Friday, December 12, 2008

The Hard Way Pt. 2

Taking me a while to update my posts. Apologies. The learning curve is keeping me busy. Collecting excellent stories to share. Give me more time...

:“That’s right. I did nothing all day. I fake added up my I/O’s. These numbers you see here, they’re fake.” I was adding up the last hour of I/O’s after report had been given to night shift. They come on at 1830, I leave at 1900, that leaves a half hour gap for me to take care of.

Preceptor: “Ha. Ha. Okay I see. Because if you hadn’t added up your I/O’s I would be VERY angry at you.”

Friends, my nerve got hit. Hard. I'm learning. I make mistakes. I make a lot of mistakes. Dumb ones. I don't profess not to. BUt I'm here to learn, not get verbally or brow beaten. Unlike some nurses, I throw back verbal punches. Maybe bad for the career in the long run, but my fists land. And they leave marks. And sometimes they land hard enough where I don't have to go home hating myself.

Me: “I DON’T GIVE A SHIT if you get mad or not. If I had neglected to add my numbers up until the last minute then I would be disappointed in myself for not using my time properly which, apparently you haven’t noticed, I did.”

Preceptor: (Not really sure that he had just got told off): “Uh…ha-ha.”

Sorry friends. Preceptors can be jerks, micromanage, hell they can even be disrespectful. But getting angry over not adding up I/O’s as a threat of some sort, sorry. Needed to put him back into line. The blowback? I’m sure he told anybody who would listen how terrible I am but I’m not really too worried about it. For the last few days other nurses have been coming up to me and saying, “How’s M------ abuse treating you today?”

Repercussion for my words? I don’t know. I don’t care. His preceptor, 3 years ago, was a notoriously abusive bitch, it’s too bad he hasn’t figured out he doesn’t need to act that way anymore. My preceptor is a good ICU nurse. Obsessive, detail oriented, gives a shit about the patients. He is somebody I have learned a lot from, and he has helped be focus on areas where I need work. Certainly I can be a stubborn fucking mule. Dangerous qualities as a new grad in the ICU. I am aware. But I don’t believe in fear based nursing. I see how my preceptor is afraid of management. He doesn’t understand that kissing their ass has brought him no respect, just more responsibilities that he doesn’t get paid for taking on. The ICU day shift supervisor told my preceptor to “drill instruct me” and have me ready to be solo in 2 months. Well, I’m ready to be solo. Scared shitless about it but ready. But I aint in the military. Call it pride, ego, vanity, stupidity, whatever. I got boundaries and they will not be crossed, as a matter of self preservation. So much disrespect and dehumanization burned me out as an E.M.T. the first time around. I’m not going to let it happen again.
As my best friend, who is a S.I.C.U. nurse told me, “Dude, just make it off probation.”

Has to be on my terms. This is why I write about my one confrontation as a new grad. Because it has to be done to change nursing. I write to remind myself and other nurses that being disrespected, patronized, condescended to, yelled at, or humiliated in any way is unacceptable by any medical personnel. That HORIZONTAL VIOLENCE is behavior that is truly unbecoming of a nurse. Not having a fucking opinion that differs from the general consensus should not be the impetus for school yard behavior.

The Hard Way Pt. 1

This is a long ass post, my apologies. I know shorter posts are easier and more fun to read. But I don't have much time these days, so I crank it out when I can. I seperated it into two parts so you can take a break, go to the bathroom, make some pop-corn, grab a beer, make love to your signifigant other, WHATEVER YOU NEED TO DO, so you can read the whole thing. Tally Ho!

Hard thing, to be a new graduate in an I.C.U. Trying to acclimate to steady stream of new information, theories, styles of practices, sometimes mellow- sometimes brutal clash of personality. It’s a hard thing. I’ve grown a lot these last few months. It’s been a wholly healthy experience, trusting a hospital unit to mold me into a functional nurse that can be trusted to take care of a very sick human being. So many defenses pop into my head when I trust my unit. I work for a corporation, it’s image or brand is that of Catholicism. I am precepted by various instructors, of all nationalities, sexual preferences, mentalities, experiences, I am open to their criticism, their warnings that something I may be doing is not working or will lead to more trouble down the road. I am even open to the ever stinging and painful attitude adjustment. I put trust into my I.C.U. that it’s interests are getting me up and running, not degrading my worth as a nurse and person.

I don’t know why nurses feel it is so important to remind newer nurses that they are new. I know only a tiny fraction of the over all incredible tidal wave of information required to run an I.C.U. I mean, I know this. This realization occurred to me my first week: In my career I will never learn every condition and procedure in great depth of detail enough to be masterful in all workings in the unit. This truth was stunning and provoked fear in me. That in itself as humbling as hell. More experienced nurses, however, are so threatened by the fleeting moment of recognition that every new grad has, when training comes together, when that smile comes on our face, “Hey, I learned this. I know this. I know why it happened, I have enough background knowledge and theory to manipulate this situation to favorable outcome because I’ve seen the outcome of this situation before.”

My preceptor with 3 years experience says to me, “Yeah, well, I think you just got lucky here.”

Then I go into my patient’s room and the noise by the charge’s desk drops. It gets eerily quiet. Cuz they are talking shit. That is the attitude adjustment. Not that I have done anything wrong but the attitude adjustment lies in the fact that the words that come out of my mouth reverberate around the unit and can leave a favorable or unfavorable impact, depending on the disposition of the nurse gossiping. I can control some of this, I must retain the attitude that I know so little and am awed by the skills of those more experienced. Sadly, my true feelings are threatening and infuriating to the more experienced. By claiming some victory over a situation I have hit a nerve with any nurse with more than 3 years of experience. Some of my preceptors let me have opinions let me make the mistakes that change those opinions wisen me up while most are too insecure to let me do so. To the insecure nurses, my attitude has changed. For the sake of peace, and career longevity, I swallow it and oblige their weakness. My attitude has changed.

Well sometimes. Mostly, I’ve been good, kept my mouth shut. I know better than to point out the 5000 contradictions that preceptors have amongst each other. I did try to point this out one time out to a preceptor that while I had no problem doing the task they asked of me or the way they asked me to do it, my previous preceptor the night before felt just as strongly about doing it completely different. That never chills ‘em out though. They just feel more threatened and insecure. Secure preceptors don’t give a shit about minute differences. Insecure ones cannot fathom that one single task can be done safely and appropriately 20 different ways. Especially when it comes to charting. That night’s preceptor kept saying, “But do you understand why I do it this way?” I was like- fuck, I understand you rationale is perfectly understandable but DO YOU UNDERSTAND THAT IT CAN BE DONE THIS WAY?
Preceptor: “What’s this?! You haven’t tallied up any of your I/O’s? You’ve already gave report. You’re behind.”

The following is my response after 2 months of my 27 year old preceptor acting like a cocky ass, making nothing but negative comments, criticizing my questions as repeats and therefore-stupid, not making any attempt to communicate, looking only for inane mistakes in my paperwork ( I put the MD’s name after the telephone order as opposed to putting the MD’s name UNDERNEATH the telephone order), all around being pretty worthless. Acting as if my dumb mistakes are somehow a reminder of my total failure as a new nurse. Each “Tssk" and deep sigh pushing me closer to the edge. Each day he’s got closer and closer to being out of line.


Saturday, November 22, 2008

Cold Cold Ground

I could write for days. Days, I tell you! Funny stories, aggravating instances, tales of monotony and terror, personal reflection and the ultimate sad but true truth. Highlights like a hot lady with dark hair and that kind of naughty, kind of cute, light brown streak, the highlight, running across the lateral side of her head. Lateral. Hot chicks with high lights. New grad dude nurse feels overwhelmed for 12 hours can't seem to get it right. When is this shit gonna get easier?
Still love the ICU. I'm happy and grateful to be there. My supervisor wants me to be more humble and ask questions more nicely. Reasonable request. Cuz don't forget, experienced nurses can shit all over you but the second you bite back they're moved to tears and outrage and cookies and WILL NOT BE SPOKEN TO LIKE THAT BY A NEW GRADUATE. Sorry. Just don't make up hospital protocol (if a doc writes an order for ANY drug you as nurse have the autonomy, the discretion, to give the dosage you see fit as long as it doesn't exceed the order) and get pissed when I point out that legally, that's asking to get sued. If a doc writes an order for 3mg morphine and you think it might kill your patient, call the bastard up and get a new order for 1mg of morphine, even better, have it written as a sliding scale PRN. That's legit. That's communicating with a doc who probably appreciates the foresight. Now, who wants to be the motherfucker to call at 0300 for that bullshit? Not me. That's when you give a nursing dose. But regardless, we may give the drugs, but we don't write the fucking orders. And don't male up rules on how "it really works". I didn't call you sloppy. I don't even care. I just don't roll that way. So now all 30+ ICU nurses know of my argument and have taken away about 20% of the warmth they initially extended to me. Ahhh, good looks can only get you so far when you come across as an arrogant dickhead.

