Licensed To iLL

My People, R.N.

2010-04-01T17:33:00.001-07:00

Wouldn't Sinead be a great R.N.? Maybe she is. "Drink before the War" rocks.

I'm still alive. I'm still in the game. I'm straightened out.

Found some great co-workers.

I'll meet their excellent standards in time.

How many nurses are survivors of abuse, drama trauma, rough lives, chaos, sadness, death?

How many nurses are healthy strong people, have a competent sense of boundaries, a technically up to date and proficient and STILL have the time to function with an aura of the hollistic/empathic?

A bunch. A fuckload.

Ready and happy to be back. Start my new gig on 04/12. For keeps.

RN's ROOOAAARR!

They're Winning

2010-02-27T19:42:00.000-08:00

I live in the Pacific Northwest now. They view Californians the same way one keeps track of a bee that is buzzing around the picnic. If it gets too close to the food or the kids WE-WILL-SQUASH-IT!
I bring plague. I bring experiences they have not had. I bring experiences they cannot believe. I bring psychological trauma. I bring hurt. I bring a profound narcissism that make constructive criticism impenetrable. I bring stories that are funny in ways they couldn't have figured. I bring disgust of hierarchy. I bring open wounds. I bring contempt for myself. I bring the hope that this will all wash away.

I bring the notion that I know more, but I accomplish less, I don't care for their structure. I bring the shakes, pale faced adrenaline rushes, I bring old trauma.
And its not their job to see that I make it through.

I bring experience that has left me pondering the purpose of my knowledge the tangentiality of coincidence, I bring my hunger for numbness.I bring the idea that after you've met me you know something isn't right. Somehow, you want me to succeed.
Somebody let me in.

I bring greetings tucked in with apologies.

30 Seconds to Mars: A Lifetime of Vanity

2009-12-17T18:23:00.000-08:00

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.

NursingPUNK

2009-12-14T18:15:00.001-08:00

http://www.gallup.com/poll/124625/Honesty-Ethics-Poll-Finds-Congress-Image-Tarnished.aspx

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.

THIS IS A STREET FIGHT GUYS!! AND EVERY YEAR THEY GET ONE BLOCK CLOSER TO TO OUR SACRED TERRITORY: OUR WAGE AND SCOPE OF PRACTICE.
EVERY YEAR WE GET MORE RESPONSIBILITY, MORE LIABILITY, LESS SUPPORT, LESS RESPECT AND IT'S OUR FAULT!
HAVE YOU ENJOYED AIR TRAVEL RECENTLY? WE ARE THE NEXT INDUSTRY TO BE COMPROMISED BEYOND ALL RECOGNITION. THE ASSAULT IS COMING. MINIMIZED AND TERRORIZED. INSTEAD OF SHAME THEY HAVE PROFIT MARGINS.

2009-12-03T14:53:00.000-08:00

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...

Kick Against the Pricks: dOCTORS iN sHORT sUPPLY

2009-11-10T13:40:00.000-08:00

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.

http://allnurses.com/nursing-news/doctors-short-supply-437419.html

And here is the link to my response. http://allnurses.com/nursing-news/doctors-short-supply-437419-page2.html

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.

Nurses are responsible FOR EVERY SINGLE PROBLEM THAT ARISES. WE KNOW HOW TO FIX PROBLEMS QUICKLY AND WITHOUT NURSES DOCTORS ARE UTTERLY UTTERLY USELESS. NURSES ARE ALSO RARELY GIVEN CREDIT FOR SAVES, EMOTIONAL THERAPY TO DE-ESCALATE ASSAULTIVE OR DISTURBED PATIENTS, ALL THE LITTLE FIXES, THE THINKING AHEAD. IT IS EXPECTED OF US. NURSES DO NOT EXPECT TO GET CREDIT. DOCTORS DO. DOCTORS HAVE CREDIT SEEKING BEHAVIOR.

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:

" Today, 12:32 PM

Re: Doctors-in-short-supply-responsibilities-for-nurses-may-expand

Originally Posted to sonnyluv

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 NP...best 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!

Paper Planes

2009-10-27T08:33:00.000-07:00

Nice to be the 4th most popular dude R.N. in the universe. http://www.lpn-to-rn.net/blog/2009/50-best-blogs-for-male-nurses/

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.

It Eats Raw Meat

2009-10-17T16:36:00.000-07:00

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...

Yeah..."

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

Death of A Star

2009-10-06T08:45:00.000-07:00

"Tucked In"

By Licensed to ILL

Good white Soul

Righteous indignation

Carnage Deluxe

A Symptomatic Soul

Watches the Elite Burn

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 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.

Conan the Barbarian

2009-08-29T18:04:00.000-07:00

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.

To Live and Die in L.A.

2009-07-30T23:00:00.001-07:00

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.

THE RULES OF STAFF NURSING AS I HAVE COME TO KNOW THEM:

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.

You fucked up, you REALLY fucked up.

2009-07-13T22:19:00.000-07:00

FUCK YOU BRN-NOW YOU HAVE SOMETHING BETTER TO DO THEN HARASS NURSES WHO HAD ONE TOO MANY WINE SPRITZERS.

HOW ABOUT CHANGING NOT JUST WHAT NURSES DO BUT WHAT OUTSIDE FORCES DO TO NURSES?

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 priceride.com 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.

One thing Leads to Another

2009-06-17T04:54:00.001-07:00

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)

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

2009-06-10T05:15:00.000-07:00

http://www.ama-assn.org/amednews/2009/06/08/prl10608.htm

I posted this response on allshmurses.com. 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.

IT DOESN'T TAKE A DNP TO PROVE "M.D. level" COMPETENCE. ALL NURSING NEEDS TO DO IS INSIST ON RECEIVING CREDIT FOR THE WORK WE ALREADY DO. SPREAD THE WORD. WE ROCK.

I guess that's why they call it the Blues

2009-05-31T01:16:00.000-07:00

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.

Soft Shelled Soul

2009-04-14T00:34:00.000-07:00

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?"

"Yeah,"I replied, "But great experience". CHECK THIS OUT: ALL THE WHILE I'M STILL TAKING CARE OF MY OTHER FUCKING VENTED PATIENT.

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."

Electrified and Numb

2009-02-16T22:13:00.000-08:00

Occasionally, my coworkers are serpent-esque. Dealing with them is as challenging as handling this intubated snake.

I’ve been busy. Bizzzee. Dizzy. Running around. Puttin’ out fires. Starting fires. Paying my dues. Because in nursing you think you pay your dues in nursing school but this most certainly isn’t true. You pay your entrance to the show dues in nursing school so you can pay your real membership dues, dues to the V.I.P. lounge once the fun begins. And then you pay your dues for at least the first three years of being on the job in all sorts of painful, alienating ways. Cuz every step you take, every move you make, some bitter nurse with more years of experience then you is there to tell you how completely stupid you are to do what you did. I can’t help but identify with Shaolin Kung Fu monks or Jedi Knights. When it gets bad or heavy, I think of Luke Skywalker as a R.N. being reamed becuase he didn't turn off the occlusion alarm fast enough for the older, more irritable Jedi's who perpetually have Jedi migraines from using the force all the time. Someone is always more experienced than you and not nice about it. Even your good moves show weakness.
“Didn’t you do this with your preceptor?” My first admit from the E.R.
Yeah. In September. But my preceptor didn’t really let me do it because she thought I wasn’t up to it, i.e. it’s such a tedious mindless procedure with pages of redundant paperwork that my preceptor didn’t even want to bother. And none of my 10 preceptors ever did. I was going to do an admit last week but the charge nurse said loudly, “He’s new. Brand new. No way.” Except I’m not brand new. I’m off orientation for about a month. I’m past brand new. Perhaps you could call my current stage: I’m really new but still held accountable for everything goddamn thing that happens regardless phase.
Last week the charge nurse thought I was too new to admit a patient. This weeks charge nurse feels I’m not so new to admit a patient, who happens to be the fucking E.R. doc’s father V.I.P. patient, so I’m pretty much shit out of luck. So yeah, I did it with my preceptor but I didn’t do it. Impossible to explain to the current charge nurse without sounding like I’m throwing out excuses. So I asked for a quick rundown of the necessary admitting paperwork. She makes a face like I asked her if we could try and resuscitate Adolfe Hitler. Her face says: How stupid!

Two shifts ago I had a patient on a ventilator. He coughed so hard while I was repositioning him that he popped the oxygen tube right off the connection point at the ventilator. I couldn’t figure out how to get the thing back on because the respiratory therapist put a “tester hose” right in front of “the real hose” which didn't fit the oxygen tube. So my patient now has no oxygen source and I’m trying to connect a fake hose to a real one and it’s not working. And my patient, without an oxygen source is desaturating to the low 80’s. Meaning he's not breathing.
Uh-oh time. My supervisor, Murphy’s fucking Law, happens to be walking by as this is happening. My supervisor has already told me she thinks I’m “weird” and “will make life real hard” on me. I’m not sure if she despises me in particular, possibly just any other living human being. My supervisor smiles when they pronounce someone dead. She giggles during CPR. She admires the pain on a patients face when a NG tube is being placed. And she loves pussy. She huffs and curses at you under her breath when you don’t know the location of the bacteria that has gotten your patient into isolation.
“Why is your patient in isolation?” she asks everybody at the beginning of the shift, because you know, fifteen minutes into the shift R.N.’s have time to go through the chart in a leisurely manner and find out facts that are only useful to her. (funny because now I make time to find these facts out cuz I’m sick of her cursing me beneath her breath.)
“Because he has MRSA.”
“Where?” She asks impatiently.
“I don’t know.”
“Son of a mother huf gab dubda…”
And that face. Oh, that hateful frown. That look like You utter piece of shit, now I have to do my job. Personally, I don’t give a shit where my patient has MRSA. I’m wearing gloves, gown and a mask no matter what this mother fucker has. Who gives a shit if my patient has MRSA in the nares. I’m not going to be picking his nose anytime soon. I won’t be licking his nostrils for pleasure in the immediate future. What the fuck lady? What…the…fuck?
So the ventilator alarm is screaming. The monitor alarm is shitting itself. Hell is starting to break a little loose.
Enter: The know it all nursing assistant. He walks in and cops what I call the “observationist attitude.” And attitude, I must say, I have been guilty of plenty of times. The observationist attitude is where you are watching a stressful situation unfold and you feel free to predict the outcome of the situation before there could even possibly be an outcome. CNA’s are especially guilt of second guessing nurses. Nurses are especially guilty of second guessing doctors. Doctors are especially guilty of second guessing specialist MD’s. The observationist has several qualities that make him/her an observationist. They are:
1) The Observationist has no actual responsibility in the situation.
2) Feels comfortable enough to openly judge the performance of those around her/him, though he is “below” their position.
3) Thinks the solution is easy to fix, having never fixed it.
4) Everybody is stupid because the solution is easy to fix.
5) Resents the fact that she/he is making one fourth of what the stupid people around him are making because he knows how to fix the problem.
6) Is pissed cuz he knows if she/he keeps talking he will be told to shut the hell up.

So I gots this little situation on my hand. I got a mildly retarded CNA who I swear comes to work for the free coffee and to give out tax advice though he makes 10 bucks an hour. I have a positively hateful short haired, dyke supervisor (she prefers to be called a dyke) who openly hates my ass. I’ve got an explosively coughing intubated desaturating patient, and oh yeah, there is a volunteer in the room who looks up to the CNA for some unknown reason (I think she loves free coffee) and is adding to the clutter and general chaos in the room. Could things get worse? Of course they can silly! They can get absolutely fucking horrible.
Supervisor tells me to get the hell out of the way. She yells, “Start baggin’ him.” I concur. Except we can’t find a BVM. It’s buried somewhere behind the ventilator. The nursing assistant dives in front of me, in an effort to impress the supervisor, “I’ve got it.” But he doesn’t have it, because he is the observationist, and observationists have nothing. I ask him is there a BVM?
“No!” he says. I stupidly trust the CNA. As I’m sprinting out of the room to my other patients room to grab a BVM my supervisor shouts, it’s right here, it’s right here! The observationist is already back tracking, trying to explain in the middle of this situation why he couldn’t see the BVM. Nobody cares. He tries to hand the BVM off to the volunteer who is jumping up and down like the last kid picked for a kickball game. “Here! Me!” A fleeting thought runs through my mind, You are about to get showed up by two unlicensed coffee drinkers and THIS IS MY PATIENT! I am responsible for the outcome of this situation!

