Small rant: “I can’t afford Motrin”

Feb 152012
 

I just got up and took my OTC cold medicine plus some ibuprofen and a big glass of water. Because that’s what you should do for most crud. I thought, hrm, for probably less than $1.50 I just averted what many of our ER patients will pay $1200 or more for—or, rather, taxpayers will pay for them to do so. And many will do it at the finish because they either want pain medication or, wait for it, a prescription for Tylenol or Motrin. You see, they can’t AFFORD Motrin, but their medical card will pay for it with a prescription. (I was baffled by this when I was new to the ER and not yet jaded and cynical.)

Now people, I am not bitter about patients who are genuinely flat-ass broke and sick. The ER is a safety net, and sick people need to be able to come there. I believe that. I’m just sick of the blatant abuse and entitlement. By abuse and entitlement, I mean people who are using Medicaid/Medicare, smoke a pack of cigarettes a day, and regularly run up $1000 ER bills on the public ticket so they can get a prescription for a $3 OTC medication. How is that not ridiculous? I try to be compassionate and see some reason or commonality in every single patient I see, but this is wearing very thin.

Plus, I feel irresponsible for not pointing out, “Look, you need to quit smoking anyway. That’s probably why you have this URI to begin with, and it’s costing you a fortune. If you went one single day without smoking, you could buy the ibuprofen.” That would be the best health education I could probably give. But I NEVER point it out. Why? Because it would hurt my patient satisfaction scores and possibly my hospital’s reimbursement—we’re all about customer satisfaction. The sad thing is that some people probably actually haven’t thought of that and would change their behavior, but I have no way of knowing who would appreciate the idea and who would feel unfairly judged and complain about me.

This system is just BROKEN. Bad.

Why I love Evernote, for realz

Feb 132012
 

I’ve had “blog about Evernote” on my to-do list for a few days to the point that I’ve spent more time looking at it than doing it, so here we go. I’ve been an Evernote user since it was in beta, I think, so I’ve evolved with it. It was cool to begin with, but now a lot of other services integrate with it so it’s become increasingly useful over the years.

So what is it? I’d say it’s an information management system. By way of explanation, I’ll describe how and why I use it. I have a basic personality problem in that I hate clutter but I want to save everything because I never know when I might need it. Evernote solves the problem because I can save everything with minimal hassle (I’m also lazy). With Evernote, I can speak to it, draw in it, scan PDFs directly into it, send iSight photos into it, snap photos with my cell phone, or type into it. Then it syncs the information with just about any platform you can name (mine are my MacBook, iPhone, and iPad). I have multiple notebooks, and each note can be tagged. You can perform complicated ninja-like searches to slice and dice your data or you can just type a simple keyword, and Evernote does handwriting and text recognition from its server side. That means once you sync, you can search for text on business cards or scribbles on scraps of paper you’ve taken a photo of your phone with.

All of that is powerful because on the rare occasions I feel dedicatedly organized, I can put notes into notebooks and tag them. On the more usual occasions when I don’t, I can toss the information into Evernote willy-nilly with confidence I can easily find it again anyway.

Most browsers have Evernote clipping extensions, too, so if I see something I want to blog about or read later I can click the icon and it appears in my Evernote default notebook.

Evernote will geotag, and it allows the creation of lists with checkboxes. With all of this, the possibilities are basically limitless. Examples of stuff I’ve done with Evernote:

  • Taken a geotagged photo note of a menu posted on a window for a restaurant I wanted to come back to
  • Made a voice note about a blog idea while I was driving and couldn’t write
  • Added to that note supporting Web sites when I was at my laptop
  • Made a notebook for my BCEN adventures complete with Web sites, confirmations, to-do lists, and notes for weak areas I needed to study for (and then a scanned-in PDF of my certificate!)
  • Kept a “Journal” notebook for stuff I can’t bring myself to get rid of but don’t want physically lying around, like personalized Christmas cards
  • Taken snapshots of stuff I see in stores that I want to remember as gift ideas

Because you can combine media in a note, you can type something in and then drag in a photo and clip a Web site to the same note. Presto.

Evernote has a free service and a paid service. I use the free one and have never bumped against the usage limits, but that’s probably because I use Dropbox for other types of sync-age.

