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You Can't Polish A Turd…

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…alternatively titled “AD Lays The Smackdown On A Snurse Manager.”

Snurse = Stupid Nurse, in case you were wondering.

For the past two weeks, I have been teaching classes every day I haven’t been working, which explains the dearth of posting over the past five days. Fatigue, coupled with not seeing KatyBeth nearly as often as normal, has had me totally drained.

I’ve been so tired that even the prospect of sitting nekkid in the beanbag chair, watching Skinemax and eating Cheetos hasn’t seemed appealing.

So the Cranky Switch was set on HI this weekend for the PALS class I was teaching. To make matters worse, my lead instructor’s truck went Tango Uniform one day prior to class, another instructor’s Mom had a heart attack, and that left your humble scribe teaching Pediatric Advanced Life Support to 16 eager students all by his lonesome.

*sigh*

Now all it takes these days to teach an American Heart Association class is a brainstem and an index finger to push the PLAY button on the DVD player, but I still like to, you know, teach during those moments when they allow us to pause the Boring and Absurdly Simplistic(TM) video and discuss things.

Normally, with the appropriate cadre of instructors, I’d have broken the class into three or four smaller groups to cover the material. Small groups make for better discussions and interaction anyway. Unfortunately, aside from about three hours generously provided by the Ex Missus, I had them all in one big conference room.

Now I’m a fairly entertaining speaker. I can hold the attention of a few hundred people and get my laughs along the way. I can usually draw even the shyest, most timid new nurse grad into the discussion, or pique the interest of the grizzled dinosaur who has taken the same class ten times before…

…except for that one person, the one that doesn’t want to be there.

Those people generally fall into the category of Turds. They tend to stink up the entire class.

I have an educational philosophy that simply states: You Can’t Polish A Turd.

Any attempt at polishing will only serve to smear feces on you and the rest of the class. Turds should be flushed, and quickly.

This particular Turd was a nurse manager for a med-surg unit at Nearby Big Hospital. She was being required to take the class for work, and didn’t see the utility of knowing anything about pediatrics. Her unit doesn’t do kids, but the class was required of her for one reason or another.

To top it off, she was forced to travel an hour or so to take the class at Podunk General Hospital, Nail Salon, Tire Repair and Crawfish Hut, rather than take the pathetic exercise in rote memorization quality class typically offered by her own facility.

And when she gets to class (ten minutes late), she discovers, much to her chagrin, that the whole thing is being conducted by a – *gasp* – Ambulance Driver!

I recognized the Turd stench the moment she walked in the room, but I gave her the benefit of the doubt. I am not one of those Old ACLS Biddies who likes to walk into the room and imperiously announce before class begins, “Some of you are not going to pass this class!”

Oddly enough, the majority of Snurse Educators I’ve met believe such statements to be an excellent motivational tool.

So throughout the first couple of videos, I tried to ignore the Turd’s not-so-whispered conversations with her neighbors. I even ignored the bored and disinterested expression and disdainful looks she gave to her classmates whenever they tried to contribute something meaningful to the dialogue. I tried all the commonly used tactics they teach you in those superficial little AHA instructor courses about how to engage the Bored Advanced Participant.

Problem is, she was definitely bored, but she certainly wasn’t advanced, and calling her a participant stretches the definition of the word.

I played nice, right up to the point she started casting those disdainful looks and sighs in my direction. I can deal with the fact that her facility made her come against her will. I can commisserate that they’re holding her incentive pay as ransom.

But one does not exude an air of intellectual superiority to this Ambulance Driver, particularly when he is trying to teach you something, because unless you are a pediatric intensivist or a grizzled PICU nurse who has been there and done that, I can almost certainly guarantee that I know more about the subject than you.

So I got medieval on the heifer.

AD: “Snurse Manager, why don’t you expound on seizure management for the class? I’m sure you have something to add to the discussion. Tell us the clinical presentation of a patient with complex partial seizures, as opposed to say, simple partial seizures or tonic-clonic generalized seizures.”

