Posts Tagged Nursing stupidity
Posted by torontoemerg in Acme Regional Health Centre, Battered Nurse Syndrome, Before I Start Throwing Things, I'd Better Write This Down, Charge Nursey The Movie, I'd Better Feel Sorry for Myself 'Cause No One Else Will, Life in the Emergency Department, Nurses Behaving Badly on Monday 13 June 2011
I write this blog for a number of reasons: my own amusement, to educate, to share various random thoughts, to tell stories, to stimulate discussion on topics important to nursing, to provoke thought beyond the superficial, to challenge assumptions, and lastly, to rant.
Today I am going to rant.
Those of you with delicate sensibilities may want to get out. I am going to use some earthy language. Repeatedly.
So, to begin: I love my colleagues with the generous love I share with my family, but like some of family, they can be gaping assholes.
I’ve been seconded again for more administrivia duties. Since part of what I’m doing will have focus on improving quality of nursing work life, I am very excited and eager to do this. I believe making our work places better for nurses will, in the end, save nursing as a profession.
For this work, I needed to buy some markers. With the manager’s permission I (innocently) ordered a pack of multi-coloured, fine point Sharpies, which with the wholesaler’s discount came to $6.35 (six dollars and thirty-five cents) plus HST, and charged them to the departmental budget.
The markers arrived on my day off.
Then the nattering started, which (from reports) quickly escalated from a simple “why were these markers ordered?” to attacks on my integrity, discussions about my worth as nurse, and lurid suggestions I was dogging it.
From the reaction, you might have thought I was running a child prostitution ring in the Resus Room, and was using departmental petty cash for start-up costs. It was that bad.
One of my colleagues, a woman I previously thought as an ally, was incredibly hostile. “Why” she asked, “couldn’t you buy your own?” Of course, her anger left me slack-jawed and stupid and the correct answer escaped me at the moment: for the same reason I don’t buy my own kidney basins and bath flannels.
Yes, it was bullying, and afterwards, I reflected on the irony that so soon after writing on the subject I should become a victim of it myself.
So, it was hurtful. But mostly it really, deeply pissed me off. Remember, I’ve been working with some of these nurses for ten years or more.
I know I’m a damn good nurse, and you’re lucky to have me, so fuck off.
I’m working hard to make your lives easier as nurses, so again, fuck off.
And yeah, I know about horizontal violence and the rest of that, but the bottom line: you are responsible for your behaviour. Stop being a high school gossip queen — and for some of you, you’re closer to retirement than your senior prom — and start being a nurse. Because when you undermine me or anyone of your nurse-colleagues, you’re really undermining yourself.
Another colleague, far more sympathetic, suggested that nurses have been doing it to each since Florence was beating the carpets at Scutari, and we are never going to stop acting, collectively, jerks.
I fear she may be right.
So I say again to those nurses who found it fun and interesting to shred my character in a few minutes time: um, fuck off. And fuck you. You aren’t worth my time.
End of rant. Thank you for your attention.
Some random reflections on my clinical progress as a nursing student. 1990s.
First rotation: Medicine. A “heavy” floor. Mostly strokes, CHFers, Unstable Anginas. It was here I decided I did not want ever to work on a med-surg floor. The distress and despair among the nurses was palpable. Lots of encrusted, bitter old nurses, and equally nasty physicians engaged in a kind of ritual war of attrition; it reminded me of my parents’ soured marriage. Here I witnessed a physician publicly denounce a nurse* for holding an antibiotic causing an allergic reaction, her passive-aggressive response, and the utterly disheartening silence of her colleagues. And also: RN collecting a urine cultures by wringing out an adult brief; another RN packing a wound with her bare fingers; an RPN “punishing” a stroke patient by leaving him sitting in a stool-filled adult brief. His crime? Failing to use the call bell to call her for the bedpan. It’s a wonder I didn’t run away screaming.
Rotten unit filled with the worst representatives of the nursing profession. Happily is now closed.
Second rotation: Surgery. No specific memories, except for a shave prep of a vast inguinal hernia the size of a very large cantaloupe. Also the hallway was carpeted. On a surgical floor! Think various dripping body fluids. (When the carpet was finally taken up years later, it had to be treated as bio-hazardous waste.) Lots of suture and staple removal. Post-op baths. Sterile fields and aseptic technique.
