In Our Own Words

The Recession in New York

Last week was marked by rising oil prices, tens of thousands of lost jobs, and plummeting share prices that will have a profound impact on the 2008 candidates vying to succeed President George W. Bush. I have to admit that times are tough today. Job losses, rising oil prices, market losses on Wall Street, home foreclosures, rising food prices, empty “For Rent “ bodegas on Lexington Avenue… At my local bodega, the fresh flowers seem to have no buyers. I see people stockpiling cans of ravioli, cutting coupons, and reading shelved magazines at the local library instead of buying them.

My apartment building has become a revolving hotel with tenants moving in and out because they can’t afford the rents. Most rents in the building now exceed $2,100 per month. Lucky ole me – I’m well below the market price value as my apartment is rent stabilized. However, I have to admit to looking for a new job that offers benefits and other things including a heftier hourly salary. Thinking of my retirement years… Have even thought of leaving NYC…Moving to? Maybe North Dakota! But there’s one big problem with that choice – I have freaky wires implanted in my head.

In a recent interview Warren Buffett, the world's richest person, said “The U.S. economy is in a recession that will be more severe than most people expect.” Well, if he’s saying this, then it must be true – we are in a recession. Yet, the Wall Street Journal reported that the ailing economy would ease the nursing shortage! More nurses going back to work, part-timers going to full-time, etc. Okay, what then? Will we have too many nurses? Will salaries go down for us? Will hospitals fill those empty positions or not?

How has the recession affected you?

The Last Lecture

To millions who have watched him on the Internet or on Oprah Winfrey's TV show, Randy Pausch is the 47-year-old professor dying of cancer who inspired them with his “last lecture,” about achieving childhood dreams and living with integrity and joy. His neighbors in a Virginia suburb know him as the guy biking around the streets for exercise while chattering into a cell-phone headset.

That's what the Carnegie Mellon University computer science professor did to expand his 76-minute talk into a book without taking time that he doesn't have away from the people for whom the book was intended: his 3 children, all under 7 years of age, that he won't be around to help his wife, Jai, raise. I clearly remember watching his lecture on Oprah --so much of it was inspiring, moving, exciting, stirring, rousing; but also sad in a sense. The Professor was dying. After all, what do you say in a “last lecture?”

Pausch found out in September 2006 that he had pancreatic cancer, an especially deadly cancer with few treatment options. Last August, he learned the cancer had spread. Doctors told him he had 3 to 6 months live. He recently suffered heart and kidney failure. He's in pain all the time and he hasn't been strong enough to ride his bike. He's stopped chemotherapy and spends many days in bed. I just bought the book, the same size as the book Tuesdays with Morrie, by Mitch Abloom.  It arrived this morning -- 266 pages of discussions about enabling the dreams of others -- primarily his 3 children.

To read online, see Randy Pausch's blog and health report and  "The Last Lecture."

Have you read the book or listened to the lecture?

Silent Auction for Dystonia

Broadway  was crowded with tourists today. A cool wind wiped the petals of tulips along Park Avenue. It felt like early March weather. I had done my research. I was visiting the Broadway theaters one by one to ask for donations for a silent auction to benefit dystonia. Something needs to be done. Research is not progressing, except for a form of dystonia that is genetically-based and affects less than 10 % of those afflicted with dystonia.

Broadway is known for its theater district and often is called the “Great White Way” because of its bright lights that shine at all hours of the day.  Broadway originated as a Native American trail, called the Wickquasgeck Trail, which was carved into the brush-land of Manhattan. This trail originally snaked through swamps and rocks along the length of Manhattan Island. Today I was swamping my way through crowds, primarily those carrying maps and NYC tourist bibles.

One by one, theater after theater, I stopped in, asked for a silent auction donation to Care4Dystonia  and the Dystonia Association of Kentucky.  Soon, I had billboards autographed by directors, souvenirs from Mary Poppins, and miscellaneous caps, mugs, and posters. In a few hours I had about $5000 worth of material for the auction. Not too bad, considering this was my first time! I really had no idea how a silent auction worked, but if it brought revenue to nonprofits, then that was all that mattered.

An Aging Population -- Why Can't NPs Provide Needed Care?

The Washington Post reported last week that by 2030, the number of adults 65 years and older will make up almost 20% of the population. Currently, this age group makes up 12% of the U.S. population and accounts for:

* 26% of all physician office visits
* 35% of all hospital stays
* 34% of all prescriptions
* 38% of all emergency-medical-service responses
* 90% of all nursing-home use

John Rowe, professor of health policy and management at Columbia University headed an Institute of Medicine panel that released a report on the healthcare outlook for the 78 million baby boomers about to begin turning 65. The report from the arm of the National Academy of Sciences reiterated:

*  There aren't enough specialists. It found there are about 7100 US physicians  certified in geriatrics, one per every 2500 older Americans.
*  Insufficient training is available.
*  Specialists are underpaid.
* Medicare fails to provide for team care that many seniors need.

The report said Medicare may hinder seniors from getting the best care because of its low reimbursement rates, a focus on treating short-term health problems rather than managing chronic conditions, and lack of coverage for preventive services.

