code blog: tales of a nurse

... but didn't:

Travelers getting requested cancellations are almost unheard of. I know that has not been the case since you joined us, but take it from me - these are usually very rare occurrences.

I did not make you join this staff as a traveler and thus inherit all of the injustices that the position comes with. If I remember correctly, though, you are very well compensated.

I did not make the policy which dictates that regular staff get cancellations before you do. I just have to follow it.

It does not matter that you asked for the cancellation before everyone else. The only thing that matters is the numbers.

Having said that, it was not I that requested and received enough cancellations to put your numbers higher than the other traveler's numbers. That was all you.

Was it an extra kick in the pants to have to take that traveler's patients so she could go home early instead of you? Why yes. Yes it was. Serendipitous even.

Being in charge is sometimes a real pain in the ass. How unfortunate that the irritation this time had to come from a professional colleague.

Kim at Emergiblog has the latest Change of Shift up. CoS has officially started its third year. Kim has done a fantastic job as this Carnival's mama :-)

Not to be confused with "Change of Shift," for which you should head over to Emergiblog to get info on how to submit your entry for the next edition! It's quite easy - all Kim wants is your very first post!

We were recently on vacation and on our way to returning the rental car, we stopped to fill it with gas. I thought I'd go in and get the boy some pretzels to munch on until we could get him some real food. I picked out a bag and went up to the counter to pay for them. The clerk informed me that they were doing "shift change" and that I'd have to wait if I planned on buying that bag of pretzels.

Seriously? I have never been in that situation before. I was quite surprised. My face must have shown it, because she said that she'd allow me to have the bag if I provided exact change.

In the hospital, we have shift change at least every 8 hours. Our shifts are so varied, though, that it's possible to have nurses coming and going every 4 hours. We even had shift change at 3am at times until that shift was eliminated. The biggest shift change is undoubtedly at 7am, the next at 3pm and the next at 11pm. We have a rule that there is to be no family in the unit while shift change is occuring, and we aren't too keen on taking phone calls from family members either. For the former, patient privacy is the main concern. We talk to each other at the desk, but the desk is really out there in the open and anyone standing around can hear private information. For the latter, it is a courtesy to the nurses. The off-going nurse wants to give report and go home. The oncoming nurse wants to get report and start her shift. Constant phone calls that interrupt this just prolongs report and so we encourage people not to call for updates during these times.

I don't find this unreasonable. Most other people don't either. There's rarely anyone around or calling at 7am, but the 3pm shift change is another story. There are usually lots of visitors and phone calls during that time. Most people understand, but there are a few that get angry at being told they have to wait until report is over.

I gotta tell you though. Shift change at a gas station was a new one for me.

Maybe you won't be after reading this.

Like the title says, this post has nothing to do with nursing. Or medicine.

Ok then! I just read this on Yahoo! news:

"His father, Yosef Cavalin, frets about the piano-playing, noting that his only child recently broke his arm pursuing another passion, martial arts. He has won several trophies for his age group.

"Finals are coming and everything and he cannot play with both hands. He'll just try to play with the right hand," he says. "I don't know how his grade's going to be in piano. It worries me a bit."

Um. Your kid, who 10 and is excelling in college level science courses, broke his arm while winning trophies in karate. And you're worried about his piano grade? I can confidently say that no one is going to take the kid to task over a B in piano that he earned while playing one handed. I'm just saying.

And secondly, I have a plea. Go read this. I have thus far managed to snag some on Ebay here and there, but it's not even available there anymore and I'm down to the last bottle. (If you keep it in the fridge, it keeps it from going icky.) It is truly unobtainable. So now I guess I have to switch to something else. Any ideas? It has to be leave-in. And it has to smell delightful. :)

Hmm... I guess I will tack on something nursing-related (kind of) seeing as how it just happened about 90 seconds ago. I started a business a couple of months ago and it doesn't even matter what that is - what matters is that I haven't sold a thing, have not brought in one penny. (I'm not ready yet! But that is besides the point.) Just now I received a call from some Congressman (well, his "aide") who is proud of my business accomplishments and would like a business leader like me to get some sort of Congressional merit honor badge club ring and go to Washington to represent business leaders, blah blah.

I have been a bedside nurse for over 10 years. I have seen and done some incredible things. I have helped fellow humans through some truly horrible illnesses and have been there for them. I have been hit at, hit on, spit on, kicked at, thanked, hugged, and I've even had a couple of thank you letters to the hospital with my name mentioned. I have been a business owner for 40 days and have not yet managed to actually do any business. Yet this is what they want to send me to Washington for. This country is MESSED UP.

This weekend we had a patient who had come in with chest pain. He was taken to the cath lab and was stented.

Normally this kind of patient would go home in a day or two if there were no complications. Unfortunately this patient had a big complication - he was an alcoholic. So by the time he was ready for discharge for his heart problem, his alcohol withdrawal had kicked in.

He is now on day 5 of his stay at the hospital. He spent at least 4 of those days in ICU which costs many thousands of dollars a day. He was still there Sunday afternoon when I left, and still on his Ativan drip. He was nowhere near getting transferred out to the floor.

I'll cheerfully bet you $100 that even after all of the hell his body went through detoxifying from alcohol, he will get some good 'ol ETOH from somewhere within an hour of leaving the hospital. You see, when he started getting goofy from DT's, we started drugging him. Probably with some oral Valium at first, then when that didn't work, we hit him with some continuous intravenous Ativan. Once the worst of the DT's passes, we wean him off IV Ativan back onto oral Valium. When he's stable on that, he gets discharged. I admit that I don't know exactly how that works, because we just transfer them to the floors. Does he get sent home? Does he go to some alcohol treatment center? I have no idea.

I do know that some of our detox patients are in ICU because they have presented to the ER for whatever reason and request to be detoxed. They've had enough; they want off the sauce. Even the relapse rate for this is high; I often see the same patients come back over and over again. And those patients want to detox.

But when alcoholics come in for other health problems, they are detoxed whether they want to be or not. It's for staff and patient safety, you know. People going through DT's can be very combative and can be dangerous to themselves and others. So if they don't get out of the hospital before the shakes hit, they automatically buy themselves a week's stay... or longer.

This practice is downright counterproductive. If the patient comes in with a health problem, they should be assessed (as they currently are) for their alcohol intake. If it seems that the patient is an alcoholic, they should be counseled about it ("you should really stop drinking, you know") and then be allowed to make their own decision. If they choose to keep drinking, they should be allowed to drink in the hospital. I know there are all kinds of possible ramifications to this idea, and I'm not talking about letting patients get sloshed. But if a beer or three a day will keep the DT's at bay, then they get a shorter hospital stay. Which would taxpayers rather pay for? A case of beer or a $40,000 hospital bill?

Obviously it would not be a good idea for everyone, but I believe that it would be very helpful for some. I can't tell you how many patients I've seen who come in for some minor surgery (appendectomy, chole, etc) and end up with all kinds of complications because we decide that they need IV Ativan more than they need a glass of wine or three at dinner.

They're adults. It is utterly ridiculous how we healthcare providers think we should fix every little thing about a patient when all they need is a stent and a bus ticket back home.