Archive for February, 2012

Insert Snark Here

English: Linear Skull Fracture with arrow poin...

What this patient did not have

Mr. CD, 88, took a little tumble at the nursing home when he slipped on a loose rug (or something, the details are a little vague here), obtained for his trouble a scalp laceration the length of Q-tip on his temple, bled like a stuck pig, transported by EMS, triaged, assessed by both MD and RN, x-rayed, CT’d, declared medically cleared and fit to go home, deblooded, stapled, tetanus’d, acquired a head dressing worthy of a maharajah, and finally sent back to the nursing via a private ambulance and their ill-paid yet (hopefully) competent attendants.

Whereupon the RPN (i.e. LPN for you out of province types) or whoever was minding the door of the nursing home refused to take the patient back.

“Oh my God, he needs to go back the emerg,” she said, eyeing, perhaps, the overwrought head bandage. “He has a skull fracture! I can tell!” And promptly sent him back, alert, oriented x 3 — and bemused.

I have only two possible explanations for her extraordinary statement: she either is wasting her time at the nursing home and depriving humanity of a set of assessment skill so exquisite she can, using her psychic x-ray powers, detect a skull fracture under approximately twenty layers of clean, white 4 x 4 sponges and tape gauze, or else she thinks despite all the assessments and investigations, we are complete boobs. ( Admittedly, I have a sneaking sympathy at times for the second possibility.)

There is actually a third possibility, but I am far too polite to mention it.

That’s all I got. Feel free to insert your own snark.

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Your Man Reminder

Anti-pink ribbon breast cancer awareness from Rethink Breast Cancer. The charity bills itself as the “first-ever, Canadian breast cancer charity to bring bold, relevant awareness to the under-40 crowd; foster a new generation of young and influential breast cancer supporters; infuse sass and style into the cause; and, most importantly, respond to the unique needs of young (or youngish) women going through it.” And adds in bold type: “No pink ribbons required.”

The video gave me a tiny thrill watching too, and evidently a lot of other people too — it’s had over 2 million hits on YouTube. (Take that, Susan G. Komen!) Of course there are apps for Android and iPhone.

 

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In Which TorontoEmerg is Famous

OK, not really famous, but published on Kevin Pho’s site, KevinMD.com. Check it out, and Retweet/Like/comment as you will — it’s all in a good cause. I’ll repost it here sometime next week.

I am this morning getting an uptick in visitors from KevinMD.com. Welcome, and free to poke around.

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Friday Night Flicks: Bottle

Lovely and not quite what you expect. [Couch mode here.]

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TV Series Hot

Gob-smacklingly stupid or hip advertising? I’m leaning towards the former. Via CBC:

A Stockholm hospital that published an online ad looking to fill a summer position with a nurse who is “TV-series hot” says it was “written to catch people’s attention.” 

“We want people to be curious and have a little imagination,” said Elisabeth Gauffin, head nurse at Stockholm South General Hospital (Södersjukhuset) to the Metro newspaper.

My Emergency department colleagues

The ad read, in Swedish: 

“You will be motivated, professional, and have a sense of humour. And of course, you will be TV-series hot or a Söder hipster. Throw in a nurse’s education and you are welcome to seek a summer job at Södersjukhuset’s emergency department.”

(“Söder” literally means “south,” but here refers to Södermalm, a fashionable district in Stockholm. Think “Soho.”)

The hospital’s nursing manager said the phrasing wasn’t meant to exclude anyone based on looks. 

I (sort of) get what the hospital was trying to do. Readers may have noticed I’m not without a sense of humour. But I’m not sure the “And of course” phrasing of the ad effectively signals the intended irony. It’s a little pathetic the hospital needs to rely on a tired old cliché to recruit nurses. Ultimately, I think, the ad trivializes what nurses actually do in Emergency departments, and reinforces public perceptions and stereotypes. As a well-seasoned RN, I would be somewhat disinclined to work there. But maybe it’s all lost in translation, and the ad is deliciously funny in the original Swedish.

Incidentally, for the record, I am not “TV series hot.” On the other hand, I know to work the buttons on a defibrillator.

[Thanks to my friend Leigh for sending this along to me. Her comment: "Laugh or cry?? Mostly exasperation I think. Add more horror that the survey results show that people think this is appropriate!"]

