My People, R.N.

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

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

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

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.

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

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

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.