Tuesday, August 12, 2008

Reasons I'm Leaving Emergency Medicine (number 4)

(if above illegible click on image and you should have it in technicolor)

The Excuse Matrix

"That kid has a well-constructed excuse matrix" is what the instructors in my old fighter squadron would say about newbies whose first response to a question or criticism was an excuse.

The Excuse Matrix in Emergency Medicine is anchored deep in the earth with steel girders blasted into bedrock and built to withstand hurricanes and tornadoes.

I understand. Really I do. We are asked to do the impossible in the ER every day... to see more patients than our staffing and facility can handle... to transfer the lifelong alcoholic with variceal bleeding to an institution that will agree to lose tens of thousands of dollars in her futile care... to restrain our fingers, at three in the morning, from choking the life out of a mother of a cute little two year old girl who wants us to document for the court, the possible sexual abuse by the father who just walked out on her (yes, we are often used at pawns in court)...

But really, whether you are a nurse, a tech, a physician on the other end of the phone, or the gal that cleans the floors, didn't anyone teach you, EVER, that listing the excuses as to why you have not drawn the labs, given the medicine I ordered two hours ago, or got that pesky second EKG on the guy with unstable angina, is going to kill me when I pop that undiagnosed circle of Willis aneurysm? Because guess what? Even though I am 'the boss' in the ER, I can't fire any of you and you know it. Those of you that DO work hard and do care are shouldering the load for the losers. How does it feel?

Are we not in the same boat bailing with the same buckets? Ix nay on the excuses already. Here's one that I like and really the only one that is appropriate, "I'll get to it as fast as I can, sorry."

That's it. I don't care that nurse X is a slacker... we all know that he is, but when you declare the obvious it makes me think less of YOU. I KNOW doc, dammit, that you have already had ten admissions... I sent half of them to you and my partner sent the other five. I can probably tell you more about them than you know yourself, so telling me about how slammed you are makes me think less of you because, well, I'm working harder, and the minute I start making excuses is the minute I quit.

I am on the verge of making excuses, so, rather than come of like a pussy, I'm quitting. Done.


  1. You're "the boss" of the ER! HA, thanks for the laugh.

  2. That was meant to be said in a joking way, not so much the bitchy tone it has. Smiles!

  3. just don't quit blogging...

  4. p.s.
    why not go finish off your "career" at a smaller/community hospital?
    i.e. easier?

  5. Re: Excuse matrix....with the levophed drips, I like to put the order in myself (what parameters do you want doc?!) while the doc is shoving lines in the patient...by the time the line is all gussied up and purty, the levophed arrives. You really just can't pull levo out of your ass though. It has to be approved by the pharmacist and sent down. I give a little heads up call though like "hurry the F up, patient be dyin, yo".

    I'd get you ALLLLL the central line kits you need, dear 911.

  6. so... this is what we get when 20 somethings go to junior college for nursing via LOTTERY!!
    i know there are some fine nurses out there; but my take now, is that an awful lot of kids are shopping on line, fantasizing about paychecks w/o a clue re: the profession.
    there was a time when nursing school was based on merit, not a number pulled from a hat.
    i don't make excuses. do the job.
    love the old docs i work with.. we all know the slackers.
    the big issue is this.. it isn't MY license when the shit hits the fan and the central line is delayed, labs delayed. tests missed.i think it is called "respondiat superior"

    it is YOUR license.. so i totally get where you are coming from.
    i hate to see the good old ones go ( docs & nurses)..
    who is going to put our line in??

  7. dear lillly,
    alas, i work in a 'small community hospital' right now. having worked at a large trauma center and smaller trauma center i can say without a doubt that this is much harder. the reason is that depending on what night it is i have zilcho for consultants. i have to send routine stuff away now because the specialists, and i don't blame them, have fled for the protection of large groups and big multi-specialty hospitals. can't find a heart surgeon or neurosurgeon or urologist or peds surgeon willing to come to our hospital. it's a joke and it's a bad one and it's all courtesy of the weenie-wads who wrote EMTALA, and the bigger weenie-wads at 'the JC'. nurse K, you rock. and just so this is not misinterpreted, i NEED nurses and good ones in the worst way because they SAVE MY ASS (and the patient's) when i miss something or someone starts to crump. we can not fire the bad ones and can not keep the good ones. to all my super nurses, i love you.

