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.

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

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.

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.