was their gopher, bitch or whatever you want to call it, but I liked it. Just run between the units and letting people take a break or help with whatever they needed.
Really anytime they want to pay me to socialize, transport patients, assist nurses and docs without the responsibility of charting or other BS I'm there.

Don't get Old

If you were to ask the two things I hear more than anything else in the hospital from patients, it would be easy to answer.
Almost every shift a patient is guaranteed to do their imitation of Oliver Twist saying, "Please Sir, can I have some more", not referring to porridge, but their favorite friend, Dilaudid.

The other thing, because the majority of patients you work with in the hospital are older, they feel compelled to tell me about being old or something to that effect. Getting old sucks, just wait until you get this old, and usually when I'm helping them, they simple tell me not to get old.

Truth is I really only have two choices, but Bless their souls anyway, well most of them.



Emergency Department as Primary Care

Walking in and out of work I usually take a door that goes by the Emergency department, and look to see how many people are in the waiting room, which gives me an idea of how busy the shift will be, on whatever floor they send me to that day. My shift starts late morning and if it is standing room only the docs will be writing patient discharge and admission orders, and the nurses and aides will be running around trying to get it done, which describes most days.  Then when I leave the ED always seems slower, just one of those optical illusions I guess.

Anyway, many of the patients using the ED are not here to be admitted, they are here to use it as a primary care visit for themselves, or their kids. If they had some kind of insurance they could go and see their general practitioner, get their prescription for ear drops or whatever, and be on their way.

Why are we clogging up the Emergency departments and stressing the staff with people who should be seen in a clinic, or as I remember a little office with a little waiting room and old magazines?

Patient Ratio Laws, Careful what you Wish For.

I'm seeing it more and more with hospitals crying about the lack of money.
This time it is the Nursing Assistants taking a hit, by being given a larger number of patients to care for, or cut all together.
I first noticed this at Kaiser Hospitals in California when they pulled most or all the nursing assistants from the floors, and made the nurses do total care for the patients, all in order to save a few dollars. I think it was also a little retaliation, because California nurses pushed and got laws passed for the number of patients they could care for at one time. However, talking to travel nurses it is happening in other states also.

This is just a bad business model and another reason patients are not satisfied. As a nurse you get trapped into making decisions between patients that you should not have to make. When I should be helping a fresh post-op patient with pain control and getting settled, instead I am making sure my confused, unstable and impulsive 88 yr old man is not falling out of bed because he thinks he needs the bathroom.

I love a good nursing assistant and jump to help them when I can, but in reality it is the patients suffering as they wait long to be fed, transported or cleaned.

To all you hospital bean counters who think of money before patients 

Nurse Killed in State run Mental Hospital

Article:  Nurse Killed in State run Mental Hospital

So sad and condolences to this nurses family and friends. It makes me ask why was this man not under constant control?
Years ago before I became an RN I worked in a government operated long-term mental health facility as an aide, but sometimes I felt like a caretaker for grown adults, and it was unpredictable.
Truthfully, I loved my clients and 99% of the time they were great and fun to be around. But, every once in a while there was a reason they were located there, and would end up spending time deescalating from some crisis in a padded room. That was the thing, sometimes you knew what set someone off, other times it just happened and you were caught in the middle. My facility was for people not safe enough to be in public unsupervised, but it was not a full lock-down psych facility, like where this nurse was killed last week.

Dust aka Dead Skin

Ever get that sun beam shinning through the window which suddenly illuminates all the little dust particles in the air making a perfectly shaped column slicing through your living room. We all know those dust particles are made up of dried skin, pollen, dust mites, their feces and various other household products.

It has also been shown that sunshine coming in a patients room makes them happier and they recover quicker, even if it is only for a few hours a day. Really aren't we all happier with a little sunshine?

So how does this relate? While helping with a patient the other day who was stubborn about ambulating two days after heart surgery, but it was time for him to move. A co-worker who would not take no for an answer got him up as he complained while squeezing his heart shaped pillow to his chest.

Being the good assistant and trying to make the patient feel better I said I would grab him some clean sheets, as I ripped the old ones off the bed. As they flew off and traveled through the air a plume of dust, aka dead skin illuminated in the sunlight of the patients window. Not wanting to breath in what I was seeing I did the old nurses trick of holding my breathe and walking away towards imaginary clean air, but there really is no such thing in a hospital. I really can't imagine how many things we breath in during a shift at work.



Horrorscopes

It was a few days early but I called and wished a friend of many years a happy birthday, better early than forget later, and it made me think of horoscopes, because she shared this day with an ex. These two in good and bad ways are different, like those born on my birthday, even in the same year, we are different.
We have all read some form of a horoscope, but most realizing they are just for entertainment, that is why they are located in that part of the paper, and not under news or current events. It's human nature to want to believe the good horoscope or fortune cookie and leave the bad ones on the table. But like life it is how we interpret what is said and our attitude towards it.

You see it in patients all the time, the positive upbeat ones do better than those negative people, this also plays into how they get treated. The Md's, nurses, therapists and all staff just tend to spend less time with those patients who are confrontational, pessimistic and like a bad wound seeping negative energy.
It reminded me of a now d/c'd comic, reminiscent of the Far Side, called Horrorscope. It says a lot into how we interpret events and words both current and past; do you want them to be negative or positive?

My Nursing Diagnosis

You ever catch yourself saying the wrong thing in front of a patient or their family? I have kicked myself for saying something in front of a patient who is unconscious that I would never say if they were even a little conscious. You get busy and stupid, the other day I needed to prep a patient for surgery, a new admission was coming and time management was a good concept at the beginning if the shift.

My nursing diagnosis would be brain deficit R/T neurons not firing secondary to lack of caffeine and time.