Nurse Marge in Charge

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 RN who works in a small medical office setting. Many of our patients are quite elderly and not in the best health. I’m really blessed to work with a fabulous doctor and my fellow nurses are great — the best I’ve ever worked with!

The problem is one of the ladies who work in the office. She is always — and I mean always — sick. One week, she’s sneezing her head off, the next, she’s out there hacking up a lung! It’s disgusting. She never misses a day of work, though, no matter how sick she is. She’s right there, checking files, answering phones, checking in patients.

This is driving me crazy! I can’t even begin to imagine how many of our patients this woman has made sick. When I said to her that perhaps she should stay home if she was so ill, she shrugged and said she couldn’t afford it. When I asked about the patient’s health, she snapped, “Who do you think brings the germs in here in the first place?”

I talked to my manager about it, and she said that they were aware of the situation and that there was nothing they could do!

My question for you is this: Is there a way to make Typhoid Mary take time off when she’s sick or do I just have to learn to live with it?

Signed,

The Georgia Germaphobe

Dear Georgia Germaphobe,

You know every office has one: a Typhoid Mary, Virus Valerie, Dysentery Dawn, Bacterial-Infection Betty-Anne — the perpetually ill colleague who just won’t call in. These folks will come to work even while they’re actively coding. You’ll be there, doing CPR for all you’re worth, and they’re on the phone, telling a patient the earliest available appointment is six months away — and that’s only if they can come on Thursday evening, if it’s raining!

While you have to admire the dedication, the truth is that working with these folks can be taxing. That’s why we ask the obvious but wrong question: How can we make them stay home? instead of How can we make them better?

Answering that question allows you to make a positive change. Think about it for a minute. Here you are: an office full of highly trained medical professionals, with years and years of training and experience focused on helping people achieve optimum health. You mean to tell me that working together, you can’t conquer your colleague’s chronic crud?

I don’t believe it. I choose to look instead to management, who have a surefire way to address any impossibility: you must form a committee — maybe even a task force!

The mission of this task force is to totally transform Typhoid Mary’s health.

One member is in charge of nutrition. They must diligently monitor everything Typhoid Mary eats, redirecting her choices as appropriate to options that are nutrient dense and high in Vitamin C. Simply saying “Wouldn’t you rather have an orange?” everytime Typhoid Mary picks up a candy bar can produce quite an effect!

Another task force member keeps track of Typhoid Mary’s physical activity. Regular inquiries about exercise routines is recommended. You can also coordinate with the office manager here: changing up job duties and routines can require lots of extra effort and wasted motion — and we know that burns calories and gets the old circulation system going!

You’ve got a doctor right there! Put him on the task force, and have him check Typhoid Mary’s condition daily. An ounce of prevention is worth a pound of cure — throw Doc on the scale and act accordingly!

Get your most sympathetic and understanding task force member (I’m guessing this wouldn’t be you.) to be in charge of mental health. This person should monitor Typhoid Mary’s moods, listen deeply to her concerns, and provide a supportive therapeutic environment in which Typhoid Mary can exercise a range of healthy decision making strategies.

Each task force member should meet with Typhoid Mary daily, if not hourly!

I don’t know about Typhoid Mary, but after about a week of this treatment, I know I’d be staying home for sure!

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!

Nurse Marge in Charge

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,

They say it happens to everyone, but it’s never happened to me.  Puking at work, that is. I have to admit that I’ve gotten kind of proud of that: if you’re an ER nurse, an iron stomach is a GOOD thing!

You know that we all kind of keep track of this.  (Hey ER nurses are different!) My best bud in the world lost it one time when we had a patient who could have been the Exorcist — projectile puke EVERYWHERE, and there was Irene adding her lunch to the mix. Doc G., the best attending you could ever hope for, once power puked after dealing with a nasty GI bleed.  There are dozens of stories – c-diff and feeding tubes and foleys and you know that someone’s going to vomit.

Except me.

Until now.  It’s not like we’ve never had dirty patients before — some of our folks haven’t been bathing regular for a long time, if you get my drift.  But this particular patient was filthy: skin caked black with grease and dirt. And he smelled.  And he had a beautiful three-corner laceration, the skin flipped back just enough — and as soon as I saw it, it was my turn to run for the bathroom.

You can imagine how much fun my colleagues have had with this.  I’m completely mortified — I was *sure* nothing would make me hurl.  How can I prevent this from happening again?

