Nursing Voices

Tuesday, June 24, 2008

On the Couch with Darth Vader

I found this news story over at WebMD. It seems as though a team of researchers from the psychiatric department of France’s University Hospital of Toluouse have far too much time on their hands. After extensive research, and I’m guessing after a few too many beers, they’ve concluded that Anakin Sywalker, aka Darth Vadar, suffers from Borderline Personality Disorder. Team members rolled out the results of their research last month at the 160th annual meeting of the American Psychiatric Association.

According to the authors of the report, Skywalker suffers from an identity disturbance, and meets the criteria for the borderline personality disorder because he has difficulty controlling his anger and impulsivity, he has issues of abandonment, and because he has a "pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of ideation and devaluation.” Sure, Darth has some serious issues, but I’m not seeing true evidence of borderline behavior. Most individuals suffering from borderline personality are cutters, and there is no evidence to suggest that Darth cuts himself with his light saber. And more importantly, there is no evidence that Darth carries a transition object, such as a teddy bear, in the privacy of his Death Star. Personally, I think he’s a narcissist. He’s always killing people and destroying universes so he can be the center of attention.

I guess even rich and famous villians have issues.

It's iPhone Week at Grand Rounds

I want an iPhone and I want one NOW!!!!! I wonder if my husband is reading this post. My birthday is next month. Hint-hint. But until then, it’s time to settle back and read Grand Rounds over at Shrink Rap. There are a lot of great posts over there, so go check them out.

Monday, June 23, 2008

Word Games

Do you remember President Clinton’s infamous quote during his 1998 grand jury testimony on the Monica Lewinsky affair? When asked about his relationship with Lewinsky, Clinton started out his response by saying, "It depends on what the meaning of the word 'is' is.” His response is a classic, and that type of deceptive response is alive and well within the world of healthcare.

I spoke to a psychiatric social worker this weekend that would have made Bill Clinton proud. She had a psych patient in her emergency room that she wanted to unload—I mean place—at our hospital, and she called me to see if I had an empty bed on my unit. The conversation went something like this:

Social worker: Hi Mother Jones, I have a delightful 45 year old gentleman that I'd like to place at your hospital. He tried overdosing on pills and alcohol, but he’s medically stable now.

Me: What do you mean by stable? Does he have an IV? What about his medical history?

Social worker: Well….um, about that IV, his nail beds are still a little dusky, but we can take the IV out before we send him to your hospital. And his medical history…..he’s diabetic, but surely his COPD and pacemaker wouldn’t disqualify him from getting a bed on your unit would it? And then, there is that other thing….you know, besides this long history of drug and alcohol abuse.

Me: What other THING?

Social worker: He’s on oxygen therapy, and he's on a liver transplant list. He’s kind of a funny color, but he’s medically stable.

Me: Nice try. Have a nice day.

This screening was too easy, and it was obvious that the social worker was a rookie. It usually takes me a few more questions before I can figure out who is trying to send me a dump. She’ll learn how to be more deceptive, and I’ll be waiting for her. I have a very long memory.

What’s your definition of medically stable?

Friday, June 20, 2008


I should have seen this coming. As you may recall, one of my former patients, who is a criminal, tried to kill me , and I’ve been having some symptoms of PTSD ever since. Human resources initially said, “Oh Mother Jones, we love you, and we want to help you feel better. We will pay for your acupuncture as a way of making it all better.” It was great until the bills started rolling into their office. Now they are saying, “You should be cured by now, so no more acupuncture for you!” A friend of mine, who is a psychiatric nurse practitioner, took care of patients who were at the Pentagon on 9/11. They told my friend that they, too, initially received an outpouring of support from friends and colleagues, but that support eventually waned shortly after the 9/11 attacks. I guess that people think that time heals all wounds, and they can’t understand why victims of violence just can’t “get over it.” Of course, in my employer’s case, it’s all about the money. Lip service is cheap. Liars.

It looks like I’m going to have to file a Workers Comp claim. I can't take much more of this crap. In the the words of a good friend of mine, "Release the Scotch!"

