Family Practice Patient Care Nurse

THE MARKETING OF MEDICINES

2006-06-27T18:47:00.000-07:00

Pill Pushers: How the Drug Industry Abandoned Science for Salesmanship

This is one of the more troubling aspects of medical care today. I once had a female patient ask me in all seriousness about her enlarged prostate and wanted medicine for it because she had seen advertising for it on the television. While it makes us want to smile, it really isn't funny. The problem just continues to grow and we will see more serious situations develop until the drug companies accept responsibility and change their ways.

THE LIGHTER SIDE OF DEMENTIA

2006-06-26T16:11:00.000-07:00

Mabel and Marge were two delightful patients who graced our floor for a short while. Roommates, the couple of octogenarians got along like a house afire and kept the staff laughing with their antics. Everyone from housekeeping to phlebotomy left their room with a smile on their faces after listening to the two ladies and their bantering.

After a week of close friendship, however, Mabel had a definite change of personality. Suddenly she became extremely difficult and paranoid. Her mental changes slipped and she became forgetful and argumentative.

Suddenly Mabel and Marge were no longer buddies. Mabel had declared war, accusing Marge of stealing her bed and moving right into her room without even asking. When the nurses tried to intervene and reason with her she wasn't having any part of it.
Vainly, the nurses explained she was not at her house, but at the hospital.

"I know I'm at the hospital," she said, in a tone of aggrieved . "There I was, sitting in my living room when all of a sudden five men came in and dragged me here."

From the other bed came a wistful little voice from Marge, "I wish I had five men in my living room." Her tone said she knew exactly what to do with them.

2006-06-22T18:24:00.000-07:00

BIG BROTHER IN THE OPERATING ROOMS

2006-06-19T20:18:00.000-07:00

Probably almost every hospital or medical society in today's society has some sort of system in place for tracking nurses and their responses to patient calls. Big Brother is watching. This was brought home to us recently in a humorous manner, although the nurse involved did not find the experience funny.

Jason had to prepare an elderly gentleman who was incontinent for a colonoscopy. Anyone who has had to do this knows what an ordeal this can be.

First, he had to manage to convince the man to drink a gallon of colyte. Not only was the amount of liquid a whole lot more than he was used to drinking, but the slightly metallic taste was slightly off-putting.

When the colyte started working, the man started complaining. He continued to complain all night long as he had one watery stool after another.

By morning Jason had enough. Jason's sense of humor is quirky, at times. As he was cleaning the man up from another watery stool, he realized he knew the doctor doing the colonoscopy. With a wry grin, he got an indelible marker and wrote on the patient's backside, "Hello, Dr. Julian!" He added a smiley face for good measure! He gave a quiet chuckle, thinking of what the physician's reaction would be.

Jason wasn't chuckling a few hours later after the patient had gone down to special procedures for his colonoscopy. The endoscopy nurses called him to come down to Special Procedures immediately. The patient lay on his stomach, prepped for the procedure.

Jason was curtly instructed to clean the patient's bottom until the offending message was no longer visible. All the while, the entire endoscopy team, except for the doctor, stood and watched, as he scrubbed. Jason was embarrassed and humiliated.

Jason's humiliation, however, was not complete. He then had to face a dressing down by Dr. Julian and plead for his job. It was a wonder he was not fired.

This is a funny story, but it is not so funny. It goes as a healthy reminder. Big Brother IS watching.

MANDATORY OVERTIME

2006-06-19T17:55:00.000-07:00

Our unit works is unique in that it is self-staffed. We do not pull from other floors nor do we rely on agency nurses or travel nurses when we are short a nurse. We call in one of our own nurses or we work short staffed.

Self staffing is a big boon for the hospitals, saving them a lot of money. Agency nurses and travel nurses, the mainstays and backbones of many hospitals, due to acute nursing shortages, cost a lot of extra money.

