Nursing Dectective

Hmmm, immaculate make-up, not good.
"You look well for someone who's been sick vomiting for four days" I said.
"I haven't eaten a thing for four days. I feel sick still now, but I'm trying to eat" said Sarah as she took a bite of her Snickers bar.
Hmmm, Snikcers bar, not good.
"Why didn't you call me then? I was on-call all weekend"
"I didn't want to bother you"
Hmmm, birthday party on saturday night, Sarah was checked out of dorm. Was seen at party. Not good.
"Your symptoms seem a bit odd Sarah. Vomiting for four days, no diarrhoea, mild stomach ache. I'm surprised you didn't go see a doctor then."
"Oh, I wasn't vomiting... Well, a little bit on friday night, then just some nausea."
Hmmm, story has changed. Not good.
Patient looks well, skin turgor good, lips not parched, immaculate make-up, smiling and energetic.
"You had a major assignment due this morning that you've missed."
"But I was sick. I still am stick, but getting better." It was the first time Sarah had raised her voice to me. "Are you calling me a liar?"
I raised one eyebrow "Are you?"
Sarah stormed out my office in tears.

Could I have handled it better? Maybe. Probably.
Every single day it's a battle of wits. This job isn't about medicine. It's about filtering the exaggerators, the liars and the truly sick. It's about looking at the whole picture, from school grades, school behaviour, discipline issues and absent parents.

I'm told not all school nursing jobs are like this. I'm also told that I should treat the patient, the symptoms, the signs of illness. I do this. But not all the times the symptoms add up.

But any nurse knows what someone looks like who's been vomiting for four days, oh, that's right, the story has changed, vomiting a little on friday and a little nausea for three more days.

I could be wrong.
But I'm not.
This time.

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The Dumping Ground

Maria, 14yrs old, caught stealing from another student, expelled from "World's Best Boarding School."

Maria, 14.5yrs old, found intoxicated, hospital called next of kin, no answer, so called me. Expelled from "World's Elite Boarding School."

Maria 15yrs old, found semi-conscious in nightclub, missing underwear, probably sex with stranger, expelled from "World's Top Notch Finishing School."

Maria 15.5yrs old, caught drinking, given warning, caught stealing, eventually expelled from "Boarding School for the Rich and Famous."

I was there on the last occasion. "You're the only people who've ever cared for me" Maria stammered, tears streaking down her face. My colleague, Jenny, was close to tears as well. "I'm sorry, it's not up to me" Jenny said, then gave Maria a hug.

Maria clung to Jenny as if clining to a life raft. She then gave me a hug as well. We helped load her bags into the car.

Jenny is one of many kids dumped into 'Elite' boarding schools around the world. I know there must be some truly quality boarding schools out there. But boarding schools are a business, and businesses are there to make money.

I blame the parents the most. They've got loads of money, but won't face up to the responsibility of raising their children. It's when children stray they need their parents the most. But I think Maria was an exception. I think her parents are assholes at best, but that's being kind. They're abusive assholes who need should be arrested.

But then there's the schools who know each child's background. They know they won't make a difference, but they'll take the money and accept the child. There are some good schools out there that are designed to take on troubled children, but many aren't.

If Maria had been allowed to stay, I think Jenny and I could have made a difference. But there's the other kids to think of and the school decided that Maria was too much of a risk. She could have cost them money.

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If I had the Power

If I was the head of the hospital, or even head of the nursing department.

1. Double nurses salaries straight away. By doing this we would save money. We would have no problem finding nurses to work as a fulltime employee, and we'd save millions each year in nurse agency fees.

2. Have doctors' about to do surgery personally sign the part of the body about to be operated on. As far as I'm aware, when the doctor who did the surgery signed the body part, they operated on the correct limb every time.

3. In general med/surg wards limit the number of nurse/patients to one RN per six patients.

4. Provide free meals to management, but they only get the same meals as the patients. I'm pretty sure this would improve some of the food I've seen in some places.

5. Support charge nurses when they make requests for extra staff.

6. Don't force in-house job positions to be advertised outside to the wider community when we already know who we want to employ and have quietly told the person they've got the job. This would save me and dozens of other nurses time and effort.

7. Use less out-sourcing, eg Cleaners and Kitchen services. In two hospitals where I was present when this happened, the quality of food and cleaning services dropped. This may not be accurate with other places, but it should be looked into.

8. Employ doctors who speak the local language. I've worked with so many doctors whose use of the English language was atrocious and dangerous.

These are just some of the things I'd do. I didn't actually have to think about this, it just came off the top of my head. Imagine what I could come up with if I ever did think about it a bit.

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Gynae nightmares

"Stop pissing around and start unloading the fucking breakfast trolley" bellowed Bettie. Bettie was my first charge nurse and I was just new graduate. "Is this normal?" I whispered to Shelly, my preceptor. Shelly's face wore a frown as she motioned for me to begin unloading the trolley. "They're not all like Bettie. She's a bad charge nurse. Don't trust her and cover your butt" explained Shelly.

I'd only been on the job one week and I hated my boss, hated all but a handful of the staff, and hated nursing. What the fuck was I, a male, doing in a gynaecology ward? I had the worst possible start to a nursing career that anyone could ask for. The patients regularly refused to have me as their nurse and the feeling was mutual.

What did management expect? I never had an interview, the hospital took the top dozen graduated from the nursing school and placed them in wards. It didn't help that my name had been mistaken for a women's name.

And now my preceptor was insisting I do everything a female nurse did. "I want you to catheterize Mrs Jones" said Shelly. I nearly walked out then and there.

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Another Drug Talk part I

"Sir, what's the most dangerous drug around?" asked Shane. The normally rowdy class was silent as twenty pairs of eyes locked onto mine.

As usual my presentation was last minute and unplanned. It may not have been the best way to presnt such an important subject but I preferred it that way. I just told stories of the things I'd seen and done during my years as a nurse. The stories of my two years spent working in a psychiatric ward were always very poignant when it came to talking about drugs.

"Well, I guess some are more dangerous" I began, but Shane interupted "Yeah, but which ones are more likely to harm us. Which ones are gonna kill us?" I paused briefly to consider the best way to answer. "They can all kill" I evetually said. "Some slowly and some quickly. There's no safe drug..." Shane interupted me again "Marijuana's safe" he called out.

It hit me like a bolt of lightning. It was time to tell them the story of Jamie's joint.

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help me understand

Miss Wright is a laywer, an American lawyer. She had a breast cancer scare a while back. Now no one will insure her.

Mr Obama wants everyone to have healthcare, not just the poor, but even a wealthy lawyer like Miss Wright.

Can someone explain why so many Americans are against public healthcare. There will still be the private option of 'elite' care that only money can buy, but what surprises me is that some people without insurance don't want public healthcare.

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