Third rotation: Medicine. Here I got into trouble. I failed to document the necrosis on a right great toe. (No other nurse had either, though clearly it didn’t happen overnight.) Big fuss, got written up, warned and made to write a long essay to expiate my sins. Altogether a lot of to-do over what I would now consider a fairly minor documentation error. The reason for the fuss? The attending physician noticed the lack of documentation, and suitable scapegoat was needed. Actually some good lessons learned. One, take responsibility for your own documentation, and by extension your own practice, and never mind what everyone else is doing. Second, nurses eat their young if given the chance.
Fourth Rotation: Paediatrics. Superb instructor, but was known for failing one student every rotation. We all breathed again when the unlucky student departed the second week.
Fifth rotation: Psychiatry. Good instructor. I was told, rather disturbingly, I would make an excellent psych nurse. Long pointless conversations with non-disclosing schizophrenics and BDs. Otherwise, zzzzzzzzz. . . .
Sixth rotation: Surgery. Urology floor. TURPs, CBIs. Placed my first foley catheter and learned how to calculate true urine, a skill which in my ED career I have never actually used. This rotation was in the middle of some Harris government health care cuts. “Why would you ever want to be a nurse?” More than one staff member asked me. I was beginning to wonder.
Seventh Rotation: Surgery again, different floor. Rigid, unhappy nurses. The surgeons here deemed the nurses too stupid to find extremity pulses and decreed with the acquiescence of the manager all pulses — even bounding radials! — had to be verified using a doppler. No one thought this demeaning. Nurses lived in fear of her, and the surgeons. Not a happy floor, and was very glad to finish.
Eighth rotation: Labour and Delivery/Post-partum. Great instructor. Lots of breast cupping, boggy fundi and lochia rubra. (Too much, if you ask me. Sorry, AtYourCervix.) Learned the archaic langauge of childbirth. GPA. Primip. EDC. Apgar. Presentation. Pre-eclampsia. Pit drips. The placenta freezer — the hospital sold them off to cosmetic companies. More than one mother utterly disgusted with the idea of breastfeeding, one of them telling me, “They’re for my husband.” Helped to birth one baby.
Ninth Rotation: Medicine. Different hospital than the rest. Great instructor, tremendous advocate for nursing who taught me, I think, about the potentiality of nursing, not its limitations. Physicians were respectful, the nurses generally enormously competent and more importantly (for me) welcoming to students.
Pregrad, first half: Telemetry. Awful. My preceptor had the blunted affect of a chronic oxycodone user. Flat, uninterested, incurious, dull. She later went into nursing informatics. She disliked me, and franklyI wasn’t much fond of her either. When I insisted on doing full assessments, including chest assessments, she told me it wasn’t necessary because “that’s what the doctors do.” Telemetry floor apparently only in name. The only time I ever was close to quitting. It was that bad.
Pregrad, second half: Emergency. Amazing preceptor. When I witnessed my first trauma, all the intense orchestrated confusion, I confessed to her I thought I would never learn how to do it. “Oh you will,” she said cheerfully. Also she taught me the trick of placing the body bag under the sheets for incoming VSAs.** Except for the time the patient arrived VSA but survived long enough to go to ICU — after we discreetly removed the body bag. I have never done it since.
So, a mixed bag, and for better or worse making me into the nurse I am today. I suppose I did learn something, if by osmotic process — the mechanics of nursing, anyway. How to give subcutaneous injections. How to change sheets with the patient still in them. How to make mitred corners while making beds. (A skill which never leaves you, and then finishing by tucking in the pillow cases just so, exposed edge facing away from the door.) One of the things that strikes me is that how much of my real clinical education was by reverse example, if only because the exemplars — the nurses on the units — were often so terrible. I learned how not to treat patients, how not to eat our young, how not to pack a wound, how not to deal with physicians. To say the gap between gold-standard or even just normal good practice, and actual practice was significant and large would be an understatement.
Another thing: how few are the positive memories, how very scarce were the good instructors, how the two or three great ones shone. Education ought to be for challenge and growth — until the dead hand of educators comes along! Yet I can honestly say the two or three great teachers I had influenced my present practice in ways I can’t begin to express.
I’m curious: was everyone else’s clinical experience as ambivalent as mine?
*It still amazes me, even now, to see physicians speak to nurses in ways they wouldn’t speak to their mothers, spouses, daughters, patients, the girl behind the Tim Horton’s counter, grocery store clerks, bank tellers. . .
** See Glossary.
Your humble charge nurse had an awesomely bad day, in a week of similarly nasty days, so crappy in fact that I’m too tired and fed up even for my usual upper-management-idiocy snarkiness. The only slight consolation is that I understand nearly every hospital in the Greater Toronto region has been overwhelmed with patients. Superior Hills General, our bigger neighbour down the road, I’m told, had an 36 admitted patients boarding the ED, and an unbelievable 61 patients held for consult.