Getting data out of Evernote is the only downside I’ve found. You can export notebooks as HTML or PDF or Evernote archives, but you can’t easily export a notebook as individual notes. Practically, that bothers me only because it makes using Evernote as a journal impractical. I want my data back for something like that, and not in an ugly PDF. But that’s just me, and it’s a small thing.

Evernote keeps my apartment from being totally littered with scraps of paper and piles of stuff I might need to look at “someday.” Also, when someday comes and I need to find something, I actually can. Love it.

Why I love Evernote, derailed to Amanda Trujillo

Feb 122012
 

@doctor_jeff asked me to hook him on Evernote recently,

but I got caught up in (meaning pissed off about) this Amanda Trujillo crap. Yes, blogosphere, I said CRAP. Also STFU. Which I know hurt. Recommendations about big-girl panties come to mind, but I guess I should keep those to myself lest I be personally bullied by nurses who are pissed off about me being a bully. I discovered through various Twitter interactions that I am young (that actually perked me up), have no experience, and went against my dad’s wishes regarding his cancer treatment—impressive given that none of it was based on fact. I had planned to drop it because it’s so wearing to refute things like the following illiterate scrawlings, sadly posted on The Best in Nurse Blogs (“sadly” because if this is the best we have, frankly, we should probably keep it to ourselves), but hell, I pay for this domain, so I figure I can write on it:

“She also stated on twitter that she doesn’t feel nurse should support other nurses, just because they are nurse.”

What do I even say? Learn English and then try again? Capitals and plurals aside, commas make a difference. If you’re going to play spokesperson, please learn to, you know, speak. What I said was nurses shouldn’t support other nurses just because they are nurses. That quote says something entirely different. The opposite, in fact. The quote above, as written, means I wouldn’t support nurses by virtue of the fact that they’re nurses. Which also is ridiculous (“You’re a nurse? Well, screw you then”).

My coworkers and I sat around debating this case the other night, which by the way is what nurses should be doing with this (talking about it and not just being all emotional and sentimental about this sad single mom being treated unfairly), and none of them are online. I find it interesting that they watched the video/phone interviews with Amanda and all said she needs to be shut down. One said, “She’s a wingnut” (after commentary about how hospitals are doing this because nurses are COSTING THEM MONEY). Do you see doctors making idiots of themselves like we are when they screw up? Not generally. We may have something to learn there.

And spare me the “we must speak up” speech…I am the most outspoken irritating person most of my real-life acquaintances know. If it weren’t for me, actually, we as a field would not have a published position in a national nursing journal on our right to discuss this as we are in social media. OK? God, I love irony.

Anyway, the point is, there are good nurses and bad nurses. Just because someone says, “Hey, I’m a nurse!” doesn’t mean I’m going to say, “Groovy! You’re so right about everything you say and do!”

As for the compassionate nurses who attacked me over my dad, here’s my stance. I fought with my family for 6 months to support what he wanted. Not what they wanted. I’m his DPOA. He, his partner, I, and his physicians agreed on a course of treatment, which made him damn sick, as he knew it was going in, as a result of informed consent. If a nurse had waltzed in at the point he was puking sick before his transplantation and jacked all that up, you’d better believe I would have her ass. He probably met criteria for hospice care and would have opted out of the transplantation at some points despite his original and eventual wishes. Opting out of it would have killed him. Now he’s doing really well. Someone said this was a sophomoric anecdote, and it is anecdotal, although not, I think, sophomoric; still, it shows only one of a possible multitude of “other sides.” The anecdotal argument can be applied to Amanda herself, actually. I could stand in front of a camera and say whatever I wanted. Doesn’t mean it’s true or the whole story.

