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.

Does it make sense to use car safety seats only sometimes, or only when children are older?

Rebogging. It’s not the same as doing it yourself, but still….

The Pediatric Insider

The Pediatric Insider

© 2013 Roy Benaroch, MD

Trusted Pediatrician: “Mrs. Johnson, Bobby is doing great! He’s growing fine, and doing all of the things a six month old baby ought to do. What questions do you have for me?”

Mrs. Johnson: “Well, now that he’s six months old, and I’m wondering if now is the time to start using his car seat.”

Trusted Pediatrician: “Now? You should have been using a car seat all along, every time. We’ve talked about that, it’s on our handouts, it’s on the sheet from the hospital, it’s recommended by every health authority in the entire world.”

Mrs. Johnson: “Oh I know that. But I did my research on Google. So I know young babies aren’t yet developed enough to use a car seat. That’s why I waited.”

Trusted Pediatrician: “Car seats are specifically designed and tested in little babies. They really need to…

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So this is what nursing looks like in 2013

nursing

I shake my head so much at work I am going to file for workplace injury.

This week alone I heard of a nurse who indicated an interest in a specific leadership assignment in the unit, but was not considered and now she is all up in arms and filing a grievance. Know why she wasn’t considered a suitable individual? Because she can’t work a full shift. She is ‘medically accommodated’ to work 10 hour shifts on any Monday and Wednesday she works. Why? Because she is going to ‘therapy’ at 17:00. Not physio for an injury that is going to improve, but psychiatric therapy for a break that is never going to heal. So this means ever week at those times, her patient assignment is handed over to another nurse so she can leave and go to therapy. Why can’t she book these appointments on her scheduled days off or trade shifts so she can actually do a full day’s work on the days she is scheduled? Seriously, I asked the same questions.

Or consider the veteran nurse who was administering a patient’s oxycodiene. She went to the automated dispensing cabinet and removed 5 tablets for the dose. The ordered dose was 5 mg. The tablets come in 10 mg. It says when you go to remove the medication what the ordered dose is for that patient. Then she took the medication to the patient who refused it – she had been refusing the medication for several days. So fortunately the patient didn’t actually receive the fatal overdose. But the next step will astound and horrify you. The nurse left the medication at the patient’s bedside where it was found a couple days later, in the bedside drawer by another nurse. Whiskey. Tango. Foxtrot.

It starts early. Nursing students who expect ‘medical accommodation’ in their practicum rotations because they are immunosupressed. Oh and they wont be getting any vaccinations either.

In an attempt to train or even shame nurses into providing basic nursing care the educators on one service have put up a sign over each patient’s bed that says ‘Have YOU brushed my teeth today?’ Some staff love it, but there are about 50% who are offended. There seems to always be 50% offended. Grievance? Sure. I am offended. Next week it is going to be ‘Please clean your hands” right there, right over the bed. Going to ruffle some feathers I suspect.

The stories go on and on and I continue to wonder at any impact I might be making. It isn’t just nurses making idiotic decisions. Found out this week that using a bladder scanner is a nursing activity denied to LPNs. Why? Does anyone know why? They can use a doppler. They can give IV push medications, but they cannot use a bladder scanner? How does this make any kind of sense?

Perhaps that is the answer. Ultimately the world has gone restriction mad and the only possible response is to abdicate all rational thought and action in the face of so much silliness. Are the idiotic behaviours we see in the workplace simply a response to the overwhelming stupidity of the licensing and regulating bodies that tells us what we can and cannot do?

As good an answer as any.

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….