Posts Tagged nursing students

The Case of the Disembodied Placenta

Now, there's some cool Kelly clamp usage.

Let us bow down before the sacred placenta.

Amen.

Sorry. I don’t mean to beat the thing to death, but the media reaction to the reinstatement of Doyle Byrnes and her colleagues strikes me as, well, odd. Their consensus: the school may have been a bully, but they photographed a placenta — why, that’s a very sensitive organ! People feel very strongly about their placentas! Robyn Urback at Maclean’s, for example (for my U.S. readers, Maclean’s is a Canadian news magazine):

And they weren’t doing anything exceptionally inappropriate with the organ, just posing and snapping photos (which is curious enough, to say the least). But the situation is complicated for a number of reasons. Firstly, the placenta is an organ involved with reproduction and birth, which makes it a little more personal, sensitive, than a lung, for example. It’s the difference between posing with a heart and posing with a pair of severed testicles; one snapshot will elicit a little more reaction. Secondly, the students are studying to be nurses, a job that demands professionalism and empathy, especially when working with patients whose illnesses have robbed them of dignity. Nonchalance in the presence of blood, scars, feces, vomit, etc. (except when medically necessary) is the mark of appropriate bedside manner. Few patients would feel secure watching their nurse gawk at their oddly coloured growth.

Hmmm. Not sure exactly how photographing a placenta makes nursing students any less professional and empathetic, but let’s give that one a pass. Let’s recap for a moment, though:

The nursing student was appropriately gloved and clearly in a healthcare setting.

The placenta was not obviously attached to either mother or child, and was sitting in an examination tray (as opposed to resting next to pitcher of sangria with a little yellow umbrella poking from the cord.)

The previous user(s)/owner(s) of the placenta were in no way identified.

Anyone who has watched reality television has seen far worse and in a much more exploitative context, than say, nursing students getting excited about getting up close and personal with a placenta in the pursuit of knowledge.

In short, it’s hard to see from where I sit how the students were disrespecting the placenta, if in fact it’s possible to do such a thing. Let’s put it another way: hospitals don’t make any exceptional provision for protection of placental integrity and dignity. There are no special rules for the disposal of placentas. Evidently, the hospital which provided the placenta to the students had no concerns either. Then there’s this: when I was a nursing student there was a designated placenta freezer. The hospital sold them to cosmetic companies. (I’d be curious if that practice still goes on.) Bottom line: it’s a piece of tissue, people. 99 people out of 100 would not recognize one if they fell over it on the street. Having fulfilled its function, a placenta has no spiritual or mystical value, if it ever did so in the first place. It has no feelings to be hurt. That’s all. Or am I completely out to lunch on this?

[Update: corrected some minor spelling/grammatical issues, and changed a couple of words for clarity. Because tonight I can’t proofread worth a damn.]

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The Placenta, The Nursing Student and the Teachable Moment

Johnson County Community College has fired back at the harsh criticism it has received  — including from this blog — for its expulsion of four nursing students, including Doyle Byrnes, the student who initiated the lawsuit against the school:

Johnson County Community College plans to vigorously defend the lawsuit brought by a student against the college. The lawsuit also asserts individual claims against the members of the college’s distinguished faculty and administrators.

“The entire college community is disappointed that the students have decided to abandon the academic appeals process and take their grievances to the court for resolution,” said Terry Calaway, JCCC president. “We regret that the students used such poor judgment to take such a unique educational opportunity that was presented in a private clinical setting and broadcast it on the Web. We teach our students to respect the confidentiality of patient care, which extends beyond the hospital room and includes situations when the nurse is not in the presence of the patient. The actions of the students showed not only poor judgment, but also lack of respect and a complete disregard for the ethical standards of the nursing profession.

[snip]

“We will not tolerate such insensitivity on the part of our nursing students. We also must protect the reputations of our business partners in health care. We provide students with real-life patient care opportunities, and we take our responsibilities very seriously. Please know their actions do not reflect the standards of our nursing program, which is renowned for the quality of its instruction and its graduates. Thankfully, the situation was brought to our attention by other students in the nursing program. We are grateful they recognized the inappropriateness of the other students’ actions and sought advice from their faculty, who took immediate action to ensure the posting was removed.

