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.

Advertisements

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.

Why I am Quiting Today…

pixis wtf

Can you tell me what is wrong in this picture?

It might involved the cleaning lady climbing up on a ladder to remove empty medication boxes that had been tossed up on top of the automated medication dispenser.

It might involve this not being an isolated incidence, and one that is not occurring in any other unit.

Which means, it is not the pharmacy staff delivering the medication who are doing this, but rather, the nursing staff retrieving medication from the machine.

So just to be clear, nursing staff, removing medication from the medication dispensing system, throw the empty boxes up on top of the tower rather than throwing them into either the garbage, or recycling. Which are two steps to the right. And this person or persons, does this regularly.

So, what other mean, random acts of maliciousness do you perform each shift RN? If your brain see this as acceptable, what else?

I fear for our patients. Please, if I ever need critical care, don’t let them admit me to this unit

Why I am quiting, today

ICU is a terrifying place for families. They are dealing with handing over their loved one to strangers who speak a terrifying language. The families understand an occasional word of this new frightening language and yet are expected to act like it is all understandable. The rules if the ICU are strange and much like having your loved one in a prison, only at least in a prison they tell you exactly what you can and cannot do in clear words.

The gate keeper of the ICU is the Unit Clerk. This crucial role, the first face and contact is given to those least able to provide a welcoming presence. Frightened people don’t often see signs and instructions of more than a word or two – Stop. Go. – are often unprocessed depending upon the level of fear and anxiety. Yet the first person they meet when they enter this ICU is the GateKeeper. A frighteningly cruel witch who interrogates them and points out exactly what they did wrong and how they have already fail the admission test. None Shall Pass who cannot provide the correct answers.

gothic-gate-keeper-jpg-free-dark-art-and-202574This morning, a young man entered the unit. Looking around anxiously and confused he stood unsure in the hallway. From behind the desk the GateKeeper barked at him – ‘Excuse Me -Where are you Going?’

The frightened young man explained he was her to see his mother and the GateKeeper informed him

‘This is ICU. You have to call in first!’

She didn’t get up from her post behind the desk. She didn’t greet him and introduce herself and ask if she could help him. She just barked orders at him. Unfortunately this behaviour is not isolated to one individual. It is the SOP. The Standard Operating Procedure – the Way Things Are Done here that then guides anyone else who is put in that role. And so not a single person who is placed with the singular job role of greeting the families, performs as a Greeter. I have in fact observed some individuals in the role actually tell families they have to go back outside the doors and call in. Despite the observable fact they are standing right in front of the desk asking for directions. These gatekeepers are the reason today I will quit. This behaviour has been identified as hurtful. It has been recommended to be changed, and yet, it continues to be the strategy for entrance into the ICU.

I recommend we hire Walmart Greeters. At least they smile and say Hi. And they would likely cost less.

Tabula rasa

TabulaRasa

So here again is the tabula rasa before me. And the self excuses of why I have not continued to add entries to this blog. They are in no particular order:

Too busy – an all time favorite all around. In despair over the state of nursing I picked up a second job with a university nursing program to teach. Actually two programs – one for the critical care certificate and one for the international nurses upgrading to bridge to writing the licensing exam. I figured that if I couldn’t have any impact on the job maybe I could have some pre-job. Jury is still out. However, these two teaching positions required anywhere from 1-3 hours per week per student and I have managed to shepherd 21 students through their learning experience with me in the past year.

Transitioning coach – I have been diligently, and with certainly a lack of patience, assisting in transitioning the significant other to the normal life – you know the one where people don’t go to work with a gun as part of their daily tools. This has involved teaching cooking, cleaning, gardening, laundry, though we still struggle with time management we now have fresh baked bread, slow cooker meals and a grow op in the basement.

Worried about offspring – not the band, my children. While the smart twin and the pretty twin, svarn and flying-kitty-princess all assure me they are fine, I still find time to worry about at least one on a daily basis. Sometimes I will really do a work out and worry about two or three of them.

Worrying about job – well, budget. Need I say more. Well ok, maybe a bit more. I have been suffering extreme deja vu. 1974, 1985, 1990, 2013 – same rhetoric, same actions. We can’t seem to learn. Having been here before and I can read between the lines on the messages to staff from the ceo. Positions will be disappearing and my non-bedside may just be seen as extraneous. More on this.

I’m a little tired – I have joined the Gluten-free cult and still run into things that put me in a coma. Who knew that some cook would put flour in a rice dish? Upside is we don’t eat out so much anymore.

Winter in this place – 5 days to Spring 2013

spring 2013And it is still snowing. I have a firm winter policy that I don’t shovel in March, however this has been challenged this year.

Part of the solution, not the problem – this has been severely challenged more and more. As the adverse event reader for my area I struggle daily with not saying, or even thinking – “Whiskeytangofoxtrot!  WHO is responsible for this?” I know, I know – 90% or more are systems errors and not a personal fault, but jeebus save me it is difficult to understand how someone could insert a tube into a neutropenic patient despite the tube use criteria clearly indicating neutopenia as a contraindication, and it not be an individual failing rather than the system. Critical thinking and problems solving skills seem at an all time low in my profession. And instead of bemoaning this and pointing fingers I think a solution is needed, but the problems is much beyond my pay grade to fix. So how to work with what I have…

Adverse event reporting remains low throughout healthcare, and not surprisingly action on the reports that are made are frequently not solutions but more band aids. Is patient safety a buzz word of no meaning? Is it window dressing for accreditors? Words to point to in mission statements and values to show how seriously we take it?  When statements get made such as, ‘Patient safety is everyone’s job’, we know that means since it is everyone’s job we scatter responsibility to no one and as everyone’s job, it is no one’s job and things will remain the same. We will continue to have recommendations to adverse events that include ‘create a policy to…’, or, ”provide education on…” – actions that change nothing but make the board feel like something was done and a solution that can be pointed to indicate change.

Research – I have a couple studies percolating in my head. Have even reach the point of getting part down on paper. Definite interest from co-contributors, so something to look forward to going to work for if I can only get work stuff from interfering in my research stuff. I wonder if they would give me a sabbatical…? Poster is off to printers for IHI conference in London, less that a month to wheels up. Very excited to be presenting four posters at the conference.

Ok, so now I get it down perhaps I have a few reasonable explanations  on why I have not been able to write more. Perhaps, in retrospective reflection I set the bar way too high for myself, but I have to keep lowering it at work, so perhaps in response I raise it for myself?

Did I mention that mediocrity is now acceptable? Fodder for next time

zen5Stay out of the hospitals.