Thursday, February 28, 2019

Student Nurses Misappropriate Birth Certificates to Imbibe

Vintage diploma nursing schools had rigid, authoritarian  rules for just about everything  that could be construed as fun. From restrictions on outside visitors, especially men, to strict study hours, all recreational outlets were meticulously managed with onerous regulation. The rules regarding alcoholic beverages were especially strict and came from the hallowed chambers of  The Hospital  Board of Trustees. This mysterious and often cited governing body was a force to be reckoned with because just one measly slip up of their regulations could get you expelled from the nursing program.

According to the esteemed board, alcohol was the ultimate in forbidden fruit, especially for stressed out and underaged nursing students. The notion that imbibing in the magical elixir of alcoholic drink was wrong, made it all the more appealing. Diploma nursing students were in the same boat as Eve in the Garden of Eden.

By the time nursing specialties: pediatrics, psych, and obstetrics, rolled around, nursing students were feeling the pressure of their chosen vocation. I was going to say chosen profession, but we were brain washed into submission and nobody really believed we were worthy of such a lofty title. I'm just a nurse was our mantra. Doctors were professional-nurses were not.

All nursing specialties were difficult and stressful. Cures for seriously ill children were few and far between. Leukemia of any variety was a death sentence. Our clinical psych experience was on the back ward of a state hospital and it was your lucky day if your patient wasn't homicidal. I don't know which was more trying on your soul,  psych or pediatrics. It was a toss-up.

Obstetrics was different, especially post partum where the exuberance of young mothers was uplifting. Our time in OB was rotated in monthly intervals through delivery room, nursery, and post partum. Everyone had their particular favorite, but delivery room duty was the highlight of just about any young student  nurse's  training. The miracle of birth was something that stayed with you and served as an antidote to all the pain and suffering in the rest of the hospital. Birth and death were the ultimate Yin/Yang experience.

The delivery room had another up side. Stashed right next to vials of silver nitrate which was used prophylactically in  babies' eyes to prevent blindness from contact with gonorrhea was a stack of blank birth certificates.

The unwritten rule was that each student nurse was entitled to one blank birth certificate at the conclusion of their delivery room rotation. Students treasured documents from their various specialty rotations and I still have a plundered birth certificate along with a sponge count record from the OR and a restraint and seclusion record from psych.

I first learned what could be done with a blank birth certificate from one of my fellow students who had been released from Cook County School of Nursing as being unsuited for the practice of nursing. That "unsuited" business was a catch all phrase that covered a multitude of sins and was a step up from academic failure because some of these students were able to transfer to another diploma nursing program after "maturing." Transfer students were a valuable resource when it came to surviving nursing school because they knew many of subtle ins and outs of getting through the madness of three years of torture.

Light fingered nursing students knew exactly what to do with a poached birth certificate. "All you have to do is fill in your own name with a birthdate of more than 21 years ago and the document becomes your ticket to freedom from the evil clutches of the sanctimonious "dry" hospital environs," explained one of these wise transfer students. Time to unleash the libations.

Barkeepers found the neighborhoods surrounding hospitals as fertile ground for their trade. There was no shortage of stressed out workers that had pay checks to support their bar tabs. These taverns often had clever names like "Recovery Room" or "Barborygmi." The bar of choice near our hospital was "Ratzos" and the barkeep would just wink and pour when presented with a birth certificate with freshly inked infant footprints. This little charade had been going on for a very long time and was one of the dirty little secrets of old school diploma schools. Cheers! as Sue  would say.

Thursday, February 14, 2019

How Hospitals Transitioned From Chairity Care to A Corporate Cash In Culture

The land of the free and the home of the brave is home to some  the most expensive health care in the known universe. What the heck happened? The last I remember,  the  rate for nursing, room, and dietary in a big inner city hospital was 68 bucks per day. The charge was known as the hospital NRD fee and it covered just about everything except for OR fees and pharmaceuticals which were dirt cheap.  A visit to the ER was 28 bucks if you had it and no patient was ever out of network or even asked about insurance.

 Hospital superintendents were paid slightly more than nurses and there were no big bonuses for anyone. We were all in the same boat and everyone knew and respected frugality. This is my anecdotal account of what happened during the transition to the current cash-in culture of today's healthcare. One caveat, these notions have been filtered through what's left of an ancient nervous system that remembers old school nurses who never expected to own much of anything and lots of MDs were content with an apartment.

It's easy to rattle of a list of culprits in the stratospheric rise of healthcare cost. Entrepreneurially motivated physicians and nurses wth the notion that I worked hard and deserve bountiful financial compensation for my work is a part of the story. Patient care in of itself was the old school compensation and material deprivation produced a sense of solidarity among nurses with everyone looking out for one another.

Old nurses like myself really had it easy compared to the all for one, and one for all whippersnapperns of today when it comes to salary. Our basic needs were met without worry and there were no school loans or financial demands. If we needed medical care any MD would gladly see us as a professional courtesy and if a hospitalization was required, our diploma school had a private "alumni room" for our exclusive use. It was the only room in the hospital with genuine Karastan carpeting. Nurses lived the good life without money changing hands. It's no wonder we affectionately referred to our hospital as "Mother."