The good news is that a judge has ruled against Johnson Community College in the placenta Facebook case. To say the court spanked the College would be an understatement. Some more details on the events leading to the expulsion:
Byrnes said the picture was on her Facebook profile for about 3 hours, until Delphia [Byrnes' lab instructor] called her and requested she remove it, which she did. Byrnes says Delphia told her she wasn’t in trouble during the conversation.
But the next day, Byrnes said, Johnson County Community College Nursing Director Jeanne Walsh blasted her and the other students by screaming and crying at them.
“During the meeting, Director Walsh’s emotional conduct precluded the students from defending themselves and adequately explaining the reasons for engaging in the conduct in question,” the complaint states.
“Director Walsh summarily dismissed Plaintiff Byrnes and three other members of the lab group from the nursing program, and exclaimed, ‘I don’t know if I would want you back.'”
Is this how we want nurse educators to act? I don’t want to flog a dead horse, but again it strikes me the true professionals were the students, not the Nursing Director. In its press release, JCCC was typically gracious towards the students in admitting defeat, as it has been in this whole process. Okay, maybe not so much.
“We are disappointed with the court’s decision today,” said Terry Calaway, JCCC president. “Of course we’ll abide by the judge’s decision and readmit the student to the nursing program.
“The JCCC nursing program is widely known and respected for the quality of its instruction and its graduates. Sensitivity to patients and confidentiality of patient care is at the heart of what we teach. We took what we believed to be appropriate action, but the court saw the situation differently, so the student will be readmitted to the program.”
The students who took the photos were never expelled from the college, as has been reported, but were temporarily dismissed from the program.
Three other students who had been dismissed from the program will also be readmitted.
Classy to the bitter end, eh? (See, I’m so tired even my sarcasm bone is exhausted.)
To Doyle Bynes and colleagues: congratulations and well done. You do us proud, and you’re a credit to our profession.
*JCCC needs to give up on the “temporarily dismissed not expelled” spin. It’s a distinction without a difference, and it’s silly.
Posted by torontoemerg in Battered Nurse Syndrome, Before I Start Throwing Things, I'd Better Write This Down, Health Care Policy That Matters to Nursing, Uncategorized on Tuesday 21 December 2010
Recently, as part of an ongoing collaborative initiative on supporting family caregivers with AARP (see the comprehensive, and free, AJN supplement called State of the Science: Professional Partners Supporting Family Caregivers), I listened to a group of family caregivers talk about what it’s like to care for sick parents and relatives at home.
What they said they needed most to ready them for caregiving was what nurses used to do to prepare patients for discharge: teaching patients and family members about dressing changes, medications and diet, etc.; helping them arrange for follow-up like home health care; and making sure they had prescriptions and knew when to make a follow-up appointment (or, sometimes, just making the appointment and sending caregivers home with a day or two of medications).
How did we lose these things? How did it come to be that these discharge preparation activities became dispensable? What next might we give away because there’s no time? Is there a “line in the sand” that we won’t cross?
I know in my own practice and practice setting (charge nurse in a busy Toronto-area ED) the discharge piece is essential to completing the circle when providing patient care. We routinely make referrals to social work or home care, give out information and do health teaching about diet, scripts, dressing changes, signs and symptoms of infection, when the sutures need to come out, when to return, OTC medications (we’re permitted to do this in Ontario) and so on. It’s all well within our scope of practice, and indeed I would think it’s a professional expectation. It’s a chance to appropriately end the therapeutic relationship and, of course, there’s a liability issue attached to not prepping well for discharge.
But I know all is not well in other places. The questions posed by the post are good ones, and the answer, has to do more with the attempted (and ongoing) deskilling of nurses over the past few decades — the idea that hospital administrations essentially view nursing as task-driven and routinized; nursing roles in this model are severely circumscribed and reduced to a set list of tasks to increase productivity and lower costs for the hospitals. The predictable result: nurses who are emotionally and intellectually disinterested and disengaged in their practice. Sound familiar? I guess the larger question this begs is to what degree are nurses themselves (and, it must be said, self-described nursing leaders) complicit in the deterioration of our profession; indeed, it’s hard to imagine another profession that would undermine itself and give up valuable roles so cheerfully.
Or maybe we should just give up the pretence that nursing is a profession altogether?
Posted by torontoemerg in Battered Nurse Syndrome, Before I Start Throwing Things, I'd Better Write This Down, Public Images of Nurses and Nursing on Tuesday 02 November 2010
My pet peeve du jour. Why is it every time you read an article or blog post about men in nursing, you get the inevitable disclaimer about the “stereotype” of male nurses being gay? “We’re manly men who happen to be a manly nurses” seems to be the general consensus, and advertising campaigns seem to reinforce it.
