Some Nurse Love

The word nurse appears in at least 120 different posts on this blog (I just counted). In exactly one of those posts I took nurses (in general, as a group, which was overstating things a bit) to task for some odd behavior I’d observed.

Guess which post I’ve been hearing about, at length, from my nursing colleagues? This one, for those who haven’t already guessed. It’s peeved several of them, which I would find amusing except they’re angry way out of proportion to the offence. Humor is individual, and there’s some individuals I work with who didn’t find it humorous.

So, for the thin-skinned and those with short memories, here’s a couple of blog posts wherein I’ve demonstrated some of my feelings for my nurse colleagues:
A break, too late
My Side

I appreciate everything the nurses do for me, and they do a lot. In no particular order, nurses do/have:

  • caught allergies I missed
  • gotten that bit of history that makes things make sense
  • alerted me to a subtle finding that changes the disposition
  • talked to the family and kept them informed so they’re happy
  • ordered that lab I’d left off by accident
  • not yelled at me for the third set of added-on orders
  • reviewed my orders and found that omission that would cause a problem later
  • carried out orders they didn’t want to, because the patient needed it
  • taught me something about a medication
  • got that IV in the septic drug abuser with no veins

…and on and on.

I respect all of you.

And it’ll be a while before I write about nurses again.

Who makes the ED run? The Secretaries

Having been threatened reminded of their contribution I have decided to expound upon the unsung heroes of the ED: The ward clerks/secretaries.

Most people don’t realize the power the ward clerk has over everyone in the ED: patients, nurses and most especially doctors. ED clerks/secretaries (I will use the term interchangeably, and always with the greatest respect) make the place function. A bad one can completley ruin your day, and a good one can make you look better than you deserve.

Let’s go over the duties I know of for clerks: order supplies, answer the phone, order lab tests and tell jokes. Sounds simple, doesn’t it? Well, here’s how it works: while entering 12 lab tests and the same number of xrays for a critically injured patient they’re overhearing the doctor yell for the neurosurgeon to be called, while taking the call from the on call specialist for another doctor, not forgetting the other two calls to doctors (which aren’t really calls to doctors, they’re to answering services, who seem to delight in thwarting our efforts to contact their doctors). This doesn’t prevent them from calling to get the light repaired in the view box, paper towels in the bathroom and vomit mopped in the halls. Oh, and remember where the joke telling stopped so we can pick it up when things slow down.

It has never occurred to most doctors that the clerks don’t know every medical abbreviation, have never heard of the Kleihauer-Betke and don’t know what it does, and will look on, flabbergasted, when the “spiral chest CT for PE” gets entered as a regular chest CT (they look for different things, and aren’t necessarily interchangeable). This isn’t their fault, and the experienced/smart ones shine when they make the doc/nurse look good (I knew you wanted a pregnancy test on that patient, so I added it on), to our eternal gratitude. (Eternal measured in ED minutes, which last about 10 seconds, or until the next time they’re needed).

I cannot imagine running an ED with inexperienced ward clerks, and I offer the following as an illustration: I worked in an ED that moved from the clerk-runs-the-world system to one in which the ED docs entered all the orders on a computer. It worked fairly well, but there wasn’t a second set of eyes seeing the entries, leading to the inevitable delays wherein needed tests are belatedly entered. The real fun began when the computer went down, and the clerk wasn’t one of the heavily experienced ones. Suddenly the entire load of the ED went onto their untrained shoulders, and it wasn’t pretty.

I’m glad we have the system we have, and I appreciate our clerks, and fully understand the hell we’d be in without them. Thanks, folks!