“We Don’t Care What’s On Your Head. We Care What’s In It.”

So there’s this thing in Quebec which I’m sure my Canadian readers have heard of and maybe also a few of my American readers, which involves the Quebec government devising some legislation called the Charter of Quebec Values. I have to say “charters” and “values” are nice happy positive words, and Quebec is filled with deliciously cheesy poutine, hockey, maple syrup, and those devilishly sexy Québécois men, so what’s there not to like (except for les Habs, boo, hiss!)?

The thing is, this Charter of Quebec Values wants to ban wearing obvious religious symbols for all public employees, including nurses and other health care professionals. This, I have to say, has ABSOLUTELY NOTHING TO DO with some nice Ladies of Muslim persuasion cheekily wearing hijab in broad daylight in Montreal and everything.

From the Government of Quebec website. Top: acceptable. Bottom: Va te faire foutre (You can Google Translate that too.)

(Just so you know, American readers, I must also officially tell you is NOT racist, and the fact the proposed legislation targets Quebecers with brown skin is merely, um, an unfortunate coincidence.  We say this because the Quebec government is acting from the purest, noblest of intentions. This is a Fact, because the Quebec government has told us so. (You can Google translate it or something.) It is well-known that the separatist, ruling Parti Québécois has long been offended by clerical collars, Jewish kippahs, wimples and garish Roman Catholic crucifixes. This is also a Fact, which you can also Google.)

The proposed charter will affect health care professionals, including nurses. My question, then, does the wearing of religious symbols or associated clothing have any place in the provision of health care? Should nurses don hijab on the hjob?

Before you run off to start raving, maybe you should consider a few things. First, banning headscarves (or whatever) has a distinct element of authoritarian nastiness about it. Should the nursing profession be that coercive? There’s probably no getting around the fact that if the legislation is passed, it will be nurses enforcing the ban against other nurses.*  (The irony of having the Quebec government telling Muslim women how to dress, partly, it is argued, to ensure gender equality, is beyond these guys.)

Another thing: nurses have a long history of wearing weird things on their heads. It’s safe to say that if you look over the course of the history of nursing, no crazy headgear has been the exception, not the rule.

Like this:

Or this:

Or this:

Which reminds me: some of you might say, oh it completely different! it’s a religious thing! Muslims shouldn’t be pushing their faith in our faces!

Well, there’s this:

+

And this:

But not this? (Love this ad, by the way. It was created in response to the proposed Quebec law..)

So if you’re offended by women in hijab but not by Catholic nursing sisters, what’s the difference? Do you really believe the hijab (or any other piece of religious accoutrement) sucks out the nursing from the nurse?

So dear readers, hijab for nurses and other health care professionals, yes or no?

____________

*The Quebec nurses union, FIQ, has courageously taken the position of taking no position at all. In other words, the union won’t defend members running afoul of this law. I’m pro-union, but holy Sam Gompers, sometimes their leadership are dumb as stumps.

If You See a Teddy Bear, Shoot It

That would be the taste of barf in my throat

Nurses Week is fast approaching. I am steeling myself  mentally for the steady drizzle of syrupy tributes from various health care apparatchiks and functionaries, who will inevitably make some reference to nurses as “angels” and the “beating heart of health care” or some such tripe. I have yet to see an article this year illustrated with a teddy bear dressed up as a nurse, but it is early days yet. A reminder: if anyone approaches you with such a teddy bear in recognition of Nurses Week, do not look the bear in the eye, but instead beat it against a hard surface till the stuffing flies out, or the honour of the nursing profession is restored, whichever comes first

(In case you are new to this blog, here’s why I hate teddy bears and Nurses Week so much. Well, not so much hate, but a deep visceral loathing.)

I was put in mind of all of this reading some of Nurse Keith’s old blog entries over at Digital Doorway. I came across this post, which pretty well sums up my feelings about the association of teddy bears and angels with nursing, and also their use in scrubs. Nurse Keith wrote:

Somewhere along the line, the “angels of mercy” moniker became attached to nurses as a group. Granted, in the early days of nursing, nurses’ ability to act autonomously was extremely limited, and we were, by and large, the handmaidens of deified doctors. However, as much as that regrettable history has largely changed, the image of the nurse as angel unfortunately persists quite widely in our culture and websites galore promote gifts and baubles that continue to diminish nurses’ professionalism. Images such as this one drive home the point: nurses are childlike individuals with starched white hats who love teddy-bears. Adding insult to injury, nurses can actually be depicted as winged angel/teddy-bears, further enforcing the infantilization (and deprofessionalization) of our profession. Would doctors allow themselves to be thus represented to the public?

