February 7 to March 29, 2019
Updated: Apr 11, 2019
I'm pissed at the nurseswebsite administrators because they want to restrain me in my comic expressions, so I plan to spend more time here on davey do 22 dot com.
My first hospital nursing job was as an LPN on the psych unit where I often worked as the med nurse.
Some of the patients would call the big orange metal med cart "The Drug Wagon" or various other uncomely names.
So, I had a contest with the patients to name the mad cart and I would act as the judge and select the winner. I chose the name I liked the most and lettered the winning entry on the med cart:
Sadly ,I got written up for defacing hospital property and had to remove my artwork.
I believe that was the first of many times I got into trouble as a nurse.
I work out to The Boss. I got this idea while on the elliptical.
This is a verbatim conversation I had with a high-maintenance somatic patient on Sunday.
I started this thread on nurseswebsite titled "Pyxis Problems". I asked the other members if they could identify something awry with each character. The got all except the character in front to mine.
I told them that character was choking his chicken!
" I'm tired of going into report every morning and seeing that clearly not a single nurse actually wants to do report in the patient's room, but as soon as management comes along they all scurry into the doorway quickly to avoid being chastised." -nurseswebsite
"(A patient's) family knew he was dying of chronic lung disease when he was taken by ambulance to a hospital, unable to breathe.
But they were devastated when a robot machine rolled into his room in the intensive care unit that night and a doctor told the 78-year-old patient by video call he would likely die within days."
I'm attempting to get my head around the behavior of some nurses' recent behaviors. "S" refused to intervene in a patient whose status was in a state of decompensation and "M" responded favorably to being instructed like a dog, in one word commands.
There was a recent thread where a student nurse questioned the reason why an attending nurse refused to respond with comforting measures to an aphasic patient who was in obvious distress. I came up with a few reasons which were based in feelings such as power, apathy, and fear.
But what if S gets pleasure from seeing a patient in pain? What if S, seeing a patient in pain, like one of Pavlov's dogs response of action/reaction, gets a rush of endorphins as a result?
And on the other side of the spectrum, what if M does things that causes others to react negatively toward her? What if she too gets a rush of endorphins from conflict with others?
Geriatric psych had 10 patients plus two admissions with one to be a 1:1.
M attempted to get into a conversation I was having with house sup Mandy when I pointed at the computer she had just left and said, "Chart!"
Later, M attempted to look at my computer admission process when I turned and said, "Floor!"
Like an obedient dog, she followed both of my commands.
This is my thorny crown...
16 years at Wrongway got me to thinking of other places I've worked for several years..
We ordered an expensive new couch from Anomaly Refrigeration on Wednesday. It is black leather two seater with a console storage compartment for B's knitting and stuff.
I have some drawings and other images I like and wanted to use them somewhere.
I am a lazy slug who wants to do nothing but art all the time!
Sunday night, I was assigned to work the adult women's psych unit. I don't think it was my turn to be pulled, but as I told Mandy the house sup, "The next time it's my turn to be pulled, I want a Get Out of Jail Free card!"
After getting shift report at about 1920, I introduced myself to the patients in the day room, and met them each personally. Then, in the company of the LPN, I went looking for the infamous patient, Marie A, who had been responsible for at least six staff injuries. Marie A truly was, the Psych Patient From Hell. I could go on and on and on, but please accept my label.
At 1925, the LPN and I found Marie A on the floor, laying face down, between the beds, unresponsive. We couldn't see her breathing, she did not respond to our shake n shout, so we log rolled her to a supine position, as she was wearing a neck brace. The LPN did sternal rubs while I checked for a radial pulse to no avail. I told the LPN to go call a Code Blue and I tilted the patient's head back as best I could and got an sound like a snoring suck of air. Spontaneous respirations were present, I found a pulse, so I yelled, "Make that a Rapid Response!" and I checked her pupils and lightly patted her cheek.
Marie A was groggy and slow to respond when the RR team arrived, we assessed her, backboard, gurney, yadda yadda yadda, and she left the unit at 1945 for one of her many trips to ER.
At about 2200, I was in the process of admitting and getting med orders for a suicidal patient sent from ER suicidal positive for heroin, amphetamines, and cocaine who was yelling profanities and acting out when she knocked over a WOW. The tech and I assisted her into the locked seclusion room.
