Wednesday, September 3, 2008


I finally did it last night. I said the words, "are you an RN? Can I speak to The RN please?" The subtext is of course, you are a lowly LPN and unworthy of me even speaking to you. The reality is when one of my patients expires, it must be a RN who pronounces the death.

So I'm very sorry Nurse LPN, I know how it feels, but it had to be done. I'm quite certain you know what death looks like and are quite capable of listening to absent heart sounds for the required time. I'm also certain that when pressed, you know how to report a death to the medical examiner. I know why you were so passively aggressive toward me as I've been in your shoes.

One hundred and two years ago, when I first went to nursing school, I was looking ahead to my divorce and desperately needed a quick nursing program. Since I was going to be a single mother with bills to pay, I needed something that would get me a job somewhere rather fast. I chose a vocational program to be a Licensed Practical Nurse as my path of least resistance. It wasn't a bad little program and I learned a lot. Mostly, I learned that LPNs aren't highly respected-even when they're smart or have a boatload of experience. Many RNs and all administrators look down on them. I also learned there aren't too many jobs for the LPN. I had my choice of nursing homes to practice my trade, but that's about it.

My first job was at a horrendous little nursing home where the afternoon shift nurse (a RN), would prep the medications for the nightshift nurse. That's right. She'd take the pills for each patient out of their little identifying containers and place them in cups. The cups would go into a little well with the room number as the only identifier of the mysterious pills. This was to save the ONLY night shift nurse (me), some valuable time. Otherwise, I'd never get to go home and sleep. The most important things about a med pass, known as the five rights, are carved in stone AND written in Florence Nightengale's blood: right patient, right medication, right dose, right time and right route (and I didn't have to google the five rights to check these facts-neither did any nurses reading this.) Can you see the hamster in my brain having a massive seizure at this med set up? I remember asking the seasoned RN how I'd know which medication was which. She told me she didn't make mistakes. Okie dokie then. I quit after my one and only shift. I could not and would not work like this.

A bit later, I took a job at another nursing home. We had sixty patients on my unit, one RN, one LPN and one or two nurse assistants. The RN, a woman from India, seemed nice enough when I first met her. I thought, mistakenly, that she was joking when she told me, "IDRN, I Sit. UDLPN, udodmeds." What? For sixty people? Was she out of her mind? Apparently, she was. True to her word, she sat on her ass all night while I passed every single medication at midnight and then again, at 6 AM. Oh, she had lots of good tips about how to get this done quickly, none of them included her jumping in to help. I never finished my med pass before the end of my shift. Never.

Not once in one hundred and two years, have I forgotten DRN. I've not forgotten the way she made me feel either: small. Last night, not wanting to leave the confines of my home to go pronounce a facility death, I let the dreaded "RUDRN" leave my lips in a rather haughty way. I regret it. From DRN to DLPN, please accept my heartfelt apology.


Sandy said...

That was interesting to read and I've heard through my years of work and with people I knew who were LVN's working their way up, these types of stories.

I did medical transcription for thirty plus years and ....sure glad I don't do that job anymore.

I love how the doctors would dictate while rolling around gumballs or some such substance in their mouths, and to top it off, they usually had a difficult accent to understand.

I do not miss those days. The last few years before I quit work, were pure hell because I hated it so much.

Rudee said...

OMG Sandy, I've seen and heard doctors dictating for years. It's true, they're eating, drinking and slurping while they do it! hahahaha.

Are you aware of how much medical transcription from the states is sent overseas for transcription? I know transcriptionists who can't make a living here anymore. Someone thousands of miles away is undercutting their fees, getting the contract and doing it for a song. It used to be a decent living for people and an opportunity for some to work from home while watching their babes.

I don't know how you feel about it Sandy, but I kind of don't like someone so far away knowing all about me and my innards.

distracted by shiny objects said...

Thanks for bringing this up, and I hope some LPN's are reading it. I've worked with many LPN's that I would pick any day over some of the RN's coming through the pipeline now. When I first started working (right after the Black Plague)LPN's were staff in our 17 bed ICU, and I was damn glad they were there. Good nurses, every one of them.

Lisa L said...

Excellent post Rudee.

Sandy said...

Rudee, yes, it was getting bad before I quit. I worked at home as a "cottage" worker and had for years. Actually I worked at home before the cottage industry (home transcriptionists) were even a thought. We knew it was coming for a long time. I eventually (because of the privately owned business selling out to the "suits" found myself working for a huge corporation and they were sending their stuff out too. It was only a matter of time, so I quit before it started to affect me... although I suspect a lot was going to the overseas companies.

I use to do a lot of "ER" and orthopedic transcription and my work was decreasing in volume quite a bit towards the end.

p.s. I had one old orthopedist, who would dictate from home and you could hear his dog barking, and he would cry because he was so frustrated.. He was in his 80's and still doing surgery - scary...

I had 30 plus years of hearing these thoughtless docs dictating...

Rudee said...

Dear Distracted,

I aspirated my iced tea reading the black plague comment. Very funny.

I've worked with many LPNs and RNs who were LPNs and they are almost always the workhorses. Not too many of them sitting on their dupas,

Rudee said...

Thank you Lisa.

Rudee said...

Sandy, I don't think people really realize what a big deal this is-shipping their medical records overseas for transcription. At least here, medical employees are bound by privacy laws that may not extend where their records have gone. Not that most of us need to worry, but really, it's the point of it all that bothers me.