We don’t know whether a family member complained about Amanda. We don’t know anything about the other side. This is the point I was originally trying to make, and I’m unsure why it’s so incendiary. I don’t know that the case was like my dad’s. I don’t know that it wasn’t. I am just saying that there are a million possible explanations about why things are happening the way they are and that open minds are seeing that. Let us not bash physicians because we assume they are against “us,” the nursing profession. I’ve read physician blogs about this issue and think they make some good points. Do I want nurses’ scope of practice limited? NO. Do I think nursing education and knowledge is vital? YES. Do I think Amanda Trujillo acted appropriately? I have no basis to make that determination, nor does anyone else who knows only her side. Do I think she’s acting appropriately now? Well, we know the answer to that. (It seems based on my use of STFU…sorry folks, I do say “fuck,” regularly, I mean I usually don’t even abbreviate it as F, and Amanda, if you don’t want your daughter seeing you questioned or seeing abbreviations such as STFU, perhaps you should not have made your life so public or let her on Twitter…just a thought.)

I’m trying to avoid being overly defensive because the people having a field day bashing me on Twitter don’t know anything about me, but it is irritating. And yes, I know it’s a fraction of what Amanda is going through. She’s choosing to be defensive, I’m choosing to be defensive. Got it. Anyway, I do however show up for this field. I work hard at my paid job, and I’m damned good at it. I take patient advocacy to the wall. I take evidence-based practice seriously. I look up policies and shit. I took the time to get board certified. Why? Because I care about nursing and showing that we know what the fuck—yes, fuck (deal with it)—we’re doing. I serve as a board member on our local ANA chapter. Is this fun and jolly? No! Again: I care about our profession. I write for a national journal. I have not been a nurse for 100 years, but I know a thing or two, and more to the point I have a few careers under my belt and can spot potential bullshit for what it is.

I also do more than simply bitch on Twitter about the state of our profession. I, like, serve on boards of nursing organizations and write articles in actual journals to change it. OK? Supporters of this case may find themselves badly bitten if it backfires on our profession, which it has a high potential to do. Think again before jumping on the bandwagon. Nurses who are all, “OMG, this single mom got totally HOSED by Banner Health! Let’s cry real tears and join her conspiracy theories!” may be glad they can disappear when it blows up. I hope that doesn’t happen. I hope the Arizona BoN says she did everything right and that nurses are smart cookies who can do what their patients ask. But it’s too early to get this riled up about it.

So sorry, @doctor_jeff, I’ll talk up Evernote shortly!

Anatomical Organ-Shaped Jewelry by Lou Giesen

Feb 112012
 
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via laughingsquid.com

It’s a lung necklace! Love it.

More on Amanda Trujillo

Feb 072012
 

Just read “Why Nurses Are Furious About the Amanda Trujillo Case” by one of my favorite nurse bloggers, and it provides additional food for thought. They’ve now ordered a psych eval? Are you fucking kidding me? That does make me furious.

Amanda Trujillo…STFU

Feb 062012
 

UPDATE 2/10/12: This blogger makes some additional good points to think about regarding this case…please go check it out!

I’ve been (uncharacteristically) waffling over what I think about the Amanda Trujillo case. First I panicked and thought it was another instance of “them” taking away “our” autonomy, which, I think, was the kneejerk reaction of most of the nursing Twitterverse and blogosphere. Then I thought wait a minute, we are hearing one side of this story, and it’s unusual for a nurse to throw this much of a public fit. Why? Because if she wasn’t unemployable before, she is now. She  named her employer and possibly has violated HIPAA if the details of the patient case she has given are correct (I don’t assume they are because most of us are smart enough to change stuff like that when we publicly discuss our patients). Who will hire her again? She’s brought preemptive negative publicity to the Arizona Board of Nursing, and that can never end well. I try to fly under the radar of the BON at any cost. They are out to get nurses in my view, which admittedly is somewhat jaded because they wouldn’t let me take boards on account of a misdemeanor—driving with expired tags because my husband put the bill in a drawer. THAT is definitely a huge concern that should take a nurse off the floor. Yeah, I’m still bitter about that little incident.

Anyway, I’m not missing The Point, which is that nursing’s scope of practice IS being curtailed slowly but surely and that we ARE being relegated to being handmaidens to the doctor. I’m just not sure that Amanda Trujillo is the best icon for us to rally around because she is not behaving well or professionally. I’m not sure she isn’t, either. I am just taking more of a wait-and-see approach because something seems off about the whole thing. I don’t mind in-your-face nurses. I jumped on the warpath immediately when the JCCC student sued them for the placenta incident because that was transparent bullshit and both sides were in the press. This is just different because Amanda Trujillo has gone off the rails and is making herself look like a rabid idiot.

