5 West Nursing

If you’re a nurse, I’m sure you’ve seen one of these… you know, those things that seem to jump out of nowhere when you’re not looking while you make your way down the hall. They’re also known as WALLaroos.  (Little did I know that a wallroo  is actually an animal a little smaller than a kangaroo and a little larger than a wallaby.)

Well, the WALLaroos at our hospital litterally jump out of sight. I came in the other day and all you find are four patched holes on the wall, a tell tale sign that marked where they once were. When I asked a colleague what happened, he told us an interesting story…

As the day progressed, the relative quiet was broken by a crashing sound coming from down the hall. Upon doing a quick survey of the area, they found a doctor, someone well known in our hospital, on the floor, unconscious, with a WALLaroo beside him. He was apparently making rounds and was writing his progress notes on one of those things when he leaned forward and ripped it off the wall, hitting him on the head and knocking him unconscious, according to witnesses. Frantically 5 women nurses rushed to his aide, all of them probably hoping to give him CPR my colleague said. He was then taken to the ER for further evaluation and treatment. I guess in an effort to please the doctor, the hospital took all the WALLaroos out the following day. I wonder if they’d do the same if it happened to a nurse. I’m sure they would, but then again nurses are liabilities, doctors are assets, and therefore, they could care less about the nurse.

I’m just glad these occupational hazards are out of service. I know a few nurses that have been sent to the ER for sustaining minor injuries because of these things, especially when left half closed. It’s just sad that it had to take a “high profile” doctor to get hurt before the hospital decides that WALLaroos have to go. But then again, thanks to this doctor’s sacrifice, the rest of us wouldn’t have to. Way to go doctor… way to go!

“Stupid is as stupid does.” – Forrest Gump

I never knew what that meant. Some attempt to explain it as “the quality of your substance”, or that you shouldn’t judge the book by its cover but by its content. I guess you can say, “if it looks like a duck, smells like a duck, and quacks like a duck, it must be a duck!” Philosophy aside, we experienced what stupid did one night.

We got an admission from the ER at 0600, one hour before the end of the shift. The admitting nurse stumbled upon a vague order as she was getting report from the ER nurse. Here’s what the order read:

“Give small dose of Lopressor and repeat EKG when heart rate is slower”

Surprisingly, this order was carried out by the ER nurse claiming that it was the previous shift who wrote it. On top of this, the patient did get a dose of Lopressor (documented on the MAR) despite the fact that the order did not specify what “small dose” meant or defined the meaning of  ”slower heart rate”. Eventually it was written up as a medication error. I’m sure you’ll agree that the ER nurse should have clarified the order.

What can I say? I guess sometimes we just have to get back to the basics and use common sense. In this case, I think I know what Forest Gump was saying about stupid. It’s a good thing that in our ICU…

“Nursing is as nursing does!”

“Change we can believe in!”… that’s what some leaders in Congress are saying as the new $700+ billion stimulus package passed and is on its way to Pres Obama’s desk. Speaker Pelosi praised Obama for acting faster than anyone else to help jump start the economy with this huge spending bill. Way to go Congress… we just dug ourselves into a bigger hole! On the other hand, isn’t it comforting to know that this bill has a 50/50 chance that it might work? If it does, then Obama’s the hero. If it doesn’t, then he can kiss the next 4 years goodbye! What a gamble… I give him props thought. I believe this was a very gutsy move.

After all the usual partisan bickering, Pres Obama calling the delay “inexcusable and irresponsible“, Republicans opposing the bill because of too much “pork”, it’s finally here. Interestingly enough, nobody truly knows what’s in the bill. Incidentally, I received a reader comment on a portion of the bill that touches on healthcare which I found interesting. Here’s the link thanks to Michele.

Speaking of “pork”, have you heard some of the things that were included in the bill? Most of them sound like only a few people will benefit from it… mostly the “rich”, some business owners, and those special interest groups. One of my friends told me that this stimulus bill isn’t an economic stimulus bill at all. With all the “pork” infused in it, this bill sounds more like payback for those who “supported” Obama financially and helped him get into the White House. No wonder they wanted to get this thing passed ASAP! Well what can I say… let’s brace ourselves and hope for the best. What’s the worse thing that can happen at this point? Time will only tell!