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Just Lie Back and Think of Florence — Or Not

Nurse K, possibly the doyenne of nurse bloggers, gives her two cents on Amanda Trujillo. Her advice is to surrender:

Yes, I’m going to say it: Forget advocating.  Be humble.  Be honest and consistent.  Go through the process.  Listen to your attorney.  Your most important asset as a terminated person is an unrestricted nursing license and lack of bitterness.  Get advice from your attorney and mentors about what to say in job interviews about your termination.  Rehearse your answers to the question of “why were you terminated from Banner Health.”  Don’t decide that you’re never working for a hospital again and you don’t care what anyone thinks. You’re a single mom on welfare with a termination on your record; you don’t have the luxury of being picky. 

This termination was not about who can order a case management consult.  This was the typical crap that I saw every day.  Someone important (in this case, the surgeon who was to perform the transplant) [it was a gastroenterologist, not the transplant surgeon,  incidentally --- ed.] looks bad or is pissed at someone for something and demands a termination and the thing spirals out of control.

This type of stuff is a hospital culture problem and certainly needs to stop, but a terminated employee is not going to stop anything like that, so don’t expose yourself to the world as a fired person with a chip on their shoulder. 

Well, fair enough. You pick your battles. What she’s suggesting is that for Amanda Trujillo, maybe this wasn’t the hill to die on. This is true in some, maybe even most, cases. It is excellent advice, in fact. I have a friend whose employer reported her to the College of Nurses of Ontario  — the semi-equivalent of state boards of nursing — for a serious med error that contributed to the death of a patient. She went through the process, humble and contrite, and received a formal written caution and oral reprimand.  Her employer supported her through her rehabilitation, worked out a mentorship and learning plan with her; she took a refresher course on medication. She is still practicing. This is how the system is supposed to work, right?

To paraphrase Queen Victoria, just lie back and think of Florence. I don’t think I am caricaturing Nurse K’s position here, not much anyway. Most times, silence is golden and discretion is the better part of valour, and all those other platitudes your mother taught you.

But then, this isn’t a conventional case. Let’s review for minute: Trujillo offers a patient information regarding an organ transplant and arranges, as per usual practice and at the patient’s request, a hospice care consult; this angers a physician; she is arbitrarily fired for exceeding her scope of practice in ordering this consult, which was inside her scope the day before; no one was harmed or put at risk, except, perhaps, the physician’s ego; Banner Health, Trujillo’s employer, reports her to the Arizona State Board of Nursing for practicing outside scope of practice  which — I can’t say this enough — was practicing inside scope of practice the day before; the case languishes for months and months in some sort of bizarre Board of Nursing limbo; then the moment Trujillo’s case caught the attention of some ratty-end nurse bloggers, the Board of Nursing orders a psych consult, evidently because publicly defending yourself makes you crazy; the Board of Nursing subsequently (and in a highly dubious fashion) informs Trujillo’s university she’s under investigation, then denies it despite clear proof to the contrary; and now the latest buffoonery, a new accusation from the Board of Nursing that Trujillo has “misrepresented” herself as to her academic credentials.

If this is a typical case, we are all in trouble.

And there’s this observation: isn’t shutting up and going away what employers and managers and nursing boards expect front line nurses to do? Don’t make trouble, nurses. It’s unbecoming. It will just make things worse — yes, for you. Don’t advocate for yourself — because — we will call you crazy. You will be screwed over — and you will like it!

The thing is, even before all the fuss, it’s hard to imagine how this could have gotten worse for Amanda Trujillo. If the fix is in, if you’re being railroaded by your employer, and the state Board of Nursing (as Nurse K says) is shady and duplicitous, being demure and helpful and willing to take your lumps is not going to help you. And why in the name of everything that is sacred and good should you help someone who is seeking to harm you? And as for meekness and docility now? Seems rather besides the point now.

In any case, nurse as silent martyr is not a great image. Nurse as battered wife is worse. Advocacy for yourself, and for your profession is sometimes not one of many bad choices, it is the only choice. Because of circumstances yes, but also because it is right. And as Nurse Ratched points out, often it only takes one pebble to start an avalanche.

