Archive for category Random Thoughts
Posted by jeanhill in Good Nursing Practice is Practising with the Heart and Mind, Nursing Discussion, Random Thoughts on Wednesday 04 July 2012
A few years ago I cared for an acquaintance. She was a friend of a friend who had been living out of the country for several years, but had come home to visit family friends. She was rushed in to the ED and before I even knew who she was I was delivering her 19 week old fetus. When I finally looked up to see the mother’s face I realized we knew each other. I said nothing. In that moment I didn’t care about what the College would say about caring for those you know when there was a real emergency to deal with. I held her hand as she passed the placenta and focused on stabilizing her blood pressure by putting in the largest IVs as I could. I asked her if she remembered me and if she would prefer another nurse cared for her. She asked me to stay. I comforted her and showed her the baby she would never get to know. I checked on her every half hour that shift and came in early for my next shift to find out how she was. There was no time to feel sad until my shift was over and like the other children and babies and fetuses I have seen pass away, they stick around in my heart and mind a lot longer. There are those patients that stick with you, elderly or middle aged, etc, but I think most any emergency nurse can agree that child patients are the some of the longest lasting in our memories. And for me, the ones who haven’t even started in this world are forever imprinted.
I saw my acquaintance a few months later, she was home again, in the grocery store and she thanked me for what I had done for her and told me she would never forget me. The thank you warmed my heart but I knew she would no longer remember me as the girl she had a beer with when we were in our early 20s, but as the nurse who was there when she lost her baby. Judgment, confidentiality, privacy, all of those ethical principles aside, perhaps that’s why we shouldn’t care for ones we know, even if just a little, because it affects us too.
I recently found out that she gave birth to a daughter and it’s amazing how happy I felt for someone I don’t really know to have had a baby. I wanted to find a way to contact her to wish her well but elected not to as I didn’t want to be THAT nurse wishing her well, inadvertently reminding her of what she lost before. Nevertheless, I personally take solace in knowing that despite all of the sad and terrible we see rarely hearing from these patients again, they do in fact have happiness and joy in their lives later on.
Posted by jeanhill in Good Nursing Practice is Practising with the Heart and Mind, Life in the Emergency Department, Nursing Discussion, Random Thoughts on Friday 15 June 2012
I recently took a course with nurses of varied years of experience and ages, but it was primarily made up of fairly new graduate nurses within the last year or two. During one lecture the facilitator was speaking about the future of nursing and how we need to address the current issues and challenges that exist in the nursing profession today, and asked the class to outline a few. Issues such as the global nursing shortage, heavier workloads, lack of education support, feelings of little public appreciation and individual unit situations were brought up. One nurse felt that on his unit there was a large divide between the older senior nurses and the new junior staff. This perked up my ears. He felt that the senior nurses were threatened by the amount of theory and knowledge that he and his fellow junior colleagues had and insinuated the senior nurses felt the juniors were going to take their jobs or roles on their unit. He continued to say that the generational and differing nursing requirement (degree vs. diploma) issues existing on his unit put a huge divide between the younger and older staff. (*disclaimer* While yes, I have written about how nurses can eat their young, I disagreed with the standpoint he took.) It’s terrible to think this is happening, and despite what I have written (that is only a handful of nurses FYI, by no means the picture of the entire Acme Regional ED senior staff in the least) I personally find that there is a great blend of ages and levels of experience within my unit personally. He stated that perhaps the junior nurses should be on their own line with the senior nurses on another. I cringed at the thought of that. For any unit to run effectively and safely it is in my opinion, which I am almost positive would be shared with most, that there needs to be senior staff at all times. A line of strictly junior staff would be unsafe and potentially detrimental to patient care not to mention the amount of issues, disagreements and incidents that could and would arise. I think of inconsistencies in care and the potential for a patient’s change in condition to be overlooked simply due to inexperience until too late. I have found that the novice and senior staff continue to learn from each other as each are on different ends of their careers with different types of knowledge to share. This nurse went on to say that maybe the senior staff needs to go in for remedial courses to be brought up to the “standard” of the new grad degree nurses. *insert shocked look on face*. I nearly fell off my chair. If the experienced diploma nurse does not want to go for their degree how and why could one be forced to take theoretical courses that in my mind, often have little to no benefit to the patient at the bedside. I relayed my personal opinion that the diploma nurses he is suggesting should go for remedial courses to be “brought up to speed” in fact had far more clinical time as students than any of us degree nurses and as a result were far better prepared going to the bedside when they graduated as opposed to us. I reminded him of the amount of papers and classroom time we spent talking more about nursing than actually doing it. I could write a 10 page paper on how to properly sew an emblem on a jacket with 4-5 APA references if I was asked to (please no one ask me) as a result of the amount of theory referencing involved in the degree program. This nurse’s sentiments about how degree nurses are far more qualified to be at the bedside than the diploma nurses and generation gaps exist out of jealousy or by being ill prepared made me question what sort of nonsense he was spoon-fed upon his obviously very successful graduation from a degree program. I am the product of the degree program but I do not endorse the structure of degree nursing program, at least not the one I was in. I think I should have been at the bedside far more than I was. I had yet to give an IM injection to a real patient until I was consolidating in my final 4th year placement. I had however written an excellent 25 page paper on nursing leadership and how to effectively determine who should get Christmas vacation with examples of different leadership skills, roles and suggestions on effective management.. *insert vomit sound*. I suppose however it can depend on what one wishes to do with their career and the direction they want to take it.