“BOTH OF YOU GET OUT OF THE WAY!” They scrambled out of the way. In fact the volunteer ran outside of the room and never came back. I haven’t seen her in the I.C.U. since. My supervisor looked at me for the briefest millisecond ever recorded in humanity with a look of like, Well maybe this guys not so bad cuz he just was really rude to these two lesser human beings. Supervisor hooks up the BVM to oxygen. Now I’m shouting where is the mask? The CNA, with his observationist ego badly wounded shouts back, “He doesn’t need one!” Damn. Duh. I was an E.M.T. in the ER waaay to long. The CNA, now with his mojo back, tries to tell me how to connect the E.T.T. tube onto the BVM but I’ve already done it realizing my mistake.

So this is the part of the story where the dues are paid. I start bagging the patient. Trying to get that O2 sat back up from 70’s land, where it’s been for about 10 seconds. I’m just thinking, Fuck it, I’m gonna fill this fucker full of O2. The sats start to rise. 82% 86%. I was pumping that bag like Arnold pumped iron. My supervisor barks, “He was on 12 respirations a minute, how fast are you bagging? You’re gonna fill him with air.” I start to argue, look I just want to get these numbers up but then I realize I’ve already fucked up enough today so I slow down. I slow down bagging. BUt each squeeze is hard, people. I make those 12 resps. a goddamn wind tunnel. And I shut up. The O2 will go up anyway, just slower. IN WALKS THE DYKE SUPERVISOR’S ARCH RIVAL: THE OTHER NURSE THERE WITH MORE THAN 25 YEARS EXPERIENCE: The charge nurse. SHE HAS COME TO COLLECT HER DUES FROM ME AS WELL.
“Why the hell are you bagging so slow, The R.N. Formerly Known As Angry Male Nurse?” Carol, the arch rival, bellows at me.
I start stuttering, I’m thinking cuz super dyke told me to but then I don’t want to have that fight right now, I just want everyone out of my fucking room, so I sidestep the confrontation and just say the sats are going up.
My supervisor decides to engage the bogey. “You don’t want a belly full of air do you?”
Carol switches to guns and fires her canon, “Who cares? Get the oxygen up.”
I manage to sputter out, “Oh look 90%, good, back in business. Where’s that RT?”
The arch rival’s stare each other down. Then they look at me. I’m standing there like, “Garsh, ladies.” Pretty fucking stupid. Afterwards they both took me aside to tell me that they were right and the other one was wrong. Supervisor says bag slowly (which is stupid) but she was actually nice about it because technically I took her side during the engagement-Arch Rival Carol says do whatever you have to do to get the O’s back up (right thing to do).
Hark, I am at everybodies mercy. And when the mistake is a blunder, whoa baby! Everybody has their two cents to put in.
2 minutes later everybody left my module to go talk shit about me. Everybody left. The supervisor left, Carol the arch rival left, the CNA left, fuck even the secretary we have once a week scrambled out of there. Paying my dues. No bizness like show bizness. When I finally got to lunch I attempted to retell the story but when I started recanting the tale, I noticed that everybody looked away and the fellow new grad I was telling the story to just looked down. Then I realized the CNA was sitting right next to him. Oops. I forgot. My story had already been told at least five different times in five different ways by people who couldn't wait to tell of the failure of this new R.N. What is he doing here if he can't even figure out how to reconnect the patient to the BVM? It takes years among people who feel bad about themselves to give their esteem and respect to others. It takes 6 seconds of confusion to get labeled a doofus for life. I'm glad my supervisor was confused, too. Otherwise, I probably would have been written up.
Turns out the hose that stumped me and my supervisor was a “tester” hose to check the quality of the connection. Why it was taped directly in front of the port connector I’ll never know, cuz the RT sure as fuck didn’t. But then again, RT’s don’t know much of fucking anything. (Sorry guys- I still can’t figure out what you guys do exactly. I guess wearing white lab coats has gone to your head. But I'm more or less an observationist to your skills.)
What a bonehead beginner mistake to make. And of course I received the obligatory lecture on always knowing where your BVM is from my supervisor. Which I deserved. The whole thing was my fuck up. Because I am new, and prone to stupid yet deadly mistakes, I have to pay my dues. Even the CNA’s get a piece. Fuck even the volunteer got a little slice of my pride.

I still love my job. I love getting better at it. I love knowing I will never make the same mistake again. I also like knowing that I am one of the few nurses who checks to make sure that the BVM is hanging inside of its bag and where exactly it is on the bed of every single one of my patients from here on out.
Right now I have to go. I’m meeting up with that Observationist CNA. He said he’d do my taxes for $50 bucks.

The Hard Way Pt. 2

2008-12-12T11:12:00.000-08:00

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...

Me:“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

2008-12-12T10:44:00.000-08:00

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.

END OF PART ONE. YOU GOT 5 MINUTES. HURRY UP. OTHERWISE I'LL START WITHOUT YOU.

Cold Cold Ground

2008-11-22T19:29:00.000-08:00

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.

Cloud Nine

2008-11-04T21:28:00.001-08:00

I AM OVERJOYED!!

CYNICISM, BITTERNESS FADE AWAY.

THE 8 YEAR PRISON TERM IS OVER.

FREEDOM BREAKS THROUGH LIKE CRACKS OF LIGHT IN A CRUMBLING BRICK WALL BUILT ON THE BACKS OF THE WORKING CLASS SLOGGING THROUGH LURKING POVERTY.

Appetite for Deconstruction

2008-09-27T09:40:00.001-07:00

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?”

The Filth and the Fury

2008-09-11T07:53:00.000-07:00

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.

Meet me in the Morning

2008-08-31T13:08:00.000-07:00

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!!

Everyday People

2008-08-03T16:05:00.000-07:00

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

Good Vibes

2008-07-16T21:39:00.000-07:00

Cheers to this shit, neh?

Thanks Kelly! Awesome resource!
Sincerely,
The R.N. formerly known as "Angry Male Nurse"

(I'm in a transitional phase)

Date: Thu, 17 Jul 2008 09:43:10 +0530
From: kelly.sonora.83@gmail.com
To: licensedtoill1@hotmail.com
Subject: Licensed 2 ILL

Hi,

We just posted an article, "100 Networks and Resources for Male Nurses" (http://www.nursingschoolsearch.com/blog/2008/07/100-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

Songs For the Deaf

2008-07-12T00:36:00.000-07:00

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?

So, FINAL THOUGHT:
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.

The Day I Tried To Live

2008-07-06T22:55:00.000-07:00

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.

Love My Way II

2008-06-04T22:41:00.002-07:00

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.
Whatever.
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,
by
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.

Search and Destroy

2008-05-04T21:46:00.001-07:00

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.

Beat that tin drum

2008-03-03T18:28:00.000-08:00

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.

How Soon is Now

2008-02-18T21:42:00.001-08:00

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. "

The Racist Medical Field: Racist R.N's: Race Warfare

2008-02-10T22:22:00.001-08:00

Some shit boggles the minds, friends. Pull up a chair, read my rant, because in my rant you will see how my day transpired. Oh, just a warning. Don't read this shit at work because IT WILL get your lazy ass fired. (You should be so lucky!)

Fuck I want to write about racism and the medical field. I pondered attempting to get into it early in my blogging chronicles but I trust my fellow nurses so little that I didn't want to become the angry male nurse of the damned, like one of you snitches would call the California BRN and alert them that a possible immoral nurse is harvesting racist thoughts- "liquefy his potential license at once!"
so I decided to back off. I imagine the comments I would have received for an open and frank discussion about race relations in a county medical system would have enabled me to garnish my blog with the same snotty bitch comments I received on allnurses.blob. "Very unbecoming of a nurse." and "Its a shame that nurses like you exist." I even got excommunicated from the site for 6 months, I think my time is up, but like Lindsey Buckingham says, "I aint never going back."

I didn't get kicked off allnurses.blob for being racist, I got kicked off for being rude to other nurses who were trying to validate snacking themselves to death for super low pay. One of them went into it about how nursing should be a vehicle for all the disenfranchised 3rd world women of the world to come to America to provide substandard non-English speaking care and i lost my shit. I actually got kicked off by a foreign nurse who was moderating the discussion on the pro's and cons of foreign nurses. That's good ol' nursing objectivity for you. When I suggested that perhaps she wasn't the ideal candidate to be the MOD I got busted. Privileges revoked!

I'm sorry, I just don't see how extracting all the nurses form Nigeria will help anybody out. You think Phillipno's have shitty little tempers? Well baby you never met a Nigerian RN on her third 16 hour shift in a row with like nine capitalist kidsat home and an unemployed security guard husband. See, basically, we took them from fighting to have enough food, sheer poverty environment, from understanding what it is to value being alive, we took them from fighting for family and sincerity to fighting America's losing battle with soul-lessness. Fine now they won't starve, but they think they're starving because MOM RN won't buy them that Wii fast enough. Now they have enough food to eat so they are morbidly obese. Now they can trust their government (right), but grow up thinking they're deprived because their jeans don't cost $120. Now their newly minted Nigerian-American children are fighting battle to get the Iphone and $140 addidas. Do you think her kids give a shit about their starving cousins in Nigeria? Fuck no. As every red-blooded American kid knows, regardless of where their parents are from, those new blackjacks come in a mint green and they are fucking tight!

Fuck Nigeria. Fuck the Philippines. Fuck Vietnam. Fuck the UK. Fuck South Korea. Fuck North Korea, too. Fuck Kenya. Fuck Canada. Let me fuck Canada again. Fuck Canada. Fuck Japan. Fuck that former MD now lowly ass wiper RN from Romania. Fuck him. Fuck Arkansas. Seriously you travelers from that creepy state need to stay the fuck home. You're worse than the goddamn Guamese. Fuck Guam.

Fuck you white people. Fuck you black people. Fuck you Phillipinos. Fuck you all Asians who get to work early and take my good parking places. Fuck you mexicans. Fuck you el Salvadorians. Fuck the Jews. Fuck the Muslims. Fuck the Mormons, scientologists, 7th day Adventists (WTF!?), Fuck the kwanasians or whatever they're called. Fuck the Buddhists. Fuck the Taoists, the Hindu’s, the Sikh’s, And fuck that Pharmacist dude who knows that the best shitter is upstairs in the medical library and always stinks it up before I can get to it. He looks swarthy, maybe Moroccan. Fuck Morocco. fuck the jehovah's

Wait a minute- gotta talk about the Jehovah's.
If the wife and I ever decide to get around to further fuck our lives up with another kid- and we're getting down-and a fucking Jehovah comes knockin on my door, on a Saturday, right when I'm bout to penetrate that furry distance that sometimes separates me from my wife-It's gonna be like Luigi to Donkey King: I'm a gonna freak a the fuck out.
Seriously, I'm a morning fucker, I'm too tired to fuck at night. Fucking in the morning for me is like wake and bake for others. It's just how I like to start my day. Quaker instant oats and my wife’s delicious poonani. Mazeltov to that.

Fuck the Baptists, fuck the protestants, fuck the Catholics, fuck the episccipalianz, fuck the Lutherans, fuck the nondenominational mega church fuckers, the only ones I don't say fuck you to or those wacky fuckers who handle the rattle snakes, I love that shit. That's just fucking cool. I always see them getting interviewed on TV:

Hot Latina female Newscaster: Have you ever been bit?

