About nursing heretic

I was born before the invention of television, I still remember playing outside until the street lights came on or my dad whistled for us to come home. Every year in between the then and the now has been...interesting, at the very least. I like to observe and wonder about what makes this go that or there. What I write here may be true, or I may have made it all up. You decide. Is truth stranger than fiction? Or does life imitate art?

Where is your cape?

 

nurse with woundedThe despair increases daily. Was it always like this?  I suspect in the beginning there was despair over how patients were treated, and thus was born the training programs of the Nightingale.  Cleanliness, nutrition, exercise, fresh air, compassion. Where are these aspect in nursing today?

I had the opportunity to ask a like question at a research day for nursing recently.  A room of fresh young nurses, and a few older ones and we talked.  I asked them when we stopped touching patients.  I asked if they were taught this in school and about half said yes and half said no.  How can that be?  Either this is a basic human need or it is not.  The evidence is there that it is a basic human need, so…

I told them about nursing in the 1970’s.  How the first thing we learned and what every patient received each and every day was a back rub.  I heard from the nurses in the room on possible reasons why this is not a part of what we do.  I talked to them about gloves and how touch in nursing used to mean skin on skin contact and how nurses use gloves now to protect themselves. One student said she heard a nurse tell a patient that she was not giving a back rub because she is a nurse, not a masseuse.  Another nurse, a male this time, said he would never, ever give a patient a back rub. There was talk about societal  understanding of touch, and how it is  more acceptable for a female still today to provide touch. There was caution and discomfort in the men to consider delivering compassionate touch, despite was we all know about the therapeutic benefits.

It is easier to be comfortable with the technologies of nursing, than the basis of nursing.  Touch and compassion is not seen as ‘being scientific’ and nursing carries a great shame of not being seen as scientific.  Compassion requires you to be present, to take some time, to be there for that patient at that moment, without a consideration of what came before or what comes after.

I heard of doctors ordering lotion application to get the patient touched, or hugs.  We still require a physician to direct our practice? This is not the professionalism nurses sought.  This is a façade. We would be better to go back to hospital based apprenticeships.

This drive to ensure a degree  as entry to practice is a dismal failure. We churn out nurses who don’t know and create a culture that can’t care.

But we do know APA.

The introvert’s lamment

Why oh why, great organizational gods must we ‘share’ with strangers in meetings?

_introvert-mind

I am not sure where this obscenity came from, who is the evil behind this, but I am betting it was some extrovert who thinks introverts are quiet and removed simply because they are shy and afraid to share.

Well I have one this to say,

Screw off!

We are removed and quiet and not sharing because that is how we like it.  It doesn’t mean we don’t have something to add, and when we do we will add it.  Stop trying to force us into your definition of normal organizational behaviour.  I don’t want to be social because I have only so much energy to give to this job and when you decide I need to use it up on social chitchat I have less to give to the actual productive work I need to do.

brain

So just stop.

Today I thought I would attend a morning session highlighting some of the quality improvement activities that various departments have undertaken.  There was some very interesting projects about reducing ED visits by having paramedics assess and treat in place, a unit process to accelerate getting patient a picc so they could go home and a study about errors and how it impacts health care providers to make an error.  Interesting stuff

And then it occurred.  Before the next session we were all give a piece of paper with a number on it.  And the host stood up and told us what RCT meant.  Now t most of us it means randomized controlled trial.  But here, in this setting it means randomized coffee test.  Basically you are supposed to find the person with the same number as you and spend 10 minutes talking about an improvement project you are doing – or some such thing.  I stopped listening about then.  Especially when she said no sneaking out.  And that there was no coffee.

Seriously.  If I wanted to talk to anyone about my projects I have plenty I can call.  if I want to talk to strangers I ride the bus each day.  I take a book for a reason.

What insecurity is it that extroverts house that means they have to force introverts out of their comfort zone and into 10 minutes akin to wearing an itchy wool sweater that is too small and the seams are crooked?  Why can’t we just be?

It is a daily struggle now that I share an office.  There is social conversation at least three times a day each session lasting for 30-40 minutes.  Topics range from christmas lights, to carrie fisher and then back to christmas lights. And from down the hall I can heard the cpr training AEDs directing those who will never use the training to deliver a shock

And that leaves me 1.5 hours to be productive when everyone goes home.

