Archive for category When the Health Care Corporation Speaks

Fat Nurses Need Not Apply Revisited

More on the Texas hospital, Citizens Medical Center, which banned fat people from being hired. Citizens Medical Center, you might remember, made it policy to exclude new hires with a body mass index >35, and explicitly stated employees appearance should “fit with a representational image or specific mental projection of the job of a healthcare professional . . . free from distraction” for patients. Medscape has a video (sorry, couldn’t figure out how to embed) from a medical ethicist named Art Caplan with another point of view. Partial transcript:

Look, I’m all for trying to set a good example and I think there are plenty of businesses where being thin and being in shape really do matter. I guess if you run a modeling agency it is very important. But I’m not convinced, really, that putting in weight restrictions is the best idea in terms of sending out the right message or a necessary message to patients. Patients, I think, can work with their doctors to try to overcome common problems. Doctors see all kinds of patients with all kinds of habits and all kinds of lifestyles. I think patients can deal with seeing all kinds of healthcare workers with all kinds of habits and all kinds of lifestyles. If they want a thin one, they should be able to pick one, but I don’t think the hospital necessarily should have to say that only the thin ones can work here. [Emphasis mine.]

Really? That last bit sounds needlessly, well, stupid. Does he really think patients should be allowed to choose their health care providers on the basis of their appearance?  “Let’s see. . . ” one can imagine patients musing, “that nurse is too fat. Tht nurse is too old. That nurse is too. . . dark. That nurse is too male. That nurse is too Muslim. That nurse is too gay.” And so on. Apart from fostering bigotry and discrimination, and demeaning and devaluing staff, in practical terms, you’d soon run out of nurses. I mean, not every nurse looks is thin, white, young and female.

One more thing. I understand there is a role for hospital policies regulating appearance: hygiene, facial hair, tattoos, uniforms and jewellery are usually targeted. Fair enough. I also understand the need for an ethicist to weigh (so to speak) both sides of the issue, but isn’t there some point where, after all is said and done, you have to say evaluating people of the basis of their body characteristics  in general is just wrong? I don’t think that medical ethicist Art Caplan exactly said it was wrong. Making a value judgement, that employers treating nurses and physicians as human beings with inherent dignity and worth, is important. It might even be a good place to start.

[UPDATE] Also, too, these thoughts from a writer named Susan Pape at Policymic.com:

When I am in need of hospital care, I want the staff to be the best, hardest working, most talented, most caring available. I do not care if they are overweight. Employing health care providers on the basis of their competence is a matter of life or death …to me.

And.

Obesity is not a choice, and it is not immoral.

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Nursing Week Ain’t What It Used to Be

My Nurses Week joy was shattered last night when the son of a patient reamed me out for discussing the patient’s condition and treatment plan — wait for it — with the patient. He thought his father, who was a rather elderly but very independent and shrewd man who still lived in his own house and putted around in a low-mileage 1992 K-car, might be disturbed and upset. I thought the son was a controlling little freakazoid, but didn’t say so. Not very nurse-like, I know, but your humble writer smiled and nodded and went on, curiously enough, to validate and affirm the son’s distress even as the son was proceeding merrily along with the aforesaid ream spree.  Then I promptly charted the conversation because, as all nurses know, these things come back for endless amounts of arse-biting. My life as a nurse: Florence, eat your heart out.

Management Approaches with Nurses Week Greetings

Also, Acme Regional’s annual Token of Sincere Appreciation, a.k.a. the Swag Bag, has evidently been cancelled. So in other words they are replacing crap with no crap at all which, when I come to think about it, represents a net gain.

Hurrah.

Anyway, EDNurseasauras and I seem to be on the same page when it comes to Nurses Week. After listing all the cruddy, oddly depressing, and inevitably unattendable Nurses Week festivities at her workplace, she writes:

Bobo, our medical director and somewhat socially challenged on his best days has actually paid out of his own pocket for some nurses day gift (I think his wife is a nurse).  In the past we have received lunch bags, t shirts, and coffee mugs.  But slogans like “Nurses Call the Shots”,  “Love a Nurse PRN”, “Nurses Rock” and other silliness goes right to the bottom of the charity bag for me.  Let me say that I truly appreciate that he has taken the time and effort to do this.  I really do. But I actually hate that more than the company logo.
At my nursing school graduation 35 years ago, one speaker exhorted us as newly minted nurses never to condone slogans that exploit us as men and women in health care, perpetuate stereotypes, and fail to present nurses as professionals.  Big boobs, thigh highs and stilettos, giant syringes…..you know what I’m talking about.  I have a few Emergency Nurses Association coffee mugs from a former boss that are tasteful, but other than that I say NO to silly slogans.
The only Nurses Week recognition I’m looking for is just a little sincere appreciation for the job I do from my employer.  Sincerity is not one of their strong points, so hopefully my boss will come through with the ice cream.

