Don’t Be So Sure of Your Diagnostic Skills!

Two interns were watching an elderly gentleman move slowly down the hall.

“I’ll be you $5 he’s had a hemorrhoidectomy.”

“No way. He’s suffering from arthritis.”

They both approached the man to inquire.

“Why are you moving so slowly, Sir?” asked one intern.

The old man replied, “My slippers are too large.”

The Top Ten Things You Don’t Want to Hear in the Emergency Room

10. It’s first come first serve here

9. What side is the appendix on again?

8. Have a seat in the waiting area and try not to scratch it

7. Dr, Have you tried googling it?

6. Open up your mouth and say $50 copay

5. Can you come back tomorrow?

4. That’s probably contagious.

3. No, but I did stay at a Holiday Inn Express

2. This is probably going to hurt a lot.

1. OOOOPS!

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.

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

Top Ten Signs Your Anesthesiologist Is A Quack

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

ER Terminology and Glossary by Paul Millard, RN, Etc

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.

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?

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

Dilution

From the popular webcomic XKCD:

Nursery Rhymes by Susan Elaine Arnold, RN, BSN, CCRN

The following clues represent phrases made up of words which a nurse might use in the course of a day. Each phrase is two words which rhyme. For example, “an intelligent ventricle” would be a “smart heart”. Understand how it works? See how many you can solve!

1. An iliac crest tear
2. A migraine drug
3. An injection for a small child
4. Ms. Nightengale’s olfactory organ
5. A cranial blood vessel
6. A fake defibrillation
7. A medication invoice
8. An angel of mercy’s pocket book
9. A rapid venipuncture
10. An anesthesia lesson
11. A cervical spine exam
12. A single skeletal component
13. A compensated nursing assistant
14. A sutured site pruritus

Click below for the answers! Read more

A Night in The ER

Just another 12 hour holiday weekend night shift in the ER. Inner city, City/County Hospital. Level 1 Trauma Center, teaching facility. Literally a stones throw from the Mexican border. But hey, what could go wrong? Trauma codes in all 3 trauma bays need to be expedited because more are on the way. It seems some disagreements are being settled with the good old high velocity hot lead enema tonight. Some people have been waiting in the lobby for almost 24 hours. I know nurses are superior to mere mortals, but is it OK to say I was starting to feel a little bit stressed at this point?

We worked a regular schedule, so each shift was the same staff, and mine were the best. I was doing chest compressions in the Trauma suite when someone decided that tonight we needed to play Tourrette’s Syndrome. All I know is that while doing chest compressions, the youngest nurse with the most angelic face and sweetest disposition moved a stool near me and leaned over to whisper in my ear so that only I could hear. Little Miss Susy Cream cheese unleashed a chain of vulgarities beyond anything I could ever imagine, causing me, I believe, to be temporarily transported to another dimension, and when I returned I was laughing and crying (and doing chest compression) all at the same time, and to this day I believe I was in God’s presence for a few seconds.

All over the unit staff were whispering vulgar, profane, hedonistic, physically impossible things into each others ears causing laughter and tears, and decreasing the slight feeling of tension we were experiencing that terrible night. I lost track of how many celestial discharges we had from the trauma bays that night, but will be forever changed by my other worldly experience.

Contributed by Paul Millard

Take Me Out to the Ball Game!

As part of the community integration goal, the residents of a psychiatric rehabilitation facility went to a baseball game — along with their aide, who prided himself on his “Tell it like it is” approach.

He’d get everyone pumped up, excited about everything. For weeks in advance, he coached his patients to respond to his commands. When the day of the game arrived, everything seemed to be
going well.

As the national anthem started, the aide yelled, “Up nuts!” And the patients complied by standing up. After the anthem he yelled, “Down nuts!” And they all sat.

After a home run he yelled, “Cheer nuts!” And they all broke into applause and cheers.

Thinking things were going very well, he decided to go get something to eat, leaving another aide in charge. When he returned there was a riot in progress. Finding his assistant, he asked what happened.

The assistant replied, “Everything was fine until some guy walked by and yelled, “PEANUTS!”

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