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.

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Well Being

The American Journal of Nursing asks whether we are well beings. They skitter around the topic of nursing burnout, brownout or flat out as a consequence of being an unwell being. Or is it the trigger of being unwell?

Nursing has always been a hard job. It is not for the faint of heart, not for the drama queens (of either gender), not for the delicate souls wounded by the world’s pain. Yet we see them there, at the bedside. The coping mechanisms nurses employ to distance themselves from the pain, deaths and fear they encounter continuously are often seen as skills.

There is technology – it has become embedded into the work of nurses to such a degree that it can, and does, offer a multitude of opportunities to divert your focus away from the patient and on to the machines, numbers and data. A ‘good nurse’ in the profession, is seen as one who can balance the machines competently and skillfully, taking off a bit here, adding a bit there, continuously adjusting and balancing the multitude of variables that get the patient through the shift. A facinating array of machines to take the place of clinical observation leading to looking at the numbers rather than the patient.

There is bitchiness, also defined as a ‘vocal nurse’ and mis-defined as a patient advocate. These are the ones that create the image that we eat our young. They also eat other professions’ young, families, other nurses, physicians and patients themselves. They make life a living hell for managers and have the union grievance process memorized and on speed dial. They take patient safety guidelines and use them to create an excuse to act in a way that should get them a time out in the corner. They bully their way through the day and have been doing it for so long that everyone one else refers to their bad behaviour as ” oh, that’s just X”. We all know who they are and they are on every unit. Worst of all they think they are the expert nurses on the unit and have a divine obligation to tell everyone else exactly what they are doing wrong. They are trolls.

There are the overtimers. They will take any and all extra shifts, at overtime only of course. I saw one nurse’s OT payout for the year. It was $120,000. For one year. Does this make the nurse a dedicated nurse, a better nurse? Hell no! Truckers, pilots, train engineers and other professions have requirements of how much extra hours they can work and still be safe. Nursing has no such professional limits set. Your nurse could be functioning on her 6th 12 hour shift this week. He could have switched from days shift to night shift with 8 hours in between. This person is mixing and administering poisons to you and titrating them to a specific effect that is desired. This nurse is expected to attend to hundreds of alarms, subtle clinical changes, new information and mix it all together and make rapid decisions about what you need now. They need to be able to communicate clearly and effectively with other health care workers about what they are seeing, smelling, hearing and feeling yet they probably have no idea what day it is or where they gave you your medication on time or at all. They are sick, forgetful and hazardous to themselves and others.

There are thousands of good, skilled competent nurses who know when enough is enough. They don’t work more than is safe, they have families and outside interests to balance them into human beings first and nurses second. They understand that the art of nursing is more important than the science of nursing. They value the young and believe in succession planning. They are not threatened when you ask what they are doing, what that medication is, and you never have to ask who they are because they tell you first thing. They are the quiet professional of nursing and we thank the nursing gods for them. They are well beings.