Archive for category The Stupid is Strong with This One

“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..)

We’re always looking for the highest calibre health professionals to come join our team. This is our newest recruitment ad that will be running in Montreal.  So for anyone looking to work in a leading hospital focused on safety and quality, check us out.

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?

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*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.

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9 Comments

Best. Comment. Ever.

Blog reader “Sarah” REALLY gave me a big old can of whoop-ass when she wrote something on my blog post “The Value of Nurses” She really schooled me! So take it away “Sarah”!

Nursing is critical to patient health and recovery. Nurses are responsible for the day to day care of the patient. 

Nurses are also useful for disease prevention and chronic disease management (trust me, MD wants to go to school 12+ training in the medical model of care to tell fat Type 2 diabetics they need to stop eating pie).

That said, yes nurses know how to do all the technical things listed. Respiratory threrapists [sic] can also expertly read EKGs, blood gases, and recognize heart sounds. As can paramedics. These things alone are not rocket science.

Nurses are never trained in pathology using the medical model of care to form a differential diagnosis of disease. Otherwise they’d be unhappy underpaid junior doctors. Try calling a nurse a para doctor and see what they say. Nurses seem to forget that the nursing model of care and training is a different role from MDs.

Sure nurses save lives and do some great things providing care for patients, but many other jobs do as well. Personally, if I have a disease, I’d be putting all my money into the MD/PhD in the lab trying to cure me vs a “good” nurse. I find most nurses can provide basic care but anything advanced is rightfully over their training. Good nurses recognize their limitations, not toot their own horn. So I gave up expecting competent nurses while in the hospital.

Yay so you can recognize a cardiac cycle or a hypoglycemic attack in your patient (how did you let the patient get that way in the first place?!). That still doesn’t mean you have knowledge worth $40 hr+.

Well Sarah, you are absolutely right. I was thinking just the other day about the time me and Doreen were sitting in the Resus Room playing cribbage for a nickel a point when Greta from Admissions walked by and said to us, “Hey, that monitor had some funny pointy lines.” We looked up and yep, she was right! So we talked it over— I was five dollars and two bits ahead — and we thought since he — the patient, I mean — was maybe in ventricular tachycardia we should call in Dr. Handsome. So we did and all of a sudden there was this big fuss, Dr. Eagerpants and Dr. Contentious and Dr. Fusspot came running in and started doing IVs and xrays and EKGs and catheters and everything. It was just like that TV show, House. Then I skunked Doreen and she got mad and left without paying me my five dollars and twenty-five cents which was now eight-fifty, and also the patient died. Dr. Handsome said sadly, “If only someone knew how to do an emergency cardioversion, we could have saved him!” and pounded his first on the Resus Room desk, just like on House. Haha. What a dummy! Like nurses can do anything like that!

Then there was the time Doreen and I were painting each other’s nails in Exams, and one of those nosey housekeepers told us the guy in bed 4 was throwing a seizure or something. And despite our wet wet nails we went over and looked and Doreen said he was! Then he stopped. I found out later he died. I guess he did something called, um, sounds like asparagus but isn’t. Dr. Handsome came in, and pounded his fist on the desk again. “If only someone knew how to give a benzodiazepine and also protect his airway we could have saved him!” he said. Doreen and me just looked at each other. What??? Nurses can do that??? But anyway I had to pee. I think on reflection we fell down a little on that one and definitely didn’t earn our $40+ an hour!

There are some other things too, so yes you are right, nurses should stick to wiping bums and leave the real doctoring to doctors, though RTs and paramedics can do some doctorings too sometimes. I will toot my horn though just a little, though! I once found some old lady had a fever once! So that was awesome!

Also, I once told a fat man with the diabetes he ate too much pie. Isn’t that kewl??? It’s like we psychically share a brain! But maybe you have it this week!

Thanks for writing!

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16 Comments

Just Because I Don’t Remember You Doesn’t Mean I Didn’t Care

In the Emergency Department where I work, the number of patients we see pushes 200 some days. We assess and treat a lot of people, mostly for lumps and bumps, breaks and bruises, but also for major, cataclysmic, life-altering events — MIs, trauma, stroke, what-have-you.