Ultimately what I am trying to get at is while I am sure generation gaps exist on units, I do not believe it is entirely as a result of degree vs diploma more than it might be just personality related. Differing maturity levels, different interests, and people at different points in their lives not to mention the obvious that we are all individuals. I enjoy working with the tough take no nonsense 15 year nurse as much as I like working with the 35 year veteran nurse who still gives every patient a bed bath and the novice 2 year nurse who wants to learn about every patient condition possible. A few of my closest coworkers have nearly 10+ years on me with a couple who could even be my parent.
Gaps exist only if we let them and really, we are not here to make friends. When we do that’s great, however, we have a job to do. If that 25 year nurse doesn’t like me, she at least knows I can get an IV on a 5 day old on the first poke and that’s all that matters. We often forget how our “issues” can affect the patients.
So i ask this, do generation gaps exist on your units? If so, are they related to degree vs diploma nurses or more just due to differing personalities and individuals at different points in their lives? Do you find yourself getting along with the nurses of the “opposite” generation?
One of a series of YouTube videos from Bedsider, a program of the U.S. National Campaign to Prevent Teen and Unplanned Pregnancy, on having the birth control discussion with a physician.
Babies are great…when you’re ready for them. We think in the meantime women should have the right to a healthy, happy sex life without having to worry about unplanned pregnancy. For that to happen, women need to take an active role in their own reproductive health. We want to help with that.
Bedsider.org (Bedsider) is an online birth control support network for women 18-29 operated by The National Campaign to Prevent Teen and Unplanned Pregnancy, a private non-profit organization. Bedsider is not funded by pharmaceutical companies. Or the government. Bedsider is totally independent and the info on it is honest and unbiased. Our goal is to help women find the method of birth control that’s right for them and learn how to use it consistently and effectively, and that’s it.
Right now, seven in 10 pregnancies among unmarried women 18-29 are described by women themselves as unplanned. That sounds like a lot to us. We hope that Bedsider will be a useful tool for women to learn about their birth control options, better manage their birth control, and in the process avoid getting pregnant until they’re ready.
That any of this would still be controversial in this the year of God’s grace 2012 boggles the mind, especially the part where it’s okay for women to be sexually active and enjoy it.
One small quibble to Bedsider: nurses get to talk about birth control too.
Not what you think. Trust me. You may even have a tear or two.
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.
Posted by torontoemerg in Before I Start Throwing Things, I'd Better Write This Down, Health Care, Health Care Policy That Matters to Nursing, If You Gonna Have a Circus, You Gotta Have Elephants, Random Thoughts on Friday 17 February 2012
A Republican supermajority has muscled two of the most restrictive anti-abortion bills in years through the Virginia House, despite bitter yet futile objections from Democrats, with one GOP delegate deriding most of the procedures as “matters of lifestyle convenience.”
And the ultrasound legislation would constitute an unprecedented government mandate to insert vaginal ultrasonic probes into women as part of a state-ordered effort to dissuade them from terminating pregnancies, legislative opponents noted.
“We’re talking about inside a woman’s body,” Del. Charnielle Herring said in an emotional floor speech. “This is the first time, if we pass this bill, that we will be dictating a medical procedure to a physician.”
The conservative Family Foundation hailed the ultrasound measure as an “update” to the state’s existing informed consent laws “with the most advanced medical technology available.”
The Oklahoma legislature passed a similar law a couple of years ago. Full disclosure, in case you didn’t know it: I dislike abortion, but I’m strongly pro-choice. Even if you are strongly against abortion on moral or religious grounds, I would like to know how a medically unnecessary, coercive, invasive procedure can be ethically justified in order for a patient to receive health care? (I think we can safely dismiss the Family Foundation’s reasoning as spin.) And if the patient is a 13-year-old rape victim, how is this not despicable and evil?
Another question I would like to ask: if you’re a health care professional, would you excuse yourself from participating or facilitating in enforcing this law?
