Archive for July, 2010

Favourite Poems XV

Death be not proud, though some have called thee
Mighty and dreadfull, for, thou art not soe,
For, those, whom thou think’st, thou dost overthrow,
Die not, poore death, nor yet canst thou kill mee.
From rest and sleepe, which but thy pictures bee,
Much pleasure, then from thee, much more must flow,
And soonest our best men with thee doe goe,
Rest of their bones, and soules deliverie.
Thou art slave to Fate, Chance, kings, and desperate men,
And dost with poyson, warre, and sicknesse dwell,
And poppie, or charmes can make us sleepe as well,
And better then thy stroake; why swell’st thou then?
One short sleepe past, wee wake eternally,
And death shall be no more; death, thou shalt die.

— John Donne,  Divine Sonnet X

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Nursing Program Teaches Students to Act Like “Real” Nurses

I am really trying to understand this:

A new cap on class size in the University of Manitoba’s nursing faculty has left some students fuming after learning their studies have been put on hold.

But the faculty’s dean says the cap is meant to benefit fourth-year students, whom she says were told about the plans at their orientation in March.

Nursing students contacted the Free Press after showing up to enrol for classes last week and early this week, only to find key courses were full.

In other words, after spending thousands of dollars in years One through Three, these nursing students won’t be permitted to graduate because the nursing faculty didn’t have the foresight to plan properly for their students. Or maybe the UM nursing program is trying expose their students to real world bullying and nastiness, in the best nursing traditions of eating our young. Good role-modelling, that.

There is a justification for this, of sorts, under the category of blaming the victim:

Faculty of Nursing dean Dawna Crooks said students were told in early spring that changes were coming down the pipeline.

“They were warned that we were controlling the numbers in the courses by semester, and that if their GPA was lower, they would have more difficulty,” she said.

Oh yes, we’re only preventing the ones with lower grades from graduating. We warned them. If there’s going to be finger pointing, it should be back at the students. Et cetera. A couple of problems with this explanation. First, it implies if everyone got straight A’s, there wouldn’t be an issue. Clearly, this isn’t true: class sizes were going to be capped regardless of GPAs.  And if the UM nursing program was attempting to get rid of students it thought were going to be practising at an undesirably low level, why did it choose this back-door method of booting them out of the program? The official explanation doesn’t inspire a lot of confidence in University of Manitoba Nursing or its integrity. Potential students, be warned.

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The Reality Check

A Tragedy and Farce in One Act.

(Curtain rises to reveal a busy Resus Room setting, full of patients, families, and nurses. Occasional moans, and nurses calling out, “Can you bring me a syringe?” and “I need the doc in here stat!”)

(A patient’s husband approaches a Nurse, who is drawing up some drug or another.)

Husband: (very angry and yelling loudly) My wife is having a stroke! I have never seen her act like that? There is something seriously wrong with her! And you guys are doing absolutely nothing! I have never seen such incompetence!

Nurse: (calmly, looking at syringe) She’s receiving appropriate treatment. We have assessed her, positioned her so she maintains a patent airway, started an IV, drawn bloods, and monitoring her heart rate and rhythm. . .

Husband: (the same) I’m an RN in the ICU at Holy Somolians Hospital downtown.

Nurse: But. . .

Husband: I know when someone is neurologically impaired! You guys don’t know you ass from your elbow! She needs a CT, stat!

Nurse: (a little exasperated) If you work in an ICU, you would surely recognize an ethanol level of 83.*

Husband: What? That’s impossible! (voice trailing off) She doesn’t drink, she quit a couple of years ago. . .

(Curtain.)

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*In perspective, you’re considered legally impaired with a level of 17.

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Nurses are Bimbos, Aren’t They?

And then there’s this shite, wrong in so many, many ways, again via The Truth About Nurses:

If you are gorgeous, compassionate, and ready to star in a hot new television show, this may be your big opportunity. Studio Lambert, the production company behind the mega-hit CBS show Undercover Boss and creator of Project Runway, is teaming up with MysticArt Pictures and they are searching for dynamic nurses and nursing students for a new docu-series titled Cali Nurse.

Cali Nurse will be a light-hearted, sexy docu-series that follows a group of young nurses and nursing students as they experience comedy, romance, and fun. The girls will eat, sleep, and live together while viewers watch what unfolds at the house, at the hospital, and in their social lives. Nobody knows more about helping people than nurses, giving viewers the opportunity to see their big hearts and caring ways at work. Studying for practical exams, dates with McDreamy, and working an extra job in your spare time – the TV audience will see it all as the show captures the lives of those learning to save lives.

Sexist and demeaning and devaluing to nurses? You think? There is some sort of letter-writing campaign against this, but I guess it will deter the producers not in the least. And I don’t doubt either there will be no shortage of nurses or nursing students* willing to contribute to the bimboization failing to appreciate the dignity and value of their profession.

Also, it reminds me of this.

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*Aside: Any nursing student considering doing this, needs to seriously and reflectively think about being a nurse.

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“The Doc was Awesome!”

