Thursday, December 17, 2009

30 Seconds to Mars: A Lifetime of Vanity

Look, I know many of my readers don't know who this poopy concoction of turd rockers are- mainly the band features visual prossy Jared Leto, yeah the heart throb from "My so called life", Jared Leto who can't LET GO. Dude, you stop trying to get attention. Find out why you need the attention so bad and remember, creepy narcissism is not cool!

Figure this as your rock bottom: Your band sucks and your talent is questionable. I know you asked yourself this when you made that shite movie about John Lennon's killer and the answer slapped you in the face: Yuppers, you lack all talent.
Dude, leave media alone and find your soul. I saw you on Kimmel two years ago. The audience was comprised entirely of morbidly obese 17 year olds. Ponder that, dude.

Now that your new album is out I see your advertising budget has shrunk but still I feel harassed. Please, get a job and fuck off.

Monday, December 14, 2009


Gallup's annual Honesty and Ethics of Professions Poll

83% Y'all. We just smoked pharmacists.

Feels good to be America's most TRUSTED profession.

MY patients listen to me as I have my their best interest at heart, in my heart and they sense that. It is a position I love being in. Black and white. Right and wrong.

Nursing is punk. Like Yoko Ono, Dennis Kucinich, Elmo, Don Rickles before us...We keep slogging through that losing battle to prevent hospital care from being transformed into a greased out fast food restaurant. Nurses don't want you to have to ask for ketchup, napkins and refills! You fucking deserve it for free! We try to fight the M.B.A. belief that patient care can be transformed into a goddamn Marriot for those with insurance, a lowly motel 8 for those with medicare and a two bit YMCA for those without any medical back up.

Fellow nurses you can deny it, choose to not observe it- but we are in a weird professional position. Our very existence costs hospitals money- our code of ethics is nothing but an irritating expense. But without us, a visit to the hospital would be an expensive an absurd form of rape. We are hard steel screws, holding tight in a time of cheap unreliable surgical glue. If you think infrastructure will be reinforced with quality materials think again...

Keep advocating for those in our charge, keep fighting the faceless cowards who are trying to destroy our salaries, savings and whatever meager pension is left. Stick together, stop gossiping and start collaborating.


Thursday, December 3, 2009

I'm busy learning how to be an E.R. nurse. I find it especially challenging, and especially rewarding as well. Funny how two different departments can be so incredibly different.

I think I like the E.R. I love the constant mix of people, the sheer number of personalities that present. I love the instant gratification of working in the E.R., being able to help someone as suddenly as they have come in.

Here's to the E.R.!!! And finally a little peace...

Tuesday, November 10, 2009

Kick Against the Pricks: dOCTORS iN sHORT sUPPLY

I love kicking ass on allnurses.bomb. An article shows up stating a fact that Nurse Practitioners are going to be in higher demand soon to come. No fucking shit. All of America is about to get a free insurance card to score Vicoden, endlessly.

Wait...Here it comes...Uh.Uh. Rant: Has anybody in Obama's government spoken to a single healthcare worker on this new healthcare shit?

Let me make a prediction RIGHT NOW:
When everybody gets insurance there is going to be a tidal wave-no fuck that- a goddamn epidemic of opiate abuse. Maybe even Adderrall speed abuse. Instead of going to the streetoofr oral candies, the people are going to figure out what to say to the NP to score. Here it comes America. If you thought our appetite for illegal drugs was bad-wait till you see how truly fucking obese we are when it comes to LEGAL DRUGS!
Rant finished-

So anways I'm a kicking ass on allnurses.bomb. Some dorky little troll pops on and tries to say that tired absolutely bizarre and insane argument that doctors are inherently smarter, they spend so many more hours on the floor (which is always a rather naive argument cuz everybody knows residents walk around in a sleep deprived, stoned stupified daze for the bulk of their training). Nurse practitioners are so stupid we couldn't figure out, we are simply utterly incapable of sending out for referral. So all of our patients are going to die. Here's the link.

I've also kindly provided you with the text. Seriously, I should have been a goddamn writer cuz this little letter (I still call them that) is a whopper. Even my response on allhearses.barf has been good.

I know this post is way too long but I expect more out of you, my readers. I know you can handle long posts. But the post is also about my impressions as a new E.R. R.N., into how my first days as are going (Gulp!):

"I paraphrased you there but the problem with your logic comes from what appears to be your obvious inexperience. The primary flaw in your logic is is the fact that despite the numerous hours of experience med students and residents put into their training, the quality of their care is often comical. How often do I see med students and residents standing around, gossiping, studying? Completely oblivious to the goings on around them? How often are they really part of the hospital team? Not much. Just because you are inside of a hospital doesn't mean your are learning anything that is actually useful. Massively piling hours up sounds like a recipe for incompetence to me.
Since very few doctors have ever gone to nursing school and most to this day truly don't know what a nurse actually does, the unknown fact is that nursing school is at minimum a two year crash course in how TO RUN A HOSPITAL FROM THE GROUND UP. On the flip side, nurse's have to know what a MD does to do their job. MD's frankly consider 90% of the necessary functioning of a hospital someone else's problem. This makes MD's weak and ineffectual. I find med students and even up to R2's utterly clueless on how to contact the resources available to them (i.e. lowly custodial staff, dieticians, social workers) to efficiently wrap up a case and help expedite a patient's care.

In addition, I regularly meet physicians with numerous years of experience who find that when other members of the team ask them to do something a certain way, like writing orders, to follow the standardized procedure, they simply will not do so. The primary reason why MD's are so spectacularly ineffective in their roles is their utter arrogance to admitting the fact that 1) other people are as important as they are and 2)that every time a physician decides to do things "their way" it costs untold man hours to rectify the problem and get the patient back on track.


When a nurse decides to transition into the practitioner role, if in their practice they are treated with the same professional respect as MD's I have found them to be far more effective, getting the job done with out so many displays of tantrums and blatant disregard for the job everyone else has to do. MD's have the luxury of being told they are so very very important from day one. Nurses are taught we are not as important from day one. We have learned to diagnose and treat in a round about way, integrated into our standards of practice so as to not dare cross over into the "medical" model and dare speak a diagnosis. As if what nurses do isn't "medical" from the second we step into a hospital. Being trained "in the medical model" doesn't make you a jedi warrior, it's hilarious when a M.D actually brays that from their lips. What nonsense.

The bottom line is that this change in roles, this impending tidal wave of need has been brought on by doctor's themselves, who for the last 60 years have been running around touting their incredible powers of mind and yet have been in fact, accomplishing extremely little.

Prime example: Last night I worked registry in a local E.R. The on staff, full time physician ordered a bladder irrigation for a patient, s/p bladder resection from bladder CA. Large amount of spraying blood, gross hematuria, fair amount of blood loss. M.D. refused to consult pt's urologist. I asked the wife to call. She did. We did this without E.R. M.D. knowing.

E.R. M.D. didn't know what type of fluid to use for irrigation. Didn't know how much. Didn't know how fast. Wasn't worried about blood loss. "Have to get the clots out" was his mantra.
Didn't want to pay to have coags drawn. Didn't want to type and cross. Patient nearly died. Pt didn't die because I: 1) drew coags, drew type and screen and broke the rules when I put two on cross later. 2) I called a darn urologist cuz I didn't want the patient to bleed out. 3)I started an 18 guage IV without permission. 4)I demanded he get a uro consult. When uro consult came he admonished moron doc in front of all of us and 5)pt was rushed to or where HE DIDN'T DIE. Doctor didn't thank anybody, was oblivious to THE HOURS OF MANHOURS HE wasted when it took 5 RN's to get the show on the he road and get the work done. AND THEN HE PROCEEDED TO ATTEMPTED TO TAKE CREDIT FOR THE WHOLE SITUATION IN FRONT OF UROLOGIST WHO THEN ADMONISHED HIM. THIS IS A REGULAR OCCURRENCE. I was expected to clean up an incompetent doctor's mess.

