Why I am Quiting Today…

pixis wtf

Can you tell me what is wrong in this picture?

It might involved the cleaning lady climbing up on a ladder to remove empty medication boxes that had been tossed up on top of the automated medication dispenser.

It might involve this not being an isolated incidence, and one that is not occurring in any other unit.

Which means, it is not the pharmacy staff delivering the medication who are doing this, but rather, the nursing staff retrieving medication from the machine.

So just to be clear, nursing staff, removing medication from the medication dispensing system, throw the empty boxes up on top of the tower rather than throwing them into either the garbage, or recycling. Which are two steps to the right. And this person or persons, does this regularly.

So, what other mean, random acts of maliciousness do you perform each shift RN? If your brain see this as acceptable, what else?

I fear for our patients. Please, if I ever need critical care, don’t let them admit me to this unit

Why I am quiting, today

ICU is a terrifying place for families. They are dealing with handing over their loved one to strangers who speak a terrifying language. The families understand an occasional word of this new frightening language and yet are expected to act like it is all understandable. The rules if the ICU are strange and much like having your loved one in a prison, only at least in a prison they tell you exactly what you can and cannot do in clear words.

The gate keeper of the ICU is the Unit Clerk. This crucial role, the first face and contact is given to those least able to provide a welcoming presence. Frightened people don’t often see signs and instructions of more than a word or two – Stop. Go. – are often unprocessed depending upon the level of fear and anxiety. Yet the first person they meet when they enter this ICU is the GateKeeper. A frighteningly cruel witch who interrogates them and points out exactly what they did wrong and how they have already fail the admission test. None Shall Pass who cannot provide the correct answers.

gothic-gate-keeper-jpg-free-dark-art-and-202574This morning, a young man entered the unit. Looking around anxiously and confused he stood unsure in the hallway. From behind the desk the GateKeeper barked at him – ‘Excuse Me -Where are you Going?’

The frightened young man explained he was her to see his mother and the GateKeeper informed him

‘This is ICU. You have to call in first!’

She didn’t get up from her post behind the desk. She didn’t greet him and introduce herself and ask if she could help him. She just barked orders at him. Unfortunately this behaviour is not isolated to one individual. It is the SOP. The Standard Operating Procedure – the Way Things Are Done here that then guides anyone else who is put in that role. And so not a single person who is placed with the singular job role of greeting the families, performs as a Greeter. I have in fact observed some individuals in the role actually tell families they have to go back outside the doors and call in. Despite the observable fact they are standing right in front of the desk asking for directions. These gatekeepers are the reason today I will quit. This behaviour has been identified as hurtful. It has been recommended to be changed, and yet, it continues to be the strategy for entrance into the ICU.

I recommend we hire Walmart Greeters. At least they smile and say Hi. And they would likely cost less.

Does it make sense to use car safety seats only sometimes, or only when children are older?

Rebogging. It’s not the same as doing it yourself, but still….

The Pediatric Insider

The Pediatric Insider

© 2013 Roy Benaroch, MD

Trusted Pediatrician: “Mrs. Johnson, Bobby is doing great! He’s growing fine, and doing all of the things a six month old baby ought to do. What questions do you have for me?”

Mrs. Johnson: “Well, now that he’s six months old, and I’m wondering if now is the time to start using his car seat.”

Trusted Pediatrician: “Now? You should have been using a car seat all along, every time. We’ve talked about that, it’s on our handouts, it’s on the sheet from the hospital, it’s recommended by every health authority in the entire world.”

Mrs. Johnson: “Oh I know that. But I did my research on Google. So I know young babies aren’t yet developed enough to use a car seat. That’s why I waited.”

Trusted Pediatrician: “Car seats are specifically designed and tested in little babies. They really need to…

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So this is what nursing looks like in 2013

nursing

I shake my head so much at work I am going to file for workplace injury.

This week alone I heard of a nurse who indicated an interest in a specific leadership assignment in the unit, but was not considered and now she is all up in arms and filing a grievance. Know why she wasn’t considered a suitable individual? Because she can’t work a full shift. She is ‘medically accommodated’ to work 10 hour shifts on any Monday and Wednesday she works. Why? Because she is going to ‘therapy’ at 17:00. Not physio for an injury that is going to improve, but psychiatric therapy for a break that is never going to heal. So this means ever week at those times, her patient assignment is handed over to another nurse so she can leave and go to therapy. Why can’t she book these appointments on her scheduled days off or trade shifts so she can actually do a full day’s work on the days she is scheduled? Seriously, I asked the same questions.

Or consider the veteran nurse who was administering a patient’s oxycodiene. She went to the automated dispensing cabinet and removed 5 tablets for the dose. The ordered dose was 5 mg. The tablets come in 10 mg. It says when you go to remove the medication what the ordered dose is for that patient. Then she took the medication to the patient who refused it – she had been refusing the medication for several days. So fortunately the patient didn’t actually receive the fatal overdose. But the next step will astound and horrify you. The nurse left the medication at the patient’s bedside where it was found a couple days later, in the bedside drawer by another nurse. Whiskey. Tango. Foxtrot.

It starts early. Nursing students who expect ‘medical accommodation’ in their practicum rotations because they are immunosupressed. Oh and they wont be getting any vaccinations either.

In an attempt to train or even shame nurses into providing basic nursing care the educators on one service have put up a sign over each patient’s bed that says ‘Have YOU brushed my teeth today?’ Some staff love it, but there are about 50% who are offended. There seems to always be 50% offended. Grievance? Sure. I am offended. Next week it is going to be ‘Please clean your hands” right there, right over the bed. Going to ruffle some feathers I suspect.

The stories go on and on and I continue to wonder at any impact I might be making. It isn’t just nurses making idiotic decisions. Found out this week that using a bladder scanner is a nursing activity denied to LPNs. Why? Does anyone know why? They can use a doppler. They can give IV push medications, but they cannot use a bladder scanner? How does this make any kind of sense?

Perhaps that is the answer. Ultimately the world has gone restriction mad and the only possible response is to abdicate all rational thought and action in the face of so much silliness. Are the idiotic behaviours we see in the workplace simply a response to the overwhelming stupidity of the licensing and regulating bodies that tells us what we can and cannot do?

As good an answer as any.