Turd the Snurse Manager: “Huh?”

AD: “I’d like you to share your experience with the class. What’s the difference between a simple partial seizure, a complex partial seizure, a generalized absence seizure, and a generalized tonic-clonic seizure?”

TSM: “Uh, what happened to grand mal and petit mal seizures?”

AD (rolling eyes and sighing): “Timid New Nurse Graduate (who had been paying attention), educate your colleague.”

********

AD: “…and that’s why true supraventricular tachycardia behaves so differently from sinus tachycardia, because of the nature of the reentry mechanism. So what you do is…hang on a sec. Excuse me, TSM?”

TSM: “Huh?”

AD: “Why do you think it might be a bad idea to give adenosine to a child with Wolff Parkinson White tachycardia?”

TSM: “Uhhhh…”

AD: “You know, orthodromic atrioventricular reentry tachycardia, specifically through the Bundle of Kent. I’d like to hear your thoughts on treating it.”

TSM: “Is this on the test?”

AD: “Nope, but one of your classmates asked the question, and they all seemed to understand the answer. I was just checking to see if you were with the rest of us.”

TSM: “Uh, I’m sorry. I wasn’t paying attention.”

AD (sighing and rolling eyes): “Timid New Nurse Graduate, educate your colleague.”

**********

AD: “Okay, in summary, we had a six-year-old with a history of valvular insufficiency and arrhythmias, and a recent febrile il
lness. He was lethargic and not interacting with his environment, exhibited tachypnea with no evidence of retractions, and pale, mottled skin with a capillary refill time of six seconds. What do the Pediatric Assessment Triangle findings tell us?”

Timid New Nurse Graduate: “Uhhhh…shock? Decompensated shock?”

AD: “Excellent, TNNG! Now, lung auscultation revealed bibasilar rales, jugular venous distension and a blood pressure of only 60/30. So how do we – “

TSM (bored and disinterested): “Fluid bolus of 20 ml/kg.”

AD: “Thank you for your medically inappropriate cookbook answer, TSM! Actually, the question I was asking was ‘how do we categorize this child’s shock state?’”

TNNG: “Ummmm…cardiogenic shock?”

AD: “Excellent answer, TNNG! And how would you treat it?”

ER Doctor: “Inotropes.”

TNNG: “Would dobutamine work? Or maybe that one we talked about in the review…milrinone?”

AD: “Dobutamine would be a good choice, and since this child has poor vascular tone as well, dopamine would also be a good choice. You’ll want to stay away from milrinone in this case because his BP sucks, but I like your reasoning, TNNG.”

TSM (with just a hint of fear): “Is this stuff on the test?”

AD (grinning evilly): “Actually, yes.”

TSM (whispering to TNNG): “What was that last drug you mentioned?”

AD (still grinning evilly): “TNNG, why don’t you – “

TNNG (winking): “Educate my colleague? Sure, no problem.”

**********

AD: “…okay, so the baby’s heart rate drops to 40 during the intubation attempt. What do we do?”

ER Doctor: “Assure correct placement of the tube using clinical exam criteria and end-tidal CO2 monitoring, and resume ventilation.”

TNNG: “Shouldn’t we also start CPR if his heart rate is that low?”

AD: “Yes, we should! And what do we do if his heart rate doesn’t rapidly improve?”

TSM (timidly now): “Uhhhh…give epinephrine?”

AD: “Epinephrine is indicated for refractory bradycardia in pediatric patients, yes. Only in this case, it doesn’t work. Anyone know why?”

ER Doctor (knowingly): “Vagal response.”

TNNG (waving hand like Arnold Horschack): “Oooh, oooh! Let’s give atropine!”

TSM (confused): “Wait a minute! I should have given atropine instead? Why?”

ER Doctor (winking at me): “TNNG, educate your colleague.”