Aren’t these aspects of care that nurse practitioners are so well trained in? We may be able to solve the impending looming healthcare crisis.

NPs – what do you think?

English Only?

Over the weekend (after 3 long night shifts in the ICU), there was an incident and controversy about the use of English vs other foreign dialects spoken by employees within the Unit. Imagine that you are on Jeopardy, and Alex Trebek gives the answer:  "This is the official language of the United States."  You buzz in and blurt out, "What is English?" Just like that, you lose the money.

Although English has long held supremacy in our national consciousness, the truth is there is no official language of the United States. So, we may be in for a rude awakening in the form of a civil-rights lawsuit if we have an English-only workplace. Yet, on the other hand…

What should an employer who desires to implement an English-only workplace policy do? First of all, the employer, while recognizing that the workplace is not and cannot be a democracy, should be sensitive to the varying life experiences and perceptions that are brought into the workplace by employees with diverse backgrounds and experiences. Because of this, the employer should take the time to communicate effectively with all employees to ensure that an English-only policy is fully explained to everyone.

All employees may not agree with the business reasons asserted by the employer, but at least they will recognize that the employer believes there is a business reason for the policy, and it is not being imposed simply to discriminate against or offend any group of employees. This seems to be such a sensitive topic….

An English-only policy would be highly controversial in nursing, no matter how it is explained. If it is implemented by simply posting a memorandum on a bulletin board without explanation, the reaction of some nurses is likely to be extremely negative and they may feel personally offended by the policy. Some nurses may well feel they are being discriminated against because they were not born in this country. As immigration patterns have shifted in the United States from Central and Western Europe in the early part of the century to Central and South America today, the emotional issue of language may well be tied to perceptions of national origin discrimination by nurses.

What are your thoughts about an English-only policy in the workplace? Has this been mandated where you work?

Workplace Violence: Disruptive Behavior, Bullying, Verbal Abuse

Over the last couple of weeks there has been a disturbing video shown within the media involving young teenage girls assaulting another teen. Premeditated violence? Their ages range from 14 to 18 years with charges having been filed as adults for each. This leads me to wonder about a new article that I read about workplace gossip within nursing.

Disruptive behavior such as bullying, lateral violence, and verbal abuse is so common in healthcare settings that the Center for American Nurses  recently released a position statement calling for zero tolerance to lateral violence and bullying in nursing work environments. The Joint Commission also proposed new standards that will require organizations to develop codes of conduct that define and address inappropriate workplace behavior.

Whose responsibility is it to stop disruptive behavior? How do we even stop the bullying and gossip that seems to run rampant? Why not use that time to formulate strategies to solve current issues within nursing? Instead, it is all too easy to ignore the behaviors seen within nursing, rather than to confront them? Gossip, backstabbing, withholding of information, and shunning of our co-workers are all forms of workplace violence. Apparently, this trend appears to be growing.

Have you been a victim of workplace violence? If so, please share your story with us.

(For more information on The Center for American Nurses' position statement, visit www.centerforamericannurses.org/positions/lateralviolence.pdf)

Giving to Honduras

My photographer, Michael, who documented my DBS Surgery in 2004 as a pictorial essay (www.parasphotography.com/beka.html), left me a message teling  me that he was headed to Honduras,on a mission once again this  April. In support of the New York Honduran Committee, 11 volunteers travel to Tela, Honduras, one of the poorest countries in the western hemisphere, to provide free health care. The medical team examined more than 220 patients and performed 28 surgical procedures in 2007.

These health professionals performed health evaluations, hearing and speech screenings, and major and minor surgeries for children and adults. In addition, they provided many people with donated hearing devices. The medical mission is always geared first towards children, but each year they see many adults who are in need as well. Michael went along to photograph the journey, the dirt, the isolation, the lack of basic necessities, and other needs. In a country where most people can't afford basic health care, the chance for free surgeries and exams can be a life-saving opportunity.

I have always wanted to go on a medical mission, or even to join the Peace Corps (Maybe I’m too old for that now?) Have any of our readers gone on a medical mission? Tell us about it.

See the Honduras 2007 Essay here.

Some information on joining medical trips:  So You Want to Go on a Medical Mission

A Dreadful Event

I recently attended a fundraiser for movement disorders. It was the worst one ever. During the event I excused myself, and hung out in the gold-plated restroom until I thought the guest speaker was done with her awful, dreadful, unpleasant, and simply terrible speech.

She was a well-known actress who thought we would all be as interested in her life story as she was, including many lurid and explicit details. Her juicy speech seemed to go on forever, making me think the event planners had either not given her a time limit, or that she had ignored it. However, she forgot to mention that there are over 40 million Americans living with a movement disorder today (source: http://www.life-in-motion.org).

The event was for the supporters of a medical school and their expanding movement disorder program. It was all about science, saving lives, research, and how we could help (hint: $$$$). However, I found the disconnect between the speaker and the purpose of the event unbearably painful. I later felt badly for the event planners who had put that one together. But I had heard it all before at other events that I had attended – the galas, dinners, symposiums, “think-tank scientific forums,” “dog walks,”  golf invitational events at exclusive high-end golf  clubs (I certainly was no golfer -- not with my head twisting to the left -- where do you think the ball landed on the greens ?).