When I was but a nurseling, working in a hospital way out in the sticks, it was a pretty common occurrence for someone or other to come up to me in the grocery while I was picking over the melons or something, and say, “I am so much better now, thank you, thank you.” I hardly ever remembered them at all, but that was okay. It was nice they noticed despite their fractured tib-fib/DVT/SVT/head injury.

Far fewer people approach me now in the big city. Occasionally I see the odd ex-patient, though. Last summer I was in Merrickville, way out in Eastern Ontario, having dinner at a bar; a guy saw me, and said “I remember you. You were there when I had my heart attack. The doc was awesome! He saved my life!”

Well, I thought, actually no. I did remember this guy, who came roaring in with the proverbial elephant sitting on his chest, and smelling like a two-pack-a-day habit. He was a bad anterior wall STEMI. The doc emphatically did not save his life; we as a team saved his life. As for the nurses, we

  • identified his chest pain as probably being cardiac in origin
  • gave him ASA
  • got the diagnostic ECG, saw it was an MI, and promptly alerted the physician to his presence
  • did the usual secondary assessment, hooked him up the cardiac monitor, provided oxygen, and started two IVs
  • prepared the thrombolytic drug for IV push
  • ordered the chest x-ray and drew bloodwork
  • Pushed the thrombolytic, gave him morphine, metoprolol, and enoxaparin and sedative

All within ten minutes of arrival. And apart from the thrombolytic and the other meds, before the doc even laid eyes on him. The nurses’ role in this was slightly more than secondary and hand-maidenish, wouldn’t you think?

I was reminded of this incident yesterday, when I saw this on the The Truth About Nurses website:

Physicians are Awesome

Tonight ABC will air the fifth episode of Boston Med, the eight-part documentary about the work and personal lives of health care workers at Massachusetts General, Brigham and Women’s, and Children’s hospitals.

[snip]

But the new series has received an amazingly positive reaction from some reviewers and even some nurses because, along with the 16 physicians and surgeons profiled in the four episodes that have aired so far, there is one nurse! In a few scenes, this MGH nurse, Amanda Grabowski, displays technical knowledge and gives viewers some sense of nurses’ roles as patient advocates and autonomous practitioners. But as the episodes go on, the show steadily forgets her clinical work, focusing instead on her social life. This approach undermines the sense of her as a serious professional, and even flirts with the stereotype that nurses are mainly about romance.

[snip]

But it’s unlikely the nurse elements will have much impact alongside what will likely be profiles of some 25 physicians, especially since those profiles utterly ignore the nurses who actually provide most of the skilled care to the patients portrayed. The overall message is that physicians, especially surgeons, are the life-savers who do everything that matters. [emphasis mine.]

It’s the same old story: the physicians get the glory, and the nurses get the minor supporting roles. We’re ancillary, and remember, ancillary comes from the Latin word ancilla, meaning, “maid.”

At some point you have to ask, how do physicians always  get the good PR?  What’s the mystique about? (Trust me, up close and personal, there ain’t much.) And also, how much of this do we nurses do to ourselves?

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In Which I Tie Silliness, Art, and Poetry to Nursing, Somehow

Too pooped to write a real blog post — the past week has been a bit of a wretch all together, and my poor tired brain is wired for wine drinking and lounging today. So some bits and pieces I picked up on the web.

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First up: silliness. You got to remember this kind of thing goes on all the time. Unfortunately for the folks up in Peterborough, they got caught:

Conducting an ultrasound on a pregnant dog is unusual, local animal experts say.

[snip]

The question arose after a Peterborough Regional Health Centre employee was caught using the hospital’s portable ultrasound unit, in the emergency department, on a pregnant dog.

The sight of a dog trotting through the emergency department wouldn’t have set off alarm bells for staff and patients because the hospital allows visits from pets, a hospital spokesman said.

Jonathan Bennett, PRHC spokesman, said pets are allowed in the hospital because of their therapeutic value.

That doesn’t, however, extend to what happened this time.

The PRHC employee was disciplined sometime over the winter for using the publicly funded equipment on a dog while patients stood in line at the emergency department that day.

Since we’re Canadians, I’m not clear if the objection was to the queue-jumping or the fact it was a dog.

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More silliness. From my WordPress stats tracker.

Is MRSA from nastiness?

Why yes, according to the best medical authorities. It is from nastiness. Thanks for asking.

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Now some art, via P.F. Anderson, who also has a pretty cool blog. If I had my druthers, all nurses should either read one poem or contemplate one piece of art daily as part of their practice. Call it continuing education for the spirit. Anyway, a woodblock print from the Japanese artist Yoshitoshi. “A ruthless man has become insane. He watches the skulls of his victims in agony and will perish soon.” [More images here]

And the poem? His death haiku:

holding back the night
with its increasing brilliance
the summer moon

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Favourite Poems XIV

Something a little different. “La Cigale et La Formi”, a reworking of one of Aesop’s Fables, was the first of Jean de La Fontaine’s Fables Choisies, published in 1668 to amuse and edify the French middle-class during the reign of Louis XIV. In it’s Disneyfied form — The Ant and the Grasshopper —  it’s a straightforward morality tale of thrift versus dissipation; but the original version contains considerably more ambiguous questions on the value of art and the meaning of charity.