 

introvert1

 

Nursing is Hard

florenceYou can’t go into this thinking you are going to bring peace and comfort to patients and their families in their times of great crisis. You must shed your image of you coasting silently through the unit in dim light bringing healing to the ill, solace to the dying and wisdom of your experience to the new nurses.

You are going to have to work.  And you are going to have to document that work. Every, Single. Day.

I had the unpleasant task of sitting down with a nurse of over 20 years last night and showing her where her documentation was deficient. Now granted, the switch from paper to electronic can be a struggle, but that happened over 5 years ago and so should be nailed down. As an experienced nurse in an area where assessment is king, I would expect that understanding to be represented in the documentation.  If you did it when you were paper documenting, why would you think you could omit parts when you went to electronic?

Patient after patient the documentary followed the same pattern – it was like she disappeared every night between 0030 and 0200 and reappeared at 0500. How can you possibly remember what the 2100 urine output was at 0530?  How can you possibly expect anyone to believe that you remember the vital signs each hour as correct 6 hours later?  There is a reason block charting is not an acceptable norm in specialized areas where you have 1 or 2 patients to care for, and it has to do with you being present in the patient’s environment all shift long.  There is an understanding that in a rapidly changing environment where patient condition fluctuates the nurse is expected to be able to document those fluctuations when they occur.  If you cannot manage to do that for each patient, perhaps you should be in another area of care.

I am stumped at how a whole shift can pass without a single thing being documented.

And yes, I am peeved that every time  there is a conversation about something you need to do differently you cry and blame it on someone else. I can see emotional manipulation a mile away.

Grow learn change. You are the professional, You are responsible for the actions you take. We all are, me included

Of course in an union environment there is not impetus to be accountable and responsible.  The union will stand with you to demand that you didn’t get the correct education/training/opportunity/etc so how could you possibly be expected to do your job correctly. So why is it that other people can meet the standards?  Were they given special treatment you did not receive? I suppose that is where this is going.

Nurses want to be seen as professionals yet they continue to be represented by unions that indicate they are not professionals but rather downtrodden workers in need of protection. Make a choice.

Are they finished yet?

I know it makes me a heretic, but I hate nurses’ week.

nurses weekThe absolute ridiculousness of the ‘Thanks a nurse’ campaign irritates me. Imagine a Thank an Accountant week, or Thank Your Structural Engineer! messages.

For a group so driven to prove they are a profession, they sure engage in unprofessional activity. A lot. Do other professions need a week of the year dedicated to celebrating their existence, or is this a purely sanctimonious practice evolved from nursing and bleeding over into the other groups ?

I think having a day dedicated to Flo is great, but this self-congratulatory week of celebrating nurses is a sign of entitlement and insecurity. Get back to doing your job. Stop needing a pat on the back or some swag to show you are appreciated.

Appreciation isn’t purchased with a box of cookies, a pen or a pair of scissors. It comes from the faces of the patients and families who are receiving your dedicated and skilled care and compassion. It is seen in the rummy eyes of the 90 year old woman, all alone, in a hospital where no one visits or calls when you take 10 minutes to sit and hold her hand. It comes from the 56 year old man, scared and afraid who has to be strong for his wife and kids, but whom you let be scared and afraid.

I hate nurses week. it makes us look weak and childish needing positive reinforcement to do a job that has its own intrinsic reward, plus a fairly good salary. We get paid pretty well to put up with all the shit. We don’t need to come off all needy and attention seeking.

So stop it. Just stop. Celebrate Flo for making us respectable, but don’t demean all she did by being needy whiners.

175x225nurse_accusing1What would Flo Do?

I propose we start this as the campaign. For one week nurses will clean rooms, feed patients, wash patients, change linens and answer call bells without whining and complaining

florenceI read a blog or something on the interwebs this past week – Rules for Nurses 1887. The very sad thing were the comments from the nurses who said it wasn’t like that, they didn’t believe it and how hard THEY worked and how it was so much easier back in 1887.

Are you fucking kidding me?

nurse with wounded

Don’t let me get sick, don’t let me get sick…

I pray this daily, or would if prayer was effective. Rather a mantra instead.

Why after 40 years in health care would I be terrified to get sick, or to have a loved one ill and in the system?

One reason. Healthcare workers.