Are we adult enough as nurses to think seriously about the underlying assumptions of this disclaimer, which are decidedly homophobic and sexist? Think of it this way: assertions of masculinity among heterosexual male nurses play on negative stereotypes of gay men as being effeminate, passive and weak (and trust me, I’ve seen plenty of butch gay men in the Toronto emergency department where I work — more masculine, actually than my straight male colleagues.) And guess who else carries that stereotype of feminine, passive and weak. . . you wouldn’t be talking about, um, your female colleagues, would you? If the aim is to recruit more men, straight or gay, to the profession, starting off with a claim which is simultaneously negative and probably offensive to gay men is not the way to go.
In essence, it’s the attempt to build up one part of the profession by knocking down another which makes me cranky. Yes, Virginia, there are gay nurses out there. So instead of a weak, defensive “Hey, I’m-not-gay” approach based on perceptions and overt demonstrations of masculinity, one might think it’s better and more assertive and just to say, “So what if I am gay? I’m a nurse, period.”
I was prepared to like the advertising campaigns on the right. Straight-forward (so to speak) and showing the diversity of men who are nurses. Having thought about it, I don’t like them quite so much. The tag lines perhaps redeems them a bit: “My nurse is a hero” — “If you want a career that demands intelligence, courage and skill and offers unlimited opportunity, consider nursing”. Some adjectives and nouns I think which apply to all nurses, gay or straight, female or male.
This article in the Toronto Star about the salary inequality of non-unionized and unionized nurses caught my attention, not so much because of the story itself, but because of the comments which followed. For some reason, when nurses’ wages are discussed, people go a little nuts. Apparently, we’re all lazy, stupid and overpaid. Some representative comments:
Nurses often say they work hard, handle more than a person should but I wonder, who makes those standards? and who are they making this comparsions [sic] to? I have been to a the public hospital here and oversea in asia (Hong Kong – not a third world country). When I compared to that, our nurses gossip too much, slack off often, slow paced and unefficient. Most nurses also carries this arrogant attitude when I talk to them while the ones I been to oversea is polite, helpful, direct and informed. I am not slamming unions, it’s just that they have to be realistic. Many skilled workers work much longer hours, handling more work and bring home much less. Nurses should be thankful they have a relatively secure well paid job compare to most of the workers in Ontario.
*** *** *** *** ***
You have to feel sorry for all those poor nurses. Here I work in a totally private company as a professional and can only dream of making $40 per hour. When will this madness ever stop? When will the public service employees realize they are not worth that much money? When will they stop holding their friends, family, and neighbors’ hostage, and stop sucking us dry? I think the real question here is why are the other nurses worth $49 an hour? Maybe they should take the pay cut down to the other nurse’s wage???
*** *** *** *** ***
Except the MDs who already get the astronomical pay I met showing some good attitudes, many health professionals like nurses, lab technicians taking medical tests, X-ray pictures are sometimes overly domineering, arrogant and unprofessional. Once, I did a body checkup in a clinic and a medical test in a medical laboratory, I was told to follow the steps like taking off the clothes by these ‘medical professionals’ in arrogant and almost rude manners. I didn’t feel surprised because these people are well protected by job security and don’t need to provide any good customer service to patients. Staying in hospital would be worse by deduction.
When nurses are confronted with complaints about our pay, our usual reaction is, “You don’t know what I do. We work very hard, we have huge patient loads, we’re often and literally up to elbows in shit and snot. We deserve our pay.” My reaction: So what? Take a number, the queue starts here. A lot of people have terrible, awful, thankless jobs — ask the workers in fast-food restaurants, or in meat processing plants. This answer, the I-have-a-really-crappy-job defence, frankly, is a bit whiny. More to the point, it works to our detriment by reducing nurses and nursing to a series of mindless tasks and skills — and that is exactly how we’re perceived by the public, in popular culture, and yes, by hospital administrators. Guess what? You can train a monkey to take a blood pressure, start an intravenous, or put someone on a bedpan.
So what makes nurses different? I want to suggest a paradigm slightly amended: we’re paid well not because of what we do, but because of what we know. Our value is in our knowledge. Yes, we’re well paid. Are we paid for what we’re worth? Here’s a very small fraction of what I know; every nurse can (and should) come up with their own list.
I know the signs and symptoms of hypoglycemia.
I know why alcoholics are at risk for esphogeal varices.