“La Cigale” translates as “cicada”, through it’s traditionally rendered as “grasshopper”. I have retained the original meaning.

The Cicada and the Ant

Cicada sang summer away,
Then in an unfortunate way
She found herself when frost bit
Without the leastest tidbit
Of fly or worm. She cried hunger
At her neighbour’s, Madame Ant.
Cicada begged her to grant.
A little wheat to sustain her
Until the new season of summer.
She cried, “On my creaturely oath,
I will repay you in full both
Principal and interest,
Before August’s new harvest!”
Now Madame Ant does not lend;
Worse faults she may defend.
She asked her supplicant and guest
“In fair weather, how did you list?”
“To all comers, I gave my song,
Night and day, I sang: am I wrong?”
“Sang all summer? I’m glad, and how!
Very well then, you may dance now!”
La Cigale, ayant chanté
Tout l’été,
Se trouva fort dépourvue
Quand la bise fut venue.
Pas un seul petit morceau
De mouche ou de vermisseau.
Elle alla crier famine
Chez la fourmi sa voisine,
La priant de lui prêter
Quelque grain pour subsister
Jusqu’à la saison nouvelle.
« Je vous paierai, lui dit-elle,
Avant l’oût, foi d’animal,
Intérêt et principal. »
La Fourmi n’est pas prêteuse ;
C’est là son moindre défaut.
« Que faisiez-vous au temps chaud ?
Dit-elle à cette emprunteuse.
–Nuit et jour à tout venant
Je chantais, ne vous déplaise.
–Vous chantiez ? j’en suis fort aise.
Eh bien ! dansez maintenant. »

— Jean de La Fontaine
trans. by TorontoEmerg, 20/07/10

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About Anonymity, Confidentiality, and Fear

I wrote a post a few days ago about the family member of a patient threatening to report a colleague at another hospital to the College of Nurses of Ontario. In response, I received an email from a nurse in British Columbia who deleted her entire blog when it became apparent she had readers from government domains, including the College of Registered Nurses of British Columbia. She writes (I quote with permission):

Even though I have nothing incriminating on my blog, because I was aware of the “small world” thing that is Canada…..I didn’t trust  what I was seeing.   Perhaps I am paranoid.  Perhaps all it was, was someone interested in what I blogged about (some of the references were papers drawn up by the government itself)…..but since I value my income….and know what the CRNBC is capable of – witch hunting…..and if they ever decided to haul me in or whatever……I decided I would leave nothing to chance and deleted everything.   Just wanted to let you know – be very wary of who is doing what out there……  I don’t trust anyone out there in the government – or any governing body……and in my 30 years plus of nursing……I have seen a lot of what they can do…..

It is sad and disheartening to see yet another nurse-blogger take a dive because of feared retribution from someone in authority. Even sadder when our professional regulatory bodies — with some justice, I’m afraid — are viewed by the frontline as The Enemy. Is it good public policy when nurses self-censor themselves because they fear losing their licences?

I also appreciate the concern expressed in the email. I am the Queen of Paranoia myself. Rest assured, I have been very diligent in applying the principles outlined in my disclaimer. I am resolutely anonymous. I can count on one hand and have fingers to spare the number of people who know my true identity. And, I figured out a little while ago — like, I think, most health care bloggers eventually do — that the stories I share with you about my experiences in the Emergency Department aren’t actually about working in a hospital: they concern human beings, the good, the bad, and the funny — especially the funny. (I’m looking at you, Dr. Weanus.)

The point being, the importance isn’t in the details but in the narrative, the exposition of the human condition. So a lot gets changed, which protects patients (and myself) — but the essence always remains. I want cover my butt, you see, and continue to regale you with tales from the Other Side of the Bed Pan.

So I’m going to carry onwards and upwards, more fool me. Where angel fear to tread, and so on.

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Reason #3451 Why I’m Posting Light This Summer

A rose by any other name
Rosa ‘Mrs John Laing’

Need I say more?

No mildew or blackspot this year either. Last year was horrid.

P.S.  Does anyone know why my photos, which look delightful on my laptop, look positively awful and out of focus when I upload them?

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Karmic Retribution?

Or just plain common sense? The physician who caused the arrest and trial of two nurses when they complained about his practice is now finally under scrutiny:

The Texas Medical Board has lodged a formal complaint against the man at the center of the nationally publicized Winkler County nurse trial.

The old adage, “when it rains, it pours”, certainly seems to hold true for Dr. Rolando Arafiles, Jr.  After completing their investigation, the Texas Medical Board filed a 12-page complaint on June 22nd.  In it, they outline several violations they found he committed, some dating back to 2008.

The Texas Medical Board is requesting a contested case hearing against Dr. Arafiles, who is accused of alleged violations of the Medical Practice Act, among them are, “failure to maintain adequate medical records,” “poor medical judgement,” “poor decision making,” “over billing,” “improper coding,” “non therapeutic prescribing and/or treatment” and “intimidation of witnesses.

It appears the hospital he works for continues to defend him. The wheels of justice grind slowly, et cetera. Too bad the nurses were vilified in the first place.

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