  8. bummer.
    i do get the lack of specialty coverage is really scary..
    and forget the hours wasted on transfer paperwork.
    oh well.
    good luck,
    if you come to MY er don't you worry your pretty little head. we won't miss nothin'
    hopefully; if JC is there... they will AUDIT the chart.

  9. I know in the medical world, that the paramedics are the object of much scorn and disdain. Let's call it what it is -- people in emergency medicine give a lot of lip service to how we love the paramedics and ems blah blah (here's your EMS week meat and cheese tray from 11 to noon on Wendensday), but the reality as I see it daily is that a lot of people think we're fucking stupid.

    That's not a personal indictment against anyone who posts on this site, just a general observation about how the world works. Nurses are a particularly bellicose bunch towards EMS.

    What it really comes down to is that fact that I get to do what I want. I used to think that as a MD or DO, you had a lot of freedom to do what you want, how you want. I don't think that's the case. At all. Nurses either.

    I'll tell you what -- within reason mind you, I get to do what the hell I want, how I want, as much as I want, in the way that I want. We have our protocols, and standards of care and what not, but I don't have half the fucking bullshit to put up with.

    Part of that is I just don't have the people to do stuff for me. If I don't do it, my partner doesn't do it, or the dumbfuck firefighter, it doesn't get done. There's no conflict resolution, no silliness.

    I once busted out a car window with a flashlight. I wanted to. I needed to get someone out. It was fun. The door was unlocked on the passenger side. Ooops.

    I kicked out a residential door once. We needed to get inside.

    A guy pulled a knife on me in the ambulance and grabbed my throat. I pushed him out of the ambulance as we were driving down the road at 30 mph. I'm not going to lie. It was scary as fuck, but a hell of a good time in retrospect.

    I ripped a car door off its hinges by prying it backwords to get a dude who was shot 8 times. He had poop leaking out of 2 holes in his gut. I pick him up with a Chicago lift and all this poop squeezes down my arms and on to my pants. Horrible. But I got to rip the shit out a car.

    It's the bravado I'm trying to sell here. Because EMS doesn't pay shit, and I have to deal with a lot more abusive fucks that people realize. I'm not respected really and I don't feel like the general public understands what the hell constitutes an emergency. That's not the point.

    What I want to get across is how much freedom I have to do my job. As long as I'm within this amazingly wide set of norms, nobody cares.

    I hear the stupid shit like "We need a portable chest in two!" I can't! The patient isn't in the system! Who has a scanner? Can someone do a readback? Where's bipap? I don't know. RT won't answer their phone. Get the RSI drugs out then. We need a name! He's not in the pyxis! I can't do John Doe with the RSI kit because of the etomidate. Do you have a DOB? Has he been here before!?

    Fuck all that. No name? No ID? No info? Oh well. Allergies? None until proven otherwise. Wristbands?! Ha. Just the one from the bar.

    Pyxis? Hand me the blue bag next the cot. Read back and double check? Please.

    Lovely. In a way, I would really like to be able to do much more than I'm able to now, but I love the autonomy to do what I want. I'd miss that.

  10. It's NOT the bravado, I meant to write. I don't want to sound like some "Rah rah FDNY 911 EMS HERO" bullshit. I hate that stuff.

    So modify the following paragraph
    It's NOT the bravado I'm trying to sell here. Because EMS doesn't pay shit, and I have to deal with a lot more abusive fucks that people realize. I'm not respected really and I don't feel like the general public understands what the hell constitutes an emergency. That's not the point.


