Thursday, December 14, 2017

Nursing Awards - Emmitt Knows Where They Belong

Proud winners of a nursing award. At least
their trophy has relevance-looks like a bath basin.
When Emmitt Smith, the hall of fame running back for the Dallas  Cowboys received the"Galloping Gobbler" award from John Madden, he knew what to do with it. No pretentious acceptance speeches or bubbly gratitude for a meaningless award.  When Emit thought he was off camera that pointless award was unceremoniously deposited in it's rightful place, the garbage can.

It's too bad that some nurses lack Emmitt's judgment and discretion regarding meaningless, phoney baloney awards worth their weight in wormwood. Hospitals of today often have a shrine-like  area where garish gold plaques are displayed honoring a select group of nurses. Nothing wrong with this concept if it gives recognition to deserving nurses who have honed their technical skills to help patients, but frequently the awarding entity is far removed from patient care and  has little insight into bedside nursing excellence or comforting patients. Physicians, administrative nurses (if you could even call them nurses,) insurance companies, and the nurse academic/ office sitter complex all have very minimal working knowledge of what makes a good bedside nurse. Doctors just love nurses who know their rightful place and never question orders or call them up in the middle of the night. Administrative types view nursing through the distorted lens of corporate goals and please don't get me started on office sitters of any permutation. Discretion is the better part of valor, I keep muttering to myself. Sometimes it's better to keep my foolish mouth shut.

We certainly had nothing like this when I was a nurse. Our instructors and mentors (if you could call them that) always stressed that the satisfaction of helping patients recover from injury or ailment had to come from within. If a trauma patient walked out the door or a patient's pain was relieved, you did a good job and that was your reward.  In their mind nursing was a calling and required self motivation which was also a good reason for paying nurses a poverty wage. If you are looking for good time Charley back slapping rewards or big money you are in the wrong profession.

As a public service the OFRN institute for nursing practice is going to separate the wheat from the chaff when it comes to awards for nurses. If you notice any of the following words or combination of words in the criteria or award title, its of  dubious distinction: influential, pinnacle, showcase,  emerging, distinguished, rising star, engagement,  paradigm, cameo, or eminent. It's time to go above and beyond or even eschew nonsensical awards. It's time to take a lesson from Emmitt Smith and deposit these chucklehead awards in their rightful place.

Here are a few worthy nursing awards that have straightforward criteria and reflect nursing as it's clinically practiced, untainted from pie-in-the-sky bafflegab.

The Last Nurse Standing Award... An endurance award of sorts to the scrub nurse that can hang in there on one of those knee aching  surgeries that start before sunrise and end after sunset and I'm talking about Chicago - not the Arctic circle. My personal best is close to 8 hours on a complex trauma and that's not even worth mentioning because  my mentor Nancy went for close to 12 hours on a Whipple with complications. She deserves a standing ovation and a well deserved trip to the bathroom.

The Stink Finger Statue...goes to the nurse who never shied away from any mess-you name the body excretion and this nurse gets down to business, sans gloves. I really admired this nurse because almost everyone has an Achilles heal when it comes to messes, mine was that gooey blood/bone chip slurry mess left on the floor of the ortho room after a messy case. problem, bone problem, but mix them together and the resultant combo brought me to my knees every time. Thanks to Colleen and Gail for bailing me out on this one. You deserve this and remember to refrain from sniffing those fingers.

Venous Access King or Queen...goes to the best IV starter. Bring me your hypovolemic, phlebotic and sclerotic patient and I'll slide that angio cath in faster than you can say central line.

The Sailor Award...goes to the most fluent user of off color language. I usually avoided this one because it resulted in much childhood unpleasantness if caught uttering swearwords, but I  some how felt a sense of relief when others spouted out colorful descriptive language. Nurse  Felix deserves this award for coming up with the u;timate inclusive cuss word (sh++t,f**k.G++d**n it) all in one breath. What more can I say?

Most Likely to Cry...I always admired nurses that could do this. It's better than alcohol or drugs at diffusing sadness. The most I could come up with were a couple of stray tears, but at least I tried.

Most Kind nurse...We all know one of these. This nurse is nice to everyone and always sports an infectious smile that's even visible under a mask. As nurses age this trait seems to decline although I have met a couple of these angels in white who were well into their 60s. Rita you deserve this award if you can stop puffing on that Winston long enough to claim it.

