I've Landed!

Thursday, October 11, 2012

The ER Staff......My favorite!

I have to tell you, the ER Staff have always been my favorite people in any hospital where I have worked.  They are the front-line health care providers, the life flight personnel risking their lives in helicopters, the transport team, the  PODP's ("possible organ-donation" Pointers).

Now that I am old and likely to need them sometime, I'm glad I know how skilled and caring they are.

I trust them completely.  

I would trust them with my life in any emergency.

I have never been an ER nurse (not enough nerve).  But I have hung-out in the ER as a nurse a lot, helping a little, basking in the red hot glow of drama, avoiding the ever present containers of one kind or another of their food treats.  (ER staff seem to never go to meals...in fact I am not sure they even pee!  That is how ON-DUTY they are!)

I love these people!

One day I was just sitting there at the long counter in the ER, unneeded, watching the river of rapidity flowing by me.  I decided to do a secret audit just to occupy my mind.

Secret audits are not allowed.  Any hospital audit, to be valid, has to be trumpeted ahead of time and performed in broad daylight.  Heck, when the Joint Commission on the Accreditation of Health Care Facilities makes their visit to AUDIT a hospital, plenty of WARNING is given and they do NOT show up at 2am!
This WARNING allows the hospital to dust off the policy manuals or make sure every computer is actually working that provides access to on-line policies, etc, and it provides time for crash courses for nurses who look confused, indeed are confused.

The WARNING allows time for harried hospital Big Wigs to zip through the hospital personally looking for any outdated medication or infant formula........an exercise that increases the Big Wigs' stomach pain next day when the REAL auditors easily find outdated medication and formula!!  (Yes, we couldn't help but wonder if those auditors did show up at 2am to plant outdated medications and infant formulas!   However, in retrospect, having now been honed in terror threats, I no longer think the AUDIT people sneak in with their outdated vials to trip us up.  I now totally believe it is always an "insider" job! And since it is never targeted to innocent people but only to Administration "Make 'em sweat!", I do not believe it is terrorists....but rather insider stealth revolutionaries.   At any rate, an insider job.)

The WARNING allows the hospital to pull out their best staff for show&tell, and more importantly to hide the "Joe Biden" doctors with their motor mouths, expansive gestures and honest-malarkey-attitudes.
A Doc Martin would be ok, since his disdain is so strong he cannot even verbalize it.
It is that verbalization that brings 'em down.
Who cares what you think as long as you keep your mouth shut
and hopefully a smile on your lips.
Warm handshakes are allowed.  That's it.

My little secret audit was nothing like that, so right off you know this audit wasn't "valid".
But it was sure as heck revealing.
I had just read in an infection control journal about a VALID hand-washing audit done in a big NICU (Newborn Intensive Care Unit) east of where I was.  The bottom line: a disaster in compliance.
Highly educated, clinically competent physicians, nurse, techs, therapists..received a TOTAL FAILURE on  their individual and collective hand washing scores.  However, the article pointed out that though they did wash and wash and wash,  to be "in compliance with policy and good practice" they would have had to wash their collective hands over 6000 (six thousand) times in 12 hours.   Case closed.  

So.......I am watching my favorite ER staff.  Three outstanding AND good looking physicians credentialed in Emergency Medicine, four RN's, all Trauma Certified, Advanced Life Support Certified, Pediatric Advanced Life Support Certified.  There was an ER Tech who was appropriately educated.  There was a Housekeeper who tripsied in and trapesied out, a Security Guard who appeared and disappeared magically from time to time.   There was a clerk but I did not count her.  And there was Riverwatch, sitting on my butt wasting time, using patient dollars, doing nothing.  What do you expect from administration?  Nothing less.

My little secret audit of my own creation was to count how many times our ER staff washed their hands.  I only had a half hour to "kill"....so it would be like a "little snapshot" of practice.
In the half hour I monitored, we had two bloody traumas come in, a one year old baby girl with RSV, a heart attack victim, a sprained ankle, maybe broken, and 3 or 4 "whiners".  (Gosh, but we hypochondriacs get a bad rap!).
I was seated where I could see every sink.  Well, I couldn't see the hopper but I assumed nobody would wash there!  Of course I couldn't see the sink in the bathroom, but I could see if any staff used that bathroom and none did.  You cannot work ER unless you are the MASTER  of your bowels and bladder!......& your stomach, your nerves, your emotions, your itches, ...in short you must be master of your universe to even enter such an arena as the ER!
You are NOT expected to control your dripping sweat.
     Thus, I was sitting at the desk....a "guest", if you will.  I am not real in control of my mind & body which is why I am a Control Freak and a Hypochondriac.   Control Freaks who try to work Emergency Care crash and burn in the ER.  Always having to pee or something.
Hypochondriacs crash and burn everywhere, never dying, always whining.  Clogging the medical system wherever we light down.
  Can I just say something about hypochondriacs?  We do get sick and we do die....so run those tests!  You never know when we are for real.  Heck, WE never know when we are for real!

But I digress.  Our little patient with RSV was contagious.  But she was just so cute that the nurse assigned to her picked her up and held her close.  No, no infection control gown.  Much to the mom's delight, her little darling was trotted all around the ER, being passed from RN to RN to MD to MD to Tech, etc......all got the joy of holding her!  Except me.  I said "No thank you" and I withheld my lecture on Infection Control  saving the tale for when I  retired. Besides, you "mess up" an audit if you lecture during it, changing behavior (or NOT!).
The loving staff held her for her breathing treatments....showed her off to the heart attack victim, and especially to the whiner patients.
Nope, no infection control gowns.  Nope, no hand washing.  The staff were suddenly super busy now with those two traumas.
Finally I saw a  hand washing sink being used!  By two ambulance personnel.  They were washing a bloody back-board, and then both scrubbed their arms up to their elbows.  I was so happy!
However, those ambulance people weren't our staff.
I erased the X's.

My half hour was almost over and there had been no hand washing.
Plenty of glove changing.  No hand washing.

Then I spied Corby.  Not his real name of course since all names are changed to protect the guilty.  Corby was in the Med Room washing the sticky off his hands, the remnants of the glazed donut still sticking to the corners of his mouth.  No, he did not wash before eating.
I decided right then and there that every patient heading to the ER should stop on the way and buy a box of sticky donuts for the staff.  It's an infection control thing.
In a half hour of drama, Corby got the one and only star.  Sort of a "Lance Armstrong" award.

Next day I meandered into the ER.  It wasn't busy.  I sat down beside the best-of-the-best doctor who was busy doing paperwork.
     "Can I ask you something?"  I ventured.
     "Sure", he said, never pausing or looking up.
     "All the staff down here make fun of the Center for Disease Control.  Do you  think the CDC just hypes HIV and it really isn't that important?"
     He lifted his head, gave me a tired but contemptuous look and said, "If I even THOUGHT about HIV  I wouldn't be working in an Emergency Department."
     He threw down his pen and walked away, obviously ticked off that I had caused him to think of HIV.

     See why I love those ER people?  Not only are they masters of their own universe, they are so interested in saving you and me that they do little to safeguard themselves.

     It doesn't get any better than that.

     Except on the cross.