stinks in here...

News this week. One of the hospitals within the system is closing. The leadership originally announced the ed services were ending, but i guess the full release also included stopping all inpatient services. They were gracious enough to give 90 days notice. The evil, sneaky, money-grubbing, dirty bastards!

the bigger they are...

It is in the air. Rumors are all around. The hospital leadership are up to something and the popular feeling is the doors are going to close.

Closing the hospital will not me overnight. No, this will be a slow death and promises to cause much damage to all of those who made the hospital a mainstay within the community. The writing has been on the wall for some time. Units closing, first they say it is only temporary and later we are told it is permanent. The hiring freezes in effect and certain key hospital leaders fleeing for positions with competing health systems. The rats jumping ship is always a tale tell sign that something is up.

The evil part is they know the truth and manage to take care on their needs before the rest of the employees are crushed by the impending news.

The leadership has been having these town hall meetings over the past few months to help outline the future plans of the hospital and the system as well as to alleviate fears of the employees. The thing is everything they have promised and said they later did the exact opposite.

The latest rumor is July 1st some big changes will take effect - we will have to wait to see exactly what the news will be, but we know it will not be good!

cluster..

I was called into work yesterday after being down staffed. It was one of those days where they needed a nurse immediately, because they had a "situation". So, I needed some hours and I sad yes and got my tail to work.

I walked into a shit storm that took the entire day to correct. One patient was to be discharged once he was seen by the diabetic educator. However, the educator discovered the patient could not afford any of his medications. So that left little ole me to track down case managers and social workers to help resolve the situation.

I kept thinking that all this should have been discovered much earlier and isn't that the responsibility of the case manager to initiate discharge planning from the get go. Why are we dealing with the issue right as discharge? And more importantly, why am I caught in the middle?

The whole process took over 6 hours and was a major cluster to deal with and he was my easy patient. The other one was being whisked to surgery as I walked in the door. The nurse gave a quick frantic report and she was out the door. She had some family drama going on and her head was not in the game.

Minutes after the one patient left for the OR I get this call from some bitch of a nurse in the OR holding. "Why did this patient come without a nurse?" I was a little thrown - "what there are not any nurses in the holding area?" Yea, poking fun at mean bitchy nurses never ends well. She went on to complain that the patient was sent on cardizem without a monitor or a nurse. I explained that I literally walked in the door and peeked at the patient while the other nurse was getting her out the door.

Later the manager of the unit comes to me with the list of complaints that included the patient was naked (covered with sheets/blankets only), the sheets were blood soaked, and the patient was on a cardizem drip. I explained to the manager that it was the other nurse who stated the monitor was not needed that the cardizem was to prevent vasospasms and not cardiac related, the patient had been hot and requested not to have a gown and her fashiotomy was the reason for the bleeding - DUH!!

When the patient came back she told me stories of the angry nurses back there. She made me laugh when she said, "those hens need to get laid and maybe they would stop being bitches." She was a great patient and she had gone through three procedures within three days and could still crack jokes and roll with the punches.

do over??!!

Sometimes people as me, "do you like being a nurse?" Depending on the day they ask my answer changes. I usually give a pat response of , "sometimes." I mean the job has its good days and its bad days and there is always a hint of resentment when it comes to the path I have taken.

I did not set out to be a nurse. I mean seriously, how many little boys grow up with the dream of being a nurse. I was the kid who thought about being a physician. I had the grades, smashed the SAT, but it was the funds that get me in the end. I could not afford college. I could not qualify for financial aid because my parents made WAY too much money and did not feel it would build character to pay for my college. However, they paid every cent of my older sister's tuition.

So, I paid for community college where I would go and then drop and a year or two later go again. Eventually I did earn an ADN and thought I was done. Later in my career I got the bug to return to school and now I cannot seem to stop. I finished my BSN and then decided I wanted a graduate degree and then a second one and now - oh I don't even want to go into what I am neck deep in at the moment.

But still, if I had it to do over again I would never have selected nursing. If I could magically go back in time and start again I think I would do something totally different. Architect sounds fascinating and I love houses and buildings, the design to possibility to use my creative side. Sounds like a dream job. Plus, it requires no ass wiping!