Explosive growth of technology and electronic record keeping consumes lots of dollars. So do mindless Press Gainey surveys. Old school physicians would argue until they were blue in the face that patients are not qualified to make judgments about the quality of their care. I can see their point. Some of the very best surgeons I worked with were not very touchy-feely, and that's putting it nicely. Dr. Slambow would visit post-op patients with part of his breakfast and/or lunch spilled on his tie and shirt. I can see why folks would question the credibility of a surgeon wearing his breakfast and lunch, but he was one of the best when it came to minimizing post-op complications.

In the late 1970s my humble school of nursing was closed down for good after being in existence for almost 100 years. The building functioned as an oncology clinic for a couple of years and was then razed for the construction of a multi-level, monstrous parking garage. Fancy hospital parking facilities are given short shrift when considering how corporate interests made health care such an expensive commodity. This is where the rubber meets the road (or parking garage) in my woe filled tale. Parking garages are at the root of the problem.
Parking garages became the welcoming mat for hoards of greedy go-getters

Very few nurses owned cars when I was toiling at the bedside. We made do with the CTA, bicycles or good old fashioned shoe leather, those Clinic shoes were made for walking, It's interesting to note that our nursing school was way ahead of the curve when it came to alternative transportation. The first object to greet someone approaching the school was a massive bike rack, usually at least half full. There were no worries about locking your bike. Who would even think of stealing a nurse's bike?

Physicians and the fortunate few that owned autos found ample space on the street or small unregulated surface lots. Patients arrived at the hospital by taxi, bus, or walk-ins. There was no EMS, and trauma patients frequently arrived in the back of police cars or paddy wagons. Chicago police operated unique,  three wheeler Harley-Davidson motorcycles  which could be ridden just about anywhere. I vividly recall a drowning victim from Montrose Beach being hauled up to the ER secured to the back of a police officer's tricycle motorcycle. The officer even went so far as to suggest the road bumps jostled the water out of the victims airway. The patient survived with quite a story to tell. Maybe the cop had a point.

Hospital parking garages dramatically demonstrate the ridiculous profusion of administrative busy bodies, clerical, and unnecessary hucksters attempting to sell everything from pharmaceuticals to medical equipment. Visit just about any hospital parking facility on a Sunday morning to observe first hand how few workers are  really necessary to take care of patients and it's not because administrative big shots and pharmaceutical representatives are attending church. The Sunday morning deserted parking garage syndrome is even more acute at government agencies such as VA Hospitals.

Hospital parking garages are like a beacon to pharmaceutical hucksters. In the old days drug reps were a non-entity. No one needed to sell penicillin because it really did kill strep and everyone knew it. Much of drug pricing today is done with blatant extortion. A marketer of Zyprexa might claim that his drug will negate the necessity of long term hospitalization saving untold tens of thousands of dollars, hence,  his product is worth a ridiculous charge.

Epinephrine was dirt cheap. Everyone  knows what Mylan's Heather Bresch did with exorbitant charges for that "lifesaving" drug. I betcha if drug reps had to ride a bicycle to hospitals they would be few and far between.

Parking garages and the influx of money seeking hucksters changed how doctors and nurses thought about their patients. Money changing hands at every corner of the hospital amidst a bean counter culture changed who people were. Mega bucks doled out in bonuses to administrative big shots who never helped anyone except for themselves became the rule. It was so  much better when all I had was a Raleigh Super Course bike to ride to work and to heck with all those monstrous parking garages.

Sunday, February 10, 2019

What Blood Loss??

 What blood loss? That's all irrigation in the suction bottle. At least 2 liters.

A good scrub nurse always agrees with the surgeon even if the patient lost a unit or more  of blood. I felt just like Nancy when concurring with a surgeon understating the blood loss. I always felt there were 3 categories of blood loss estimates: ABL, anesthesia estimated blood loss -  EBL, estimated blood loss by the surgeon  and NBL negotiated blood loss after the surgeon vs. anesthetist argument concluded. Actual blood loss was one of the great mysteries.

I promise this is the last of my political foolishness. Blame it on my brain freeze.

Thursday, February 7, 2019

Euphmistically Speaking

I overheard a group of whippersnapperns discussing the advantages of rewording the term "terminal wean" to "compassionate extubation" when discontinuing mechanical ventilation and  allowing nature to take it's course in a critical care unit.  Over the years lots of terms were changed: Directoress of Nursing is now Chief Nursing Officer, Hospital Superintendent is now CEO, Janitors are Environmental Engineers, and Personnel became Human Resources.

All this got me to thinking, which is always a dangerous proposition. I'm  in the midst of a midwinter brain freeze when my thoughts are too incoherent for a typical post. Anyhow, here are some terms that could be reworded to be more politically correct or incorrect, depending on your perspective.

Suicide to euthanasia from unbearable emotional pain.

Bathroom privileges to free range bathrooming?  That sounds dumb, but anything is better than B.R.P.

Doctor's orders to physician's proposals.

Physical restraints to boundary maintenance aids.

Near miss to near hit

Drug addict is a label loaded with lots of pejorative connotations. I've never really had to deal with this issue because old school discharge criteria mandated that a patient be relatively pain free upon discharge. There were very few legal narcotics outside the controlled environment of the hospital. So..lets start referring to those poor souls addicted to drugs pharmaceutical aficionados

I'm saving the best for last. An oldie but a goddie; Emesis to feedback. The simplest ones are always best.