About that time, Marie A returned from ER via wheelchair. I advised that she return to her room when Clark started some ramma lamma ding dong with her. I got between Marie A and Clark and proclaimed, for safety's sake, she needed to return to her room.
In assisting Marie A to her bed, she became threatening and combative. A code Green was called and, with the assistance of Clark, techs, and security guards, Marie was therapeutically held. I recited, in a voice to be heard by everyone from rote memory, my spiel about the reason for the therapeutic hold, the legal process, and the criteria for the restraint to cease. I also said that I was going to contact the doctor for a chemical restraint.
I went back to the nurses station and Mandy the house sup, God bless her, had gotten an order from the psychiatrist for Thorazine 50/Ativan 2 IM now. I set up two syringes and returned to the room to find Marie A out of a therapeutic hold. I said, looking at Clark, the staff member who certified me in CPI, and recited, "Only a licensed practitioner can discontinue the restraint process"!
As I said, " Sunday night, I was assigned to work the adult women's psych unit. I don't think it was my turn to be pulled, but as I told Mandy the house sup, 'The next time it's my turn to be pulled, I want a Get Out of Jail Free card!'"
Mandy asked me what I meant by that and I said I'd come up with something she could sign:
I was in medical records at Mixed Nuts Health Systems back in 2002, looking through a client's chart. I wanted to note something and couldn't think of the name of those sticky yellow pieces of paper.
I asked the secretary, "Could I have one of those... oh you know... 'pasties'?" She laughed and said, "Do you mean Post-Its?" I replied, "Yeah- that's what I mean!" I paused, looked pensively and asked, "What is a 'pastie' anyway?" She said, "It's those things strippers wear over their boobs".
So, the OldDude has a point: The house sup should take both of the Post-Its in case she decides to be a stripper who uses Post-Its instead of pasties!
From The Anomaly Telegraph:
Situation: On the psych units at Wrongway Regional Medical Center, 15 minute Patient Safety Round Forms are completed on the MN shift. Copies of the completed forms are made for the house supervisor to pick up when she visits the units and the original is placed in each patient's chart, usually by the charge nurse.
The house supervisor comes to the geriatric psych unit while all staff members are out on the floor providing direct patient care and finds two stacks of the completed Patient Safety Round Forms in the nurses station:
Since black ink is used for charting, it is difficult to determine which stack are the originals and which stack are the copies.
Which stack of for ms should the house supervisor take with her ?
A nurse wanted suggestions on how to curb a patient's behavior who was "faking illnesses.. and getting worse recently".
I used this image in a thread on nurseswebsite where the writer started out with "Unless you've been living under a rock..."
A nurse complained that the hospital where she worked was being real scrimpy with inconsistency briefs, wanting to cut costs on supplies and kept them under lock & key.
I am not waiting until I retire to start doing what I really want to do. Sure, I'd like everything to be the way I want them and not have to be responsible for anything, but it just ain't going to happen. So I'm responsible as much as I absolutely have to be and the majority of the time, I do what I want.
Well, I did take care of some business. Just what I absolutely had to do. Then I went for one of my rare-this-year bike rides, a ten mile round trip to Walmart for wine, a ring pillow, a couple of DVDs and some other stuff.
It took me over 45 minutes to get there with the winds blowing out of the SSE and less than 30 minutes to get back home.
I worked with Marsh Ella and Nickle on Sunday night. Marsh Ella must have started some shit with Nickle because Nickle requested to the House Sup Mandy not to work that shift with Marsh Ella.
I believe this may be the third nail Marsh Ella has driven into her coffin, as she's been called down to Inhuman Resources twice because of complaints by Fridgett.
This was not Rooty's weekend to work but he picked up a shift and Eleanor picked up 8 hours on Saturday, so the Dream Team was together both Friday and Saturday nights!
I've had problems with them since I was 16 years old. I haven't had trouble with them in years, I believe because I eat relatively well, lots of vegetables & fruit, take probiotic & Vitamin C with fiber every day, regularly exercise, and pretty much watch my weight.
But they came on with a vengeance, probably because I've spent weeks sitting in my Art Room.
"I thought Perry had a glass eye", the LPN pulled from another unit asked me as I was setting up HS meds Saturday night. "He does", I replied. She said, "Well, he doesn't now".
The tech sitting with Perry on a 1:1 found a convex prosthetic eye on the mat beside Perry's bed. Believing it should have been spherical in shape, I closely searched the floor for fragments and examined Perry.