I can tell you, no med student on earth would ever, will ever, know how to handle that situation. A nurse with one year of experience will. Your argument logically looks great, just like a nice lab coat and a clean pressed shirt with a tie. But the argument is own by the reality of what happens, day in and day out in every hospital in America. No matter how smart the doc is, they simply cannot fix all the problems with any level of efficacy that they think they can.
And I'll tell you something, because of that experience, because of this article, so help me god, I'm going to NP school. And in three years I'll be healing people the right way, with HUBRIS, but I will not hesitate to take or give credit when it is and where it is deserved."

Okay Licensed to ill fans- check out this young reader reply:

"Old Today, 12:32 PM

Default Re: Doctors-in-short-supply-responsibilities-for-nurses-may-expand
Originally Posted to sonnyluv View Post
WOWOWOWOWOWOWOW!!!!!!!!!!! probably one of the most amazing posts I have ever read, on any subject/topic or discussion board, hands down. Period. I'm not even a nurse (yet)...and you have rocked my world!!! You will be a fabulous of luck to you. "

No shit, friends. I rocked her world. It appears she had some kind of literary orgasm. I love changing lives.
Off to therapy!

Tuesday, October 27, 2009

Paper Planes

Nice to be the 4th most popular dude R.N. in the universe.

I start out in my new E.R. next week. I'm really lucky to get the job. Over 150 applicants, five picked, I made the grade. As much time as I spent in the E.R. as an E.M.T., I am not an E.R. nurse. I have not worked with babies and kids as a R.N. The thought of putting an I.V. into a little guy makes me nervous as hell.

I miss the E.R. Quick movement, patients in and out, more volume than detail. I am also frustrated that an I.C.U. nurse with one year of good trauma experience can't get an I.C.U. job. The market is tight. Enthusiastic career minded new nurses are treated like a plague. We work cheap, we don't bitch as much, and we take abuse we probably shouldn't.

I have found that a lot of experienced nurses didn't really apply themselves to the books when they first started. They didn't need to. It was more about volume, families, more patients died. It seems that I.C.U. nursing is more about science now, memorization of facts and numbers, understanding deep pathophysiology. I feel like I never got out of nursing school. I went straight to I.C.U. , my head up the arse of a book the whole time. For the last year and few months I have been given book after book, taken test after test, all of critical care knowledge. I learned it because I enjoy it and have passion for critical care.
That knowledge is an absolute detriment to my career because experienced nurses are quite savage and vindictive to anyone who might know more than they. My pathophysiology and technical knowledge is far more deep than the average veteran I.C.U. nurse (20 years). However, it is the veteran's practical skills and experience with outcomes that makes her captain of the ship or general of the cluster fuck. Veteran nurses run circles around me because they don't follow the same rules I am expected to follow. They write their own orders, they dismiss labs. They are so bitchy and obnoxious to residents that the residents wait until they are gone to write orders which means 7 pages of crap for me. Basically, they do what they want to.

I had to take and pass a critical care exam to work in my last I.C.U. I was told that I scored higher than anyone before me. When I got on the floor I was EXTREMELY careful to not flaunt my knowledge or act like I knew better than any senior nurses. I was a good boy. Instead, I got labeled a "new nurse" by everybody. The manager told me that if I didn't ask question she would be worried. If I asked a question any of my 5 preceptors in 5 weeks (scheduling bonanza)and they knew the answer to it- what a a stupid question! I'm really surprised you didn't know that! If they didn't know the answer they would tell me it was not of any importance. I got quizzed constantly about drip rates we never used, nursing interventions for problems that didn't exist, I must have been quizzed 60 times on why we deep suction every two hours. So annoying, all these hags so proud of themselves because they can say the word "VAP" and know how to minimize it. Never mind the fact I already was suctioning q2 hours with oral care. I even wrote it into my daily plan of care before the shift started for them to see. Never mind I was taught in nursing school how to reduce ventilator associated illness AND THEY JUST STARTED SAYING "VAP" LIKE QUACKING DUCKS A MONTH AGO. Not one time did a preceptor say, "Clearly you understand." and leave it. Their insecurity manifests in hours of wasted time.

I didn't want to be argumentative, so when one of my preceptors decided I didn't know the onset, peak, and duration of fast acting insulin she went to the hospital's intranet and showed it to me. "This is the IntRAnet!" she said , proud of herself. I nodded like a puppy. I appreciated the fact that she was taking the time to help me out so I said thank you for the information. But the bottom line is I had never heard of Aspart insulin, the last two hospital systems I worked at used Lispro.
My preceptor pop quizzed me-"What is the onset, peak, and duration of fast acting Aspart?"
"You mean Lispro?" The PDF she showed me just said "fast acting".
"I said Aspart!"I was 30 minutes off the peak time, I think I said an hour and a half. The rest of my times were correct. I recited from rote memory. Mind you that my preceptor of course had no fucking clue the onset, peak and duration and was also writing her own order for insulin. I was trying to get her to tell me what THE BRAND NAME OF ASPART WAS when she decided I was incompetent.
Two weeks later the I.C.U. manager called me into her office and told me, "I was told you don't know what fast acting insulin is. I'm very disturbed that Janice had to explain fast acting insulin to you."

I told her that just because Janice had explained it didn't mean I didn't know as people were explaining things to me all day that I already knew. Oh the catch 22. I think it is beginning to dawn on a lot of senior nurses that the game has changed and is in the process of becoming a whole other game entirely. I think it profoundly bothers old nurses that I'm coming out of school with one year of I.C.U. experience and I am able to demonstrate more clinical knowledge then they ever had. It's not their fault, nursing education is different now. Better research is out there. But they hold us responsible for their aging. And I need them, which they know. They have the experience to put it together. They know what rules to bend and which to ignore. They know how their particular machine works, they helped build it after all, but the machine has been redesigned.
Nurses get paid for how long they have been in, not what they know or are capable of.

Saturday, October 17, 2009

It Eats Raw Meat

Now I'm no boxer, not much of a fighter. I'm an unemployable loud mouth knowitall know too much dumbass jacked up to the grain R.N. but...

This speaks to me:

The great cornerman BUNDINI maybe once said:

"God don't care about you! Don't
care about me! In all of everything,
we mean nothin'. He don't know us.
We be.
And that's the onliest
thing he did.
And that's good
'cause that's why we free. But
free ain't easy.
Free is real.

And realness is a motherfucker...

It eats raw meat.

It walk in its own shoes.

It does not waver...


Fuckit, if it takes boxing movies to get my soul back in gear, well then, that's what it takes.

Tuesday, October 6, 2009

Death of A Star

"Tucked In"

By Licensed to ILL

Good white Soul
Righteous indignation
Carnage Deluxe
A Symptomatic Soul
Watches the Elite Burn
Saying Goodbye
Saying Goodbye
Saying Goodnight
Let's put ourselves to Bed
Peer Out over the Covers
Soak the sheets with Our Sweat
Baby's Dream is Baby's Whispers
Loving the Sweetest thing
It's okay to Say Goodbye
Saying Goodbye
Saying Goodbye
Saying Goodnight

I got diagnosed with PTSD relating to a patient of mine who got raped
No one would touch her because she was a dirty homeless meth addict
I told the resident She had a punctured lung
Her left midaxillary chest snap crackled and popped with subcutaneous emphysema
He just shrugged his shoulders
What happened to her?

So my recent co-workers pointed out that I seemed symptomatic.
They told me they were there to help.
My manager fired me three days later.
They saw another nurse who needed help and then they fired me

I no longer live in L.A.
I no longer live in California.
And now I have no job.

And I'm not feeling so good.

Saturday, August 29, 2009

Conan the Barbarian

I have left Los Angeles. Moved to a smaller, more chill city. Northern city. Bought a house in the suburbs. Kind of a blue state, kind of a red state. People seem nice. A lot more white people walking round than in L.A. That's kind of weird. Wonderfully color full, diverse pockets but mostly white. It's weird blending in. I like the anonymity. Why do I notice race? I spent my High School years in a predominantly Caucasian area. Spent my entire 20's as a racial minority. It tends to give one reason to pause and reflect when racial makeups around you change as well as pervasive attitudes and outlooks.

