Quick Realities pt 2

Okay, now I can at least be more coherent.


...So nurses cost the hospital a lot of money. But they can't run the hospital without nurses. They try, but they can't.

So they need to cut $$ somewhere....they can't cut nurses, and if the nurses are unionized (as most are in my state), they can't really do pay cuts. So how can a hospital still be operational, but cut operating costs at the same time?

They get rid of the ancillary staff.

At my hospital, we have CNA's (Certified Nursing Assitants), HA's (Hospital Assitants), MA's (Medical Assitants). The HA's are pretty much CNA's. The MA's are CNA's with phlebotomy training, and they're only used in the ER.

The CNA's were phased out for HA's. HA's have less training than CNA's and can't do things like take blood sugar. So now the RN's do blood sugars. No big deal...except that you're doing 3+ blood sugars on your patients, every day, at precise times of the day that occur at exactly the same time that you're supposed to be doing other things.

They are getting ready to downgrade the HA's even more, and take away their ability to take vital signs. Currently, all the HA"s do is vitals, and turns. Now they're just going to do turning patients every 2 hours. The RN will have to do the every 4 hour (or more frequently if needed) vital signs, the AC/HS blood sugars, the EKG's....

The goal of this, of course, is to get to a point where managment can say "you know, why are we hiring HA's and paying them $17 an hour to do q 2 hour turns? We should just get rid of those HA's. The nurses seem to manage fine without them."

So, down the road, they are going to eliminate the HA's, like they did with the CNA's, and the LPN's (what archaic notions..LPN...where do they even work these days? Not the hospitals).

The hospital I work for is already talking about getting rid of the transporters...they are HA's or CNA"s that transport the patients from the ER to the floors, from the floor to Xray, etc.

So who is going to transport the patients?

The nurse. the nurse will transport the patients from here to there.

At the same time s/he has 5+ other patients.

So who will watch those patients while the RN does the transporting?

ANOTHER nurse, who has their own group of 5+ patients.

So you'll have a nurse who is watching 10+ patients for an indeterminate amount of time. S/he will be responsible for all the vitals, the medications, the general wellbeing of those patients while the other RN is away.

It's madness.

it's unsafe.

And yet we continue to work through it. Work in it.

not because of, in spite of.

Already they are short-staffing the HA's and MA's.There aren't enough to go around. So people don't get turned (uh oh! Medicare doesn't pay for pressure ulcers that develop in the hospital). So people fall out of bed (whoops! Sorry aunt mary got a broken hip, we didn't have anyone to answer her call light). People piss and shit on themselves and sit in it for hours. Call lights go unanswered....

And upon each discharge, we give patients a "Patient Satisfaction Survey"...how were we at answering the call light, at answering your questions, at treating you like a person?

Options range from "excellent" to "poor". We only get credit if the answer is 'Excellent'. Not "most of the time" or "pretty good". Only EXCELLENT counts. Everything else = poor (why they don't just give the patients the option of "Excellent" and "Poor", I'll never know)

So of course customers, er, patient satisfaction is waaaaaaaay down. Like in the 40-50% area

who gets the blame?

CEO's, for cutting the budget (but not their salaries)?
Management, for not hiring or replacing missing workers?
Decision Makers for slowly chipping away the tasks that can be performed by each group?

no

The nurses get the blame. We need to be faster, quicker, more polite, more on top of it.

We need to have more arms than Shiva

We need to shape shift and be a CNA, a babysitter, a councelor, a nurse, a doctor, a pharmacist.

We need to be able to be in 7 rooms at once, passing meds, giving CPR, calling report, tucking someone in, and helping someone to the bathroom all at the same time.

We need to work 13 hours a day without peeing, without eating, without sitting.

It's all our fault. We are just imperfect. The lack of "excellent" votes by patients means that we are too idle. That we are undedicated. That we don't care.

~~~~~~~~

Idle behaviour is the bane of management.

Don't ever let them see you sitting. Even if you're charting. Even if you're looking up labs. You can't sit. And you can't talk to co-workers. God forbid they catch you on a break. Even if you're allowed to have one. Even if they told you to take one. You can't do it. They give you that look. The gasface. The i'm going to make a mental note of this "break taking" for your next review, missy. I'm going to make a mental note of this for sure.

And you're so exhausted, but you have to tough through it. You can't sit, you can't eat. You can't have drinks at the nurses station (JHACO SAYS NO!) So we're dehydrated, full of pee, needing to eat, but we can't. Our legs ache and our backs scream out. But we have to plow through it, and work harder, and longer, and 3 of your co-workers called out this morining, and you know you can't leave your team like that, so you stay for 16 hours. And you still get the gasface when you try to take a break. Or sit down.

~~~~~

Why do we do it?

I don't know. But we do. And if we didn't, there would be more of a health care crisis in the US than there is now. And there's a big one now.

Remind me one day to tell you about 8 hour waits in the waiting room, and 45 people in the waiting room, and ambulances lined up in the bay, and people in the hallway on ventilators, and taking care of 8 critically ill patients at a time...

First post

So it's a warm Saturday (which is odd because this seems to be the city that spring, and summer, forgot).

It's 4:50, which means only about an hour and a half before I head to that awful place where I spend 36 hours a week.

I'm a nurse. RN, to be exact. Have been for several years. Working in the ER of a large, busy, inner-city, level 1 trauma center. We get burns, psych, drug OD's...anything that walks through the door we will accept with open arms.


This is a blog about the realities of nursing, and patienting, as I see them. I see and hear and do a lot of shit. I've seen really great things happen, and really awful things happen. And I like talking about the things that I see, and that I hear, and that I do. I hope you like reading about them.

So it's a warm saturday afternoon. A neighborhood block party is going on, so undoubtedly we will see tons of drunkards, and OD's and other forms of inebriation. I swear, I would have died and had no street cred (well, the little that I had anyways) had I been taken to the ER for "drunkenness" in my youth. Blah! What pussies! Always 14 and 18 and 22 year olds, can't handle the hooch, come in spitting and ranting, so we dope them up and make them sober up, sleep it off and piss on themselves for 8 hours. Great time to be had by all. A great use of federal and state funds, by the way...

Or oh! It's Saturday night which is perfect for getting shitfaced and getting behind the wheel of a car and plowing into 2 other autos whilst going the wrong way down the interstate. Enter outraged family of DUI'er who threaten to sue you each time you mention that their dear lovely little lovey was shitfaced and driving, which are 2 things that should never go together.

Gotta love families.

Or the people who come in for toenail pain, and get frothy because they have to wait in the waiting room for 8 hours. And they have all 18 of their kids with them, rolling on the floor, digging through trash cans. I'm not a babysitter. I really don't give a shit if your kid gets a needle stick from digging through garbage. Yeah, heartless? Probably. But I got other shit to do, like keep people alive when their bodies have other ideas. Like keep an eye on the med students & residents who do things like write orders for a heparin drip for someone with a GI bleed (BUT THEY HAVE AFIB!! yes, and your point would be...??) . Oh and fielding the at least once a week question of "but can't you just IV push the potassium?" No. I can't. You can, though :evilgrin:

So off to work it is in an hour and a half.

If I'm your nurse, you're probably having the worst day of your life.