Nurse Ratched’s Place

This photograph was taken by the Los Angeles police department on October 22, 2006, and shows an ambulance crew taking a patient to a homeless shelter in Skid Row.

Hospitals, beware, if you’re caught discharging homeless patients to the streets, you could end up in court. The Associated Press reports that a Los Angeles hospital accused of dumping patients in Skid Row is facing criminal charges. The investigation started last March when a 63-year-old woman was discharged from Kaiser Permanente’s Bellflower hospital and was found wandering the streets of Skid Row wearing a hospital gown and slippers. The hospital is being accused of false imprisonment and dependent-care abuse charges. The city is also suing Kaiser under a state law of unfair business practices.

At first, Kaiser defended their practice, noting that there are social service agencies located in Skid Row that can help patients get back on their feet. Then, after a lot of bad publicity, they apologized. Hospital workers can no longer sneak patients into Skid Row. They have to call Skid Row service providers first before they dump patients off at the provider’s doorstep.

We do not live in a perfect world. As a nurse, I believe it’s wrong to discharge patients to the streets, but as someone who recognizes the economic realities of running a business, and make no mistake, health care is a business, I understand why patients are being kicked to the curb. There are no easy answers, and I think things are going to get a lot worse before they get better.

Warning: This post is NOT politically correct. There are two types of kids that are admitted to psychiatric units, those with serious mental disorders who need professional help, and those who need a spanking. This post is about the latter. Before you send me hate mail, please hear me out.

There’s a new diagnosis making the rounds on psychiatric units. The diagnosis is Conduct Disorder, also known to many doctors and nurses as Brat Disease. I’ve never been able to understand how this disorder develops. Let me give you an example of what I routinely see on my unit. Two highly intelligent parents bring their little darling to the hospital because he or she won’t mind their manners. The kid dresses like a thug, uses drugs, assaults his or her parents, and refuses to go to school. The parents are dismayed by what is happening. They stand in front of the nursing station, wring their hands, and say, “We don’t know why our baby is acting like this. We’re afraid of our child. Please, help us.” Meanwhile, the kid is making demands, and telling the parents to go to hell. The parents cower, and give in to the child’s demands. That’s when I step in. I tell the kid that while that type of behavior is tolerated at home, it will not be tolerated at the hospital. I let them know whose boss, and the parents stare at me, slack jawed in disbelief. Yes, Mom and Dad, it’s called setting limits.

I feel sorry for the psychiatrist. The parents are paying big bucks to have their child hospitalized, and they expect results. The kid usually goes home within three days, and like clockwork, the parents are calling the unit the next day, complaining about the incompetent doctor. Of course, the parents are clueless that they are part of the problem, and nothing gets resolved. It’s a no win situation, and unfortunately it’s the kid who suffers the most. I’ve observed that children are cured of Conduct Disorder when they turn 18 years old. After they turn 18, their condition changes into Convict Disorder, and they go to jail.

She’s back!

In today’s post, Dr. Mary R. Melendy, M.D., PH. D. tells readers what qualities make the perfect nurse.

Dr. Melendy advises the perfect woman that from time to time, she may need to hire a nurse to help care for an ailing family member. She said that a perfect woman must not only be a good mother, but a good wife as well, and that by hiring a nurse she will have more time to cook and clean, and wait on her husband. God forbid that a man should ever be expected to get off his dead-butt and help around the house.

It was hard to find a good nurse in the early 1900s. According to Dr. Melendy, the perfect nurse had a bright and cheery disposition, a light step, and a happy face. Since men were repressing women back then, I’m sure these requirements contributed to the nursing shortage. During the interview process, Dr. Melendy encouraged readers to look for a Christian woman with a pleasant voice, a cheerful smile, good dexterity, a strong back, and good culinary skills. A nurse had to be a whiz in the kitchen so she could whip up a batch of gruel when it was needed. Readers were also told to look for an obedient woman who required little sleep. Dr. Melendy warned readers against hiring anyone who was “croaker” or a “putterer,” saying that they ought to be either “married or widowed.”

It was very important that the perfect nurse know how to setup and maintain a sickroom, because without an ideal environment, the patient would never regain his or her health. Dr. Melendy said that good health depended on superior room ventilation, so the perfect nurse knew to open all the windows, even in the dead of winter. The perfect nurse protected her patient from drafts, removed wilted flowers from her patient’s room, and protected her patient’s eyes from the direct rays of the sun or lamp light. She also knew how to use a mop, and a scrub board when washing her patient’s bed linen. Like today, the perfect nurse could multitask.

As archaic as Dr. Melendy’s ideas seem today, she did give her readers one excellent piece of advice on how to find and retain a good nurse: Follow her advice, pay her well, and most importantly treat her with respect and dignity.

In my next installment of the Perfect Woman we will discuss Dr. Melendy’s thoughts on courtship and marriage.