No fragments were found and the area where Perry's prosthesis had been appeared to be healthy mucosa.
Imagine my surprise when I found out that most prosthetic eyes are not spherical globes in shape!
To quote Gomer Pyle, "Surprise, surprise!" The 8 hour inservice wasn't all that bad.
We started with introductions and we were to give our name, title, and home unit. I sat at the back of the room, so I was the last to introduce myself and said, "I'm Richie Cunningham, CEO, your boss, Ivory Tower, and I proclaim 'No Inservice Day'! "
It got a laugh.
The initial presenter, Chrissy RN, is a supervisor with whom I respect and she said, just to make sure no one would get up and leave, "That's Davey Do. He likes to kid".
Lo and behold, she gave a really interesting presentation which centered on a new type of rating scale for suicide called the Columbia. It's an evidenced-based rating system which will soon be implemented at our facility. The Columbia system will change the manner in which we assess potential patients and, subsequently, the type of interventions we employ.
The subject was so darn interesting to me that I asked many questions and cited information from collateral resources which supported the Columbia's rating system. It felt neat to know a system was being implemented which didn't cause me to roll my eyes and say, "Oh gawd!".
Another neat thing about it was seeing Chrissy's excitement rise as I asked questions which allowed her to share more of her knowledge about the subject.
So, the first two hours of the 8 hour inservice held my interest.
I'll probably share more as I sit in my art room going through my notes, editing my sketches, and reliving the day...
Years ago, a buddy of mine owned and ran a Head Shop in downtown Anomaly Illinois where he sold paraphernalia under the guise of a tobacco shop. He was closed down one time by the police but was allowed to reopen and operate because nothing he sold was in and of itself illegal.
One part of the inservice was on contraband patients may bring into the hospital. A video was of a police chief who showed examples of how some dangerous contraband could be disguised as ordinary items. One particular item was a surgical steel blade disguised as a common ink pen. The police chief said, "One of these can be purchased for about seven dollars".
I wondered how distributors could advertise such an item on the up and up:
Of course some of the inservice was the same old song and dance.
Maybe it'd be more interesting if the made a Rock Opera out of it.
The psych division of Wrongway Regional Medical Center (WRMC) is primarily housed in its own building adjacent to the medical center. Geriatric psych is housed in the medical portion of WRMC, so I don't know the psych division building as well as I do the medical side.
We had the last part of our inservice, the portion of CPI having to do with take-downs, restraints, etc in the gym of the psych division basement which has a gym. When we done and informed the inservice was over, we headed out the door like Bob Seeger leaving a Disco.
Some went for the elevator, while I asked Colby, a big gentle bear of a male RNwho usually worked in the building, "Is that the door to the stairwell?" I pointed, Colby told me it was, and I opened it only to set off an alarm. Colby yelled, "Let's get out of here! Quick!"
Colby and couple of others bounded up the stairs with me in the lead. I came to a half gate, tried it and said, "It's locked!" and jumped over. Colby came up behind me, took hold of the gate, opened it and and calmly said, "Dave- it opens the other way".
Embarrassed, I said, "Yeah! But weren't we just like the Beatles in the stairwell scene of 'A Hard Day's Night'?!"
This is a thread I stated on nurseswebsite titled "Jason Hiney RN":
Jason Hiney RN was a relatively new nurse when he was hired at Wrongway Regional Medical Center (WRMC) to work MN weekend option primarily on the adult male psych unit some ten years ago. Jason was in his late 20's, had about a year experience in LTC, and I quickly perceived him to be very intelligent, charming, and one of the funniest people I've ever met.
Jason and I were coworkers/friends, which means that I have no personal relationship with any of my coworkers outside of work, but at work our relationship goes outside of a totally professional one. With Jason and me, for example, he has helped me with some computer and automotive problems and I have helped him with a lock problem and loaned him a little bit of money. Nothing terribly involved, just stuff a couple of chums would do for each other.
Jason quit WRMC a few years ago to work in home health and to be able to spend more quality time with his family. He remained per diem, working a shift here and there.
Shortly after Jason left WRMC full time, the institution gave phenomenal raises to its nurses based on other facilities' pay rates and I can tell you, my raise was outstanding!
Jason attempted to get hired back to his old weekend option position in order to cash in on the pay raises, but was informed that the weekend option program had ended for the freshly hired nurses. In other words, those of us who were in the weekend option program before would continue, but newly hired or rehired nurses would be scheduled to work every other weekend.