Another job I would have considered is one as a pharmacist. I loved all things science and I was a chemistry geek! I actually took additional chemistry classes as electives. Microbiology was also one of my favorites and could see myself on the side of research in a non-patient care role.

Alas, it is too late for me to start over. That is part of the reason I question others about their desire to become a nurse. I am usually blunt and give a good argument for selecting a different career path. I admit, I took the easy way out. A job I could work soon with little training. Little did I know the utter piles of shit that went along with the choice. However, it is my fault and mine alone for the path I have chosen and I am determined to make the best of it.

My overall goal is to teach at a university level and sprinkle my teaching with a healthy dose of reality. My instructors always painted a rosy picture of nursing - in short they lied! I have taught in a community college setting and found those evil children are uncontrollable and that is why a university setting is my goal.

I would love to update the college's nursing brochure to better reflect what the hell these kids are getting into. The typical brochure shows all these smiling faces and clean compliant patients. Yea! Right! Where are the restrained poo throwers? Where is the family who threatens to lawyer up? Where is the unreasonable physician who demands you walk the 500 lb pt in the halls QID? The fighting with pharmacy because the stat med you requested 5 hours still has not arrived? None of that is anywhere on the nursing brochure - trust me I have looked!

made me smile...

up in the air...

What to do..what to do..I decided when I returned to Pittsburgh that I would stay put through the spring & summer. I wanted to see as many baseball games and plays as I could shove into one season. I was unburdened with classes and freaky schedules and most importantly the second home sold and now I was down to just one mortgage payment. The better part of this year was to be vacation like before making the big move.

The employment has thrown me a curve ball and I need to know what to do. I am being down staffed at an alarming rate and this is taking a big hit on my finances and I cannot continue to do this. However, I am waiting for results to have a better understanding of my own timetable.

June is the magic time where word comes on what the future holds and it will produce one of two scenarios. In the first, I leave out of Pittsburgh in October and in the second option it would have me starting my new career in March. If March is the case then I seek out a travel gig until the big change takes place.

There is always a very slight chance I will start before October and that is the reason I sit and wait and hope the news comes sooner than later. Plus, I have a significant financial investment in baseball and theater tickets. I purchased a season ticket package for the Pirates and I recently purchased Phantom tickets - so to leave early I would lose some of the money I have spent on the tickets. I am sure I could sell them all, but I would most likely not get all the money back.

Just a few week.....and the planning will begin.

no cure for a dying hospital...

"The writing is on the wall."

"It has never been this bad."

"It is only a matter of time."

The mood in the hospital is somber and the feeling among the long time employees is that the end is in sight. The census has been spiraling downward for months now and people are losing shifts each and every week.

The facility has been in the area for over 100 years and maintains a long history in Pittsburgh, but the health care landscape has changed over the last decade and to maintain profitable the health care system has made the difficult decisions.

Mergers and cutting of services along with reorganization has taken the teeth from the hospital and now all the acute care services are being moved to the flagship hospital. What will happen to this hospital? The leadership state that there is a plan. OB services have been moved here, but that is all and final decisions have not been made.

The long term employees feel it is only a matter of time until the facility closes its doors for good. The signs do not look good as some of the hospital leadership are leaving like rats jumping from a sinking ship. The nursing VP was the latest to scurry away. So now everyone is starting to get a little antsy.

Units within the hospital are closing and not reopening. A hiring freeze is in effect and remodeling plans have been stopped. Forget about new equipment and the word down staffing is used daily. The place smells like death and for once it is not coming from the patients..

They say a star burns brightest just before it explodes, but a failing hospital just limps and staggers until somewhere a group of suits decide to shoot it. Sending the employees out without a second thought.

Welcome to the new world of health care.

jebus love me this I know...

Sweet baby jebus has smiled upon me today. He has allowed me to be cancelled for the entire day. Believe me it was a much needed day off! I know I will feel this when payday rolls around, but my body is way thankful at the moment.

