Nursing Voices

Tuesday, July 31, 2007

Learning the Tricks of the Trade

I enjoy reading a good book, and it looks like this nurse does, too. I found a book on eBay that made my heart gallop with glee when it was delivered to my postal mailbox. It was the ultimate handbook for nurses who were preparing for their state boards back in 1929. The book is full of tricks of the trade from the turn of the century. It’s entitled State Board Questions and Answers for Nurses, Being the Actual Questions Submitted at the Examinations of 31 State Examining Boards For Nurses, With Answers. It was compiled and edited by John A. Foote, M.D., and it was published by J. B. Lippincott Company. The previous owner, Miss Estey C. Cox, a student nurse at St. Elizabeth Hospital in Lincoln, Nebraska, wrote notes about her days as a nursing student throughout the book. In the chapter about psychiatric nursing, she wrote, “Hardest of all. More power to me.” Some things never change.

I’ve read this entire book and I have concluded that I would have failed the boards. But really, did you know that the active ingredient of Dover’s Power was opium and that Fowler’s Solution was made from arsenic? And I bet none of your nursing instructors taught you how to give your patient a sulfur bath, or how to prepare a cream enema. I’m sure that this young nurse knew all of that stuff. Doesn’t she look confident? I bet she could have answered this question from the book:

As a district nurse, how would you give a sweat-bath with dry heat in the patient’s home?


To give this bath, a small alcohol lamp will be required, also several blankets, rubber sheeting, ice-cap, towels, a piece of stovepipe elbow and, if procurable, a piece of asbestos. Place a rubber sheet covered with a blanket under the patient, remove patient’s gown, place several chairs over patient to form a cradle for the blankets, place a blanket covered by a rubber sheet well over these chairs, standing well below patient’s feet and up to his chin and coming well down on either side so that a closed chamber will be formed. Arrange lighted lamp on chair beside the bed, place stove-pipe elbow over the lamp and let the other end pass under the blanket near one of the chairs, about three or four inches over patient’s feet, being careful not to leave the blanket over the opening of the pipe. Tuck the blankets around the patient so as to leave no opening and place a towel between the blankets and patient’s neck. Wrap asbestos or a wet towel around the end of the pipe as it passes under the blankets and fasten blankets about the pipe in an airtight manner.

Place ice-cap on patient’s head, and thermometer, if obtainable, in an accessible place under the blankets. The temperature should be 130-150 degrees F. Holy cow! An alcohol lamp and flames near bed linens? Asbestos? I wonder what JCAHO would think. I enjoy learning these old fashion tricks of the trade. This is just one question out of my 582 page book, so be looking for more test questions soon.

Thursday, July 26, 2007

It's Time to Monkey Around at Change of Shift

You don’t need to be a monkey to enjoy blogging, but there is one famous Monkeygirl in the nursing blogosphere that you really need to visit. She’s the host of this week’s Change of Shift. Monkeygirl will make you laugh with her quick wit and her insightful comments about the state of our country’s health care system, so make sure that you drop by Musings of a Highly Trained Monkey. And when you’re done reading Change of Shift, you must drop by and see Drugmonkey, who is my all time favorite pharmacy guy at Your Pharmacist May Hate You. I’m trying to talk him into running for President this year, but he’s not interested in running for public office. It’s too bad. I think he’s just the guy for the job.

Monday, July 23, 2007

What the Shadow Knows

If you’re old as the hills like I am, you might remember hearing about an old radio show called The Shadow. According to Wikipedia, Walter B. Gibson created The Shadow in 1931, and the character skyrocketed to super stardom thanks to Orson Welles. He was the original actor who played the character in the popular radio series. Each show would begin with the phrase, “Who knows what evil lurks in the hearts of men? The Shadow knows.” Here's a new twist on the old trademark phase. It goes like this: "Who knows what goes on behind the scenes on a psychiatric unit at a major East Coast hospital center? The Shadow Nurse knows!"

