Change of Shift Begins Fourth Year: Volume Four, Number One // Emergiblog

Change of Shift Begins Fourth Year: Volume Four, Number One // Emergiblog

The pre-eminent Nursing Compendium gets more mature, and more fun. Many congratulations.

TCU nursing student ‘steps up’ during in-flight emergency | Fort Worth | Star-Telegram.com

TCU nursing student ‘steps up’ during in-flight emergency | Fort Worth | Star-Telegram.com

Good on ‘ya, Nursing Student Joslin!

Growing our own…

This was sent by one of our nurses (and a frequent commenter) with her title “Growing our own Nurses”.

our_own_rns.jpg

When she originally showed it to me, she said this is how to treat doctors: the pacifier does the trick.

I’m not saying she’s wrong…

Nurses to be Evaluated for Compassion

…just not individually…

From BBC, which focuses an unflinching eye on the reality of socialized medicine, and the astonishing weirdness within and without (though I should say that the eye sees without seeing…)

BBC NEWS

Nurses to be rated on compassion

Nurses are to be rated according to the levels of care and empathy they give to patients under government plans.

Health Secretary Alan Johnson told the Guardian newspaper that he wants the performance of every nursing team in England to be scored.

He said he believes compassionate care was as crucial to the recovery of patients as the skills of surgeons.

Nurse leaders welcomed the move and said they would work with ministers on developing the system.

But he ruled out rating individual nurses and also said it would not affect pay.

Group compassion? What the heck are they even pretending to measure?

Pallimed: A Hospice & Palliative Medicine Blog: "I Wanna Be A DNR" and other Goodness from the Web

A little humor for your day, via Pallimed (via Dr. Wes. it’s a tangled WWW):

The description, per Pallimed:

A ICU Nurse and some colleagues rewrote the lyrics to the popular Nickelback song “Rockstar” to emphasize how some patients may feel in the ICU. The video itself is just the lyrics. Here is hoping she puts together more song parodies and maybe a video or two.

Gallows humor, but it’s well done and humorous.

101 Little Known Scholarships for Nurses | NOEDb

101 Little Known Scholarships for Nurses | NOEDb

Here are 101 different scholarships that are out there designed just to help those entering the nursing and healthcare professions. With the cost of education taken care of or reduced, students will be able to concentrate on becoming a caring and competent nurse without the heavy financial burden to distract them.

In my area, the first qualifier might be very applicable.

Losing another

I found out recently (I’m usually the last to know) that one of our best nurses is off to the carpeted zone, that area of the hospital that consumes good people and delivers paper and protocols to the ones actually doing the work of the hospital.

Like my kids, I love all our nurses equally, though there’re some that seem to get what being an ED nurse entails more than others, and there are the few who can anticipate the next three moves, make them happen, and tell you when it’s done. It’s wonderful when they have your patients, as they’re in good hands and so are you.

This disappointment means a couple of things, good and bad. The good news is that I’m finally in one place long enough to be an ‘old timer’, but it’s actually painful to watch the terrific nurses go.

So, here’s to you, and best of luck in the less-exciting but more stable life outside the Emergency Department.

Movin’ Meat: It’s been nice to know you

I had the temerity to point out some less-than-effective nursing behavior before, and was threatened with a range of personal revenge up to and including threatened (but not acted upon) unprofessional behavior.  Mine was mild compared to Dr. Shadowfax’s, with the tag line:

Movin’ Meat: Death of a thousand little cuts


But the rest of the day was no different. Note that during this whole time the nurses weren’t exactly jumping on the other patients, either. Getting anything done was like pulling teeth. I hate to rag on nurses, since without them I get nothing done, and many a good nurse has saved my ass. But good lord it’s infuriating when you are stuck with the “B” team.

I predict his local nursing mafia will make him Persona Non Grata, and he’s going to have to kiss a lot of B-team backside to get out of this one.  (And, we’ve all been there, I’ve just actively censored myself before posting.)

So, syonara Shadowfax, it’s been nice to know you.

Nurses: Help Requested

I got a call from the friend of a friend, a young male, and he has a question I’m not terribly qualified to answer: what should he do to get into the Nursing field, de novo?

I am asking, on his behalf, for constructive input.  Keep the snark to yourself, this is for those interested in entering the worthy profession of nursing.

Nursing Home MAR’s sent to the ED with all times removed: A new and horrible trend

There is a new, intentional and horrible trend in nursing home transfers to the ED, and it’s not the patients. It’s the records that come with them, or more specifically those that don’t.  Allow me to explain.

The patient is sent with a chief complaint, a lot of weeks-to-month-old labs and a medication list, but all the administration times have been cut off from their typed MAR’s. (MAR stands for Medication Administration Record, and is the only written record of which patient got what medicine, when). Got that? A patient sent from a nursing home comes into the ED with a list of their medications, but the list has the times and dates of administration removed. Intentionally. They come in with little strips of paper with the medication names and doses, but the administration times are on the paper that wasn’t sent. That’s not an accident. Definitely not.

When they’re my patients I now ask for a faxing of the patient’s MAR from the nursing home with the removed information included, because it is, you know, part of the medical record, and may well be useful in the diagnosis and treatment of the patient. A patient often sent in with “AMS” (altered mental status) as the one-line explanation for the transfer, and the patient is on several (usually more than a dozen) medications, at least a third of which could cause an altered mental status. It would, in that case, be nice to know if they got their regular, let alone their PRN (as needed) sedative(s), as well as all their other medications.

The kicker is, since I cannot determine when their medications were administered (because the times were cut off of the copies sent to the ED), a lot of very useful information is now denied to me, the ED physician, and then most likely to the admitting team, since none of us can say who got what medication, and cannot account for their altered mental status. (I’m using AMS as the example here, but there are other complaints that could be medication related).

This intentional removal has happened often enough ( from different nursing homes and at different ED’s) that it’s clearly part of an organized effort on the part of Nursing Homes. I’m at a loss to think of a single innocent reason why this practice would have started. When I’ve called personally to have the information faxed (for patient care, the reason they sent the patient to the ED) the Nursing Home nurses routinely say that “It’s policy”, and then sometimes send the information, and sometimes they don’t.

This is outrageous. A chronically ill patient is sent to a higher level of care for an acute problem, and without a complete information base; but not just that, information crucial to the care of the patient that’s being intentionally withheld.

It is a situation that makes me, frankly, nuts. When did intentionally withholding critical patient care information become acceptable? Seriously, have these people not learned from history? The coverup is always, always worse than the crime, and is looked upon less favorably and punished more severely that any original offense. You could ask Nixon, but he’s dead.

Send me all the info you have, and our patient will live or die based on their problem(s); withhold information I need, and it’s on you, Nursing Home nurses.

(Nursing homes that engage in this awful practice, beware: I now document ‘Patient sent to ED with MAR with times removed’ on my charts, and you’re kidding yourselves if you think this kind of obfuscation will get you out of a medicolegal jam.  Were I a plaintiff’s attorney (and I’m not) I’d be at least somewhat interested in what was withheld, by whom, and why. Still seem like a good practice?).