I keep telling them, the experienced ones, till I'm blue in the face, "I understand your rationale, you don't want to overdose your patient but you need to get a new order if you are going to change the dosage and a sliding scale or dosage parameters have not been set." Not that abrasive right? Opinionated, fuck yeah. But I'm not like, " ALL NURSES OLDER THAN 35 WITH MORE THAN 5 YEARS OF EXPERIENCE SUCK AND ARE STUPID COMPARED TO MY NURSING SCHOOL ASS. I WAS CLASS PRESIDENT BITCHES, AND DON'T FORGET IT." My god, I politely didn't agree with your practice and had, what I stupidly thought, was a healthy argument.

And with that, my friends, I earned the label "Cocky". It is pretty ridiculous, I mean I'm a new grad, a student with a license, telling them how to do something they've been doing for 10, 15, 25 years. It IS outrageous. What can I do? I'm gracious when they share knowledge with me, my questions come across as a challenge and that's my bad- they aren't challenges-I thoroughly enjoy debates and spirited arguments, I love tumultuous, vigorous conversation. I do not raise my voice, I do not call names, I preface my statements with, "I don't mean any disrespect" or "I'm confused about this order do you have a second to explain it to me?" Even, "What do you think if I was to do it this way?"
And then I argue until I understand what they are saying. That's just me. A stubborn weirdo who respects the people who can thoroughly explain their rationale before I implement it into my own practice, so I know why I'm doing what I'm doing, rather than just doing it. My preceptor tells me I don't ask enough questions. God, I must be a prick.
In nursing, its just not okay to debate. Nurses are fragile with their truly impressive knowledge. I'm not being sarcastic. I love nursing knowledge. But all it takes is some first year intern to tell them they are wrong and toss out what the nurse considered to be a rule of biblical proportions (give Desmopressin to a polyuric pisser who basically has no electrolytes and is in DI). Intern says no, "Lets keep supplementing with IV electrolytes." Resident backs it up. Attending likes the way it sounds. They all read some study on desmopressin that R.N.'s don't even have access to. She's pissed and humiliated.

Nurse: your knowledge is hereby rendered dated and you just lost a little more of your repetoire.
I guess I realized this week that new grads aren't allowed to bring new nursing science to the table. It's seen as insanely arrogant and mildly suicidal.
Kind of sucks. I wouldn't argue with experienced nurses unless I respected them. But I don't think too many of them respect themselves so they don't really get that.
My ICU preceptor and subsequent staff are aware of my argumentative hard headed nature. I tried to hide it. But its been 90 days, I'm still on precepting. I still make stooopid mistakes. I forget to sign off the morphine I gave two hours ago, again. I feel stupid. I forget to transcribe the lab results onto the flow sheet because I've got the hard copy in my hand and I've already shown the critical values to the resident. My preceptors says, "You know, I'm tired of babying you with these lab results, you need to record these on the flow sheet as soon as you get them and intepret them."
I ask, "Even before I notify the doc that my patients K+ is 2.5? He says, "Yeah".
I don't argue. And I make mistakes. Some preceptors are cool. Some are hard asses. Can't say for sure I 'm making the grade. I think I am. I mean, I ask for the heaviest patients the ICU has, I make 5 million little mistakes throughout the day but I always leave on time. I just woulda thought that if a new grad, a preceptee, asks for the heavy patients then the powers that be, that general hum that runs through a unit, like a positive ion gossip charge pulsating through a rumor bed, I thought they would have cut me a teeny bit o' slack. Guess not. I asked. I received. duh.
Yep, there is a lot I could write.
But I'm tired and tomorrow I have to be able to tell my preceptor where an MI is likely to occur in someone with right coronary artery failure. Inferior, posterior left ventricle, I think. Got me. They're not gonna let me get near a heart patient for like, 15 years anyway. And understandably so.

Tuesday, November 4, 2008

Cloud Nine





Saturday, September 27, 2008

Appetite for Deconstruction

Better than your brightest lights
Because they still can’t penetrate the darkness
Of the heart with their song of
The ballad of the buried woman

Dazed and confused up for nights
Soaring in fingertip reminiscence
Of larger bore needles bored to tears
Once again, you can't imagine the depths

Every night, every shift
We wade through people who feel like human debris
Rendered bed-ridden by too much grease, not enough time
And hard earned paychecks that as slim as their chances
Of getting out of here alive, this time anyway.

You know me, and I know you
We both know we are better than that
But empathy is in short supply for the perceived
The poorly recepted. The gravely misunderstood patient

Whose bad judgment has left her on my unit
Confined to a giant bed, that rotates her adipose years
From side to side, to keep her skin from obliterating
And showing us that the color of her soul is a milky yellow

She wears a mask during sleep that I would have thought cool as a child
But it only prolongs her suffocation, from yearly daily routines
That provided sustenance, but coated her vasculature a bulbous insulation
And now this mass, my patient, this woman, teeters on the brink
Of becoming an empty vessel that five of us can barely move

And she suffocates when sleeps on her right side
Her lungs squeeze themselves masochistically when we roll her on her right
I watch her face turn from turbid fleshy pink, to turpid red, to ending purple
She is a human so huge she can't live anymore

And she’s a dime a dozen. Well, at least that’s the deal she got every morning she told me with a smile on her face.
“In between litigation, and depositions I found time for Chinese. In between discovery and cross examination I had a two meatball grinders with a chicken on the side. And during bathroom breaks during trials I ate boxes of krispy kreme donuts and chased it down with 1/2 gallon of chocolate milk. I don’t think I’ve gone without a soda during my waking hours since I was a 15 year old fat girl. I drank diet coke for twenty years, but that’s like switching form Marlboro Reds to lights, really what does it matter?
But I never did drugs, never smoked, never had sex. I stayed disciplined, dedicated, I listened so well. I am an excellent attorney. I just can’t breathe anymore.” Her Trio cell phone rings. She answers it. I see the custom made three piece suit still on the chair in her room. I see the diamond studded feminine Rolex awaiting security to come and lock it up. Her engorged fingers have many rings with precious bright stones, some colored the same as the incredible amount of fluid I will see leave her cracked open chest later on that night. Like a fortune cookie. What did the fortune say? It said:

“We are all here. We are all here.”

I think dignity and control are fleeting in any situation.

But I have paperwork to learn how to do properly. Blood to draw, progress notes to read, sugar to check, insulin to give. IV’s to titrate, dressings to change, wounds to pack, pictures of wounds to take, charting to chart, labs to ponder, family to let in, sheets to change, a body to clean. And these are the “eassy” patients. The painfully ironic “lighter load” patients. I have to explain that we can breathe for you but the bacteria that traveled from your vagina to your kidneys to your intra stellar galaxy will get you first and I must remark that I never seen anybody with such a rapidly dropping BP answer so many seemingly important phone calls. Never has sepsis had such a soft punch.
Later on, something popped in that chest, and the megalomaniac brilliant cocksucker cardiothoracic degenerate surgeon did surgery in her temporary office, the air support bed. And just before she became a live dissection a passerby would have heard one of us say from her room:

“So you want to know the life of a mind?”