Shit crazy Christian snake handler: Oh sure. Yeah.

Hot Latina female Newscaster: How many times?

SHit crazy Christian snake handler: oh, I'd say about 300.

Hot Latina female Newscaster: That's fucking crazy.

Shit crazy Christian snake handler: Yeah. He-he. Yeah.

I fucking love that.

FUCK THE CHRISTIANS! AND FUCK RN'S OF ANY RACE WHO FORM CLIQUES BASED ON RACE AS A GODDAMN LITMUS TEST. Cliques in hospitals should be formed on the capability of each member to perform grossly negligent behaviors, to destroy morale, who in the unit can take the most breaks and feel no shame? Who can eat a box of snackwells in less than 2 minutes, thereby turning them into Mealwells? Who can turn the most miniscule of events into A BIG FUCKIN Deal that requires written warning to be dispersed amongst the employees who actually work. Cliques should be formed based on how much personal chaos is brewing in your life, how many times you've cheated on your spouse and how much Wellbutrin you snort at lunch. CLIQUES HAVE NOTHING TO DO WITH RACE! THEY ARE ABOUT FUCKERS WHO SEND COMPANY WIDE EMAILS IN CAPS ACCUSING EVERYONE OF DOING A SHITTY JOB EXCEPT OTHER MEMBERS OF THE CLIQUE!! Cliques have nothing to do with race, they are about a group of the most fucked up, foul, seriously miserable haters getting together to make everyone else hate their lives as much as they hate theirs. If I roll up to a unit and you fuckers are speaking in Tagalog- how the fuck am I supposed to know how in control and evil you are? How can you manipulate me in a language I don't understand? It just doesn't fucking work. Proper hatred is spread through all races, creeds, denominations. That's what makes the shit effective. Hold on a sec.....

I just had the most violent BM of all time, I was like bracing myself against the bathroom walls, that's how much you guys pissed me off tonight. fuck. I just gave birth in there, the porcelain is cracked and needs me to hold C-spine.

I'm going to try and sleep.

Next up, drugs. That's right fuckers. Co -workers on Drugs. It's ridiculous, we are trained to look for this shit and we are the ones who are high!. Just because a MD wrote the script doesn't mean we can't tell how on your ass you are. If that post doesn't get me sued then nothing will.
(You know who the biggest druggies are in the hospital?- RN's? Pharmacy? anesthesia? Access is power. Access is power. Access is power.

One good thing about Bush

2008-02-05T16:04:00.000-08:00

One good thing about that fucking heartless criminal George Bush:

RECORD, and I mean RECORD voter turn out for a primary. After these last 8 miserable years, you bet your ass people are going to start voting again.

History will haunt Bush Co. like a fart in a car. A car with the windows rolled up and the heater on. It will linger way too long.

The Roughest Nursing School West of the Mississippi

2008-01-17T14:30:00.000-08:00

The beat goes on. Or maybe I should say the beating goes on. Semester 4. Holy Moly! Glad to be here. Glad to be almost done.
This semester instructors did their usual show-of-force routine as previous instructors before them: not acknowledging the presence of any individual students, no smiles, no jokes. Eyeballing us secretly from the back of the room where they quietly congregated,looking at us, turning away and chatting, then looking back at us as if to say, "Look at that one there. What a chump. I'm gonna break him!" It had a real WWF wrestling vibe to it. I envisioned my 5'10,rather husky Nigerian born instructor, picking me up and spinning me above her head like apiece of pizza dough and then throwing me against a pile of chairs. After I hit the ground she bellows at me, "What labs should you check to see if you're okay after this traumatic injury? RBC's? No! Who cares how many red blood cells you have? BUN/Creatinine? I don't care about your kidneys. No! Check your CKMM, YAARGGH!"

The 4th semester chair had this to say, "I guarantee you by the end of this semester you will be burned out, so use your sick days wisely."

WTF!? Is that what nursing is about? A fucking marathon of busy work and a battle of wills? Maybe it is. What I can never separate, what I continually struggle to understand, is my instructors desire for us to be very competent novice nurses or are we reveling in their dark sticky bully side where they get off on fucking with us. I guess all this ball-breaking is for a good cause, and I, no doubt, will look back when after graduation and be thankful for the lessons I learned while still in school as a student as opposed to being on the floor with a license to defend...but at what cost? I can not BELIEVE how tired I was a month ago. It was scary. I was so tired, I didn't EVEN KNOW how tired I was.

I finally decompressed on the last week, the 4th week, of break. The first two weeks of vacation I was an anxious, irritable ball of nerves. The third week I slept, the fourth week I rejoiced.

Now I'm back in it with more soon to be fulfilled promises of extreme exhaustion and cramming. These fuckers even want us to come in on Saturdays to go to healthfairs and recruitment sessions (and I know like you know you can't recruit to a captive audience). Including clinical which is 17 hrs a week, I'm in class another 8 hrs over two days. Plus fucking 6 more for Saturdays. Isn't there some like nursing student sweatshop law? With all the massive write ups, projects, and arbitrarily graded care plans (fucking 3 our last semester- grand total of 9 throughout the program) and hellish exams I'm already in a straight jacket.

Whine, whine, whine. Fuck it, just get through it, I'm almost done. Keep on'. I'll do whatever it takes to have a job I feel truly passionate about and be able to adequately support my family. I should be so lucky.

Thanks for everyone's support with the previous post. It really helped.

Stacked and not so Angry anymore

2007-12-27T00:40:00.000-08:00

Aaahh my people. My fellow nurses, healers, friends, nemesis's, those I adore and admire, those I can't stand.

One more semester to go. So much to tell. So many thoughts have furrowed my brow, like a crashing thunder storm on a hot summer afternoon, passing as quickly as it obscures the sun.

I got real depressed this semester. Every afternoon, around 1530, after school and on the way to pick my son up from day care. I felt so empty. Tired and empty. I have never felt depression like that before. It was like, physically painful in my gut. I felt no joy. And let me tell you, picking up your child, and feeling depressed, joyless, really makes one feel ashamed or guilty. It can be a very destructive cycle.

So AMN, what was bothering you? Why so blue?

The critically busy 7 days a week schedule, the lack of sleep, the monotony of obligatory rotations that have questionable value, the constant degradation and mind games at the hands of perpetually insecure instructors. Friends, I was bummed the fuck out.

You know what I realized? I'm not Angry Male Nurse anymore. I realized I had become:

THE MOST SHIT TIRED BURNED OUT NURSING STUDENT IN THE HISTORY OF FUCKING NURSING.

But I'm cool now. I rested. I contemplated my sadness. I contemplated my anger. I wandered the hallways of my mind, pondering the meaning of a nursing career, directions to take, units to work in, mistakes NOT to be made. My friends, I pondered!
My wife and baby (he's doing great by the way) are visiting family out of town. Last night was the first night that I had slept alone since June 26th. It was the first time I did not wake up two or three times during the night in a very long time. And I realized: "Dude, your depression was secondary to your incredible exhaustion. Who the fuck wouldn't be depressed?"
I think Everybody, I think I was just really really tired.

I'll keep this relatively short:
I was working in the ER a month ago as a Student Nurse Worker. Basically an overworked NA. Two Samoan- American kids came in from a popular local rave. Roller #1 was a small guy, about 20, shaved head. Roller #2, was a pretty buff young dude, maybe 19, looked like a rugby player. They were under arrest for possession. They were handcuffed to their gurneys. And they were ROLLING THEIR SAMOAN BALLZ OFF! Dilated pupils, chewing their jaws like they were made of gum, rubbing their heads on the pillows of the gurney in ecstasy. Looking back, they probably had just ingested several pills prior to arrest to avoid more prosecution. Probably a good thing they got arrested because, frankly, I have never met guys their age with such warm, open, and funny dispositions. Such vulnerability. (It was also abundantly clear that neither of these guys should be behind the wheel) Maybe it was the E. Proably it was the E. Maybe they were just nice dudes. They got cleared after my shift was over, I worry about what happened to them in County lockup. But ecstasy only lasts a couple of hours, so by the time they got cleared they were probably more hungover than anything and got their sense back. (VS stable, both had fevers probably related to pharmacodynamics, no immediate cardiac or respiratory distress- though they both were hypertensive and diaphoretic.)

The following is a rough transcript of the conversation that made my soul feel better:

Roller #1: Hey man. Where is your wife? Your baby?
(I don't know how he knew that I had a wife and baby)

AMN: Home.

Roller #1: But you are here.

AMN: That's right. I'm working.

Roller #2: You can do it. Man. Keep on with yourself.

AMN: Gotta pay the bills. I'll see you guys in a couple of minutes.
( I came back fifteen minutes later. They watched me while I worked with other patients.)

Roller#1: I know you're tired. I can FEEL how tired you are. Keep on though. Keep on.

Roller #2: I'm not embarrassed to say it. Right now,I think I love both of you, dearly.

(His eyeballs kind of rolledback into his head, his eyelids nearly close-then his eyes popped back open. He satisfyingly grinded for a few moments.)

Roller #2: This is true.

Roller#1: Hey nurse guy, we believe in you. It's okay to be tired. You look really tired.

AMN: You guys alright?

This is no joke everybody:

Roller #1 and Roller #2: We're more worried about you, man. How are you doing?

AMN: Well, I guess I'm a bit tired.

Roller #1: I'm open to talking.

Roller #2: That's what we're here for.

I guess I looked as bad as I felt. Tired and blue! But what can you do when the only official protocol, the only mandate available is to Keep on'.

So I kept on. And we talked. Not advocating drug use, but their empathy was wonderful. I know, boundaries, bad idea to burden the patient with my problems, but in this instance, it just worked. I didn't give them intimate details but I summarized. I'm pretty much a closed book to coworkers and patients alike, I guess my soul was cold, and I needed their warmth.

Those young dudes completely shocked me. I realized, nobody had asked me recently how I WAS DOING. And yet another reminder to never EVER judge a book by its cover.

More to come friends!

Stay up Late

2007-08-01T04:04:00.000-07:00

Fatherhood continues and evolves. For this first month, my wife and I have had a pretty moody little dude on our hands. Gas, poop, and hunger. Limited amounts of sleep. Something to work through. I couldn't hold him without him kicking and screaming, waving his tiny balled fists, trying to swat away whatever it was that was agitating his pain. My little dude was not having a lot of fun with this new life and frankly, I wasn't having a lot of fun, either. The wife did great though, kept her spirits up and worked with what she had. Mother in law came to stay with us for a month and that was immensely helpful. Mother in law left, and we still had the Moody Dude on our hands.

But!

For the last two days, miraculously, for who knows whatever reason, perhaps on of the thousands of tricks we employed to fight colic and fussiness paid off. The last two days have been awesome! Little crying, just a lot of looking around and even a few smiles. A vessel ready to explore the world. A baby that listens to and watches his mobile, as opposed to hysterically shrieking at it, he sometimes smiles at the hanging mobile that to me, is strangely reminiscent of a Pink Floyd concert I went to in high school. The change has been so dramatic, we noticed it immediately. And best of all, we pulled five hours of sleep. I probably shouldn't us "we" because my wife has to get up far more frequently than I do to give him the bizoobs but the change is duly noticed. And it feels great!

