Posts Tagged Nursing stupidity
Posted by torontoemerg in Good Nursing Practice is Practising with the Heart and Mind, Nurses Behaving Badly on Thursday 22 March 2012
Irony alert! The best way to decrease empathy in nurses, apparently, is to actually practice nursing. A new study of nursing students found that
as students gained more clinical exposure, they demonstrated a much greater decline in empathy scores over the year than did those with limited clinical experience during that year. This finding extended to students with previous work experiences in the clinical setting, who also evidenced declines in empathy of practical importance. . .
The study indicates the usual suspects in this decline of empathy: lack of time to empathetically interact with patients, lack of support, lack of role modelling, focus on the technical aspects of nursing and so on. It concludes: “[U]ntil the art of nursing is recognized as a necessary criterion for successful completion of coursework and as important as passing an exam, students will likely continue to demonstrate behaviors that make them good technicians but not necessarily very good nurses.”
But I’m not very surprised. I was speaking to a friend the other day who is a clinical instructor for a certain university-based nursing program in Toronto. She told me of the open and enormous contempt the academic instructors at this university have for the clinical instructors (the majority of whom are bedside nurses as well) and by extension, for bedside nursing in general. (This isn’t the first time I have heard this, and I have experienced this myself when I was a clinical instructor.) It isn’t a large leap to suggest what we esteem in bedside nursing, i.e. empathy and compassion, are devalued in the same way, and that negative attitudes are passed on to students.
The rot, it seems, begins early. I would be interested to know the experience of other clinical instructors, or new graduates. Or am I just talking through my hat?
Posted by torontoemerg in Good Nursing Practice is Practising with the Heart and Mind, Nursing Naval Gazing, Random Thoughts on Tuesday 31 January 2012
Ian Miller, blogging over at ImpactedNurse.com, notes a disturbing trend in Australia, one, I’m afraid, is becoming more common in North America. “These days,” he writes, “being a nurse is tough. Really tough.”
I look around and see many struggling at the bedside. I see the increasing perception that this is menial or bottom-of-the-professional-foodchain work.
I see more and more of this sort of feeling online.
What our brightest and best nurses should be doing instead of creating a culture of escaping the bedside or doing time at the bedside is acknowledging that it is the nurse providing direct care to the patient or client that is the absolute most important domain of our increasingly diversifying profession.
Nurses do not really want to be business entrepreneurs, unless they have no other choice. They want to be nurses.
I would even argue that if you are not regularly within arms reach of your patient/client you are not nursing. And if you have not done this for a long time you are not really a nurse. You are something else. Strong stuff1 I know.
The bedside nurse should be re-valuing themselves not re-inventing themselves.
Miller’s solution is “8 in 8,” i.e. having non-bedside nurses work an 8 hour shift every 8 weeks at the bedside as a condition of their registration. This is an idea I like the more I think about it. However, it would be complicated to implement, not the least because of resistance from said non-bedside nurses — and can you see all those functionaries from nursing regulatory agencies or upper management pulling on scrubs and Crocs and tending to stool incontinence and urinary drainage bags?
Hmmm. Maybe not.
But Miller’s premise, that bedside nursing itself is demeaned and devalued to the point where many of us — including myself — are plotting our escape to greener pastures is sadly true. But why? The reasons for this are pretty simple. Despite years of education and rhetoric, nurses aren’t really permitted to practice to the full scope of our knowledge. We all have heard managers speak of their time at the bedside like it was a prison sentence. Television shows like Grey’s Anatomy tell us bedside nurses are stupid. We know that hospitals view nursing not as a valued added service, but as an expensive cost centre, and that Human Resources thinks of nurses as a “problem” to be managed, like the kitchen guys who make the salads, not as practising professionals.
To be clear, we menialize ourselves as well, when we view nursing as a job rather than a profession, or when we see nursing as a series of tasks to be completed before shift change, rather than a process requiring frequent periods of critical thinking.
It’s all pretty overwhelming, and though I will publicly stand up for the value of bedside nursing, and argue strenuously to its central importance in health care, there are times when even I have a little shadow of doubt.
So really I’m not very surprised if nurses of all ranks and positions view the bedside as menial and demeaning. If people around you all day tell you you’re worthless and menial, and if you view what you do as being more or less thankless and trivial, pretty soon you’re going to believe you are worthless and menial — and so is your professional practice.