What is abnormal? This book was published in 1964, and its cover illustrates the many misconceptions people hold about those who live an alternative life style. Susan Palwick over at Rickety Contrivances of Doing Good posed the question, “What kind of education do emergency-medical personnel get about gender and sexual identity? If they don’t get any, how can that be changed?”

I was never given any information about or training on handling patients with sexual orientation/gender issues when I was in nursing school. I went to nursing school many years ago, and my school was located in a town where people were routinely wearing white sheets and burning crosses in a public park that was designated for Blacks only. Believe me, no one in that town, or in my school talked about tolerance. I thought things would be different when I graduated from school and moved to a liberal university town, but in 1983 I nearly lost my job for letting a gay man sit at his partner’s bedside after visiting hours. His partner died of AIDS during my shift, and I was suspended for breaking the rules about non-family visitation. I’m not telling you this story because I want you to think I’m a saint, I’m telling you this to illustrate how misconceptions about people can interfere with the delivery of good patient care.

Like Kim from Emergiblog, I have always asked my patients what their needs are, and how I can help meet those needs. There’s nothing magical about taking care of a transgender patient. All you have to do is treat them like everyone else.

Here’s a picture of the hard-boiled virgin. The man is “testing” her to see if she’s done. I don’t know how a virgin becomes hard-boiled, but some of you have voiced some intriguing ideas.

Men fawn over girls who look like this young woman. I had a classmate named Mary when I was in nursing school. She was a knockout. Leagues of men adored her, and they all wanted to take her out on a date. Mary enjoyed the attention, but she wasn’t a tramp. She was a rare combination of beauty and brains, and she was very serious about her studies.

I never thought that being beautiful would have a downside, but Mary occasionally had problems with sexually preoccupied patients. She approached this challenge with dignity and grace while providing superb nursing care to dirty old men, horny teenage boys, and the sporadic sexual pervert. They would grab at her, and she would bob and weave. They would ask her out on a date, and she would tell them she was their nurse, and nothing more. Some of the men exposed themselves to her and she would just walk out of the room. I was amazed at her unflappability. She was never demeaning when setting limits on inappropriate behavior, and she always enjoyed taking care of her patients.

Maybe the hard-boiled virgin is a nurse. She looks intelligent and kind. She also looks like she can take care of herself. Watch out! I think she’s going to put this guy in his place.

What does Mother Jones RN and these boulders have in common? We’re all stoned. Get it? Those pains pills I’m taking for my injured ankle are kicking my butt.

I taped up my ankle, took my pain pills, grabbed my crutches, and hobbled to the polls first thing yesterday morning. My husband dropped me off in front of our local firehouse, and then went to park the car. While I was waiting for my prince, several people came up and asked if I need any help. Oh no, I was fine, really fine, because the pain pills were kicking in. Some very nice redneck good-old-boys let me cut in line, and my prince and I were done voting in about 15 minutes. Chivalry is not dead.

Like millions of other Americans, I watched the election results on ABC and Fox. The guys on Fox looked glum. I also heard that Vice President Cheney went hunting on Election Day. I hope someone took the buckshot out of his rifle when the election results started coming in.

Do you remember this?

Here I am at home in my favorite red gown. My prince adores me and he’s waiting on me hand and foot. He just polished my tiara. How do I look? Ok, maybe I don’t look exactly like this, but a girl can dream, can’t she?

I am a princess nurse who is very tired when I come home from work at the hospital. My prince appreciates all of my hard work, and he spoils me rotten. I work 16 hours every Saturday, and my prince serves me breakfast in bed every Sunday morning. He makes me French toast, my favorite. My prince supports my dreams of returning to school, and he takes me shopping for books whenever I want. He is kind, considerate, and patient, which is a good thing because I can get cranky when I’m having hot flashes. My wish is his command. He works on keeping the passion alive in our marriage.

When I’m not at work or at school, I kickback and relax by blogging or by reading a good book. Like I’ve said before, I’m not Martha Stewart, and if you enjoy a spotless home, don’t step foot on my property. My house is cluttered, but this doesn’t bother my prince. He just steps around the junk that’s lying around the house. It’s also a good thing that he likes to cook because I can’t boil water. The last time I tired boiling water, the pan caught on fire, but that’s another story. The kitchen is his domain, however, I do have visitation rights to the refrigerator whenever I want a can of Coke. He won’t even let me clean the kitchen when he’s done preparing our meals. The best thing about my prince is that no matter how old and wrinkled I get, he always thinks I’m beautiful. Love is blind.

I think I’ll keep him. I’m the luckiest princess nurse in the world.

Democrats, Republicans, Independents, lend me your ears. On November 7th, log off your computers, go to the polls, and vote. This is very important, people. You need to be a part of the political process.