  11. dear anonymous paramedic,

    i'll tell you the truth. nurse k, got my back? monkey girl?

    nursing schools are churning out nurses who don't know their shit clinically. they can fill out papers like there's no tomorrow but they don't know 'sick' from a hole in the head.

    paramedics know their shit because their training is clinical and very ER minded.

    you are protocol driven but a medic with a few years under his or her belt kicks the ass of about every newbie nurse that is 'just starting' in the ER.

    you guys know 'sick' and you guys get shit done and that's where it's at in emergency medicine.

    i have seen the bias you speak of from nurses towards medics. i have no clue why... had my nurse manageer at my old facility tell me 'tell your medics this is not their ER'. have no fucking clue what she was talking about.

    at my residency program we residents stood in the room and shut our yaps for your reports because they were, many times, invaluable. i did a month of ridealongs with EMS and i just love you guys.

    good for you for doing something you love in spite of the shit pay. in my neck of the woods it pays about 14$ an hour. yes, my peeps, you heard that right, 14$ an hour to save lives. terrible. but in that system the paper monkeys are taking over too... bunch of administrators who aren't on the street anymore fucking everything up by buying into the paperwork religion.

    one last thing... in the last ER i worked in we had some medics functioning as nurses. with apologies to my very special nurses (and you know who you are 'cuz you are the best), give me an ER staffed with medics and we'll make it hum.

  12. Seems to me that a few years back, most ER's required nurses to work on the floor or ICU for a year before they were considered "ready" for the ER. Now, with the turnover we're experiencing from all of the issues discussed in the blog, we're having to replace veteran nurses with fresh grads. With only a few exceptions, they are awful.

    A good ER nurse requires seasoning. As 911 said, the new grads are okay at the paperwork (to please the omnipotent JC), but they can't assess or prep a patient for evaluation, and they have to look up every damn med that you order.

    Part of the reason that I went into EM was that I loved ER nurses and enjoy working as part of a team. I remain convinced that the best nurses in any given hospital are the seasoned ER nurses. Fresh grads in the ER are more often than not just dangerous (IMHO).

    As for the anon medic. I DO sincerely appreciate medics. My trouble is often with their protocols which cause them to do things I wouldn't recommend. I can't fault them for that and I take those complaints up with the medical directors, not the medics.

    When I was an intern, I griped at a medic about something silly. He looked at me and asked if I had ever tried by myself to start an IV, perform a rhythm strip, take a blood pressure, administer meds, chart, and call report all while sitting in the back of an ambulance at 60 miles an hour through Dallas traffic. I had to admit that I had not. He then said "I can't do your job, so you shouldn't assume that you can do mine". Wise words that I've never forgotten!

  13. If your ER is hiring new grads into ER, that's a big problemo. I wouldn't want to work with a new grad RN in an ER either. It's a sign the ship is sinking at whatever facility you work. Ours doesn't hire new grads, even if they worked as a tech (doing EKGs, labs, etc) in the ER for years. If we have trouble staffing the joint, we use travelers or agency ER nurses.

    I couldn't say that I'd trust any of the local medics with my patient after the first 5 minutes. No, gallbladder/RUQ abd pain is not the same as chest pain, medics.

  14. There is nothing worse than working with somebody that doesn't recognize "sick".

    You don't have to know what's wrong, you just have to know that something's wrong.

    K, our travelers suck. Like new grad suck. And so do a lot of our medics.

    But generally speaking, I'd take a medic over a nurse most days.

  15. thanks for laugh:)

  16. UM..... maybe if you spent as much time on your patients as on your clever flow chart, YOU could have done all the nursing shit.

    Just fuckin wid you 911. you are a funny fuck.

    I like the anon. EMS dude... love jobs where you can break shit.