A couple of weeks ago I started looking for a PRN position at local hospitals in an effort to subsidize the meager paycheck that I earn at Hospital X. The hospital where I was interviewing has a stellar reputation in the community, and I was looking forward to checking it out. During my initial job interview, the unit manager, who incidentally is not a nurse (this is NOT a good sign), looked at me and said, “I bet you could really give me a tough time if you really wanted to make my life rough.” I couldn’t understand what he was talking about. Yes, I’m seasoned, intelligent, assertive, and a patient advocate, but I’m not impossible to work with. I had no idea why he was being so defensive. All I did was say hello when I handed the guy my resume. He just stared at me for a few seconds, and then we chatted about why I wanted to work on his unit. After about a thirty-minute interview, he said he wasn’t sure if I was a good fit for the unit, and he said he wanted me to come back one evening so I could shadow his nursing staff. That way I could see what it was like to work on the unit, and the staff could decide if they wanted me onboard.

Two weeks later I walked onto a unit that was in total chaos. JCAHO was inspecting the unit, and one of the day nurses had been a no-call-no-show for her shift again. Things became more interesting when it became apparent that one of the evening shift nurses was also going to be a no-call-no-show for her shift, too. I offered to come back on a day that wasn’t in the crapper, but the charge nurse said that this was a typical shift and that I should stay to see what happens. I stayed on the unit for four hours. During that time, the nurses asked me their questions. Welcome to the Inquisition:

A nurse asked me if I had any restrictions on my nursing license. She explained that the last psych nurse that the hospital had hired couldn’t pass meds because of a history of drug abuse, and that they caught her shooting up Dilaudid in the med room after the Board of Nursing lifted the restriction off of her license. No, I do not have a restriction on my nursing license, thank you very much.

Another nurse asked me how I deal with patients who have personality disorders. I responded by saying that I am a disciple of Skinner, and that I use behavioral modification techniques when dealing with patients who are impulsive and self-destructive. I gave a few examples of how I have used behavioral modification techniques in the past. The nurse smiled and thanked me for the information. She said she was going to use my techniques the next time she saw her mother who suffered from Borderline Personality Disorder. She continued to tell me things about her mother that I didn’t want to hear.

Then it was my turn to ask questions. I asked if there was a place in the hospital where I could sleepover just in case I had to come in early in order to beat bad weather that was moving into the area. I explained that I lived many miles from the hospital, and that I was worried about driving in icy weather during the winter. Everyone at the nurses station just glared at me. Finally the charge nurse said, “Look, we don’t want anyone working here that’s going to make us look bad. No one comes in early, and no one stays late. Got that?”

I don’t think they need anyone to help them look bad. I think they are doing a fine job on their own. I have no plans to work on their unit, and my quest to find PRN hours goes on.

Tuesday, July 17, 2007

Stylish Privation

Here’s a book that my husband picked up a long time ago. Ernest Callenbach wrote the book, and it published in 1972. I think Callenbach was a hippy. This is the book’s introduction:

Poor Is “In”

“Millions of Americans have discovered how to be free. And to be that, they are willing to be poor: to drop out of the corporations and universities and official culture and instead try building up a life-style that will suit them. This can mean scrounging, scavenging, welfare, do-it-yourself, subsistence farming, communes, odd jobs, and part-time jobs. It’s not an easy life. But it can be a real and personal satisfying life—fit for man to live. This book has been written to try and bring together information that can be useful in living this new life.”

I’m glad that I have Callenbach's book. It is going to come in handy after my yearly employee evaluation. This is going to be interesting. Mr. Gringe isn’t happy that I keep pointing out issues regarding patient care that the hospital chooses to overlook. I refuse to wear rose-colored glasses to work. On a brighter note, Mr. Gringe has also announced that the nurses working a Hospital X are getting a “substantial” pay raise this year. That’s the good news. The bad news is that he is playing down the fact that our big, fat, raise won’t cover the increase in premiums that we pay for our health insurance, nor will it cover the increase in copays associated with our new policy. My coworkers will need a pair of rose-colored glasses when they start reading the fine print on their insurance policy.

If poor is in, then I'm living the highlife. Like the majority of Americans, my family and I are struggling to make ends meet.