Thursday, September 11, 2008

The Filth and the Fury

So I've been working as a R.N. in the ICU. Finally. Spent a lot of time contemplating what was fucked about nursing and the medical field. Spent a a few brief moments contemplating what was cool about nursing and the medical field. It revealed some truths about myself and it revealed an uncomfortable amount of truth regarding our culture, race, class status, identity. It has been a lot of painful discovery. I have been misunderstood every step of the way, accused of being a monster, a racist, a dude working in the wrong field. I am working in the right field for this stage in my life, for who I am as a person and the fact I have the integrity and stubborn mule-ishness to stand up for the good ol black and white. Learning to slowly accommodate for some of the grays, too.

So far, all my patients have been intubated and either comatose or completely sedated. Frankly, I prefer my patients sedated. At this stage in my level of expertise, I need them to be quiet so I can focus on getting organized and delivering pharmaceuticals in a safe and effective manner as well as the stack of paperworks the depth of the 9/11 commission report on a nightly basis.
On my first clinical night, I might as well call it "Krystal Nacht" from here on out for the brutality of it. The poor tiny 100 lb female Nepalese nurse across the way from me had a 4 BILL (that's a 400 pounder) RETARDED HUNGRY AS FUCK MASTURBATING BEAR NPO of a patient. The kid was S/P left AKA with the biggest, nastiest dehiscence I've ever fucking seen. As far as I could tell that amputation had never even been sutured together. It had that bright red meat grinder look to it. And you know how scared, mentally retarded compulsively masturbating opiate resistant patients are when they are confined to a bed and are missing a limb that they were partial to. Fuckin' crazy.
I felt bad for her, the nurse. She kept screaming, "Stop touchin' your stoof" in a cute accent. At first it was funy. But then he would scream so wretched a response in gutteral grunt language, desperate. Communication was completely impossible. I was kind of cracking up at first, listening to the nurse telling him over and over, knowing his behavior was a matter of self preservation and not anything that could be reasoned with.
And then I saw Baby Huey WAS frantically touching his stuff and it was just sad. I mean it was like a statement about man. When man is confined, lonely, missing his Mom who feeds him multiple chickens daily, when man gets down to it, he beats off his Foley'd tiny penis, buried somewhere in the mounds and mounds of flesh with a brutal vigor.
Finally, after a shitload of fentanyl, ativan, and fucking haldol the attending decided it was time to put in a central line via his left subclavian. The poor giant retarded kid. The attending turned the patient into a goddamn pin cushion and he must've hit the clavicle on one of his stabbing expeditions because at one point because he withdrew the needle (I swear to god it had to be a 16 guage) and it was completely bent in the middle. So then the attending chuckled in the same way one chuckles when accidentally throwing a gutterball at the bowling alley, I grabbed another triple lumen kit and he started over, gunning for the left femoral. And the attending made it. That's right, he put a delicate, highly invasive line INTO THE KID'S RANK CROTCH. Perhaps the attending is used to lots of male masturbation. One word comes to mind with this type of line placement with this type of patient: Inevitable.
An hour later the masturbating bear, in a furious attempt to satisfy his ungodly minotaur urges ripped of the soft restraints, yanked out the femoral line and furiously stroked himself into a brief five minute slumber. The interesting thing about this was that he didn't bleed. The mounds and mounds of fat applied pressure to the torn sutures and open vessels. Lord knows what was now floating around in the kids blood stream but at least it wasn't a bloody mess.

Then it was time to pack up, monitors, ACLS drug pack, more R.N.'s and off to CT to figure out why this retarded kid had been acting retarded. You read me right. Head Ct time. One of the residents decided that this kid's behavior was unusual. His mother said he doesn't act this way at home when he gets hamburger helper intravenously. So naturally the first thing that comes to everyone's mind is: "Yeah, lets take this completely fucked up man/child down into the basement for a CT scan where he could hurt himself/or any number of staff members on the trip down to see if his brain is bleeding. There is no reason why his brain would be bleeding but he is screaming very loudly." Never mind the fact his former left knee looks like a raw, marinated porterhouse steak. That's secondary to whatever else they can bill somebody for.
I mean, there's no way the isolation, the drugs, the no mama to grossly over feed him, the missing limb and loss of ability to walk, the tube in his penis might have anything to do with his bizarre behavior. The resident thought it might be a brain bleed because he had fallen two weeks ago after surgery trying to get up at night. This is the same resident who was the first to bail when it came time to get Gigantor downstairs to CT.
I made him stay. I don't care if I'm a new grad or not. I don't care if he found it aggressive or pushy or rude. His little pager went off, the resident attempted a lame performance of having to run so I blocked his exit. I stood right in front of him and I said, "You ordered the CT. You will help us get him down to CT and make sure he doesn't get hurt on the way. You push from the head, I'll guide the front." And he obeyed. Easily, just like all doctor's do when you are assertive and don't apologize all over yourself like a fucking ninny.
Once we got him in front of the CT suite we couldn't fit him in because the bed didn't fit through the doors. Ultimately, this patient and the word "suite " should never be used in the same sentence. The effects were exhausting. (What's the deal with hospital's building doorways that beds and people can't fit through, is this just me or do you know what I'm talking about?) This kid was in the biggest Hill/ROM ortho giant bed they make, with big steel bars forming a rectangle on top, for a pull up triangle. We pushed, we pulled, we kicked. Couldn't get the fucker through the doorway. Looking back, I don't even know how we got the bed in the elevator. Tran, the CT tech got so pissed off he kicked on metal frame that was above the bed, above my 6"1 head as hard as he could, a beautiful crescent kick, reminiscent of something Bruce Lee may have done except that Tran was Vietnamese. The metal frame shot out of its damning socket and freed itself of the main bed frame. And in we went to take an expensive pointless picture.

Once we got the kid onto the table I went to the linen cabinet to get a new sheet and when I turned back around the resident had split but that was fine. Because there was no way this dude was going to stop beating off for the CT to work anyway with sedating him to a goddamn inch of his life and maybe then young Master Resident would understand the comedy of futile useless back breaking labor. Nurse Nepalese nailed the Big Kid with another round of Haldol. And if Nepalese Nurse played her cards right, and filled the incident report out properly, Young Master Resident might have to answer for the destruction of his Master's handiwork. (central line). Post Haldol blow dart, he stopped jacking off for like, 15 seconds. Just enough time for a brand new 64 slice Catholic CT scanner to do its thing.
We got the kid upstairs, two tiny female nurses, and me: appallingly out of shape male nurse (me) grunted gutterally ourselves, sweating, earning our bucks. What other job do you need to know the intricacies of the science behind the machine that works you to the bone and only get credit for this boggling dichotomy in your head? Sweet nursing.

It feels great to be back in the game everybody. I had a good, soulful time getting the kid to CT. To me it was funny and bizarre, and one of those situations where I'm just like, "what the fuck am I doing here at 3 A.M.?" Making money. Practicing my knowledge of how things work, inside and out. Applying past experiences of knowing how and what medically related people are thinking, mostly either 1) how my co-workers can avoid breaking their backs and 2)how patients can get a sense of how suddenly any sense of control has left their lives.
And looking forward to learning so much more.
I left at 7 in the AM, utterly exhausted, kind of pissed, kind of euphoric. Critical care nursing is going to be great once I figure out what the hell I'm doing.
Oh, babies, I am home.

Sunday, August 31, 2008

Meet me in the Morning

Made my employment decision. Didn't choose to work at "Your Jew Masters of Beverly Hills Hospital, yeah That's Right We Are Shitting Money". The pay and environment was better at Catholic Mother of the mountains of the everlasting Guadalupe ripe milky breast of the heavenly del taco. Surprisingly. Finished orientation. Orientated. And confused. Said, "Okay. I get it. Gotcha. Right." Maybe 50 times. So much critical info.
Didn't comprehend the sheer volume of paperwork associated with an ICU unit. Sadly noted that many of my stack of obligatory paperwork filings is to verify that a MD has done their job and filled out their necessary paperwork. Yes that's right. A good 25%, one full quarter, roughly 13 pages of the easily 50 pieces of paper I am expected to completely fill out on a daily basis pertain to me verifying if a doctor has written med orders, bothered to fill out informed consent for emergency procedures, asked about advanced directives, parameters for sedation vacation, instituted any sort of pain management protocols whatsoever, whether or not restraint guidelines have been ordered and a fucking shit load of paperwork regarding abnormal lab values and hemodynamic parameters. There is even an informed consent for anesthesia that I, as R.N., am supposed to fill out. Say what? I guess I am an uppity, arrogant new graduate but what business is it of mine to fill out any paperwork for anesthesia? How the fuck am I educated enough to evaluate whether or not a non-english speaking patient knows the inherent risks of general anesthesia? It scares me. The physiological responsibility is overwhelming, but the legal/administrative responsibilities are mind boggling as well.