The Walking Wounded...These tough nosed, hardened nurses can work through bone on bone hip joints, unremitting Crohns Disease, or even while on chemo for aggressive cancers. Tough as nails; the primary objective is to die at the bedside with their Clinic Shoes on. I did manage to scrub on a case one day after having impacted wisdom teeth removed and I was never so grateful that it did not involve oral surgery. The pain sharpened my senses, but I would not never,  ever want anyone to work for this award.

A really good nurse will do whatever it takes to help a patient in need not because it's about award procurement, but because it's the right thing to do. The fact that the obsessive pursuit of awards leaves profound deficits in other areas of direct  nursing care is a definite reality. Emmitt got it right.

Friday, December 8, 2017

Ahh-The Good Old days

I got sick and tired of viewing that  image of the traumatized (and that's putting it nicely) young man in my previous post. Kind of a foolish post and I should probably refrain from reading old posts.  My proof reading skills are lacking to the extent when I go back over my post to correct errors, I make it even worse. Paradoxical indeed!

I've had this picture floating around and could not come up with a post that equals what it illustrates. I catch myself staring at it and daydreaming of the old days before patients were customers and hospitals became health care centers. It's so much nicer than that previous traumatic  illustration. What was I thinking?

Caps, Rotary dial telephone, paper charts, and nurse attentively viewing a cathode ray tube monitor. I think I just heard that distinctive air bubble  gurgle from a vented glass IV bottle as it infuses. 

Tuesday, December 5, 2017

Who You Gonna Call?

I certainly hope for this young man's sake, that the  tattoo is prophetic, but who are we going to page to extricate that foreign body. Many decades ago, all it would have required was a quick page for my general surgeon hero, Dr. Slambow.  In the days before surgical protocols were  dreamed up by busy body office sitters,  limiting the scope of a surgeons intervention, general surgeons did it all. Amputations, setting bones, circulatory grafting, repairing lacerated livers, kidneys was their stock and trade. There were few "specialists" and no subspecialties.

Dr. Slambows treatment plan would be to anesthetize and "succ" the above patient and then simply yank that nasty blade out. "Standby...if there is bleeding we will have to go in and find the bleeder, lets hope for the best." Dr. Slambow always called the standing around and waiting routine, "masterful inactivity."

I can't imagine the number of specialties that might be consulted today for a case like this. Here is the conversation between two residents considering the various consults that might be indicated.

"We better get an occuloplastic surgeon to see this tattooed knife target. That wound is pretty near the eye."

"No..I'm calling the ENT man, that toad sticker is obviously impacting his maxillary sinus. Maybe an oral surgeon too."

"What about that hospital directive advising a neurosurgery consult for any wound to the head?....That's not his head, that's his face I' calling the chief plastic surgery resident on call."

The straightforward approach would be a call to Dr. Slambow to quickly resolve the problem while the others are pontificating and checking the patients insurance coverage.


Thursday, November 30, 2017

Hospital Signage - Yesterday and Today

Visits to contemporary hospitals always throw me for a loop. The hodge-podge assemblage of signage is indeed mind boggling, at least for me. Practically every vertical surface or door has a sign of one sort or another dutifully posted. Guide signs, financial responsibility notices, warning signs, nursing award plaques (none of those back in my day, that's for sure,) and mystery signs that my foolish mind simply could not decipher.
Signs were few and far between in vintage hospitals.

I found myself asking myself, how in the world did old school hospitals function without the copious ( that "c" word is one of the all time  favorite words of my generation of nurses) use of signs? The hospital building itself was without an identifying sign. It was completely unnecessary because everyone intuitively knew it was a hospital. A hospital was a hospital and everyone knew where it was. Does God sign the sky?

Walking through a modern hospital corridor with all those solid, opaque doors with confusing (at least to me) signage does cultivate a sense of mystery. When one of these  modern, occlusive, door  contraptions swing or magically whoosh open, I scramble to peak inside. I could have read the ever present, omniscient signage, but I like the feeling of being an explorer on an adventure. It's like a series of hidden little worlds where computers and electronic doo-dads seem to dominate.