Rather than being perceived as cherubic angels and childlike creatures, this writer feels that being perceived as the valuable and skilled professionals who we truly are would allow the public to have a much more accurate perception of what we do, and our importance to the care of millions.

[. . .]

Nurses’ uniforms have certainly changed over the years, and as scrubs have become the norm for nurses in most clinical settings, many companies have capitalized on the popularity of such utilitarian clothing. Now, designer scrubs covered with angels, teddy-bears (there they are again!), and any number of cartoon-like images adorn the hard-working bodies of nurses around the world. If nurses want to be taken seriously by the public—and by doctors and other professionals—how does the wearing of such (in my opinion) unprofessional clothing help our cause?

Shoot on Sight

Picture this: a team meeting occurs midday to discuss a patient on the adult oncology floor. Present at the meeting: a medical resident, a medical student, the attending doctor, the oncologist, two unit nurses, a social worker and a respiratory therapist. Of all of the professionals in the room, who would possibly be wearing pink scrubs covered with teddy-bears and hearts, and a pin on her chest saying “Doctors Cure, Nurses Care”? And what message does this convey about the nurse’s self-image and how the other professionals present in the meeting should perceive him or her?

Well exactly. Imagine you’re dressed in an angel-motif scrub top, and you’re trying to give discharge instructions to a patient. Do you really think the patient is going to take you seriously? Really? Or you’re trying to get the physician to order more narcotic analgesia dressed in deep rose pink scrubs, a colour, I admit, which makes me do the inward cringe every time I see a nurse wearing it. Does that deep rose pink convey to the world the exact amount of professionalism and intelligence nurses believe they possess?

I guess I am wondering if there anyone out there willing to defend the whole nurse/teddy bear/angel thing, or even say three cheers for teddy bear scrubs or even frilly “feminine” scrubs?

Registered Nurses won’t make newspaper headlines, but your local sports pro will

Click to enbiggen

With Ontario’s Nursing Week approaching, May 7 – 13, posters for the Ontario Nurse’s Association (ONA, our union) campaign on supporting nurses the same way pro-athletes are have been put up around Acme Regional.

The conversation often arises among my colleagues about how a baseball player can make over 20 million dollars a year where 3 or 4 nurses’ lifetime salaries combined will never compare to that. I often feel bitter when I think of those in the business world who receive all sorts of financial and personal incentives for their work. People who go on all expense paid trips because they have sold the most insurance (selling you safety nets in case you fall, but you likely won’t, however you have to have it…) for example that year, meanwhile in that same year I may have resuscitated a child, held the hand of a dying man during his last breath and treated a father of 4 for a heart attack among caring for other incredible people. I received my same pay as always and more importantly, do not expect an incentive. I don’t feel bitter that I’m not getting a trip, I feel bitter that in this society, a pro-athlete or businessman is more supported than nurses. On the other side of the coin, it makes me wonder what sort of nursing culture would be bred if nurses were provided incentives for life saving measures or actions/treatment/education. And what treatments or care would be deemed “more important” than others, garnering a higher incentive? In the emergency department health teaching is imperative; to prevent illness and disease so one could argue that is as important as treating the patient having a stroke. If incentives in nursing existed would the wrong sort of people be attracted to the nursing profession? Some say it’s a calling, the art of the practice; only certain people can and will do the job and do it well have you. It would be worrisome to think that an individual would only want to save a life or teach parents about how to appropriately treat fevers if it meant they would get a financial bonus.

And yet, despite all of this, I still struggle with the fact that people who sell the most cars, buy the most stock in a company, etc… are seemingly more valued and appreciated then those that save lives, give people more time on earth and genuinely (most of us at least) care about humanity. I have a hard time finding the balance in it all. Emergency nursing is in the “business of life saving” is it not? With more and more facilities receiving incentives for improved and rapid physician to patient initial assessment times, where does appreciation for the nurses fall in to all of this?

