November 18, 2008
How Does Your Workplace Treat RN Travelers?
As I watch the stock market plunge again today, I am hearing rumors of more and more local medical facilities letting their per diem nurses go, replacing them with RN travelers. Is this the right approach, considering the nursing crunch?
Throughout my career in various ICU settings I have met many nurse travelers, some quite knowledgeable, some well gifted; others could use a few classes in organizational and efficiency skills. But, all have been flexible in meeting the needs of the various units. Yet, speaking to them one-on-one, many believe that the nurses that they work with don't seem to recognize their abilities and skills. Nor do the managers. Some RN travelers feel like they are portrayed as incompetent in knowledge and skills.
I have found exactly the opposite. Many of the RN travelers one meets are exceptional nurses and interact with patients more so than the regular staff. This makes me feel a bit sad as many my colleagues see the traveler as a simply a “body to take over the next shifts' patients,” without recognizing who they are, where they went to school, their hobbies, interests, and why they chose travel nursing. It is not easy to acclimate to new setting every 13 weeks or so, but they do so in multiple, varied environments. So, why don't we take the time to get to know them and their accomplishments a bit better?
How does your workplace treat RN travelers?
November 12, 2008
Are You Tending to Your Own Emotional Needs?
How often do you leave your workplace drained physically and emotionally, especially after a hard day or night of work? I have slept the past two days -- I thought I would never complete my 3 shifts last week. All 3 shifts were racked with people with GI bleeding, an intubated 95-year-old frail woman, entering the last stage of life (without family support), and other patients whose families wanted “everything done for them,“ despite end-stage diagnoses …Is this what nursing has become today ? Keeping the dead alive?
I realize that is a rather blunt statement. I find these patients to be the most taxing emotionally, their families often making the provision of care even more difficult during a 12-hour shift. I left all 3 shifts emotionally drained. I felt I had done what I could for these patients. Yet, their families wanted more. What is “more,“ when a patient is attached to every modern medical device available to maintain life?
Feelings of turmoil ran through me as I climbed aboard the bus each morning. Sheer exhaustion…
At home, I climbed into bed, after stopping for breakfast at the local diner. I was going to sleep things off. Renew myself by reading a newly written biography on Einstein - 452 pages left to read and then window-shop for the rest of the week. Until my next 3 shifts…what would they encompass?
What are your thoughts on compassion fatigue? How do you cope?
An interesting Web site: Compassion Fatigue Awareness Project
November 05, 2008
Imagine Working as a Nurse in 1889!
In New York, Columbus Square, the fall colors have not erupted to brilliant reds, yellows, and golds quite yet. Yet, everyone seems to be taking advantage of the 70 degree weather -- jogging, walking their dogs, strolling along 5th Avenue, and seeking hidden shopping deals at Bloomingdales. I just finished working a 3-day weekend, which wasn’t that bad although my body seems to be in a constant state of movement as my DBS battery has a lifetime of 5% left. Yikes! I've noticed that lace seems to be making a comeback in clothing trends -- rather popular in the 1890s as well!
Can you imagine working in 1889 as a nurse? This list is a partial one of duties left to nurses of that time. (Wonder what physicians were doing?) The list (Nurses' Duties were Different in 1889) starts out, "In addition to caring for your 50 patients, each nurse will follow these regulations:"
* Daily sweep and mop the floors of your ward, dust the patient's furniture and window sills. (Now called the Dept. of Housekeeping or Environmental Services!)
* Maintain an even temperature in your ward by bringing in a scuttle of coal for the day's business. (A responsibility of BioMedical Engineering!)
* The nurse's notes are important in aiding the physician's work. Make your pens carefully; you may whittle nibs to your individual taste. (Anyone know how you “whittle nibs”? I’m clueless!)
* Each nurse on day duty will report every day at 7 a.m. and leave at 8 p.m. except on the Sabbath on which day you will be off from noon to 2 p.m. (Does this refer to Ethnic origin and religious practices?)
