Journal of Nursing Jocularity

Nurse Marge might not have all the answers, but after *ahem* years as a RN in some of the nation’s toughest hospitals, she sure knows how to make up something that sounds right! We get lots of questions here at JNJ, from nurses looking for advice and guidance and Nurse Marge has graciously agreed to answer them for us.

So with that, let’s turn the floor over to Nurse Marge!

Dear Nurse Marge,

I’m a new nurse, having just graduated in December and finally landed a job. The problem is this: I’m young (23) and I look even younger than that. I mean, I get proofed to buy lottery tickets! This is turning out to be a problem: no one at the hospital is taking me seriously. Not the doctors, not the other nurses, and not even the patients! Last week, I had one of them ask me to ‘go get a grown up to take care of my Mother’!

Yours, Too Young in Three Rivers

Dear Too Young,

This is a problem? That I should have such problems! I’ve got uniforms older than you…

Seriously, the nice thing about this issue is that it’s self-resolving. You may look young now, but trust me: two years on this job, and you’re going to find yourself being offered senior citizen discounts when you go out to eat.

My advice? Take them. 10% off all these meals adds up!

If you don’t want to wait for the stress induced gray hair to mask your lack of years, here’s some tactics you can take to make your fellow nurses and the occassional doctor take you more seriously. I can’t promise this will work on every doctor, I’m a nurse, not a miracle worker!

First, it’s all about the attitude. If you want to be taken seriously, you have to act seriously. Confidence matters — a lot! Bear in mind that some of your fellow nurses were once in the same boat you are in now: we were all new nurses once. Of course, for some folks, that might mean they’ll have to stretch their mind back to the dark ages to remember that fact — but it’s true, never the less!

Second, the trick to a long career as nurse is to never miss an opportunity. When you’ve got a patient requesting a ‘grown up nurse’ — go find them one. Trust me, that’s not a patient you’re going to enjoy dealing with. Why not make them happy and hook them up with someone of more advanced years than you? Of course, if that nurse you find happens to be the one who gives you the roughest time about being the new kid on the block, well, some lessons just keep on giving, don’t they?

Simply smile, tell them the patient wants a grown up, and ‘You’re the most grown up person on the floor!” I’m sure they’ll be thrilled.

Good Luck!

Nurse Marge

Have a question for Nurse Marge? Simply email it to her at Cindy@journalofnursingjocularity.com and our fearless editor will pass it along to her! Chances are good she’ll answer it in an upcoming column. Nurse Marge in Charge updates every Monday.

Also: Our lawyers insist that Nurse Marge’s advice and opinions are only that — advice and opinions. Use them at your own risk!

• Plz RT Ck out these hysterical ladies performing for Benefit for CA One Care. Amazing lineup, great cause! http://ow.ly/2bzgx #

Dear Nurse Marge,

The parking at our hospital is terrible. There’s not enough spaces for all of the staff, never mind patients’ families and visitors. It’s been this way for the entire five years I’ve been here, and from all these memos I’m reading about cutting costs and conserving supplies, it’s going to be that way for the foreseeable future. It’s not going to change.

Don’t Blame Me! I Bike!

Dear Don’t Blame Me!

Your instincts are right on, and I want to congratulate you on attaining one of the most important Nursing Skills: The ability to choke off the automatic response that any normal, sane person would give to an inane question.

You might want to try using some of your other nursing skills to address this question. Restating is particularly helpful. Try saying, “I hear you saying that you had a difficult time parking today.” Follow this up with other helpful observations, such as, “The sun appears to have risen in the East this morning!” and “Would you look at this? This glass of water is full of wet stuff!” can provide valuable reinforcement of the basic concept, and help with both comprehension and retention. It’s important that we provide this type of patient education — and people are so very grateful for the insight!

Empathy and limited self disclosure can help. State that you commiserate – and up the ante by sharing how far away you have to park, regularly, in order to make it to care for their relatives and friends. “Sixteen blocks! And there are no trains — not even a cab! You have to run the whole way! Uphill! And bears chase you! I’m not sure if they’re rabid, or if that white foam is just residue from too many Danskins chewed to bits!” It won’t make your visitor feel any better, but it will keep them entertained, and as we know, entertained visitors are visitors who put positive comments on those helpful survey cards that litter the place like so many self-referential doilies.

