Posts Tagged snark

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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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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Doctors Are From Mars, Nurses Are From — Oh, To Hell With It

News flash! From Fierce Medical News, here’s the shocking headline:

Docs, nurses miscommunicate on respect, job role

When you guys pick yourselves off the floor from laughing, here’s the money quote:

In particular, the survey found differing views of how doctors treat nurses. According to 42 percent of nurse leaders, physician abuse or disrespect of nurses was common, whereas only 13 percent of physician leaders said it was common. Fifty-eight percent of nurse leaders considered disrespect for nurses uncommon, while 88 percent of physician leaders said it was uncommon at their healthcare organizations.

“I do believe nurses and physicians are on two different pages when it comes to communication,” Pam Kadlick, vice president of patient care and chief nursing officer for Ohio’s Mercy St. Anne Hospital, said in a HealthLeaders Media article. “Nurses have a tendency to give a very detailed report, more than what a physician may want to hear; hence, the physician may interrupt, seem to be abrupt, even rude at times.”

But most physicians don’t consider such behavior to be disrespectful, she noted.

You’re telling me abuse of nurses is all about physicians being insensitive, maybe, and nurses having too many hurt fee-fees? Really? And nurses are supposed to be surprised that physicians “don’t consider such behavior to be disrespectful?”

Why does this sound like a ’80s sitcom?

Why does this sound like this report is trying to validate abusive physician behaviour?

You can only shake your head. And you just know, somewhere, in a darkened office maybe, in an obscure corner of a mega health care corporation, a manager is reading this report and exclaiming, “I knew nurses were to blame!”

I will very happily concede abusive behaviour of all kinds has declined markedly in my own time as a nurse, though I will say I work in an institution that enforces a zero tolerance policy against abusive behaviour. Moreover, the physicians I work with, shoulder to shoulder, are lovely and professional, and there is a true sense of collaboration. This makes for excellent patient care.

However, by no means is this true everywhere. So let’s not pretend the brow-beating, the mocking, the chart-throwing, the patronizing  — to be blunt, treating nurses like you wouldn’t treat your mother, daughter, wife, bank clerk, Wal-Mart greeter, housekeeper, or dog — still doesn’t go on. Denial will never fix the problem, either from physicians — or nurses.

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Death to PowerPoint and Other Notions

Back again.Yeah, I’ve been away for a while, for reasons that have absolutely nothing to do with writing or blogging. However my unintentional sabbatical has had the benefit of leaving me refreshed and full of ideas and so maybe wasn’t such a bad thing after all. I mean, in the two years I have operated this blog, I’ve written something close to 700 (!) posts, so maybe a break was in order before my brain turned into cranial equivalent of this.

So what have I been doing? A little of this and a little of that, but mostly working at the administrative-type secondment I’ve been assigned to for the past few months. I’ve worked closely with a group of other nurses, which I have been thinking lately resemble the Seven Dwarves. Their names are Pouter, Shouter, Passive-Aggressive, Bashful, Grumpy, Beautiful, Grandma, and of course, we have a Princess as well. (There isn’t an Evil Queen, though I don’t exclude the possibility I may in fact be that person.) Beautiful and Grumpy I don’t see much, and in any case I like and get along with them. Ditto Bashful, Grandma, and Passive-Aggressive. Princess behaves, well, like a princess though she has children old enough to be in university. But she’s a likeable sort and always means well. Pouter is irritating me all to hell; she’s pouting because I, um, spoke harshly to her friend Shouter, who walks around rigidly and inflexibly, like an angry exclamation point.

Shouter is generally tiresome to deal with, to the point where everyone tends to avoid conversation with her — which of  further angers her and makes her even more rigid and inflexible. Also, I don’t exactly like her (though Lord knows I’ve tried) and the feeling is even more reciprocal on her part. Not very constructive, I know, but I’ve concluded that not every relationship needs to be “fixed” — and frankly, this one ain’t worth the time and effort.

All in all, the work is fascinating, but I will be very glad to finish. I am beginning to think I get along better with the cat than I do with most people.