I would like to tell you my own motives for escaping the bedside are pure, but when I seriously reflected about it, I realized some of my reasons for wanting to leave had much to do with decent hours and status. And something else: the ability to act autonomously and effect change in a real way.
In other words, it’s all about power, and this explains why bedside nurses are so demeaned and devalued and want to escape.
Because we have none. Or think we do.
(I would argue front line nurses have far more power to shape their practice and workplace culture than they realize, but we all have been indoctrinated since the first day of nursing school never to question their place in the food chain and to always ask permission. And I’m not speaking about “making a difference in patient’s lives” — a phrase which has always struck me as infantile and meaningless. But this is a subject of a whole other post.)
Each of them eloquently speaks to the heart of what we do as nurses — and why nurses find how Amanda Trujillo was fired and subsequently reported to the Arizona State Board of Nursing so troubling. (Via The Innovative Nurse.)
The first is from Andrew Lopez (Twitter: @nursefriendly.)
Michael Pergrim (Twitter: @CoachPerg)
Lastly Carol Gino. “The statement nurses eat their young — we’re not doing that. There’s a group of us who are going to stand with her. we’re not going to be powerless any more, because a defenceless defender is not good to anyone.”
The latest instalment of Nurses Behaving Badly featured the night charge and the day charge (i.e. me) getting a status asthmaticus organized in Resus 1 a few minutes after shift change. It’s probably reasonable to wonder why the two Resus Room nurses weren’t attending (and attentive to) the situation, especially after we paged the physician and the RT in quick succession for a possible intubation, and especially since both of them were less than twenty feet from where we were working.
We thought at first they were getting report on the only other patient in Resus, but after 10 minutes or so we began to wonder how long it actually takes to give report on a stable, routine, admitted, pain-free NonSTEMI.
Meanwhile we got the patient on high-flow oxygen, assessed, drew blood, did an ECG, set up stacked Ventolin treatments, placed two large bore IVs, hooked the patient up to the cardiac monitor and generally got organized to tube the patient.
Turns out they were looking at a jewellery catalogue, drinking coffee, texting, socializing, what have you.
Grrrr. And when the night charge asked our two colleagues to cease and desist from shopping and tweeting and trading bon mots and actually do some, you know, nursing, we got the “whatever” look: face squinched up, hands up in the air, eyes rolled. The look that manages to convey a dishful of entitlement and irritation, with a light sauce of fuck you to complete.
By the time I gave my report, it was nearly an hour after shift change. But what goes around comes around. There is cosmic retribution and it is just. That night Nurse Tweedledee and Nurse Tweedledum received, in addition to the now intubated status asthmaticus:
A cursing psychotic patient in four point restraints
A cursing drunken 20-year-old who managed to pee and puke all over herself all at once
A non-compliant insulin dependant diabetic in DKA
And just before shift change, a fulminating CHFer, which required them to stay long after their shift was over.
In short, they had a craptacular night. The complaints, the bitterness, I am told, from the pair was tremendous. They needed to leave. They had child care issues. Husbands needed vehicles — and one of them was written up for being late. They were tired as no nurse in the history of the universe was tired. Why are we so afflicted? they moaned. What did we do to deserve this?
Karma, baby, karma.
The cosmic lesson being simple, work starts promptly on the hour. Not after fifteen or twenty minutes of “social” time. Be considerate of your colleagues. They’ve been working for twelve hours and want to go home. Many, many, bonus points if you come in ten minutes before to get report so the nurse you’re relieving can get out on time.
To say I had any sympathy for either of them would be a bald lie. Can you say schadenfreude?
*VSA = Vital signs absent.
A small, belated Christmas tale on how not to manage an emergency department. But first a few preliminary points of information.
First: in Ontario, front line nurses are generally forbidden from taking vacation over the Christmas holidays, usually from some point from the first or second week of December to the first or second week of January. There are a couple of reasons for this: first, there are always staffing issues over Christmas. Secondly, if vacation time is granted by seniority, and if it werepermitted during the Christmas break, the most senior nurses would always get Christmas and New Year’s off, making merry while leaving their more junior colleagues to toil through the happiest time of the year. Hardly fair, and scarcely a morale booster.
