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.

here again

The birds were up early this morning – 3:30 I think it was. One of the joys of living in a northern climate where the sunrises early and sets late this time of year. Then suddenly at 06:00 it was silent. So silent it woke me – perhaps the end IS nigh, I thought as I pushed the cat out of my face.

A quick review of the news shows we are not in danger of the zombie apocalypse – or indeed, any other kind of apocalypse and I turn to health news.

More Hospital Deaths on Weekends reads the headline. Yes, and I know why.The thin wedge keeping you alive during the weektime admissions – the boss- is absent. Huh?

How on earth, can a group of people who never lay a hand on a patient keep them alive just by being inhouse?

Ok, I know there are a bunch of factors in this really – short clinical staffing, fewer experienced medical staff inhouse, decreased support services along with absent manager, but I am getting a sense that it really is a thin blackline protecting you during the week.

I get to receive all the adverse event reports for two critical care areas. As part of my job I am to review and investigate to determine whether there are actions we could or should be taking to prevent or reduce the chances of adverse events occurring. Adverse event reporting in entirely voluntary in our system and an interesting trend is emerging in the reports – assaults on nurses.

Now nurses have always been in line for some abuse at the hands of patients and families, particularly in the ER and increasingly with the frustrations of long wait times, but what I am seeing is a bit different. I see reports of nurses being bit, hit in the head with the call bell – repeatedly, kicked in the chest, pushed, choked and having things thrown at them. In reading the reports – often very badly written, I’m surprised at the lack of ability to spell by nurses – it seems that they were just doing their job and the patient assaulted them for no reason. But a read between the lines shows something more disturbing.

A recent report was of a man in the ICu who was banging on the side rails to get the nurse’s attention (she wrote this was his ‘chosen form of communication’). She entered the room (read stood in the doorway) and told him to stop banging on the side rails and what did he want. She then reported he just stared at her. So she writes, she told him he shouldn’t bang on the side rails if he didn’t want anything. He then threw a urinal at her.

Fortunately for her, he had been significantly weakened by his lengthy and complicated ICU and hospital stay and his aim was off so the urinal missed her.

unfortunately for him, she still didn’t get it.

So she reported this behaviour, in the adverse event reporting system, where reports of harm or potential harm to patients are to be reported. Many of these reports of assaults on nurses include similar descriptions – a nurse insisting that a patient be turned when the patient didn’t want to be turned results in being beaten off with a call bell, a nurse telling a patient and family, “we don’t do that here” after they ask for a pen and paper so he could communicate and the nurse later being pushed by the patient…what it comes down to is nurses treating patients as tasks to be accomplished, deliverable, the patient is alive at the end of the nurse’s shift.

I blame the profession of course. The biggest mistake we ever made was eliminating the hospital based training schools and move the training into the university. Nurses are no longer trained, they are educated and as a result they arrive, freshly scrubbed and polished on the ward with no idea of what the work of a nurse entails. Oh sure, they get the theory – nursing theory, mind numbing inane – but they have no or little practical experience to draw upon when dealing with ill, frightened, frustrated people.

The nurse is also frightened and frustrated because they now find themselves in a terribly threatening environment where admission of lack of skill, competency or confidence signals a weakness and the pack will turn on you and tear strips of flesh off you each shift until you either grow scars or flee.

So the nurses bully the patients, each other and the residents. The residents bully the medical students, other nurses and each other. The management either bullys or acts as a behaviour filter while they are there, which disappears the first long weekend.

The whole health care system is circling each one looking for vulnerability in another, watching for the weakest to throw under the bus…which shouldn’t really be surprising since they are only human and humans have behaved this way since before they climbed down from the trees.

Which really doesn’t help me find a solution or even a bandaid to cover the wound and promote healing.