Learn from the MD’s: When they don’t know, they call in a consult! When that visitor stops you, immediately call in the head of buildings and grounds and perhaps the director of development. Together, you could address that pressing concern — or at least convince the powers that be that some signs addressing the parking situation should be hung sooner rather than later!

Good Luck!

Nurse Marge

Horoscopes just for Nurses!

Cancer

Shouldn’t there be a RR for nurses? Somewhere lovely, after the shift’s done, where cell phones don’t work, and people who enter asking you anything besides “Is that enough chocolate or would you like more?” spontaneously combust?  Cancer’s inquisitive nature and a busy week has you searching for this wonderful place — let us know if you find it!

Leo

Knowing that all bleeding stops…eventually…and that ignoring a problem can, in fact, make it go away rather permanently is part of being a nurse.  It doesn’t however apply to interpersonal relationships with colleagues, friends, and random people you know! Speak up and take care of yourself NOW!

Virgo

When the obnoxious caller rings for the third time in two hours demanding to know how Mom is doing, tell them — substituting information about your own Mother.  This is a great solution, unless, of course, your Mother has passed away.  Use your judgment, people!

Libra

The good news, Libra, is that management has your back.  The bad news is that they’re considering it as the next sharps storage unit! Document, document, document.

Scorpio

It’s well known that a very fine line separates “Hobby” from “Mental Illness” — but this week, you’re not worried about that line — you’re dazzled by what your patients do for recreation!

Sagittarius

Did you hear about the butcher down in the ER? Backed right up into the meat grinder. Not only is he in really rough shape, but he’s behind at work!

Capricorn

Capricorn fears when security is called to pediatrics. Nerves settle down when it is revealed all the trouble was simply a three year old resisting a rest.

Aquarius

What happens to GI specialists when they die? Generally, we barium. May the winds of change be a source of delight to you this week, Aquarius!

Pisces

The simplest explanation is often the best one, which is good to keep in mind when taking patient histories! It’s amazing how often and awkwardly people will fall, particularly in states of undress…

Aries

What side of a duck has the most feathers? The outside! Aries, don’t get caught up in details to such a degree that you miss the big picture!

Taurus

If a patient’s refused medication, do the pills go to whoever calls dibs on them first? This can be an interesting discussion — particularly if the right ‘concerned visitors’ are around!

Gemini

Patients convinced of your superior nursing skills want you to diagnose what’s wrong with them based on the stool sample they conveniently brought from home, in the underpants they happened to be wearing. Tell them you only read tea leaves and tarot cards – anything else requires the MD’s personal attention!

Star Charts by Suzanne LaBarne are for Entertainment Purposes ONLY!

Last week I was on my way to Kona, Hawaii to give a keynote speech to over one thousand people. I called home during my connection in Los Angeles and my wife told me my father passed away.

I made a decision to continue on to Kona. My plan was to give my speech the next day and then fly back home in time for the wake and funeral services.

The following morning I was at the hotel restaurant having breakfast. My thoughts were on my father and all the wonderful memories we shared. I felt a wave of emotions building up. The one thing I didn’t want to do, was to loose it at a restaurant. But it was too late, my emotions got the best of me and the tears began to fall.

Just then I felt a hand on my shoulder. It was my waitress. “Mr. Rizzo, she said, is everything alright?”

Without missing a beat, I turned around in my seat, looked her straight in the face and said, “No it’s not. This is the worst omelet I’ve ever had!” (more…)

No doubt the suspense has been killing you.

When we last got together on this page, I was guiding the hospital’s barely-legal-to-drive valet manager through the post-accident process. A valet backed another patient’s high profile pickup into my low profile convertible, crushing the front corner of my car.

Ouch.

This repair would require more than bandages and stitches.

After accident paperwork was completed and my pre-op appointment ended, I headed back to my car. I had plenty to think about for the hour-long drive home from Denver.

My doc and I were still in the planning stages for what this knee revision surgery would exactly entail (I say ‘we’ like I had ideas to contribute… Not!). My cutting edge (oooh, bad pun ahead) orthopedic surgeon wasn’t happy with the options. There was no optimal answer. But that’s another story for another time.

Take my word for it – my mind was whirling from the appointment. So much so, I’d temporarily forgotten about the car incident until heading for my car. “Ugh.” That plus a few other words escaped my lips – feel free to use your imagination. If you can think it, it spewed.