I’m sure you’ve seen it all over the news. Congress has been working on a new economic stimulus package that’s going to cost us close to a trillion dollars, a bill which most Obama administration critics call is the end of capitalism and the dawn of European socialism in the United States. I didn’t think that this was going to happen, however, it would seem like we are headed in that direction thanks to the influencial president, er, speaker of the house Nancy Pelosi. Sometimes it makes me wonder who is behind this bill because president Obama is so far removed, it seems like Pelosi is the one that sits in the oval office. I guess that’s what we get for electing a president who spent more time campaigning than actually getting things done in the senate. Regardless, there is no doubt that president Obama is off to a rocky start… yup, blame it on Bush… that’s if you’re a pinhead. (It’s OK, you’re not the only pinhead around! ) Remember, power in numbers!

Talking points aside, I decided to be part of the solution. Instead of having this “I’m entitled to a handout because I’m a victim” mentality I have actually used my noodles to cook up an economic recovery/stimulus package that will solve most of the issues that plague America today. Ready for it? Here it comes…

I present you the 5 Wester Economic Recovery Package!

What is it? It’s a person on a stationary bike, pedaling away to power up the generator which provides a current to charge the massive 110 volt battery which stores energy, which will eventually make its way to electric distribution centers, which will power our homes! Brilliant, ain’t it?!

How will it solve our current economic crisis? Here’s how…

1) Helps create jobs and keep them in America – it will help create millions of jobs (sky’s the limit), and best of all, it cannot be outsourced! Imagine a few thousand of these units that make up the new power plants of America? In the last few weeks we’ve seen companies slash thousands of jobs, one company, 4000, another 6000, yet another 20000 jobs. With the above setup, there is no excuse that able bodied people will be unemployed.

2) Good for the environment – now we can have really “clean” energy production and decrease our dependence on foreign oil. The only waste created is metabolic waste (you know #2), which is environmentally friendly and biodegradable! You don’t have to worry about global warming on this one.

3) Positive health benefits - not only will it help create jobs, keep them in America, and decrease our dependence on foreign oil for energy, it also has positive health benefits which will lower the cost of healthcare. Now burning calories not only benefit the individual, but the whole community as well. It’s a win-win, what can I say?!

4) Applicable to other industries as well – the future of the automobile is not flying cars or alternative fuel hybrids. No sir! The Flintstones already figured this out!

And there you have it, the 5 Wester Economic Recovery Package!

It is so ridiculously simple and radically brilliant, it will never happen in America. I guess well just have to wait for the government to figure this out. In the meantime thousands more will lose their jobs. Oh well, what can I say?

Hmmm… I wonder if I can sell this idea to China. Just kidding!

I came on my shift and my co-worker was having tough day. The shift haven’t even started for the both of us and he was already busy trying to coordinate a rapid intubation for one of his patients. It’s a good thing we had a CRNA at the bedside who just happened to bring a patient in from recovery. Long story short, we did it just in time.

As they were making phone calls to the appropriate MDs, my co-worker makes a startling discovery. The patient was on an Ativan drip at 25ml/hr, with a 1:1 concentration, he was getting 25mg of Ativan per hour since 1600! Ironically, the pulmononologist on consult for vent management ordered Ativan drip to sedate while on the vent. No wonder the patient’s mentation was steadily declining up until we had to intubate.

As it turns out, this patient was supposed to be on Insulin. As his blood sugar rose to the 300s, his “Insulin drip” was being titrated up, but instead of getting Insulin, someone had spiked a bag of Ativan. What a mess. And to make matters worse, the patient had renal problems too.

There is no doubt that this is a major medication error. A scary fact, but it does happen. We just don’t expect it to happen to us much less a co-worker. But what could have caused such as mixup?

As I contemplated on the events of the day as told by the previous shift who had the patient, I made a few observations which could have prevented the situation if the nurse had followed the simple rule of the “5 Patient Rights to Medication Safety”… Right patient, right drug, right dose, right time, and right route. Unfortunately whoever grabbed the bag of Ativan and started the drip did not verify one of the 5 rights. Looking back, here’s what may have happened.