  17. 911doc & erdoc85 & monkeygirl & nursek&et al

    this is brilliant.
    medics are great as responders those first 15-20 minutes.
    we do the management for the next couple hours; and hopefully the pt is admitted (wishful thinking..what NO icu beds??) and so it goes.
    i think new grads need that old mandatory 2 year med surg trial by fire.
    learn the basics and then go to the er/icu/nicu/ or wherever the hot shots see themselves.
    THE COMPASSION( yes.. we all have that , sometimes beneath the cynicism)
    oh.. sorry for the capitals..
    and the ability to actually talk to people.
    all kinds of people.
    dumb.smart. old.young.esl.all kinds of folks.
    and longer that 2 minutes.
    thanks for this blog
    BTW.. i am going to keep doing er nursing until
    all the others i love and respect decide to retire.. maybe 8-10 more years.
    allah willing.
    thanks for the rant.


  18. Even though I am 'the boss' in the ER, I can't fire any of you and you know it.
    What a pathetic way to run a business.

  19. I'm the anonymous person from above. I'm not trying to start some medic vs. rn thing here. The reality is that I don't know half the shit nurses do. Half is being really generous, too.

    I really think the animosity comes from the fact that I get to do whatever the fuck I want and nurses don't. Sure sloppy shitbag medics, and there are many, take full advantage of this to render crappy care. RNs get paid more, better job security, more job opportunites, but I have more fun.

    The point of this is simply to say that I used to think that the further up you got in licensure and training, the more freedom you have to run things how you want. I no longer think that due, in part, to the hundreds of posts on the subject on this blog. I've spoken with ER docs and frankly, there's a lot of unhappiness and crabbiness.

    When Mr. Fucking Sickle Cell Opiate Addict calls me for the third time this week, I can tell them that they're a fucking drug addict and nobody believe their story. At the ER, I know they have to deal with this shitbag all night long. Oh my pain! I need that dil- drug. Nolthing else works for my pain!!! Wa wah wah.

    30 minutes later, I'm done with the call. It's tragic in a lot of ways. I do my best to stop the ER abuse before it gets there, but sometimes you just have to pass the buck.

    Maybe the ICU isn't so bad. Half the time they're fucking gorked, intubated, on a vent, or physically restrained. Less griping. Who knows. I like what I do.

    Nurse K, I get what you're saying and I don't disagree. At the same time, I have seen atypical presentations of just about everything. So personally, my index of suspicion is fairly high.

    There's cases documented of ST elevation that, after invasive treatment, were attributed not to cardiac origins but cholecystitis.

    But the expectations are the same for me as many hospitals.

    QI guy says to me: Grub, why the fuck did you take 20 minutes to do a 12 lead on this guy? Our expectation is oxygen, aspirin, and 12 lead within the first 10 minutes. Get with the program.

    Me says: Ok! 12 leads on everyone! Yeah!

  20. Anon medic, don't feel too badly. I caught a lot of crap from the nurses when I worked in a lab. Some of the ER nurses I was friends with, but some of them liked to call and just piss at me over the phone. They generally had no clue of our processes, or that there was a scientific reason that things take a certain amount of time to preform. I would literally run my ass off my whole shift.

    I'm not sure where the animosity came from, but I can tell ya this:

    If anybody sends me an unlabeled tube of blood through the pneumatic tube system and then calls me and requests that I label it for them and send it to blood bank, I'm gonna reject it no matter how pissed you get. My ultimate responsibility was to my pathologists because it was their collective necks on the line.

  21. I'm in pre-nursing right now and a lot of my peers aren't...the cream of the crop, so to speak. Not even on an intellectual level -- I'm talking about fundamentally dense people. The kind of (girls, usually) who, in the past, would have gone to university to get their Mrs. degree. Now, instead of marrying that doctor or engineer, they see nursing as a ticket to the big money. I guess because it's more socially acceptable to say "I want to have a career and blah blah..." instead of "I want to marry a rich dude and not have to do anything for the rest of my life."

  22. I slowly learned the real truths about Emergency Medicine over the years. The truth is never taught in medical school or residency.