Friday, July 13, 2007

When HMOs Meet GI Joe

I saw a news story that made my stomach turn. Bob Woodruff reports that more than 22,000 Iraq war veterans are being discharged from military service due to a “pre-existing” personality disorder. Why are our war heroes being branded with this diagnosis? It’s simple. Our government has found a way to deny mental health benefits to veterans who are suffering from mental health disorders related to their time in Iraq.

HMOs have been playing this game with patients for a long time. It's the game of “Plausible Denial.” I’ve seen insurance companies cook up all kinds of reasons to deny people mental health care services. I once cared for a woman who wanted to kill herself by jumping in front of a train. She was serious, but since a train couldn’t possibly come through our hospital unit, her insurance company said that the patient was no longer an imminent risk to herself, so they refused to pay for her hospitalization. Now the military has adopted the same HMO mindset, and is screwing over our service men and women who are coming home from Iraq. Please read Bob Woodruff’s story about our government’s latest shenanigans, and then write a letter to your member of Congress. Tell them to court marshal the people who came up with this bright idea. I’m sure whoever came up with this plan will have a bright future with an HMO one day whenever they leave military service.

Thursday, July 12, 2007

Change of Shift

Change of Shift is up over at Go check it out!

My favorite Monkeygirl from Musings of a Highly Trained Monkey will be hosting the next Change of Shift on July 26th. I can't wait to see what she comes up with. Her blog is a blast! Love ya, Monkeygirl! Send your submissions for the next Change of Shift to ermonkeygirl (at) hotmail (dot) com.

And don't forget to check out Nursing Voices. There is a lot going on over there, and it's a great place to meet!

Sunday, July 08, 2007

My Crystal Ball

Check out this nurse’s crystal ball. Nurse Sue Whittier has a dilemma. Should she tell her dying former sweetheart the truth about his scheming wife? Apparently, the evil wife is having an affair, and the other man is the father of her son. Hmmm, decisions, decisions. May I suggest that she just go kick the wife’s butt and be done with it, or is that too un-nurse like for me to say? I guess she’ll just have to gaze into her crystal ball to find the answers to her problems. She also needs to stop pining over her old flame. Nurse Whittier, get a life. He’s married and he’s dying, so get over it. Yes, I’m feeling rather cranky today. I looked into my own crystal ball and I don’t like what I see. America has a growing dilemma. It’s our health care system. The dilemma has to do with the Baby Boomers who will one day overwhelm the health care system.

We geezers are growing older, and as we age, we start outliving our usefulness to the insurance industry. The cost of our health care goes up, and we all know how happy insurance companies are when we ask them to pay our bills. And who can blame them. Health care is expensive, and what good are old people anyway? We just take up valuable space. My crystal ball showed me that the insurance industry is going to solve this dilemma. One day, when you least expect it, the insurance companies will get Congress to pass a law that will legalize assisted suicide in our country.

Science fiction writers have already figured this out. Do you remember a movie called Soylent Green? The movie takes place in the future. It is a dismal time when there are too many people on the planet, and there isn't enough food, water, and housing to go around. There’s a scene in the movie where an old geezer, played by Edward G. Robinson, just can’t take it anymore, so he goes to an euthanasia clinic and is put out of his misery. The scene was disturbing, but I'm sure that his HMO was happy because they didn’t have to pay his expenses anymore. I’m positive that they preauthorized his extermination. I bet you’re thinking, “Life is sacred and this will never happen in America.” I’m sorry, but I have to disagree with you. In the view of the insurance industry, life is sacred as long as it’s not too expensive to keep someone around.

Here’s my suggestion for their future slogan: Say yes to death.

Thursday, July 05, 2007

The Good Old Boys and the Damsel in Distress

I’ve always said; if you want to play the damsel in distress card, tell people that you are a nurse.

My 4th of July literally started off with a bang when my back rear tire exploded while I was driving to work. I was on a busy two-lane highway traveling 60 miles an hour when I ran over a nail. Damn nail! The car swerved into oncoming traffic, but I was able to get the car under control, and coasted to the side of the road. I kept my cool until the car stopped, and then I freaked out. Unlike the rest the of civilized world, I don’t own a cell phone, so I was basically screwed. After I calmed down, I decided it was best to keep limping down the side of the road on my rim and look for help.