The nurse in charge had Insulin running. Seeing that he was low on Insulin, he grabbed a bag of what he thought was Insulin from the medication room and hang it on the IV pole, then he took a lunch break. The IV pump starts beeping as the bag empties, someone comes over and seeing a fresh bag of medication spikes the bag of “Insulin” which is actually Ativan, restarts the pump and walks away. The nurse in charge comes back from lunch, takes blood sugars and discovers it is high, titrates the “Insulin” up, not realizing that a new bag of Ativan is hanging. A few hours later, patient is non-responsive and needs to be intubated.

Regardless of what happened, I’m sure you’ll agree that this all could have been prevented if someone, the person who grabbed the bag, or the one who spiked the bag, had remembered to use the simple rule of the “5 Patient Rights to Medication Safety”. This is the reason why I personally do not restart or spike a bag of medication or IV fluid when responding to a beeping IV pump unless I verify with the nurse in charge. It is also the reason I verify the IVs that are running by looking at each bag at the start of my shift, just to make sure we are on the right track.

Leason learned: You can never be too careful, and mind your own business. What a sobering thought!

Have you ever talked to your director many times about an ongoing issue in your unit and feel like your words are falling on deaf ears? I’m sure you’ve been in that situation many times before… I know I have.

An article posted by ABC news a year ago mentioned that power causes people to take others less seriously, which explains why your boss doesn’t listen. A recent study shows that your boss doesn’t listen because “there are no consequences”. Fortunately I discovered the secret for making my boss listen to me while I was in a “counseling” session with her one day.

I’m not perfect, and it’s not an excuse, however, some wise *ss day shift nurse thought that writing me up for giving blood “without consent” was a good idea. The fact of the matter is, the patient did give and sign a consent to receive blood… he just had major surgery and was bleeding, Hgb 7.5. Well… my “incident” reached the corporate office risk management department who forwarded the writeup to my director, who called me for “counseling”. At the end of the session she told me to “be careful because these write ups go straight to the corporate office and I have to show them that I took action.” I thanked her and left.

One night, I had to take my patient to CT scan STAT, however, I was having some equipment problems. For some reason, the battery packs on these essential ICU equipment would not charge and therefore, the machine died every time you tried to use it. I’ve told my charge nurse, and my director a few times before, I even wrote her a letter about the situation regarding the poor maintenance of these equipment, but to no avail… this problem had been ongoing for months. How do you get your boss to fix ongoing problems in your unit? Simple… you do it the MIDAS way!

You see, where I work, we have an incident reporting system called “MIDAS+“. It’s a nifty little system that enables you to send an incident report straight to corporate’s risk management office. All I did was to write a report about equipment malfunction in the ICU under “patient safety risk”, hit the SEND button, and wait. Because of the sheer volume of reports they have to deal with, it usually takes about 3 months before they get to read what you send them.

A few months later I was approached by my director in the hallway at the nurses station. She tells me to step aside and starts of with “I’m really bothered about what you sent risk management regarding malfunctioning equipment in the unit. Do you know that when you use the MIDAS system it goes straight to corporate?” “Yes I know”, I replied, “that’s why I used the MIDAS system… so that corporate will know that there is a potential patient safety risk in the ICU”. She tells me to stop using the MIDAS system and let her handle situation because it is her responsibility to do so. I politely reminded her that I did tell her about it many times before, however, the problem still exists.

I may have added to her gray hair, but one thing’s for sure… enough is enough. I’m sure she’ll be more attentive next time. For now, I’m just a thorn in her flesh. I figured, if no one stands up for the patient’s sake, who will?

Well, I don’t recommend using an incident reporting system to write up your boss, however, maybe sometimes you might just get the results you’re looking for. A word of caution though… use at your own risk! Regardless, I know I got her attention. Maybe this time, like she said in her own words, she’ll “be careful because these write ups go straight to the corporate office and I have to show them that I took action.” I thanked her and left.

Time surely flies when you’re having fun!