Ungrateful wench! At least she might get ice cream.

So how is your Nurses Week going?

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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

A Medication Error Leads to Suicide

A nurse commits suicide:

Kimberly Hiatt, 50, a longtime critical-care nurse at [Seattle Children’s Hospital], took her own life April 3. As a result, the state’s Nursing Commission last week closed its investigation of her actions in the Sept. 19 death of Kaia Zautner, a critically ill infant who died in part from complications from an overdose of calcium chloride.

After the infant’s death, the hospital put Hiatt on administrative leave and soon dismissed her. In the months following, she battled to keep her nursing license in the hopes of continuing the work she loved, despite having made the deadly mistake, friends and family members said.

To satisfy state disciplinary authorities, she agreed to pay a fine and to undergo a four-year probationary period during which she would be supervised at any future nursing job when she gave medication, along with other conditions, said Sharon Crum of Issaquah, Hiatt’s mother.

“She absolutely adored her job” at Children’s, where she had worked for about 27 years, said Crum. “It broke her heart when she was dismissed … She cried for two solid weeks. Not just that she lost her job, but that she lost a child.”

Is it just for a nurse to be fired for a medication error, even if lethal? Most hospitals do have procedures in place to deal with such errors, aimed at discovering the root causes of mistakes in order to improve patient safety. A key part of this process is to encourage nurses to report medication errors and even near-misses without threat of retaliation or disciplinary measures, but instead to offer education to strengthen skills and critical thinking. The hope is that in doing so, flaws in the process of drug administration can be easily identified and corrected.

Unfortunately, such an arrangement requires a certain degree of trust between management and the front line. When I worked in the U.S., management decided to implement a “No discipline, no retaliation” policy for medication errors. When the ED manager was asked if there actually would be no discipline taken for medication errors, she laughed and told us it would be “situational.” You can guess how successful the new policy was. Once trust is lost between front line nurses and management, it’s difficult to restore.

Firing a nurse distracts from actually promoting safety in a meaningful way, and diverts attention, as Kevin Pho points out, from where responsibility ultimately rests for ensuring safe medication practices: the senior management. Hospitals will fire nurses in the mistaken belief that removing a nurse who has committed a lethal error — an easy target, at that, if truth be told — will somehow reduce risk and liability and demonstrate commitment to patient safety. In fact, the precise opposite is true. By disciplining nurses who commit errors, and by not engaging in remediation with these nurses,  a climate is created where errors, if they occur, are likely to go unreported and unresolved — and substantially increasing risk.

It it enormously tragic a 8 month-old child died as a result of a medication error. And to be clear, none of this evades the ultimate responsibility of the RN to administer medications correctly. It’s important to note the state nursing board imposed substantial sanctions on this nurse, just prior to her suicide, including a requirement to be supervised while administering medications for four years.

Yet it’s also tragedy multiplied that the Seattle Children’s Hospital saw fit essentially first to scapegoat her, evading its own responsibility, and then to drive a 27-year veteran from the profession, leading to the point where she saw no other option but to kill herself. It’s interesting, in the context of the discussion around bullying this week in the nursosphere, that this news story should present itself. Were hospital administrators acting as bullies? When you think of how bullies behave and the sequellae of their behaviour on their victim — suicide being among them — you have to wonder.

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Nursing Malaise

Not Nurse Ratched has written compellingly on her blog about the seemingly chronic and unfixable malaise in nursing:

I maintain that currently registered nurses work in an environment perfectly engineered to create and perpetuate anxiety, hostility, and eventually depression. Why do we eat our young? Because we are anxious, hostile, and depressed. Healthcare today is a society of witch-hunting, and someone has to be burned. In all likelihood it will be “the primary nurse.” The primary nurse currently has responsibility for nearly everything, including ensuring physicians are correctly entering computing orders and ensuring that all the electronic pieces of the chart are present and correctly uploading to the main system. We now must double-check ourselves, our aides, our secretaries, and our physicians. If any part of the system goes down, you’re the one responsible. This is in addition to heavy patient loads. Speaking of which: you’re assigned too many patients for safety? Complain, and you’re written up for being a bad team player. Don’t complain and make an error, and you run a real risk of losing your job and/or your license.