Codes, codes, and more codes

Jan 302012
 

I’m a bad blogger. I have so much paid stuff to write I’m neglecting anything for-free-and-for-fun. Bad. Bad.

But never fear, NNR continues to wear her invisible cape and save (or at least prolong) lives through the night, three nights a week. Stunningly, nightshift is short. As it always is. We are not, however, having our asses handed to us as we were a few months ago, so it’s mostly tolerable. Our resus rooms seem full more often than not, though. People who don’t believe in the collective unconscious are not nurses. We’ve got months where we have few codes or traumas and then suddenly both rooms are full all the time. This is one of the latter times. It’s one of those times where you brush your fingernails across your scrubs and say, “She left our department alive. Our work here is done now. CLEAN THE ROOM QUICK.”

One of our docs summed it up well the other day: “That [pointing at resus room] is why we love what we do. These other things are just fluff.” It’s true. Any trauma nurse, if pressed, will admit that it’s life-and-death situations that get our pulses thrumming. We hear “code blue in progress” over the radio and we fight warring impulses…if we search deep in our hearts, we halfway hope the patient can be shocked quickly into a live-saving rhythm, and we halfway hope it’s something complicated that will require transport and detective work to solve. I love and hate that time in a code when the doc says “anyone have any other ideas?” and people throw out weird shit. Those H’s and T’s. Sometimes just running down an algorithm WORKS. I love that. “Did we do an ABG? A UDS? A fingerstick?” Simple things that save lives.

And if the life isn’t saved, I think our hospital does a good job with helping families. That is so important. Our chaplains show up as if by magic, looking perfectly put together at any time of the night, and stay with the families until everything is complete. I love them. That’s actually part of my job that I like—that therapeutic presence part—but I never have as much time as I want to be with the family and help them through the situation. The chaplains do ONLY that. And they rock. The mutual respect between the chaplain staff and nursing staff is palpable. I like that a lot. I feel like we are good team players. They have checked in with me months after a difficult code to see how I’m doing. That’s nice. It’s hard. It’s nice to know people realize these things are hard on us too.

So my working life can be summed up as codes, codes, codes. I’m proud to say our community has rocking EMS teams and a rocking ER staff. We do a good job. It feels good to see people do that wordless trauma dance…it’s like magic to be a part of it. I love my job.

Rainbows and unicorns

Jan 172012
 

I just realized I haven’t blogged for like a week. Lazy! Actually, I’ve been busy as hell copyediting by day and playing nurse by night. I had one night off and I spent it with a new possible romantic interest. Well, I mean, the interest isn’t just possible, but  the romance may actually work out. You know what I mean. I am difficult to appease with my dating life because most people annoy the crap out of me, so yeah.

In fact, almost everything in my life that went horribly, horribly awry last year has sort of righted itself, hence my post title. I am restoring my bank accounts to their original upright positions by taking editing work, I still have the ER job I want, my dad is evidently healthy, and most importantly I don’t feel like a nervous wreck all the friggin’ time. This I attribute to the miracle of metoprolol ER. I know, sounds nuts, a beta-blocker as a miracle drug. But for me it is. Anxiety made my heart race and gave me palpitations and chest pain constantly, and after not very long that can make you really nuts. And I have really low blood pressure so normal beta-blockers made me faint all the time. And other anxiety medications made me jumpier. I can, however, take a shitton of extended-release metoprolol; my pulse stays in the 80′s and I feel okay. I mean, I get nervous and pissed off about things, but everyone does, especially people who work in emergency departments.

Now my concerns are a little more pedestrian…my next trick will be to get my hemoglobin up so I am not too anemic to work out, because I’m greedy and want to GLOW with good health. Iron is the only pill I’ve ever come across that makes me hork. I could probably digest tree bark without issue, but iron feels like I’ve just drunk acid (I assume, never having actually drunk acid). The only extra iron I can tolerate is Flintstones chewable tablets. It’s irritating. Really, though, that’s relatively not a big deal.

