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Code Blog Gets Four Calling Birds

Ever want to know who my favorite reindeer are?  How about my most embarrassing moment at work?  I dished it all over at Addicted to Medblogs!

And that picture?  That is soooo totally me, right down to the white fur-lined knee-high platform boots :)

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So True

So unbelievably true.  This is really how we see you, and this blogger put it perfectly.

(thanks to GruntDoc for the link)

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Charity Auction for Lobster Quilt

Benefiting the Childhood Brain Tumor Foundation.

The author at Suture for a Living doesn’t only suture up people, she also sews quilts!  And she made a lovely lobster quilt to auction off to benefit this foundation.

All the details can be found here.

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Are you missing a man in a kimono?

“Zookeeper, RN” writes:

I am an RN at a very large public safety-net/regional trauma center/teaching hospital. It is a very interesting place to work as a nurse as there is always some kind of drama going on. I work on a medical floor where we see lots of infectious disease (HIV, MRSA, VRE, TB, c. diff, you name it), complications of IV drug use and booze, diabetes, renal failure, and many psych co-morbidities. As we are a public safety-net hospital, we see a lot of the same people over and over again because, well, no one else in town will take them.

One such gentleman we see quite often, we’ll call him Sammy, was assigned to me recently. Sammy is what happens when you drink too much for waaaay too long. His liver is shot and all those toxins that a healthy liver would filter out have permanently damaged his brain, so he’s confused, but pleasantly so. He’s yellow as a banana, and he has a history of leaving AMA (against medical advice) – he often will just get up and walk out. Which is another reason why we see him over and over. But I digress.

So Sammy is my patient. He wanders a lot, around and around the unit, talking to people and going into other patients’ rooms thinking it is his . On this particular admission Sammy has been wearing a flowery silk kimono over his hospital PJs. It’s kind of dirty but he refuses to give it up and I have 9 zillion other things to do besides argue with Sammy about his wardrobe. During my shift, one of my other patients codes, so I am tied up for a good hour or so. When I am done, I go check my other patients. Can’t find Sammy. I check all his favorite hang out spots – no Sammy. I have him paged throughout the whole gigantic hospital – he does not come back. I call Security and they look for him (“Oh yeah! We know Sammy” they say) – no dice. I am starting to think he has left AMA again. The ER is screaming at us because they have 50 people in the hallway down there that need Sammy’s bed.

We are about to give the room away when our unit secretary answers the phone. She starts laughing. She’s laughing so hard her mascara is running down her face. She looks at me and says “It’s for you.” I pick up the phone to hear “This is Officer So-and-So from Central Booking. Are you missing a man in a kimono?” As a matter of fact, I am, I say.

Turns out, Sammy did indeed decide to blow that popsicle stand and walked out of the hospital. He wandered up the street to the nearest drug store, where he was promptly arrested for shoplifting. Now, keep in mind he kinda stands out – his skin is day-glo yellow and of course, there’s the splashy kimono. (Side commentary: WHY do we bother arresting this guy? He can’t tie his own shoes let alone summon enough brain power to plot a crime. Total waste of taxpayer money). Anyway, down to Central Booking he goes where someone at last notices the hospital PJs and his ID band and give us a call.

An hour or so later, Sammy returns to my unit wearing a new outfit: a bright orange jumpsuit and carrying his kimono in a little plastic bag (very sad!) I ask him if he is all right. He looks bemusedly at me and says “Well sure hon, why wouldn’t I be?” I explain he left the hospital and was arrested. “I was?” he says. “What did I take?”

At this point I am thinking Sammy has suffered no injury from his adventure. And then he asks me for a sandwich.

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Change of Shift!

A Thanksgiving edition of Change of Shift is up over at Rehab RN.  I hope everyone had a happy and relaxing Thanksgiving!  :)

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Naked

Anne writes:

A friend once said that if you throw enough putty at the wall, something’s bound to stick!  Well, here’s some unedited putty.

I’d been practicing nursing for 20+ years when I was diagnosed with lupus and fibromyalgia and there was a nasty bout with previously well-controlled epilepsy. I needed to stop working, stop practicing my chosen profession of nursing.