It went on like that for the better part of two days. I didn’t kick her out of class, and I didn’t ask her to do any scenarios the rest of the class hadn’t already handled. But for some odd reason, she didn’t come back after lunch on the second day. Missed the final written and scenario exams.

I just love it when the Turds flush themselves.

View Comments

  1. Dick says

    You are an evil, evil man. I just did two major presentations today in balmy Salt Lake City (insert egg/sidewalk joke here). I’ve presented for years, but your Turd Techniques are amazing.I plan to share this out with my young presenters as a best practice. And I’ll tell them it came from an Ambulance Driver, the person that I’d want handling my flabby middle-aged body (well, you know what I mean) when I’m in the ditch face down.

    on July 17, 2007 @ 11:57 pm.
  2. kingmagic says

    Sounds like a “Close Encounter of the Turd Kind!”Devilish instructional techniques there AD.

    on July 18, 2007 @ 12:19 am.
  3. SpeakerTweaker says

    Oh. My. God.I’ve got a couple guys at work that I need to have handled in just such fashion.Ever think of taking up high-end audio/video instruction?Just a thought.tweaker

    on July 18, 2007 @ 12:29 am.
  4. Hammer says

    Beautiful. Handled perfectly

    on July 18, 2007 @ 12:56 am.
  5. born_yesterday says

    Good job AD. We’ve been missing you here though :)

    on July 18, 2007 @ 1:51 am.
  6. Fyremandoug says

    Dude you are the Maestro, My EMT instructer one time told a student if they were going to act like a Turd just go out and lay in the grass with the rest of the fecalmaterial

    on July 18, 2007 @ 2:02 am.
  7. armed_and_christian says

    And this is the problem with becoming entrenched in your one specialized field of study: you not only become a know-it-all, legend-in-your-own-mind tool, but you forget how to deal with patients of other sorts who present with S/Sx different from what you are used to. Well done, AD. Since it’ll be a while before we make it back down to Louisiana to visit my wife’s family, why don’t you come up to Indy and conduct a couple Audit & Review classes?

    on July 18, 2007 @ 2:15 am.
  8. Divemedic says

    I would tell you that I ignore the videos and, you know, TEACH. I would tell you that nearly every student likes that better than video instruction.But that would require me to tell you that AHA doesn’t approve. The would also make it necessary to point out that we don’t do that, because AHA doesn’t approve.I don’t have to tell you that.It can be our secret.

    on July 18, 2007 @ 2:23 am.
  9. JeRRTep says

    OMFMind! after a very brutal 12 hrs on the floor running by very behind off catering to the whiny a** needs of all the crabby family members and my patients, I come home to hear pretty poopy news from my 14 y/o of her deadbeat daddy getting drunk last night and letting my 16 y/o unlicensed daughter drive his drunk a** home with my 14 y/o in the car as well, I needed that laugh!! and I mean you made me Laugh Hysterically!!!I’m sick, very sick of the Know-it-all’s who time after time prove they know absolutely nothing!!!YOU ARE MY HERO OF THE EVENING!GO AD! you rock man!

    on July 18, 2007 @ 2:39 am.
  10. Epijunky says

    As a somewhat timid type (at times, I’m working on it), I have to stand up and clap :) Now if you could use the Turd Technique on my I/C, I’d elevate you to Sainthood.Thanks for the great read!

    on July 18, 2007 @ 2:54 am.
  11. Babs RN says

    Heh heh. Sweeeeeeet.

    on July 18, 2007 @ 3:11 am.
  12. Brendan says

    Great job AD. Unfortunately, I’m in a glass half-empty kind of mood. Ergo, I come to the conclusion that she’ll find some other shmuck’s class that she can skate through and get a certification that has no basis in actual learning. But it won’t be on your license!

    on July 18, 2007 @ 4:33 am.
  13. USS Ben USN (Ret) says

    What a turdzilla that snurse was!No offense to Godzilla, of course.Well done, btw! Glad she didn’t clog up the toilet on the way out.