At all of these events, there was little focus on actual patients living with movement disorders.
The gist of the event really was that we all wanted to see the celebrity of the evening. Right? Well, I saw her. No doubts about that. But, where was the money for patient care? The movement disorder program? Perhaps forgotten in the focus of the evening.

Maybe we should keep it simpler and keep the emphasis where it should be. How about a fundraiser called “Pizza for a Purpose?!”

Spring Blooms

I don’t like the time re-adjustment that happens in the US in the spring (Daylight Savings Time). Well, that’s not really true: I don’t like the mornings, but I do like the daylight in the evenings. I’m a late riser -- 12 noon usually -- and the time change means I’m getting up earlier, according to my body clock. There isn’t enough Starbucks’ coffee in the world to cope with this sort of thing.

But even as I struggle to adjust, I walk the neighborhoods on the Upper East Side, passing flower shops and bodega cafes. The spring blooms are out on the sidewalks by 10 am. Shipments are delivered well before daylight arrives – around 5 am. Boxes filled with carnations, lilies, tulips, and daffodils- true signs that warmer weather is coming.

Of course, for me -- this could only mean “beach weather” -- time spent on the South Jersey Shore. A few years ago we had had a warm spell in April; I found myself listening to the ocean roar and the waves pounding the white sand, as I munched on a hamburger, sunbathing on the Shore.

I’m ready for spring and the onset of summer. How about you?

New CPR Guidelines Coming?

Imagine – sitting on the bus (no one knows you are a nurse) and someone calls out “Help!”  A person collapses. Everyone stands still as the bus comes to a sudden halt. What do you do? Run off the bus, or say “I can help- I’m a nurse?” Bystanders who see someone suddenly collapse should quickly give the person chest compressions even if they are not trained in cardiopulmonary resuscitation -- the American Heart Association (AHA) released this new recommendation this past week.

The AHA urged people not to stand idly by because they do not think they know how to administer CPR while an adult stricken with acute cardiac arrest is dying in front of them. (People still stand by idly and watch dumbfounded at these events, don’t you think?)

In recommendations published in its journal Circulation, the group emphasized "hands-only" CPR -- a simple procedure that bystanders can perform without worrying about doing the mouth-to-mouth part of CPR. All too often, no one at the scene does anything to help the victim of sudden cardiac arrest -- often because there is no one trained in CPR and the general public is scared that they will do something to make the victim's condition worse.

Will this be a new recommendation added to BCLS?  Have you tried to save a life outside of the medical setting? If so, do share your amazing story with us.

The PBDS Test for Nurse Travelers

Quite a few nurse travelers have been hired throughout the New York City area to cover hiring freezes and staffing shortages. Ever since I placed my resume online, I have had calls from various travel nurse companies looking to fill a variety of positions, although I am primarily looking for an optimal NP position that will not tire me out or induce dystonia symptoms. (Lately I feel like the actor Michael J. Fox -- I want to hide and not be seen or questioned about abnormal movements or possible and current treatments.)

A requirement for travel nurses to prove their competency in their area of specialty is to take the "Performance Based Development System,"  otherwise known as the PBDS Exam. It consists of video scenarios of multiple clinical situations requiring you to evaluate the clinical diagnosis (are nurses allowed to diagnose? Uhmmm? I thought not…), identify it, and list actions you would take to correct the problem. (Avoiding the answer – “Call the Doctor” is a must to passing the exam.) Travel nurses cannot begin a contract assignment without passing this test.

Some of the scenarios might include:
* What would you do if a family member arrests in a semi-private room (Scream for help!)
* A doctor makes the comment “I don’t know why hospital administration won’t hire any decent nurses when there are plenty of girls out there?” (What sort of girls is he referring to?)

The test seems to focus on nursing actions used to correct a medical diagnosis. I thought we were nurses, not physicians, or is there now overlap between the two professions? When was the last time a white-coated physician gave a patient a bedpan? Anyone recall?

Whatever happened to the good ole resume and job interview format? Is this the right exam to test the competency of skills and knowledge for a nurse? I'd like to hear from others who have more experience with this.

John McCain and Healthcare

As Election 2008 moves forward, I decided to read up on John McCain. The only 3 things I know about the man are: he’s a senator from Arizona, he’s a former POW released in 1975, and he’s had a bout with skin melanoma (I won’t admit to the fact that his wife does like she stepped out of Vogue magazine each week! She never has a hair out of place.)  But I know nothing about his political views, especially those surrounding our healthcare system.

John McCain is bolstering his reputation as a maverick by encouraging Americans to buy lower-priced drugs from Canada, a plan that may cost Pfizer, Inc, and the drug industry $40 billion over 10 years. Isn’t that a lot of monetary revenue? Enough to rebuild the Lower 9th Ward in New Orleans! McCain, the Republican presidential candidate, says crossing the border for less-expensive drugs will increase healthcare access by lowering costs. Spending on physician services can be cut too, he says, by paying set fees for disease treatments, not on the amount of care provided. He also wants to encourage the purchase of insurance by offering a tax credit paid for by taxing workers' health benefits for the first time.