“We will do whatever we need to do to reassure the community that this behavior is not what we teach at JCCC. Because we cannot tolerate such unprofessional behavior in our students, we took what we believed to be appropriate action. The behaviors of the students were insensitive and disrespectful toward the mother and the human tissue involved. The fact that this story has so quickly gone viral is evidence itself of how damaging social media can be if not used appropriately.*

“The students who took the photos were not expelled from the college, as has been reported, but were temporarily dismissed from the nursing program. They are permitted to re-apply to continue their nursing studies in August 2011 and to graduate from the program in May 2012. In the meantime, they have been asked to participate in a project on medical ethics, which could turn this unfortunate incident into a teaching moment for the students. However, the student who filed the lawsuit is getting married out-of-state in August and therefore wants to complete her studies this spring. She is suing the college for immediate reinstatement so she can graduate in May 2011 according to her own schedule.” **

Yes, there are certainly teachable moments, but the college and the nursing program seem to have studiously avoided them:

1. We often talk about the need to acknowledge errors made and an ethical approach would demand acknowledgement of error, reflection and restoration. For example, if I commit an error adversely affecting a patient, best practice is not only to admit the mistake, and learn how to avoid it in the future,  but go to the patient to accept accountability and responsibility. I wonder if the director of nursing had any second thoughts about the punishment she doled out, and if she did, whether she considered ameliorating it. She might have avoided a lawsuit, and her nursing program going viral on the Net in the worst possible way.

Interestingly, from the published accounts, the students seem to have understood this before the school escalated the conflict out of control. Not so their instructors.

A corollary to this is the old maxim from public relations (which for this school have been disastrous): acknowledge mistakes, fix them and move on.

2. The College is now telling us after being expelled, the students would be permitted to “reapply” to the program in August 2011, and if accepted, would graduate a year late. Meanwhile, the school is requiring the students to attend some sort of “project on medical ethics.” Despite the clarification, the punishment is still high-handed and disproportionate. However, clearly the director of nursing felt there was some gross violation of ethics (even if the rest of us didn’t perceive it); Doyle Byrnes, for her part, was contrite and apologetic, and she pulled the photo off Facebook as soon as it became an issue.

Given these circumstances, measured consideration and a pragmatic, reflective approach might have suggested first meeting with the students to informally discuss the concerns about the photo, perhaps with an impartial facilitator, then working with them closely to develop a learning plan to meet the nursing school’s concerns, while keeping them in the program. That, I think, would have been true leadership. Instead, there is virtually no hope any of the students will ever complete the required ethics course, and it’s probably doubtful they would even want to return in any case. I wouldn’t blame them. So if the director’s original purpose was remediation of the situation, and rehabilitation of the students, it was a complete failure. It accomplished nothing, except some highly negative publicity. An alternative disputes resolutions process may have worked better.

Put another way, what’s the procedure at this school when a student makes a med error, when the harm is actual, not virtual, theoretical or imaginary?

3. Nerdy Nurse: “Opportunities like this should be used as ways to write policies and develop protocols to follow regarding healthcare and the growing involvement we are all having with social media, from nurses to doctors, to grandmas, and great aunts. Everyone is connected.”

Again, mission not accomplished. In the end, I’m curious what precisely the nursing school did accomplish in victimizing it students, besides trashing its own reputation and a lawsuit?

__________

*I guess that means we should all just shut up, like good nurses.

** A few random thoughts about this train wreck of a press release:

  • it still isn’t evident to me precisely which ethical principles of the nursing profession were violated. To say there was a breach of a patient’s confidentiality or privacy is frankly a stretch.
  • a placenta, post-partum, is a discarded by the body because it is no longer needed, having fulfilled its function. To fetishize it by assigning it great intrinsic value in of itself  — how can you diss a placenta? — strikes me as bizarre (to say the least).
  • calling the expulsion a “temporary dismissal” is pure spin. When you must reapply to be re-admitted to a program, you’re expelled.
  • I have seen photos in nursing textbooks which were clearly more exploitative.
  • the school’s real difficulty, it seems, was that the student posted the photo on Facebook, and Facebook, as we all know, ipso facto, is evil.
  • related to the above is that it seems there was no clear policy on the use of social media by students.
  • related to the above it’s pretty evident the school’s administration has no accurate knowledge of the nature of social media.
  • and again, the school and its nursing program are behaving like the nurses we all hope we aren’t: vindictive, arbitrary, authoritarian, backbiting  and petty, i.e. the college’s lawyers now claim, for example, the reason for lawsuit is related to Byrnes’ desire for a May wedding! Excellent role modelling, that. And great messaging the nursing program is sending out too: that any nurse who advocates for herself (and by extension her profession) and challenges a perceived wrong deserves to be slapped down, hard. The point being, if the nursing school demands exceptional ethics and professionalism from its students (as they should), it should at least demonstrate how exceptional nurses behave: with compassion, insight, and clarity of thought.