    on July 18, 2007 @ 8:43 am.
  14. CrankyProf says

    I love it when you can boost antoher timid student’s self-esteem, and get a sacker to admit that they weren’t listening.Job well done!

    on July 18, 2007 @ 11:21 am.
  15. StarfuryZeta says

    I loved the technique. Sure beats bringing a clue-by-four to class.

    on July 18, 2007 @ 11:57 am.
  16. Loving Annie says

    Very good, AD, very good. Put her in her place with exqusiite skill and scorn that cannot be complained about ! Ah yes, the joys of eliminating the bad turds without having once had to swear at them or lose one’s temper !I promise if I ever take one of your clsses it’ll be because I WANT to ! And I will pay homage to your wise instructor-dom with fresh baked goods and attentive gazes of humble adoration in your direction.p.s. I’m glad you enjoyed my blog post the other day ! Thank you for the nice comment !It was so much fun writing it — and getting the re-awakeneed naughty side of me back out of the closet, that I’ve started an erotica blog… *bombshell news delivered and accompanied by very angelic innocent look*I’d love it if you came to visit !It’s called ‘Mhmmm Yes I Love That’, and can be found at :http://www.yesilovethat.blogspot.com Hope that are scheduled for a day or two off to catch up on your rest, one of the other instructors is back to help teach the class, you get to see KatyBeth, and that you have a good Tuesday !Genuinely,Loving Annie

    on July 18, 2007 @ 12:00 pm.
  17. Jay G says

    “<>Snurse = Stupid Nurse, in case you were wondering.<>“Those of us that have read your book (thrice) already knew that… Nice story, AD. I taught Biochemistry at a state university as a graduate student, and almost without exception the worst students were the nursing student who had no idea why they had to take Biochemistry other than it was a required course.In fact, you’ve just given me a <>GREAT<> idea for a blog post…

    on July 18, 2007 @ 12:46 pm.
  18. Billy Sparks says

    I will admit when you are required to hear the same lecture for the 400th time it is boring but I try to keep my mouth shut because someone in the room might be on there first time. That is unless I really know the instructor at which point try to liven the class up with “interesting” answers.

    on July 18, 2007 @ 1:13 pm.
  19. Scoob says

    I knew I was in for a good one as soon as I read “medeival on the heifer”. Bravo.

    on July 18, 2007 @ 2:47 pm.
  20. mielikki says

    A good one. Though I was a little unnerved, as TSM are my initials, in “real” life. . .

    on July 18, 2007 @ 3:19 pm.
  21. Sarah says

    I think that I have it a little better when I teach. My bad students just fall asleep or wait until they’re out of class, and *supposedly* out of my hearing to complain about how they didn’t need that instruction. I try to be gracious when a few days later they come to me and ask me how to do the very task I was trying to teach. Management frowns on the slap upside the head approach!

    on July 18, 2007 @ 3:55 pm.
  22. phlegmfatale says

    well done!

    on July 18, 2007 @ 4:25 pm.
  23. John says

    OK dude- I have to do this-I know you have more awards than SC and LA has Mediciad Patients but I have to pass on the Reflective Bloggers Award to you. Please see my site later this evening for details. You’ll never really know how much you helped initally AD so enjoy it my friend!Should be up later this evening and definitely before nights end.John

    on July 18, 2007 @ 5:42 pm.
  24. Cinnkitty says

    Dude! Okay.. you must have been channeling my way becauase I swear I was doing pretty much the same thing with someone at work yesterday! Okay.. yours was medical and mine computer..but still…Rock on AD!! Keeping sending those “smack down” vibes my way. :)

    on July 18, 2007 @ 7:10 pm.
  25. Christina says

    Outstanding work as usual, AD.I enjoyed every word.Except turd.

    on July 19, 2007 @ 1:22 am.
  26. Loving Annie says

    Good Thursday morning , AD !

    on July 19, 2007 @ 1:55 pm.

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