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Doctors Are From Mars, Nurses Are From — Oh, To Hell With It

News flash! From Fierce Medical News, here’s the shocking headline:

Docs, nurses miscommunicate on respect, job role

When you guys pick yourselves off the floor from laughing, here’s the money quote:

In particular, the survey found differing views of how doctors treat nurses. According to 42 percent of nurse leaders, physician abuse or disrespect of nurses was common, whereas only 13 percent of physician leaders said it was common. Fifty-eight percent of nurse leaders considered disrespect for nurses uncommon, while 88 percent of physician leaders said it was uncommon at their healthcare organizations.

“I do believe nurses and physicians are on two different pages when it comes to communication,” Pam Kadlick, vice president of patient care and chief nursing officer for Ohio’s Mercy St. Anne Hospital, said in a HealthLeaders Media article. “Nurses have a tendency to give a very detailed report, more than what a physician may want to hear; hence, the physician may interrupt, seem to be abrupt, even rude at times.”

But most physicians don’t consider such behavior to be disrespectful, she noted.

You’re telling me abuse of nurses is all about physicians being insensitive, maybe, and nurses having too many hurt fee-fees? Really? And nurses are supposed to be surprised that physicians “don’t consider such behavior to be disrespectful?”

Why does this sound like a ’80s sitcom?

Why does this sound like this report is trying to validate abusive physician behaviour?

You can only shake your head. And you just know, somewhere, in a darkened office maybe, in an obscure corner of a mega health care corporation, a manager is reading this report and exclaiming, “I knew nurses were to blame!”

I will very happily concede abusive behaviour of all kinds has declined markedly in my own time as a nurse, though I will say I work in an institution that enforces a zero tolerance policy against abusive behaviour. Moreover, the physicians I work with, shoulder to shoulder, are lovely and professional, and there is a true sense of collaboration. This makes for excellent patient care.

However, by no means is this true everywhere. So let’s not pretend the brow-beating, the mocking, the chart-throwing, the patronizing  — to be blunt, treating nurses like you wouldn’t treat your mother, daughter, wife, bank clerk, Wal-Mart greeter, housekeeper, or dog — still doesn’t go on. Denial will never fix the problem, either from physicians — or nurses.

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“What’s Wrong With Our Bodies, Anyway?”

Um, nothing. Just that runway models — and expectations — are getting skinnier. From Plus Model Magazine. On the left is a “straight-size” runway model, on the right, “plus” size model Katya Zharkova (size 12-14). A stunning contrast between the near-anorexic “norm” and healthy reality, wouldn’t you say?

According to the magazine:

-Twenty years ago the average fashion model weighed 8% less than the average woman. Today, she weighs 23% less.

- Ten years ago plus-size models averaged between size 12 and 18. Today the need for size diversity within the plus-size modeling industry continues to be questioned. The majority of plus-size models on agency boards are between a size 6 and 14, while the customers continue to express their dissatisfaction.

- Most runway models meet the Body Mass Index physical criteria for Anorexia.

- 50% of women wear a size 14 or larger, but most standard clothing outlets cater to sizes 14 or smaller.

More images here.

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Favourite Poems XLVIII

In Winter in My Room

In Winter in my Room
I came upon a Worm –
Pink, lank and warm –
But as he was a worm
And worms presume
Not quite with him at home –
Secured him by a string
To something neighboring
And went along.

A Trifle afterward
A thing occurred
I’d not believe it if I heard
But state with creeping blood –
A snake with mottles rare
Surveyed my chamber floor
In feature as the worm before
But ringed with power –

The very string with which
I tied him — too
When he was mean and new
That string was there –

I shrank — “How fair you are”!
Propitiation’s claw –
“Afraid,” he hissed
“Of me”?
“No cordiality” –
He fathomed me –
Then to a Rhythm Slim
Secreted in his Form
As Patterns swim
Projected him.

That time I flew
Both eyes his way
Lest he pursue
Nor ever ceased to run
Till in a distant Town
Towns on from mine
I set me down
This was a dream.

— Emily Dickinson

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Friday Night Flicks: Last Minutes with ODEN

Bring tissue. Some time I’ll tell you guys why my dog — well, why I love her better than most people. [Couch mode here.]

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