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What else? A few interviews for other, more managerial positions, which in the inimical manner of Acme Regional’s Human Resources Department, have evidently fallen into the Hell of Waiting for an Answer. “Oh,” they say, “we’ll contact you in a few weeks.” I am not sure what machinations HR needs to carry out to spit out an answer, but there it is.

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Death by PowerPoint. I gave my very first PowerPoint presentation to an enthralled group of colleagues on the topic of sepsis, which my employer has discovered to be the worst threat to patient satisfaction metrics since inedible hospital food. (Seriously. One of the reasons given for beating down sepsis rates at Acme Regional is “to increase patient satisfaction.” And here I thought “Not Dying” was sufficient enough.)

This was my presentation, in thirty-three PowerPoint slides:

Sepsis is very bad and many people die from it. We at Acme Regional, in an effort to be accountable and responsive to patient concerns, are determined to crush sepsis like mice under a stampede of rhinoceroses. In history, sepsis was discovered by Louis Pasteur. He was French. Other French people include Charles de Gaulle and Victor Hugo. They died of something else. In conclusion, not all French people die of sepsis. Thank you.

It actually went very well, I didn’t hardly talk about coagulation cascades and endothelial function, and people were very impressed, etc., and asked pertinent questions at the end like they had paid attention. I was pleased. Having sat through approximately a billion PowerPoint presentations in my nursing career, I have come to the conclusion the key for effective presentations involve three simple rules:

1. Less is more.

2. Speak to the slides, not read the slides. (Your audience is literate, right?)

3. Avoid pathophysiology like Yersinia pestis.

Or else, you can can check this out for good measure.

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Saving the World from Terrorist Breastfeeding Toddlers [UPDATED]

An Atlanta, Georgia suburb is fighting one of the most pressing causes of our era — children who breastfeed past twenty-four months. Because breastfeeding after the age of two will damage human society beyond repair:

On Monday night, Forest Park passed a public indecency ordinance to prevent public nudity. Previously, the city only had a public indecency ordinance that covered adult entertainment businesses.

 According to the law, no woman can breast feed anyone older than 2 years old in public. City manager John Parker called the law a proactive step.

 “It sets up a process whereby we can try to control nudity throughout the entire city,” Parker said.

There was, in response, a public nurse-in ridiculing of the notion of breastfeeding posing a clear and present danger to societal values, and a response to the nurse-in predictably filled with comments from various yobs and jackasses. What I’m not getting, though, is the conflation of breastfeeding (regardless of the age of the child) and public indecency. Or stigmatizing  a practice which is healthy and beneficial for both child and mother, and for 99.9999% of human history was the normal means of providing nutrition for infants and young children and continues to be for the vast majority of the world. Oh, but there’s this bit of enlightenment:

Do you think he — or the Forest Park City Council — knows what projection means?

UPDATE: I was gulled (blush), as Jenn points in the comments, by a hoax. “Citizens Against Breastfeeding,” portrayed in the Youtube clip, as snopes.com points out, is a prank. Such are the times when even an outrageously obvious hoax is believable — and yes, the point still stands.

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Observations and Assessments

Notions too small for a blog post all in one place.

April Foolishness. I guess I got  — or more likely annoyed — a few of you with my little April Fool’s prank. In case you missed it, I faked a news report from Trout Creek, Montana (pop. 261) stating the local hospital was going to fire all it nurses and replace them with housekeepers. I even put up a picture of some hospital in India, complete with palm trees (in Montana!). Some of you waxed quite indignant before realizing it was the First of April. What’s interesting is how readily people believed it — which speaks volumes about nurses’ perceptions about how they are valued by their employers. Which is to say, not much.

Nurse goes all postal on Craigslist. This epic rant has been making the rounds — those with delicate sensibilities may want to avert their eyes:

Well, after a year of getting rejected I have finally decided to give nursing the bird. FUCK YOU NURSING FIELD! Too bad the schools and media are still insisting that people go to RN school. Believe me THERE IS NO FUCKING SHORTAGE! New grads are considered garbage. On top of that, the degree serves no purpose in any other setting. BSN is a complete waste of time and money.