So Jason continued to work in home health, stopped picking up per diem shifts, did not continue his mandatory training at WRMC, and was eventually terminated all together.
WRMC's psych division utilized the medical side's house supervisors for several years on the weekend and MN shifts and they were generally worthless. So WRMC psych division began hiring nurses, both within the facility and from the outside, for their own house supervisors. Jason applied for one of these positions as psych division house supervisor and was hired.
A week back, patient Perry Penguin, who was on a 1:1 status fell on the geriatric psych unit while I was charge. I questioned the tech assigned to watch Perry as to what had happened, assessed Perry, and found no apparent no injury. I contacted the NP and got an order to reduce one of Perry's BP meds. I contacted the wife and she informed me that two physicians had suggested the fine tremors I had noted while performing an accucheck could be benign tremors or Parkinson's. I contacted Dr. Banjo, the psychiatrist who had put Perry on a 1:1, and he wanted to be sure staff was following a strict 1:1 protocol. I informed the tech who was with Perry what Dr. Banjo had said. I contacted the house supervisor, Jason, informed him, and requested the Final Fall Form that the house sup and nurse need to complete together be generated. I documented the situation in Perry's nurses notes and completed an incident report.
This weekend, my supervisor, Roofelmo, approached me and said the Final Fall Form had not been completed. She had read my nurses note and had asked Jason about it and, according to Roofelmo, he denied that I requested the completion of the form.
I feel like kicking Jason in his Hiney.
A psychotic geriatric psych patient who calls himself Bob, has a history of being naked flopping around on the floor like a fish, was saved from falling off a bedside table, and grabbed my crotch like a shopper would grab sale merchandise at a blue light special, is doing better. He now keeps his clothes on and can be out with the general population while on a LOS (line of sight), always in view of a staff member.
Bob's behavior continues to be inappropriate, but not to the point that he is a threat of harm to himself or others. He was manifesting some behavior toward me, and I believe I know the reason:
Candy, a female patient with an axis II diagnosis of a borderline personality disorder (BPD), has lately been in the same area as Bob. I have a method of dealing and interacting with patients with BPD in that I am basically unemotional, concrete, direct, and do not engage in an argument with them, or respond to their challenges in depth. Patients diagnosed with BPD have a tendency to try to manipulate conversations and situations, resulting in discord.
Being straight-forward and firm in Bob's presence probably caused him to react like this:
I worked the desk Friday and Saturday nights, and had a couple of admissions, so I didn't have nearly as much interaction with the patients as I do when I work the floor. Sunday night Sharn worked the desk so I made rounds, did direct care, and took turns sitting with Perry Penguin who was a 1:1 and Bob who was on LOS.
While the other two who were working the floor sat with Bob, he slept. At 0330, soon after I sat down to observe Bob, he woke.
Bob turned to me, smiled, and stretched out my name, saying "Daaaave". The other thing about the way in which he said it was to start out in his normal tone of voice, but as he finished, he ended in a bass tone. So I responded, "Booooob", stretching out his name, starting out in my normal tone and ending in a bass tone.
We exchanged each other's names back and forth several times:
"Booooob". . .
Then I said, "Booooob and Daaaave" and he replied, " And Daaaave and Boooob". We repeated this too several times:
"Booooob and Daaaave".
"And Daaaave and Boooob". . .
Finally, in the same manner, I said, "Hooooow iiiiiiiis Boooob?"
And he replied,
which he is!
Oh, they wanted me back, with two RNs on vacation and two who called off. I was on the adult women's psych unit for the first four hours and geriatric psych for the lat eight. Six patients, two 1:1s and an admission without Eleanor.
People are so drawn to drama.
The drama thread gets voluminous replies, yet a thread about Abraham Lincoln and a nurse gets two.
It's always enjoyable when someone asks me to draw an idea of there's. Here's one from the the School Nurses forum on nurseswebsite where a member asked me to draw Tina Turner running on a Hamster Wheel singing a version of "Proud Mary":
He is a 58 year old ex CNA dementia patient who was admitted for aggressive at the nursing home. Also aggressive in ER it took Haldol 5, Ativan 2 , Benadryl 50 IM and 4 point restraints to control his behavior.
I thought he was a cute little guy and in my journal entry I drew him as an unsteady Perry the Penguin.
The next day he kicked Dr. Banjo, had a fall on MNs while on 1:1, and vomited.