Signed,

Suddenly Squeamish

Dear Suddenly Squeamish,

There’s really two different questions here.  One is how do you keep from puking when something grosses you out, and the second is how you deal with having your Claim to Fame disappear in a big, retching hurry.

The first part is easy — for me at least, because all I have to say is “Heck if I know!”  Every nurse has their ‘thing’ that sends them over the edge: for some, it’s maggots, others, c-diff, others, visitors who eat off the patient’s meal tray. For me, it’s JCAHO inspectors.  Let me tell you what a treat that is!

Once you know what your trigger thing is, you can avoid it as much as possible — that’s been my route to JCAHO and let me tell you that’s worked out well for everyone, in the long term — or you can try to develop a tolerance for it.  You can become immune to anything, given enough exposure.  I’m not sure if that’s a good thing or a bad thing!

Now let’s address the pride goes before a fall aspect of this.  She who brags about her iron stomach laughs last over a chunky bedpan, you know what I’m saying? This can teach you to be more compassionate to your fellow nurses, and extend sympathy and understanding to those student nurses who lose their lunch and what little confidence they brought with them that day.

I mean, I understand that people do do that sort of thing.  I don’t, but it’s been done.

What you’ve also got here is your own “War story”.  If you can’t embrace compassion, education, and empathy, you can at least be entertaining.  Practice telling the tale of how you lost it and eventually, you’ll have a treasure: a tale so disgusting, so vivid, so compelling that you can clear a lunch room full of nurses simply using words.

And that, my friend, is power.

Use it wisely.

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!

Nurse Marge in Charge

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’ve just finished orientation at my new job, and it turns out they left out one critical bit of information.  You can’t put anything down in this facility — your pen, your lunch, even your stethoscope — or it will come up missing!  If I hadn’t of walked by the nurse’s station at exactly the right moment, one of the residents was going to walk off with my stethoscope — and when I confronted him about it, he said, “Oh, it looks just like mine!”

When I asked him if HIS stethoscope had MY name written all over it, he just glared at me and stomped away.  I realize that medical school costs a lot of money, but if I had to shell out $250 for mine, can’t I expect him to pay for his? What is wrong with people?

Signed,

Shocked by Sticky Fingers

Dear Shocked,

Let me be the first to congratulate you on achieving Nursing’s First Realization: Orientation doesn’t tell you anything about what the job is really like.  Of course, even the best orientations won’t include the fact that many of your colleagues, whether they’re nurses, doctors, or doctors-in-training, are beset with Swipeitits – a common yet seldom discussed condition that manifests in lost lunches, stethoscopes, and more.

There has been a great deal of ‘research’ into the causes of Swipeitis, but what’s really interesting are the ways you can combat it.  Sometimes it’s necessary to forgo fashion for the sake of security: Pepto Bismol pink stethoscopes get stolen far less often than the traditional black ones. Canary yellow works well too, and don’t overlook acid green’s appeal — or lack thereof.

Get creative in your storage strategy. Think through where you leave things like lunches and bags — forgo supposedly safe locations like employee lockers and the breakroom, opting instead for innovative, little used spaces, such as the storage area for small gloves. That’s got to be perpetually empty, as most facilities haven’t had an adequate supply of gloves since 1931.  Of course, this will mean having to leave the floor to run to your secret storage spot every time you need your stethoscope. In some lights, this could be seen as a drawback…but only in some lights.

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!

Nurse Marge in Charge

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’ve just come from a meeting where our latest PG scores were the main topic– you can imagine how much fun that was! We learned our rooms were too cold — except when they were too hot. It was impossible to watch the big game on the TV (local area blackout). No one provided snacks for visitors and family members — even when the nurses were asked for such things! If you can imagine the horror, someone kept checking on the patients — taking vitals, giving meds, checking pumps. Management is in a tizzy and we’ve all been asked to come up with our plan to address these ‘customer service issues’.

What should be in that plan? So many of these things are completely beyond our control! And they’re complaining about us doing our jobs — how do you answer that?

Signed,

Confused

Dear Confused,

You need an anagram. Anagrams are management’s Ativan — you hit them with a good dose, and they suddenly forget that they have any problems at all. After all, an anagram can be used to create a public relations campaign: they can make posters and announcements and even television commercials about how much they CARE, and that affects public perception, and that’s what the PG is all about, really.