    As an emergency physician, you have 2 primary responsibilities.
    First and foremost, your job is to fill out paperwork. You just get to see a few patients on the side.
    Second... your role in the ER is to eat the sins of others. Understaffed? Your fault, not administration's. Med delay to patient? Your fault, not the pharmacy. Patient only speaks an obscure Mexican dialect with no available translation phone? The lawyer says your fault. In the great sausage factory of emergency medicine you only put the casing on whatever crap everybody else made for the insides. And when the patient finds out what the sausage really has inside, you assume the responsibility for the sausage. You eat the sins of the real makers of the sausage.

    As to some of the misperceptions of Emergency Docs.
    You are in charge -- like ernurse said... good one. Your position is ceremonial, much like the Queen of England. Sure, you have a title and a little (metaphoric) land with a castle, but the real power is in parliament, or in the hospital setting... the carpeted section. And, like the queen, every so often you have to publicly read off the carpeted section's agenda with forced to smile, even though you know it is, well, bad sausage meat. Only because your group's contract is correctly positioned in the guillotine.

    The excuse matrix -- in reality this is the end product of beating the slaves until morale improves, brought to you be the wizards in the carpeted section. The wizards look at numbers in a quiet, secluded board room, complete with coffee and food. When the wizards find out that there is only a 36% compliance rate with the JC mandated standing straining stool velocity (SSSV) documentation, well what would JC do? Send out the middle management minions to beat the slaves into compliance, and more morale beatings until the SSSV is measured in both feet per second and meters per second, with pre and post poo temperatures (PPPT) on the 2 page audit form. And when good slaves leave, the carpeted section wizards cannot understand it. After all, they give the staff movie tickets. Occasionally.

    So, I look forward to the day when my aneurysm pops. If the brain damage is moderate, I can be a hospital administrator. If the brain damage is severe, I will have a long career at the JC.

    Oh yeah, and sorry if my use of the JC unapproved abbreviations SSSV and PPPT brings a blog audit. My reply is "Terminate life of JC representative after 1-3 minutes of begging". Damn. Range order. Sorry again.

  23. I have seen something like this in the ER while doing some rotations for my EMS class. I never knew doctors had this train of thought lol. Thank you.

  24. igloo doc,
    one day drop me a line and tell me where you are and i wouldn't be surprised if we know each other. nice, nice take. props.

  25. I think your blog is great,
    just don't quit blogging...

  26. igloodoc & 911doc & all you nurses..

    we will make some kind of internet pact..
    we will all work together someday.
    somewhere in the ethers
    and we will do it right.
    range orders
    compliant hospitalist program
    my favorite.. over riding pyxis ..
    staffing up the kazoo.. never a "bed" problem.
    guess what.. we can even have the same patients.. we'll just be able to care for all the bullshit more efficiently.

    in my nursey dreams.

  27. we used to have that... prior to EMTALA. now it's wrecked for everyone and this makes folks happy who have leftist tendencies. it's already happening with private facilities that do not accept medicaire/medicaid/___-care. pay to play. unfortunately this was inevitable. docs, for some reason, have not walked out in sufficient numbers to force a repeal of emtala or simply get it funded. i am against funding it and want it repealed because the funding would create three more beasts and three more jaycos and all manner of idiot bureacracies that do nothing for patients and make our lives more complicated.

  28. I would take one of the paramedics who work in our ED any day over the nurses. One of our night nurses was on the phone ordering pizza while her patient was circling the drain, and the paramedic had to step in and take over. The are proactive and know their shit.

  29. 911doc:

    Love this topic. Yes, I'll probably never work ER, but I admire the quick-thinking the folks do there.

    I can tell you why some of the new grads are terrible--they get all puffed up in nursing school with inflated grades and they think they are "it" and the greatest thing ever. They never study or work hard and consequently, they never learn. They are just too good. I'm an old bat who's out of a darned good school a little over a year now. Those type of "kids" really scare the sh*t out of me.

    They think learning is for idiots. I'd take a competent medic over some green ER RN who doesn't know when to say when and get a hand.

    And yes, even in rehab, we call our docs the boss. And in many businesses, just as in medicine, if you make the boss look good, you may just have a very long career ahead of you. Karma's a b*&ch and she has puppies!