Do you get it yet you pansy MD's reading this out there? Do you understand that it pisses me off that it's considered part of my job description is to wipe your ass for you?
and that if the day to day actual maintenance of the patient is not maintained perfectly I have been advised by my manager that you will then "yell" at me? (yeah right, I dare an MD to bellow at me in any situation other than a code. Bring that shit on.) I just want to be left alone with a patient and their difficult family members. I want to manage a sick person's health, I want to be a conduit for their families anger and sadness and futility but I don't want to be a secretary for a bunch of socially retarded prima donna's that are so smart they can't even DO THEIR OWN JOB. HOW THE FUCK IS IT MY JOB TO MAKE SURE THEY DO THEIRS, AND IF THEY DON'T, THEN I AM TO BE HELD RESPONSIBLE FOR THEIR FAILINGS?

But wait alright, I'll be cool, zen ponies, zen ponies- every nurse out there has to do this too, right? I am just experiencing some sticker shock- a newbies surprise at how things really are, how many things there really are- alright everybody. I'll be cool. And I will maintain my "stay shutup" policy and do my job. And do it well. Nothing to be angry about. I have a family. They need me more than my selfish anger does.
My first clinical is on Tuesday. Thank god I'm going to nights. No other place for this currently angry, antisocial motherfucker. Formerly. Heh. heh. What happened to my zen waterfall with unicorns and pixies and shit? Don't worry friends. It is still there. Every job, every gig, every aspect has its problems. I've got to roll with it. Nursing isn't about bliss. Its about skills, ballz, ovaries, and common sense, and organization. Things are well. I'm employed. I'm learning the ins and outs of a trade.

Things are well!!

Sunday, August 3, 2008

Everyday People

Alright. So I gots a license. I gots my ACLS. Now all I need is a fucking job.

Gave my heart and soul to the county. Did two internships. Licked the festering bung of the endless stream of managers, assistant managers, nurse educators for the SICU at the the hospital I wanted to get hired in as a new grad. Hard to do but I'm psychotic. Had 3 fucking interviews that were like totally Japanese. It consisted of the unit managers screaming at me: "You are shit! You think you know so much but you know nothing! You pissant. It will be a year before anyone will trust you by yourself for ten minutes. Tell us how you are similar to poop. Tell us! List, starting from the most similar way, to the least similar way, the ten ways your very existence as a nurse is similar to a meaty turd. Begin!"
So I get hired. After I tell them what a piece of shit I am and how I will become maybe, a squirt of piss if I follow their SICU tutelage. The following Monday the head manager quits, a new interim manager is named. I calls the new manager, I think she said, "County wide hiring freeze and besides you are 4th in line. Get another job." Click. Fucking click. Or should I say fucking clique. Not a word of thanks, apology, let alone acknowledgement for the internships and multitude of interviews. Anyway I think that's what she said but my Tagalog kind of sucks. I'm sure she has like six cousins and a husband who want the sweet position. So I calls downtown.
"Oh no baby, it's not a hiring freeze. It's a hiring hold. Just wait until October and then we can process your paperwork."Just a typical LA County, "I hate my job I'm just here to retire before we find this bitch floating dead, tits up. Go fuck yourself, na-ah, don't you talk to me like a human being, na-ah" attitude. They don't even say "please go fuck yourself."
Oh, okay! Great! I'll sit on my duff for 3 months while Schwarzabastard and the stooges from the now totally defunct "Killer King" fuck around. Why pay rent when you can get evicted?
Fuck me? Fuck you.

So you know what I says friends? Fuck county. 7 days later I got hired at a Catholic private. Even before the interview I knew I was home. Just like county, patient wise. I loved the lobby: Dead bloody Jesus statues on every wall, at eye level. Dude, they nailed that fucker through his hands AND his feet, crazy. Maybe that crazy bastard really did die for me cuz it looked like that shit hurt- and crackheads everywhere. It was like a mid 80's Cure video. I immediately thought to myself while I waited in the lobby for the ICU manager to come down, "Yes. Just like county. These are my people. Broke, dangerous, desperate, grateful, entitled, high, low, furious."
They check you out but they don't judge because they are in no place to judge. and neither am I.
I immediately accepted a position as a new grad in their completely dilapidated, fully understaffed ICU (no Na's, clerks, RT's, or EKG techs). One commode in the whole unit. ICU designed by Stevie wonder. The manager was like, "I gotta tell you, the nurses up here are a little tired of new grads right now. But do what you're told and lay low and hopefully you'll make it." Fair warning. I appreciate that. Bathing in toxicity. Wouldn't expect anything less nor do I want it.
I accepted the position with a non-contract 5K sign on bonus for working nights for a year, and then, the next day, a recruiter for the most prestigious LA private (Hint:they give the babies of celebrities shitloads of heparin) called. When I told him I had accepted a position at St. Mother of Dead Holy Jesus Mountains of the Tired Goat Naked Guadalupe in the Rivers of Nacho Bel Grande he started foaming at the mouth and wanted to talk money right then. Jews. My people. So I hustled him back and tomorrow I gots me an interview with the much coveted hereby named: "Your Jew Masters of Beverly Hills Hospital, yeah That's Right We Are Shitting Money" SICU manager tomorrow. *
La' Chiem!

The HR building I'm going to tomorrow is named after a very famous director. He's made movies about a sex addict archaeologist, an extra terrestrial that likes little boys, dinosaurs that eat Jeff Goldblume. It's literally called the Steven S------- Human Resource building. Gimme some of that private health care baby, let me see what you taste like.

Poor people, my people. Scandalous people, my people. The other clique, on the west side, my people (I guess). I'm not looking for the perfect place. I'm looking for the place where the waterfall beats down evenly with its harsh cold stomp onto the nape of my neck and I cease to exist.

Bring it!!!
* As a Jew, and a poor working class one at that, I reserve to mock the gaudiness of my own culture

Wednesday, July 16, 2008

Good Vibes

Cheers to this shit, neh?

Thanks Kelly! Awesome resource!
The R.N. formerly known as "Angry Male Nurse"
(I'm in a transitional phase)

Date: Thu, 17 Jul 2008 09:43:10 +0530
Subject: Licensed 2 ILL


We just posted an article, "100 Networks and Resources for Male Nurses" ( I thought I'd bring it to your attention in case you think your readers would find it interesting.

I am happy to let you know that your site has been included in this list.

Either way, thanks for your time!

Kelly Sonora

Saturday, July 12, 2008

Songs For the Deaf

And he hath been given license to breathe songs of lost rage and furor to the ears of the closed. For it was true- Their ear pussies would never be rocked with his Gospel of Nursing Blasphemy.

I am licensed friends. The Nusring School Graduate possesses a License to Ill.
It feels good. This joy is pure, genuine. And the relief is like the sweet warm clouded breath of my baby boy when we snuggle. And when my wife joins we snuggle like Champions.

Right away my resolve to not respond to every little thing in the nursing world with anger was put to the test.
I was able to schedule an interview with the management of the unit I want to work for the day I got my license number. So arrived, hair freshly shorn, faced shaved to a crisp, my balls smelling finely of expensive ode de cologne, oh babies I was prepared.
The interview consisted of Unit Manager, Unit educator, Assistant Manager.

The unit manager started the assault kindly: "First off, you are a very attractive candidate. You are the most enthusiastic student we've ever met."
Nice. But from there, they voiced their concerns. Concerns strangely identical to my instructors blast of me right after the award and scholarship debacle.
"Cocky" "Loose Cannon" "You started here way too overconfident" "We don't think you can handle the criticism required to work in this unit" "You mean you aren't ACLS certified?" "Do you think you know more than a med-surge nurse?" (I got my license THAT FUCKING DAY. AT WHAT POINT BETWEEN 0600 AND 1130 WAS I TO ACCOMPLISH THE TWO DAY ACLS COURSE?)

