If Hospitals Were Run Like Denny's.....
What do you suppose a nurse's job would be like if healthcare facilities were managed like a decent chain restaurant? I've always thought that one of the only differences between floor nurses and the average food server was about twenty-five bucks an hour. After all, we run hard all day....we're focused on "customer service".....and we try to take care of people the best way we can. (Unfortunately, we don't get tips.) CAUTION: This is only a fantasy!
"Hey, Flo! You're getting a new admit in 206-1," says Mel, the charge nurse. "ETOH, admitted for detox, alert and oriented times 1-2. He's got an IV but ER says it won't last long the way he's picking at it. He's coming up in five minutes---they've gotta get him outta there 'cause he's stinkin' up the place."
Flo, of course, has her hands full with six patients---three of whom are total care, two of whom are high-maintenance types who can't reach the water pitcher without an RN's help, and the other is merely a little needy. She explains this to Mel, who asks her friend Alice (with only five patients) to take the admit, while she runs off down the hall to see what 204-2 wants.....again.
"What'll you have, Mrs. A?" she asks in as cheerful a tone as she can manage. "It's about time for some pain meds, isn't it?"
"You're an hour late," growls the patient, a lady of indeterminate middle age with a bad dye job and an even worse attitude. "I want Dilaudid, right now!"
Flo scans the eMAR, finds only orders for Tylenol, ibuprofen, and Norco, and informs Mrs. A. "I'm sorry, ma'am, I can only give you one of those three. Which one would you like?"
"I said I want Dilaudid," insists Mrs. A, becoming somewhat agitated. "Now go get it, or I'll call someone who will!"
"Sorry, I don't have any to give you," Flo replies. "If you want Dilaudid, we have to ask the doctor for it. In the meantime, would you like Tylenol, ibuprofen, or Norco?" In a snit, Mrs. A refuses all three and tells Flo to get out of her room. Flo heads down the hall to her next patient, a COPD frequent flyer who is at least as endearing as he is annoying. "Hi there, Pete," she says cheerfully. "How are you doing today?"
He proceeds to give her a lengthy---and exquisitely detailed---description of the quality and character of his most recent sputum as she assesses him with a practiced eye. She's dealt with fellows like him all her working life, and she's as familiar with what really ails him as he is: it's loneliness. Right now, however, he needs nothing more than a cup of hot coffee and a breathing treatment, which she provides with a smile and a few kind words before she has to be on her way to her next "customer".
Before Flo knows it, it's time for her lunch break, and she asks Mel to cover her hall while she's in the lounge. It's crazy out there, as it is on every day shift, but the teamwork is good and she never has to worry about whether her patients are being taken care of. Unlike her previous hospital, the charge nurses here don't take patients, allowing them to cover for breaks and lunches as well as emergencies; this ensures that the nurses actually get time to eat (and even PEE---what a concept).
By the time she gets back, Mel has medicated everyone and even handled the brittle diabetic in 202 who'd cursed at her and the CNA earlier that morning about the "lousy service". As a matter of fact, he kicked the matter upstairs to Charlie, the department manager, who had promptly informed the patient that his behavior was unacceptable and he would be discharged if it continued.
"Charlie just handed him the AMA papers and showed him where to sign," says Mel, grinning. "He told the guy that this is a HOSPITAL, not a Shilo Inn, and said he was free to check into St. Elsewhere across town if he wants better 'service'. Charlie's got our backs---nobody gets to treat us like that and get away with it!"
Back on the floor, Flo and the aide turn and change two of their three total cares before Mrs. A's light comes on. This time, she tells Flo that she herself spoke to the doctor, and he'd ordered Dilaudid. Flo searches the computer records for the order, and of course, finds none. It's time for a little reality check.....but instead of taking it all on herself and risking a big ugly confrontation, Flo pages Dr. Awesomesauce to the floor.
He has to come from the ICU, but eventually he does get there and Flo can't resist the temptation to listen to the conversation from behind the door. Sure enough, he orders the Dilaudid, but not before he discontinues the Norco AND gives Mrs. A a little speech on how medication orders are carried out. "The nurses are the ones with the keys to the med dispenser," he reminds her, "and they check every order to make sure that it's right before they give a medication. It's in your best interests NOT to lie to them, or make them wish they didn't have to come in here."
