I do believe I'm applying to grad school.
I NEVER would have believed this when I was a school hating child of 8.
Wednesday, February 15, 2012
Thursday, February 9, 2012
Keep your desk job, I'll be right here, in the trenches.
When I rip on Medicare? THIS is why:
And also why case management would be the LAST job on earth I would ever want to do. Keep me at the bedside, please.. necrotic tissue, vomit, feces, confusion, and being physically assaulted by patient is preferable to dealing with THIS:
http://www.youtube.com/watch?v=5J67xJKpB6c&feature=player_embedded#!
And also why case management would be the LAST job on earth I would ever want to do. Keep me at the bedside, please.. necrotic tissue, vomit, feces, confusion, and being physically assaulted by patient is preferable to dealing with THIS:
http://www.youtube.com/watch?v=5J67xJKpB6c&feature=player_embedded#!
Tuesday, February 7, 2012
Why I hate Medicare
If I owned a hospital, I wouldn't take Medicare. They don't pay for shit, they have more red tape and bullshit guidelines than a used car salesman selling stolen adhesive products from the back of a minivan and hospitals lose money on EVERY Medicare admission. The statistic put out by the hospital that employs me released a figure that said every Medicare admission costs the hospital 400.00 PER DAY. Good thing we are a non profit community hospital because that shit is jacked. That is not to say that I don't see the need for Medicare and programs like it, I do see the value- but if I owned a hospital, I'd, oh I don't know, want to actually have across the board billing that gets me paid for what was done. I wouldn't have to jack up the prices of things like Tylenol so that 40 year old Jim Bob in 523 with Blue Cross has to pay extra so that 99 year old Matilda Sue in 520 doesn't bankrupt the friggin hospital.
Every year they pay for less and less and every year hospitals become more and more unsafe and the care becomes more and more substandard.
One way Medicare came up with to get the medical community up the ass with a cactus is to not pay for re admissions to the hospital within one month of a discharge.
Okay so let me get this straight. Medicare pays a fraction of the actual cost for each admission, won't pay for ANY part of the stay if a patient contracts an infection of any kind (case in point.. patients on vents routinely develop pneumonia no matter how careful staff is about infection control. Doesn't matter- if a Medicare pt. contracts pneumonia during a hospital stay, Medicare won't pay for it.) If a patient contracts a UTI from a foley catheter being in place, their stay is free. Okay so the good news is, less people are getting infections because money talks, and quality of care does go up when we know we will lose money if it doesn't improve.... what I DON'T like is that Drs are encouraged to push people out the door who might not really be 100% ready because those patients are costing us money and yet, those patients are getting re admitted and we are losing money anyway because those re admissions are free!!
What a complete and utter waste of time and resources. Want to know why people keep coming back? How about the patient I got who was newly diagnosed diabetic and the doc wrote for her to start daily insulin injections... at 9am (that was the first I heard about her starting SQ injections- she was on metformin prior to her admission) and that I had to have all her discharge instructions done by 10:30 am so she can drive to the main hospital and pick up her glucometer and sample insulin pen. The dr didn't write for me to do any diabetic teaching (probably because he knew I didn't have enough time to do any). Plus I had 5 other patients to discharge. WHAT THE FUCK. Patients should be self injecting, do meal planning, learn how to count carbs, understand when to check blood glucose levels, what A1C levels mean, etc etc. wayyy before they are discharged. It's impossible to do my job the right way sometimes and that is extremely frustrating to me. I can't blame that entirely on Medicare, but the whole revolving door mentality starts squarely with them. You would think not paying for re admissions would curb premature discharges, but NOPE.
Every year they pay for less and less and every year hospitals become more and more unsafe and the care becomes more and more substandard.
One way Medicare came up with to get the medical community up the ass with a cactus is to not pay for re admissions to the hospital within one month of a discharge.