How will I be perceived here? In L.A., some people could care less about race. Some people were openly prejudice. Some people hid their feelings until a moment arose when a preconceived notion was activated by some behavior or incident, some conflict that confirmed the belief they thought they secretly held to themselves. Some people were abnormally nice to me because of my race. Usually because they held ill feelings towards another race and would rather associate with mine. Call it racial motivation. Most people don't think that it exists. But it does. Race is the seventh patient identifier and everybody should goddamn know it. The people that did not care about race were the people that acknowledged these feelings existed in themselves and everyone around them and then simply moved on to more pressing matters. Like building a team, making a friend, finding support.

I do not think I was one of these people. I felt too vulnerable. Been attacked physically and professionally too many times cuz in the summer I look like Opie, with all my freckles and red headed step child hair. I always tried to test the racial water first, to see if the person I was talking to believed that we are all in the same boat, that sinking one, called the USS Middle Class, the one with all the working class people, of all different sexual orientations, creeds, religions, colors, hanging onto the side of the boat for dear life. If they knew this, recognized that this sinking boat also served as a trough to be tossed scraps by the uniform One Raced Management. Management is one race: How can I fuck you without telling you? race. If my coworker knew this, well then, I made a friend.

I am aware that I am damaged goods. I am prone to disgruntled status. I've been burned. Left to fend for myself. Didn't have help way too many times. What I experienced on a daily basis does not seem to happen here, in hospital of the insured land, where they want the "customer" to be happy. Everyday I realize that the abuse I took in the name of "trauma" and most likely also in the name of large corporate bonuses was wrong and hurt full to my disposition, my ability to give a shit about my patients. Right now, I'm grieving. I ache for my naivete, for my spen last honest intention, for my foolish belief that my unit supervisor actually BELIEVED IN the mission statement of the hospital. I am mourning over the days and nights my wife and son had to deal with nightmares that I futilely struggled to not bring home. The drama and the disgusting behavior, the utter maliciousness, usually in the name of an older nurses fragile ego, I brought it in right along with the MRSA and VRE, a prescence that no happy home should ever see. I am so sad that I was so right and so naive enough to think that what was "right" had any meaning or impact on policy or behavior.

I left my hospital in good standing. No official writeups or patient harm issues. I worked hard. Did my job. Got a good referral from a supervisor. Took a lot of abuse, in the name of making it through my first year as a new grad I.C.U. nurse in urban hell. I did my time. I paid my dues. Again. But with my dues came the knowledge of how to shut up, what to say and not to say and how, above all else, to keep the mind sharp and decisive despite the thunderous din that 20 A type I.C.U. nurses make as they watch you take on their workload, their trade and pride, acquired with years of experience AND NOT FAIL much to some of the bitter one's chagrin.

I feel like Conan the Goddamn Barbarian. Especially right at the end of the movie, where he sits on his throne, queitly tough from battles, everything conquered, pondering what made him hook up with Grace Jones. Nothing for ol' Conan to do but reflect on moments of war where he showed true grit but didn't even realize he was doing it at the time. Now, I've only finished my rookie year and my conquering days are far from over. I have many many more battles to fight, lessons to learn, plateaus to reach and ascend from. I'm just getting started.

But in this market, I'm a veteran. And really, I'm more embarrassed for what I went through and saw. I'd rather not talk about it. Cuz when one of the experienced nurses here tells "this one time" story it just pales, in the same way my stories paled in comparison the Old schoolers who taught me.

I don't know what nursing is now. Is it an exact field where everybody has all lab values memorized and we practice over and over the documentation and techniques required for conscious sedation? Or is it a field where you have O2 ready, make sure the patient is on monitor, have an intubation kit ready and just keep track of the fent and versed in your head while you pensively look between the patient, the monitor and the Doc? Is nursing duct tape or a text book? Is it hardcore bullshit or is being a critical care R.N. over studied, over trained, alphabet soup CCRN credentials but with insufficient application experience?

What brought all this up, you ask? During orientation a PACU(post anesthesia) nurse told her super intense story about how a 80 year old woman had to be restrained. Okay whatever. For her, it was scary. But later on, when we were talking about thorough documentation in the unfortunate sentinel event you get called to court I told a story about how my charge nurse got choked out unconscious by a crack head who was coming down and wigging out and how hospital management blamed her for the assault telling her, "You should of known better than to tell a drug addict to please keep her voice down and not go into other patients rooms." Management was mad because they had to hire lawyers to impose a permanent restraining order against the patient from ever intentionally coming to the hospital again. She got blamed for even going to court.

My new co-workers were horrified. Jaws open. I could see one guy giving me the "You're so full of shit" look. But I didn't even tell them the whole story. How the crack headed lady skillfully grabbed my balls while she scratched the face off my charge nurse, how ten nurses, male and female dove head first into a brawl with the crack heads family members who immediately accused us of HURTING HER. (Right?) I didn't tell them how the cops came, en masse, five white cops (Of course it's a predominantly African-American neighborhood) billy sticks out and mace drawn, ready to kick some ass-the offended "You pissant" look the Sergeant gave me when I told them to put their clubs away because we had finally gotten the family isolated in a room and they were going to freak when they saw the clubs. I didn't tell them how I wasn't afraid of the crack lady, I was afraid of her 20 year old son, ghetto brawler who slyly stepped just outside the room when we went in (yes you do have eye balls on the back of your head cuz it wasn't Yoda squeezing my sac) and to a lesser degree her husband, right hand in his pocket, gawd jeezuz I can only imagine what lethal weapon was going to come out of that fucking pocket.

The PACU nurse said to me, "Oh my gosh you have been hurt! It sounds like you've had a pretty rough introduction."

Yeah. I am disgruntled. I'm pretty sure I was thrown to the wolves but they only got an arm or a leg.

And I need to get over it, fast because the medical world I'm in now, it may actually be the Disneyland of hospitals. I mean don't worry, I always find a way to be horrifically outraged and crank out master rants of disgust, don't you worry, my literary scoobie snacks will prevail but- I've got to stop mentally wanking on my post scary situation bitterness.

Later the PACU nurse said some very nice, sincere things to me. She told me she was glad there was people like me in the field. She said I seemed like a good nurse. She told me never to take nursing bullshit home. She hasn't worked in five years. She's never been a critical care nurse. She doesn't know.

But she is right. She is right.

We are all here. We are all here.

Thursday, July 30, 2009

To Live and Die in L.A.

I have just resigned from my first nursing job for a number of reasons. I gave three weeks notice. Sadly, I do not feel relieved. I feel scammed and ripped off, exhausted and abused. I don't feel free. I'll expound more on that next week. First, I must share my lessons learned so that others following in my footsteps can remain modestly protected. Thick skin is understandably and necessary requirement to nursing, however it appears shank proof skin is more the order of the day.

1) Even the "cool" experienced nurses you think you can trust will jab the knife in deep given the opportunity.

2) Everybody has a family and obligations, just like you do, they don't care and as a new nurse, even with identified potential you are still a flash in the pan.

3) Experienced nurses (+8 years) absolutely cannot tolerate being identified as having made a mistake or doing anything that might reveal they are human and not perfect. If you stumble across a nurse who say, has proudly announced that she thinks restraints are unnecessary and cruel while her patient is now holding their yanked out portis subclavian central line DO NOT WANT YOUR HELP

4) An experienced nurse who suddenly befriends you has fucked up amongst the other older nurses and is using you as a surrogate friend until the old guard accepts her back.

5) If you ask for help from an experienced nurse and actually receive it, the service comes at a cost: they will then take credit for all of the work you have performed on the shift until that point, with no shame. NOTE: The exception to this rule is older male nurses. I don't know why but they seem pretty stoked when anyone will just listen to them.

6) If you are suicidal enough to point out an error in logic, intervention, or treatment with an older nurse dumbly thinking they will appreciate this then you will forever be labeled as a "know it all" and "dangerously arrogant" despite the fact that usually, the only patients dying from lack of informed and or supervised care is their own. (Hence the constant phrase: "oh, but he was old")

7) Sadly, the one way to break down most fucked up nurses is to ignore them and be openly hostile. I myself hate behaving this way, it makes me feel dirty and sticky in my soul but after a month the same nurses that would literally ignore a question to their face will be hugging you and be delighted to see you.