Another year has passed and a new one’s comin’ round the corner. It’s been a wonderful ride with a bit of history in the making. I’m excited about what 2009 brings! Looking back I can say we’ve been truly bless… and so despite all that’s happened, especially with the current economic meltdown and the uncertainty that we are all facing, I decided to look back and count my blessings.

I can say that the number one blessing my family has received this year was our house. After years of moving, living in apartments, living with relatives, renting a house, then moving again, we finally have a place to call our own. Just a few months before the financial economic breakdown that hit our nation, we closed on a pretty good deal… $1300 closing cost and the buyer paid the down payment which was a little over $10,000 and just in time before we got evicted from the home we were renting that unfortunately the owners foreclosed. What’s can I say but “God is good, all the time, and all the time, God is good!”. On our own power (credit), I don’t think we could have qualified for a home. But with God’s help and His timing, everything fell into place.

Another blessing I received during the year was my diploma… I’ve finished my associate degree in Information Technology and am currently working on my bachelors. After I’m done with that I plan on going into nursing informatics, creating electronic medical records systems that make sense unlike the one we use at our hospital. I know with the Lord’s help, everything is possible. 

One other blessing I am looking forward to is the balance on the $50,000 sign-on bonus I’ll be getting after January 3. You see, I signed up for a 4-year contract to serve the people of South Texas in that great “white hospital” by the freeway. This is my 4th year now… worked 2 years in 5 West, Telemtry, and almost 2 years in the ICU, and despite all the BS, frustration from managers or policies, and especially EMR systems that don’t make any sense… I’m still here! My former boss, who unfortunately took my “complaints” for a better system as a “chip on my shoulder”, who actively tried to get rid of me, is no longer there. After 10 years, they gave her the boot. I guess with a house and everything, God is telling me, “you’re staying in South Texas for a while”, and I guess that’s what we’re going to be doing. McAllen isn’t such a bad place… we’ve settled here for now and that makes it a better place!

There are a whole bunch of other things that I am thankful for, but if I were to list them down, it might take a whole book just to go through them. So, with brevity in mind, I’ll end here. I know the next year will brings about more blessings, and I can’t wait to turn a page on a new tomorrow. 

So, to all of you out there who, may or may not be counting the blessings of the past year, I still say, May you have a prosperous and Happy New Year from my family to yours!

‘Twas the night before Christmas, when all through the house, the nurses were buzzling, yes, even their mouse…
clicks heard here and there, admissions quite fair,
The ER is rollin, trauma codes in the air…

There’s nothing like spending Christmas eve and Christmas day with your patients. Yes, you have family waiting for you to get home so that they can open their presents, however, it’s sad to think that some people spend Christmas in an ICU bed by themselves. I’m sure they can use a little company… I’m happy to be here for them… it’s called time and a half! Get real!

No one, even nurses, wants to be in the hospital on the holidays (we do  have a life, and nursing ain’t it). However, we are a 24-hour operation, and like “they” (whoever they are) say, “the show must go on!”. Nothing will stop us from keeping our doors open… no, not snow, not hail, not hurricanes, not even the current economic breakdown caused by whoever you want to blame.

See the picture of our ICU Christmas tree? Not even that was spared from the global financial crisis. Sad isn’t it? Nothing hanging, just that pathetic looking bow. That thing didn’t last for a day… the hospital had to sell it to avoid further financial loss. Maybe they should stop admitting ICU patients who are not ICU patients… you know, those patients who can be downgraded from ER to Med/Surg or Telemetry… no drips, on vent, walky-talky, and constantly on the call light. Either that, or they need to hire better case managers. Who cares? I just work here. As long as they pay me, even if they assign me a vacant bed, I’ll take it, because I’m a nurse, I CAN HANDLE ANYTHING!

So to all of you out there, nurses, and otherwise, who are kind enough to sacrifice time away from your family to care for the sick and needy this Christmas day, I say… MERRY CHRISTMAS!!!!

What a circus! The sign is up, the sign got stolen, the sign is back, people protesting on both sides, now you can’t put up displays on the state capital building. The drama goes on… and on… and on. What can I say?