Posted by torontoemerg in Good Nursing Practice is Practising with the Heart and Mind, Nursing Naval Gazing, Random Thoughts on Tuesday 31 January 2012
Ian Miller, blogging over at ImpactedNurse.com, notes a disturbing trend in Australia, one, I’m afraid, is becoming more common in North America. “These days,” he writes, “being a nurse is tough. Really tough.”
I look around and see many struggling at the bedside. I see the increasing perception that this is menial or bottom-of-the-professional-foodchain work.
I see more and more of this sort of feeling online.
What our brightest and best nurses should be doing instead of creating a culture of escaping the bedside or doing time at the bedside is acknowledging that it is the nurse providing direct care to the patient or client that is the absolute most important domain of our increasingly diversifying profession.
Nurses do not really want to be business entrepreneurs, unless they have no other choice. They want to be nurses.
I would even argue that if you are not regularly within arms reach of your patient/client you are not nursing. And if you have not done this for a long time you are not really a nurse. You are something else. Strong stuff1 I know.
The bedside nurse should be re-valuing themselves not re-inventing themselves.
Miller’s solution is “8 in 8,” i.e. having non-bedside nurses work an 8 hour shift every 8 weeks at the bedside as a condition of their registration. This is an idea I like the more I think about it. However, it would be complicated to implement, not the least because of resistance from said non-bedside nurses — and can you see all those functionaries from nursing regulatory agencies or upper management pulling on scrubs and Crocs and tending to stool incontinence and urinary drainage bags?
Hmmm. Maybe not.
But Miller’s premise, that bedside nursing itself is demeaned and devalued to the point where many of us — including myself — are plotting our escape to greener pastures is sadly true. But why? The reasons for this are pretty simple. Despite years of education and rhetoric, nurses aren’t really permitted to practice to the full scope of our knowledge. We all have heard managers speak of their time at the bedside like it was a prison sentence. Television shows like Grey’s Anatomy tell us bedside nurses are stupid. We know that hospitals view nursing not as a valued added service, but as an expensive cost centre, and that Human Resources thinks of nurses as a “problem” to be managed, like the kitchen guys who make the salads, not as practising professionals.
To be clear, we menialize ourselves as well, when we view nursing as a job rather than a profession, or when we see nursing as a series of tasks to be completed before shift change, rather than a process requiring frequent periods of critical thinking.
It’s all pretty overwhelming, and though I will publicly stand up for the value of bedside nursing, and argue strenuously to its central importance in health care, there are times when even I have a little shadow of doubt.
So really I’m not very surprised if nurses of all ranks and positions view the bedside as menial and demeaning. If people around you all day tell you you’re worthless and menial, and if you view what you do as being more or less thankless and trivial, pretty soon you’re going to believe you are worthless and menial — and so is your professional practice.
I would like to tell you my own motives for escaping the bedside are pure, but when I seriously reflected about it, I realized some of my reasons for wanting to leave had much to do with decent hours and status. And something else: the ability to act autonomously and effect change in a real way.
In other words, it’s all about power, and this explains why bedside nurses are so demeaned and devalued and want to escape.
Because we have none. Or think we do.
(I would argue front line nurses have far more power to shape their practice and workplace culture than they realize, but we all have been indoctrinated since the first day of nursing school never to question their place in the food chain and to always ask permission. And I’m not speaking about “making a difference in patient’s lives” — a phrase which has always struck me as infantile and meaningless. But this is a subject of a whole other post.)
A note sent to me from my favourite MRT (Medical Radiation Technologist). A reminder too, that nurses aren’t the centre of the universe, even if we think we are.
Some thoughts from an MRT. . .
If a portable examination is requested it’s because the patient is too ill to come to the department, not because they are in the bed nearest the window and it’s a hassle to get them out of the room. Portable exams give less information than a department film so why chose inferior diagnostics?
So the patient is too sick to leave the floor might there be a need for a nurse to help the MRT with the patient? Just saying, just wondering. Now this help isn’t for the MRT’s benefit – though lifting and maneuvering people one handed is tricky – it’s for the patient.. Even if your patient is sitting bolt upright and square on do you think it’s a kindness to have them pulled forward by one arm as the heavy cassette is placed behind them? Because this is what the MRT has to do if the patient can’t lean forwards.
Oh and please don’t all run the minute the portable machine comes trundling down the corridor. It isn’t radioactive. And if you don’t have time to move 2 chairs, a commode, a walker, and a couple of tables out of the room what makes you think the MRT does??
You know if you help with the exam then I’ll help put everything back in it’s place.
In Emerg, when you call the tech for a stat film then do acknowlede ge them when they arrive, and maybe even stay to help, (see above re too sick to go to the department.) If you don’t hang around then do answer the tech when they ask if the patient can be sat up for the film, or have any other questions about your patient.
Points well taken. Remember it’s about the patients, right? I’m pretty sure too other health care professionals have similar valid gripes about us. Ladies and gents, we need to pull up our socks.