8) Escape into patient care and knowledge. When in a confined environment surrounded by jackal infidels the only place to go to is work. Might as well do it well. Do not ask questions from senior nurses as they are inherently insecure and confuse genuine curiosity as an inquisition and threat. One question too many may shatter their fragile sense of competence. REMEBER QUESTIONING IN NURSING SCHOOL? IT WASN'T ABOUT WHAT YOU KNEW BUT HOW WORNG YOU WERE. The field hasn't progressed, trust me.

9) It's a great idea to make allies with interns and residents, usually because they relate more to younger novice nurses than older snappy ones and working together to help a patient becomes an effective, educational , and rewarding experience.

10) If the older crew see you relaxed and making jokes with physician staff they will call you "lazy" and will accuse you of ignoring your patients despite the fact that is exactly what they are doing when gossiping about you. Never mind that. Nobody wants a letter of reference from an old crabby nurse who treats the latest evidenced based research and knowledge with the same disdain as she would the newest thrash metal album from Slayer. She aint buying it.

I wish instead of a LA TIMES 20 part news story about 80 whacked out nurses and how they have fallen through the cracks of diversion, I 'd like to see a story on the tens of thousands of tax paying Californian R.N.'s who get regularly scammed and shorted on their paychecks by gloating big bonused hospital management. (Again next weeks topic)
I feel fucking violated. Not only were their staffing ratio's absurd, but when I found out how my new hospital staffs their ICU I got choked up. Seriously, I choked up.
Patient with a balloon pump: 1 to 1.
Patient on ventilator with ANY pressor going:1 to 1
Patient on CRRT: 1 to 1
Patient returning from any invasive emergent cardiac procedure:1 to 1
Seriously, it made me cry. I've had assignments so unbelievable and harrowing while three morbidly obese shit talking multiple personality snackers loudly predicted any possible negative outcome to my patients. ONE TIME IN A YEAR did I have a 1 to 1. Septic, over 300 pounds, active MI, central in groin and central in R IJ, Multiple blood products, fucking 14 PUMPS! NO shit. At 0430 the supervisor literally grumbled all right, make it a 1 to 1 at which point my other co-workers literally stopped what they were doing and demanded I thank them for RECORDING THE VITAL SIGNS ON MY OTHER PATIENT.
Friends, I have had patients code during report and then been barked at by my supervisor for taking too long to get report on my second patient.
After the interview at my new hospital. I, a man, a dude who is semi-permanently disgruntled, prone to the negatives, a man who relishes the positives when they come, a nurse who gives a shit about his patients because it is the only way to stay sane and true of heart, a father, a husband.
Well, I cried.
I cried for my exploitation, I cried for my patients who got just -enough-to -keep-you-alive-care night after night. I cried for the thousand and thousands of times I signed my names to documents that no one will ever look at, selfish documents to cover some lawyers ass that took unreasonable time from patients rotting with bed sores and their own shit. I cried for my co-workers who just don't get how disgusting it is that one ICU manger can cause so much human suffering and distress to get a fat bonus. Cuz that's the bottom line and it always will be. If you need someone to create abrasive, unethical policies that save substantial money in an environment that requires vast resources, well your soul has a price.
The last few weeks I have been blaming foreign nurses. But I may be wrong. I don't know. I do believe foreign nurses don't bring a whole lot to the profession as a whole. I think they inadvertently bring standards down to the standards they are accustomed to.
  • My new unit has no foreign nurses. Not one. 60% of the staff R.N.'s have CCRN certification. As opposed to NONE in my last I.C.U with 20 more beds , a staff of 60, and most nurses with easily over 10 years experience residing in a level two trauma center. I will never hear report in Tagalog at my new hospital. My supervisors will communicate in English.
I hope that the racial divide that is burning like napalm in nursing will not be present in my new unit. I hate how discussing the fact that foreign nurses is in no way good for American nursing is considered racist.
I have left Los Angeles. I have left my home state of California. Surprisingly, the money is better in a more affordable state. It appears, on first glance, the care is better. It also appears that the treatment I will receive as a professional R.N. will be commiserate to the demands and complexities of my job.
This all, of course, on first glance.

Monday, July 13, 2009

You fucked up, you REALLY fucked up.



Man I wish the media would come up with a better tag line than "due to the ever increasing nursing shortage this hospital now has...."

From there we fill in the blanks: "Due to the ever increasing nursing shrtage this local hospital has..."

  • Happy go-lucky MALE NURSE perverts working for them.

  • Drug stealing junkieusers working for them.

  • Shameless overpaid nurses on overtime falling asleep on the job recklessly killing patients and laughing all the way to the bank.

  • A male nurse who molested every single female who came into the 500 bed hospital and managed to used the prolapsed anus of a 90 year old woman as a cigarette holder for him while he peed on her dog as he was insanely high the very last pills of ambien and colace she had,etc.

It's never real shit like: nurses don't get breaks anymore, management harasses R.N.'s who have a conscience, nurses seem to be making LESS money despite this incredible shortage...

As a R.N. I see nurses everyday who shouldn't be practicing in a perfect world. Some because of their atrocious attitude towards patients (burn outs), others with obvious mental problems who probably wouldn't be safe to handle fries at Burger King (related to traumatization and abuse on the job), and some who simply came to this country to make more money then they could in their home country. (sorry Pinoy but 6 out of 7 of you guys do a disproportionately large amount of the fucked up shit I see. Your ambivalence towards human care is as horrifying as it is somehow culturally ingrained)
There is no nursing shortage in the U.S. That's nonsense propaganda created by hospitals to get cheaper foreign labor. Only hospitals that are so hellish in their treatment of nursing staff have staffing problems and experience a "shortage".
The AMA and hospital associations have enabled tens of thousands of nurses to come to this country from other countries for the sole purpose of making money on cheaper, more obedient labor. These nurses not only leave their home countries in a void of health care but also leave American R.N.'s to take up the slack. At least four of my coworkers don't speak English adequately enough to carry a conversation but know how to perform medical tasks. Some were able to take the licensing exam in their native language. I am constantly covering their butts just to make it through the shift. If I were to complain I would lose my job, union or not. I would be called a racist. A hundred years ago they would have called me a "nationalist" but nobody knows what that word means anymore.

Nursing is an unbelievably complex job that is constantly being put down by media, hospital administration and physicians. So many nurses have drug problems because the people who take care of you HAVE ABSOLUTELY NOBODY TAKING CARE OF THEM.
The article that led to 6 out of 7 BRN members getting tossed on their ass demonstrates how absolutely crucial the job the R.N. performs is.
The effectiveness of the BRN is severely limited because the BRN is inundated with three types of complaints: 1) My nurse doesn't speak English. 2) Hospital managements lodging erroneous complaints against nurses in retaliation for sticking for themselves and their patients. 3) Complaints filed by hospital management to cover up mistakes of arrogant physicians.

The largest reason the BRN sucks is because its staffed with hacks and non-nurses. Go figure! Political payback is tasty.

Nursing practice has changed so much in 20 years- the job that older nurses were trained to do simply doesn't exist anymore, nursing is truly not "nursing" as people know it. It is an incredibly complex, demanding, and intensely challenging job that requires dedication and- the nursing profession still doesn't recognize this- it requires talent.

Nurses are treated so poorly by physicians, hospital management, and most certainly the patients that they treat that a dangerous nurse is easily overlooked because everyone walks around in the medical field thinking "another dumb nurse did this".
True bad eggs like the ones in the article would be cracked and disposed of more quickly if quality nurses were recognized, and nurses who have no business being in the field were rooted out.
Bad nurses get away with it because, frankly, it seems that the public is quite happy with the stereotype of nurses being angelic, mothering, brainless assistants.
I don't think the public or the media comprehends the importance of the nurse in the disease and healing process from a technical and clinical standpoint. At all.

