Thursday, May 2, 2019

Custom Made Signage by Nurses

 Hospitals are infested with signage developed by office sitting busy bodies promoting policy, giving direction, or threatening grave consequences for those with the nerve to be non-compliant with their all important edicts. Signs have authority and grab your attention. Who  in the world is going to fool with a red bag tagged with the warning: CHEMO THERAPEUTIC INFECTOUS WASTE? It's enough to scare the daylights out of a Pope.

Bedside nurses  put other's   needs before their own  because they are wired differently at the factory as compared to business minded hospital big shots. Information flows down from the top with a remarkable efficiency, but enlightenment gained in the trenches stays there. Hand made signs posted by harried nurses are an attempt  to break this communication barrier. It's difficult and dangerous to transition a one way street to bidirectional traffic, but that doesn't stop sign maker nurses from trying.

Nurses can be their own worst enemy. In nursing school we had a bulletin board for posting NLN test results that we called the wailing wall. Instructors were also known to publicly humiliate their students by posting signage advertising particularly egregious clinical  blunders. One memorable sign announced with great fanfare that "Gwen had attempted to irrigate her patient's Foley catheter with a TB syringe." That was cringe worthy because the syringe was too small by a factor of 100cc. or more.

Step down units are typically located adjacent to critical care units and the staff members get along about as well as cats and dogs. Step down nurses think ICU nurses are cowboy or girl know-it-alls with overblown egos and are eager to put these hot shots in their rightful place. I noticed a huge poster plastered on the ICU locker room door stating "THIS CAME OUT OF ICU." It was a double heparin locked IV catheter. An ICU nurse was probably doing a gazillion things at once and failed to notice the patients IV was capped with a heparin lock and hep locked the needle previously inserted. I figured out a scheme to convert the sign from an admonishment to amusement by inserting several more needles and hep locking  them in place so there was a series of hep locks about a foot long. A dose of good natured badinage helps improve relations among feuding groups of nurses.

UPMC, the health care behemoth here in Pittsburgh has power. When they acquired Montefiore Hospital which was built into a hillside ala Pennsylvania bank barn style they changed the names of the institution's floors. What nerve!  The hospital was entered from the summit of the hill on a floor called "Main." A, B, and C floors were underground and the floor above main was the first floor. UPMC renamed "C" level as the  first floor and the other units followed in numerical sequence. A series of lengthy, confounding memos and signage flowed from the corporate geniuses at UPMC explaining the new nomenclature. Leave it to a nurse to explain things in simple, straight forward language with her sign explaining, "MAIN HAS MOVED TO 4TH FLOOR AND FIRST FLOOR HAS MOVED TO THE 5TH FLOOR." It may have sounded whacky, but everyone knew what she meant.
Who made this sign? Not me!
Coffee is an essential on any nursing unit and anything impeding it's consumption must be dealt with. Our neuro ICU coffee pot shared electrical outlets with a vending machine and somehow the coffe maker was often unplugged. A nurse attached a sign to the electrical cord running from the coffee maker: "DO NOT UNPLUG-VITAL LIFE SUPPORT EQUIPMENT" Folks honored the official looking sign and we always had hot coffee.


  1. LOVE the Code Blue sign!!! I made up more than a few signs in my day ~
    Thanks for sharing!

  2. Yep! Nothing gets the message across like a nurse made sign.

  3. "enlightenment gained in the trenches stays there". Genius. Mind blown.

    1. Thanks for enjoying my foolishness!

    2. No doubt you have done much to “ improve relations among feuding groups of nurses” over the years. Who could forget your unofficial role of arbitrator years ago when in nursing school? Memories of the unspoken rule of dispatching feuding nurses to the elevator and pushing ground for OFRN to resolve differences, are still fresh from one of your precious posts.
      If we could have defied the time/space continuum’s during practiced together, we would have been great friends. OR nurses liked it when I showed up to gown and glove up to receive newborn with a C/S, and I loved all of them who had my back and welcomed me in the OR.
      I’m the modern world, I rely on nurse techs to devise signage like “ dietary, please let nursing know when you drop off a tray.” Although i decry computers and other modern technology a few (hundred) times a day for the decline of moral civilization, printing out signs in a basic word processing program and laminating them, has on the whole elevated nursing to a higher level of literacy and decorum.

    3. Printed signs do seem to carry more weight than hand scrawled notices. We could have come up with some dandy official looking notices with today's technology.

      I liked to illustrate my signs with assorted artifacts like the near foot long stack of heparin locked needles. One other sign I made was to discourage the use of a particularly nasty type of adhesive tape on sensitive skin. I plastered a chunk of the offending tape to a sign and smeared mercurochrome next to it to simulate the erythematous lesions it caused. That sign was worked like a charm.

      Sometimes nurses can over do it with their signs. One evening shift nurse plastered a sign on just about anything that needed reordered thus shifting responsibility to the overworked day crew to procure supplies. Someone (not me this time) got fed up with a note in the bathroom requesting toilet paper. Her "revenge" sign stated: YOU ARE FORBIDEN TO LOOK AT THE TOILET PAPER AFTER WIPING YOURSELF!

      Thanks for your continued readership of my foolishness! Your comments make my day.