One in four registered voters is a nurse. Unfortunately, most nurses don’t understand the political process and feel powerless to change the things they don’t like about the government. There are 2.9 million nurses, making us the largest group of healthcare providers in the country. Imagine the impact we could have on government policy if every nurse voted for the candidates of their choice.

Nurses can no longer afford to be part of the silent majority. I urge you to vote.

This is substandard nursing care. I want a Coke! My weekend is not going well. It all started when I was admitted to my hospital’s ER. I’m a klutz and I fell down some stairs while doing housework yesterday evening. People who know me know how much I hate cleaning my house—I’m no Martha Stewart—and after my tumble down the stairs, it will be a cold day in hell before I get the urge to sweep up anymore dust bunnies.

Like most nurses, I’m the world’s worst patient. I didn’t want to go to the ER last night even though I was screaming in pain and crying like a baby. No, not me, I’m on the schedule to work the weekend and I’m not going to call in sick. My ankle was swelling, so my darling husband packed my ankle in ice, elevated my foot, gave me Motrin, and I called it a night. At 4 a.m. I woke up in searing pain. I roll out of bed and crawl to my office to use the phone. I called my nursing supervisor.

Me: Hello Nice Supervisor, this is Mother Jones RN. How many patients do we have on the unit?

Nice Supervisor: Well, good morning Mother Jones RN, you’re up early. What’s going on?

Me: I fell down some steps and my ankle is painful and swollen. I think it might be fractured. I’m NOT calling in sick, but if we’re busy, is it alright if I just sit behind the desk with my foot elevated and take off orders and answer the phone.

Nice Supervisor: This sound serious. I’m marking you down as sick for the entire weekend and I want you to be seen in the ER. You may have a compartment fracture, but even if you don’t, we need to be checked out. I hope you feel better. Goodbye.

I was overcome by guilt. “Maybe I’m over reacting, and I should get a second opinion,” I thought. I called the 24 hour health hot line number I found on the back of my insurance card. I spoke to a nurse and told her what was going on. She laughed when I got to the part about feeling guilty. She said that nurses are the worst patients, and that I must listen to my nursing supervisor. She said she was preauthorizing my visit to the ER. I woke up my sweet husband from a sound sleep, and we started our trek to the ER. I’m going to live, I just have a bad sprain.

Too bad the doctors in our ER don’t look like the ones on TV. I would still hate going to the hospital, but at least it would be more fun. I’m still feeling guilty about not going into work today, but every cloud has a silver lining. Now I have more time for blogging.

My boss scheduled a mandatory inservice yesterday, and I had to go into work on my day off. No, I wasn’t happy, but it gave me a break from housework, and I got the chance to catch up on some hospital gossip. When I walked on the unit, the meeting was about to start. The first order of business was to watch a video about pandemic flu. Look at the people on the book cover. I think they saw the same video. They look scared and they are running to the grocery store to stock up on bottled water and nonperishable foods.

(Cue scary music from a 1950s B movie) World Wide Pandemic Flu: What You Don’t Know Can Kill You!

Sitting behind a desk we see Nurse Germicide, the hospital’s infection control nurse. She’s wearing her white uniform, her hair is pulled up in a bun, and her glasses are perched on her nose. She is the picture of decorum. Nurse Germicide is smiling as she reminds viewers that the pandemic flu is lurking in the shadows, and that it will kill millions of people around the world. She calmly reviews hospital policies involving crowd control, mass casualties, and how to care for patients while everyone around you is dropping like flies. She reassures hospital employees that there is no cause for panic or alarm because the hospital would be on lockdown when rioting breaks out in the streets. She also reminds staff to bring their own food and water from home because hospital supplies will quickly be depleted, and that we can’t depend on outside help from the government. At the end of the video Nurse Germicide says, “We all hope that there will never be an outbreak of pandemic flu, but if there is and thousands of people in our community begin to die, our hospital will be a beacon of hope during a time of despair.” (Cue cheery, happy music) The End.

We then welcomed the head of our security department to the staff meeting. He told us how to use a metal detector wand like the ones they use at the airports. Referring to the video, he said the wand would keep us safe when drug addicts break into the hospital during the riots. I said, “Excuse me, but a junkie would kill his own mother for a fix. How will the wand keep us safe?” He said that the wand would tell us where they were hiding their weapons, and that we could hit them over the head with the wand if they tired to hurt us. I said that if we were being robbed, we wouldn’t have to worry about finding their weapons—they would be waving them in our faces—and that when
someone breaks in looking for drugs, I will give him what he wants and send him on his way. He frowned at me. I don’t think he liked my grumpy attitude.

I know that the threat of pandemic flu is serious business, but must I hear about Armageddon on my day off? It makes me feel like I’m going into battle with Braveheart. Too bad he’s wearing the wrong kind of personal protective equipment. Hey Braveheart, where’s your mask and gown?