Thoughts swirled all the way home. Once there, I managed to remember to call my local x-ray department. Ah yes, the rules and regs of insurance. My surgeon was out of network but approved. That doesn’t mean insurance would pay for all x-rays taken at his office. That would be way too convenient and efficient for everyone. I needed to get more x-rays taken an hour south where I lived in Colorado Springs. That office would then need to have a currier drive the film x-rays to my surgeon in Denver. Aiy yi yi.

The day of the x-ray appointment was one of our worst blizzards of the year. I didn’t want to delay the pre-surgery process by cancelling. Plus, I’d scheduled my car to be repaired at the body shop that morning. I’d also reserved a rental car for the day. The rental car place and body shop were at the opposite corners of town from my house. X-rays were across town from there. As any good (ex) Minnesotan says, “Uff da.”

As I found out quickly, my rental car didn’t handle the snow and ice quite as expertly as did my Saab convertible. Those Swedes know how to make a winter- ready car.

Slowly making my way across town, I barely made it to my x-ray appointment on time. After adding to my already overly radiated body, I gingerly trekked out to my rental car, nicely buried in snow and ice. Fortunately, I’d thought to grab my extendomatic ice scraper from my own car and brought it with me. All would be ok.

Or so I thought until I got closer to my rental car. What’s with the bright orange neon dayglow sticker attached to the driver’s side window?

Come back next week for the real final conclusion of the car vs medical appointments saga.

Chief Inspiration Officer Kris Harty is the Stickability Specialist. Kris helps healthcare teams persevere through Compassion Fatigue. By sharing tools (Stickabilities) that she learned from her own medically challenged life, Kris encourages healthcare professionals to Stick to it – no matter what! Kris’ constant companion – her walking Stick – is the inspiration for her message. Diagnosed at age seven with Juvenile Rheumatoid Arthritis, she draws on 40 years of stories as a healthcare recipient. She is the patient who now returns to say “You make a difference. Thank you.” Her sometimes funny message is always content-rich, practical, engaging and inspiring. Kris’ company, Strong Spirit Unlimited, reduces burnout, turnover, and Compassion Fatigue by re-engaging healthcare leaders and professionals, especially nurses. Kris Harty is an inspirational keynote speaker, author and small group facilitator who helps people overcome challenges by creating unstoppable momentum in life and work. Clients say her message is life changing. Call 877.711.STICK, e-mail StrongSpirit@StrongSpiritUnlimited.com, or visit www.StrongSpiritUnlimited.com.

Whenever I give a lecture or a workshop, I never fail to encourage participants to read “Man’s Search for Meaning” by Victor Frankl. He was a psychiatrist who survived the Nazi concentration camps during World War II and who developed a form of psychotherapy called Logotherapy as a result. His book profoundly shows how individuals can survive the most horrific of situations through grace, dignity and even humor.

In the preface of the book, Gordon Allport writes: “Hunger, humiliation, fear, and deep anger at injustice are rendered tolerable by closely guarded images of beloved persons, by religion, by a grim sense of humor, and even by glimpses of the healing beauties of nature—a tree or a sunset.”

I’ve heard many accounts of how this type of humor, called “ gallows humor”, has helped many people in difficult jobs, particularly health-care professionals. Anyone overhearing some of the conversations between nurses or doctors might be deeply offended, but for them it becomes a way to get relief from the horrors they witness.

As a child, I was dragged to many an Italian funeral, which often resembled a Federico Fellini movie. There was great drama as the black-clad women wailed and moaned. Then there’d be bursts of laughter as people began to recount stories about the dearly departed. And, of course it would all end with a giant buffet.

It was then that I realized that love, laughter, and lasagna made life worthwhile. I often hear individuals talk about how little they laugh because of how complicated their lives have become.

It seems that as a culture we have forgotten that we are not simply here to get through the day as if it were a forced march. When humor is absent from our lives for an extended period of time it can lead to depression, anxiety, anger and irritability.

When we lose the ability to laugh at ourselves, we become less kind and tolerant of others behavior. Give your laughter muscles a good workout everyday so that when you really need them their buffed and ready to go.

Frankl said “that humor was the soul’s preservation”. Keep that in mind the next time you’re making a mountain out of a mole hill.

Loretta LaRoche writes the Get a Life column for the Patriot Ledger.