I know, “some people got jobs”. That does not justify the majority (1000’s) who did not and are now working retail for minimum wage. There is something fundamentally wrong with this country. My school counselors, nursing instructors, media and nurses I know urged me to go into nursing. As soon as I got my degree and the check to the school cleared I heard the unmistakable sound of the door to nursing closing—slamming actually. And it is not just the economy. Hospitals turning huge profits stopped new grad programs and hire foreigners.

It is over. I am a stale grad and I am out of options. The new graduates fresh out of their precepts will be flooding the market to add to the already rancid oversaturated pool of disgruntled STALE GRADS. So, I guess giving up a nice job for school, dedicating 6 years (yes, I was foolish enough to get the BSN), dropping 20 grand and putting up with nursing school stress was all for nothing.

And no, higher education is out for 2 reasons. One, you need RN experience to qualify for any NP program. Second, why would I throw more money at a system that just failed me and ruined my life? It is clear that the educational system is bunk. I am completely embarrassed at the education I experienced at the California State University–It is appauling.

I hate nursing. I hate it so fucking much now. The true colors of the profession are now clear. So, now society can have a derelict because that is what I intend to become. I now plan to make a living mooching off the system.

It would probably take a year of posting to unpack all of this. Suffice to say, I do have the tiniest bit of sympathy for her, as I graduated at the nadir of nursing joblessness in the ’90s and was forced to work part-time for the first three years of my career. That being said, I wonder at her commitment to the profession, despite the six years of expensive education; one senses she wants her dream job handed to her on a platter. It doesn’t work like that. So I’m with everyone else: don’t let the door hit you on the way out. Or else come to Toronto — I know some 5 North nurses who would love to have you as a colleague — and they’re hiring.

Uterus, uterus, uterus. In another take to the uterus-as-filthy-word story, now you can incorporate your womb. (Thanks Terri!)

Take me to your leader. In case my American friends and readers haven’t noticed, we’re finishing up the second week of a federal election campaign, where the forces of light and the agents of doom and darkness will collide in a colossal battle for the heart and soul of the nation, etc. Being the flaming left-wing commie-pinko-socialist I am, I will prevaricate until the very last minute till inevitably holding my nose and voting Liberal. All which is to say, if I seem more, um, political in the next few weeks, I can’t help it, it’s the environment.

Hope they were praying for epinephrine. Speaking of Members of Parliament, there’s a report in the Le Devoir this morning that three Conservative MPs witnessing a severe allergic reaction on a flight to Taiwan responded by laying on the hands and praying. I guess I slept through that part in my critical care courses where Prayer comes before Airway, Breathing, Circulation. [ Via. ]

Non-nursing blog shout-out:  Worcester College Gardeners — actual professional gardeners charged with the maintenance of 26 acres of grounds surrounding Worcester College , Oxford, U.K. Reading through the blog puts lie to the notion of effortless gardening: it becomes quickly very apparent all those charming, perfect English garden scenes Canadians wax green over are the result of some pretty intensive labour. What I could do with a flock of minions and unlimited cash!

A pair of quacks. I was happy to learn that both Mehmet Oz and Andrew Wakefield, the fraud-mongering anti-vaccination advocate, were recipients of the annual Pigasus Awards. Oz — and any self-respecting  nurse is always glad to see him taken down a notch or two — was given the award for promoting such quackery as energy fields and faith healing and advocating the bereaved call a psychic for consolation. (Why is this jackass still on television?) Wakefield got the award for continuing to peddle his nonsense despite being called out by the Lancet and the British Medical Association.

Mini-rant. To anyone who has cut and paste from this blog: it has come to my attention bits of my writing — which I remind you are not free, in the sense you can use them at will — are being circulated unattributed and altered contrary to the copyright notice on the bottom of this page. Please note that even if you did not see the copyright notice, you are still subject to its provisions. In other words it is your responsibility to ascertain your obligations.