Okay so let me get this straight. Medicare pays a fraction of the actual cost for each admission, won't pay for ANY part of the stay if a patient contracts an infection of any kind (case in point.. patients on vents routinely develop pneumonia no matter how careful staff is about infection control. Doesn't matter- if a Medicare pt. contracts pneumonia during a hospital stay, Medicare won't pay for it.) If a patient contracts a UTI from a foley catheter being in place, their stay is free. Okay so the good news is, less people are getting infections because money talks, and quality of care does go up when we know we will lose money if it doesn't improve.... what I DON'T like is that Drs are encouraged to push people out the door who might not really be 100% ready because those patients are costing us money and yet, those patients are getting re admitted and we are losing money anyway because those re admissions are free!!
What a complete and utter waste of time and resources. Want to know why people keep coming back? How about the patient I got who was newly diagnosed diabetic and the doc wrote for her to start daily insulin injections... at 9am (that was the first I heard about her starting SQ injections- she was on metformin prior to her admission) and that I had to have all her discharge instructions done by 10:30 am so she can drive to the main hospital and pick up her glucometer and sample insulin pen. The dr didn't write for me to do any diabetic teaching (probably because he knew I didn't have enough time to do any). Plus I had 5 other patients to discharge. WHAT THE FUCK. Patients should be self injecting, do meal planning, learn how to count carbs, understand when to check blood glucose levels, what A1C levels mean, etc etc. wayyy before they are discharged. It's impossible to do my job the right way sometimes and that is extremely frustrating to me. I can't blame that entirely on Medicare, but the whole revolving door mentality starts squarely with them. You would think not paying for re admissions would curb premature discharges, but NOPE.
And now for something completely different..
The phone rings and the lady of the house answers, "Hello".
"Mrs. Ward, please."
"Speaking."
"Mrs. Ward, this is Doctor Jones at the Medical Testing Laboratory. When your doctor sent your husband's biopsy to the lab yesterday, a biopsy from another Mr. Ward arrived as well, and we are now uncertain which one is your husband's. Frankly the results are either bad or terrible."
"What do you mean?" Mrs. Ward asks nervously.
"Well, one of the specimens tested positive for Alzheimer's and the other one tested positive for AIDS. We can't tell which is your husband's."
"Mrs. Ward, please."
"Speaking."
"Mrs. Ward, this is Doctor Jones at the Medical Testing Laboratory. When your doctor sent your husband's biopsy to the lab yesterday, a biopsy from another Mr. Ward arrived as well, and we are now uncertain which one is your husband's. Frankly the results are either bad or terrible."
"What do you mean?" Mrs. Ward asks nervously.
"Well, one of the specimens tested positive for Alzheimer's and the other one tested positive for AIDS. We can't tell which is your husband's."
"That's dreadful! Can't you do the test again?" questioned Mrs. Ward.
"Normally we could, but Medicare will only pay for these expensive tests one time."
"Well, what am I supposed to do now?"
"The people at Medicare recommend that you drop your husband off somewhere in the middle of town. If he finds his way home, don't sleep with him."
"Normally we could, but Medicare will only pay for these expensive tests one time."
"Well, what am I supposed to do now?"
"The people at Medicare recommend that you drop your husband off somewhere in the middle of town. If he finds his way home, don't sleep with him."