10. Puts on the gas mask and pretends he’s Darth Vader.

9. Asks you to count backwards from 10 and then yells out “Houston we have a problem!”

8. Thinks that drinking moonshine and biting down on a bullet is a viable form of pain management.

7. Has Pink Floyd’s “Comfortably Numb” on repeat.

6. Offers to let you borrow his siesta mask.

5. Takes a deep breath off the gas mask and says “That’s about right.”

4. If the patient should wake up during surgery, instructs them to hit the “Snooze Button”

3. While waiting for the surgeon to arrive challenges you to a quick game of Guitar Hero.

2. Keeps referring to the fluid in your IV as Booka Juice!

1. Has never heard of Picis Anesthesia Manager.

Contributed by Joe Bailey, Picis

FDGB

Fall Down Go Boom, a patient who has unsuccessfully attempted to break the law of gravity. Usage “EMS is inbound with a FDGB.”

Siamese Friendship Bracelets

Handcuffs.

Level 1 Drama

A hysterical or hyperventilating patient and/or family.

SPTWD

Pronounced “spitwad.” Refers to a Self Propelled Toxic Waste Dump, interchangeable with Self Perpetuating Toxic Waste Dump. A chronic substance abuser.

Crypod

A screaming child.

S*** Magnet

A doctor who attracts lots of patients.

The “Q” word

“Quiet,” a word that, if used in the ER, is proven to bring the wrath of obscure Gods who will rapidly rain down upon the ER prodigious numbers of very ill patients.

Meal break

5 to 10 minutes to go to the bathroom, obtain and consume a meal, enjoy a cup of coffee, and rest, before you’re paged overhead to come take orders from a doctor by phone.

Coffee break

Not applicable.

Pyxis

The drug equivalent of an ATM. Built in stress sensors will cause it to fail or require you to change your password during a cardiac arrest or major trauma. Proven can opener proof by the author.

Cell Phone

Senses the healthcare providers presence and emits loud obnoxious sounds. A device designed to distract patients from attempts to treat them.

The tattoo paradox.

The more tattoos a male patient has, the more likely he is to fear needles. Does not work with females.

Triage

The process of prioritizing care so that loud complaining patients are sent to the waiting room while the patients who are quietly sitting there dying are brought directly to a room for lifesaving care.

Bedpan or urinal

Torture device to force patients to overcome a lifetime habit of not urinating or having a bowel movement while in bed.

Shift

The amount of time you are given to do 2 times the humanly possible amount of work. In theory, contains beginning and ending times which in reality are either from another time zone or dimension.

Writeup

Whimsical documentation of your inability to do the impossible. The more absurdly inaccurate it is, the more likely you will be asked to explain the occurrence in 3 sentences or less.

Complaint Scale

None = very ill

Pain = ill

Uncomfortable bed = a little sick

Poor cell-phone reception = ready for discharge.

Found with my own eyes in recent chart. Not the kind you get in an email and wonder if it’s made up.

Chart of a 50-60′ish patient with hx drug abuse brought to ER in cardiac arrest. (No I don’t think Cardiac Arrest is funny. Stay tuned.)

Pt last seen well 24 hrs ago. ‘Found unresponsive by mom in morning, no med attention sought until evening when pt’s sis couldn’t awaken him.’

And my boss and I were kinda laughing as we were picturing the scene…. some 70′ish mom calling out “Hey John, you up? Nah? Sleepin’ in again?” and I guess she notices, hmmm, he’s not sleeping, he’s ‘unresponsive‘ (to quote the chart).

I’d think she’d have said something like ‘Gosh I thought he was sleeping!’, to at least give herself some dignity, heart, whatever. We see that a lot, unfortunately. But no, it says FOUND UNRESPONSIVE. Which means she found him unconscious.

But I guess, tra la la, she goes off to work or to Bingo or whatever ………thinking what??? Maybe he’ll ‘respond’ later? Maybe when his sister Mary comes home from work he’ll ‘respond’? Maybe just let Mary deal with the body or what?

My job in Quality Assurance is of course, to always to look for anything we missed, could we have done better/ faster etc, what we can learn and/or fix from these records.

So what we learned from this one is:

Be nice to your mom or she’ll get you back when you really need her!

Contributed by Bina Simon, RN. Spot a great chart chuckle? Send them to