I’m sure you’ve heard about this controversy that is happening in Olympia, W. A sign sponsored by the Freedom from Religion Foundation stands next to a Nativity scene. People have now questioned the judgement of Washington state governer Chris Gregoire for allowing such a sign which attacks religion to be displayed. Now, others have applied for similar displays such as the spaghetti monster, “festivus”, and “Santa will send you to hell”. What’s next, White supremacy signs during Martin Luther King Day? Have we lost our minds yet?

I’m glad we have freedom of speech in this country, however, things are starting to get totally ridiculous. Whatever happened to the America with high ideals? And we call this “progressive” as the seculars would call it? The only progress we are making is the breaking up of the United States as obviously the country is very much divided at this point. We have the Republicans vs. Democrats, the far left-wing nuts vs the far-right wing nuts, the Liberals vs Conservatives, Straight vs Gay, etc., etc., the list goes on and on. Interestingly enough, the very holiday that was supposed to unite us, is causing division among us.

I’ve heard on Fox News that in 1870, Pres Ulysses Grant, signed into law, Christmas as an official holiday. This was the era after the Civil War and the country was still greatly divided, and so to unite the country, the president signed the bill into law making Christmas a federal holiday, a time that everyone observed, no matter what side they where on. Unfortunately, this is not the case today. Regardless of what you believe in, I think there are some traditions that need to go, and some that need to stay, and I say this one stays!

So, to all of you out there who are either watching or who are part of the circus act, I say “Have a MERRY CHRISTMAS and a Prosperous New Year!” May God bless you all, and may God bless the United States of America! And if you are an atheist, tough luck! Here’s something to think about…

For the message of the cross is foolishness to those who are perishing, but to us who are being saved it is the power of God. For it is written:
“I will destroy the wisdom of the wise;
the intelligence of the intelligent I will frustrate.”

Where is the wise man? Where is the scholar? Where is the philosopher of this age? Has not God made foolish the wisdom of the world? For since in the wisdom of God the world through its wisdom did not know him, God was pleased through the foolishness of what was preached to save those who believe. Jews demand miraculous signs and Greeks look for wisdom, but we preach Christ crucified: a stumbling block to Jews and foolishness to Gentiles, but to those whom God has called, both Jews and Greeks, Christ the power of God and the wisdom of God. For the foolishness of God is wiser than man’s wisdom, and the weakness of God is stronger than man’s strength.” – 1 Corinthians 1:18-25

Here’s how the “Big 3″ automakers should have gone to washington for the bailout instead of firing up the jets and traveling in typical “CEO” fashion. Maybe Washington or the public for that matter would be sympathetic to their plea. Interestingly enough, they all came to Washington last week in their hybrids, a far cry from the jets that shuttled them back and forth weeks ago. At least they didn’t have to pedal for miles to get to the government watering hole. Surprisingly they came with bigger buckets. Instead of the original 25 billion, they now would like a bigger bailout, who knows how much. Now, everybody wants a bailout… when will it end?

I don’t know what these people have been doing all these years, but one thing’s for sure… they grossly mismanaged the companies they represent, and now, we the people would have to reward their fiscal irresponsibility by giving them a hand out. Yes, people argue that 3 million jobs are at stake. It’s sad if those people lose their jobs, but then again, if the companies go belly up, maybe that will be good for everybody. Not only will they have an opportunity to get “reorganized”, but they can actually start with a new slate and build the companies up to where they will be more viable.

Regardless of what happens, whether they do get the bailout or “loan” (sly use of words) from the government, one thing’s for sure… these companies need to learn from the other automakers like Saturn, Honda, Chevy, or Toyota on how to manage their business to keep them viable.

Yup, our president-elect yObama aptly puts it when he said that “things are only going to get worse before they get better.” I guess the reality of the situation is starting to rear its ugly head as he gets “in tune” with the real situation in America. Sure it’s easy to say, “we will create jobs”, but how, and what kind of jobs would you create in this economy, not to mention the quality of jobs that would actually support a family of 6.

Despite this there’s hope, and I’m not talking about the hope our president-elect Obama thinks he personifies. I’m talking about the real hope… the kind of hope we find in Jesus. Yes, it’s not Obama, it’s Jesus that America needs… and all we have to do is call on His name. Wake up America… it’s time to wake up!