Of course, to be accurate, a promise to CARE would mean:

C: Cater to a patient’s every need, no matter how insane or excessive. You need your Pomeranian pampered, your hair done by a Hollywood stylist, and the room decorated to suit your personal design aesthetic? No problem!

A: Allow you to enjoy every single aspect of your life without any regard to any silly, namby-pamby health concerns. You’re scheduled for a quadruple bypass three days before your 23rd birthday? Why shouldn’t you have that takeout your buddy brought you from the Heart Attack Cafe? It’ll be funny, ironic and hipster! The surgeon was just kidding about you being NPO before the procedure anyway.

R: Respect the extensive medical expertise you and your family brings to the hospital. After all, you’ve done such a good job keeping yourself healthy and moving so far! Why should we bother you with all these pesky tests and labs and procedures? If your Great Grandfather had flea bitus just like this and they cured it with mustard paste, vinegar and a compress of busted beer bottles and iron filings mixed in bear grease, well, that’s good enough for us!

E: Expertly diagnose your medical issue, no matter how rare, obscure, or complicated it may be, by asking you three or four bizarre, deeply personal questions and screaming at your family members. That’s how it works on television, that’s how it’s going to work here. All health concerns will be resolved in a 55 minute time frame, unless, of course, your untimely death proves to be necessary to advance the plot.

You may want to tweak the wording a little bit before passing it along, but you get the general idea. Who knows? If the big wigs like the idea well enough, you might even get one of those restaurant gift certificates they give folks who complain about being in the waiting room too long.

Ok, now I’m just being silly.

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!

Nurse Marge in Charge

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,

We’ve got a little gossip problem where I work. Everyone talks about everyone, all of the time, cutting each other down, critiquing each other’s performance, just nasty stuff. I’ve looked for advice on how to deal with this, and I’m told just to focus on my work and ignore what’s going on around me. How exactly does that work? If you’re not talking to these people, you’re the one they’re talking about! I don’t want to tear my fellow nurses down but I don’t want to put a target on my back either!

Signed,

Gossip Girl

Dear Gossip Girl,

You can’t eliminate gossip. The urge to chatter, to speculate, to find fault and blame and something to complain about is as old as time. It’s almost as old as me!

That doesn’t mean you have to participate in it. Your instinct about not wanting to tear your fellow nurses down is good — but if you really want to mix things up where you work, subvert the paradigm. Point out something good about whomever is being gossiped about — maybe they’re actually a great nurse, despite the fact that they’re a little OCD about cleaning the nurse’s station and insensitive to the fact that someone might want the only-slightly-fuzzy sandwich they threw away.

If you get blowback about this from anyone, simply say, “Hey, this is what I do for everyone. Wouldn’t you want me to do it if they were talking about you?”

It might not work every time — but it sure makes them think!

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!

Nurse Marge In Charge!

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’!

How am I supposed to handle this?

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!

Nurse Marge in Charge

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.

So tell me what do I say to all of the visitors who tell me what a horrible time they’ve had parking? I hear it every single day, from practically every visitor — I’ve had people stop me in the hall when I’m on the way to answer a call light to tell me they had to park two streets over in order to be able to drop in and see their ailing friend. I so want to say, “What would you like me to do about it?” but after five years of nursing, I’m beginning to suspect that the thing I most want to say is the thing I should never say! What do you think?

Signed,

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

Nurse Marge in Charge

Dear Nurse Marge,

I’ve just read a New York Times article about robots replacing classroom teachers — apparently the robot teachers do just as well as the human kind, in some respects. Now I’m worried: do you think we’ll be replaced by robot nurses?

Signed,

Not Ready to Be Replaced

Dear Not Ready,

I want you to do something very difficult now, and think like a hospital administrator. Yes, I’ll wait while you have the lobotomy.

You all set? Now let’s think through the value of robot nurses. Certainly, they may be able to do some of the tasks ordinarily performed by nurses: monitoring vitals, with nifty robot alarms that are programmed to sound when things are too far out of whack; distributing meds, robo-dialing attendings until they at long last give up the battle and pick up the phone.

Computerized charting? No problem: and there’s no need to give report. Robot nurses never need a break! They can simply retain all of the relevant patient information until discharge. Talk about continuity of care!