Right now, bad nurses run the show. The pathological liars, the borderline personality disorder bullies, the perpetually immature 14 year old girls breaking hospital units down into clique war zones. Right now, everything that is wrong about nursing rules the roost. Nobody complains about anything that means a fucking thing. Nothing about patient care, nothing about pay, nothing about safety, nothing about the blatantly redundant paperwork. Everyone feels like they can't change it so on Tuesday lets gang up on Tina and whisper behind her back and start some shit. Then we'll complain that she was mean to her patient, "no it's true, she was soooo mean to her patient cuz I was on like getting a hotel room for vegas so I like heard everything..."

Oh well, tonight I sleep good. For the first time in many moons, the nursing gods have hurled in some political 18guages that pull blood out like central lines.

Wednesday, June 17, 2009

One thing Leads to Another

One thing led to another, that day in the late afternoons of early summer. Holding hands on an unchaperoned date led to heavy petting which then led to some very heavy anal sex.
That little toke off that marijuana cigarette led to IV heroin with dirty needles. Like shooting hoops on the city court with some friends leads to the Lakers winning ANOTHER goddamn championship (along that plump vein- a team winning a championship leads to numerous cars getting rocked off their fucking shocks and stores burned wide open). Billy shooting a pistol at the Beverly Hills Gun Club leads to Arnie "Ahmadinejad" Iran posessing nuclear weapons. Like sending your kids to college leads to Bernie Madoff, like telling your Mom your love her leads to homosexuality if yur a dude, lesbianism if you're a chick and it's yur dad. One thing leads to another. One small thing leads to the motherfuck of all things.
Pre-WWII German's wanted government subsidized healthcare and ended up with six million jews dead, 3 million of them doctors so that fucked that whole thing.
An enthusiastic go-getter of a Jedi, Anakin Skywalker, thought he was being passed up for promotion too often so he turned into Darth Vader.

It's a scary fucking world.

A few weeks ago a pharmacy tech at Long Beach Memorial Hospital in Long Beach California killed two employees (both of whom were his managers). I used to work at that hospital and I knew that man. Not well, but it was he who handed me my first few bottles of legal speed, Adderall. One pill of Adderall leads to a blog called licensed2 ill.

Management at Long Beach Memorial is positively viscious. Disgusting. What did it take for him to snap? How much dignity did they make him dole out in handfulls before he found out that they were going to ditch his already overworked ass. One thing leads to: BOOM!

Last night my patient was an 88 year old man. Shortness of breath leads to intubation> leads to sepsis> Leads to ARDS> Leads to sedation with fentanyl and versed>leads to levophed> leads to CPR> leads to death.

But lets back up. This 88 year old man happened to be one of house anesthesiologist's father.

Here's the kicker: She wanted everything done to her pop possible to save his life despite the fact he was a DNR. Do Not Fucking resuscitate Under Any Goddamn Circumstance unless you want to lose your license, get sued, go to jail. But when push came to shove, and even though the old man had the DNR because he saw his wife go the same way a few years ago and a) couldn't live without her and b) didn't want the same treatment. But when the time came and death grabbed the old man by the ballz the daughter, Dr. anesthesiologist did what she could only do in a moment of grief. Jump in and intubate his demented ass. (He may have dementia as well no one knows). Fuck me.

Here's the other kicker. The two pronged double kicker: She is an anesthesiologist-the stoner of medical specialties-she orders no sedation, no pain meds, nothing to make him more comfortable. Father is totally on ventilator, restrained, cannot move shitting in bed with not a single opiate or benzo for his ass. For those of you who don't work in the field, being awake on a ventilator has got to be one of the most hellish and violent experiences a human being could go through. A machine tells you when to inspire and expire, every hour some dipshit like me is sticking a tube deep inside your lungs to suck the mucus out. It is excruciating. But no pain meds. Per her strictest orders.

So at 0400, after asking him 20 times all night if he was in pain, each time he said yes, each time I asked him if he wanted pain meds he said no, I said is it because of your daughter he said yes, I said does it feel good when I have to reposition you every two hours he shook his head no. Enough.

Enough. I could help but feel in my heart to the it of my gut, my son, my two year old in thirty forty years making this decision. Me old, sick, dying in bed. My life, my youth robbed from me by the same clock that has taken it away from all others. A selfish scary view of mortality that keeps knocking me upside the head, more and more lately. Enough. MY sweet boy. Her father. His age, his eyes, they looked like the anesthesiologist's eyes, his nodding and shaking his head. MY job. My license, my beautiful wife. Her body is still young, so is mine I guess, HOW LONG HAVE WE GOT?

But here's the second part of the kicker: He came in filthy with bed sores all over his body. He was being neglected at home. He had over nine documentable wounds - wounds severe enough we had to document them with pictures on his 88 year old body WHY KEEP HIM ALIVE WITHOUT PAIN MEDS? Enough. I called the intern. Gimme morphine for the old man. Hell no the intern said, it was his ass. Give him tylenol intern tells me. Fuck you Brian. I gave him tylenol. It didn't do shit. Silence. 2mg of morphine slow as fuck. Thank you. Done. I gave it like sloe gin joe. He slept for the first time in days.

Jesus on vent, nailed to the Hill-ROM ICU bed with nothing for pain or sedation. The next day he did so well on his CPAP trials he was extubated.

How did his daughter know? How sick is it she knew the drugs of her own trade, given in our protocol doses would have killed him, kept him from getting better.

How did she know there was a lonely isolated male nurse taking care of him who eased his own futuristic uneasiness by medicating her pop. Whatever. That's the second time I've seen a train wreck come back when the physician parent declares a "no opiate rule no matter what" with the patient and a miraculous recovery is scored with in days. Like going from your deathbed to cooking breakfast for every nurse in the ICU.

God there is so much I don't know, like waking from the nightmare in a room with your eyes open but its still too dark to see.

Like Ben n' Jerry's Cherry Garcia leads to morbid obesity.

Like depression and burnout lead to apathy and disgust.

(I know the holocaust joke is a bit much but goddamn it people- the shit I see- thie shit I see)

Wednesday, June 10, 2009

AMA makes me go AMA (aint got nothin' on me)

I posted this response on The AMA is pissed that the new nursing doctorate program exit exams are touted to be as challenging as the third level of USMLE. Seems MD's are worried that these fake doctor's will obtain REAL doctorates, then call themselves doctors and thus will give physicians a bad name by providing excellent care, actually listening to the patients, and actually giving a shit. Outrageous.

This is a long post- my posts always are- that's how I roll- but I'll end the argument right here.

This one is important. I think the DNP is waaaay ahead of itself. Certified nurse specialists are hardly recognized. I work on the floor with N.P.'s who are kicking themselves because the payoff for 20K to 40K in loans and two more years of time and effort has been NOTHING. Having a BSN's doesn't guarantee diddley squat professionally, either. I don't think R.N.'s need a doctorate to prove their worth. It's like an industry wide lack of self esteem. The ability and potential of a minority of educated and motivated nurses is like medicine's dirty little secret.

"Medicine decries nurse doctorate exam being touted as equal to physician". Uhhhh-so what if it is? There are many different kind of nurses. Many different kind of doctors. Lawyers. Sales people. Pool cleaners. Judges. Some people in their chosen profession choose to take it as far as they can. YOU WANT TO ENCOURAGE THESE PEOPLE. Some nurses I wouldn't even let take care of my pet turtle. Same goes for everything. So what if the exam is equal to the USMLE?

Whenever I talk about my job people ask me if I'm a doctor. I proudly tell them "no, I'm a R.N."- I usually get a quizzical look implying the person asking the question thinks that if I'm not a M.D. I must hang around slinging bed pans all day, their look clearly says: "Why is this guy talking about HIS patient like he makes decisions about their care?" So I politely explain that M.D.'s make disease diagnosis and are in charge of plotting a course of treatment for the patient. I explain that is is my job to not only understand the course chosen for treatment- but I am the one who institutes the treatment and I manage it's physical run. Yes, doctor's prescribe medications and order diagnostics. But in my I.C.U. they sure as heck don't give medication. I start the I.V. I give the medications, I assess the patient and if anything goes wrong I need to catch it before it happens and give the doc a heads up so they can re-plot the course of treatment. If this is not true then why do I need to have a license? Why am I held accountable for an adverse reaction to treatment or a change in patient status?