Tuesday, June 17, 2008

Disposable Heroes

This story from ABC News and the Washington Times just makes me sick. It seems as though our government is using our war heroes as lab rats. Scumbag researchers are giving soldiers who are suffering from PTSD an anti-smoking drug called Chantix, and then they are sitting back and watching what happens next. And oh yes, the researchers aren’t telling anyone in the study that the drug can cause psychosis and suicidal ideations. After all, the test subjects have enough emotional problems, so why freak them out anymore than they already are by explaining that the drug has pesky side effects. That makes sense, right?

Go ahead, call me a cynic, but why is the government targeting soldiers that are emotionally fragile? Maybe the army isn't trying to find a cure for smoking after all. Not that our government ever lies to us. Just sayin.' The whole thing reminds me of the "Tuskegee Study of Untreated Syphilis in the Negro Male."

Thursday, June 12, 2008

Let's Hear it For "Old School" at Change of Shift

Welcome to Change of Shift. I want to thank Kim from Emergiblog for allowing me to serve as host. Today’s issue of CoS is a salute to old school nurses. What’s an old school nurse? They are the individuals who went into the profession back in the “good old days” of nursing. These nurses attended hospital nursing schools, surrendered their chairs whenever a doctor walked into the nurses station, and they wore nursing caps. Take a look at these ladies. They were tough, and they gave excellent patient care. I wonder what these good old gals would think about what’s going on in today's world of nursing. I think that they would be shocked, as well as amused, by some of the things that are going on inside of the profession. Let’s give a big cheer to our predecessors and start Change of Shift!

My first post comes from a nurse named Naughty. She doesn’t have blog of her own, so she asked me to post this on my blog for CoS. I couldn’t refuse after I read her letter. Naughty comes from a family of nurses, which is common among old school nurses. This picture reminds me of how we pass our nursing traditions on to the next generations.

She writes:

Hello Mother Jones, RN

I am celebrating 30 years as a nurse this year. In my career, I have had the good fortune to have many experiences including, but not limited to : NICU nurse, Neonatal Transport, Staff Education, Shift Coordinator, School Nurse, School Nurse Practitioner, General Pediatric Nurse Practitioner, and Research Coordinator. How many careers can offer that broad expanse of opportunity? I have loved every day of this career; funny, but when I made my decision to go to nursing school, it was made somewhat blindly. My mom was a Navy Nurse, and still practicing when she died (young, at the age of 40). I fell into it because I loved biology, liked being with people, didn’t want to be in school for an eternity, and didn’t want my job to become my life. When I graduated I thought I could save the world. Now that I am 51, my ‘world’ only encompasses several dozen patients – but guess what? I am so grateful that I had the opportunity to do just that little. But my greatest accomplishment? My love of nursing inspired another young person to enter the profession. She watched my joy and tears as I talked about the people I took care of each day. She wanted the same for herself. When she talks about her trip to South Africa to do AIDS research, or talking about the County ER practicum, her eyes glow. . . Her starting job is at a children’s hospital in the cardiac ICU. She won an award at her pinning ceremony for clinical excellence. How do I know so well? She is my daughter, and I thank God that she is so happy, and has chosen a career that makes her heart sing. Will she survive? I think she will, and here is why. She knows that having a social life and a network of friends is of paramount importance – work is only part of life, albeit an important one. She is willing and capable of working hard. She is organized but not anal. Rules are generally followed, but if they do not make sense, she acknowledges the frustration, does what is needed, and moves on. She does not dwell on meaningless detail. I have had many nursing faculty in my career who could learn from her approach! The biggest drawback to nursing? Too many women. Not enough Wo-Men. Sometimes petty, sometimes backstabbing. Sometimes not assertive enough, and sometimes picking too much on the interns. Too much blame on others at times, too little taking the bull by the horns. By nature, a caring profession, and therefore doing anything to make patients better, which takes pressure off the system that doesn’t serve, only delaying the meltdown. Using technology and allowing it to override our gut. A divided profession in regards to academic preparation. And last but not least, *&(^$%$ nursing theory. What do I love? Darn near everything. Every memory. Polly, Debbie, Phyllis, Karen, Patrick, Billy, Derrick, Sheniqua, Jerome, Aiden, Lakesha. More than a few opportunities to make a small (sometimes big) difference. A career that allowed me to go to grad school, and raise my family. Working with wonderful people who actually gave a damn – from the techs to the surgeons and all in between. And someday, soon I hope, one of them will be involved in repairing this broken health care system. It will take courage and perseverance, so we can’t count on a politician. My deepest regards and affection to all of you who have made my life rich beyond my dreams.