I could not sleep very well last night and when I checked my message this morning to find out I was cancelled for the first four hours, my heart jumped for joy (not literally). In the cheap ass facility where I work they insist on cancelling you for four hours at a time (insert resentful look here). So basically I am not pain, but expected to remain on call the entire day.

So with the additional four hours this morning I decided to strap on my New Balance and Ipod and go for a run. My thinking was that if I got the blood pumping it would wake me up in case I was called into work later. I ran a pathetic 3 miles, but I did find a good steady pace around mile one. However, I remained slug like when I came home.

The second call came and informed me I was cancelled for 4 additional hours - so I called in and told them to shelf me for the day. They promised to try. Thankfully, it was to be and I finally was able to grab a quick nap. Now I feel the balance returning to my body. The bags under my eyes are a little less noticeable and I think with a day of lounging in bed with the dogs I will be refreshed and ready to return to work tomorrow!

Victory Is Mine!!!

I located the chirping smoke detector and ripped the 9 volt battery from its casing - oh sweet silence!!!

chirp that..

I woke before the alarm this morning. Partly due to dreading the fact that I have to work today and partly because one of the smoke alarms is making that damn chirping sound. It seems that when the battery gets low the thing chirps every 15 seconds. The part that drives me fucking batty is that I cannot easily identify which detector is the guilty member.

I sit in bed and hear the fucking chirp ever 15 seconds, but when I go downstairs to the detector I suspect of being the one with the low battery - not a peep. I stood beside the damn thing for 15 minutes and not a sound. I come back upstairs and within seconds - chirp! I am minutes away from taking a bat and bashing every smoke detector in the house (there are 5).

The thing is that beeps, chirps and any type of alarm drives me freakin crazy! It is one of those things that gets under my skin and makes me nuts. I worked at one hospital that had IV pumps that would beep as you were changing fluids. The damn thing would beep faster and louder the longer it was not addresses. I swear I came close to throwing a few down the stairwell and had I stayed there for an additional assignment, a few of them would not have made it out.

I can understand the need for an alarm, but come on!! The alarm of the monitor for high/low BP reading can me silenced/acknowledged but continues to alarm until you change the parameters. It is not enough to simply acknowledge it!! Drives me crazy - so the option is to remove the module or make the parameters so outrageous that is does no good to monitor.

Once I had a PRN gig at a local LTACH and it was a horrible job!! This whack-a-doodle place had a respiratory therapist manager who had input in the staffing of nurses. I know - that is out there. Anyway, he thought it would be a good idea to have the call bell monitor reset so that nurses could not acknowledge the alarm. If you acknowledge the you have a few minutes of relief from the ringing until you finish what you are doing and turn off the bell at the bedside. But no! Dunder-fuck thought by acknowledging the alarm nurses were ignoring the patient - like the fat bastard had a clue! So, the bells kept ringing - nonstop! Forget taking phone orders or answering calls from families. Instead everyone avoided the nurses station and physicians complained about the damn noise.

I ended up leaving that messed up place. In part because of the less than qualified staff and because I was offended that a respiratory therapist with a sad little associate degree had any input to patient care outside his scope. I like order and I like when organizations position responsibility according to education and practice level...

soon ...but not soon enough

I hate my job! I really hate it, but I am attempting to stay put until the end of the summer. I have big plans - huge - when the fall arrives and all I need to do in remain calm and endure until then. It is very difficult at times and there are those days where I want to say, "fuck it" and head for the door. That is when I need to take a moment and remind myself that I have a goal and I need to manage frustration and think of the end results.

My way of thinking for my current position is different than anything I have done before. I am working as a staff position and in doing so I punch in, go where they tell me and punch out. I have zero desire to go the extra mile, do any favors of get conned into helping the facility out. The facility can kiss my ass. I agreed to work specific shifts and my responsibility ends there.

This past week someone suggested I join a committee and attempt to ladder. I actually laughed at that. I explained that I have no intention of doing either. My comments garnered a look of both shock and surprise. I was not going to explain my plans called for me to move in a few months and felt it was none of their business.