    Good luck wherever you roam. Life's too short not to enjoy it!

  30. this is an amazing discussion for me to read. i'm not in the medical field, and i'm impressed by:

    -the honesty and lack of name calling here.

    -the desire for real solutions in the name of helping people

    -the humor in the face of stress

    -the fact that you can make a flow chart, much less one so darn clever

    -did i mention the humor?

    i'll be back. keep caring. we need you peeps.

  31. one more thing

    did i tell you that " weenie wad" has been my favorite word for, like, 30 years??
    uh, right there with fartknocker.
    i have even used it in my triage notes.
    I LOVE MY JOB!!!! sorta

  32. Love the matrix. Perfection. Has it been approved by the 20 gazillion committees that make up the legal and marketing departments? Be proactive--make this your Christmas card this year. The hospital will love you for it:>)
    PS. If you do bust that undiagnosed aneurysm in the Circle of Willis could you please wait till shift change? My elbow really does hurt and the IVC cart wasn't sent to be restocked by the unit clerk and my biorhythms are out of whack.

  33. What happened to the patient?

  34. OMG. Love the Matrix....just like where I work.

    I don't work ER, but love it when I float there...they asked me to "join up", but I don't care for there she-manager much...so when she leaves I'll check back into it. I love that you get like 15 different diagnosis in an hr, and you actually have to use your brain while assessing and pulling drugs and doing iv's. I work Tele/Pccu and have 5 yrs expereince ICU...I hate it when you call a doc with vitals in the commode and tell them "Patient C just doesn't look good...Vital signs are crap" to be told to hang titrating drips...that we are not allowed to manage on the floor because...duh, takes an acutal monitor to monitor the bp and hr and stuff...then the doc...will change there minds...well don't want to send patient to ICU...30 minutes later you're calling them back to tell them the patient coded and is now in ICU, and they have to come to the hospital to manage pt (if the patient actually makes it after the code!).

    Keep up the great blogging, you keep me sane.

  35. the patient "lived" on levophed for a bit, then died like always.

  36. Man did I miss you guys while I was gone ...

  37. Just a few observations....the main on being...if I ever leave ED nursing (nursing in general actually) this genius poster will be the number one reason why.....

    I have been an ED nurse for about 8 years....after being a medic for 5. To all you docs....I hate the slacker nurses just as much as you do. Maybe because of my years in EMS or maybe just because of a natural inclination to hate bullshit in general, I have never been the darling of nurse management. My focus in on being a team player and saving the patient.....charting is what I do with my time AFTER doing everything else. That is the reason I spend more time in the nurse managers office than that stupid fuck who almost gave vec during a conscious sedation (*vacuous giggle* "opps") I have said many times a nurse can look "perfect" on paper but completely useless at the bedside. Nurse managers don't like when I say that...oh well....tough shit! It does get tiring year after year to not get a raise as high as the stupid ones because I don't dot all the "i's" and cross all my "t's" I almost sent one nurse manager into seizures when I suggested that the docs we work with should be part of a nurse's evaluation........to say she was lived would be an understatement.

    I am not ashamed of any of the write ups in my file....especially the one from the CT tech that states I was rude and unprofessional when I told her to "get out of way and show me which button to press" if she wasn't going to do the scan. We were r/o a stroke patient and getting perilously close the 3 hour window, and the order had not yet been received through the computer system.

    Beside, doctors whispering in my ear that they would much rather have me take care of their sick patients is much more valuable to me than any lame nursing evaluation...seriously..have any of you guys ever seen one..."Does nurse leave a clean work area"..."Does nurse utilize her resources wisely"...."Does nurse look clean and presentable" I kid you not!! And what is infuriating is that the slacker nurses always come up smelling like roses. I am in taking care of their very sick patient....patient is so sick that he/she will not remember being taken care of. She is off making nice with all her other patients. My patients are being ignored and will be mad and complain about their care to anyone that will listen. Slacker nurse will get "nurse of the month award" I will be forced go to remedial customer service training.