Then I went really nutty and told them of my contemplation of being a CRNA. And the shit subsequently really hit the fan. I know how dumb it is to tell a SICU manager you want to be a CRNA. I know the risks, but I took it. I told her, (I totally stole a line from "HEAT") "I give you my word that I will be here for 2 to 3 years. I know you don't know me personally but my word means something. My word is good."
The manager said, "I've been burned many, many times". But I won't burn her. My word
is good. I hope it shone through. Then she said, "I already knew." And I said, "Yeah, but I told you." I know who told her, too. This CRNA who works at the hospital who promised me he wouldn't tell her and promptly told her.
They said a lot of shit to me, most of it not nice, not innapropriate but not nice. The only unit in the hospital that isn't begging me to come work for them and these managers treat me like I'm some nursing failure. I've never been called a "loose cannon" before. That was pretty cool.
Then the education manager went onto the floor and asked a friend mine what he thought about me (he's a RN). My friend said, "People think he's arrogant but he's not. He's just really enthusiastic." I owe him one. At least she asked. It shows intent right?

How arrogant am I? How cocky do I come across? More than your average nursing student that's for sure. Your average new grad won't take her eyes off the floor. In a perfect world, in a world where capitalism led to happiness and fairness and real live ethics I would have been a salesman. That's what I do. I sell things, anything. In nursing, I sell safe health care, I sell the idea that you should change your diet at home. I sell the idea that talking rumors about me the second you think I'm out of ear shot is off limits to you. I sell the idea that the patient needs stronger pain meds. I sell the idea that I can outwardly feel as good about myself, I can answer questions and address situations with as much confidence, arrogance, sarcasm as that strapping young socialite MD over there. Basically put: The Nursing school Graduate possesses a License to ILL doesn't know his place. I see the ridiculousness of treating a human being a certain way just because of their job title, educational resources, or race. It deeply alarms people because I threaten their consistency. Because maybe consistency in what to expect, good or bad, is better than uncertainty. That's the problem with growing up in chaos. It often makes more sense than violent social organization.

That's my problem. I don't buy into the hospital hegemony because I'm too immature and vane to accept the fact that the force of my determination and sheer will does not give you status or credibility. Let them talk shit, let them challenge me and let me learn my place.

And in time, I will put pictures to my liking on the wall.

Sunday, July 6, 2008

The Day I Tried To Live

Angry Male Nurse is dead.

I've been wanting to kill him for a while and I really wanted to do it after I got my R.N.
To give his assassination a little more Umph.

But really, waiting to kill him until I get my license defies the purpose of ending this facet of myself.

Finishing nursing school, studying for the NCLEX, taking the NCLEX, waiting A GODDAMN MONTH FOR RESULTS has been wonderfully cathartic (and thanks to nursing school I can't ever use the word in any context without thinking of a juicy enema) and has really given me an attitude adjustment that I've been needing for awhile.

I'm going to keep this entry relatively short because readers don't read insanely long posts and I feel like what I'm going to be writing about for the next few posts is important, that these entries will pertain to you and your practice and your outlook on the medical biz and why you are in it.

I don't know if I passed the NCLEX. I know everybody says that they feel like they failed, some people KNOW they failed the exam- I categorize myself in the KNOW group. Maybe I am wrong. Hopefully I passed. But what I struggled with during the exam were like the ridiculously basic questions. Priority of nursing interventions for non-critical situations, mundane situations , situations so basic I've never seen a nurse intervene in them. Like a muscle cramp at 3 am while the patient is at home or brain freeze after drinking too much cold beverage. Given 4 choices, all of them right, one of them really right. The exam was testing my ability for analytic thinking. I'm not an analytic thinker. I'm a mechanical thinker, a creative thinker, a process thinker, but not an analytical thinker. But I don't blame the NCLEX or anything. It is a right of passage, weeding out the poor test takers from the truly dense and unsafe, from the ones who struggle with English, from the ones who just think too much (me!). Don't read into a question-well I do. I love to. That's why I like nursing. I love the puzzle.

So right now I am a nursing school graduate, with an I.P. permit, but not an R.N. And I have no blogger name because the blogger I was was really starting to disgust me and hinder my learning about nursing. And ultimately I'm a baby in the nursing game and newborns shouldn't be cynical. Part of the real me was AMN, part of me wasn't. But that is not so much important. What is important are the lessons I have learned from 7+ years in the medical field, starting when I was 20, ending where I am now in my early 30's (took a few years to work in media and sales) with a wife and a baby and a fuckload of ambition, tired outrage, exhausted disbelief at human behavior, annoyed with my own human behavior. 7+ years of lessons that could have changed me into a different person in so many different directions. I'm sad because sometimes those lessons stuck but most times they did not and I have repeated the same self destructive behavior over and over again. I have mastered the root cause of all nasty behavior in a hospital, I have the impetus for the worst behavior thoroughly mapped out under the guise of protecting myself from it but all I've really done is draw a route on the map to direct myself from point A: Unlicensed asshole who has been observing everybody and the constantly changing work dynamic to point B: Licensed asshole who thinks he knows everything but doesn't really listen to anything anyone has to say because their role as "fucked up person" has a direct route leading straight to and from my wacked and exhausted mind.
There is something to be said for acknowledging political play, to knowing what manager is trying to get what from what supervisor but it is an endless movement of gossip and really has no bearing on the job I need to accomplish on a daily basis.

I have been in a bizarre survival mode from really old shit, the kind of shit that makes you are what you are from the way you were raised, the kind of shit your therapist loves to dissect, the kind of behavior that I observed in others that disgusted me but when I got down to it, when I really looked at myself, shamefaced I realized it was in me.

I finally had to "stop, collaborate, and listen". (That's right, I just utilized Vanilla Ice as a major reference point for great personal change and goddammit it felt good).

I am going lay down some hardcore Mea Culpa, some ultimate my bad's in the next few blog entries and try to recenter myself.

1) I don't like what I've become, I don't like my response to the stress of being a nurse, to the stress of life and I don't need an R.N. to add credibility to the gravitas and sincerity of my will to change.

2) I will not be tightly wrapped anymore, the possibility of really bad things happening are ever present and it is a terrible life to live in fear. As Saint Al Pacino said in one of the finest films made,"Heat":
Tone Loc: Man, I could get killed for telling you this.
Pacino: Yeah, well, you could get killed walking your doggie!

3) I will not talk shit about my coworkers anymore as a useless attempt to gain alliance with other coworkers I hope will protect me from my own bad behavior.

4) I will not talk shit about anyone regardless of how much shit they talk about me. And if they are speaking ill of me because I have done something out of protocol I will wise up and get back in protocol.

5) When a patient, another nurse, a doctor, a respiratory therapist, family member makes a negative comment about my personality that is true I will not take it to heart and I will not hate myself for the imperfection of my personality, or for the exposure of being human. I will not hold a grudge against said co-worker for pointing out a human flaw and attempting to exploit it for their momentary gain. I.E. co-worker saying "I think he over reacts when he gets a patient with PVC's-pretty goofy" I do get alarmed easily. When alarms are going off in the C.T.U. It's because I don't want my patient to go into v-tach and code while I'm staring at the monitor with my hands warming my balls. What matters is the quality of your job performance and the condition of your patients before and after your shift was over. Am I in protocol? Yes? Keep on.

To be an Angry Male Nurse is the saddest possible fate in the world for me. Because while adults often demonstrate less than adult behavior in any job, in any situation I do believe there is a disproportional amount of BS in our field compared to others. The possibility of perpetual exasperation looms over me. And I do believe some nurses do behave unprofessionally too much of the time, either for their lack of knowledge of what appropriate behavior is or because they are simply overwhelmed by the endless barrage of shit they are expected to assess, plan to handle, implement, and evaluate the outcome of their handling. This job is doable, it does not require bitterness and contempt to do it right.