Lessons in Drug Seeking Behavior
I was orienting a new nurse over the weekend and she got to experience her first drug seeking patient. Well, the patient did have some documented back issues, but the pain regimen she was given inpatient enough to put down a horse. There is no way she was getting that much pain medicine at home, so the tolerance argument is invalid. 2 mg IV dilaudid Q4 plus 40mg Oxy SRQ12 plus 30 mg oxycodone prn Q4, plus 2 percocet Q4 prn is not a regimen she was getting at home. And it's HIGHLY unlikely that with all those narcs that a pain of 9 and 10 will be present in your head, then your back, then your leg. So I told my orientee all about the K.D. Lang lookalike incident http://codebabe.blogspot.com/2011/11/you-aint-foolin-anyone-k-d-lang.html and the orientee came back from giving the pt dilaudid and was telling me all about how she talked to the patient for a while and that she thinks her pain is really that bad etc. then we hear a beeping coming from the room. Screen on the IV pump says "Door Open" the IV tubing was wrapped around the pt's hand, around the pole.. it was obvious she was tampering with it. Why? I'm thinking first she tried squeezing the tubing to make the narcs go through faster, then she was trying to pull the tubing out from the IV pump so she can run the IV fluids quickly so she gets a rush from the dilaudid that way. I fixed all the tubing, and engaged the lockout feature on the pump. When I walked out with the orientee she said "I hope you know that was NOT how the tubing looked when I left that room 2 minutes ago.." I said, "Oh, I know it wasn't. I'm shocked she didn't pull something like this sooner." Orientee looked at me in wonder and said "You really know your shit." YES, YES I DO. lol
So, let's sum up what to remember about drug seeking patients:
1. They will always call for pain meds early. Don't give them early, not even 15 minutes-- over time if you consistently give a pain med early, eventually the patient will be getting more than the Dr. ordered in a given 24 hour period. This is especially dangerous with narcs.
2. Their pain level is always 7 or higher. Even 10 minutes after a dose.
3. They like to sleep a lot. When they are not sleeping, they are asking for more pain meds.
4. They are manipulative. They will change stories about where pain is located (documenting all they say is key and helps the Dr. piece together a true picture of what is going on) They also can be very complimentary of you and the hospital in general in an effort to make you "like" them and want to continue making them happy.
5. They think you are stupid.
6. They will sometimes ask you to push IV meds faster than you should. (2-3 minutes IVP is standard for narcs.. or any med, really. The only med I might push faster is zofran for nausea if someone is violently retching)
7. They will make strange requests. (like asking for 10 ml syringes full of normal saline. Those are to remain locked up at all times. Substances can be dissolved and injected through IVs with those; don't fall for it.)
8. If they do make a strange request, listen to your gut and just don't agree to doing it.Even if you can't give a good reason why not.
9. They will tamper with everything possible
10. They will risk their safety- and as a result, your license in the bat of an eye. WATCH THEM AND DOCUMENT EVERYTHING
There you have it. The drug seeker.
So, let's sum up what to remember about drug seeking patients:
1. They will always call for pain meds early. Don't give them early, not even 15 minutes-- over time if you consistently give a pain med early, eventually the patient will be getting more than the Dr. ordered in a given 24 hour period. This is especially dangerous with narcs.
2. Their pain level is always 7 or higher. Even 10 minutes after a dose.
3. They like to sleep a lot. When they are not sleeping, they are asking for more pain meds.
4. They are manipulative. They will change stories about where pain is located (documenting all they say is key and helps the Dr. piece together a true picture of what is going on) They also can be very complimentary of you and the hospital in general in an effort to make you "like" them and want to continue making them happy.
5. They think you are stupid.
6. They will sometimes ask you to push IV meds faster than you should. (2-3 minutes IVP is standard for narcs.. or any med, really. The only med I might push faster is zofran for nausea if someone is violently retching)
7. They will make strange requests. (like asking for 10 ml syringes full of normal saline. Those are to remain locked up at all times. Substances can be dissolved and injected through IVs with those; don't fall for it.)
8. If they do make a strange request, listen to your gut and just don't agree to doing it.Even if you can't give a good reason why not.
9. They will tamper with everything possible
10. They will risk their safety- and as a result, your license in the bat of an eye. WATCH THEM AND DOCUMENT EVERYTHING
There you have it. The drug seeker.
Sunday, February 5, 2012
Sing it, girlfriend
One emotionally draining thing about my new job is I see a lot more cancer patients. They really go through hell and it's so hard to watch it all unfold. I'm in awe of what they are capable of enduring and generally they come back with, "Well, you put up with it because you HAVE to.."