    I have though long and hard about going to NP school......but an now veering towards PA school...even though it will much more of a financial hardship.

    And they really pick nurses for school on a lottery system...that's insane.

    And 911doc...I truly hope you keep posting. I can't think of a better indicator of how screwed up our system is than of people like you being chased out of the profession

  38. jennifer,
    God bless ya. go to PA school! the focus will be more on clinical accumen, but go either way and get on the other side of the fence. right now we are running off our great clinical nurses and we can't can the bad ones. nursing evals are shite. unfortunately, the 'good on paper' and 'nicey-nice' shit is bleeding over to our side. personally, i don't give a rat's ass if you are nice or not, just fix my heart attack or take out my appendix or whatever, just do it right.

  39. Oh dear, I read the comments, and I see most of them are from medical professionals who also have their "axe to grind". I've only read two of your blogs so far, and you have me a bit fascinated, because it is my impression at this point that you're writing from the perspective of the patient, the fucked up, fucked over patient. Yeah, we're not all perfect out here, we haven't got it right, and we're coming to you, we're relying on you ... we're actually praying that you can help us, help the people we love. I could go on and on. Keep writing, keep saying it, until they get it!!! For God's sake ... is there a God, do you think ... NEVER, EVER GIVE UP!!!


  40. dear kate,
    anyone who quotes Winston Churchill can't be all bad, but since I'm not currently fighting hitler I do think I'll put my sanity and family ahead of bailing the titanic with a shot glass.

  41. Are you talking about this quote:

    " Never, never, in nothing great or small, large or petty, never give in except to convictions of honour and good sense. Never yield to force; never yield to the apparently overwhelming might of the enemy.''

    Or this:

    "We shall defend our island, whatever the cost may be. We shall fight on the beaches, we shall fight on the landing-grounds, we shall fight in the fields and in the streets, we shall fight in the hills. We shall never surrender!"

    WC, in the Hizzle!!!

  42. I beleive the WC quote was, "Never give up... Never give up, never, ever, etc...

    The scholar and men's cager Allen Iverson paid WC an homage with his similar quote," we're talking about PRACTICE! not a game! practice, practice, not a game! Practice! etc... Didn't know AI was a WC fan.

  43. bullshit call, win the game

  44. Random thing---The nurse who everyone bitches about because two patients (no matter if it's on critical care or non-critical care) is just too much to handle bitched ME out for criticizing the hospital's desire to be a magnet hospital when I've been recognized as an up-and-coming leader or whatever. I'm all, dude, being a leader isn't necessarily about kissing ass and cheering for the latest framed poster saying how great we are. Let's quit canceling the stroke education days, overtime, and the ACLS re-cert classes for budget concerns first before we start spending big dough to get some minor agency to say we're great.

    I should have said, why don't you take some f'in patients before you start worrying about this stuff. Hospital politics suckass.


  45. I just graduated from a nursing school in May and I have to agree with the pre-nursing student who posted earlier. The school I went to was out of my district, and I had to move to get in because the schools in my district all went by lottery. A big university was out of the question financially, but it doesn't matter - they go by lottery too.

    The school of my choice went by academic standing, and I barely squeezed in with a 3.8 gpa; number 62 in an admitting class of 60. I had to wait for two people to drop out before I was accepted in. The impression that gave was that I would be in a class full of people who cared about what they were getting themselves into, peers that I could respect. Some were amazing students, and provided incredible care in clinicals despite only learning the basic concepts of nursing. It's clear that there are some people who are fit to be nurses.

    Some take a little longer to learn - I remember my first day of clinicals I was TERRIFIED of going into my patient's room. The idea that someone was depending on me was scary considering I don't even separate my whites from the colors when doing the laundry. At the end of nursing school I was more than comfortable (other than dealing in PEDS - not my bag). I'm not close to being an excellent nurse, but I do believe I am competent at providing care based on what a patient needs, and know when to call in for extra help.