Supporters say that by attacking health costs, the Arizona Senator can make care more affordable for the 47 million Americans without insurance coverage. Opponents say the ideas are unrealistic. To me, it all seems rather confusing….To save money, McCain wants to give physicians a so-called bundled fee for treating a condition such as heart disease instead of reimbursing each procedure as they do now. Now, I wonder how that would affect private practicing nurse practitioners.

What are your thoughts? Should we be going to Canada to buy our prescriptions?

Health Matters in the 2008 Election

Organ Transplant Tourism

Need a kidney? Buy one for $20k in Russia.
Need a liver transplant? Visit the Philippines. Cost $129k.
Need a heart?  South Africa has them for $140k.
(Lisa Ling, Reporter, National Geographic Special on Organ Donation)

The shortage of organs available for transplantation continues to rise in the United States and the demand for organs exceeds the supply. Thus, many Americans, rather than staying on waiting lists for 5 to 15 years, are traveling to various countries to obtain necessary organs to remain alive. China recently stopped allowing Americans to travel to that country for organ donations. Executed prisoners often were utilized as organ donors in the land of the Great Wall. To me, this sounds rather barbaric.

The shortage of donated organs and the lack of supervision of hospitals in China have led many to view transplant surgery as a cash cow. Many people have been enticed to profit from this situation by offering their organs for sale. The same seems to now be occurring in Russia, India, and other under-developed countries as well.

I kept thinking about how needless all of this would be if we didn't have such loose organ donation policies in the United States. Do we even have a governmental policy on organ donation? The US government’s site on organ donation and transplantation (http://www.organdonor.gov/ ) offers the following statistic: "Each day, about 74 people receive organ transplants. However, 18 people die each day waiting for transplants that can’t take place because of the shortage of donated organs." That's about 6500 people who die every year in the United States waiting for an organ donation -- two times the number dead in the 911 attacks. Should we be doing something more – education, public service announcements, or online marketing to lower these drastic numbers?

About 2.4 million people die each year in the United States. Only a fraction of these people are organ donors. Why are so many life-saving organs being thrown away? What do we do with the growing number of people requiring organs? Do we let them live out their lives as they are or institute a change in the voluntary "Become an Organ Donor" card, such as somehow making it mandatory in nature? What are other countries doing to solve the problem of organ donation?

Please share your suggestions.

Work-Life Managers on Staff

A news feed from Google caught my eye – “Medical School Hires Work-Life Manager.” Interesting, don’t you think?  I have always thought that the some of the best nursing managers I have had in the past are those who recognize that their employees cope with the daily struggle of trying to balance the demands of work and home. It’s not easy, is it?

The truth is that workers do bring their personal lives to work with them. How often do we  have conversations about our kids, soccer games, homework assignments, etc. at work? Organizations that ignore this fact are probably risking poorer performance, stressed-out employees, and the loss of an opportunity to fully capitalize and enhance on the skills and expertise of workers.

However, I do have to ask, at those workplaces offering work-life managers and similar support systems, if a perception exists that those who use these services are less "serious" about their work? In some places, employees who use flexible work policies, employee assistance programs, and/or childcare and eldercare supports, are sometimes labeled as "slackers" or “weaklings.” I would suspect that by not supporting workers with personal/family commitments, managers lose in the long run, employees lose, and therefore the company loses as well.

I’ve never used any sort of work-life support systems at my workplace. I don’t even know if they  exist! But, it is an idea that may be of benefit to all of us, taking into account over 110,000 of us are going to retire in 4 years! So, why not implement Work-Life Managers to ease the current stressors at work and at home?

Does anyone work in a facility that offers these services? If so, please tell us about it.

Another Super Tuesday

I woke up early today and convinced my neighbor, a young chap, to carry my hybrid bicycle down four flights of stairs to street level. Spring was coming. The air has been warm and breezy, although it looks like it is going to pour buckets later on today. As my neighbor brought my bike downstairs, I loaded myself with oil cans, polish, torn wash clothes no longer useful to the human body, and a tire pump to clean the dust that had accumulated on my bicycle during the long winter months. I haven’t ridden my bike in over a year. Balance is still a problem for me. The last time I tried riding a bicycle was in Aruba and I ran into a vehicle instead.

I used to be an avid cyclist, often riding along the Erie Canal for miles in Upstate New York. Riding 40 to 50 miles a week was not unusual until dystonia hit me. Cycling soon evaporated as symptoms progressed. I used to be a true cycling junkie! Now I’ve become a political news junkie!

As the morning went by, the polish came out and I began attacking the dust on my bike – one of my treasured prizes, second only to my Turkish carpet. Slowly, my neighbors began accumulating on the steps as I scrubbed. And soon, talk about today's  Texas and Ohio primary races erupted, leading to our own lively sidewalk debate. I was becoming confused by the entire Electoral race, not really sure who the right candidate should or even if the Democratic race would be decided by tonight -- March 4, 2008. Super delegates, allegations, and other issues were discussed. Essentially I was an “undecided,” not knowing which issue was of more importance – national security, the economy, or healthcare?