I get the calls that beg for help when a certain unit is short, but I never call back. I get dumped on enough without volunteering for more. I stay put!

The happiest day in my life will be walking out of that horrible facility for the final time. That single thought is the only thing that drives me on the really dark days and each day I inch a little closer to the dream.

the casualties of war

The bastards sent me to work on a med/surg floor. A place most nurses care not to go. A place where the decor and equipment has been neglected for some twenty years. The rest of the facility has been updated with new flooring, nurses stations and equipment - but not in the land of med/surg!

In this evil unit the thermometers are secured to the wall, if they are even there at all. They own exactly one dynamap and the fat aids keep it hidden and protected. Even if you do find it and pry it from the fat greasy hands of the tech - it still does not work. BP cuffs are in the rooms (most rooms), but they are old and many have rot on the rubber tubing which makes them no so reliable. Some of the charting is done by computer, but half of the computers are broken and there are so few that work it becomes difficult to gain access as residents, case managers and other staff also need to use the computers.

The patients are usually not that bad, but it gets old apologizing for not having items. Yesterday, I apologized for not having tops to water pitchers, non-skid footies, pillows, pillow cases, straws, any type of food or juice, a working phone for the room, a working call bell, a working television for the room and toilet paper. It is like working in a war zone or a third world country.

I feel for the nurses who work there every day and have grown accustomed to those conditions. I can honestly say that when my time here in this facility is done - I will NEVER work a med/surg floor again!!

there is the door...

I get a call during my shift. It is the wife of Mr X. She explains that he just phoned her all in a tizzy and demanded that she come to the hospital and pick him up now. Shocked at hearing this second hand I explained to Mrs X that the patient has not been discharged and no plans were in the works today for that to happen.

Enter the room and speak to Mr X who begins to throw a huge tantrum explaining how he has not slept in six days and that he must leave the hospital today and nothing I say or do can change his stance.

Along comes the pulmonary doc (to my delight) who gets the joy of seeing a 50 year old acting like a full blown baby. The physician attempts to reason with the patient with no luck. And then it happened. This 50 year old grown man held his breath attempting to make himself pass out. The pulmonary guy looks at me and states, "is he for real?" At this point I am attempting not to laugh, but with little success.

Now that Mr X understands his ploy will not work he goes for plan B which involves throwing things around in his room, cursing and being a royal baby! The physician turns to me and says, "good luck with this" and he leaves.

So, I am on the phone with the surgeon and give him a rundown of the events so far (there is much more that I will not mention here). The surgeon is not amused with the behavior of Mr X and states he can leave AMA and the surgeon will not schedule a follow up with any patient who behaves in such a manner.

A few Xanax and some blunt conversation seems to calm down Mr X ( for the moment) then the phone rings again. Mrs X received another call from the patient and this time he threatens her with divorce if she does not pick him up. In a very flip moment I respond, "no big loss there" she actually manages to laugh, but goes on to explain under no circumstance will she come in to pick him up.

We manage to keep the patient the rest of the shift and endure the occasional childish outburst. When I give report I am elated to be leaving and the oncoming nurse has the look of dread in what will be a very trying 12 hours for her.

If it had been up to me i would have told the fat ass to leave and never come back, but I must bite my tongue and deal with irritating fat non-compliant patient who on this day cause me to hate my job!

the horror...

I went to see the movie Iron Man 2. I know, after seeing Iron Man I should have known better. But for my defense I was caught up in all the hype and slick previews. i am a sucker for a flashy trailer and hypes up sound track. i cannot help it!

The movie as a whole was very forgettable. One exception! Wait, one enormous exception! Gweneth Paltrow sucked up any faint hint of life from this movie. If there an actor/actress in this universe who is worse than the Paltrow? How on Earth does she get work? I know the old saggy whore won an Oscar - I am still gobsmacked over that one, but then again they did award the Pulitzer to Obama.

I am making a solemn pledge at this very moment to never ever ever see any movie that has anything to do with the awful Paltrow. As God as my witness I will never suffer through her horrid acting again...

rush and dose

It is late in the shift and the charge yells out that I am getting a patient from the OR. She says it is a belly of Dr Boran and those are always messy.