She then adds:

I don’t know what can be done about that part of the job. It’s a hard job, we choose it, and we figure out how to cope or we quit and find something else. This other stuff…I can’t give up believing that this bureaucratic terrorism is not a necessary part of the profession. I feebly cry out to my nursing brothers and sisters: what can we do? Is there a solution? Can we not stop the environment of fear?

What’s appallingly obvious about this present malaise NNR describes so vividly that it is nearly always the result of nurses abusing other nurses. This, I think, is the elephant in the room. We can talk at great length about hospital policies, regulatory requirements, the exercise of power in hierarchies, horizontal violence, corporate culture and all the rest and how they negatively affect the quality of nursing work-life. But strip away all that, and you’re left with nurses formulating policy, making decisions and giving direction which adversely and sometimes abusively impact other nurses. In short, we do it to each other, and then we blame some impersonal force, like “the hospital;” for some unfathomable reason, we think that is A-OK.

I’ve argued on this blog before that there is a spurious belief out there that once a nurse becomes management he is somehow exempt from the professional duties and responsibilities which bind all nurses, and hospital policy or the demands of human resources takes precedence over these obligations. This pretense needs to stop: it’s damaging to the profession and it harms patients. Nurse managers who create an unsafe or hostile working environments are responsible in turn for increased patient mortality and morbidity. The evidence is pretty strong for the link between quality of nursing work-life and patient outcomes. By the nursing standards of practice here in Ontario — like most places — abusive behaviour and  harming patients is surely a matter for professional discipline. Do we need to start reporting a manager’s “bureaucratic terrorism” to our respective colleges/state boards of nursing? Maybe it’s time we called them on it. There is clear sense among frontline nurses that we need managerial accountability for poor practice, and evidently hospitals aren’t providing it.

But ultimately (and I speak from personal experience here) the best answer is to speak truth to power, take care of ourselves and our profession, and walk away. Toxic workplaces are beyond the ability of any single nurse to fix, and the clearest (and most financially damaging, for it costs big money to fill a nursing vacancy) message we can send to abusive employers is to vote with our feet.

Nursing is a hard job, physically, intellectually and emotionally challenging. But no nurse signed up for working in an environment of fear and hostility. Coming home from every shift emotionally drained and numb for anxiety is not sustainable, not for patients, not for nurses personally, nor for the profession as a whole.

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English Only, or Else

Another exhibit in the Museum of Hospital Stupidity:

Dozens of Filipino hospital workers in California sued their employer Tuesday alleging they were the sole ethnic group targeted by a rule requiring them to speak only English.

The group of 52 nurses and medical staff filed a complaint accusing Delano Regional Medical Center of banning them from speaking Tagalog and other Filipino languages while letting other workers speak Spanish and Hindi.

The plaintiffs are seeking to join an August complaint filed by the U.S. Equal Employment Opportunity Commission in Kern County federal court over the hospital’s enforcement of a rule requiring workers to speak English.

Filipino workers said they were called to a special meeting in August 2006 where they were warned not to speak Tagalog and told surveillance cameras would be installed, if necessary, to monitor them. Since then, workers said they were told on a daily basis by fellow staffers to speak only English, even on breaks.

“I felt like people were always watching us,” said tearful 56-year-old Elnora Cayme, who worked for the hospital from 1980 to 2008. “Even when we spoke English … people would come and approach us and tell us, ‘English only.'”

And furthermore:

“Our co-workers, supervisors and any staff that doesn’t speak our dialect, they approach us once or twice a day along the hallways, nurse’s stations and even at break rooms, saying ’speak English’ even if we’re not talking, even if we haven’t opened our mouths,” Cayme said.

[snip]

Wilma Lamug, who is a plaintiff in the lawsuit added, “The president said whoever was caught speaking Filipino language will be suspended or terminated.”

I suspect this whole drama was the result some misguided initiative to “improve patient experience” or because of a patient complaint of dubious validity. Then the hospital got out the truncheon to enforce the rules — which speaks volumes, incidentally, about the quality of nursing work life at this hospital. And let’s be clear: it’s no use pretending these nurses and other health care workers weren’t targeted because they were perceived to be powerless in the hospital food chain. Do you doubt any physician would be subject to the same rule?