I really don’t mind people lifting my writing so long as it’s unchanged and attributed to me. I actually like it, because it’s free publicity. But when I find my original work altered to the point where my authorship is in doubt, it starts to piss me off. When you don’t link back to me, you become a thief.

P.S. When I write “shit” I mean “shit”, not some milquetoast euphemism you have determined won’t offend your readers — which  incidentally doesn’t nullify the copyright either.

P.P.S. Why do I think it’s a losing battle?

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Uterus and Other Bad Words

More April Foolishess, but real this time, from the Florida legislature. Here a blow was struck for the advancement of science by making “uterus” is a dirty word. I suppose that there is a certain delicious irony about objecting to the use of the word “uterus” during a debate on abortion, though I doubt those who find the word offensive would get it:

At one point [State representative] Randolph suggested that his wife “incorporate her uterus” to stop Republicans from pushing measures that would restrict abortions. Republicans, after all, wouldn’t want to further regulate a Florida business.

Apparently the GOP leadership of the House didn’t like the one-liner.

They told Democrats that Randolph is not to discuss body parts on the House floor.

“The point was that Republicans are always talking about deregulation and big government,” Randolph said Thursday. “And I always say their philosophy is small government for the big guy and big government for the little guy. And so, if my wife’s uterus was incorporated or my friend’s bedroom was incorporated, maybe they (Republicans) would be talking about deregulating.

“It’s not like I used slang,” said Randolph, who actually got the line from his wife. He said Republicans voiced concern about young pages hearing the word uterus.

In the interests of prurience, and also of saving tender ears, from, well, science and education in general, I have composed a list of objectionable medical words:

Penis: Well, duh. Also better exclude the adjective “penile”. Also “penal” is problematic. Use “prison.”

Testicle: Again, duh. Testimony, testify etc. are dubious too, doubly so, given the fact (male) witnesses in ancient Rome held their spuds while in court.

Clitoris: Triple duh. Flogging offence. Do not EVER use. As a substitute, I’ve always liked le bonhomme au canot, which has a certain charm, but might be objectionable in the U.S. because it’s so obviously French. Best never to speak of it, or even think about it.

Cervix: Leads to the u-place.

Vagina: Leads to the, um, cervix. Also, do not use “Regina” as in the capital of Saskatchewan, because you might think of what rhymes with Regina, and that is the road to Hell.

Coccyx: Do you really want to say this in public?

Bartholins’s Gland: Just sounds dirty.

Mesentery: Say it with me, slowly: ME-sen-ter-ry. Get a little illicit thrill? Don’t use it.

Menstruation: Eeew.

Masturbation: Is a sin, and therefore the word is sinful. Only use if you’re sure you worship the Devil:

Abdomen: Where the u-place is, and is close to other “bad” parts. Avoid. Use “tummy” instead.

Pubic: Generally offensive, and in any case it’s not a word you’re likely to drop into everyday conversation:  “Hey, I have a pubic lump.” Not.

Anus, rectum, colon etc.: Someone, somewhere will be offended if you use these.  Besides, they are icky.  Just don’t.

Buttock: Near the above. Makes you think of other, more collequial, badder words.

Oral: Do I really need to tell you?

Epididymis: Only leads to troubling questions of the knee-bone-is-connected-to-the-thigh-bone type. In any case most guys don’t realize they possess them.

Semen: Only should be used when speaking of sailors.

The list, actually, could be endless. Feel free to add.

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“The Latest in Sanitary Conveniences”

[A rerun: I will return on 16/02/11. I feared when I reread this, thatI might have been a little harsh. After due consideration, no. However, the new low point in Western civilization was actually the email I got some little while later telling me “even the obese have the right to a clean perineum.” Amen. Originally posted 1/10/09]

The telling lines: “it extends your reach by a full eighteen inches” and “follows the contours of your body and comfortably cleans.”

Dear Lord.

I know, before you tell me, about the folks with back injuries and decreased range of motion and the morbidly obese who can’t reach around.  (That there is a market for this product may represent the nadir of Western civilization.)