I know why congestive heart failure can cause right upper abdominal pain.
I know how to triage.
I know how to pronounce death.
I know how to listen to heart sounds.
I know how to relieve pain without medication.
I know how to communicate effectively, and to teach you about your condition/medication/problems in a way you can understand.
I know how to do a head-to-toe assessment.
I know how to arrange home care services for you.
I know why mechanism of injury is important.
I know how to make you comfortable.
I know how to tell you your mother has died.
I know when you’re getting sicker, even before you do.
I know where to place the IV to cause you the least discomfort.
I know how to place an nasogastric tube safely.
I know how to recognize the early signs of skin breakdown.
I know that pancreatic pain is sometimes felt in the left shoulder.
I know what crackles mean, and the difference between fine ones and coarse ones.
I know how to protect your confidentiality.
I know the optimal lead placement to do an ECG.
I know which heart rhythms are life-threatening.
I know why Treatment X is prescribed, not Treatment Y.
I know when your blood pressure is too low, and what to do about it.
I know what an elevated heart rate can mean.
I know when you’re starting to feel better without you telling me.
I know how to document your progress clearly and accurately.
I know how to organize my care so you get the best possible care.
I know what to do in a trauma.
I know the difference between ventricular tachycardia and supraventricular tachycardia.
I know the side-effects of beta blockers. I know why it’s important I know.
I know how much morphine I can safely give you.
I know the name of the bone being x-rayed.
I know what to do when you’re about to give birth.
I know when you’re about to die.
I know what ST elevation means.
I know what fluid balances mean, and why it’s important to you.
I know how to interpret blood results, and I know when they are of concern.
I know how to interpret blood gases.
I know what to do when your heart stops.
Is this knowledge valuable for patients? You tell me if I’m paid too much.
Any experienced nurse can walk in to any particular unit and tell almost immediately if it’s a happy place to work. There’s something about the body language, maybe, or the lack of laughter, or how the nurses present themselves. Like pornography or good art, you can’t exactly put you finger on defining it, but nevertheless, you know it when you see it. I like to think (for all of my moaning and biting) my own little corner of nursedom is a fairly happy place to work, or at least, it’s far, far better than most of the places I’ve worked.
My father has a chronic condition which requires fairly regular if infrequent visits to a particular Toronto-area hospital for consultation. So today I spent the day with him and his wife at this hospital while he was getting treatment. While my father was in the procedure room, I remarked to his wife (who incidentally is a retired nurse, and a pretty sharp observer, to boot) that the nurses working in the short stay unit seemed particularly unhappy.
“Oh yes,” she replied. “I’ve talked to a few of them and they’ve all said it isn’t a pleasant place to work.” She lowered he voice. “In fact, I’ve seen the manager come on the floor and ream out a few of them here in front of patients and families. Totally, totally inappropriate.”
At that moment the manager came out. She was short and pale, and looked like she ate nursing licences for breakfast. Hell, she scared even me. There was an immediate stiffening amongst the nurses, and a couple of them, I noticed, surreptitiously left the unit through a back exit. Definitely an authoritarian, then. I felt sorry for this gem’s staff.
If I were a manager, and my staff were avoiding me like the Ebola virus, I might think I may have a problem. She probably thinks she’s doing a good job, and has mastered the voo-doo arts of human resources management.
I emphatically would not work that particular unit, nor would I work in a hospital that supports that management style. It’s bad nursing and bad for nursing.
I wondered though: in choosing between a happy work place and an unhappy one, wouldn’t you choose the former and eschew the latter as being unfavourable for morale and a quality nursing work-life environment, and therefore poor inducement for retention and recruitment, and more importantly, an indicator for poor patient outcomes?
Posted by torontoemerg in Before I Start Throwing Things, I'd Better Write This Down on Tuesday 10 August 2010
My jaw dropped to the floor and narrowly missed striking the cat on the head when I saw this:
The highest-paid nurse in the Regina Qu’Appelle Health Region earned close to a quarter of a million dollars last year.
The top five salaries paid to registered nurses in the RQHR ranged from $180,530 to $243,540.
The nurse earning $243,540 was employed on a nursing unit at Regina Pioneer Village, while the second highest wage earner was an emergency room nurse who received $186,562.
Now, the top base salary for nurses in Saskatchewan is around $84,000 per year. Which means, roughly, the nurse making over 240K a year was working, approximately, 80-some hours a week, each and every week of the year.
My first question: is he or she freaking nuts?
My second question: how can this nurse provide safe and competent when she or he is working, literally, every day of the week for a year?
My third question: why would his/her manager permit it?