Leaving aside the demeaning and crude bullying tactics, co-worker harassment apparently enabled and encouraged by the hospital, dire threats from human resources, and the bizarre, Orwellesque promise to install security cameras to monitor spontaneous outbreaks of Tagalog, I had to ask myself: what were these guys smoking? Is there ever a good outcome when a hospital targets nurses by their ethnicity? Let’s tally this up. A lawsuit. International media exposure, for innovation of the worst kind.  Public approbation. A new reputation for racism. (I think this is a fair reading of the situation.) A strong message sent to the community that people of colour are not welcome on the premises. An equally powerful signal sent to health care professionals that whites only need apply — in an era where every HCP is gold. Conscientious nurses spreading the word through social medial about a thuggish employer. Snippy little blog posts from the likes of me.

Yep, looks like a all-round win to me, boys. Well done. The optics on this are fabulous.

More important, though is the effects on patients and quality of care. Achieving good patient outcomes is notoriously difficult when nurses practice in a poisoned work place. I’m guessing a hospital where staff are being deliberately pitted against each other because of nationality is not a very happy one.

In short: would you want to work there? Or be treated there as a patient?

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10 Comments

At This Hospital, The Stupid is Strong

St. Joseph’s General Hospital in Comox, British Columbia is having some problems with opening up a new transitional care unit. It’s evidently understaffed and poorly planned, and of course, in planning this new unit, hospital administrators neglected to consult the most important people working there, i.e. the staff. Despite a rosy picture painted by the hospital’s CEO, the nurses are having none of it. Money quote:

By way of example, [B.C. Nurses Union Rep Juanita] Munroe noted that dispensing some medications requires the signature of two nurses. There will only be two nurses on the entire TCU. When one of them is on break or otherwise occupied, how will those medications be dispersed?

Munroe said that one hospital administrator told a member of staff who asked the question to get a housekeeper to cosign.

Get a housekeeper to co-sign. I read this twice to make sure I got it right. Yes, truly. The stupid here is breath-taking. When nurses double-check medications, it’s because the drugs in question are dangerous. Would you trust a housekeeper to double-check medications? Well, unfortunately, gob-smacking asshattedness happens when administrators don’t involve nurses in planning, or worse, analyse their function in terms of what they do, not what they know.

In the event, I’d like to know what kind of hospital administrator is down with the housekeeping staff to co-sign medications. Because, after all, nothing says quality care and patient safety like getting the housekeeping staff to check meds.

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4 Comments

When Hospitals Block Facebook, Laziness Is The Real Issue

Phil Baumann argues that hospitals should seize the Twenty-First Century by the sub-epididymal masses and set free Twitter and Facebook. “Should hospitals block Facebook?” he asks,

That’s not really the question. Here’s the question:

Should hospitals block the 21st Century?

If they can, then that means they have access to technologies which can also probably cure all disease from the face of the earth.

Then they’d be out of business, and we wouldn’t have to fret about their policies over staples of mainstream communication like Facebook and Twitter. :)

And here’s the fiduciary responsibility part: the more comfortable a business is using social media internally, you know what happens? It becomes more proficient in marketing and public relations in our time.

Management is morally obligated to ensure the best care for patients. It’s also legally obligated to do what’s right for Investors.

I don’t disagree with Phil Baumann much about the supposed reasons hospitals block social networking sites: risk management, security and patient privacy are common excuses, and are mostly founded (as Baumann says) on fear and ignorance. But I think the real purpose of hospitals blocking Twitter and Facebook has more to do with control and productivity than risk reduction and confidentiality. Plainly speaking, social networking sites make people lazy.

Let me illustrate. My employer, Acme Regional Health Centre unblocked Facebook  and Twitter from hospital computers for a short time. I won’t exaggerate and say it was an unmitigated disaster, but when you sit down at a nursing station and see every computer terminal opened to Farmville, and the nurses in Resus are tweeting the nurses in Exams, there’s a problem.

The experiment lasted about a month. It failed because it ignored a fundamental fact of human nature: if people are given the choice of doing something amusing and fun, like playing on Facebook, and doing something tedious and boring, like filling in MARs*, amusing and fun will win every time.

And yes, it looks extremely poor if patients and their families catch you fooling with your Facebook photo albums, when you should be getting the bedpan for the 98 year-old in Obs Six.

In the end, health care professionals — I include physicians as well as nurses in this categorization — can’t act, well, professionally with social networking sites. The ideals suggested by Phil Baumann are exciting and visionary. The reality is somewhat more drab and prosaic.

___________

*Medical Administration Record

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