Most hospitals in Ontario will arrange scheduling in this way: nurses work either Christmas or New Year’s (either we pick or alternate each year) but we get five or six days off in a row over the holidays. Like any compromise, it inconveniences some people, but most seem happy about this arrangement.
Second: most Emergency departments over the holidays look like a merger of Bedlam and a random circle of hell from Dante’s Inferno. High acuity and high volume. I might add this holiday season war zone ambience is as predictable as, well, Christmas falling on the 25th of December. We just gird our loins and sally forth. Nevertheless, even halfway through January, we’re all a little crusty and stressed out.
So what would you say to a manager who takes vacation — and not a short one either — over the Christmas holidays? One of my minions has informed me that an ED manager at one Toronto-area hospital took vacation from roughly the middle of December to the middle of January. Needless to say, given all of the above, her staff are not impressed. They are angry. They felt abandoned at a time when leadership was needed. They resent the double standard, the flaunting of the no-vacation-over-Christmas rule. Some of them, I’m told, are so disgusted by this behaviour that they are actively seeking positions elsewhere.
I understand that managers deserve and are entitled to their vacations, and that from a staff nurse’s point of view of there may be no good time for a manager to take time off. Even so, taking vacation when staff cannot, and over time period when volumes and acuity are notoriously high indicates a certain amount of — what? — cluelessness?
Management does have its privileges, but also has responsibilities. To me responsibility means sticking it out and providing leadership to your staff, even when it’s personally inconvenient. It might mean delaying a vacation for a month. It means not bailing out when you know things are going to be awful. This is good nursing leadership. Or am I completely off base about this?
UPDATE (22/01/12): Minor edit of mispelling. I need an editor, but can’t afford one.
I look around.
There is no ward clerk in sight.
I answer. “Emergency, Charge Nurse.”
“Can I ask you a question?” The voice on the other end sounds flat and tired.
“Sure,” I say warily.
“I came to see you guys a three days ago and I had a sore chest and you guys did a whole bunch of tests even though I told you my Ventolin had run out and my asthmas was real bad, and you did nothing for it, and the nurse was real rude, like, and you guys took blood and, and did a heart test I did an xray, and I was real afraid of the xray ’cause of the radiation, and I don’t want to get cancer or nothing ’cause i already got cancer like my mother who died of breast cancer and the doctors didn’t do nothing, and then the doctor told me I had an infection in my chest and I think it he said it was pneumonia and he gave me a prescription and I got it filled and I took the first dose tonight, and it didn’t do nothing, and now I have a rash on my arms and stomach and it itches real bad —” The caller paused for breath.
I jump in, wondering where exactly the question lay. “Are you asking for medical advice?”
“I guess. Can you help me?”
“We don’t give out medical advice,” I say. “You can call Telehealth, and they should be able to. You have pen and paper and I’ll give you the number?” I think, please let me give you this number, so I can end the call. She’s not having any of it.
“Are you guys busy?” she asks. Every emergency nurse knows this question, and we all have the same answer.
“I can’t answer that,” I say. ‘It depends on how sick the patients are, and how many people come into the emerg.”
“How long is the wait?” she persists. “Will I have to wait long?”
“I can’t answer that, ” I repeat.
“Can I pre-book an appointment?”
“I’m sorry, no.”
“Well, thank you for fuck all!” She bangs the phone down.
Thanks and you’re welcome, I mouth. Another happy customer who has made me very glad to be a nurse. And ten minutes of my life gone for ever. I swear I will never pick up the phone again. Really. I mean it.
The phone rings.
I look around.
There is no ward clerk in sight.
Posted by torontoemerg in Battered Nurse Syndrome, Before I Start Throwing Things, I'd Better Write This Down, Life in the Emergency Department, Nurses Behaving Badly on Saturday 20 August 2011
It’s probably more than little trite to say the Emergency Department is a microcosm or laboratory of humanity, but like most clichés it has an element of truth. We see all types in the ED, the good, the ugly, and the purely despicable. (And then I could talk about the patients.) We’re human, after all. But in general, ED staff are as generous and warm-hearted as anybody anywhere. For example, when one of us is injured, or has a death in the family, or is seriously ill, we’ll take up a collection, and sometimes we raise surprisingly large amounts of money. Enough is donated, usually, to cover incidental expenses, and to keep our colleagues in need well-supplied with parking passes and Timbits while getting cancer treatment (for example) at Princess Margaret.