I have a problem. The moment to the patient leaves the department I tend to forget them. Completely. If you are a run of the mill STEMI, I swear I will not remember you the next day. I may not remember you in an hour. A little while ago, my manager asked me about a case receiving some, um, legal attention. It was only after a good deal of prodding that I vaguely remembered — and this was a Code Blue! (Fortunately the legal formalities were about treatment received on previous visits, so I wasn’t directly involved. My charting was good, anyway.)

I do remember some cases which for one reason or another have stuck in my mind. (For example, like here. Or here. Or here, among others.) But mostly, nah. Maybe it’s because of the sheer volume. Maybe because my head will explode if I remembered the details on each and every patient. Maybe it’s just coping skills. Who knows. Anyone else have this problem?

Anyway, I was triaging the other day, and a patient told me how much she appreciated the care I gave her husband. (He was a Triple A, and survived.) I goggled at her for a second — we don’t frequently receive compliments in the ED — and said, “Yes, of course, I remember him.” She beamed. I made her happy. But I didn’t remember him at all. The patient’s husband was all in a day’s work for me — and a hugely important day in her life. We tend to forget what impact we have on patients and families. So a small lie for a good cause, I guess, a tiny bit of therapeutic communication.

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Some stupid to ponder, or how a local employer treats their nurses like idiots. Our local CCAC — the provincial agency which arranges for Home Care and related services — hath decreed that case managers are no longer permitted to use hospital-provided educational materials because 1) they haven’t been vetted by CCAC and 2) because the case managers haven’t been in-serviced on them.

Really.

CCAC evidently thinks their case managers — all RNs, by the way — are complete idiots in that they can’t tell patients using a hospital provided form when to come back the ED because (for example) their saline lock is infected. And CCAC believes that hospital put out bogus and misleading educational materials.

Sometimes you just have to shake your head. And mutter. Who comes up with these bonehead rules, anyway? Do managers lie awake at night thinking them up?

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On a personal note, thanks to all who emailed or tweeted or otherwise left messages of support regarding the family medical emergency a couple of weeks ago. All is well again, but I was a little frightened for a while. Your concern was really appreciated, and made me realize that I — we — have a great little community around this blog. Thanks!

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9 Comments

Fat Nurses Need Not Apply

A Texas hospital has declared war on the scourge of obese nurses:

A Victoria [Texas]  hospital already embroiled in a discrimination lawsuit filed by doctors of Indian descent has instituted a highly unusual hiring policy: It bans job applicants from employment for being too overweight. 

The Citizens Medical Center policy, instituted a little more than a year ago, requires potential employees to have a body mass index of less than 35 — which is 210 pounds for someone who is 5-foot-5, and 245 pounds for someone who is 5-foot-10. It states that an employee’s physique “should fit with a representational image or specific mental projection of the job of a healthcare professional,” including an appearance “free from distraction” for hospital patients.

“The majority of our patients are over 65, and they have expectations that cannot be ignored in terms of personal appearance,” hospital chief executive David Brown said in an interview. “We have the ability as an employer to characterize our process and to have a policy that says what’s best for our business and for our patients.”

It all sounds so, well, high-schoolish, and I don’t think the CEO is seventeen, though he’s acting like it. I mean, can you get any more shallow? Since when does physical appearance have anything to do with competence or worth or dignity of any health care professional?

Or maybe David Brown doesn’t really believe nurses actually have skills — we just stand around as decoration, lookin’ pretty.

And fitting the  “representational image” of hospital employees to meet patient “expectations?” What the hell does that mean, anyway? If  patients expect this (and this is a pretty common “representation”)

A representational image of a nurse

then hiring practices should make sure all nurses are boobalicious? What if the patients want all-white nurses? Or all females? Or no Muslims?

The man is a bit of a dink, obviously. I can only imagine how valued overweight nurses employed by this hospital must feel.