I wait patiently for report, but here it is 1820 and not a peep. Ten minutes later I am on the phone with Mona and she tells me patient is on the way and the vent settings are tidal volume 600 and rate of 12 and then 'click'. I am like - WTF!!!?? That is all the report I get?

Six minutes later the gang comes rambling in. The other SICU nurses rush in to help set up the patient as I get a partial report from the anesthesiologist. Patient was a train wreck and they don't expect him to survive. He is 82 years old and just had a whipple by the most incompetent surgeon in the hospital (but you didn't hear that from me).

During the report of what the patient was given and what his vitals have been the anesthesiologist says:

Anes: Yea, he is gonna need something for pain and maybe a touch of sedation.

Me: I have the propofol ready to go.

Anes: ok, and for pain lets give him well. How bout you give him what any prudent nurse would deem fit and I will back you up.

Me: But what if I am not prudent?

Anes: You know what I mean, whatever you deem best.

I had to laugh a little bit, because usually physicians are more than ready to give you very specific instructions on narcotics - especially anesthesiologists. He must have been new.

P.S. Dr Boran - not his real name......

loaded up the truck and moved to Beverly..

R1: Mr Evans, what brings you to the hospital today?

Mr E: Don't go calling me Mr Evans, my name is Eddie and this is my wife Pearl. Pearl and I have been married for 32 years.

R1: Ok Eddie, why did you feel that you needed to come to the hospital today?

Pearl: He won't breath too good for along 'bout two weeks.

R1: You have been having trouble breathing?

Pearl: That what I said!

Eddie: Yup, thats wat happened.

R1: Why didn't you come in sooner, when the shortness of breath first presented?

Pearl: Eddie ain't one for runnin to no doctor for a runny nose or nothin!

Eddie: I figured I was just smokin' a little too much!

R1: How much do you smoke per day?

Eddie: As much as I got! (he he he he)

Pearl: He goes through 'bout 3 to 5 packs of smokes per day. he would smoke more if I don't hide mine from him!

R1: Eddie, it might be a good time to think about putting the cigarettes down for good. It would certainly help your breathing.

Pearl: Hell no! We won't quit smokin' for nothin!

Eddie: We love to smoke!

R1: Okay, do you take any medications, over the counter?

Pearl: We purty healthy and don't need no medications.

R1: Any street drugs?

Pearl & Eddie: Huh?

R1: Marijuana, cocaine, heroin, etc..

Eddie: Oh yea! We done some coke in the past but it got too hard to afford. Weed we smoke all the time.

Pearl: We LOVE our smokin' dont make no difference what it is we smoke it.

R1: Eddie, how often do you smoke marijuana?

Eddie: 'bout 4-5 times a day!

R1: You understand that your breathing will get easier if you quit smoking. The best advise I can give you is to strongly recommend you and your wife quit smoking or your breathing problems will never improve.

Pearl: WE AINT NEVER QUITTIN!!!!

Eddie: I guess I will die smokin'.

R1: Okay..

**** People from West Virginia are so colorful ****

ow ow and oh yea ow!

I am sore in places I never knew I could be sore and I hope to recover soon. Following my weight gain panic I went a little overboard on the whole working out thing. I have been running, lifting, doing push ups til I ache and crunches until I want to vomit. I am doing all I can to get back to where I want to be. Now I am also paying the price.

Lets see, my calves ache, by abs (hidden under the adipose layers) hurt, my arms feel contracted and I do not even want to talk about my inner thighs--ouch! I popped ibuprofen and stretched but the soreness is full on.

I have decided to take a day off between workouts, in attempts to recover. I am obsessed with the damn scale - weighing myself at least three times a day. However, it has been kinder since I am watching everything I eat and counting loosely my calories.

Today, I ran four miles and I am not doing anything else the rest of the day. In fact, I am heading out a little later to enjoy a few adult beverages with a friend as a reward for all my hard work!

Tomorrow, I will go all out again..