Less than a mile down the road I saw a big white farmhouse with rows of pickup trucks appointed with gun racks parked in the front yard. I noticed a group of men mulling around a barbeque grill, so I pulled off the road into the driveway and walked up to the gathering of good old boys who were guzzling their 4th of July beer. I had a feeling this was going to be my lucky day.

Me: “Good afternoon gentlemen. I’m sorry to intrude on your party, but I’m a nurse going to Hospital X, and I have a flat tire.” I smiled while pointing to my hospital ID that I was wearing on my sweater and I said, “Can one of you gentlemen help me out?”

Good Old Boy #1: “Shoot little lady, you’re a nurse?” Everyone jumped to their feet. “We’ll be glad to help you out. Come on guys. Someone throw me another can of beer and let’s go!”

While I was standing around watching my newly acquired pit crew of slightly tipsy men change my tire, Good Old Boy #2 brought me a hot dog off the grill and a diet soda. He apologized for not bringing me a beer, but he said he knew I couldn’t drink because I was going to work. He said that he and his wife really appreciate the nursing care they always receive at Hospital X, and that he and his friends were really happy that they could help out a nurse. The good old boys changed my tire in less than twenty minutes, and I was back on the road again.

I’m writing this post from my Toyota dealership while I wait for my new tire to be mounted on the car. The old tire is DOA. I’ve gotten the word that buying a new tire is going to be an expensive proposition. Too bad the Toyota mechanic wasn’t at yesterday’s picnic, because everyone, especially drunken good old boys, love nurses.

Wednesday, July 04, 2007

As American as Apple Pie

Wow, I want what she's on. Doesn't she look perky? Maybe she's had too much caffeine, or maybe she’s in a good mood because it’s the 4th of July. She looks as American as apple pie in her costume, and the feathers in her cap are a nice touch. It’s hard to be glum during a national holiday.

I’ve been reading some really great nursing websites today, so I’m feeling upbeat, too. The Nursing Voices Forum is off to a great start. There's a lot going on over there, so check it out. Kim at Emergiblog is hosting the next Change of Shift on Nursing Jobs. org blog. She got the idea from Pixel Nurse who hosted the last Change of Shift on Nursing Link. Kim said that she has no trouble giving credit where it is due or stealing great ideas!

Well, I better go now. I'm working today and I'm expecting a lot of holiday traffic on our unit. Happy 4th of July!

Monday, July 02, 2007

The Terrorist And The Gossiping Nurses

Norman Rockwell got it right in this picture. People love to gossip. Nurses love to gossip, too, even about the petty stuff, so I can just imagine what nurses at Paisley’s Royal Alexandra Hospital in Glasgow, Scotland are saying after they learned about the shenanigans of one of their foreign born doctors. It seems as though one of their Iraqi doctors, who is now being treated for burns at the hospital, was the man who tried to blow up the Glasgow airport.

I wonder if the nurses are fighting over who is going to take him as a patient. I ordinarily hate floating to other units, but I’d make an exception in this case. I’d love to be this guy’s nurse. The Florence Nightingale Pledge be damned, I’d have such fun torching the douche bag. I can see it now:

“Good Morning Mr. Terrorist. I’m your nurse, Mother Jones, RN. My, those burns look painful. Were those the kind of burns that you were trying to inflict on other people? Time to debride those burns. Let me rip those bandages off for you.”

You get the picture. I’d be having way too much fun.

I wonder how all of this is going to affect the foreign born doctors at our hospital. The FBI came to our hospital right after 9/11, and wanted to know about the doctors who built a Mosque across the street from our facility. The doctors wanted a place to pray while they were at work. These guys aren’t terrorists, but now I wonder if this incident is going to bring the FBI back for another visit.

I look for the positive in every situation. Perhaps this situation will prompt some of our foreign born doctors to start treading a little more lightly around the nurses station, and stop acting like jerks.