Old hospitals were not like this. No signs necessary. You could sense where you were by the various olfactory, auditory, or visual  cues. The radiology department was defined by the scent of photographic fixer and all those lead aprons hanging outside the mostly open doors. No mysteries here. Morgues and central supply were always in the basement and the ORs were always on the top. I rambled on about this in a previous post.

Emergency rooms were always on the same level as the street and there was  a memorable sign nearby. Old school  emergency triage began at street level and an actual sign began the process by a stern warning: AMBULANCE CASES ONLY. There was always an assemblage of police cars at the ER and I suspect hospital emergency rooms were one of the safest places in all of Chicago.

Hospital labs were easy to navigate. Everything was out in the open. Hematology was defined by the click-clck-click of manual tabulator gizmos used by the technicians to count the various lymphocytes and eosinophils in a sample. I used to love that sound because it reminded me of crickets. A bit of nature  in the midst of an urban jungle. The microbiology department was easy to spot with banks of incubators and rows of microscopes. The chemistry lab division smelled, well chemical. You couldn't miss it. The hospital laundry was easy to find, just follow that lovely clean linen smell and as you got closer, little flecks of lint falling like snow clearly defined the locus.

Old hospitals had very few people just strolling through as outpatients because there were no outpatients. Any nurse would be all to happy to direct any lost soul moving about the halls so there was little need for signs. The loud, ubiquitous hospital paging system clearly announced visiting hours and instructions for hospital visitors. One of the greatest advances in modern hospitals is the absence of verbal loud speaker pages. They could really jangle your nerves.

Occasionally, a modern hospital sign will cause my foolish, old brain to crash in a state of persistent befuddlement. What the heck is an outpatient ICU?? I was completely  bamboozled by a sign pointing the way to "Ambulatory Surgery."  How in the world, I wondered, can you perform surgery on someone while they are walking around? I suspect it is a great way to prevent post op complications like atelectasis and clots, but do the benefits outweigh the risks of surgery in motion?

I' getting carried away here so I'll leave you with some contemporary hospital signage that got my attention and made my blood boil. The sign below serves to provide the patient with all the respect and dignity of a visit to Wal Mart. The remuneration request is for something that is an abstract concept concocted by an office sitting bean counter which  contrasts with the mission of healthcare to provide tangible care for a person in need. Money and associated big business  is what robbed both doctors and nurses of their status as caring professional care givers and relegated them to nothing more than dollar sign driven minions. It's a sin and a shame.

Thursday, November 23, 2017

Giving Thanks

Thanks, Nancy

 I have lots to be grateful for and often think of those who helped me as a young nurse. Thanks to you Nancy Swabeck RN for your patience in sharing your skills as one of the most elite and skilled scrub nurses I have ever known. It sounds paradoxical, but as the pressure and anxiety came to a boil with unexpected problems your relaxed peacefulness and calm demeanor flourished. A life lesson to be sure.

Smooth and easy flowing movement of instruments with that last little burst of energy on approach to the surgeon's hand was her trademark, but it was anything but when I tried to replicate her ease of movement. Herkey, jerkey and uncertainty marked my initial efforts. "Keep at it. When you are gong through a surgical shit (Nancy didn't cuss) storm - keep on going," were typical words of encouragement from her.

Nancy was a cool headed natural problem solver when it came to instrument handling. I was always flummoxed by trauma cases that engaged two  teams working simultaneously. My usual modus operandi involved setting up two separate Mayo stands and designating one as self service. Sometimes this worked when dealing with ortho, but always left one of the teams disgruntled with my lame efforts.

Nancy taught me how to mentally divide a single Mayo stand in two sections so as to serve double duty. Half for this service and the other half for that service. It worked but usually made my head spin. Later when we received brand new elevated neuro tables with just one huge work area, she taught me how to create an imaginary Mayo stand work area. I'm a slow learner so she went to the trouble of outlining a pretend Mayo stand with methylene blue. It worked like a charm.  She always had an answer for everything.

The events of a long ago Thanksgiving are also on my mind when we had that brainstorm of a notion to cook a turkey in an autoclave. The tale of the autoclaved Thanksgiving turkey is on this blog somewhere and some day I will mater links.