But still.

Dear Lord.

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2 Comments

Good News from Kansas after a Spectacularly Awful Day

Your humble charge nurse had an awesomely bad day, in a week of similarly nasty days, so crappy in fact that I’m too tired and fed up even for my usual upper-management-idiocy snarkiness. The only slight consolation is that I understand nearly every hospital in the Greater Toronto region has been overwhelmed with patients. Superior Hills General, our bigger neighbour down the road, I’m told, had an 36 admitted patients boarding the ED, and an unbelievable 61 patients held for consult.

The good news is that a judge has ruled against Johnson Community College in the placenta Facebook case. To say the court spanked the College would be an understatement. Some more details on the events leading to the expulsion:

Byrnes said the picture was on her Facebook profile for about 3 hours, until Delphia [Byrnes’ lab instructor] called her and requested she remove it, which she did. Byrnes says Delphia told her she wasn’t in trouble during the conversation.

But the next day, Byrnes said, Johnson County Community College Nursing Director Jeanne Walsh blasted her and the other students by screaming and crying at them.

“During the meeting, Director Walsh’s emotional conduct precluded the students from defending themselves and adequately explaining the reasons for engaging in the conduct in question,” the complaint states.

“Director Walsh summarily dismissed Plaintiff Byrnes and three other members of the lab group from the nursing program, and exclaimed, ‘I don’t know if I would want you back.'”

Is this how we want nurse educators to act? I don’t want to flog a dead horse, but again it strikes me the true professionals were the students, not the Nursing Director. In its press release, JCCC was typically gracious towards the students in admitting defeat, as it has been in this whole process. Okay, maybe not so much.

“We are disappointed with the court’s decision today,” said Terry Calaway, JCCC president. “Of course we’ll abide by the judge’s decision and readmit the student to the nursing program.

“The JCCC nursing program is widely known and respected for the quality of its instruction and its graduates. Sensitivity to patients and confidentiality of patient care is at the heart of what we teach. We took what we believed to be appropriate action, but the court saw the situation differently, so the student will be readmitted to the program.”

The students who took the photos were never expelled from the college, as has been reported, but were temporarily dismissed from the program.

Three other students who had been dismissed from the program will also be readmitted.

Classy to the bitter end, eh? (See, I’m so tired even my sarcasm bone is exhausted.)

To Doyle Bynes and colleagues: congratulations and well done. You do us proud, and you’re a credit to our profession.

__________

*JCCC needs to give up on the “temporarily dismissed not expelled” spin. It’s a distinction without a difference, and it’s silly.

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Robotic Triage

Long time readers know of my intense obsession dislike of equivocating nurses/nursing with robots, and here is a classic example. Somewhere, somehow, some engineer is just not getting what triage nurses do:

If a group of computer engineers gets their way, we will no longer hear stories of patients dying in the ER after excruciatingly long waits. A solution for overburdened triage staff and long emergency room wait times appears to be in sight.

If you’re willing to wait five years, robots could help speed the ER triage process, according to Mitch Wilkes, associate director of the Center for Intelligent Systems and associate professor of electrical and computer engineering at Vanderbilt University. He is the lead author of a paper presented yesterday at the Humanoids 2010 conference held in Nashville.

The paper describes an ER that would feature electronic kiosks (like those at the airport) at the registration desk and smart chairs. A mobile robot or two might monitor patients in the waiting room.

After I finished laughing a little too gleefully at the thought of patients screaming at a triage robot, it seemed to me there is some, um, misunderstanding about a nurse’s role at triage, which decidedly is not about taking the patient’s temperature and sending her out to the waiting room. And if patients are demanding more face time with a health care professional, installing robots seems, well, a little counter-intuitive.

Here’s a thought on how to relieve “overburdened triage staff”: instead of spending a gazillion dollars developing and setting up the technology, then a gazillion more for ongoing upgrades and maintenance (for you know these things will break down when someone looks at them cross-wise), why not just adequately staff emergency departments with real, live nurses?

Naw. Too simple.

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