In nursing school, I used to bug out so hard, completely trip that the bad nurses were a reflection of me, of what I was destined to become. I felt real humiliation at their behavior as if it reflected on me because I chose the same profession. But it does not. A bad nurse does not mean I am a bad nurse. A great nurse does not mean I am a great nurse. It's like going to the gym and thinking that your body is as lean and toned or in poor shape as the people at the gym around you. I let my own identity crisis smolder on my own anger. Control, for the most part, was taken away from the nursing students at my school which was at a teaching hospital. My nursing school was an experience that is outdated and incredibly useful at the same time. It was militaristic, brutal, and like the purpose of all nursing schools weaknesses were exposed in the hope that they would be removed from the individuals performance and personal and professional growth would occur.
I obsessed over the pleasure some instructors derived from the process. I got pissed and stewed about the instructors who didn't care about the process and just laid your fuck up on you passively, completely taking away your ability to be an individual and ended every criticism with "maybe you shouldn't be here." But they didn't just say it to me, they said it to everybody. I took it so fucking personally, I started a war with the school because I thought it was wrong but also because I handled this style of educational process so badly.

Stress. Anxiety. If you can grow and learn when the pressure is on then you can learn and grow happily for the rest of your life.

I grew up with some serious stressors. But who didn't? But fuck, stress does not have to be stressful. How do I explain it? I do not have to respond to every insult, impropriety, every failure of the bureaucracy with rage and anxiety and more stress. Guess what everybody? I'm pooped. And I should be after nursing school but not this pooped. But not this soul tired. Truthfully, I started nursing school moderately burnt out. Being an E.M.T. can suck really hard.
I owe it to myself to not start out as an R.N. burnt out. I need to change and I am happy and excited to do so.

Final thought for this post:
Every single person who has left a comment on my blog has reminded me, or should I say informed me that the reality of working as a nurse with all the bullshit and back stabbing and nuttiness is like nursing school but only worse. There is more at stake. Thanks to everybody who helped me understand that because you are right. And if I go into my career serving a dish made up of my previous mindset of fighting fuckedupness with more fuckedupness garnished with some rage and paranoia sprinkled on top I would not only be the poster child for burnout but I quite possibly might hurt a patient when my mind is sailing the seas of outrage.

I feel like I am giving something up here everybody. I feel like I am giving up the fight, that I am letting poorly behaving, burn to a crisp burnt out nurses, status quo win- BUT I AM NOT. I believe that quiet professionalism with politely firm boundaries is akin to nirvana. Well, at least in the safety of my home and at my desk it does.

Angry Male Nurse is no more. Good riddance.

Wednesday, June 4, 2008

Love My Way II

Hey medical professionals-

I graduated. Without honors. As two year class president. Raised more money for my school than any class president before me. Fund raised like a phoenix, out of the ashes and into a nice prepaid banquet for everyone and half of their partner at a decent venue in the moist Armenian hills of lovely Burbank. Fucking paid by me. 75 grads. 42 a plate. I spent $175 of class money on presents for our advisors. I set aside $300 for a class legacy. I bought the class and faculty lunch, twice. I wrote a grant for re-imbursement of PDA's for all union affiliated students, which was approved. Champion. I formed a yearbook committee intentionally made up of the most jealous haters in my class. The turds who talked shit about me the WHOLE FUCKING TWO YEARS BECAUSE I DIDN'T HAVE THE ENERGY TO PRETEND TO THINK THAT THEY WERE DECENT ADULTS, WITH POTENTIAL NURSING CONSCIENCES SO I IGNORED THEM PERSONALLY. I ENGAGED A CLIQUE LIKE MAVERICK AND GOOSE ENGAGED A BUNCH OF COMMIE MIG-28'S. (Wow, that's a delightfully psychotic paranoid rant! With an 80's reference. Awesome.)
I alienated myself because this group of students, I’ve worked with many nurses that they will become. It was too obvious. Lazy, egotistical, vengeful, punitive, dishonest. Always interupting lecture to tell a story about how they went out of their way to help a patient, like "I'm gonna hold up everyone's time so I can kiss some ass with a story about something that Ididn't even do!" Or gasping dramatically whenever one of the instructors would use an example of a situation with a negative outcome. And always, always, laughing haughtily whenever an example of what-not-to-do was given, "Pshhh! I would never do that. How stupid!"
All of them instructors favorites. All of them full of utter shit. Basically stated: this was the clique of students that I found most unappealing as one of the many cliques swirling around 75 students. Just not good peoples. But I still wanted to put them to work and I did. Ironically, these were the same students that got all the awards that I did not. Very Tao. Just goes to show, Haters don't change. You can find them in their embryonic state even at nursing schools. Perhaps the old addage is true: Don't hate the player, Hate the game. I hates the way the game is played and I hates the the haters. Fuck you both. At least Players negotiate, compromise, collect rewards for everyone involved.
Informed by my faculty advisor that I was not given scholarships and awards because "Most of our clinical instructors feel that you are arrogant, don't take criticism well and are paranoid. And just so you know, the class awards are a popularity contest anyway and you are not popular with faculty."
To which I said, "I don't disagree. But do you think I would have been able to accomplish half of the things that I did if I wasn't arrogant, oblivious to criticism and paraniod?"

"No. Probably not. You will be a leader in nursing." My instructor smiled. I smiled. A little bit of candor, a little bit of real conversation goes a long way. And what did I do to receive this tid bit of discretion free conversation? Let me share...

I had brought my wife and baby to the awards ceremony only to have us sitting there with our thumbs up our keisters while some of the most relentless ass kissers and thinker-in-the-boxers received scholarships and awards. My name-definitively not called. But I was told by faculty advisor that i was a shoe-in? A fucking coup? What gived?
As fate would have it, after the ceremony I somehow managed to get my sweet little family into the elevator with the same cadre, the same junta of 4 instructors who shot me down. It was me an all of my old clinical instructors, and I was pissed. Fucking nursing games.
I said to my faculty advisor as the elevator unsteadily creaked up to the lobby, "So what happened with those awards?" The hens abruptly shut up.
She replied in the most possibly fake "I give a shit" patronizing voice ever uttered from a nurse, "Oh, honey, those were just nominations." She must have liked my wife's shoes because she wouldn't look at me in the face. My last clinical instructor, Ms. Perpetual Cell phone Coffee Break was standing next to her. She briefly glanced up and smiled at me, a hateful smile, a subtle sneer so snide that only a very hurt, vindictive person could make it. Then she looked away moments before eye contact. Steam came out of my wife’s ears. Well at least the wife saw firsthand some of the bullshit. At least she knows.
But I actually liked my faculty advisor, despite her insincerity at that moment. And I really do appreciate that a week later she told me what the real deal was with the awards. They no like me. Oh well. I no care.

I was told these realities one week after not getting said awards, one week before I gave the commencement address at graduation, in front of all the faculty instructors of the school, in front of the CEO of one of the largest healthcare organizations in the world. In front of the director of the SEIU for this healthcare system. Maybe I'm paranoid but how fucking stupid are they?

But I gave a nice speech. I sent a copy of it to one of the authors of "From Silence to Voice- What Nurses Know and Must Communicate to the Public", Bernise Buresh. She wrote me back.

ˆDear AMN,

Thank you so much for contacting us and for your kind words about our work. I read your commencement address with great interest and especially liked: There is a fine line between “taking stress home with you” and letting your family know that your intervention saved a patient’s life that day.

I am saddened, though, by your description of the attitude of your nursing instructors. It made me want to go right out there and do a workshop with the faculty. I’m pleased to tell you that I come in contact regularly with instructors and working nurses who are quite different from those you describe.

Whatever specific path you choose, I hope that you will have a fulfilling career in nursing.

With respect and best wishes,
Bernice Bureshˆ

That's nice. I could of used some more of that kind of attitude during school. Pretty cool that she wrote back, though.

I take the NCLEX on JUNE 24. Fuck me. I'll pass. I 've been asking other nursing students what their schools were like. "Easy"
"Sooo much fun", "Okay".

I have two of my classmates with me at the Kaplan review course. Rachel, a 25 year old virgin Pilipino Catholic smoker who manages to say "fuck" more often then me, and my class treasurer, gulf war II veteran Geraldo Rivera. (Yeah I changed their fuckin' names). I asked them how they felt about our school yesterday during break. They just stared at me. Then Geraldo looked away. Rachel went for a smoke and probably to go talk to hurt little baby jesus. Just my luck, I went to the gnarliest nursing school in Los Angeles County. We are the county. So I ate my yogurt and fantasized being home by 1300 so I could take a shit and possibly avoid Hep A, lice, and fresh fresh one minute old herpes for one more day from the insane public bathrooms next to the downtown LA kaplan offices.