* Graduate nurses in good standing with the director of nurses will be given an evening off each week for courting purposes or two evenings a week if you go to church regularly. (Ahh, a prerequisite required to maintain good standing…)
I find this list fascinating as it reflects how much nursing responsibilities and duties have changed over the past 100 years or so. While you may not remember back to 1889 (!), how about those of you who were practicing 30 or 40 years ago? What are the biggest differences you see?
October 30, 2008
ANA Supports Obama
My resourceful editor, Susan Yox, sent me information about ANA's support of the Obama/Biden ticket. They have developed a new Website, Nurses for Obama Biden. Through this Website, you can find more information on ANA’s endorsement process and comparisons between Sen. Obama’s and Sen. McCain’s healthcare plans. You will also find a link to watch a video of Sen. Obama thanking the ANA for their endorsement!
The very first link that I went to was the Obama Biden Marketplace for T-shirts, and other political ticket merchandise. Over the past few weeks, it seems to me that the issue of healthcare has been lost due to the volatile economy. I haven’t heard many answers to the current healthcare issues -- the uninsured, in particular, as I am one of them. It’s taken a backstage pass in the election. That worries me, since the economy is also reflected in healthcare delivery, quality, and accessibility to Americans. Correct?
Take a look at the views of both candidates regarding healthcare. How much can a $ 5000 dollar tax credit buy for you when it comes to medications, physician appointments, etc? Not much, as for me DBS programming costs more than $3600 per session.
What are your thoughts about the ANA supporting the Obama-Biden ticket?
October 23, 2008
The other day I had a conversation with a nursing supervisor about the night shift, working from 7 pm to 7 am. Our conversation became somewhat argumentative in the sense that we were both questioning if the quality of care delivered by nurses during the night shift drops significantly. It made me wonder ….
I have worked the night shift my entire nursing career. I could never return to the day shift. However, there are some issues that do occur during this shift. More often than not, I see my colleagues come in, plunk themselves down in their chairs by the nursing station and immediately focus on who is taking a break , “when, where, and how long.” At other times electronic documentation begins before even evaluating the patient. How can you assess a patient without ever seeing them? Aren’t you falsifying records or are you simply copying the previous shift’s entries? This worries me…
My shift begins the way I was taught in nursing school: Seeing the patient, introducing myself, attending to their personal needs, performing a physical assessment, providing medications, and talking to families. Maybe this is no longer the way nursing is performed? Often my colleagues ask me to come and sit down, but there is too much to do for patients today.
Are there any evidence-based indicators to support off-shift nursing outcomes? What do you think? What differences do you see, one shift to another?
October 19, 2008
Do You Pray With Your Patients?
I have been having interesting online conversations with fellow patients diagnosed with dystonia about the use and effect of spirituality and faith on chronic disease and illness. Most of us with dystonia realize that a cure is a long way off, especially with NIH funding cuts. Personally, I don’t expect a cure for my dystonia during my lifetime. I expect only the reality of dealing with a complicated, complex, disorder marked by misfiring neurons of unknown origin!
I believe that healing prayer can be effective for physical issues, mental/emotional issues, and spiritual issues. Too often, people are looking for only the instantaneous and complete healings that Jesus performed. To be sure, those kinds of healings still occur today. But they seem to be just as rare now as then. It’s more common to see gradual healing, often in conjunction with traditional healing methods like medicine, surgery, and counseling. Just keep in mind that healing is the work of God, done by his will. No one can control it. We can only position ourselves -- or others -- to receive it, and then ask. And we should not be surprised if we ask for one type of healing, such as physical, and receive another, such as spiritual.
However, I have never been asked by a patient or their family to pray with them in the ICU setting. Have you? This shouldn’t be a surprise for a simple reason. Western medicine in particular has been relatively single-minded in its approach to healing, focusing primarily on the body -- and even just parts of the body -- for physical healing. But as healthcare advances, a more holistic approach to healing is emerging. The relationship among body, mind, and spirit is becoming clearer.
As the acuity of patients rises, will the use and power of prayer increase? Should we, as nurses, encourage the role of prayer in healing and comfort? What about our own beliefs? Do miracles occur in medicine today? I’d love to hear your thoughts on this topic.