Last night- I admitted a patient from the E.R. with a primary diagnosis of pneumonia, c/o chest pain-with an extensive cardiac history. The cardiologist who ordered the admit had full privileges at my hospital as he was standing in for an intensivist who had a family emergency. The cardiologist was responsible for the admit and all other standing orders. Other than the insurance the patient had, the cardiac history, and the fact that the patient had received nitro and morphine in the E.R. the cardiologist didn't know anything abut the patient OR WHAT TO DO WITH HIM. He had no clue how to address the possible pneumonia and or sepsis. (Apparently he hadn't heard of Joint Commission)

So I walked the cardiologist though activity, diet, fluid type and rate, antibiotic regimen and all other diagnostic procedures to rule out sepsis. I wrote the "orders" as I gave them with his consent. Apparently the patient had thrown up in the E.R.- I asked for an anti-emetic-all I heard on the phone was,"uhhhhh" So I suggested a medication with rate and frequency. I asked him for cardiac parameters. The cardiologist asked me how the patient looked. I gave him my the results of my cardiac and pulmonary assessment. He thanked me profusely, gave parameters, and kept apologizing that he was just moonlighting, he hadn't done this in a while.

He asked me for my interpretation of the chest xray.

I told him "Sorry, out of my scope." But I had seen bilateral infiltrates in lower lobes when I read it. So I again encouraged that we follow the sepsis protocol. No problem. It was nice that he was pleasant. But when push comes to shove-yeah, M.D.'s don't find the R.N.s so incapable after all. And then I began the paperwork.

Later that night, the attending came by and said, "Wow! Dr.--- can still write ICU orders like he works here everyday." I'm not a doctor. I sure as heck don't know as much as one. But how much education combined with clinical experience do I need to know as much as one? No doubt, a lot. As a brand new nurse I got chewed out by the attending physician right along with the interns and residents for flubs that we all should have caught.

You see, it's role reversal, plain and simple-without the exchange of authority. I want to learn more about the disease and cures while many of those interns, now residents, want to develop their bedside manner. Seems the smart ones have figured out that it increases the odds of a better outcome to be able to communicate with one's patient. Nurses learn this immediately. Some doc's never get it, or care to. In my opinion, they are the ones who are doing the most damage to physician's. Not a DNP. It appears that the few nurses who choose to pursue advance training, pushing the envelope of our assigned role is clearly terrifying to M.D.s. Perhaps a bit of "man behind the curtain", huh?

They can call us dumb nurses, wanna-be doctors, whatever. MD's know very well that as treatment becomes more rapid, more complex, more demanding, nursing education is becoming a dynamic new modality in itself. If I don't understand or anticipate treatment then I am useless.

And as frightening as it is to the A.M.A., I am rather inclined to learn as much as I can about the science behind my work so I 1) don't hurt my patient 2) continue to bring enthusiasm to my career. That may include advanced degrees. And I'm gonna say it: In my area of specialty, it certainly appears that experienced and well educated R.N.s know absolutely as much as physicians do, in that specialty area, and physicians know it. Much in the same way a cardiologist doesn't know what to do with an admit. You want evidence to back that statement up? Ever watch a new intern ask an experienced nurse a question? Tell me who is giving "orders" to who. What doctor hasn't been shown the ropes by a R.N. at some point? From the basics "he needs a fluid challenge" to "write an order to start a levo drip at 20mcg/min and start a central!"

But to know as much as an expert, takes a combination OF YEARS and education. Expedited by education but you can't be an expert without some serious time laid out.

According the the A.M.A.-this is simply impossible.The A.M.A.'s argument is essentially,"If you didn't start your career with a M.D. then you can't ever be as capable as one." Look how they treat D.O.'s? Childish. The truth is that the A.M.A. is concerned with the bad publicity they will receive when advanced nurses start taking the equivalent of the USMLE. THEY WILL DO OUTSTANDING. Nothing like the motivation of those with something to prove.

Example: My old hospital was a teaching hospital affiliated with a major university. It has a C.R.N.A. program. The S.R.N.A.'s have to retake anatomy and physiology along with the med students. Scores were posted in doctor's break rooms. Most of the med students pulled C's and D's. The nurses all scored above 80%. The hospital promptly stopped posting scores in the break rooms.

This is a turf war, plain and simple. MD's can't operate without us. Let them waste their time fighting nurses. Nurses don't fight for turf with doctors. We fight for respect and autonomy. Meanwhile- insurance companies- the real turf monster, are wiping the floor with what used to be the physician's salary and medical authority.


Sunday, May 31, 2009

I guess that's why they call it the Blues

Keep getting called off. I had three shifts this week- called off on one of them- put on call for the other to which I was never called in. This keeps happening.

My ICU normally holds 32 patients. Right now we have 10. Can't get a new job. Nobody is hiring and I'm still too new. I don't have any PTO. Management could care less. I asked if I could pick up shifts in the E.R. or med surge and they bluntly said "no". I wish they had said "Go rot" because then it would have been completely unambiguous. Ridiculously, the other units are still using registry! WTF?

My shift starts at 1830. I get put on call at 1630 until 0030. Whopping 48 bucks.

I'm planning to leave Los Angeles with my family. Move to another state up north. I certainly don't expect the job situation to be any better.

Gosh everyone, I'm bummed out. I wish my company cared. I wish they at least pretended to give a shit, or at least would help us get more certifications while we sit on our duff like CCRN or PALS or something. One big thing about California: Nursing is remarkably uninterested in education of any kind.

I mean, only in nursing does the R.N. have to pay for the C.C.R.N., probably get more responsibilities once obtaining it, then get abused and harassed by the perpetually insecure older nurses for getting the cert but get not one cent more for having the credentials.

The only thing I like about nursing right now is my patients and their disease processes. And they like me.

Don't you feel like you retreat into the job of nursing, into healing and working with your patients to avoid all the bullshit? As if I'm hiding from the drama by doing my job.

Tuesday, April 14, 2009

Soft Shelled Soul

My life is good. My son (now almost 2!) is more like a little boy than a baby. He's my buddy. I often think about his innocence, and the sincere love of my wife for me and him during the drek of some of my more challenging, heart stopping, tedious, or humiliating shifts. I endure the ebbs and flows of an often scary, dysfunctional career choice for them, and through my family, I get stronger when the tide ebbs and flows.

Nursing is fucked. At least in the beginning. New nurses in my unit are treated like sub humans. Everything we say or do is mocked and considered stupid. And in all honesty, a lot of the things that we new nurses do is pretty darn mockable and stupid. But more often than not our treatment is excessive and has no purpose other than to amuse bitter, older nurses who feel resentfull that the profession has moved ahead and sky's the limit. It is no longer a career choice for those who seem to have chronic, deep self esteem issues and hide behind "a calling".  I hear abot the chaos of their personal lives: divorce, or other wise never married, twelve cats, vacation money spent on taking the dog to the vet.. Nurses are smart people, not particularly intellectual, observing some rigid hierarchy that takes at least 5 years to climb on and carve a niche of protection for oneself. I don't get to work with the other 12 new grads they hired into the ICU. It seems I am on the opposite weekend schedule as almost all of  them. I work except for two or three almost exclusively with senior nurses. I've spent a lot of time wondering if I am still paying dues, or if I  am the young being eaten (frustrating at 32-ooh they hate that. Second career er's).  Perhaps they are just foul tempered in general-and this seems to be the case. But an especially vicious, degrading venom is saved for new comers to the field. I would take this venom with no complaint if it came with information on how to do my job better but the majority of the time I am sighed at, snapped at, loudly gossiped about, IGNORED COMPLETELY I am not privy on how to do my job better. The worst part is that all of the experienced nurses do the same task differently and if they do bless you with advice, solicited or not and you choose to not take it, shit-you're fucked and MAN they resent that.
I have come to find that the constant stream of disrespect is not about me personally, though often the intent is to make it personal, only to make the sting worse. But I work with a group of people who have been together, most for at least five years some as much as 30 and have come to see new hires as management's way of reminding them that there is cheaper, happier, labor out there. To make matters worse, they are forced to "baby sit" us, to teach us, to guide us. They don't want to. Unless precepting they don't get paid any more for it. They are coiled snakes, Iam the urban backpacker, blindly smiling at the scenery, carousing through the grass after dipping my feet in the pool at the bottom of a waterfall when OWWW! I stepped on a snake. 