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Students Using Social Media to Inform: Webliography Creation

[When I saw this post on Terri Schmitt’s blog, Nurse Story, I was so impressed by her students’ work I immediately tweeted her to ask permission to repost it here, which she was kind enough to grant. Very cool, guys, and well done.  As Terri would say, GO NURSING!]

by Terri Schmitt Nurse Story

These students have done amazing things and have compiled legitimate sources of internet health information on a good variety of topics. This is what nursing does, we educate, and we can use social media to do that well. These nurses,  in an RN to BSN program, bring their personal interest, knowledge, and skills of internet website evaluation to benefit to their patients on the world-wide-web. I have included a table below with their twitter names and the links to their webliographies. ENJOY!

@MidwestRN – Coronary Artery Disease:http://midwestrn.wordpress.com/2010/10/24/coronary-artery-diseas/

@RnRey – Nursing and Genetics: http://rnnursejourney.blogspot.com/2010/10/nurses-and-genetics

@CampusNurse – Oral Mucositis: http://campusnurse.wordpress.com/2010/10/24/oral-mucositis/

@ahopkinsrn – Obesity: http://ahopkinsrn.wordpress.com/2010/10/20/obesity/

@clynn_rn  – Glomerulonephritis: http://clynnrn.wordpress.com/2010/10/24/webliography/

@nrodrockrn – Diabetes: http://bsnhereicome.wordpress.com/2010/10/24/diabetes-webliography/

@sandypark82 – Gastroparesis:http://sandypark82.wordpress.com/2010/10/24/gastroparesis/

@JessicaMRN – Epilepsy: http://nursejessi.wordpress.com/2010/10/24/epilepsy-webliography/

@NurseNaters – CVA Recovery:http://adventuresinmursing.blogspot.com/2010/10/recovery-from-cva.html

@thetoddrn – COPD: http://thetoddsblahg.wordpress.com/2010/10/19/copd-webliography

@Jales_RN – Preeclampsia: http://jalesknowsbabiesrock.blogspot.com/2010/10/annotated-webliography-of-preeclampsia.html

@SusanInman – To Stick or Not to Stick: http://apediatricnursesperceptions.blogspot.com

@sburntina – Interstitial Cystitis: http://sburntina.wordpress.com/2010/10/22/webliograph-interstitial-cystitis/

@RNkcummings  – Diabetes: http://kcummi.wordpress.com/2010/10/25/everything-you-could-want-to-learn-about-diabetes/

@Julia1219 – Femeroacetabular Impingement:https://nkwagala.wordpress.com/2010/10/20/femoroacetabular-impingement/

@punkerkas – Schizophrenia: http://krankenschwester-punkerkas.blogspot.com/2010/10/dealing-with-schizophrenia.html

@rjbreigRN – Chronic Fatigue Syndrome: http://anursetale.blogspot.com/2010/10/chronic-fatigue-syndrome.html

@megRN4356 – Total Knee Replacements:http://megrn4356.wordpress.com/2010/10/24/total-knee-replacements/

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Slightly Used Posts: Poo Free

A repost of one of my (IMHO) better entries in the past year, to mark the first year of this weblog. First posted November 2009.

No more poo:

Student nurses are rejecting essential elements of bedside care because they feel it is not a worthwhile learning experience, research published by Nursing Times has found.

The research found widespread conflict between student nurses and qualified staff over the tasks students should do on placement.

Tasks normally carried out by HCAs, such as making tea, washing patients and cleaning, were not seen as valuable learning opportunities for student nurses keen to gain experience with more technical roles like administering drugs.

As a result, many senior nurses feel that students are qualifying with significant gaps in their basic skills. One interview participant said: “I sometimes feel in despair that by the time students have qualified, they still haven’t gained some of the practicalities and common sense – things like time management, basic assessment skills – that we would have been doing on our first round.”