I had a wonderful woman over the weekend with stage 4 colon cancer. She doesn't have more than a year left I'd say.. maybe less. She is SO sweet, patient.. was having issues urinating because the cancer is obstructing her urine, so they placed a nephrostomy tube. She was worried because she wasn't sure how she was going to care for her nephrostomy tube at home. A consult was placed to case management. As it turns out, since she doesn't have any insurance, she doesn't qualify for visiting nurses to go to her house.
WTF, really? I am so tempted to go see her on my own time at her home, but I'm afraid I could get into trouble. Have to do some research into that.
Anyway.. people like the one in this video are why I an in awe of cancer patients.
http://front.moveon.org/the-most-heroic-response-to-the-susan-b-komen-foundation-you-will-ever-see/#.Ty1fcl7fOVo.facebook
I had a wonderful woman over the weekend with stage 4 colon cancer. She doesn't have more than a year left I'd say.. maybe less. She is SO sweet, patient.. was having issues urinating because the cancer is obstructing her urine, so they placed a nephrostomy tube. She was worried because she wasn't sure how she was going to care for her nephrostomy tube at home. A consult was placed to case management. As it turns out, since she doesn't have any insurance, she doesn't qualify for visiting nurses to go to her house.
WTF, really? I am so tempted to go see her on my own time at her home, but I'm afraid I could get into trouble. Have to do some research into that.
Anyway.. people like the one in this video are why I an in awe of cancer patients.
http://front.moveon.org/the-most-heroic-response-to-the-susan-b-komen-foundation-you-will-ever-see/#.Ty1fcl7fOVo.facebook
Friday, February 3, 2012
Another picture for my hard drive
The patient who I took down for a CT of the head on Sunday died on Tuesday. His stroke was the first presentation of posterior inferior cerebellar artery syndrome I had ever seen, but based on the severity of his symptoms and CT images, I knew he didn't have long. (The last CT images of a stroke I had seen that were this severe were on the pilot who died within a few days of his admission that I blogged about last year.) (For those of you that might not know, I save pictures from the obits of patients I knew who passed away on my hard drive. I know that sounds creepy, but it helps me deal better with their deaths and gives me closure and helps me remember them more as they were in life and not only as a "patient". Yes, I realize if the FBI ever saw those pics on my computer, it would look mighty odd. lol That said, the FBI would never have any reason to look on my computer since I haven't done anything remotely illegal, so no harm, no foul.)
He was a DNR/DNI and expressed he did not heroic measures made to save him prior to the stroke, so thank God he made those wishes known before he died. According to his family, his wife has severe Alzheimer's and looks for him every day and wants to visit him, but aside from that is very VERY confused. I wonder in a case like that, do they take the spouse to the funeral? Would she even know what is going on?
In other news, I'm thinking about getting a pair of Danskos for work. They are like 130.00 a pair, but the crocs I wear seem to be causing my pinky toe to become deformed because I tend to walk on the outer edge of my foot. (wow, can this entry get any more interesting?) My hesitation is that I can't just throw Danskos into the wash and I'm not convinced wiping them down with hospital equipment wipes is going to be very good for them. So anyway, these are what I have it narrowed down to. Uniforms are Navy Blue. I guess the burgundy is a little less IN YO FACE but:
He was a DNR/DNI and expressed he did not heroic measures made to save him prior to the stroke, so thank God he made those wishes known before he died. According to his family, his wife has severe Alzheimer's and looks for him every day and wants to visit him, but aside from that is very VERY confused. I wonder in a case like that, do they take the spouse to the funeral? Would she even know what is going on?