Laughter was mixed with the verbal exchanges with each resident having his or her own opinion. How divided the country truly is… One of my neighbors pumped up my tires for me. I climbed aboard to the applause of my neighbors -- all knew that I had dystonia, a movement disorder. They had seen me in the media spotlight, most recently on Dr. Oz's Oprah and Friends Radio Show.

However, riding a bike proved to be a feat and a challenge still, just like Super Tuesday. Perhaps I’d better go back to debating! Any thoughts on the primary process or the candidates?

The Lipitor Ad Controversy

The Lipitor advertisement  featuring Dr. Jarvik, inventor of the first artificial heart, has been taken off the air. (Pfizer Pulls Lipitor Ads With Heart Expert Jarvik).   A congressional subcommittee is investigating celebrity endorsements in direct-to-consumer drug ads, including the ads featuring Robert Jarvik. Okay, does that include the “Flying Nun” -- Sally Fields, and the osteoporosis drug, Boniva, too?

It all seems pretty silly to me to spend time on this controversy. Although I must say I did think that Jarvik was a practicing physician of some sort. He finished medical school, but never completed a residency. Thus, he can’t prescribe medications or practice medicine. I recall seeing the videos of Barney Clark in Utah who was implanted with one of Jarvik’s devices in the 1980s. Remember?

I guess the controversy centers on this question: Is Dr. Jarvik entitled to appear in advertisements and give the impression he can prescribe pharmaceuticals for patients?

But, let’s leave the “Flying Nun” alone! (Wasn’t Gidget great?)

Hospitals More Like Hotels

I recently revisited my old workplace in Rochester - Highland Hospital.  A wonderful, clear, glass atrium with painted ceramic tiles greet you as you enter the interior lobby, with welcoming and peaceful colors of mauve and lavender. A loft above the lobby holds a grand piano for patients to enjoy music therapy. Mahogany wood greets visitors by the gift shop, which has perfectly arranged, uncluttered rows of cards and miniature bears and dolls.

The old hallway is now painted in various shades of purple and lavender as well. It’s obvious there has been some planning in color schemes. There’ is even carpeting now! A recent report in the New York Times  explored the redesign of hospitals. I must admit that Highland Hospital has turned into a mini-hotel with multiple amenities for patients and even massage therapy for staff. I wish still worked there!

Are other medical facilities doing similar things? Here in New York I really don’t see much of that – many facilities look like they are crumbling, with wall plaster peeling, overflowing garbage cans, dust on window sills, and a lack of carpeting unless it’s a designated VIP ward. And those uncoordinated ceiling colors – some are the color of bile combined with tan. One has to wonder if the environment does play a role in a patient’s recovery. I’m not sure I would want to wake up gazing at a ceiling the color of gallbladder bile after surgery….

What are your thoughts on this topic? Has your work setting done anything to make the environment more comfortable and welcoming, for patients and staff alike?

For Patients, More Comfort and a Bigger Dose of Respect

Anti-Complaining Campaign

How often during the day do we hear the following?

* “Gee, the charge person gave me a horrible assignment again.”
* “Can’t we do something about these beds? None of the scales are working. “
* “What a mess my patient was left in today.”
* “Why can’t the night shift change the IV bags and tubing? They have enough time.”

I just read an interesting article describing a Canadian Medical Facility that has initiated an “Employee Anti-Complaining Program.” Two nurses bet one another in this facility that neither could do without complaining during a shift. The challenge was overheard and evolved, as more staff on the floor joined a month-long campaign to quit complaining.

“Can the complaining. Nix the negativity. Cut the criticism.” Those were the messages staff at Windsor Regional Hospital  in Canada embraced, as part of an anti-negativity, anti-complaining mission created by bedside nurses! The campaign has been so successful that now the entire medical facility is involved. Employees wear purple silicon bracelets as a symbol of membership in the program. Apparently morale has improved since the initiation of the campaign.

This is an innovative idea within the workplace. I wonder if it could be recreated by nurses worldwide to improve morale? After all, don’t we do a lot of complaining? Maybe not? What are your thoughts about this? Has your workplace initiated any innovative ideas?

A Complaint Free World

Housing for Nurses

Miami Beach is working with one of its main hospitals to ensure housing for nurses. Wasn’t this common place 20 to 30 years ago? But as hospitals expanded, housing buildings were demolished. Would reinstituting this practice bring more nurses into the field? I sure would support housing for nurses, especially here in Manhattan.

But I believe that this is unlikely to occur, when Medicare reimbursements are cut to hospitals and other centers. However, I do wonder what it was like to live in a dormitory or same-building with your colleagues on an ongoing basis. What was the atmosphere like? Any old-time remembrances about nurses living in hospital housing?

Rounds with Nursing Administration?

Distrust, lack of respect, and lack of recognition all seem to be voiced by bedside clinical nurses lately, with anger that is often directed toward nursing administrators. I used to work at a medical facility, non-unionized, where the nursing administrators, from the CEO to the VPs, would come do “walk-a-bout rounds” on each of the floors at 7:30 am, on a weekly basis. They would come and talk to each of us, listening to our concerns, gripes, and family issues, along with our own physical and other problems. They soon learned who lived where, who had just installed a pool, who was pursuing a degree, and who was basically living day-to-day.