    There are those new nurses who are now popping up in various hospital units all over the country that make me feel bad for the nurse managers they scammed into getting the job they did not deserve. These are the nurses who studied along side me, or I should say,were supposed to study but ended up cheating their was through school and barely squeezed by on practicals. I remember one girl was going to be thrown out or our class because she put her patient's safety at risk during our clinical rotation on two separate occasions with different patients. She was spared on a technicality - nothing ended up happening to her patients. That was only because other nursing students were constantly peeking into the rooms she was assigned to so they could check in on her patients and correct her mistakes. If there are people who naturally belong in nursing, there are those who definitely need to stay away. Unfortunately, there's little a school or administration in a hospital can do to weed out the troublemakers before they get accepted into a nursing program, or hired for the job in which they will establish an uncharted ethical low. Others nurse the incompetent grasshopper through school, and off they go to be babysat until they retire or get fired. Like my peer in nursing school, a lot of these nurses are adept in dodging accountability and getting the pink slip they deserve. These types are in every field. They spend more time trying to get away with things that make the job harder for every one else than they spend actually doing their jobs.

    There are still nurses coming into hospitals that will end up being good nurses. The obsession with paperwork will make it easier for incompetent nurses to not only hide but thrive, but hopefully those of us who want to preserve the role of nurses and avoid drowning in paperwork will fight to stay at the bedside instead of cubicles far away from patients who need care.

  46. Dear 911 doc - Leaving ER because of a few nurses that do not jump when you say jump? Baby, grow up. Working that ER of yours is the most "boss" of anything you will likely ever encounter anywhere else. So suck it up and bestow some gratitude on those nurses who save your ass. Cuz we surely do, daily and mostly in ways we don't have the time or inclination to lord it over you - *shrugs*
    (Speaking as a 30 year veteran of a "second city" inner city big ass ER, newly retired) Oh and by the way, a "leave em dead" drip order doesn't fire up my clogs so much. Keep up the good fight. :)

  47. dear anonymous,

    i'm typing this slowly because i know you don't read fast. if only i had been lucky enough to work with you before. thank you for your sage and wise advice. you keep up the good fight too and don't go changin'! (smiley face if i could only figure it out!!)

  48. Nurses and all their breaks suck ass. We don't get breaks, why should they?

  49. Nice language ........... I like the way you are presentinig things....


  50. I started clinical rotations just 2 months ago & I'm already sick of the pervasive attitude of "don't look to me to lift a finger or exercise my brain any more times than my contract states I must." I'd like to think that the few docs, nurses, & students who display this attitude just don't get what's wrong with their myopic approach. For example:

    Me to Classmate: "Can you show these visitors the waiting room? I have to stay with my intern & our attending to hear the case discussion for my patient (i.e., I'll get in trouble if I walk away, whereas you're free right now)."

    Classmate: "Waiting room...? Um...I don't know where it is." [Proceeds to stand silently, refusing to look at the visitors standing right in front of him. Visitors leave in disgust]

    Maybe some basic teamwork skills training (i.e., 'many hands make light work & smiling faces') could help everyone to get it so I don't pop my own undx'd anterior communicating artery aneurysm.

  51. Funny shit. I am a Federal Agent and went to an ER in uniform with a stab wound and almost bled to death. You know, my story, while 100% true, aint that damn funny. keep bloggin, it's good.

  52. dear deboe,

    first of all, thank you for doing what you do. honestly, many thanks.

    second of all, none of us here know nuthin' 'bout nuthin' and our attorneys at Wi, Cheatham, and Howe (Shadyside, NY) have advised us to say nothing further.

  53. There are several ways that a paramedic or an emergency medical technician can do to improve his or her average yearly earnings. First of all, he or she can enroll in higher levels of training. An EMT-Basic can complete a training coursework in EMT-Paramedic to increase his or her pay. The surest way to progress in this field is to find ways on how you can broaden your job classifications. Another tip to improve your wage is to relocate to areas that have higher pay rates. It has already been stated above which states have a more desirable salary for their EMTs. Average Wage of EMT