(See also ONA’s website here and RNAO’s website for nursing week.)

How Nurses View Themselves

A selection of “What I Actually Do” meme posters” related to nursing, which have been making the rounds on the Interwebs. Some of them, I guess, are funny and clever, and they’re meant (I suppose) to educate the public at large about the realities of nursing. But what I think is interesting is the way they reflect nurses’ perceptions of themselves, and how nurses perceive how others view them. Some common themes: nurse as lazy (by managers), nurse as bimbo, nurse as angel, nurse as waitress/bellhop, nurse as money-grubbing, nurse as menial. What do you guys think of them? Do they actually represent how nurses view themselves?

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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!”]

A Paean to ED Nurses or Just Annoying?

Twitter follower @camillelalonde  — thank you — sent me  this oldish link, which initially warmed the very cockles of my heart:

Guest Editorial
ACEP News
September 2006
By David F. Baehren, M.D.

[. . .]

We usually look afar for heroes and role models, and in doing so overlook a group of professionals who live and work in our midst: nurses.

And not just any kind of nurse: the emergency nurse. There are plenty of people involved in emergency care, and no emergency department could function without all of these people working as a team. But it is the emergency nurse who shoulders the weight of patient care. Without these modern-day heroes, individually and collectively we would be in quite a pinch.

[snip]

It is the emergency nurse who cares for the critical heart failure patient until the intensive care unit is “ready” to accept the patient. The productivity of the emergency nurse expands gracefully to accommodate the endless flow of patients while the rest of the hospital “can’t take report.” Many of our patients arrive “unwashed.” It is the emergency nurse who delivers them “washed and folded.” To prepare for admission a patient with a hip fracture who lay in stool for a day requires an immense amount of care–and caring.

Few nurses outside of the emergency department deal with patients who are as cantankerous, uncooperative, and violent. These nurses must deal with patients who are in their worst physical and emotional state. We all know it is a stressful time for patients and family, and we all know who the wheelbarrow is that the shovel dumps into.

For the most part, the nurses expect some of this and carry on in good humor. There are times, however, when the patience of a saint is required.

[And so on and so forth. Read the rest here. I couldn’t find a link to original article. Sorry.]

Then I thought about it. The nurse-as-saint-and/or-angel meme is quite strong in this piece, and is something that needs to be retired quickly. And why do nurses look to other professionals for validation?

Or am I being churlish?

All Nurses Are Not Equal

My best friend Reid made an interesting point the other day. “I have,” she said, “an alphabet soup of certifications. I have ACLS. I have BCLS. I have TNCC. I have ENPC. I have pieces of paper that tell me I can run traumas and defibrillate people. I have critical care courses up the wazoo. Some of these things I paid for on my own, because I wanted to improve my practice and give better patient care. So,” she concluded,”why the hell am I being paid the same as the med-surg nurse upstairs who has none of these?”

Good question. In Ontario, at least, the nurses union — ONA — has decreed that all nurses are equally qualified to work in every setting, and are interchangeable in terms of duty and practice. It’s a very pretty idea, but theoretically and practically speaking, it’s rubbish. Floating a med-surg nurse to the ED is a College of Nurses complaint waiting to happen. It’s dangerous for both patients and for nurses. Even ICU nurses have trouble coping in the ED setting (but for some reason, in my experience, the reverse isn’t as nearly as true.) The difference, I would argue, is not in the provision of basic nursing care or even the intent to provide good patient care but in skill sets, critical thinking and training. Emergency nursing, like any other high-acuity nursing speciality, requires considerable initial and ongoing education, but also, it’s important to remember, has a much higher standard of practice and responsibilities.

Further the lack of any differential in pay according to training/certifications acts as a disincentive for nurses to continue their ongoing education. For example, the fee for the Trauma Nursing Core Course (TNCC) is sometimes, but not always, paid for by hospitals, but in any case, there is no real recognition of nurses completing the certification. So apart from professional pride, why do it? Appeals to professionalism are a bit naïve and idealistic, and only go so far. If you can encourage any nurse to upgrade their skills and education by offering pay differentials, I would be for it. Better educated nurses with better skills and better critical thinking skills means better patient care, better outcomes and ultimately, higher nursing morale. The myth that all nurses are created — and remain — equal has to go.