(Remember, this is a fantasy!)
Eventually, the shift ends and Flo gives report to the oncoming nurse, a part-timer substituting for the regular night nurse who's ill with bronchitis and not allowed to come to work. (Administration doesn't like the bad PR that results when the staff make the "customers" sicker than they were when they came in.) As she drives home to her comfy apartment, she sighs with satisfaction, for although it's been a long, hard twelve hours she can sleep tonight knowing that she's done a good job, made people smile.......and earned some pretty decent money while doing it.
And tomorrow, she gets to wake up at 0500 and do it all over again. Some things NEVER change!Last edit by Joe V on Sep 6, '13
About VivaLasViejas, ASN, RN Guide
Joined: Sep '02; Posts: 26,649; Likes: 43,165
RN and blogger extraordinaire; from OR , US
Specialty: 20 year(s) of experience in LTC, assisted living, geriatrics, psychSep 6, '13To all beef patties, special sauce, lettuce, cheese, pickles, onions on a sesame seed bun.......
This made me laugh out loud!Sep 6, '13I already feel like at times we are run like a fast food place. Make you happy, have your medical care how you want it, if not you get to **** and moan and get your ass kissed.Sep 6, '13Let's not forget to put a mint on their pillows when we turn down the covers on the bed. Love your post, Viva! Hope you and your hubby are doing well..Sep 6, '13Sounds like a typical day on a Med/Surg floor. I especially love when pts ask for IV dilaudid as they are clearly nodding off, unashamedly not trying to fight off looking drowsy. Then when you peek in on them 5 minutes later they are snoring as loud as a bear. I also love when pts ask for IV phenergan, dilaudid, benadryl, and a xanax/ativan to be given all at the same time,- well you can only have one of those right now- " Well what if Im itchy, anxious, nauseous and in pain all at the same time!" Or they will want to alternate between all of these prns all day long, with no regard to what their symptoms actually are. Good times.Sep 6, '13What's really fun is when the patient sets his cell phone alarm to go off to wake him up so he can call for more morphine/dilaudid/Benadryl. It gets even better when the patient insists, "The other nurse pushes my medicine fast for me." Oh my, the patient looks so disappointed when I inform him/her that I'm not pushing his meds fast. Too bad, so sad.Last edit by TrixieRN1 on Sep 6, '13 : Reason: grammarSep 7, '13Quote from TrixieRN1Gotta love those staff-splitters, don't you? NOT!What's really fun is when the patient sets his cell phone alarm to go off to wake him up so he can call for more morphine/dilaudid/Benadryl. It gets even better when the patient insists, "The other nurse pushes my medicine fast for me." Oh my, the patient looks so disappointed when I inform him/her that I'm not pushing his meds fast. Too bad, so sad.Sep 7, '13One of our nurse managers told us we were to wake up patients at the time a prn med was okay to give again and offer it to them. What part of prn does she not get?Sep 7, '13Honestly, if you think about it, the Denny's model of healthcare could make life so much easier.
I could stand there with one hand haughtily placed on my cocked hip, smacking my gum behind fuchsia lips while I struggle to see through caked mascara spidered eyelashes sprinkled with powder blue eyeshadow.
"What'll it be, hon?"
And the wonderful thing? My surgeon could answer me in a series of grunts, points, and hand gestures all aided by pointedly tapping the choices on heavily laminated, picture laden card-stock while making prolonged eye contact.
You know....something like this:
Which would loosely translate to:
My what a splendid evening it is, CheesePotato. This fine young gent has broken his femur and such news is both distressing and makes me get in touch with my inner feelings of sadness, because I am delicate and sensitive like a flower. That being said, I wish to place either a traction pin or external fixator in an effort to provide stabilization and I have taken the liberty of pulling those tray options myself. I do hope you do not mind. What is that? Yes, clever spud, I would absolutely need a c-arm. Oh, and be a lamb and open some dressings for when I'm done. Most good. Most good.
::displays a calm and nearly flat affect. Smiles and peacefully heads back to the ED to handle said trauma/crisis::
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