I got my first 1 to 1 patient assignment two nights ago. She was my patient again last night.
During shift assignment I asked if I could have the admit, I told them ,"I need the experience, with paperwork and otherwise." I'm tired of my admits being confusing disastrous affairs. Endless paperwork I never see unless I'm admitting, trying to still balance my other patient. I am here to learn. Practice. I was not cavalier or loud. I stated a plain fact as none of them showing any pretense of liking me, a reasonable request. They got a hearty laugh out of that.  The oldest one, Rhonda, shook her head and said, "You'll never want an admit again." More evil laughing. Fuck them. I'm here to learn. I practice the number one rule, applicably to any situation in career, love, life: Do you job well, be the best, no as much as possible- and then you have a foundation.

My admit was a direct admit t from the OR, preceded from a frantic call by the OR nurse, with little to no information other than, "I don't know what's taking them so long to close her up." I asked how much blood had been lost. "They said only 300cc's but I counted 20 completely soaked towels." The patient's arrival was preceded by the general/trauma surgeon covered in sweat, writing orders. Telling me to anticipate an anxious family. This struck me as odd because the surgeon doesn't normally bring the family talk to the ICU.  "Just get the FFP in her as fast as possible, use whatever vent settings keeps her alive. She's not a full code, no compressions or defib. Other stuff. In the paperwork somewhere."  Then he split. RT got ready with a vent. The only other white male nurse on my schedule, Roger (sorry p/c world but you notice these things when you are a minority) with just over three years experience, one foot inside the circle the other foot still dangling out did his best to prep me for battle. "I'll do compressions, you just get drugs." 
He more or less gave me a pep talk which was nice. The patients arrival reminded me of a trauma arrival in the E.R. Everybody happily pumped at first, then within five minutes everyone is sick of waiting, all jokes had been told, just ready to get to work. 
My dyke supervisor hadn't shown her close cropped head yet during the shift, which was unusual. I thanked god. She is a barrage of insults, veiled threats, dirty looks, intentionally confusing verbal directions. She adds the cluster to the fuck. Gross. She just makes life miserable and nasty.

My admit was a bowel resection gone on too long, patient too old (past 75 years) to be so morbidly obese at 155kg+, her  hernia not dealt 
with for like 40 years. AMS for 5 days, apparently her bowels had been recieving no blood flow for this long-her hernia cut off blood supply. 1500/cc's of dark brown fecal matter suctioned from her NG tube prior to surgery.  50% of her gut had to be removed. She had no neuro reflexes. Levo at an outstanding 20mcg/min to start.  5 liters LR already in. She came to me with a A-line BP of 75/30. HR good. Order for 4 units of FFP waiting.  
I hooked up the A-line to the monitor while Roger got the bed situated, RT started hooking up. The OR nurse looked freaked but I ignored her. She looked to rattled to even figure out how to disconnect the portable monitor. She's always jittery so I tried to pay it no attention. The anesthesiologist starting apologizing to me for the
 chaos and the fact that the patients right IJ line  wasn't sutured in place and then I got a little freaked. Looking back, I realize- the OR nurse and the anesthesiologist  were trying to give me an updated report from the phone, also going over info I already know-but they didn't really help get her on our monitor or set her up. They both asked, "any questions?" at the same time. How do I know? I'm trying to get the patient at least hooked up- the levo was so high that her extremities were mottled, we couldn't even get a pulse ox reading. Any questions? Yeah. One. What the fuck? What about that category status?

Then walks in the supervisor. Fucking EVERYTHING up. Barking orders, pouring on the confusion. Asking for the patient's property sheet. It was so frustrating. I was 50% set up. Getting ready to take  a step back and evaluate the patient. Roger had got a little ahead of himself and had put the IV pole on the left side, even though I had told him the IV lines were on the right IJ. I had already set the room up. As the patient came in I didn't notice Roger moving the pole. By the time I did the supervisor had already started her fucking harassment. "The R.N. formerly Known as Angry Male Nurse, why did you put the pole on the left side?" First off, in this stress full situation, why ask me why? Do we really have time to explain? I continued to set up the A-line, I wanted to say, "Roger did it" so she'd get off my back but then I would be ratting Roger out, who while not being the most impressive or experienced nurse around is the only one offering help. So I say, "I didn't move it over there. " Roger finally mans up and says, "I did, I didn't see the line." Supervisor's tone TOTALLY CHANGES.  
"Oh, yeah too many people to see. No problem. Well lets move it back over." WHAT THE FUCK?

Then she barks her first direct command at me, "T.R.N.F.K.A.A.M.N. (me) start your assessment we'll move the pole." Fine except 1) my physical assessment doesn't mean shit if I don't know if the patient is alive or not and I'm 20 seconds from having the A-line running 2) Dr. Drugs didn't suture in the Right I.J. and Roger is  so fucking scared of the supervisor he's literally YANKING OUT THE LINE. I pull the lines with my right hand to get some slack and I compress the IJ insertion sight with my left. In my head I was thinking - I should explain what I'm doing to the supervisor- but then another part of my head said- isn't it abundantly obvious what I'm doing, focus on keeping the line in, yell at Roger to stop moving- I yell at Roger, "Line!' and my supervisor, I swear to god tries to pipe in "NE!" Like she's got it under control. She tells me to get out of the way again but Roger is too far away to give slack. I don't say anything. I'm literally stretched out over the bed, one hand on the jugular one hand holding the line."
She literally screams, "Fine! You don't want my help than do this yourself!"

She storms out of the room, no doubt to run from module to module telling any nurses with 10+ years how horrible I am. That's how I know how irritable she is. The more annoyed she is the less years of exeprience it takes her to slander me. I 've had her at the 5+ years before. That's not paranoia, people. Some of the ancillary staff, R.T.'s, the one tech we have until midnight, have told me verbatim the bullshit she tells people about me. I can never win.
Roger brings the line around. 
"Man she makes things difficult", I say.
"She can be a bit of a drama queen," Roger replies. But drama queen doesn't cut it. First off, she looks like an old dude. She has the worst case of penis envy ever had, I know she's wearing a fake dick.  She slanders, she lies. She cannot have a single interaction with me without making a joke at my expense, rolling her eyes, glaring at me, cutting me off.  She's thinking "How come this weird, wrongly confident guy gets to have a dick and I DON'T? I wish I could sit down with her and say," It's just a dick, boss. It's what's on the inside that counts." In her head she thinks life is easier for me because I'm a guy. A white guy. Just like the ones that treated her  former Iowan redneck ass  like total shit. I can totally picture her figuring out around the twelfth grade that the reason why no guy ever asked her to prom is because she's freakishly boyish, likes to kick football player's ass, and finds the smell of vagina somehow alluring...vowing to hate. Her last ditch attempt at femininity was to become a nurse but she quickly realized that for those with the right moves it was a way to burn to memory her unspoken desires. To this day she lives alone, childless, doesn't have an old lady, loves the 49'ers. So I suffer.
But this time, like many other times, I have my patient to retreat into, to focus on, to nurse.  I get working. It's Roger and me for about an hour and a half. He's grabbing the UA, pulls an ABG for me, relays some lab values, he grabs the four packs of FFP for me. We double check them off together. Team work until 11:00 p.m. when the supervisor comes back into the module. I see her walk in. I hear the older nurses laughing. I hear one of them say, "He'll never want another admit again." Then Roger is gone. Sadly, for the next two shifts he cops an attitude with me. Just like that. I know what happened. The supervisor made it clear. Him or me. Roger has a family, too.  Supervisor leaves and the charge nurse says, "They should of just let her go." It's a fucking hernia you jaded psychopath! Being old doesn't mean you should die. The charge nurse is like 65 years old herself. What the fuck happened to these nurses to make them hate so goddamn hard?
As they are laughing at my fading vital signs 65/30, still no fucking O2 sat because she has no peripheral blood flow. I ask the RT to get one that adheres to the head. "Nope. Can't do it. We are only supposed to use those as a last resort in the case that we can't get a pulse ox reading from the hand and we've tried repeatedly."