If I didn't have work, I would have to look elsewhere to find inspiration for my art.
The naked mam falling crotch-grabbing patient got better, donned clothing, and was behaving relatively appropriately on he Friday day shift. Later in the shift, he was flopping around on the floor like a fish and I charted his movements as "coarse and undifferentiated" due to his movements reminding me of those of an infant before the nerves are completely myelinated.
The two characters' images used in my Comic Club header from a comic drawn in December could be used again be used as both were on geriatric Psych this past weekend.
This was the initial conversation the young nurse and I had:
Well, she may not be the same nurse, as all young people look pretty much the same to me. Regardless, she did a good job and was pleasant with which to work.
The patient was a little more difficult:
Jim got up in the middle of the night and shot all of our heads off. I told Jim we didn't use them anyway and would he please be more quiet and put a silencer on his gun?
On Monday morning, while providing direct care to a patient incontinent of urine, my employee badge broke in two. I repaired it with some Scotch tape, but knew the repair wouldn't last long. It's as Garrison Keillor said: "All repairs are temporary".
So I bit the bullet, stayed a few minutes after work until Inhuman Services opened, and got me a new badge.
I had that old badge for years and had previously repaired it with micropore tape. That micropore tape is great stuff!
I had an admission Sunday night and contacted the psychiatrist, Dr. Dadda for orders. I read to him the home med list which the ER had entered. He gave the okay to continue the home meds.
ER is infamous for entering into the home med list whatever the patient says they're taking without verification, and two of the meds were controlled substances that did not show up on the patient's UDS.
The patient's preferred pharmacy was closed and I could not verify that the patient was actually prescribed these meds. I informed Dr. Dadda of this, that the patient had a history of non-med compliance, and requested that we hold off on putting the patient on these meds until the the day shift could contact the pharmacy to verify the patient's med regimen.
Dr. Dadda agreed with my request and routine PRNs were ordered in the meantime to get the patient through the night.
The next morning while walking down the hall after getting my new badge from Inhuman Resources, I ran into the house supervisor, Jason Hiney RN. Jason was loudly talking and kidding with some fella who was some ways down the hall.
I heard Jason refer to the fella as "Doc" and when the conversation ended, I asked Jason who the doctor was. He replied "Dr. Dadda".
Working weekend MN shifts, I rarely see the psychiatrists and Dr. Dadda is relatively new to WRMC, so I have never met him face to face- only talked with him on the phone.
I really wanted to meet Dr. Dadda, as he has a good reputation and always pleasantly answers his pages, so as he left and turned a corner, I called out "Dr. Dadda!"
I hurried quickly down the hall, turned the corner, but there was no Dr. Dadda. I waited a moment to see him duck out of the snack bar and again called, "Dr. Dadda!", but he hurried on down the hallway. Then I called out,
I was wearing my black scrubs, had on my black leather jacket with my black leather baseball cap, and my black leather bag hung from my shoulder. When I called out "I'm nurse Dave!", Dr. Dadda turned around and said, "Oh! I thought you were some motorcycle rider gang member stalking me!"
We had a good laugh and nice chat after that.
Wadley passed away on Thursday the 7th. That was quick. I heard about his illness the 21st of January and he was gone a couple of weeks later. (See Davey Do's Diary January 21, 2019.)
I don't fear dying as much as I fear living in pain.
Having fun on nurseswebsite with the Old Dude as Indiana Jones:
A member on nurseswebsite asked what the ice water passing procedure was on our units. I thought I'd draw them a step by step illustration:
But I warned...
Another member suggested having the water blessed by a Priest so when staff got hit by the water, it would be holy water. Yeah, but...
I'll brief through posts on nurseswebsite and then draw the first thing that comes to mind. I read a post about a germaphobe who meticulously cleaned her car after coming home from work.
I was going to post this comic until I reread her post and saw saw was behaving this way after experiencing some trauma:
For some reason, Davey Do's Diary got deleted. I found the last version of it but have been unable to restore it. Until then, the last version is still visible online as long as I don't publish the changes and make everything go away.
I know. It's confusing to me too.
Update: I got Davey Do's Diary back,and ended it. About six weeks of a daily thread is long enough.
Last night before I went to bed, I kissed B goodnight, breathed in something, and had a coughing fit. I thought I had gotten it out but the little booger is still bothering me.
It's probably really an inoperable terminal tumor.