 

Snapshots of Nursing History

Courtesy of the National Archives of Canada.

Two nursing students from the John H. Stratford Hospital Training School for Nurses (later re-named the Brantford General Hospital School for Nurses). 1895

Nursing Students, bed making. Medicine Hat Regional Hospital. You get the notion the attentiveness is feigned. Making mitred corners is not that interesting.

Nurses at St. Michael's Hospital, Toronto. Three nurses, two nuns, a sterile tray. Note the (presumably sterile? clean?) wimples.

Nursing students being instructed in dietary science at the Hospital for Sick Children, Toronto.

Nursing students in a lecture theatre, Hospital for Sick Children. Note the instructor is in full nursing uniform: role modelling both behaviour and appearance --- deportment --- was considered a vital part of nursing education.

When psych nurses wore crisp white uniforms.

On the Dying Art of the Bed Bath

Joni Watson (@joniwatson) explains why bed baths are important:

I am a fan of cleanliness, but I’d rather not bathe a complete stranger (or acquaintances for that matter). However, as a nurse, I do know that care is part of my responsibility, and I am thankful to the many great nursing assistants who understand the importance of a thorough bath, too. At times, I have rushed through bed baths, thinking of the growing to-do list and soon-to-be announced priorities. On other occasions, though, I have taken my time, even brushing my patient’s hair as though it was my only duty for the day. I know my patients felt my presence or lack thereof in all circumstances.

In nursing school, bed baths were literally the second practical skill I learned, after making the bed itself. Get the warmed bath flannels, the basin of warm water, the soap, the washclothes, towels, lotion, barrier cream; start from the top, (no soap on the face), work your way down, drying as you go, washing from the distal points up, strategically positioning the flannel to preserves modesty; rub the back with the lotion, apply barrier cream to the bony pressure points, paying particular attention to the sacrum and feet; assess the patient as you go; document.

Ta-da. Done: your patient feels like a million bucks and you get a warm fuzzy for doing a good thing.

Nurses will defend the bed bath as the most elemental nursing skill, simultaneously bringing comfort to the patient while establishing a therapeutic bond and allowing us to assess physical and mental condition. Problem is, in the emergency department, we just don’t do them. Or rather, we try, at least for the admitted patients, but are frequently unsuccessful. We get a new, complicated patient. The patient in the next bed is crashing. A code is called. It’s always something, and bed baths as a priority item of care fall off the plate, because at the end of the day, being unwashed won’t kill the patient. The majority of nurses I work with have just given up trying altogether.

It’s a bit ironic. Anecdotally, nurses will tell you of ever-increasing patient acuity taking time away from basic nursing, yet it’s these acutely ill patients who need bed baths in the worst way. When one adds the time needed for the legion of non-nursing-related activities  and documentation that crowd a nurse’s attention, it quickly becomes clear how bed baths are deemed non-essential. Except that they aren’t.

Bed baths — or the lack thereof — are symptomatic of a larger issue in nursing. The integrity of the nursing profession has been under attack for years. We are constrained from being nurses in the fullest sense by time, resources, and  ill-considered hospital policies. Or worse: attitudes. I have known more than a few nurse-managers and administrators — and if truth be told, front line nurses themselves — who think the entirety of nursing consists of a list of tasks to be performed, unthinkingly and uncritically. When nurses start thinking of bed baths as just another task, like emptying the urine drainage bag, rather than as an essential part of the therapeutic process, we’re in trouble. So bed baths illustrate rather nicely the present conflict in the profession: are we mindless drones just doing the job, or are we thinking health care professionals engaged in a holistic therapeutic process with our patients? If you want to point to a single cause of nursing malaise, it’s this dichotomy, and it starts with being unable to give bed baths properly.

Gone Gardening, and Theresa Brown Gets Bullied

Spring has finally made a tentative appearance, so I’m outside communing with nature today.

A couple of thoughts to consider: First, is there a connection between bullying in health care and this?

Also, check out the growing dust up between Theresa Brown (@TheresaBrown), who wrote in the New York Times yesterday decrying the culture of bullying in health care institutions, and the somewhat defensive, hand-wringing reactions of some prominent physician bloggers, whose principal objection seems to be nurses shouldn’t have the temerity to call out physicians who bully them. I’m guessing, incidentally, most nurses will agree with Brown on this.