One student was reported to have told a staff nurse: “I keep being asked to do things which won’t help me learn – clear up poo, mop up blood, give patients tea and toast. I realised that I needed to more focused to learn, and I don’t do those sorts of things now. [The full study is here.]

I’m actually with the students on this. There are few things going on here. One is the perpetual nostalgia that nurses have for the good old days, when men were men and nurses were nurses, and we were trained by battle-axe old-school-types who flogged us students daily with used foley catheters before we walked home uphill in a blinding snowstorm to work all night on 45-page-long care plans. And that somehow produced wonderful, thoroughly trained nurses, unlike today’s crop of know-nothings. So say a lot of you, including many of my own colleagues.

Oh honey. I have a newsflash for you. We weren’t that good, or well trained, and we fumbled around just like today’s new grads. I know. I was one of you.

And then there is a notion that since we went through all that crap that Hilda Harridan RN made us do, the current generation needs to “pay its dues” too. Though it escapes me how making nursing student go through their paces like we did will make them better nurses.

From the times I walked the floor as a clinical educator, I spent a great of time defending my students from the sort of crazy, useless busywork that the ward staff seemed determined to make them do. Staff believed they were free, exploitable labour. The manager of one of units told me, “They will be great help for the nurses.” She grew shocked and angry when I suggested they weren’t peons or gophers, and accused me of not teaching the students proper “teamwork”. This in her eyes seemed to mean making the students do the pissy things no one else wanted to do. My students, in fact, were not there to fluff pillows, cart patients to x-ray, boil the kettle, organize the bedsides, take specimens to the lab or any of the innumerable trivial tasks that can consume your average med-surg floor.

They were there to learn.

And I still don’t see how making a cuppa for the dear in 6 or running that routine R&M downstairs will help nursing students in time management or pharmacology — which seems to be the prevailing attitude in clinical areas. Good nursing skills come from hours of doing patient assessments, developing advocacy skills and learning to think critically.

And frankly, I would much rather have a nurse at the bedside with amazing critical thinking and communication skills than one who can effectively wipe the poo from my bum.

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For Students and Preceptors, Some Advice

It’s that special time of year again. Preceptors all the place over are gearing up to go to the high peaks of the north woods to midwife baby nurselings into the world. It’s up to us to train them well.

Some advice to you 4th year students from an old nurse-preceptor:

1. Relax. Breathe deeply. You aren’t expected to know everything, even if it were possible.

2. Your job is to learn as much as possible. Think of yourself as a sponge. Soak it all in. Take responsibility for your learning. Seek out learning opportunities whenever possible. You will never get this opportunity again.

3. Always ask questions. And question everything. See #2.

4. If your preceptor tells you not to do something, don’t do it.

5. You aren’t the unit gopher, and  shouldn’t be treated as such. Some will try though: refer these to your preceptor.

6. Learn safely. Know the limits of your practice. If ever in doubt, even the tiniest smidgen of uncertainty, ask your preceptor.

7. If your preceptor asks you to look something up, it’s pretty certain s/he will ask you about it the next time.

8. You will make mistakes. Your preceptor won’t be as freaked out by them as you are. The point is to learn from them.

9. Show up for shift. Be punctual. Your preceptor probably doesn’t care much one way or the other if you don’t. This is your learning experience, after all, not hers. However, poor attendance makes it far more difficult for your preceptor to write that all important reference letter.

10. Poor attendance also signals to your preceptor you aren’t very engaged and you take your professional responsibilities lightly. Which means she’s liable to take you less seriously.

11. Refer all conflicts with other staff members to your preceptor. It’s her/his job to deal with them, and probably few of them are your fault.

12. If you and your preceptor are not getting along, or you’re feeling you aren’t getting the best experience, don’t suffer in silence. Talk to your preceptor, or failing that, your faculty advisor. Again, this is your learning experience.

For preceptors:

1. Cut your student some slack. Novice practitioner means just that: she (or he) is bright and shiny and new and hasn’t made the leap between theory and practice.

2. You weren’t half as smart or experienced or clever as you think you were in fourth year. Therefore, no wingeing about how they don’t make nursing students like they used to.

3. Your student isn’t stupid. And probably is more up-to-date on best practice than you.

4. Having a student is a tremendous way to sharpen up your own practice. Take advantage of it.

5. Be aware that you have a very great responsibility, shaping the professional practice of a new nurse. Act accordingly.

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