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.

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…

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

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.

Grapes of Wrath

blogbanner_zombieprep_560x140.jpgI have struggled for years with the idea that nursing is in a decline.  I’ve used phrases like ‘transitional stage of development’ and ‘transforming professionalism’ to explain away the troubling gaps in practice observed. Or I have ascribed it to one-offs, not representative of the profession as a whole.

No more. Two events have opened my eyes to the devolution and destruction of a once valued and respected profession.

Event one: I visited someone in an acute care hospital recently. Someone who obviously needed to be hospitalized for close nursing care – because that is the only reason to BE hospitalized. On the first visit I was slightly dismayed at the disorder around the bedside, but the patient appeared clean and was improving. The next time I visited I found a someone in, analgesic and medical  respiratory distress and pain, in need of mouth care, analgesic and intervention. The NAT retrieved the RN to see about pain for the patient, and I was given the opportunity to see first hand how vital signs are taken.

A dynamap. Yes, that’s it. A patient in respiratory distress, no stethoscope, no touch of fingers on a pulse, no nursing. A automated BP cuff reading, a HR of 105 and a saturation reading of 87% and oh, let’s turn up the O2 and look 90%, that’s better, do you have a puffer?

Why are you even in this room? You don’t know what medications the patient has except to tell her that the morphine has been cut off despite the diagnosis of pancreatitis. You didn’t listen to her chest. You didn’t assess her perfusion and her ability to compensate with this health challenge. Just the numbers Mam.  You charted on the wrong chart and you didn’t wash your hands, neither did the NAT. You didn’t do a proper pain assessment. In fact you were useless.

A second event of a elicited a different type of disgust. A co-worker put in many hours creating a fun poster to bring awareness to a patient care improvement project. The poster encouraged other staff to add to it, creating a sense of engagement and just a little fun in a deadly serious work place. Many people were adding their thoughts to the poster until suddenly, someone decided that they had the right to tear it down and destroy it.

Yes, an individual, took it upon themselves to destroy the project work of another staff member.

Before 8 am I was ready to quit. People scattered as I stalked down the hallway looking for someone to provide me with answers. I want names. I want punishment and I want that toxic troll removed from the work place. Union be damned, I will find a way.

And there it is. A sad slip into disrepute, nursing slowly becomes the used car salesman of healthcare. Bullying is accepted – the nurses I talked to about the event routinely prefaced their comments with, ‘ it’s just …’

No, it’s not ‘just’ anything. This unprofessional, dishonourable action and behaviour must no longer be excused. We cannot afford to continue to look the other way, or shrug when a co-worker acts less than we expect of a professional. We must stand up to the bully and no longer support them by not speaking up. Every eye roll, every dismissive comment, every unwashed hand must be monitored for and responded to.

Nursing used to be a career you could be proud to say you belonged to. No, that is wrong – it is still to be proud of, but unless we take a stand now, immediately, we will be seeing the last days. Too soon the nurse will be seen in the same light as a physician of old – a bringer of death with unwashed hands and dubious skill. A slattern, typhoid Mary to be avoided at all costs.

My anger and disgust is morphing into a mission. A purging of the ills…and then I read the RN magazine and the multitude of disciplinary hearings for unprofessional behaviour and the ‘punishment’ of having to review 8 modules on code of ethics or some such nonsense. No wonder we are in such a state….