It is better for the patients in that self staffed nurses are already familiar with the patients and the hospital unit. Agency nurses often are so overwhelmed by the newness and unfamiliarity of their situation that they are unable to give their best care to their patients. Often they spend so much time orienting themselves to their surroundings they are unable to spend much needed time perusing their patients' charts. The end result is less than optimal care.

Agency nurses also are implicated in increased infectious diseases.

However, in reality, self staffing leads to situations that are not good for the patients. Forced to work overtime, many nurses succumb to the fatigue and stresses of their jobs. It is not easy to be cheerful and caring when you have worked four or five twelve-hour shifts. Even worse, however, is the vigilance necessary for good care. When the mind and body is tired, mistakes in judgment are made.

Staffing shortages, a chronic problem in any hospital, but a particular problem on our unit, is another danger for patients. It is difficult enough to give decent care to the normal complement of patients. Adding even one more patient to an already heavy load is foolhardy.

All it takes is for one patient to have a problem that takes up the nurse's time and, like the dominoes that fall in a row, the other patients suffer in their care, simply because the nurse does not have the time. They end up getting treated "like ugly step-children," through no fault of their own.

Is this any way to run a medical system?

WE NEED TO FIX THE SYSTEM.

DEMEROL (MEPERGAN) AND PHENERGAN (PROMETHAZINE)--THE DRUGS OF CHOICE

2006-06-16T05:18:00.000-07:00

On our floor demerol and phenergan are the pain medications of choice, usually given iv push. It amazes us nurses how patients seem to feel this drug combination is as seemingly innocuous as Tylenol.

(Thanks to Johnson and Johnson's efficient public relations most of the public doesn't realize Tylenol poses a very real danger to the liver and kidneys in amounts as littles as 4 doses of Extra Strength Tylenol per day, even less if there is drinking involved.) Just 4 grams of Tylenol can induce Tylenol toxicity. It's scary.

On our floor, however, rarely does a patient request anything so mundane as tylenol. Most of them want PAIN RELIEF. They want the big guns--demerol and phenergan--and the more of it, the better.

To give them credit, some of our patients are genuinely hurting and just want to quit hurting. Others, however, just want a legal "buzz" that will deaden their senses. In other words, they just want to be knocked unconscious.

Unfortunately, the government is doing their best to assist them in their endeavor. JCAHO, the JOINT COMMISSION OF ACCREDITATION OF HEALTHCARE ORGANIZATIONS, which started as an organization with good intentions that made suggestions to improve healthcare, has now grown into an entity much like the Internal Revenue Service, in that they can make edicts and proclamations, and there is no one to stop them, no control to oversee what they do.

One of their edicts is that hospitals must meet the patient's demand for pain medication--whether it is justified or not. JCAHO says pain is subjective and what doesn't hurt one person may cause another excruciating pain. We can only go on the patient's saying so.

That is all well and good for the average patient, but some patients are here just to get drugs. And regardless, there are ways to measure pain--blood pressure, heart rate, physical signs.

Let me give an example. I go into a patient who claims she is having a terrible migraine headache. Fine. Most people with migraines cannot tolerate noise, bright lights, strong smells, or food. This lady has the overhead lights on really bright. The television is blaring, while she talks on the phone and giggles with a girlfriend. She has ordered a strong-smelling pizza from down the street, because she doesn't like the hospital food.

Her vital signs are good--blood pressure 92/64, yet she begs me to call the doctor and ask if she can get her pain medications increased to 100 milligrams of demerol and 50 milligrams of demerol, because she is "hurting so bad."

Give me a break.

I don't mean to sound unsympathetic. I you ever saw me with my patients you would know I care, but can't anyone see that we are developing a cadre of prescription drug addicts. These people then get out and when they can't get prescription drugs, they turn to whatever they can get on the street.

There has to be a happy medium somewhere, a way to determine pain in some of these cases, that will enable us to help these people and not become legalized pushers.

IRAQ IS NO PLACE FOR TEENAGERS

2006-06-15T10:32:00.000-07:00

Sometimes things haunt you. One of my patients is haunting me now.