SO... to get to the meat, to get to my thoughts...today at work a 29 year old man ran into the ER carrying his crushed 1 1/2 year old child in his hands. When the father was leaving home, the boy ran out and the father backed over him with the massive family SUV. As bad as you've seen it in your experience, it was. I (thankfully) didn't see anything gnarly, I came into the situation as a big crowd of people moved into trauma. Staff came out of the trauma, talking in that glazed sort of way, when the adrenaline is high, the experience is burning into your psyche like a liver fluke into your gut. When your still not sure if what you saw was medically inspiring and challenging or you just voyeured into a devastating personal moment for someone. My co-workers came out of the trauma and I heard grim remarks, saw heads sadly shaking, "blood everywhere" "brain matter" " seriously not looking good". I only saw the father briefly, standing up, his head shielded by his arms as he leaned against a wall and cried, large numbers of family circling him, giving him support that must be baffling and terrifying at that moment. What do you do? What do you think? Are you angry at the father, do you feel sorry for him, do you forgive, do you dare to visualize what his life will be like after the so sudden and immediate death of his child? I was working in triage most of the night so I directed the upset and anxious family members as they poured in, asking how to get to the pediatric ER. I tried my best poker face, almost pretending that I didn't know what nightmare I was about to direct them into, "The pediatric ER is just to the left." Afterwards everyone in triage would also shake their head, what a nightmare.
And of course the Sheriff department tore apart the SUV, police lining it off where the dad had driven up to the ambulance bay doors. Furiously burrowing into the vehicle, under seats, in doors, looking, looking, for some proof that this father was a murderer and needed to be charged with a crime as horrendous as the accident. So weird, this tought looking family vehicle became a crime scene and I don't know the outcome of their investigation nor do I want to. What a shitty job...

I never felt like this before, I couldn't stop visualizing myself in his shoes, I kept imagining picking up my injured child off the ground with catastrophic injuries that I inadvertently inflicted. I couldn't imagine killing my own child. How do you live after that? How do you go to work, how do you be with family, what does your wife do? Does she hate you with the venom that mothers reserve for those who hurt their babies? Does life become a rollercoaster of self destruction, do you give up?
Do you try to die?
I'm so thankful that I wasn't even involved directly with the medical care. I've prided myself on my non-squeamishness around blood, around eagerly encountering the human wasted, the trauma's, the human drama, but I tell you what- tonight, just hearing the details, I thought to myself, "I don't have the stomach for this anymore." One of the most upsetting experiences of my medical career and I wasn't even involved.
Sadly, this validated my fatherhood more than anything else that has happened to me, more than any other joyous or challenging experience I have had with my boy, thus far, in this beginning first month. The thought of the sweetness, the innocence, the innate struggle to survive I see in my boy, for that to be taken away by my own hand is utterly upsetting.

Licensed to Ill

2007-07-01T18:10:00.000-07:00

Sorry I've been gone for awhile. It's not good blogger etiquette to only write sporadically, it doesn’t bode well with my legions of fans and fanatics. But what can I say? Personal life has kept me busy and I needed a certain amount of time to decompress, because Angry Male Nurse was becoming Burned Out Angry Male Nurse as does happen from people who invest everything they’ve got into their career form time to time. I’m okay with that, I just need to make sure I have the tools, the support, and the time to chill when I need to. Which I do.

Finished off 2nd semester. Did okay. Made it through with virtually no personal drama, until the end when the students who failed the most absolutely ridiculous and unreasonable final written in the history of Med-Surge got pissed and started manipulating student and staff to get their way. I really felt bad for the students who didn’t get through, I felt that some of the blame did not lie on their shoulders, that teachers who couldn’t even write questions with 8th grade English skills should be held to count for it. But then I saw how the failed students played games and threatened and eventually turned on each other, and I saw that perhaps that the reason for their failings their failure lay more with their lack of professionalism and maturity than anything else. So I backed off, let the chips fall where they may and began to recoup.

My wife and I had a baby on Tuesday. He is the most enigmatic, beautiful, and poopy little dude I have ever met. I’d like to tell you his name but there are some haters out there so I can’t. But it is a fitting name for such a cool dude.
Labor was 30 fucking hours long. The epidural was too strong for my wife so at about 20 hours in her contractions basically stopped, which relieved her so she could rest but scared the shit out of me because the thought of C-section after my wife’s valiant efforts would have broken my heart. I have no problem with C-section, just that my wife wanted to go natural and her spirit was into it. 2 1/2 hours of pushing and the use of Pitocin and suction and my little baby boy came out. I cried when he came out, a good cry, tears that contained my fears, my stress, my anxiety. Also with it came utter joy and amazement, love for my wife and relief that we were all safe. The nursing profession, nursing school, became small dots in my mind, like light coming into the opening of the end of a distant tunnel. Put things into perspective.

I love politics. That’s who I am. But a game is a game is a game and even though it involves human lives I am not responsible for the millions of unbelievable outcomes, for all the incredible personal tragedies I see and some that I am involved in. When I am working I am in a state I call, “In the Mix”, meaning I float from one living to dying crisis from the next, I hear all the other nurses working alongside me performing in the mix, applying their knowledge and intangible personal skills, putting out fires, fucking starting them, dealing with it, I exist in all the noise and I can apply myself one situation at a time. Brains here, not breathing in the ambulance bay there, relieved discharge here, comforted by morphine here, change the patients diapers there. I am in the mix, talking to my mind, listening to the noise but being part of it, too.

I love becoming a nurse. I feel like I am becoming something useful and functional. Skills develop and flourish, unique skills that I am very proud to possess. Some nurses wield them with confidence, other dish the skills out in utterly small insecure amounts.

Sometimes I think about the Beastie Boys from “Licensed to Ill”. Their ZaZen in the mix of 1980’s partying, music industry, cultural racial significance wrapped around them like a blanket

Let it flow let yourself go
Slow and low that is the tempo
Let it flow let yourself go
Slow and low that is the tempo

Have you ever felt water pour on your head from a small waterfall? Not that I get to that often, truly I live in an urban jungle, but I have been in nature a few times. The waterfall is surprisingly loud, and forceful, all that water pushing down on your head and neck, feels like your skull might cave in. But it doesn’t, and after a few moments you realize that the tension in your shoulders is being worked out and you are bending to the will of the water and sort of being with it. That is how I feel in the ER. Stretched out but adjustable. And when the bull shit politics starts to overstretch me, when the patients bullshit becomes a bit too odious, when the doc decides that he or she will revert to pissy 14 year old nerd mode, I put my clasped hands over my head, like a shelter, and shunt off some of that cold water pouring onto my head from the waterfall, and I look around, catch my breath, and let the beating begin again.

Let it flow let yourself go
Slow and low that is the tempo
Let it flow let yourself go
Slow and low that is the tempo

Rainbows, waterfalls, and unicorns, bitches.

Bring it!

They sue doctors, they send nurses to jail

2007-05-20T02:42:00.001-07:00

I just saw this in the LA times. Even though its like 2:30 AM and I'm study the umbilical placement of the fundus, this got my goat.

http://www.latimes.com/news/local/la-me-king20may20,0,6057993.story?coll=la-home-center

Attached is my letter. Dig it!

Subject: you idiot tool
Date: May 20, 2007 2:38:09 AM PDT
To: charles.ornstein@latimes.com

This is off the record...
Good job moron. By focusing your blame on a callous nurse and by publishing her name, you have now not only endangered her personally but you have done the bidding of various county supervisors who make unaccountability an art form. Your story is so full of holes and misinformation, all the details you forgot to include while you made a case against the nurse and police.

Incidents like this happen from time to time in the ER world. Somebody cries wolf and when it really is their turn nobody believes them. ER nurses know this better (and should know better) than anybody. So what can a nurse do in a situation like this, repeated discharges and the patient is still returning? Had they performed a full workup, or did they just send her off with Vicoden? All the triage nurse can do is check the patient in, monitor vital signs every 4 hours, as is county protocol, and let the patient do whatever the hell the want in the lobby (scream, cry, threaten, use drugs, fight). Which she did, followed county protocol. Doctor's decide when to intake the patient.

So there were no doctors involved in this situation at all? What about the too busy to be bothered doctor who couldn't figure out that she had choleolithiasis or a bowel obstruction. How is it that YOU PUT THE BLAME ON A NURSE WHO IS ONLY ALLOWED BY STATE LAW TO CHECK IN, MONITOR VITAL SIGNS, AND TRIAGE ACCORDING TO SEVERITY OF ILLNESS.
A nurse cannot order ultrasounds or pull lipase blood panels . A nurse cannot order laproscopic surgery. All she can do is check the patient in and inform a doctor of the situation. Do you think her getting a workup for the third time that day was on the top of the physicians list? Should it have been?
Obese lady is yelling that her gall stones have exploded and is carrying on. Number 30 for the day. Abdominal pain is the number one complaint in the ER. It is also the most difficult to treat and diagnose. It takes time, because all those people ahead of you with heart attacks, gunshot wounds, and diabetic ketoacidosis are in more danger than your vague (but vocal) complaint.
Junior Blogger: there was nothing the nurse or any medical professional could do for her. You know why? Because LA County DHS is run by a crew of egomaniac rich politicians. As an emergency professional, I can tell you, County Emergency medical care is fucking scary. Its called a lack of reasonable resources. That's not the nurse's fault. But guess whose it is?

You are a tool because the nurse is the most expendable member of the health care team, and as you may now be noticing, DHS is going into general quarters, taking their doctors with them into a protective PR wagon circle. You chump. And just so you know, other than increased pulse, decreased blood pressure (if the perforation was bleeding), and a temperature greater than 101, a complaint of severe abdominal pain means nothing. Ms. Rodgriguez was nothing special in the ER because half the people in the ER were waiting with the same exact complaint. Unless you are involved in a trauma or have an identifiable life threatening situation,you have to wait in the waiting room, just like everybody else at county, you wait your turn. HEY CHUMP! PAIN IS NOT AN INDICATOR OF LIFE THREATENING EMERGENCY. SCREAMING DOES NOT GET YOU BACK ANY FASTER, BECAUSE THEN EVERYONE WOULD SCREAM TO GET BACK. HEY YELLOW JOURNALIST, EVEN HER OWN BOYFRIEND LEFT TWICE TO GO "RUN ERRANDS." AFTER MIDNIGHT NO LESS! She must have been really bad then right?

She was seen by two doctors for full consultations and yet you blame the nurse who evaluated her at triage. Now some media horny DA is ruminating over filing criminal charges, we're not sure who yet, but we do already know that because of your brilliant piece of heart felt investigative journalism it'll probably be the nurse. But that's good for you, right? This ridiculous story goes on and on. Hey, maybe you'll win a Pulitzer.

Mr Ornstein, let me tell you what you are now the cathartic enema for. Nurses will be afraid to properly assess people, patients who like to scream will get moved ahead of people who are really dying (idiot, Ms. Rodriguez was the exception, most people are dying quietly in the waiting room because they are too sick to scream and carry on). When nurses become the flavor of the month for stalled out DA's, any shot of recovering the American healthcare system will be permanently destroyed. You think doctors are afraid of getting sued? Imagine a nurses fear of being sent to jail, for having the strength to do her job, to not crumble under the mountain of LA's worst stories. If a nurse is afraid to do his or her job you won't even get in the door.
That's right chump, people are dying in the waiting room everyday because there aren't enough beds, hallways, tables, to put the bodies on. If someone has the energy to scream at me, I tend to think they aren't dying. Ethical Journalism Reject, you have enabled LA county DHS supervisors to shirk off some glaring reminders of their managerial incompetence, yet again. A morbidly obese Latino woman (Hypertension + Diabetes endemic) sadly crashes after a life time of giving her shoes to people and basically being kindest, sweetest greatest person on earth, well aside from those warrants, and you want to hang the nurse whose job is to categorize and put the patient in line and attend to any life threatening situations that might arise.
I wonder why the whole night shift ignored her, lying there, screaming in pain, and no doubt in real agony. Why would they do that, I wonder...

"I am completely dumbfounded," said county Supervisor Zev Yaroslavsky. Ya think?

Good job.

Positive Role Model Found!

2007-04-23T16:36:00.000-07:00

A breakthrough! My OB instructor is great! Honest, sense of humor, argues with doctors during C-sections, is open about the problems with the hospital she works at, lets us make mistakes without humiliating us, and seems to take a genuine interest in my performance. Best of all, she believes in the absolute competence of the nursing profession, and pointing out the bad habits of uninvolved nurses.