The article goes on to note that this David Brown, CEO of Citizens Medical Center, has some issues. In 2007  he wrote memo about some foreign-born physicians in which he  stated: “I feel a sense of disgust but am more concerned with what this means to the future of the hospital as more of our Middle-Eastern-born physicians demand leadership roles and demand influence.”  He continued, “It will change the entire complexion of the hospital and create a level of fear among our employees.”

Needless to say, there is a discrimination lawsuit over that.

So let’s summarize what the leadership at Citizens Medical Center believes: scary scary fat nurses scaring patients. Scary scary dark-skinned physicians scaring employees and patients.

Clearly a place where I would want to work. Or be treated.

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51 Comments

Arizona is Where Educating Patients is Bad, Bad, Bad: An Amanda Trujillo Update

Just a few words about Amanda Trujillo.  Jennifer Olin at RNCentral.com has detailed at the latest twists and turns of her case. I won’t repeat everything, but I want to comment instead on the Arizona State Board of Nursing’s latest action. The BoN has added a further charge that Trujillo has misrepresented herself as “an end of life” specialist because she counselled and educated patients about end of life care, using the materials provided by her employer, Banner Health.

This is pretty outrageous, and I think, an abuse of process. Let me elaborate from my point of view as an Emergency department nurse. In the course of any shift I may give advice and education on:

  • wound care and dressing changes — but I am not a nurse specialist on wound care and dressings
  • casts and splints — but I am not a specialist in orthopaedic nursing
  • diet for cases of gastroenteritis — but I am not a dietitian
  • prescriptions — but I am not a pharmacist
  • preparation for diagnostic imaging — but I am not a radiography tech
  • advise first time pregnancies on the benefits of breastfeeding — but I am not a lactation nurse
  • head injury routine — but I am not a nurse specialist in neurology
  • treatment of fever in children — but I am not a paeds nurse

Now according to the Arizona State Board of Nursing, I am representing myself as a specialist in all of these areas, and probably a few score more that I haven’t listed. By the considered, professional judgement of the nursing leadership inhabiting the halls of the Arizona State Board of Nursing, I should just shut up, because I am clearly qualified to do squat.

The Arizona State Board of Nursing evidently believes nurses educating patients on anything is beyond their scope of practice. And by extension, nurses educating patients puts patients in danger.

Ridiculous?

Absolutely. And this is why this latest charge is a trumped-up nonsense. Nursing as a profession would cease to exist in Arizona if nurses had to meet the stringent requirements the BoN now apparently requires, if nurses need some sort of official certification as “specialist” before providing education of any sort. The “position” now put forward by the Board of Nursing is contradicts widely accepted nursing practice. Providing health teaching is the standard of care around the world. This is what nurses do. In my jurisdiction, you can be disciplined for not providing appropriate education.

Jennifer Olin puts it this way:

This just makes no sense. Trujillo may be interested in end-of-life issues, she admitted herself that she had provided such information to patients previous to the one involved in this incident with no objections from physicians or hospital management. In fact, that evening, she even cleared her plan of care with the clinical manager.

This is not claiming to be a certified specialist. We are nurses. We are expected to know quite a bit and, more importantly, how to find information for our clients and ourselves. The information Trujillo provided was pulled straight from the information banks of the hospital’s own computer system.

Exactly. This is what we know as nurses. We educate. To claim otherwise is to run against the experience and practice of millions of fully qualified and competent nurses. The Arizona Board of Nursing knows this too. They are nurses, after all. You can only conclude the Board is grasping at straws at this point, hoping to harass or intimidate Trujillo into submission.

The next step is an evidentiary hearing, for which the Board of Nursing has not yet set a date. As of next month it will be a year since this business started. The wheels of justice grind slowly, it’s said. Let’s just hope they grind as finely as advertised.

One more note: I spoke at length with Amanda yesterday, and she is very well and in good spirits. Her lawyer has asked her not to comment publicly further on her case, so I can’t relay what she told me. However, I will say the story grows more convoluted by the day and there is far more going on than can be publicly mentioned. So stay tuned!

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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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