Everyone knew one another by name, including our nicknames, and even our pets’ names! We were all one family, focused on creating a healthcare system that would be Number One in the city. There were common goals, with plenty of community between all levels of staff and departments. Shared inter-departmental lunches and cook-outs were not uncommon. 

However, I have never seen nursing administration rounds (unless it is Joint Commission-related) during the past 7 years at my current medical facility. I threw this suggestion in a “comment–suggestion” box mounted to a wall one day. But, I doubt it has even been read. For the most part nursing administration is rarely seen unless disciplinary action or Union contract talks are underway. 

Do you work in a facility that has administrative rounding today? Do you believe that nursing rounds like these would benefit bedside clinical staff? Or would they be a hindrance? I think they would be quite doable and beneficial for everyone. What do you think?

California Nurses

Beka - My younger sister moved to Long Beach, California, to work for an advertisement company about a year ago. She just sent me an email about California nurses in Sonoma Valley. California's Sonoma Valley Hospital is implementing a flexible staffing initiative that will include asking nurses, such as those required to be on staff at all times in the OB department, to take on non-bedside tasks, including updating records, during downtimes. "If you can wear more than one hat, do it," the hospital's CEO said. So, are the nurses’ now supposed to empty garbage cans and refurbish linen closets? 

Carl Gerlach, the hospital’s CEO, says that nurses should be trained to do other things such as reviewing medical records for quality assurance during their off-time or during slow days. Don’t they have a QA nurse or QA staff? Reading the article, full-time positions have been cut and some have been revamped into part-time positions. Flex time has been cut completely. Wow!

According the CEO, 2.2 million dollars have been saved for the hospital, the goal being to increase revenue and decrease expenses. Seems to me that money and profit are the new prescriptions for dealing with hospital finances, outcomes and directives. What is the California Nurses Association saying about this? Will this be the trend for private hospitals? What do you think?

Links: Hospital implements flexible staffing

Sonoma Valley Hospital

Don’t You Dislike it When ….

Don’t You Dislike it When ….

* Spaghetti-tangled IV lines take an hour to unravel?
* Anesthesia personnel drop off your patient without giving you any sort of verbal report?
* A paperless EKG machine stops working when your patient is having angina?
* Garbage pails are overflowing?
* You must go into dirty utility rooms?
* You get back-to-back admissions in 15 minutes, one of whom is “stroking out” as you transfer him/her from one bed to another? Help!!
* A bed doesn’t allow you to weigh a patient accurately?
* A night shift is (too) quiet and uneventful?
* A patient needs transport to MRI at 3 am?
* You find a patient lying in wet, urine-soaked bed linen even though the previous nurse tells you that the patient is all cleaned up?
* There is no razor available to shave a bearded, intubated patient?
* Colleagues forget to order out food with you?
* Nursing administrators remain clueless about the nursing shortage and the issue of burn-out and stress?
* Staffing plans don’t take patient acuity into account?
* An IV infiltrates in a patient receiving dopamine peripherally? (Where is that Regitine when you need it?)
* An automated system dispenses the wrong medicine for your patient?

Well, those are just a few of my pet peeves. Share yours today!

More Thoughts on Dealing with Nursing Burnout

Beka - Before attending nursing school, I was planning on going to art school. After all, I had taken every art course offered in high school and even won several awards. However, my father stepped in, saying “No“ to art school, pointing out that "nursing is a better career, offering job security." He proved to be right, as parents usually are!

Signs of nursing burnout include no longer finding enjoyment in areas of your job you once really liked, becoming cynical or bitter about your job, and starting to experience problems in relationships with co-workers, friends or family, as a result of the conflicts of your job. Other important signs to watch for are looking for excuses to not go to work, calling off or asking to go home early on a regular basis, becoming easily annoyed with co-workers and envious of those who do enjoy their work, and not caring if you do a good job or not. Physical and emotional exhaustion are not uncommon in burnout. Burnout can create incredible havoc on a nurse's personal life as well.

To reduce the risk of burnout, after working in the ICU setting for 21 years, I just began learning “How to Watercolor.” My mother had always done oil painting, selling some of her works, and donating the profits to dystonia. As I read the opening chapter about the supplies required to begin water-coloring, I realized that it actually would be FUN! Something new and different.  No hemodynamics involved!   

My kit includes a sketch pad, basic watercolor paints, and pencils, along with ideas on perspectives. Soon I found the first picture that I wanted to paint. The colors simply attracted me. My upstate Spring garden pansies!

As the New Year gets underway, how do you plan on avoiding burnout in nursing? Any other nurse-artists out there?

The New Heart

Beka - Have you heard the news – not the Zetia or Vytorin news, but the news about the reproduction of heart cells in mice? The New York Times reported that “Medicine’s dream of growing new human hearts and other organs to repair or replace damaged ones received a significant boost Sunday when Minnesota University researchers reported success in creating a beating rat heart in a laboratory.” My own neurosurgeon, who is heavily involved in gene therapy for movement disorders, found the results “remarkable.”

The researchers removed all the cells from a dead rat heart, leaving the valves and outer structure as scaffolding for new heart cells injected from newborn rats. Within two weeks, the cells formed a new beating heart that conducted electrical impulses and pumped a small amount of blood.