I feel like Michael Banks in "Mary Poppins" when the two kids write a letter requesting a new nanny, and FUCKING MARY POPPINS SHOWS UP. Before you know it she starts giving them hard core drugs laced with spoonfulls of sugar and making rooms fucking clean themselves. What a relief! I just needed someone to give me some guiding light: a nursing instructor that acts like a normal person!

I'd like to write more but I've got a serious PEDS/OB test manana.

Cheers

Go ahead and squeeze a little harder why don't ya?

2007-04-01T23:21:00.000-07:00

Sorry, it’s been awhile. Super busy. Super fucking busy. Got through the competencies pretty good, I got the “easy” instructors, i.e. the ones that are remotely normal and secure enough with themselves that they don’t feel the need to torture a student.
As of right now, the majority of my class is on academic warning. The 2nd semester faculty is a lot like the Bush administration: No matter how bad the classes grades get, no matter how many inappropriate acts the instructors carry out, it’s the same shtick. “We’re just trying to figure out why you guys aren’t getting it.” Never a mea culpa, no responsibility whatsoever for the fact that a group of extraordinarily driven and intelligent ADULTS are failing everything thrown at them.
No, my dear instructor, you saintly middle-aged woman in your 40’s with no kids, no husband and 20 cats. YOU’RE not getting it. You’re fucked up! And when your sole purpose for teaching is to humiliate, bully, and fail students well, you get what you pay for. A class of 72 students with the majority on academic probation.
Fuck off!
I make no apologies. The observation has been made, I shall pontificate here but lord help me if I say this in class.
If you are middle-aged, not in a relationship, don’t like young people in general, and have a freakishly large assortment of pets put a red flag on your scrubs because you’ve got some serious fucking issues and shouldn’t be anywhere near the next generation of nurses.
I’ve come to this conclusion as I have come to realize that the violently nutty nurses, the happy-sad, maybe I’ll get weepy during a lecture and then scream at a student for not wearing the right color socks (black shoes=black socks, white shoe=white socks. I’m totally serious the hard asses will send you home if your socks don’t match.), the ones who tell the students they don’t like that they should maybe think about quitting school, these are the ones who aren’t married. At my school a couple of the foul tempered instructors have been married but are now divorced, but in general they have been single for a considerable amount of time. Like, I can’t believe the huge assorment of spinsters that are instructing at my school. Somehow, they all found each other, united in disdain and contempt.
Nothing wrong with being middle-aged and single, middle-aged and divorced, fuck half the country is past 38 and divorced. But are you still in the game? Are you trying? Have you given up on the opposite sex entirely and have resigned yourselves to your sister’s kids, pretending they are your own? Do you still believe right before the increasingly shitty and bizarre blind dates you’ve been finding yourself on that this might be love?

Don’t give up. The opposite sex hates you as much as you hate them. So just fucking bite the bullet and let it go, accept someone for who they are and go make some love. As long as they respect you, treat you right. And ladies, don’t tell me you’ve tried and good men are hard to find. Because they are not. There are roughly 75 million single men in America. They may not come in the form you fantasize about, they may not treat you like shit just the way you like to be abused but goddamnit they are out there. And for the divorced middle-aged guys: PAY ATTENTION TO YOUR WOMAN. WOMEN USE SINCERE ATTENTION LIKE FUEL. JUST A FEW MOMENTS OF YOUR TIME AND THEY ARE ABSOLUTELY FUCKING STOKED. LAYOFF THE SPORTS TALK AS YOU PRIMARY METHOD OF COMMUNICATION. AND TRY AND STAY AWAKE 10 SECONDS AFTER THE NUT YOU CHEEKY BASTARDS.
Excuse while I step off this soap box.
I mean, if it’s this obvious what the bad nursing instructors’ problem is, that they have been dicked over by some of the worst taste in men this burned out society has to offer (see: firefighter, paramedic, cops, used car salesmen) they have no one to blame but themselves. I didn’t fuck up your dude radar! You should have gotten it fixed!
They act on their own bizarre experiences so often I can see their bitchy wheels turn, “Should I be supportive of this student in their time of need, should I encourage them, let them know that its okay to make mistakes when you are learning how to do something that requires immense technical finesse, great emotional intelligence, and serious attention to detail? No. Now its time to lay down some serious institutionalized abuse and sting this student good.”
How fucked up are they? You know they must have hated their patients. Probably despised them. Did fucked up shit like withheld pain medication when in a foul mood to “punish” their patients for being needy or irritating them.

Hey! You nurses out there who play the withholding pain meds till absolutely as late as possible game: you make me fucking sick. Who are you to judge and punish? Don’t do it. Don’t abuse like you’ve been abused. Cause you’re playing with fire and baby you will get burned. It’s like scratching the mosquito bite of hate: you only hate more.

Some nurses hate black people.

Some nurses hate men who remind them of their father.

Some nurses are uncompassionate to women that remind them of their mothers.

Some nurses don’t feel what a patient is going through because they have a higher tolerance for distress because of what THEY have gone through.

Some nurses are traumatized from their line of work and suddenly snap at people or patients they may care about.

Some nurses have drug problems.

Some nurses are jealous of American nurses.

Some nurses hate men.

Some nurses hate women.

Some nurses loathe white people.

Some nurses do what they are told to do too much to please the powers that be.

Some nurses like to be part of a machine that crushes people, that keeps down the dusts of change.

Some nurses are just looking for a spouse.

Some nurses are absolutely incredible fucking people who have great technical knowledge and are still emotionally capable of making someone that they wouldn’t otherwise relate to or interact with feel safe, clean, and capable of healing.

Some nurses have heart.

Some nurses know what the fuck is going on and aren’t afraid to act on it.

Some nurses could really give a shit what arrogant, pissant residents think is a “quick” procedure.

Some nurses walk the line between insubordination and always advocating for their patients as a method of humility, integrity, and keeping it really fucking real.

Some nurses think for themselves.

Some nurses are so fantastic and inspiring to me that I personally want to equip myself with the “identity” of a nurse.

Keep doin what you’re doing.

Mazeltov. Happy Passover,

And to all the haters and status quo addicts, the trick ass marks, mark ass marks, punk asses, ho's, heffers and hulahoops, skeezers, skanks, skig-scags, scallwhomps, I want you to ponder exodus from slavery you dickheads, you disgruntled bitches.

I’m coming to gitcha.
(Thanks D.C. for that rant)

How many nurses are victims of domestic violence?

2007-02-19T19:22:00.001-08:00

I posted this on allnurses.com:

Re: intimidation by nurse manager?
Quote:
Originally Posted by Cat Nurse
"I have a male nurse manager. I have worked with him for many years. I am not agreeable to some of his hired staff. I think his hormones get in the way of his judgement. But many people feel intimidated by him. Many have quit and say it is because they don't feel comfortable around him. Most, probably would not have been confortable any place or with most people!"

Is this really a gender issue? People have quit because they don't feel comfortable around him? Like, he'll hide behind around a corner and attack you? There are so few male nurse managers, please don't take the most obvious route and imply that he is a pervert. Its hard enough being a male nurse as it is. Same goes for male school teachers. Not all men are pervs. Some are, yes. But it sounds like this dude is just being a manager, which means to say he is trying to control you because most managers are too insecure to work with their staff, instead they work against them. BTW, I work in one of the largest ERs in California and the head nurse and nurse manager are both female. More of the nurses here have breast implants than don't. No joke.
Don't blame your male manager for unprofessional nurses, please. If your manager wants to act like a child let him. If patients get turned away, its his rear end.
END POST

Cat Nurse (red flag right there), feels that she's not allowed to go fulltime PRN because her nurse manager is a hormone driven scumbag. Thanks Cat Nurse! That must be it. What a bother.

Nursing school is seriously kicking my ass. Mid term tomorrow. I think I'm prepared. You never know...

I've been looking at all the first year residents, second year residents, all the residents. They seem so happy. They're so loud on the floor, joking with each other, high fiving each other. Then I look at the nursing students: Scared, painfully quiet, expressionless. The second me or one of my fellow nursing students does ANYTHING there is another nurse and our nursing instructor immediately in our face threatening us with expulsion. Seriously, I asked my instructor how many clinical days we were allowed to miss, and she fired back at me, "If you miss more than two on your first rotation you are out of here. You will be dropped from the program." What the fuck lady? I haven't missed any days, I just wanted to know.
WHY ARE NURSING STUDENTS ALWAYS BEING THREATENED AND BULLIED?
You know what I just found out? That one of the other 2nd semester instructors, a passionately pro-American ex-army nurse, I call her Chris Farley, (I wrote about her about three posts back) she makes faces at you, tsks her tongue, shakes her head, while you do the clinical competency. Not like goofy faces, but furious faces, disgusted faces. She might as well call us "maggots" That's fucked up. And don't tell me that as a nurse you have to be tough and do it right under pressure, blah, blah,blah. We're fucking students for Christ’s sake! Most students haven't even seen an NG on the floor, what the fuck do they know? This is not the military. We're not in WWII. We're college level nursing students getting a degree and planning to join (what I hope is) a professional work force. All this constant threatening, the persistent mood swings of ALL the instructors, "today I like you but tomorrow I won't" It all dehumanizes us, sucks up what little self confidence my fellow nursing students have, makes them more timid. Afraid to confront asshole doctors, afraid to tell the manager the shift they got is bullshit, afraid to switch to a better department where their co-workers at least attempt civility, afraid to say "this pay is shit and I'm going to quit and work at a hospital that treats me how I deserve to be treated!" How about instilling professionalism in the new nurses of today, which is to say, support them and treat them respectfully. CAN WE AT LEAST ATTEMPT TO BREAK A CYCLE OF OPPRESSION?
Chris Farley fails at least ten students on NG competency every semester. For stupid shit lie forgetting to tape the tube to the cheek, even if its already taped to the nares. That's great for the confidence building!
I cannot believe how hard my school works to keep us from thinking for ourselves. Every instructor loves to shout "critical thinking" about 30 fucking times a lecture but all they're really doing is enforcing protocols. I have no problem following the rules, but do you have to tell me I'm stupid while I do it? Why is this old school, oppressed female nurse shit allowed to perpetuate? Why not make everybody where the fucking white hats while you're at it?
Long shoreman makes 100K a year, to start. They don't do shit half the time. So don't tell me about the gravitas, the noble responsibility of nursing. OLDER NURSES! Most of you have failed in your careers! Your lack of respect for yourself has cost you the safety of the patients and left a smoldering hole where you once held an acorn of self confidence.

I do not mean to be crude, but I ask this question in all sincerity: How many female nurses suffer spousal abuse, be it intense physical of emotional. I'm totally serious. You think about this question, then we have the root of our problem.

Sack Launch

2007-02-02T22:45:00.000-08:00

Not a big story teller. I mean like, ER stories shit like that. I think its in bad taste. It's basically like saying, "I'm cool. I'm cool. You're not. I'm cool." the whole time you tell the story.

BUT in this case, check this out.

We're starting out with one patient for clinical. Next week we get two. This week I had a dude with an abcess on the inner aspect of his thigh, closer to the cup of his ass cheek. Monster abscess. My patient was kind on nutty, sort of a strange dude. Hispanic, spoke pretty good English. He told me that he had the abscess in early January, it went away then came back, like a tumor. He was so resistant to listening to any medical advice, I think that that he still thinks the I&D was a benign tumor removal. Anyway- here's the fucking story.