In other news, I'm thinking about getting a pair of Danskos for work. They are like 130.00 a pair, but the crocs I wear seem to be causing my pinky toe to become deformed because I tend to walk on the outer edge of my foot. (wow, can this entry get any more interesting?) My hesitation is that I can't just throw Danskos into the wash and I'm not convinced wiping them down with hospital equipment wipes is going to be very good for them. So anyway, these are what I have it narrowed down to. Uniforms are Navy Blue. I guess the burgundy is a little less IN YO FACE but:
 |
| I really like these cobalt prism ones |
 |
| These purple ones are pretty cool, too. Think I would have to see them in person though. |
 | ||||||
| These are pretty and a little more conservative and I think they would bring a nice contrast to the navy blue. Any input is appreciated. I keep waffling on which color I want. |
Wednesday, February 1, 2012
Week 2 at my new hospital.. and they put me.... drumroll please.. in CHARGE. :/
I'm not entirely sure what my manager's rationale is to hiring a bunch of new grads and RNs who have only ever worked as school nurses or never in a hospital at all. Well, I kind of understand because sometimes people with a lot of experience in a given field also have a lot of bad habits that go along with their experience, so I get why a manager would want to groom their staff to have the specific tasks performed in the way they prefer. But DAYUM a little bit of experience would be nice. :/
So anyway, as a result of my being the most experienced nurse on the floor (never mind the fact that I have no clue where to find half the supplies I need lol), I not only had a 5 patient assignment, I got to also be in charge. (ideally charge nurses should not have an assignment) And hang a unit of blood, and all by myself take a patient with an evolving stroke to the first floor to have a CT of the head done because the hospital does not have a transport dept yet. Deal with family drama (oh how I love when I have a patient with two RN granddaughters who complain about everyfucking thing). Seriously, if you are going to be there for your family member, that's great! But that doesn't mean you have to be a dick to me!
At least the doc that was there was one of the cooler ones. He saw me wandering around the hall with a handful of blood tubing from the PRBCs I just hung (I couldn't find the biohazard bin to throw it away in) and while he stopped me in the hall to ask me something my phone rang, part of the tubing fell, a bag of saline swinging from my hands I said "Well.. THAT would have sucked.." He was like "um.. do you need some help there..?" but I could tell he didn't want to touch the tubing because it was full of blood and he didn't have gloves on, then I dropped the phone.. lol I looked up and him and I said, "Really, I'm not usually *this* bad.. it's my second day and they put me in charge. I'm just happy I haven't fallen down a stairwell or rolled a patient out of bed and onto the floor."(he laughed) ...a little while later I came to find out the Dr. I said that to is the Chief of Staff for the whole hospital. How much you want to bet years down the road, that conversation will stick out in his head when I am up for a promotion and someone asks him what he thinks of me. Just Great. lol
So anyway, as a result of my being the most experienced nurse on the floor (never mind the fact that I have no clue where to find half the supplies I need lol), I not only had a 5 patient assignment, I got to also be in charge. (ideally charge nurses should not have an assignment) And hang a unit of blood, and all by myself take a patient with an evolving stroke to the first floor to have a CT of the head done because the hospital does not have a transport dept yet. Deal with family drama (oh how I love when I have a patient with two RN granddaughters who complain about everyfucking thing). Seriously, if you are going to be there for your family member, that's great! But that doesn't mean you have to be a dick to me!
At least the doc that was there was one of the cooler ones. He saw me wandering around the hall with a handful of blood tubing from the PRBCs I just hung (I couldn't find the biohazard bin to throw it away in) and while he stopped me in the hall to ask me something my phone rang, part of the tubing fell, a bag of saline swinging from my hands I said "Well.. THAT would have sucked.." He was like "um.. do you need some help there..?" but I could tell he didn't want to touch the tubing because it was full of blood and he didn't have gloves on, then I dropped the phone.. lol I looked up and him and I said, "Really, I'm not usually *this* bad.. it's my second day and they put me in charge. I'm just happy I haven't fallen down a stairwell or rolled a patient out of bed and onto the floor."(he laughed) ...a little while later I came to find out the Dr. I said that to is the Chief of Staff for the whole hospital. How much you want to bet years down the road, that conversation will stick out in his head when I am up for a promotion and someone asks him what he thinks of me. Just Great. lol
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