"I can't get a pulse ox reading and I've tried repeatedly,". I'm getting the vibe she's been Supervised if you know what I'm saying. The intern walks in. "Still no pulse ox? Can you get one of those ones that goes around the head?" The RT sighs and says, "I'm really busy, but I 'll see what I can do." Like it's a personal goddamn favor or something. You'd think the Respiratory Therapist would want to know the saturation of the patient she's setting the ventilator to minute by minute but hey, an ABG once every 4 hours is good enough I guess.
She comes back with the head band. "TRNFKAAMN, this is it. Alright. I did you a big favor here."
Is she going against the will of the Supervisor, does she have a limited stash? Or was she just to lazy to go get one? No doubt she's busy, we all are but fuck, we need a goddamn pulse ox reading. Either way, I thank her profusely, I act as if a great personal favor has been performed.
Intern wants a C.V.P. Got to set that up. Haven't set up an A-line and CVP simultaneously from scratch before. It takes me about 10 minutes longer than it should have. I see  the Supervisor an
the old Burnouts watching the monitors from outside. "Wait-there it goes, nope!HA-Ha!" It is sport. I plug it in wrong like 5 times but eventually I realized I had the CVP in the right ports, I just needed to zero the monitor out before it would start reading. Low and behold- got 'em both. Now that knowledge is mine. CVP=5. That's low. The written order is to continue bolusing until CVP is above 15. We gots along way to go.
My patient B.P. sank then rose as we brought the levophed up to 40mcg/min. The resident walks in. He sees the patient start to move her right arm. The k-hole (ketamine) Dr. Drugs had put the patient in to paralyze her is starting to wear off. I'm relieved. She's got neuro reflexes slowly coming back. So what's the first order form the rez? Fentanyl and Versed. Fucking drip. I literally said, "My BP!" The rez went on some diatribe about how much pain she must be in, I was thinking yeah, but think about how much pain she WON'T have when she's dead. He insists. An hour later, with the smallest rate of Fentanyl and Versed possible, she takes a dive like a bomb over London in 42'. which also happens to be her systolic blood pressure again. 

And then my friends, the light shone upon me. The gift of experience, the undeniable truth of going-thu-it came to visit me that eve, and left me as excited as a waking seven year old who has left  a molar underneath the pillow. The intern and I concluded: She's not dying tonight. We went to town. Dobutamine. Max it the fuck out, to start. Pound a bolus down. Family comes in. Intern and I tag team to stay functioning. I listen to their fears, he gives them the surgical realities. Intern manages to sink a one and a million shot at 4 am with a new triple lumen in right groin. Now I got accesss baby. 2 bags of albumin down the hatch. Next up: Fuck it 25% Albumin.As I'm running by  Charge Nurse says, "You asked for it." I tell her do you hear one iota of complaint from my mouth. "No. Nope," she says. Good. Shut the fuck up.No one would help me if I asked. Certainly no one offers. Snickers and asshole comments as I run. I'm sprinting to other modules to grab pumps, bags of saline since I had used all of ours. At 4:30Am the intern says, "This is a lot of work for you isn't it?" 
Fortunately he was over sedated by the day shift nurse who is approaching an increased age and mentation  where I wonder if she knows where she is during work, I can't believe she's a nurse in the I.C.U. let alone taking care of people. She means well and is generally nice. Fuck it- that counts. I know the reason why the sedation was up so high because 1) she can't figure out how to operate the ancient "computerized" pumps and 2) she had the observationist tech do it (SEE:LAST ENTRY-dude got me $4K back on my federal tax returns)  I pull back on his sedation, tighten his celestial reins and it buys me time. He doesn't have too many meds, he's certainly not shitting after the opiate load he got today, I just duck in and reposition him q2 hours. 
Supervisor tells me I have to take lunch.  My turd of a charge nurse takes over which means she parks her fat ass in front of the monitor and calls the other modules to tell them how funny it is I'm running my ass off. "Yeah. One of the new ones."
While I'm having lunch one of the most vicious of the old guard strolls in on his third lunch break, his assignments are a fucking joke, a facetiously asks me how tonight is going. This fucker never asks me that. I tell him, "Going well. You?" He doesn't makes eye contact. 

Day break comes. I hear the morning traffic start to blare out from television in the conscious patients' room. At 5:30 AM my experienced co-workers were forced to take over my other patient. I had so many pumps and drips going that according to union rule, or maybe it's in the old testament, not sure which, my patient became a 1 to 1. But never missing the opportunity to insult and degrade I hear my supervisor tell the day shift  supervisor, "Well, she's a soft 1 to 1."
Her tone insinuating, we have to, but we don't want to. Listen friends: I know it, you know it, she didn't want to give me credit, her insult was an admission of truth, there was no sarcasm to decipher no questions without self incriminating answers to stumble through: her dislike of me was a gift of credit. For if she had said "Wow this patient was a fuckin train wreck and you need some good staff on this one"-well that would have done me justice. That would have put my rank higher and I honestly would have thought that she was goofing on me. Her answer was a begrudging admittance of truth: a soft one to one, for a soft new nurse whose shell hasn't hardened yet from years of overwork, abuse from superiors, no breaks, distended bladder so-called friends hating/loving you from  one minute from the next. A soft 1 to to 1.
The patient was mine again the next night. During the day the Attending M.D. had come in, broke some rules and stabilized her with techniques unavailable to the night shift. I can't elaborate but he did what Attendings usually do and ignore patient wishes in the place of his ego's demand. No matter. She didn't die that night either. 
Three people, it's true! No less than three people told me I did a great job of keeping that lady alive.  Somebody noticed. And even though the Supervisor apparently heard that one of the people who had told me I was doing well was too valuable to her to have a compliment like that stand. Even though he too stopped mysteriously talking to me 3 hours after his compliment, the compliment had been spoken, like a wish thought out during a birthday, or a coin thrown in a fountain, or victory in snapping the majorous side of a wishbone. 
     The RN that complimented me, Chuck, normally works float during the day but was filling in as house supervisor for the vacationing real one. People generally thought it funny that Chuck was House Supe as he normally just does lunch  breaks. I needed a compressor for leg squeezers and two of the senior nurses told me to call him to bring one up. My supervisor found out and did her fake drop the jaw thing, parade around the base desk, smacking her fore head, accused me of violating the chain of command by calling the house supe who happened Chuck that night. I detected a faint smile underneath her rant. Happy, he fucked up. Of course the older nurses who told me to do it didn't speak up. When Chuck delivered the compressor he said he was glad he could help out  but in the morning when I thanked him again for the compressor he just said "whatever", scowled, and literally turned around and walked away.This is my Supervisor's way. I have experienced this with other older nurses as well when they turn someone against you. "I can't believe he did that to you, who does he think he is?" The person who previously wasn't aware thatthey had been insulted now feels SUPREMELY insulted.)
The vicory was still mine. And while I do not believe I could ever function in this high acquity without the support of my co-workers, it's too exhausting and inevitably a fuck up will slip that will put yur career's fate in the hand of the Supervisor on duty, well that's it.  However, tonight I got one step closer to independence and got just a little bit closer to not being at the whim of those who are so "experienced" as they recipricate the abuse they no doubt at some point endured or continue to endure.
I never was a bully in school. I moved a lot as a kid, some years I was popular, other years I was shit. But I never broke down an teased others to make myself look better. Now, I talked shit about every more popular, better off, better looking kid under the sun to my friends out of jealousy but this was out of general disgust of human behavior and a deeply disturbing underlying antisocial outlook on circumstances at the time but I never attacked the vulnerable. It's not in me. It wasn't then, isn't now, never shall be. 
The only thing is, is it obvious? or hidden like I like to tell myself that it is. Wanting to consume the biggers power, experience, knoweldge, standing.
I think of what the only new hire with experience in the group said to me as a friend during orientation, "I may have been a nurse for only six months but these bitches are going to hate you forever, for life. You do just the right things to piss off the older nurses.  They hate you because you are right and that's why you don't realize you are doing it."