Although the experimental results may sound exciting and dramatic, I question the application to humans. Who will be the candidates -- those facing the end stages of heart failure or those with more modest heart failure? It would certainly lead to ethical dilemmas, similar to organ transplantation. As I read the story, I felt this wasn’t for me. Too much medicine. I was feeling pity for the poor mice.

When do we let nature takes its course when it comes to living and dying? Are we taking steps that go too far? Creating new societies -- of mice for now… What’s next?

Dealing with Physician Arrogance

Beka - Last night wasn’t a bad night -- no 2 am discussions, but a good selection of Jamaican food for a middle-of-the-night “dinner.” My assignment wasn’t too tough - a gentleman who was easily extubated the day before and a 62-year-old frail female who had undergone a bowel resection and had been intubated 12 hours before for respiratory failure. As the night went on, she developed a growing metabolic alkalosis with a ph level nearing 7.67 due to her high NG output - pure green bile.

I called the surgical resident several times asking him to come and assess her. He took his time. When he arrived he decided an argument with the respiratory therapist was due at 3 am. He refused any diuretic therapy or ventilatory changes, and actually instructed me to begin tube feedings on her despite her distended abdomen and increasing ileus. TPN or HAL was already infusing, but the patient was also showing signs of sepsis.

By morning she was in visible distress although the resident had given every textbook answer there was to resolve her ileus. He refused any sort of motility agent. His arrogance, rudeness, and disrespect for nursing was obvious. I was left wondering, as a I tramped down 7 flights of stairs to street level at 8 am - what are nurses supposed to do with colleagues such as this? Have physicians always shown a belligerent attitude toward nursing? Is it in their history? Before I left I had her comfortable, but felt irritated by this resident who thought he had all the right answers.

What have your experiences been with arrogant physicians? And how have you dealt with these types of situations? Can we stop it? Do we have the power to do so?

Obama Rally

Beka - Doesn’t it seem that we have had a media assault regarding the upcoming Presidential elections? Not an hour goes by on CNN where a Democrat or a Republican candidate’s name isn’t mentioned. I just wrote to the network, asking them to consider mentioning us - nurses - the workforce behind the delivery of healthcare. If nurses were mentioned as often as the 2008 elections are, imagine the power we, as nurses, would have on the quality, delivery, and value of healthcare and potential reform.

Last week Barack Obama had a rally in Jersey City. Out of sheer interest and the momentum that he has garnered in the past few weeks, I decided to take the train down from a crowded Penn Station. I wanted to hear where he stood on several issues. Long lines awaited me. As I stood in the crowd, I was reminded of my attending a Reagan rally in the 1980s. The mood was similar - anticipation, excitement, hope, and eagerness. Optimism filled the auditorium and fused the crowd into a frenzy in no time.

The crowd grew louder as time neared for the Obama speech. As he walked out and waved, the possibility of the rally turning into a rock concert seemed likely, as the crowd began chanting “Obama, Obama, Obama.” It was overwhelming. As he spoke I heard little about issues, but more about Martin Luther King, spoken in a Southern-type drawl, typical of Billy Graham revivals during the 1950s.

I waited and waited and waited… to hear something about healthcare. Not a word was said. The word “change” was said about 21 times during the 30-minute rally. As a constitutional lawyer by profession, Obama had come out of nowhere to infuse the notion of a much needed revolution and transformation in American politics. The mood would soon change, the less people heard of possible solutions. I wanted to hear about a solution to healthcare, to the nursing shortage, the uninsured.

What’s your take on the current Presidential election process? How do we, as nurses, become heard by the television networks and the candidates?

Holiday Memories 2007

Beka - I have to admit that this was the first year that I did not work either the Christmas or New Year's holidays. For the past 9 years I have worked then, but this year my mother put her foot down and wanted all three of her kids at home for the holidays . Getting back home was a hardship -- airport delays, long lines, and the fact that an antitheft detector turned off my DBS device, which I learned how to reset this year! 

Despite sleeping in, being “cookied-out” by my mother, shoveling massive amounts of snow, and building an ice rink in the backyard for ice-skating, I did miss my patients and wondered how they were doing in their hospital beds. Were their families bringing in chocolates or desserts for the staff? How was the unit decorated, if at all this year? I remember times when stringing up holiday lights turned into a 2 am night-shift task, depending on where you worked!

Friends came a knocking to our house each day, loaded with baskets of fruit, nuts, Swiss chocolate, and bottles of wine. The house had been decorated in a Swedish style, as my mother had spent a portion of her youth living in Sweden. Christmas in Sweden is a blend of domestic and foreign customs that have been re-interpreted, refined, and commercialized on their way from agrarian society to the modern age. Today, most Swedes celebrate Christmas in roughly the same way, and many of the local customs and specialties have disappeared, although each family claims to celebrate it in true fashion in their own particular way. This is especially true when it comes to displaying the national flag.

The food you eat at Christmas may still depend on where you live in the country, or where you came from originally. But here, too, homogenization has set in, due in no small part to the uniform offerings of the department stores and the ready availability of convenience foods. Few have time to salt their own hams or stuff their own pork sausages nowadays. My mother had kept to tradition by baking 13 different types of cookies regardless.