Resident comes in with medical student. Resident is a giant white goober from Idaho. Like, 6'4. Ugly and arrogant. His medical student assistant was short, obese and African-American. It was abundantly obvious from their interactions that they did not see eye to eye on many different levels. All three of us are in the patients room, preparing for another incision and drainage of the abscess. His boss, a female jewish doctor, told him to go deeper with the cut. He protested. She ignored him. Tall goober stuck between a female Jewish boss and an female African-American med student. You could see it was driving him in red state agony. I loved it.
Pt. was lying prone. Part of his nuttiness was sort of these jerky movements, so when he lay down, he sort of flopped down and his ball sack was sticking out underneath him, like a little bag or, I don't know, a bunny rabbit tale. Dude wasn't embarassed or bashfull at all. "Fuck it," the pt. was probably thinking, "might as well air out the huevos."
Doc Goober begins to numb up the 6 cm long x 2cm wide x 2cm deep wound. He starts talking to me, the lowly male nursing student. I took it as a perverse political statement. I'm way low on the totem pole but in his eyes, better that than the black or the Jew women. So he's talking at me as he inserts the needle into the wound. Of course the poor bastard patient is completely unmedicated and biting his pillow.
Dr. Goober's pain med: "This'll just take a minute." Asshole.
So instead of walking the med student through the procedure Goober is actually looking at me while he's injecting Lidocaine. The inevitable happens when you give an arrogant conservative control of a resource: Goober loses control of the syringe.
I've never seen anything like this in my life: As if in slow motion hand ballet, like a magician winking a coin through his fingers, Goober struggled to regain control of the needle. Over the top of his fingers, bumped up again by his palm, up the back of his hand, this needle was all over the place. His germanic-irish mug was shriveled in strain and horror, like the 3rd Reich had just destroyed a potato field in Boise. He made a last ditch attempt to grab the flailing syringe and it hit the top of his fingers and went straight up in the air like a missle, did a 180 and headed straight back down to earth like a dart. Right into the bunny tail. Right into the dude's sack.
I heard him scream into his pillow, "Oh my jeesus! Oh!" I've never seen a sack pierced before. Shocking.
I need to be perfectly honest here, everybody. The pt. was a light skin Latino, had a mullet, and fuck me, he sounded a lot like Nacho Libre. I wouldn't have been suprised if he had said, "That was eeespecially painfull."
Then he started to sob. He didn't like wail, but little girl like shudders, I could here him hyperventilating and moaning. Pretty fucking sad.
The needle fell out of his scrotum and a big old bubble of blood surfaced. The good doc Goober had finished looking at me for good. He turned to the medical student. He looked away quickly. His gaze returned to the burst sack. As he dabbed with guaze, "Oops. That was me buddy." And as he lamely looked at his med student, "My bad."
I would have puked if I wasn't laughing so hard.

NEXT UP: RACE ISSUES IN THE HOSPITAL. THE TIME HAS COME MOTHERFUCKERS!

Horizontal Violence

2007-01-29T19:28:00.000-08:00

This is what I have been feeling. I read this and freaked. This describes the medical industry to a t.
I realize there is a lot of text here but I am so pleased and relieved I found this tidbit- check out the website.

http://www.acegraphics.com.au/articles/hastie02.html

Definition of horizontal violence

Horizontal violence is hostile and aggressive behaviour by individual or group members towards another member or groups of members of the larger group. This has been described as inter-group conflict. ( Duffy 1995).

Talk to all staff members about the phenomenon, break the silence.

Introduction

Horizontal violence is non physical inter group conflict and is manifested in overt and covert behaviours of hostility (Freire 1972; Duffy 1995). It is behaviour associated with oppressed groups and can occur in any arena where there are unequal power relations, and one group's self expression and autonomy is controlled by forces with greater prestige, power and status than themselves (Harcombe 1999). It may be conscious or unconscious behaviour (Taylor 1996).

It may be overt or covert. It is generally non physical, but may involve shoving, hitting or throwing objects. It is one arm of the submissive/aggressive syndrome that results from an internalised self-hatred and low self esteem as a result of being part of an oppressed group (Glass 1997; Roberts 1996; MCCall 1995). It is the inappropriate way oppressed people release built up tension when they are unable to address and solve issues with the oppressor. (Administration and doctors)

In the majority of western cultures, a dominator model (Eisler 1993) of social organization enables workplace hierarchy to limit autonomy and practice of various groups of workers and therefore acts as an oppressive force. Workers are socialised into the oppressive structures and unequal power relations of the workplace system.
Some groups of people within each particular workplace unconsciously adopt inflated feelings and attitudes of superiority. Some groups adopt unconsciously submissive attitudes, learned helplessness, within the workplace.

Horizontal Violence is a symptom of the dynamics around oppression and a sense of powerlessness. It is to the workplace culture like water is to fish. It moulds, shapes and dictates the behaviour of those within the workplace culture.
It is a form of bullying and acts to socialise those who are different into the status quo.

Horizontal violence in the workplace is the result of history and politics in western society and the ideology and practices associated with the socialisation and stereotyping of males and females in western culture. Horizontal violence is a systems and cultural issue, a symptom of an emotionally, spiritually and psychologically toxic and oppressive environment. Horizontal violence is not a symptom of individual pathology, although individual pathology flourishes in a climate that supports and condones aggressive behaviour.

Horizontal violence includes:

All acts of unkindness, discourtesy, sabotage, divisiveness, infighting, lack of cohesiveness, scapegoating and criticism

For example:

Belittling gestures e.g. deliberate rolling of eyes, folding arms, staring into space when communication being attempted - Body language designed to discomfort the other
Verbal abuse including name calling, threatening, intimidating, dismissing, belittling, undermining, humorous 'put downs'
Gossiping (destructive, negative, nasty talk), talking behind the back, backbiting
Sarcastic comments
Fault finding (nitpicking) - different to those situations where professional and clinical development is required.
Ignoring or minimising another's concerns
Slurs and jokes based on race, ethnicity, religion, gender or sexual orientation
Sending to 'Coventry', 'freezing out' excluding from activities and conversation, work related and social.
Comments that devalue:
people's area of practice;
women;
others that are different to the 'norm'.
Disinterest, discouragement and withholding support
Limiting right to free speech and right to have an opinion
Behaviours which seek to control or dominate (power 'over' rather than power 'with')
Elitist attitudes regarding work area, education, experience etc "better than" attitude
Punishing activities by management e.g. Repeatedly sending someone out of area; bad rosters; chronic under staffing; lack of concern with mental, emotional, spiritual and physical health of employees
Lack of participation in professional organisations (a subtle form of self-hatred) however, busy family lives can preclude participating in professional organizations.

Nursing Student Hell: Real fast

2007-01-28T21:34:00.000-08:00

Nursing Student Hell: Real fast

I just want my R.N., lady.

2007-01-28T18:52:00.000-08:00

Alright- my second semester of nursing school is in full swing. Getting my butt kicked, trying to figure out baffling electrolytes, trying to jam all this new info into my brain. All in all, its pretty fascinating. I'm happy in nursing school. I'm enjoying the mechanisms, gears, and gadgets of nursing healthcare.

Alas, someone has thrown a wrench into my enjoyment of education.

Some of you nurses suck. You are unbelievably childish, and all of my instructors and more experienced advisors tell me to just ignore it. FUCK ignoring middle school level attitude, FUCK not having conflicts over stupid things.
Hey experienced nurses- How far has ignoring unprofessional behavior got you? Congratulations! Have another serving of being looked down on and a side dish of co-dependant unacceptable behavior. Nursing needs to change.

I'M MAD AS HELL AND I'M NOT GONNA TAKE IT ANYMORE!

I go to a nursing school that is part of the county system. There are several hospitals in my county. For the first time, my 10 person clinical group is doing clinicals at a farther away county hospital that has relationships with public and private nursing schools already established in that area.

FOR SOME REASON, THE NURSES AT THIS HOSPITAL DO EVERYTHING THEY CAN TO SHIT ON US, THE NURSING STUDENTS.

It's completely baffling. Why do the nurses give a shit what school is doing their clinical rotation at their hospital? It's all the same nursing students. We haven't bumped any schools. All we do is come in there two days a week, wipe someone's ass for them, if we are lucky, plant a Foley, put down a NG, set up an IV. (None of which has happened yet.)

Here is the response my clinical group has gotten from the nurses:

Really nice nursing student: "Could you tell me the name of the nurse manager? This is our second day on the floor and I'm filling out a scavenger hunt of who everyone is and where everything is at on this unit."

Shithead Coordinator: "You don't know who the nurse manager is? That's really sad. Really sad."

Me: "Excuse me. Could you help me access the labs on the computer system?"
Nurse Manager: "You don't have access to labs. That would be a liability. You are a liability."
Me: "We have access to the same system at county. We need the labs to fill out our clinical write-ups."
Fucking Nurse Manager: "No you don't. There’s no way you have access."
Me: "Of course we do. We also have to chart on the computer as well. We can even access labs from our college."
Nurse Manger: "What?" she looks around the floor to make sure everyone is watching, "That's a HIPPAA violation. That's wrong."
Me: "Our college is on the hospital campus."

My instructor introduces the nurse manager. She does not say hello. She does not say welcome. She says, “You may not use the nurse break room. You may not bring backpacks to this unit. You may not use the conference rooms. If you want to access labs find the nurse for that patient and have her sit with you while you record your information.”
Walks away.

Hello. Fuck you. Goodbye.

I am not a liability to any of the nurses on that floor. I am a liability to my fucking liability insurance company and to my instructor. duh. Telling me I'm a liability is childish bullshit. Something else is going on.
Then they snuck in the LVN students. Now we "share" patients. The LVN's come from a rip-off private college. (35K a year). We come from the county, same as the hospital. What the fuck?
None of the nurses will answer questions.

Does anybody out there know what is going on?
How can nurses act like such children? So remarkably unprofessional.

And the best part: As county student nurses we are eligible to be student nurse workers. The nurse recruiter (who is so passive aggressive she is basically just aggressive) schedules the THREE DAY SITE ORIENTATION THAT WE ALREADY WENT THROUGH AT THE MAIN COUNTY HOSPITAL on the first three days of my nursing schools semester. She actually told me that she knew my instructors very well (which is a bold face lie, they had only met once) and that she was sure they wouldn’t mind if I didn’t show up for the first three days to attend orientation. Miss any of the classes the first week of school and you get yourself dropped from the roster. This nurse has 3 masters degrees. NP, MSN admin, MSN education. She looks like she is on the tail end of a 2 week vicodin run. Nodding eyes, tiny pupils, unbridled hostility. 3 masters. What a waste.

Not a single male nurse on the entire unit I might add.

Sometimes nursing, you really bother me. Nurses are so quick to behave so bad, so easily. A true disappointment.

NOBODY TREATS NURSES WORSE THAN HOW THEY TREAT THEMSELVES.

Is that nursing in your pocket or are you just happy to see me?

2007-01-16T18:40:00.000-08:00

Started second semester today. 4 classes. 6 hours of lecture. My ass seriously hurts, like my tailbone hurts.

So much reading to pour over and try to stuff into my wee brain. I already have "The fear." All those nagging assigments like mini mountains looming over a grey horizon. One down, an infinite amount to go. The horror....the horror.

I'm lucky though, I got assigned to a relatively mellow clinical instructor. Fortunately, I didn't get the psychotic ex-army nurse from the south who acts all girly and squeeky when she lectures and then bellows at her students in a voice like Chris Farley, "My clinical group gather at once! You there! What are the 12 crainial nerves and their functions!?"
"How should I know? " the autistic guy Mike blurted out.
"Oh my gawd! I've seen jackabasselopes smarter than you!" She barked like a seal with a fucking cigar in its mouth.
"What the fuck just happened?" autistic Mike said, his eyes darting around the room, trying to get a lock on anyone who offered emotional comfort. But none was to be found in this barren field. Everyone was too afraid to even look at him. I wanted to tell her that Mike is fragile but I guess, ultimately, it's for Mike to sort out.

Sorry experienced women, but 6'2, 50+ women should not talk in girly, squeeky voices, play with their hair, perform shockingly suggestive dances whenever a male student gets one of her arcane questions right and then bellow like Chris Farley after four bong hits. It's unseemly.