Quote: "Find out about prayer. Someone must find out about prayer." (Albert Einstein)
October 16, 2008
The Final Debate
Phew... the final Presidential debate is over. I clung to every word each candidate said, but shut the TV off after the final statements, not knowing what had really been discussed. I did hear the word "healthcare" about 6 times from both candidates, however most of the debate focused on tax cuts, governmental spending, and the Wall Street crisis. I must admit that McCain looked angry at times and couldn't quite contain his facial expressions, bluntly directing them at his opponent, Obama, who remained cool, collected, and poised.
The post-debate coverage on TV went on till 12 midnight, past my bedtime; yet I have been glued to CNN’s “Best Political Team” since the start of the race 20 months ago. The polls are beginning to be released, answering the question "Who won?" Shouldn't we be asking "Is America going to win?"
And who is “Joe the Plumber” anyway? What about “Nancy the Nurse”? SIGH… Election fatigue now setting in...
What are your thoughts?
October 09, 2008
I just read some interesting articles about hourly nurse rounding. Hourly rounding was described as the nursing practice of regularly checking on patients' needs using the 4 Ps — positioning, personal needs, pain, and proximity of personal items such as the call light — with the promise to return in 1 hour. I recall performing hourly rounding on the night shift over 20 years ago when I was just beginning my career as a new, young, inexperienced graduate. It worked! At the time team nursing was also in vogue. I wonder if we need to return to this practice?
How many times have we found an unresponsive patient at 4 am, when we last saw them joking to us at 12 midnight? Our time now seems to be preoccupied with individualized care plans, transfers and admissions, bed shortages, and electronic documentation rather than actually visibly seeing our patients on an hourly basis.
Of course, a major difficulty is how to establish a work-day design that actually makes hourly rounding possible. This might be a particular problem with the nursing shortage today.
What are your thoughts on hourly rounding? Has your facility implemented this practice and how is it working? Should we return to this practice?
October 01, 2008
Aging Hospital Buildings
A Canadian newspaper, the Globe and Mail, released a news story on the infrastructure of aging, crumbling medical centers. They described several scenarios that sound all too familiar to us:
"Susan Hale's hospital bed in Joseph Brant Memorial Hospital's orthopedic wing is pushed against a corridor wall, squeezed between linen carts and orphaned equipment. Cleaning staff maneuver a wheeled garbage bin around Ms. Hale's IV pole. Visitors smile awkwardly as they pass, stepping sideway to avoid bumping the family members perched on the edge of her mattress.”
One of my best friends used to work in a large medical center in upstate NY, a Magnet-designated facility, and she told me that when their ER was too full, the staff would create patient rooms out of cleaning closets. Can you imagine being stuck in a closet for a 6-hour ER wait?
The gist of the Globe and Mail story was the increased outcome of deadly infections among patients within these crumbling walls. Almost all of the medical facilities within the immediate New York City area are aging. Paint peeling, mice scrambling, flies a-flying, tiles disintegrating, and garbage falling out of bins. Infections may very well be on the rise as we encounter more and more crumbing, aging infrastructures. Frightening, isn't it ?
Do you work in an old and disintegrating or over-crowded building? Have you noticed a rise in infections in your patients? If so, tell us about them.
September 19, 2008
Financial Fallout Coming to Healthcare Too?
Stocks, bonds, and savings -- those are the 3 big words being used by CNN News analysts today. The Stock Market plunged into a downward spiral earlier this week. Wall Street executives’ actions are being evaluated, as are their salaries. I must admit that I went to the bank earlier today just to see if all my financial assets were still there. They were!
Is the same fallout going to occur with healthcare institutions? The highest paid Hospital CEO in New York City is Herbert Pardes , with a yearly salary of 5.4 million dollars as of 2006, according to New York Presbyterian Medical Center. Next come the other major institutional CEOs at Mount Sinai and Sloan-Kettering.
Is the same financial fallout going to occur within the healthcare system as investments in new patient care centers, equipment, and personnel are made?
Anyone frightened about the events of this week? Will our jobs be affected?