Thanks, Naughty, for you letter. Start thinking about launching a blog. You're a very good writer.

Look at the wicked smile on that woman's face. I wonder what this old school nurse was thinking about when the photographer snapped her picture. She looks spunky, and I bet that she was smart, too. Nurse K from Crass Pollination reminds me of an old school nurse. She works her butt off under difficult conditions while delievering excellent nursing care. And she's spunky and smart. Nurse K shows her serious side in this post about sub-par-care. Then she shows us her spunky side in this post about one of her "favorite" patients who keeps coming back into her ER.

My favorite rabble-rouser, Monkeygirl, from Musings of a Highly Trained Monkey submitted this post about a STUPID rabble-rouser who showed up in her emergency. Read about the dangers of mixing stupidity with alcohol. Some people are just too dumb for words.

This old school nurse is an army flight nurse during World War II. She’s taking care of wounded GIs on a plane that was a flying ambulance. She looks posed and confident. ERNursey talks about what goes on in her emergency room in her post, How the ER Works. I’m sure that ERNursey and her post would impress our old school army nurse. I also think that she would be very interested in ERNursey's post about nurse to patient ratios. A California hospital is cutting corners at the expense of patient care. Old school nurses would never tolerate this crap, and neither should we.

The one and only Kim from Emergiblog writes about a faceless old school nurse. Really! She also writes about patients who treat their nurses like they are invisible.

Emily from CRZEGRL, FLIGHT NURSE, sent in this post about flight nursing. She sent in a lot of good information, so check her post out. CRZEGRL, AKA Emily, is also a writer over at Nursing Jobs. Org. Read her biography, I am a Nurse.

Old school nurses respected and admired old school physicians. At least the ones who listened to their opinions, and who valued them as colleagues. The same holds true today, and I’d like to welcome our esteemed physician and colleague to CoS. Aggravated DocSurg writes about his distain for The Borg... I mean JCAHO. I admire anyone who hates JCAHO as much as I do.

I want to welcome #1 Dinosaur from Musings of a Dinosaur to Change of Shift. With a name like #1 Dinosaur, you know that this doc is old school. #1 Dinosaur sent in a post about the perils of the open-ended question in a new patient interview. Read it and learn. You'll be glad that you did.

Therapy Doc from Everyone Needs Therapy is a lot like an old school nurse. She believes that pills won’t cure everything under the sun. Read her post about ADHD.

Old school nurses depend on the hospital pharmacist to deliver top notched pharmaceutical for hospital use. I loved the pharmacist that worked at my hospital when I was in nursing school. He helped us take good care of our patients, and he helped me get through my pharmacology class. I wonder if this pharmacist is doing the same for this old school student nurse. I still love pharmacists. Drugmonkey from Your Pharmacist May Hate You submitted this entertaining book review. This guy just cracks me up.

You can tell that this nursing instructor is an old school nurse. She proudly wears her nursing cap as she holds her head up high. I found this picture in a nursing school yearbook that was published back in 1961. Nurse Practitioners Save Lives writes about her most memorable nursing instructors. Old school nurses are tough on their students because they want them to succeed in the nursing profession.

May from About a Nurse writes about a very sad day at work. Old school nursing instructors prepare students to face days like this.

Old school nursing instructors were notorious for yelling at students who used poor body mechanics while caring for their patients at the bedside. Nothing will kill a nursing career faster than a bad back. Dean Moyer from Rebuild Your Back sent in the post about acute back pain. Read his post and start rebuilding your back.

The photo of these old school nurses is from 1938. These London nurses are returning to work after they ended their strike. They were striking in order to improve working conditions. Sound familiar? Some things never change. Tammy Swofford sent in this post about Texas nurses who want to unionize.

I hope these nurses won employer concessions concerning retirement. I’ve been posting over at Nursing Jobs. Org. Check out my post about Travel Nursing: The New Retirement. Retirement is changing, and nurses need to change with the times in order to survive their "Golden Years."