It was good to see all my friends again, feels like the class is a bit more cohesive this time around. People seem to have been hanging out over break, carnally.
Finally some lovemaking has been going down in the class. There is like 7 straight guys in my class of 75: 6 gay dudes and 7 straight dudes, 5 of the straight dudes are married. Can you guess who got laid? That's right! The 2 straight single male nursing students co-mingled their loins with the blossomed flowers of a few of the previously betrothed but now broken up ladies in the class. Funny, the women that actually hooked up with dudes over break all SWORE ON THE SACK OF JESUS last semester that they were SO IN LOVE with their ex-boyfriends.
"We're practically engaged!" they felt the need to brag. Then they spent the whole break rebounding like Kobe Bryant on Meth with like the only two available guys around them.
In my limited experience I can't help but notice that nurses are weird people. I'm weird. I like weird people. Do nurses have higher sex drives, male and female alike? Is that what it takes to be a good nurse? 110% on the floor, 110% betwixt the sheets? Robby told me his balls hurt from getting laid so much. I don't know whether to be professionally insulted or proud of the little bastard. I guess I should be proud of the ladies too! Fuck it. They're young and single. Go crazy. Get your rocks off.

The married must live vicariously through the melted heartbeats of amorous, wet, stressed out nursing students.

As one straight male nurse told me about nursing school, "I like them odds."

The way of the dog.

Nurse Ratched's Place: Change of Shift

2007-01-11T16:27:00.000-08:00

Nurse Ratched's Place: Change of Shift

I like women and whine

2007-01-11T16:21:00.000-08:00

Just read a post on allnurses.com: why are newbies such whiners?

I'm a whiner. I tell you why.

Because like most newbies, I am totally fucking shocked to see the vindictive and apathetic attitude most experienced nurses have towards themselves and their fellow nurses in regards to nursing as a profession on a whole. Shit shifts, shit pay, no significant pay increases in the last six years. Constant cattiness. I got into this field thinking I could support my family. I'm thinking I got fed a load of bull. So yeah, I whine. I whine cause I want this exciting and rewarding profession to change for the better and I want to see women stop blaming men for some "glass ceiling" when all they have to do is unify, stop bitching, and start working towards better treatment.

I love the sacrifice play that nurses often pull. I've seen it twice. We'll call it: You're our hero (you're fucked)!

1) Courageous nurse steps up and says she is willing to go to the union to try and get some things to change.

2) The majority of the staff back her up to her face, (great idea, yeah let's do it!)

3) Nurse goes to the union, confronts management. All the other nurses pretend they know nothing about this when management asks who else feels this way, if anything they condemn her by calling courageous nurse a "whiner".

4) Courageous nurse is either hassled into quitting or is set up and fired.

This is why I whine. Because I am a man now relegated to unempowered woman status. And I think it sucks. All that I know technically about the medical field I have learned from women. Including E.M.T. If my fellow female coworkers could see how capable they are in my eyes, maybe they would stop feeling so inferior.

C'MON WOMEN!! YOU HAVE NOTHING TO FEAR HERE. YOU ARE THE FUEL BEHIND THE SHIP! ROAR M'LADIES!!

Where will we live?

2007-01-01T01:27:00.000-08:00

The names have been changed to protect my ass...
I'm pretty sure I was ridiculously naive. Upon entrance into the medical field. Even in E.M.T. school I had such ridiculous expectations about what working in as an E.M.T. actually entailed. I didn't think my job would be running around doing dramatic heroic things, I didn't think everyday I would pull people out of cars or something cheesy like that. I don't have a hero complex. I just thought I would be more useful than I actually ended up being. Performing a really valuable service. I didn't expect to being turned into a cog for such a dysfunctional health care machine so quickly. The ambulance company that I worked for didn't have a 911 contract so we only provided transports to and from different facilities, such as convalescent homes, mental health facilities, and halfway houses.
From day one: I encountered a human condition that I couldn’t believe was imaginable in compassionate America: My job was to transport filthy, covered in unbelievable bed sores, low BP, catatonic, elderly or unstable patients to either dialysis or a doctor's appointment. During the doctor's visit we would travel at light speed with lights and sirens blaring (code 3, totally illegal to do unless someone is truly unstable in the back but the dispatch manager was always bellowing at us it was our butt's if we didn't) to grab another patient from another facility and get them to their appointment and then dash over to pick up the first patient hopefully before their visit was over. Constant mad dash, load and go, load and go. No lunch. Ever. 12 hours and more of this every shift. My first trick of the trade: Learning that most ambulance crews are under he same stress. Any time you see a non-fire ambulance crew running with lights and siren and two uniformed employees sitting up front, they are breaking the law. You can go code 3 after you get the patient, but before you pick the patient up all you can do is get there as fast as you can. When an ambulance has a patient the only uniformed employee to sit up front is the driver. The one in attendant role is in the back.
The ambulance company was run (and still is I hear) by an ex-crip and a questionable Russian lawyer. The E.M.T's I worked with were, in general, somehow oddly suited for the job they held, maybe because the all seemed resilient to life's beat downs or perhaps were just enduring them. Being an E.M.T is meant to be a stepping stone for other career aspirations, at least in Los Angeles. The crew was comprised of people who sat down on the stepping stone. Wanna be firefighters, strip club addicts, drug addicts, Ultimate Fighting Championship half-assess and all around scandalous people.
A shining example of someone who seemed to be missing out on life was Paul, the only other white guy working the day shift was a hardcore burnout who got kicked out of the L.A.P.D. police academy for reasons unknown. (Well unknown until you spoke to him) In his mind, he was actually a cop, a super cop, and claim he had a mysterious ability to read the intentions of everybody we passed on the street from his "intense police training". Ridiculously scary statements like, "once you get that training it never leaves you. See that old lady there waiting for the bus? I've identified her as a drug mule." To bad that training didn't get him a decent job. Paul was 40 when I met him and still living with his mother. She'd call him at least 15 times a day and every time he acted like he was getting a call from the goddamn president. Transports would wait for these epic conversations, mostly about where random objects had been stored in their pack rat ancient apartment. Thank god I never had to go for a visit to Mummy but I had heard stories. One of my partners, Geena, told me "It's like, still 1985 in there. I can't explain it."
Geena was a morbidly obese dyke who was actually pretty good at her job. She could talk to patients and put them at ease and did a pretty good job of disregarding the bullshit that came from "base" which was The questionable Russian lawyer’s office and the ex-crips place of residence (Dudley). His office was his bedroom at night, but during the day his bed, a lovely white futon made his office look spacious and comfortable. As if he had clients that could casually comein and relax on his ikea futon couch. But at night:Dudley would bring out what he called "My passion." A red sating sheet would drape the corners of his bed. And the dude had chicks. Every night a different girl, every morning a bleary eyed regretful young woman would leave his office/chamber of earthly sin.
We rolled pretty much in the African-American parts of Los Angeles. Inglewood (which is actually a pretty cool little city with some great history), Hawthorne, Compton, Carson. All the cities surrounding South central. We weren't ever supposed to go into Los Angeles City proper because we didn't have the mysterious and difficult sticker that would grant us city privileges. We went anyway, quickly, the driver usually repeating the mantra "I don't want to lose my license. I don't want a $1000 fine" over and over. Maybe the fine was a threat, but everybody I worked with had expired E.M.T. licenses anyway.
The ambulances themselves were death traps. The rigs were from a dealer in Louisianna that Dudley knew. They had outlived their service in that quality healthcare state so they made their way to Los Angeles, to our sweet company. The only medical device inside was a stethoscope, a bp cuff, and an O2 tank that were all almost always out of gas. The tires on the rigs were always blowing out, they were made to handle the weight of a family van, not an ambulance. I myself blew out two tires by carelessly driving over the edge of curbs. Mechanically speaking, as far as I know, the ambulances were maintained by a team of mystical ambulance engine trolls who would "make adjustments" as the questionable Russian lawyer would say, right when no one was around to see the work being done. At least once a week one of the company’s 3 ambulances would break down on the 405 or the 105, usually with a patient inside of it. I found the possibility of breaking down with a patient inside it nerve racking. But I got lucky, I only got stranded because of blown tires. My coworkers took it as a minor annoyance. Break time I guess. I remember when I quit the company I called the Highway Patrol to report the company, typical dramatic behavior for a pissed off E.M.T. who wants revenge, for the crappy pay, the shame of transporting sick people in ambulances that were unfit for usage, the doctor's who would passingly look at a patient with decubitus ulcers to the bone and write orders that he knew would and could never be met. The cop in charge of ambulance safety at the CHP said, "Look, they just assigned me here, I don't really know what's going on. I'm sorry I don't know what to tell you." He didn't want to take the complaint. He didn't care. Another bummer lesson: I WAS THE LAST PERSON TO FIND OUT HOW COMPLETELY FUCKED UP OUR HEALTHCARE SYSTEM IS.
How could I ever forget the stupefying realizations that one could ascertain about what happens to some poor old people in American culture. The frustration of having to pick up a nearly dead patient from a con home, 7 CNA's sitting down having lunch, talking about anything but what is going on in front of them. Meanwhile the patient we were there to transport to her clinic appointment had a non-rebreather mask on at 2 liters when at minimum they function at 8. She looked sleepy and would only respond with mumbles. The shock of having to get report from the nurse in this con home, the only nurse in this con-home who, coincidentally spoke ABSOLUTELY NO ENGLISH AT ALL kept my jaw to the floor the entire time I was there. The poor nurse presented as an extremely upset Korean woman who kept pointing at the CNA's in horror but was never able to say anything. My partner Mark, didn't want to take the patient. 75/30. 50 pulse. Rapid respiration's.
"We shouldn't be taking this patient. She's about to code." Mark, a very dignified and compassionate African-American, whose goal was to be a screen writer, looked at the patient, looked at me, pushed the nurse aside and said, "Fuck it. Load and go. Let's go now." We didn't have O2 on our gurney, whatever she wasn't getting any anyway. No report, just a pile of papers. Mark loaded her up into the rig with one hand. As I was closing the loading doors one of the CNA's came running out of the con home. Some useful information? Hell no. "Ya'll have any gloves? There aren't any gloves in this whole place!" I tried to say something in disbelief but all that cam out was "whaaa?" in a hushed whisper. I thought about telling her to go to hell but Mark grabbed one of our two boxes and tossed it to her. Then we took off. I was too inexperienced to see how sick the patient was. After a while of working around sick people you can sort of look at a person, scan their vitals and figure out how stable they are, a reasonably accurate guestimate. Mark had developed this ability and took his guestimate, I just followed. My skills were too new, too inadequate to get a good BP while we were cruising at breakneck speed to what I thought was her Doctor's appointment.
"What's her BP?" Mark yelled back to me.
"80/60, I think. I think she's crashing." She wouldn't respond to my calling her name, "Mrs. Mayfield! Can you hear me?" The sleepy eyed look she had at the con home was gone. Her eyes were just closed.
"Look, you need to tell me what it is exactly. If you need me to pull over so you can do this then I'll pull over."
"all right pull over." A gray cloud was coming over me. I knew I wouldn't be able to take this BP. I was too stressed, too new, and I just couldn't seem to slow myself down enough to do what I had been taught.
"Just do it over palp, man!"
I blurted out, "What's that?"
Mark jumped over the driver seat into the back of the rig, ripped my bp cuff out of my hand.
"Inflate, when you feel a pulse over her wrist you have systolic. That's all we need right now. 70. She's holding." Off we went. We rolled into a now closed Gardena E.R. The ambulance bay doors opened, and... jammed up. We were number four on the wall. An absolute gurney traffic jam everyone waiting for rooms to open up. And in a 16 bed ER this was probably going to take a while. Graffiti marked the 80's brownish colors of the peeling wall where we waited, staring at our patient who was becoming what I now recognize as ashen. "22 crew waits you hard!" "Bad timing." "Who's fucked?" engraved into the wall by the same ballpoint pens that would no doubt write the transfer reports detailing a perfect drop off, enabling the voracious ambulance companies to secure their medi-cal payments.
Mark tells me to go find the charge nurse and to tell her that our patients bp is below 80. I find a woman who looks like she is in charge. I tell her exactly what Mark told me to say. I'm too stupid to be freaked. I think because we are in an ER that everything is cool, not our responsibility. The truth is that until the hospital takes custody of the patient, the patient is still yours. The charge is steady, calm, and collected. "3 ahead of you, two are county paramedic runs. It's gonna be awhile." I walk back over to Mark. He's found a portable BP. Holding at 70 over something freakishly low. The sun was coming down, shining through the lookout windows on the top of the bay doors, starting to turn orange. Mark continually runs the bp, 65 systolic.
"Tell the charge nurse her BP has dropped." Mark is calm. So I am calm. I tell the charge nurse. She stares at me for half a second. She walks over to my patient. The charge nurse looks at her and quietly says, "2".
The county firefighters give us hate stares as we walk by. Mark reminded me to switch over the 02 to the house tank, especially since we took our over size tank from the rig and put it on the bottom of our gurney. Too new to realize how totally obvious it was that we were working for a shit company and how ill-prepared we were. I still didn't get the gravity of the situation. Things had happened so fast that it didn't even occur to me that we had just dropped our patient off at an ER, not a clinic. E.M.T.'s do not make code 3 ER runs straight from a con home without a paramedic on board. We got back to the rig, I got on the radio and obliviously reported the run we had just finished. The manger, Tara, a very attractive, very psychotic spaz who couldn't speak to anybody without screaming "You fucking listen to me" first bellowed accordingly, "You fucking listen to me! You were supposed to drop her off at Ce---- Clinic not the C------ E.R.! I'm telling Dudley. I want your asses fired." Somewhat typical speech blaring from our banged up nextel, although this time her screech was a bit more murderous. I sat staring at the nextel. I wondered what other horrible shit would come out of its speaker. Mark calmly took the nextel out of my hand.
"Tara this is Mark." He paused, held down the speak button so she couldn't respond, "She crashed. What should we do, drop a half dead woman off at a clinic for a 45 minute wait?"
"You fucking listen to me! Yes, you should have!" Mark told me to hold down the speak button and not let go. I didn't, not for 15 minutes until we got back to the station. Dudley was there. Waiting. Dudley and Mark had what I later called, "the cool black guys conversation." Mark and I were punching out when Dudley appeared from seemingly out of no where on our left hand side. He was leaning on the closed office door. I didn't even hear it open.