So…now that I’ve written this post I’ve probably jinxed myself. I’ll go to work tonight and be puked on or punched or both or will have my ass handed to me or maybe even all three. All things considered, though, the chances of that happening are the same whether or not the rest of my life is in the shitter, so I’ll just take this letup in drama with a “thank you” to the powers that be.

Sick. And tired.

Jan 092012
 

I just reminded myself of the Bill Cosby thing where he says his mom was always sick and tired of things. “One day she said, ‘I am SICK…’ and I said, ‘and tired!’ I don’t remember anything after that.” Funny dude.

But that’s not what I sat down to write. I don’t have much to say, actually. I got the GI bug last week that’s slain our entire town, and although I’m sick a lot, I rarely get the abdominal pain/N/V/D stuff. Part of it is that I hate being queasy so much that I simply refuse to get those bugs, I think. I’d rather have pneumonia than sit on the toilet with a trash can in my hands, yet I spent a good 32 hours just about like that. It was as bad as my patients were making it look. It was as if I had the plague. A friend dropped off some Gatorade, Immodium, applesauce, and bananas and texted me “I left stuff on your doormat.” SHE wasn’t going to get what I had! So then I got over that and promptly got a fairly energetic rhinovirus, which is much more tolerable but doesn’t have me turning cartwheels yet.

Work is making me more tired lately than usual. It’s probably because I’ve been sick, and another part of it is that my stupid apartment complex feels that the prolonged use of air guns to nail up new patio railings is just fine for the entire working day. I know the world can’t totally cater to night shift, but isn’t there another one they could put on on the other side of the quad for a while?? We’re also losing nurses in droves. I don’t think I’m allowed to write about staffing, so I won’t do that, but it seems like everyone is quitting, moving, transferring off night shift, or, sometimes, it seems, simply vanishing. I haven’t been at this job for very long, and only TWO full-time nightshifters are there who were there when I started. Yeah, I was a deserter myself for a while, to a midshift, but I came to my senses and accepted my vampirism.

However. It does not attract people to a shift that turns over like that. I’m not sure what it is. Maybe supremely bad luck. One reason I like nightshift is the teamwork and “I got your back” feeling, so I don’t think people are leaving because we’re mean. I mean, ER nurses are “mean” all the time in some ways—it’s our default. If you have thin skin or can’t take a joke, work somewhere else. But there’s mean and there’s mean, and I don’t think we’re that mean relative to the profession at large. We don’t eat our young. We give new nurses plenty of training. I’m mystified. But my point is, it’s tiring. A whole shift full of new people is tiring. I want to dance into a trauma and have that magical synchronized teamwork where no one really talks but everything gets done. That doesn’t happen when everyone is new. Everything gets done, but you don’t walk out of the room doing a mental “boo-yah.”

I know. I’m very demanding. But I LOVE that mental boo-yah. Now that I’ve written this post, I’ll probably end up orienting one of these new grads. Wouldn’t that be karmic?

Butt-whippin’

Jan 012012
 

I was sitting at work, minding my own business, when all of a sudden these 50 patients came out the alley and thronged the place. Not really. Suffice it to say that I. Am. Exhausted. Exhausted in a way I rarely get, like can barely hold my head up exhausted. My feet hurt when they touch the ground. I’m not kidding. It was one of those nights where even when I shouldn’t have been busy nothing lined up correctly and I just couldn’t get ahead of myself. I wasn’t actually behind. It just felt like it. You have your eh NYE’s and your holy shit NYE’s and this was one of the few shifts where I just felt like counting the minutes. I feel like Gumby with sore feet and achy legs. I love my job, I do, it’s just that some days nearly push me past the point of physical endurance. All that time without food or bathroom breaks is just almost inhumane.

Also, I’ve gotten spoiled in our land of plenty, and these shortages of Zofran and IV benzodiazepines are putting a big squeeze on us. I uncomfortably realized that I am complacent. “They’ll always have what we need.” Well, they don’t. It’s disturbing. We’ve already had several episodes of galloping lengths of a football field to a different Pyxis to see if IT had the drug we needed. It’s very anxiety-producing. And makes me grateful that we usually do have what we need and that our patients all get what they need.

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