code blog: tales of a nurse

Spanky's Place has a post regarding nursing ratios and what nursing life is like in Arizona, where no staff ratios have been set as law. Very interesting and more than a little sad. When are people going to wake up and realize that nurses are essential to the operations of a hospital? If you're in the dark about what exactly it is that we do, here is a gentle reminder.

A few people have commented on my disdain when hearing a patient call out, "Ohhhh nuuuuuu-uuuurse." Most often asked is, "What else are they supposed to call you?" Well, I don't know. I didn't say I had a good solution, I was merely expressing how irritating it can be. It's very rare that I ever leave a patient's room without making sure they have their call light handy, so they could use that. They could say, "excuse me...." Saying "nurse" is, of course, a perfectly acceptable way of getting the nurse's attention. I'm not advocating handing out information sheets explaining that patients should not yell out "NURSE!" if they need help. Some people just have a ... well, a tone to their voice when they say it. It's not a big deal. Forget I brought it up :-)

I'm not sure how many of you have been following the case of the young kid who died in jail of a burst appendix because of lack of medical care. One quote from the article: "Loperfido [the prison nurse] visited him that afternoon and diagnosed him with a stomach virus, the documents say. Guards say they never saw her touch his abdomen for signs of appendicitis." What the hell is a nurse doing diagnosing anything? Maybe a nurse practitioner, but as far as I was aware, Registered Nurses were not to diagnose medical problems. Maybe things are different there in Florida, but if I personally had any inkling that something was wrong with that kid, I would have been on the phone to an MD in a flash. Even if I thought he was faking it, I would have done it to cover my ass. And then I would have documented up the wazoo. That's what I do anyway, with all of my patients. It is not my responsibility to diagnose or prescribe treatments... it is my responsibility to carry out and evaluate the treatment that has been prescribed to me by an Nurse Practitioner, Physician Assistant, OD or MD and then document that I did so. Another shocker was this: "They put him on the ground, but no one tried to resuscitate him because the first aid kit was missing a CPR mask." Words fail me here. It'll be interesting to see how this case turns out. Thanks to The Kiosk for the link.

I've been wanting to link to this post from Dr. Bradley's blog regarding drug-seeking behavior in the ER. He makes a lot of very valid points. There is a HUGE difference between acute and chronic pain. When I went to the ER with a kidney stone, I had no problem getting narcotics, and no one doubted my pain for an instant. I assume that ER/Urgent Care docs get pretty good at distinguishing between the two pain states.

What else... oh, yes. I started studying for CCRN last night. First chapter: Cardiac. "Studying" actually consists of taking practice tests. I know the CCRN doesn't "grade" on a percentage of correct answers, but I'm still thinking that only getting 64% of the questions correct is a bad thing. To my credit, I totally aced the Swan-Ganz and Intra-Aortic Balloon Pump questions... but totally flubbed the murmur/valve/specifics of the cardiac cycle/heart sounds (S1, S2, S3, S4!) questions. Did okay on the MI-focused and cardiogenic shock ones. Cardiac was never my strong suit (even though my first three years of intensive care nursing was in a cardiac-only ICU. Oy.)... I'm more of a sepsis/pulmonary/renal kinda gal. At least I think I am. We'll see :-)