Here's my speech: (It's surprisingly cuddly) (grab another brew, glass of vino, or some more pills cuz this here is a 5 minute speech) AND BY THE WAY-IF ANYONE ELSE NEEDS TO GIVE A COMMENCEMENT SPEECH YOU HAVE MY PERMISSION TO RIP THIS LITTLE FUCKER OFF!
Commencement Speech Class of 2008-I
some school of nursing somewhere in LA County,
Angry Male Nurse

I would like to thank my wife for her partnership and understanding, as well as giving me a baby boy one year ago.

What an outstanding day this is! What an outstanding class! To all my classmates, my fellow new nurses, I want to say that you are by far the most intelligent, motivated, and dedicated group of individuals I have ever had the honor of studying and working with.

To all friends and family members in attendance- I hope I can convey to you in the next few minutes the tenacity and scholastic intensity that your loved one has demonstrated over the last four semesters of education, AS IF YOU DON’T ALREADY KNOW! No doubt, you have observed your loved one study long, long hours, memorize seemingly incomprehensible charts and specific functions of the Human body.

During first semester we learned physical assessments which is the cornerstone for all nursing skills and the most important. Around first semester you may have noticed your loved one suddenly take an interest in all the sounds from deep inside your lungs and chest every time you took a breath. We tested to see how well your limbs functioned, we wanted to know what your regular diet was, we wanted to listen to the sounds inside your gut and we asked you about the sounds coming out of it as well. We wanted to know how you felt about your body and we probably gave you some information on how to make it work more to your liking.
We have been studying an intricate human body ballet, a multilayered framework of physiology coupled with responses to the hundreds upon hundreds of situations a nurse may find himself/herself in. So thank you for being the guinea pigs while we learned the fundamentals of the art of physical and psychosocial assessment.

I’m not sure what working as a registered nurse will actually be like. I’ve never done it before. We’ve observed and assisted nurses thousands of times throughout our clinical training in this hospital system )Omission!(. We have been able to assume responsibility for the care of as many as five patients at once and learned that our responsibilities as nurse are so numerous that delegation to nursing attendants becomes a necessity. As graduating nurses we have a pretty good understanding of what nursing will be like on a day to day basis. The nuances and details we will learn as we progress throughout our careers.

So I want to talk about what I know and what your families don’t. I want to make sure that you, family and friends fully appreciate the challenge of becoming a nurse and what clinical expectations are expected of all nurses, including students. Because there are a lot of misconceptions about what nurses actually do. Some people think nurses just give out pills. Others think nurses just change sheets. Some people think nurses are the physical embodiment of angels. Some people think nurses are grumpy. Did you know that according to a study completed by the Institute of Medicine in 1999 86% of medication errors were caught by nurses, not by physician staff?

To me, nurses are extremely well trained, tested for our capabilities in a tough situation, we are taught to think in terms of action and rationale. What we call a priority intervention, such as re-positioning a patient a certain way as a response to a specific medical situation like choking or fainting, others might call quick thinking. Nursing graduates: If your patient suddenly develops chest pain, what is the first thing that you do after assessment? We have been taught that the priority nursing intervention is to oxygenate. And again, what the untrained eye may call quick thinking, to nurses, it is a reasoned response.

So what does priority intervention mean?
Simply stated: I slip an oxygen mask over your head and tell you to take some deep breaths and try to get oxygen to those deprived cardiac muscles. The simplest of actions requires reasoning and training. If the pain persists then I will move to the next intervention which is to medicate you for your chest pain and to further relax your heart and the demands placed on it.

I would like all family members to take what you have seen and heard on TV or movies about registered nurses and replace it with these words: Nurses are leaders in hospitals. Nurses make critical decisions in hospitals. Nurses perform crucial assessments of patients in hospitals. Essentially, nurses collaborate with every discipline the medical field has to offer, from physical therapy to gastroenterology to social work.

NURSES ARE THE LIFE BLOOD OF THE HOSPITAL AND MEDICAL CARE along with administration, doctors, respiratory therapists, dieticians..

You can ask a registered nurse for medical advice. They are licensed to give it. When you are a patient seeking medical attention you can expect a registered nurse to advocate for you, along with every other member of the medical team.You can expect a RN to collaborate with physicians to obtain the best possible outcome, which is the return to optimal wellness.
We anticipate negative effects of hospitalization and counteract its forces by simply walking with you down the hall way to ensure that a clot doesn’t form in your leg, or that you skin stays free of signs of breakdown from being in bed.

We facilitate positive outcomes while healing and do it in a manner that is sensitive to your culture and beliefs.

I would like to ask all friends and family members to inquire of their graduate loved ones what they do on a daily basis once they become registered and begin working. There is a fine line between “taking stress home with you” and letting your family know that your intervention saved a patient’s life that day. Or because of your thorough daily assessment of your patient, your detailed review of their chart and labs you discovered a finding that prevented a serious, life altering event from occurring.

Classmates, we have so much to be proud of, what we have accomplished here at school and what we will accomplish as medical professionals. Please, Classmates, remember to share your experiences
Instructors, family members, administrators, you can rest assured and feel confident that through your guidance and support that this first graduating class of 2008, school name serioulsy deleted here, is ready, willing and able to accept the challenges of the healthcare system now.

Sunday, May 4, 2008

Search and Destroy

Thought I'd drop a line.

Finished classes. Whatever. Advanced Med surge was groovy but Nursing Professional Role was like sitting in cold diarrhea 3 hours a week.
The highlight of Role was when one of the instructors, who happens to be a shop steward for SEIU decided to give the collective bargaining lecture. She pointed out the good and bad of the union, relatively objective in an unobjective way. She talked about her political work, her constant advocating for more pay, better treatment. I asked her why the newly negotiated contract took specialty pay away from the critical care nurses to give regular floor nurses a raise. And why was she telling the class that she helped negotiate a raise for everyone. She stared at me for like a minute. And then she said, "We read the contract wrong. We're working on it." Oh. That's cool. I guess it's okay then.
And then she went on with her political missionary-martyrdom position for all nurses. (I just totally made a sex joke) But all anyone heard was that she received free trips to D.C. for meetings. So then the class started jumping all over her shit for taking free trips to D.C. The obligatory and perpetually righteously indignant African American chick said, "Maybe the specialty units wouldn't have lost their pay if you hadn't been taking free trips all over the country!" And then she looked around at the class and said, "You know?" Comedy.

I can safely say nobody made a point that stuck in the ensuing argument. It made me happy. A little piss to warm the diarrhea, as it were. Cuz the bottom line is the SEIU is gonna do whatever the fuck the SEIU wants to do. Negotiate. Right.

So all I got left is an 8 hour clinical competency scenarios exam. It should be called "really fucked up sick people and their incredibly depressing life stories case studies" but the test is compromised of 22 fucking case studies of ridiculously sick patients.
Here's an example:
Patient #1: NAME: Mr. RandyDickhead
AGE: Can't tell
RACE: Annoying
Wt: Fat. Really fuckin' fat.

C/C: RUQ pain, 10/10 radiates to R. flank and chest. N/V x 3 days, dysuria, fever, HA, blurred vision.
DX: Adrenal Paraganglioma
Urine: bili:0, Ket:0, Blood=neg pH=6.5, urobili=1.0, nitrate=0, glu=0, color=red, clarity=clear, S.G.=1.016, epithelial cells=>30 Bact=none
Then I get a bunch of the most incredibly fucked up labs of all time, and a bunch of intentionally contradictory and poorly written med orders, you know, like how it really is at cccccounty. Then onto priority nursing dx, nursing interventions.
But the whole thing seems far fetched. Like, I get it, pheochromocytoma but blood in the pee-pee? That's a bit of a stretch isn't it? Bloody piss because of an adrenal tumor? Do I have to change my diagnoses to Decreased renal tissue perfusion? Anybody out there? Can you guys enlighten me?
Why do I need to think about this shit?
So is the life of a nursing student.