Dudley: Say Mark, you guys got a minute? What's up? all right. You should have taken the patient to her clinic appointment.
Mark: Yeah man, you right, but see, she got bad in the back , you know what I mean?
Dudley: all right. Don't pick the patient up next time, cool? Take them to their appointments and that's it.
Mark: My bad. Thanks.
Dudley evaporated in front of our eyes, like he walked into the office backwards, turned around and closed the door behind him. I never seen anybody disappear without actually disappearing but Dudley did it. I'd never seen Dudley pissed off, he was quiet and sleazy most of the time. As calm as he was, you could tell this guy could go just as hard the other way, scary.
And that was it. A million rules broken at a million miles an hour and there was no hell to pay. Just doing the job.

One of my favorite guys to work with was an old dude named Ronny Master's. He had been working with the post office for a long time but quit for reasons unknown, not even rumors existed about why he quit, so maybe he just got sick of it. So he was now a 50+ E.M.T. showing me around where he was from. Mostly Inglewood. We'd be driving in between calls and he would suddenly bring the rig to a stop and say, "See that house right there? Earth, Wind, and Fire used to hang out there before they'd do a show at the Forum. That was the lead singers mother's house. The spot."
He also showed me a house that Sammy Davis jr. used to live in, "When he had a black wife. Before the KKK poked out his eye for marrying a white woman." He took to his mother's house in Inglewood, a beautiful home that was large for LA standards, well kept and contradicting every image I had of Inglewood. In fact, every partner that I worked with was local and went out of their way to show me the community that they were from in Los Angeles. Eager to dispel the myths they knew I had in my head about their homes. They all went out of their way to contradict them. As if I was the token white guy they could speak to and hopefully change everybody's perceptions.
One of my partner’s was a meth addict. This is where my naivete came into play. I knew my partner, Julio, was addicted to speed, that much was obvious. Losing weight, getting irrational, terrible skin,I couldn't comprehend how he didn't get fired, how he kept getting the day shift with the important repeat clients, why nobody ever said anything about his drug problem. First realization: Everybody, no matter what their job title says is a human. Lawyer, doctor, judge, firefighter, just people performing duties that have been branded with expectations of performance by the prevalent culture that may not actually represent the reality of the actual jobs. Our collective image of higher profile jobs frequently seen in the media are so wildly grandiose and in no way based on reality. Everybody has a job, no matter how unusual, glamorous, or demanding the job may be. When it comes down to it, if you work it full time and you need to pay your rent or mortgage, it's a job. And that means bullshit from above and reality engulf you like fire from a kiln.
Julio was just doing his job when he OD'd on meth and cocaine and Ronny had to pull the rig over, take the O2 off the patient in the back and put it on Julio. Ronny said the previously comatose patient sat up and said, "Uh Oh. He doesn't look too good." Julio came around, did another line and they finished the shift. I worked with Julio the night after this happened. He hadn't gone to sleep or stopped working for that matter, so while on a run to a county psyche ward with a scary ass spaceman in the back Julio started to make ponderous statements like "Do you see the spiders on my face? I think they're crawling into my eyes. Puta Madre! Do you like maple flavored ice cream? These spiders are all over me. I just gotta keep driving."
These statements were particuarly alarming because up until that moment, eight hours into the shift, all Julio would talk about was his visiting family from Idaho and his concerns that they wouldn't do the dishes after breakfast. Keep in mind this was already 11:30pm, not only had I been listenting to his concerns all shift, I was starting to get really worried about how he would react when he realized they would have to contend with the left over dishes from lunch and dinner as well.
“Damn,”I remember thinking, “I should have sat in the back.”
We finally dropped the patient off and instead of heading back to the station we had to drive around East Los Angeles for another hour looking for some fucking maple ice cream. Which he did eventually find at a 24 hour drug store and kindly bought everyone in the store a scoop.
My perception of noble, divine, honest mobile medical service had been permanently fractured. My eyes were opening up...

Put your boobs on!

2007-01-01T01:10:00.000-08:00

Hey! It's the New Year! Happy New Year. I just gave my wife a New Year's smooch. She loved it. I loved it. Happy New Year!
The mariachi band coming from the Latino neighborhood behind us has just stopped playing as firecrackers have taken their place. Sounds festive and fun. Smells good, too. I smell carne asada, barbecuing meats, even now. The wife and I thought about just going over there but our neighborhood isn't the safest. Plus these parties, while large, are usually private anyway. All the tagging that seems to be popping up with greater frequency, more and more ambulance runs every night, cop cars parked in front of houses with the light bars pulsing anxiously back and forth- nope, we'll just stay put and watch the New Years celebrations in Spanish, Korean, Japanese, English. First year of my life I'm laying low on New Year's. I'm not even drunk!

My friends are working in the ER. I quit after I started nursing school. I had to quit. Management said I had to work 24 hours a week or leave. They blamed the contract the hospital had with the union. I think they knew that not having total control over my schedule gave them less manipulating power. Last semester I was in school four days a week, what could I do? Borrow and quit.
So my friends are working, getting double time and making fun of the drunks. I feel like a war veteran pining for action.
But as I remember, I was pretty burned out anyway and nursing school was a great reason to get out. But still, I miss working with my friends.
I reread my 1st post. Man, working with that ambulance company was a fucked up experience. And that was only the tip of the iceberg! I didn't even get to the hookers on Century Blvd. by LAX or the drunk driving yet! But we will save that for another time...
My New Years resolution: I WILL NOT ALLOW OTHER PEOPLE'S BURNOUT, FRUSTRATION, OR INSECURITY EFFECT MY CORE FEELING ABOUT MYSELF OR MY ENVIRONMENT.

Angry Male Nurse wants to be angry, constructively.

You know lady nurses out there- I want you to listen to my brief encounter I had with an ex-coworker at the store today, ponder it.

Went to the store with the wife to pick up some goodies for a party tomorrow. Bumped into an old coworker, Thom. He has just finished nursing school at a community college and a preceptorship. Plans to take the NCLEX as soon as possible. Thom worked in my old ER for about two months. He left as soon as he got wind of the culture dynamic of the ER. Snobbery, gossip, and fake tits. Everyday was like a goddamn fashion show while patients sat in clothes soaked in urine, had medical complaints that never came close to being addressed, meanwhile they pranced about in ridiculously tight shirts, braided their hair, knit!, work on getting laid by your average misogynist firefighter. Sadly, a lot of them are in my age group. No fucking pride. Just bitchery.
HEY YOUNG NURSES, IF YOU SPEND MORE THAN AN HOUR GETTING YOURSELF READY FOR WORK THAN YOU CAN PRETTY MUCH BET THAT YOU AREN'T DOING YOUR JOB WHEN AT WORK. If you spend all that time and money on titties, hair, nails and inappropriate work clothing I seriously doubt you are going to be wiling to fuck all it up in one fell swoop by changing a homeless, septic, elderly code brown. Think about it. I've seen hotty nurses put foleys in like they are goddamn darts, and not because they are so busy that they have to hustle. They think they're too good for it, which is a tragedy. I never felt so good about myself as when I help an incapable human feel clean and dignified again. I'm not saying its the highlight of my shift or anything, but I know when I help clean someone up they appreciate it. I'm not above it, it's just good for my soul.
The tech's took up the slack of the sheer snobbery and incompetence of many of the young nurses, ADN and BSN alike, who were to busy living out a fantasy from the tv show "ER" to do their fucking jobs. We counted. We did the math. Out of all nurses under 40, half had fake breasts. Out of the charge nurse crew all of them except one. Seriously, 6 out of the 7 charges had fakes. Great working environment. Angry Male Nurse was born.
But I digress...

Here is the crux of my conversation with Thom:
Me: Where are you going to work? Have you picked a specialty?
Thom: I did my preceptorship in oncoIogy but I want ICU. I've checked out c------, h-------, t-------, and a laser dermatology clinic, I hear the pay can be really good on the side.
Me: Don't forget to check out C-----, they're opening up a new ICU ward, should be some great opportunities to get into management or charging, if you want.
Thom: Yeah, I heard they start new nurses at 4800 a month.
Me: Well, they just renegotiated, 5200 for new nurses.
Thom: That's what it's about, I'm not waiting to get recruited, I'm finding out the best there is.
Me: Exactly. See my beautiful wife's pregnant belly? I'm fucking paying for it.
Thom: Patient care starts with decent pay.
Me: Fucking A right.

So my point is, young female nurses, some of you, DEFINITELY NOT ALL, need to get with the program. Forget the typical
"all nurses are angels, this is a calling" bullshit. YOU ARE A TRAINED PROFESSIONAL. YOU HAVE A DEGREE. YOU ARE SO TOUGH THAT YOU DO THINGS ON A DAILY BASIS THAT SCARE THE CRAP OUT OF REGULAR PEOPLE. AND THEN YOU CLEAN THAT CRAP UP.

For the sake of my family, please dress professionally, not suggestively, and recognize your worth. What about your children, family. What if you become the only source of money?
Thom and I talk money. It's okay that we talk money. What will enable me to not burnout is my ability to distance the drama, the tragedy, and the stress from work and keep it from my personal life. I may give everything I have at work but it stops there. I am not an angel. I am a man with debts and obligations and a skill set that enables me to provide.