Robot nurses might have a real advantage with combative, abusive patients. It doesn’t matter if they get punched, kicked, or spit on: the patient is the only one who is going to feel it!

But (and this is the part where you need to think like an administrator!) robot nurses cost money. Lots of money. More than it would cost to hire an experienced RN, with superlative skills, great knowledge, and an uncontrollable urge to work every and all shifts possible. The savings inherent in hiring two or even three flesh and blood nurses to do the work of one robot nurse — well, it makes a nice little cushion in the Administration Holiday Party Fund, if you follow me.

And those abusive patients? They’re likely to sue if they bruise their knuckles pounding on Robo Nurse. You can’t expect the administration to allow that kind of risk exposure!

Finally, robot nurses would require a certain amount of supplies and parameters to work properly. A human nurse has long learned to make do — no gowns? Trade the floor below two boxes of small gloves and four pillows to restock. A robot nurse simply isn’t capable of that kind of initiative. Administrators would be forced into the completely ridiculous position of ensuring that every facility is adequately stocked with supplies, medication, and staff at all times.

Now tell me, do you really think they’re going to let that happen?

Don’t fear our robot overlords just yet. Remember: at any given time, only 1/3 of the vending machines in any hospital actually work — and if you want to know which ones, you don’t ask the computer system. You ask a nurse.

Good Luck!

Nurse Marge

Nurse Marge in Charge

Dear Nurse Marge,

I’ve always been interested in paranormal phenomenon, and make a point of asking my fellow nurses if they’ve every experienced anything out of the ordinary while they were working.  I’ve heard some great stories, and I’ve got to ask you: Nurse Marge, have you ever seen any ghosts?

Signed,

Spooky RN

Dear Spooky RN,

I’ve never seen a ghost, but like many nurses, I have a great deal of experience being haunted.  I’m continually haunted by my memories of a regular sleep schedule – going to bed at night time, seven nights a week, waking up when the sun’s actually headed up instead of going down.  And I’m haunted by the idea that there are meals that don’t come from vending machines, and entrees that don’t feature chocolate covered peanuts in a colorful candy coating. It’s completely creepy how stranger’s veins hold an unnatural appeal and people I barely know have absolutely no issue sharing their most intimate health concerns with me in the express lane at the QuickieMart.

Scariest of all, I bet you’ll find that if you ask other nurses, you’ll discover that they have had the same exact experience….

Good Luck!

Nurse Marge

Nurse Marge in Charge

Dear Nurse Marge,

Summer vacation is almost here — and that’s music to this school nurse’s ears! Let me tell you, I’m ready for a break from “My stomach hurts” and fevers that spike out of control — at 98.605! I usually pick up some extra hours working per diem at one of the local hospitals over the break but with the economy being the way it is, there are lots of nurses on the list, and I’m not likely to get called often. What should I do with my time?

Signed,

School’s Out For Summer

Dear School’s Out for Summer,

Now, I’ve never been a school nurse. But if I were, I figure it would take me every minute of that three month break to get over my twitching every time someone looked at me vaguely green around the gills and far too full of Fruit Loops. Not having “Fountains of Fun” around? Not exactly what I’d define as a problem.

So much of being a school nurse is providing basic health education to the children. You could use this time to develop innovative teaching tools. Consider programs like:

Six Super Ways to Get Mom to Let You Stay Home!

Parasites: Friend, Foe, or Really Gross Sandwich Topping?

Handwashing – Because You Don’t Know Where That Pencil’s Been. Really. Trust Me.

Sandwiches Shouldn’t Be Fuzzy: An Examination Of the Primary Grade Lunch Box Environment

Given time and motivation — both of which I don’t actually have any personal experience with, but I’ve heard such things do actually occur in the natural world — you could secure grant funding for program development! That’ll make up for that pesky lack of per diem funding!

So start planning your triumphant fall semester full of innovative cutting edge health initiatives. You could reduce stomach aches by at least .25%!

Obviously, these lessons work best with musical accompaniment. Stratospheric amounts of research indicate that children retain information best when it’s delivered in the form of a catchy tune. Many nurses aren’t particularly musical; reinforce your skills by spending approximately 9 weeks observing your favorite bands on tour to see how they make the musical magic happen. Make sure your funding source picks up the tickets!

That’s what I would do. Unless, of course, I was sleeping.

Good Luck!

Nurse Marge

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