David came in through the Emergency Department. He was just nineteen years old and had overdosed on tylenol and aspirin according to his own report. This is something
every nurse hates to hear. I groaned, getting the report from the ED nurse, but she hastened to tell me they didn't really believe he had taken the pills.

Part of the standard treatment for an overdose is activated charcoal. David was given quite a bit of it to take orally. He only tolerated it for a short time before he vomited it up, but there were no pill fragments in his vomitus. There should have been, if he had, indeed, swallowed so many pills.

After David was admitted, I learned the real story. He was a young kid, clean-cut, working and living on his own. He just had peach-fuzz. It didn't look like he even had to shave! He had a terrific girlfriend who loved him dearly. What more could a boy want?

Problem was that he had joined the Army Reserve believing the recruiters when they told him that he would never have to go to war. He was just looking for a way to pay for college.

(I know that at least some of the recruiters are saying this kind of crap, because I talked to an Army recruiter and heard the same song and dance from him! He told me if I signed up I wouldn't go to war. All this was said with a straight face. I asked him how he could in good conscience lie like that. He had no good answer.)

However, David was deployed to leave for Iraq. Soon.

The closer David got to his deployment date the more depressed he got. He never thought he would go to war. That terrified him (as well it should.) He was afraid he would lose his girlfriend.

What was he going to do?

He tried everything he could think of to get out of his enlistment, but it was ironclad. Finally he saw only one way out. If he attempted suicide...

Of course, now he will carry the stigma of a section-eight discharge with him the rest of his life. What a price to pay for the naivete and gullibility of believing an army recruiter!

This goes beyond political affiliation. I firmly stand behind the administration in most things. And maybe it just hit me and the nurse working with me so hard because we are the mothers of boys, abeit younger. But sending teens, barely out of their childhood to war is wrong.

It is one thing if a MAN wants to make a career of the military, but to dupe teens into joining the military and telling them they will not have to go to war but that they will be able to pay for college if they sign up---that is WRONG!! Whoever said, "War is hell," certainly was right.

In the morning before I left, I stopped by David's room. He and his girlfriend, Jeannie, were waiting before he was transferred to the psychiatric unit. I told them that in the coming days or years he might feel bad about his decision or have others say he made the wrong choice, but Eva and I wanted him to know that as the mothers of boys we understood. We wouldn't want our boys going to war.

He was boxed into a corner and made the only move he felt that he could. I didn't want him to be ashamed.

David thanked me with tears in his eyes and Jeannie gave me a goodbye hug. I left the room, closing the door, leaving them waiting for transport to psych.

Good bless David and Jeannie, and God bless the men and boys fighting in the war.

FAMILY PRACTICE?

2006-06-15T09:31:00.000-07:00

I work weekend nights in a Family Practice unit of a busy hospital. When curious people ask me what I do, I tell them, we get a little bit of everything. We get the overflow from every floor--orthopedics, oncology, cardiology, surgery, neurology, as well as our own patients. You name it, we've seen it. There is never a dull moment here. That is why I love it so.

It is also why when I meet another nurse in the elevator and I tell them where I work they shudder in horror. "Oh, I could NEVER work there!" they say. "It's too hard."

Hard? Yes, it can be. Frustrating, too, at times. However, when someone hales you at the grocery store and says, "You took care of my Mama in the hospital and I want you to know what a wonderful job you did," it goes a long way to making up for the poor pay and the rotten hours.

Why do nurses do what they do?

It's not for the pay. We certainly are not paid anywhere nearly enough to deal with changing diapers and the occasional incontinent person who delights in flinging his bowel contents or using them as creative fingerpaints.

It's not for the stress. We are torn between the patients and their families as well as the doctors. We do not deserve the verbal or physical abuse we take from demented patients or anxious family members. We listen patiently as patients curse because we can't get their pain medications increased.

It's not for the physical stress on our bodies. We move patients that weigh 300-500 pounds who don't understand what they are doing to our backs.

We do nurses do what they do? Because we love it.