I am also grateful to all of you who read my incessant foolishness. There are so many well written nursing blogs out there by bright, young, whippersnapperns that I hate to waste your time. At least I provide some cognitive diversity to the nursing world. Oops that sounds a bit grandiose so I better cease while I can. Thanks for your readership and a festive Thanksgiving to you and yours.

Sunday, November 19, 2017

Vintage Magnetic Therapy for Ocular Foreign Bodies

I just love gadgets and gizmos from the days of old school healthcare. Now this handy dandy device is something that I could have put to use this past summer. I'm a self-taught, self maiming, lumberjack of sorts and as I was happily sharpening one of my dull chains, a fragment of metal was hurled into my eyeball by the grinder. I dimwittedly  thought my eyeglasses would provide ample protection, but that shiny shard found an indirect  path to my eye. Metal shavings have tiny little barbs on them that can make removal difficult. I tried to irrigate that little devil, but it would not budge.

After a $600+ emergency room visit,  the metal shaving was successfully removed. I tossed the antibiotic prescription into the circular file along with an opthamology consult and lived happily ever after.

Now if I had  access to that device pictured above, the ER visit would have been unnecessary. When the American industrial age was in full swing it was commonplace for workers to experience problems with metal shavings impacting their eyes.  An enterprising opthamologist devised the above piece of medical equipment. The foreign body victim positioned their eyeball over the cone shaped proboscis like business end of this machine and the doc activated the electromagnet. PRESTO.. the metal shaving was liberated from the eyeball. I don't even want to think about the end result if the metal shaving was retro-ocular. Would the entire eyeball be pulled out? Hmm..I guess discretion is the better part of valor when using devices like this.

I've been attempting to figure out if the illustration on the right is just for demonstration or is this the outcome of treating a platoon of steelworkers after a blast furnace mishap?

Tuesday, November 14, 2017

Nursing Diagnosis - An Aimless Pursuit

Your patient suddenly loses consciousness, blows his pupils with a narrowing pulse pressure and
has the beginnings of decerebrate posturing.   What's your diagnosis nurse?

"This patient is experiencing hypovigilance secondary to disruption in the flow of energy resulting in a disharmony of the mind, body, and/or spirit." Say what nurse? Old time diploma students never dabbled in this high minded, academic  activity of  the modern  nurse diagnosticians, quite the contrary, we were sternly advised, "Nurses do not diagnose."  This resulted in many deferrals to "Ask your doctor."

We were well versed in acute clinical contingencies (Ha..Ha...I can talk just like you smarty pants nurse diagnosers) and knew exactly what to do if the patients under our care had problems.
Verigo on arising-back to bed...A hemorrhaging arm laceration-slap a blood cuff on while the resident scrambles for hemostats...Hypoglycemic..Have some orange juice...A sluggish chest tube-milk it.  It's really just plain old common sense.

A bona fide diagnosis is based on objective and measurable data, not the whim of a nurse wordsmith spouting off gobbledegook. The evidence supporting the diagnosis would enable different practitioners to come to the same conclusion. I think that those folks a lot smarter than I call it inter- rater reliability.

Nursing diagnoses grant objective status to subjective information. When subjectivity is confused with fact and treatments based on unfounded assumptions are implemented, bad things can happen such as that infamous 1-10 pain scale.

When nursing transitioned from a diploma based hands on education training to an academic setting, office sitter, nurse big shots had to come up with entities to differentiate themselves. They came up with three humdingers that are indeed, unique to nursing. Nursing research, which, more accurately should be called clinical research if the purpose is to improve clinical care. We don't have doctor research. Nursing theory of which I have written jabbered about in a previous post and finally nursing diagnosis.

These discursive disciplines have one thing in common. They are unique to nursing and difficult for other healthcare entities to understand. If the end game is to be a valuable, contributing member of a collaborative, team effort they fall short. Lots of nurses, especially old fools like me cannot comprehend them so maybe we should drop the nursing from nursing diagnosis and work toward a common goal. Diagnosis that is based on objective fact and guides healthcare workers toward effective treatment.

Nursing is all about common sense and using what you know to directly and appropriately helping patients. Having a nursing life that involves only intellectual and down right incomprehensible material is not a good way to live. Some folks think that mastering complex linguistic feats  and fancy talk is going to make them look smart and sophisticated. Truly smart nurses have a high sense of humility and plain talk that really does help patients overcome illness or mishaps.  .