I've pre-emptively changed the name of my blog as you can see. It's sort of like, you know, to psyche myself up for the NCLEX and subsequent employment. And it should solicit more hate from the haters.

Licensed 2 ill.

Hope you guys are doing well out there. Cheers.

Monday, March 3, 2008

Beat that tin drum

Gotta focus on graduating.

See everybody at end of May.

To all the people who told me to join Narcolovers Anonymous, get a life. It's called creative writing Mo'Fo's. I made it up.

Cheers. Beat your tin drum.

Monday, February 18, 2008

How Soon is Now

Prefice: I don't want no moral highground responses from this okay? And don't threaten me with the BRN alright?You can say what you want but be real. I want you to think, don't judge and try to understand that people come from all walks of life and in this profession you are in contact with them. Take off that white dress for just a sec okay, baby?

Alright friends. This is where I cross the line. Its time for the truth. Just because they don't teach it to you in nursing school doesn't mean its not out there. Yep. The blacks RN's hate the Mexican RN's. Phillipino's RN's hate the Nigerians RN's. The Chinese RN's hate the Vietnamese RN's. The Korean RN's hate everybody. Vehemently. The white RN's think that they "secretly" despise everyone but as a white guy who is as baffled by white culture as my Ethiopian co-worker during our daily lunch break talk, it's obvious and we can tell. White aint right. Brown doesn't mean its time to get down. Black is wack. What the fuck rhymes with Vietnamese?

Vietnamese don't do what you please?

But whatever. we all know race exists. We're just not allowed to talk about it. American's, technically, aren't even supposed to notice race. That would make us ˆracistˆ. My wife isn't of my race. I noticed. I'll admit it. And now I've got a little mix baby crawling around. I noticed, I'll admit it. But not enjoying the differences, pretending not to notice- bores me. You all bore me.

My friends, The intra hospital race wars is not what I have come here to speak of to you this evening. Oh no. I want to, how do you say, ˆdivertˆyour attention from the minutiae. From the atmosphere of blasé daily affairs, from the things you know you will have to do: assessment, meds, chart, dressing change, IV's, more meds, talk some shit about your fucked up co-workers, take a step back baby and just look around.

Is everybody wasting? or wasted. How easy is it to put that 5mg dilaudid into your pocket-after all your pt that hapless mother fucker with bi-lat ORIF and a glorious GSW to the left butt cheek only gets 1mg IM every 4 fucking hours. For BTP. Good luck with that. Thanks for your compassion you saucer shaped pupil resident. Took me a month to figure out why all the residents were fucking anorexic, jumpy and working 48 hours in a row. Duh! Don't be so naive you fuckers. Just takes an appointment. And its legal.

Diverting is a felony. Fel-o-ny! You are no longer a nurse but a common criminal. High as a kite.

But that’s not where it's really at, my friends. The good shit, the shit you can maintain with and make a 100k comes from your psychiatrist. That pimp dealer. He's a physician but he's a pusher too and you know what? There is no healing with that motherfucker. Where does it end? At what point does the shrink say, "I fucking fixed you with all my drugs, now you are better. I guess I need some new clients!" Doesn't happen. Shrinky dink would never say,"You stressed? Try some of this shit it's called MS Contin. You can shoot it snort, stick it up your ass, its great." That's too easy. He prescribes shit you've never heard of. The latest shit. The French have invented a new drug called "Provigil". Its like speed accept you can sleep on it and don't get the euphoric buzz of meth. Put that on the PPO card, my good man. I'm fucking street legal now.
I don't think most of my co-workers divert. I don't think the idea of slamming high octane opiates has even crossed their mind. Thank god. They get high in other ways. This I know.
The hypothetical:
But getting high has crossed his mind, friends. Up until now, he'd never had access. Now he has access and he thinks to himself, "I look at these patients with fucking unbelievable injuries, when I come on they are writhing in pain, some faking it just wanting chemically mediated release, some really fucked up and hurting. I give them their medication regardless, I am the nurse, IV push, IM, fucking PO, and whoosh-they can't wait for my q day physical assessment. If someone who has been shot 7 times and sporting a brand new colostomy with bloody drainage, if this street fighter, if this man who takes these traumatic insults in his stride while he lies in bed plotting his revenge, his URBAN COMEBACK, if he can tell me that I am the greatest nurse he's ever had- and its only 0830. Fuck that must be some good shit right there.
That shit will take the edge off of the shit I've been prescribed just to make it through this day, it'll make things alright. "
I surmise the high:

Alright. alright...he can feel his own breath hovering around his head, evaporating into delicious ether that can only come from a teeny tiny sterile little bottle with fluid in it that looks like water, that turns to red red wine and feels like some peace is finally cascading up through his antecubital to a royal fuck you all, to let him just lay low. He just smiles and nods and knows.
High, he thinks, "My pain doesn't hurt, in fact it feels good and I have a little bit of time before that fucker called work goes off again. My condo is on the same street as my hospital, I live a few sweet blocks away and in my bliss, blissed out I hear the squads running, flying by with sirens operatically calling, Code 3 is now peacefull and funny, so many times a night YYEEOOOWW, I just giggle cuz they are here to touch my mind, just wrap my skull up in a soft wool baby blanket. To breathe."

The next day- this nurse, this imbecile, rolls up to work and this dumb motherfucker thinks that nobody notices. Most don't. Most of his coworkers are unsuspecting. Some are habitual shit talkers looking for dirt. Some care and have seen it before.
Swear to god his name was Hal. Hal was an ex-army RN. Like that means something. Maybe just that he knows a lot more dude nurses.
"Hurt my knee in the Army." That was his story and he stuck to it. Hal told somebody he shouldn't have trusted that he took Demerol every night for the pain. I don't know how you could work four 12's a week if your knee was all fucked up from a softball accident in the army, I don't know, maybe Hal should have lost some fucking weight and taking the strain off that knee.
Anywhooo-Hal would roll up and work everyday, the same fuckin way. Profusely diaphoretic, extremely irritable, you could say irrational, shaking, looking so goddamn pale. Fucking in withdrawal. 4 long ass days a week. He thought of himself as an honorable and good RN, didn't want to work around patients high, I don't know what his logic was because he was pretty fucking unstable kickin four days a week.

People give me shit cuz I'm still a student RN, and I talk and write like I know so much but what a lot of arrogant nurses can't fathom is that life starts before RN and before RN I was EMT and before that I was a student , and before that was just waiting and it was always my job to obey and do what I was told and watch. And watch I did. I watched Hal's co-workers, most of whom had worked with his failing ass for at least 5 years. None of them every did anything. Is that friendship? Loyalty? Understanding that Hal had a wife and a daughter who probably wanted to go to a college she was not in the right social strata to attend?
There is no dramatic ending to Hal's story that I know of. I left that ER, Hal was still shakin' it up and his co-workers were still pretending not to notice. I'm not an RN yet. But I am an adult, a father, a human. What would I do with a license to maintain? None of my business.
But the way I found out Hal had an addiction to pain meds was simple enough. We were pushing a pt upstairs, the gurney every so lightly bumped into Hal's right leg and he said unto me through gritted teeth and sweat soaked hair matted against his fat face, "I wish I was at home with Demerol right now." Cheers to that Hal. Your girlfriend awaits. Thanks for being honest, dude.

Adderall. Wellbutrin. Ativan. Xanax. Prozac. Vicoden. Norco if you're lucky. Lamictal. Lexapro. Candy my friends. Anything to get u thru the shift. This show must go on, we've got a new star and her name is Super High Accuity. She'll make you a super nurse. Give you some stories to tell at the bar after work or at a lame party but she doesn't do shit for your psychic scars. She doesn't give a fuck about YOUR trauma. Fuck the pyxis. Comedy.

Best line ever in a movie was in Wallstreet. Charlie Sheen, Oliver Stone production.

Buddy (charlie) is about to get arrested for violating SEC insider trading rules. Police and federal agents are wating in his corner office. Right before his arrest he stumbles into one of the older traders, Lou, a kind, wise old stock trader who has seen this young man's unstoppable demise coming for quite some time.
And he says,
"Bud. I've got to tell you something. A man finds himself looking in the abyss, there is nothing staring back at him. At that moment he discovers his character. That keeps the man out of the abyss. "