Today I discovered that the hand hygiene posters I put up to inform families of hand hygiene compliance in the ICU were taken down. Of course no one ever knows who does this. Except I think they do know. A couple years ago someone took it upon themselves to tear down a poster done by one of the nurses on hand hygiene. It was a fun, amusing poster featuring sesame street characters and humourous quotes from them. The someone in the staff was ‘offended’ and found it demeaning and insulting and tore it down.  Someone was never found.

In April we agreed to post hand hygiene compliance in areas where the public could see. On the anteroom doors to isolation rooms and in the halls. ICU staff – that mysterious ‘someone’ again, were ‘offended’  I do not think that word means what you think it means.

A hand hygiene compliance rate of 49% is shameful and embarrassing, but YOU do not get to be offended by it – the public can be offended, but YOU should simply be ashamed. Fast forward to a month later. The rate is up to 67% after a month of 49% staring you in the face. And now nurses are ‘demoralized’ and feel bullied.

Sorry again, but I do  not think that word means what you think it means. Just because you do not like something does not mean you are bullied. Just because you don’t like something does not make it offensive.

Here is what bullying it – making statement that the rates are lies, that it isn’t done correctly and taking that work down. THAT is bullying. When you say it isn’t correct or that it is lies you demean and imply I am lying and dishonest, or unskilled and don’t know what I am doing. You are bullying me and the work I do. By taking the posters down you make it so I have to repeat the work I have already done. These are bully behaviours.

But we always knew you were bullies. I have not forgotten your mob rule of 2007-2008

mob rule

So back to Don’t let me get Sick – why would I want healthcare providers who only clean their hands 50% of the time caring for me or anyone I care about? Why would I want to be in the hands of a bully?

No, I am not jealous of your hair

badnurseWhen did it become okay to nurse with your hair loose and flowing? I can live with tattoos visible and even a small number of piercings, but how, in all that is holy, do you justify having your hair hanging down?

Is it done just to see how far you can push it? I honestly thought you were a housekeeper, or maybe a service worker. I was a little suprised to see you answer the phone, though your abrupt response to the family phoning should have clued me in that you were a nurse. No one else can be quite so rude when answering a phone as a nurse.

You flitted in and out, handling dialysis and patient, phone and medications, all loose and free with not only your hair but your hand hygiene.

I would not trust you with my family to care for. Simply because you can’t even make a professional attempt to appear trustworthy. You see the young, new grad in the next pod? She has her hair pulled back and she washes her hands. She has had only one year to your 20, but she is a better nurse than you simply because she takes pride in her profession.

Your practice disgusts me. I weep for the patients and families exposed to your brand of nursing. Your lack of professionalism and just plain good sense is an affront to all who have nursed before you. Women fought and died to provide a level of nursing care beyond the whores and untrained, unclean. Yet here you are, providing what you call nursing practice, in dismissal of those pioneers who advocated cleanliness and a woman of good standing as basic qualities of someone deserving the profession of nursing.

I despair for our profession. We have come so far as to be back before we started. Weep with me.

Why I am quiting today #3

Pilot lines.

pilot lineSimple piece of plastic tubing. You know the one, often hanging down in the way during mouth care. The one used to check the cuff pressure…

The one that apparently has become a target for nurses with scissors.

In the olden days when I was trained to be an ICU nurse I was instructed that I was never to go anywhere near the ETT with a pair of scissors. Tapes were tabbed and wrapped in a specific way that they could be unwrapped without dislodging a tube. Back then ETT were re-taped daily, sometimes more and it took two of us – one RN and one RTT to manage the job. The RT was the one who handled the scissors and made the tapes…

Which brings me to now. In the past month I have received three adverse event reports about cut pilot lines. Granted one was actually cut by the patient biting through it, but the other two were cut, intentionally by a nurse. On purpose. Now it is not like this ICU has no RTs to manage the ETT and ventilators – we do. And they are always on the unit. Yet on two occasions, two different nurses decided that cutting the pilot line was the appropriate step to take. No chest assessment for tube placement, no call for help, just cut and then tell someone.

Fortunately in both scenarios the patients survived the nurses’ care and the RT was able to repair the line, but one the patient had to be reintubated because the tube was displaced.

Which brings me to my W.T.F. moment. ICU care is and always has been a team activity. Playing outside the wire makes it unsafe for everyone.

Biggest problem with this is that one of the nurses can’t quite see what the problem is with what she did. I am confounded. Again.