Old school nurses would see a lot of things while caring for their patients at the bedside. They witnessed life and death dramas just like we do today. Nurse Kathy from Nurse Connect submitted this post about a very special love story. Get your Kleenex ready. You’re going to need them. Kathy also submitted two other excellent posts. Please check out her posts about nursing responsibilities, and how active listening can improve patient care as well as the workplace.

This nurse is a bookworm. I bet this nurse was strong, too. Look at the size of those books. Those books look like they weigh at least twenty pounds apiece. Old school nurses who loved to read lived in the hospital’s library. Of course this picture was taken back in the days before the Internet. Now bookworms have the option of sitting in front of their computers all day long. Alisa Miller from Nursing Degree. Net writes about the 50 best medical libraries on the web. I'm sure that this nurse would check out Alisa's post.

On behalf of all the old school nurses and their patients, I want to thank you for dropping by Change of Shift. Next edition will be hosted by Braden at 20 Out of 10: Musings of an Emergency Room Nurse on June 26th. Send in your submissions via Blog Carnival or to “braden at bkellis dot com". See you there!

Tuesday, June 10, 2008

Why Gomer Pyle Should Work For JCAHO

Are you old enough to remember Gomer Pyle, U.S.M.C ? The show’s tagline was, “Surprise, surprise, surprise!” I wasn’t a fan of the show. Gomer's tagline was irritating, and the show quickly got on my nerves.

So, now that we’ve talked about Gomer, let’s talk about JCAHO. For those who don’t know, JCAHO is the boogieman of the hospital world. No one likes them because of their white glove inspections, and because hospitals don’t know when JCAHO is coming unless someone tips them off. Last weekend, the Greatest Hospital in the World received a tip from the Hospital Down the Road that JCAHO was in town and was heading our way. All the mangers came in over the weekend and made my life miserable. Did you know that no hospital supplies can be stored within 18 freaking inches of the ceiling. I literally saw nursing managers up on ladders measuring the piles of crap that we store on top of wall cabinets. My boss looked really nervous. I know that she was praying that JCAHO didn’t arrive over the weekend while I was at work. She knows that I give honest answers to honest questions, and hospitals NEVER want their employees to give honest answers to JCAHO. Here’s the standard script that nurses are given when JACHO comes to town:

JCAHO: Hello nurse, do you give good quality care at your hospital?

Nurse: Yes, we do. I love working at the Greatest Hospital in the World. We rock!

Yeah, I’m not saying that. There’s no way that I could say that kind of stuff with a straight face, but I digress. It turned out that The Greatest Hospital in the World received bad information from the Hospital Down the Road. JCAHO never arrived and they have taken off to parts unknown. Now, let’s get back to Gomer. I think Gomer Pyle would make a great JCAHO employee. He is irritating, he gets on people’s nerves, and his tagline would make him a fantastic inspector.

Surprise, surprise, surprise!

Wednesday, June 04, 2008

Calling For Submissions for Change of Shift

I’m hosting CoS on June 12th, so listen up. I want to include YOUR post in Change of Shift. There’s no theme, so start typing, and send me your best stuff. Deadline is June 10th. Send your submissions to nurseratchedsplace AT yahoo DOT com.

The Political Opera Isn’t Over Until the Pantsuit Lady Sings

It seems that I pissed off a lot of people with my last post, so let’s see if I can do it again.

Last time I talked about how Scott McClellan described President Bush as a megalomaniac, and as a pathological liar. This time, I want to talk about the words delusional and denial, and how these words relate to Hillary Clinton. First, let’s start by looking at the numbers. Obama has received the number of delegates that he needs to run for President of the United States. This means that Obama is the presumptive Democratic nominee running for president, and that Hillary is not. Hillary said at a rally in New York last night that she has not made any decisions about the race, or about ending her campaign because she wants to be President of the United States. In her mind, the political opera isn’t over until she sings her concession speech. Is Hillary in denial? I worked for a psychiatrist a long time ago that taught me to never challenge anyone’s delusional system unless you have something better to replace it with. Sorry, Hillary, we can’t replace your delusional system with something that you want to hear. It doesn’t matter whether you sing or not because the primary elections are over. Perhaps you can start taking some psychotropic medications, or maybe Obama will replace your delusional system by making you his running mate. Or not. Just saying that this is going to be a very interesting election year.

Let the hate mail begin.