I began freelance writing to occupy my time and found instant success and satisfaction; hey, I had my own byline and received pay, (albeit poor), for articles! This was life affirming, and at the same time invalidated feelings of low self-esteem because I was no longer able to work in nursing.

Several years later, a new clinical editor was unable to increase my compensation for a column that I was editing, so she called to offer me a place on the magazine’s masthead instead. However, before doing that, she needed to do a routine background check and call me back.

I’ll never forget that telephone call. “Were you aware that your license is no longer active?” I hemmed and hawed a bit, then then realized the unpleasant truth. I had moved from one state to another and planned to apply for reciprocity in my new state – but forgot.

I felt naked and numb all at the same time. This license was part of my identity!  As a result of my forgetfulness to renew my license, I was stripped of a title (RN) although no one could take away my degree (BSN).

In spite of the fact that I believe once you’re a nurse you’re always a nurse, I’m no longer registered and I can’t say that I belong to that larger collective of Registered Nurses. I’m not like ‘one of you’ anymore. I never thought that losing a license could make me feel so small and so humble and insignificant.

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When bad things happen to good preceptees…

I don’t usually post this kind of story submission, but it does ring a bit true.  I do know preceptors sometimes have a difficult time providing feedback to their preceptees at the end of the shift, only to spring problems and issues on them later.  Anne, RN writes:

It was toward the end of my orientation as a new grad when I got a message from my day shift preceptor, wanting to know “how orientation was going.”  When I called her back she proceeded to tell me a long list of everything I had done wrong over the weekend with my night preceptor.  I was at home on the phone and she was at work talking to me, so I felt backed into a corner.

Meanwhile, over the weekend, my night preceptor told me I had done a great job as she scrambled onto the elevator to go home. I had given an antibiotic late on Saturday night and I had acknowledged it and the next day made sure I gave it on time. My night preceptor told me when I acknowledged my lateness not to worry about it since nurses that have been working for 20 years forget things sometimes. So I thought nothing more of the situation, that is until I received this phone call.  On her long list of things I had done wrong was that I gave this antibiotic late. Her other criticisms included only giving IV pain meds when the patient had PO ordered, meanwhile my night preceptor had told me that since the patient was NPO i shouldn’t give them because it would make her sick.

Then she proceeded to blame me for another nurse’s needle stick, which she later apologized for. She also said that people were saying that I didn’t care and that I always looked bored, which is completely not true. Most nurses go into nursing because they DO care. After 8 weeks how do other people think they can judge you on something so personal?  I had a lot of respect for my day preceptor until that day when she backed me into a corner, since then I can’t think of her in the same light as I once did.

My night preceptor was awful as I am sure anyone can tell, always giving me positive feedback and going behind my back to tell others that I was awful. On my first night shift with her she was talking about sex half the night, which made me extremely uncomfortable and as a new person I didn’t think I could say anything. Luckily my night preceptor has since left my floor but I still have to see her on occasion and my day preceptor has an important position on my unit.  I wanted to share my story because I think it is a great example of how nursing eats their young.  There were many nights when I went home crying and wanting to quit nursing.  Nursing is harder than I ever thought in nursing school, but I am a tough person and I have since successfully completed 3 weeks on my own!

And since it’s been over a month since I received this submission, hopefully Anne is now off orientation and doing well!

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COPD’er

Anon, RN writes:

I’m trained as an ICU nurse but lately I’ve been picking up these shifts in an outpatient pain treatment clinic. It hasn’t been an easy thing to get out of that critical care mindset. In critical care you stick with the ABC’s (airway/breathing/circulation). In clinic nursing the first question after the procedure is, “Does my patient have a ride home?”

So I’m working there the other day. Pretty much twiddling my thumbs all day and bored out of my mind because there’s really not much to do except take vital signs and fill out intake forms. But then one of the clerks grabbed me.

“There’s a patient in the bathroom that needs assistance.”

Indeed there was. I found a patient who needed me to help her out of a little situation, let’s just say. So I got her cleaned up and brought her in to the room where she would have her procedure done. I slapped a pulse ox on. Her oxygen saturation was about 70%. With a very good waveform.

