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Nurse Vs Policeman, and Other Topics

So who hasn’t heard about The Policeman vs. Nurse?  A nurse was pulled over for speeding, told the policeman that she hoped he would never end up as her patient, and was subsequently fired when the policeman complained to the hospital she worked at.

Really?  I have the utmost respect for the police of course, but put on some big boy undies and get over it.   Should the nurse have made that comment?  No.  Not in front of him, at least.  That was pretty dumb.  But being fired for saying it is ridiculous in my opinion.  Does that cop go complain to the pimp when the hooker he’s arresting makes a sassy comment?

Hey, I just saw that Nurse and Lawyer had a pretty good discussion about the whole situation.

Next up:  Rapid Response Teams Sign of Poor Bed Management.  Really?  I think GruntDoc summed it up best in his tweet about it.  The article states that Rapid Response Teams (RRTs) are utilized due to overcrowding because sometimes patients aren’t placed in a unit that is appropriate for their needs.  Therefore, their condition worsens and they need help.

I suppose all hospitals are run differently, but at the one I work at patients admitted to the ICU are sometimes rock stable.  Seriously – orders like, “Saline at 100cc/hr, Regular diet, Up ad lib.”  No pressors, no oxygen requirements, no aggressive pain management.  Why does the doc then order an ICU admission?  I don’t know.   Maybe they just have a feeling, although that’s not really a good enough reason to admit to ICU.  Regardless, it’s unusual that a very sick patient is admitted to a regular nursing floor.  We actually tend to err on the side of caution.  If a unit that provides a higher level of care has no beds, the patient stays in the ER until a bed opens up or until they stabilize and can safely be assigned to a room on a regular floor.

RRTs are an excellent resource.  Basically, if a nurse on a regular floor is taking care of a patient that seems to be deteriorating, they call for the RRT to come help out.  A nurse and a respiratory therapist (maybe others) respond to the code and help the patient’s nurse out.  How could having MORE people assessing/treating you/notifying your doctor be a bad thing exactly?   I don’t believe RRTs are called because the patient was already in bad shape and assigned to a low level of care.  I think they are called because stable patients just stop being stable sometimes.

RRTs are a way of getting people to come help you before it becomes necessary to call a code blue.   Personally, if I worked on a regular floor, knowing that I could call someone experienced to come assess a patient who was doing poorly would make me feel very secure.  Like someone had my back.  And the patient’s back, actually… there would be someone there helping the patient while I went to go call the doc.

Anyway, I know the article isn’t saying that RRTs are a bad thing.  But I’m not sure the reasoning for their use is on target this time.

Last:  Harvey MD sent me an app that he thought would be of use to nurses.  It’s a “credential reminder” to help keep track of when our various certifications expire/time to do the TB test/keep track of our CV’s.  I can’t say I’ve used it, but it does look fairly useful if your employer isn’t the sort to start hounding you about these sorts of things coming due MONTHS before they actually expire. Ahem.

Actually, that wasn’t last.  I have a bit of a rant.  I took a photography class this weekend.  It was about how to use your digital camera, tips n tricks and all that.  Very interesting class, but something the instructor said kind of offended me, and I don’t think I’m the type to truly get offended easily.  She was talking about the “scene modes” and was telling us that the camera manufacturers decided to use the little icons in the menu (the party hat, the snowman for snow scenes, the lady for portrait pictures, etc) “in case you went to nursing school instead of taking photography classes” so we’d understand what each scene the icon represented.

I’m sorry, what?

I know what she meant, but good grief.  What a crappy thing to say about any profession.  Especially nursing!  I know how to use an unbelievable amount of equipment (IV pumps, balloon pumps, CVVH/dialysis machines, cardiac output machines, monitors, etc etc etc) none of which have any icons except for the little button that has a slash through a bell.   That one is very important :-)

If she’d had an occasion to ask me what I did, I would have replied, “I’m a nurse.  You know, one of those people that they dumb down the cameras for.”  Alas, no opportunity presented itself for that ultra-witty comeback, so it’ll have to remain unsaid.  Or blogged.  Whichever.

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[...] Code Blog sums it up nicely by saying, I don’t believe RRTs are called because the patient was already in bad shape and assigned to a low level of care.  I think they are called because stable patients just stop being stable sometimes. [...]

When I was a nurse on the floor 7 years ago, I had my own version of a rapid response team. I would call someone I knew up in the icu ( I was lucky enough to call their nurse manager a friend) and say, can you come look at this patient? I think he needs to transfer but I’m not sure… They always had my back. Whether it involved coaching me through a phone call to the doc, getting an order to give some lasix and a breathing treatment,or going ahead and moving the patient to the unit; I learned a lot from the icu staff before I ever even transferred up there myself. What you have to remember is that nurses on the floor are often inexperienced and don’t get as much one on one orientation as new nurses in icu do. Sometimes they know somethings wrong but don’t know what to do about it or how exactly to go about gathering more data to illuminate the problem. Now I am an icu nurse and we do have a rapid response team. I ways try to remember how I used to feel as a floor nurse in over my head when I go out to respond to one. It can be a humiliating demeaning experience for a floor nurse to have to ask an icu nurse for back-up (or even to clean up a mess they created) or it can be an important learning experience. I get to decide based on my approach. I try to shoot for a positive result every time so everyone can go home feeling good.

I agree. She was an ass to make that comment but to get fired for it, that’s ridiculous! It’s getting to be that you can’t even have a personal opinion anymore.

Just look at that guy that got fired from NPR. Is he an idiot? Yes. Did he deserved to be fired? I don’t think so.

I disagree with the article Rapid Response Teams Sign of Poor Bed Management, stable patients due become unstable at times. I do not believe that these patients are miss-triaged from the beginning. Rapid Response Teams (RRTs) are a great resource in hospitals, and all hospitals should have them. I feel all nurses have their little niche in the hospital, the thing that they are good at. I feel for the most part, ICU nurses are excellent on assessment and identifying potential problems with patients. This being said, the ICU nurses can offer re-assurance to the floor nurses. In the hospital I am employed at the ICU nurses are expected to be able to perform in any unit of the hospital they get floated to. Due to this they are expected to bring calmness when a patient becomes unstable and a rapid response is called. To wrap it up, I do not think hospitals manage beds poorly, I just think sometimes people that are sick get sicker.

Good heavens! I’d like to smack that photography instructor. That comment was a great way to alienate students. I’ve been a healthcare architect for ten years (licensed for four), and I so prefer working with nurses on the layout of a department to working with anyone else. While they don’t always understand the drawings upon seeing them the first or second time, they really understand the processes at every level–patient, staff member, tech, physician, patient family–and can synthesize all those experiences for the architect. That understanding of the medical process and profession helps me design better hospitals and healthcare facilities.

By the way, this is a great blog! Love the interviews with staff members–it never crossed m mind that nurses never get to use the bathroom. Is it because there aren’t enough bathrooms, or there aren’t enough nurses, or because there aren’t enough hours in the day?

I really like your writing style, good information, thankyou for posting D. kkcabeeedkec

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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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