Well and good. Very nice. Pat on the back and warm fuzzies and Hero Medals for everyone.
A recent counter example: a colleague diagnosed a little while ago with a very serious and probably terminal illness. Fine, I said when I learned this coming into work. Where’s the envelope?
What envelope? came the reply.
“You know, I said, “the collection envelope.”
“Oh, there isn’t one.” An embarrassed laugh. “You know, Jane is really irritating and no one really likes her.”
I got it. In my ED, evidently, supporting and helping a colleague is a popularity contest. If you’re well-liked and “one of the girls,” it’s roses and wine and parades. If not, you get the proverbial lump of coal in the stocking. Jane, it seems (a little sadly) had anticipated all of this voiceless nastiness, and was refusing visitors from all but her closest friends. Yes, we aren’t that far away from high school after all, and nourishing a sense of compassion evidently doesn’t rate very high on self-improvement.
My nurse colleagues are smart and engaged and have empathy by the yard. I love them all for their exquisite skills in nursing, but sometimes I really don’t like them much at all. This would be one of those times.
Also: this only goes to prove the point that nurses aren’t angels. They can be jerks and asshats like anyone else.
It’s been a tough couple of weeks for Team TorontoEmerg. First, I’ve been working like a rented mule, and secondly, a colleague whom I trusted and respected sandbagged me with a nasty and embarrassing (and devastating) personal attack, which frankly put me in a bit of a tailspin. How bad was it? Think about being whacked hard across the face a couple of times with a 1″ bamboo pole, and you might get the idea.* I mention this not to whine — believe me, Mr. J. Doe has heard plenty of that — but merely to point out that life in the ED is tough enough. I mean it’s enough to face barking physicians, nurse managers who call us to their office only to reprimand, educators lying in wait to point out the merest flaw in our professional practice, not to mention the general opprobrium of our nurse-colleagues eager to pounce on any failure, without dealing with craptastic personal attacks as well.
Yes, today I truly love my profession. If I tell myself that enough, will it make it true?
*** *** *** *** ***
On the other hand, I got three compliments in the last two days, and if you’re an emergency nurse, you know that compliments from anywhere are as sweet as rainfall in a desert. First was personal. A conversation I had with a patient during one of the rare days I actually was doing something clinical:
Patient: I’ve been coming to this hospital, I’ll bet, since before you were born.
Me: (fiddling with an IV) When did you start coming to Acme Regional?
Okay, silly and obvious. But oh-so-welcome. And then another patient told me flat out my care was exceptional. And then a management muckety-muck told me my name had come up during a meeting of even higher muckety-mucks. I am, apparently, attracting attention in a positive way in relation to the administrative secondment I’ve been doing. All of which takes away the sourness of the above. A little, anyway.
*** *** *** *** ***
I work with a nurse who in nearly every respect is a superb nurse. She’s clinically smart, knows her theory, advocates for her patient and provides excellent care. I was getting report from her the other day, and she was griping how this nurse didn’t do that and that nurse didn’t do this, and it occurred to me she has never, in my experience or hearing, said anything kind about any other nurse. Not ever. It’s almost pathological. I always come back to this question: how can nurses give exceptional care to their patients and then turn around to model themselves as fine examples of human malice? Does anyone have an answer that doesn’t involve a disquisition on horizontal violence and unequal power relationships in hierarchies?
*** *** *** *** ***
To my nursing colleagues, I have one request. Next time you’re on duty, or if you’re on duty as you’re reading me, go compliment one of your colleagues. Praise a difficult IV start or a successful catheter placement or some little piece of good nursing care. Do it. Right now. Trust me: by this one small act you’ll improve our profession immensely.
And then when you open your mouth to criticize or find fault with a colleague, find something else to say. Preferably something nice. Really. It’s not that hard. Remember how you felt when you were last sandbagged? And also, you’ll find here the difference between being a good or even superb nurse, and being an exceptional nurse —- and who doesn’t want to be exceptional?
*So nasty, in fact, I’m seriously considering leaving Acme Regional. Why do I want to work within twenty miles of this person? The emotional response, I suppose, but one which is honestly how I feel, right now. Ask me again in two weeks.