Thankfully my critical care mindset kicked right back in. Step one, get her on some oxygen. Step 2, find out what the hell is going on.

Turns out she’s a COPD’er (Chronic Obstructive Pulmonary Disorder – like emphysema) who uses oxygen at home, normally 3 liters. She told me sometimes she just doesn’t bother with the 02 if she’s making a quick trip somewhere. I asked her what about today? This is a little more than a quick trip. She said she ran out of oxygen, and they should be delivering it while she was out.

I got her down to 3 liters and her oxygen sats kind of waivered between 82-88%, which is fine for someone with COPD.

She was completely stable so the doc did the procedure at the bedside. Which was all for the best because at that point she was really in quite a lot of pain.

I asked the charge nurse what we should do about discharging her. This is where the story gets really crazy.

“She only needs to be close to her baseline, in order to be discharged.”

“Yes, but her baseline is that she is on home oxygen, which she didn’t bring today and her 02 sats are in the 70′s without it.”

“It’s okay. We’ve discharged her with 02 sats in the 70′s before.”

!!!

I explained to the charge nurse that it’s not okay to discharge someone with 02 sats in the 70′s. Especially if they “forgot” their oxygen that day. It was at that point that I decided I really had no use for this “charge nurse,” and tried to come up with an answer on my own. First I tried to find out if the patient’s son could go to her house and get one of the tanks that was being dropped off. No dice. He had no money for a cab ride and we couldn’t even confirm really that the oxygen had been delivered. I tried to find out if there were any kind of social worker around that might be able to identify some resources for the patient, maybe give her a loaner tank to take home. Again, no dice. So the only other plan was to take this patient to the ER.

We arranged for a transport person to come, and I went to find a portable oxygen tank for her. The charge nurse asked the transport person if he could return the oxygen tank to the clinic. “No, I can’t,” he said. Then the charge nurse said, “Well you can’t take it, then. If it leaves our floor it will never come back.”

!!!

At this point I decided I would transport her to the ER (it was the next building over) so I could bring the precious oxygen tank back to the clinic. Also, the patient was getting a little somnolent, which is never a good sign when you are worried about hypoxemia/hypercarbia, so I figured it would be best if a nurse accompanied her. So I took her to the ER, and got her safely checked in.

When I got back to the clinic there was some talk about how we can avoid this in the future, blah blah blah, we never should have done the procedure on her, yadda yadda yadda, and the conclusion was that if she turned up at the clinic again with out her oxygen tank, we should just turn her away.

How about some patient teaching?

How about some communication with her PCP to find out why she thinks it’s okay to go anywhere without oxygen?

How about a better EMR system so we could “flag” her and alert her other providers that she needs better education?

If anyone thinks we are even close to fixing healthcare, well. I’ve got some land down in Florida you might be interested in.

Submit your own story!

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Where’s Our Bailout?

Here’s a very thought-provoking post from edwinleap.com:

So the money is flowing from the taxpayers to the industries in order to keep all of them solvent.  Mind you, we in medicine have asked for some crazy things like: increases in reimbursement for actual work on actual people; tax credits for uncompensated care; limits on malpractice awards.  As a result, Medicare payments fluctuate along with Medicaid.  Care is still free.  Malpractice litigation sails along as smoothly as the Love Boat.

Great post!

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New Home!

Welcome to codeblog’s new home!

There are a few things to tweak here and there… the search page works, but the results come up on the old color scheme.  Just goofy little things like that!

Someone told me that the page takes a long time to load due to the circled background.  I tried to figure out how to make it a smaller file, but was unsuccessful.

For those who voted that they wanted more personal stuff on the site, I added twitter to the side bar.

I’ll still be taking and publishing submissions, and there is a link at the top of the page to submit a story.

Thanks to my husband for allllll the work he did!

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  • profileI am Gina. I have been a nurse for 15 years, first in med/surg, then CVICU, inpatient dialysis, CCU and now hospice. This blog is about my experiences as a nurse, and the experiences of others in the healthcare system - patients, nurses, doctors, paramedics. We all have stories!

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