Ingmar Bergman’s Oscar-winning film “Fanny and Alexander,” although set in the late 19th century, nevertheless reflects Swedish Christmas celebrations today: a bright and lively occasion, full of excess, good food, and happiness, but also a time during which family secrets tend to surface. Don’t they always surface during the holidays?

Swedes, like my mother, expect a great deal from their Christmases. There should be snow on the ground, blue skies and sunshine, everyone must be in good health, the ham must be succulent and tasty, and the gifts must be numerous. We had snow and sun along with a bit of abundance!

Share your most memorable holiday experiences at home or with patients…

Time for Change?

Beka - First, I want to wish a Happy New Year to all my readers. I just read an interesting article on the issue of a “National Nurse” on Medscape. This issue has been brought up a few times in a few nursing journals, but in reality, I have never heard much verbal debate or discussion on the topic at 2 am shift sit-downs. Do we need a National Nurse? Or do we need poetic change as suggested by Barack Obama last night on the televised New Hampshire debates?

Teri Mills, President of the National Nursing Network Organization and the nurse who spearheaded the idea and concept of a National Nurse in May 2005, states that “Creating a National Nurse is a goal that can unite all nurses regardless of specialty, educational background, or experience.” Can it? One goal for the National Nurse is to alter healthcare by creating a focus on disease prevention rather than the current disease intervention models that are in use today. I must agree - we don’t place as much emphasis on wellness and fitness as we should. But, can one nurse really accomplish this or would he/she simply be there to act as a voice for the rest of us who work long hours, carry heavy patient loads, and even bring in patient supplies when there is none in the facility (such as shaving cream or even powder).

The promoters of the Office of the National Nurse will not accept the status quo; they envision a nation where everyone can enjoy improved health and more productive lives. Does this not sound like the present Presidential election themes?

Change? What will the year 2008 bring to nurses, nursing, and healthcare? Any proposals for change?

Health Literacy in the United States

Beka - I just read a Medscape article focusing on health literacy in America. (See: Assessing Health Literacy in Clinical Practice  - Do be sure to click on the little videos.) None of the information seemed that surprising to me. Key elements of the article described the following issues:

* About 1 in every 3 American adults has limited health literacy and, therefore, has difficulty understanding information provided to them by healthcare providers.
* People with limited health literacy are more likely to make medication errors, and they have less health knowledge, worse health status, more hospitalizations, and higher healthcare costs than people with adequate literacy.
* Although there are demographic risk factors for limited health literacy, such as membership in a racial/ethnic minority group, limited education, advanced age, poverty, and others, these factors cannot alone identify patients who have limited health literacy.
* By using rapid screening tools, such as those discussed in this article, to assess a sample of patients in your practice, you can learn the extent of limited health literacy among your patients.

Reading this, as snow and ice pellets pound my windows, I have to wonder why there is such a degree of limited health literacy. Is it the American school system? In Europe, schooling is compulsory and includes topics ranging from proper handwriting, to geography, to American History and politics. Is health literacy related to socio-economic status - the poor not having access to literacy programs? Is it due to lack of funding? I would imagine increased governmental funding would improve literacy rates.

Or it is the way our healthcare system is organized today - 15 minute office visits, 35 patient loads per day, and the “out-the-door-you-go with a prescription” attitude? Is there enough time for clinicians to perform quick health literacy screening during an office visit when 10 other patients are lined up outside the door?

Or maybe, as the article indicates, every patient should be considered to have limited health literacy and we should change the system to be better communicators to all.

Many questions. Do you have any answers or solutions?

Holiday Greetings: Best Wishes for the Holiday Season - Peace, Joy, and Rest!!  ~~~ Beka

Mallorca and the Graveyard Shift

Beka - My aunt who lives in Europe called late this afternoon asking if I’d like to come to Mallorca, Spain. My reply was “yes,”-- it would get me off the "graveyard shift" for a few weeks. I have worked the night shift ever since I graduated from nursing school. A new report was released this week indicating that those work nights have a higher risk of developing cancer. Apparently next month, the International Agency for Research on Cancer, the cancer division of the World Health Organization, will add overnight shift work as a probable carcinogen.

The American Cancer Society says it will likely follow those recommendations. Up to now, the U.S. organization has considered the work-cancer link to be "uncertain, controversial, or unproven."

This is somewhat worrisome. Scientists suspect that overnight work is dangerous because it disrupts the circadian rhythm, the body's biological clock. No surprise there! The hormone melatonin, which can suppress tumor development, is normally produced at night.

If the graveyard shift theory eventually proves correct, millions of people worldwide could be affected. Experts estimate that almost 20% of the working populations in developed countries work night shifts. What now? Will this deter nurses from working the night shift and add another dimension to the current healthcare crisis? Most likely – yes.

Do you work nights? What do you think?

I think that trip to Mallorca, the largest island off the coast of Spain, filled with growing, overflowing Hibiscus flowers, is very doable for me!
Take a virtual tour here! Come along!

The “R” Debate

Beka - I just finished watching a rerun of the You Tube Republican Debate. It was somewhat heated at times, as well as argumentative, humorous, and yet lackluster. What really disappointed me was that the focus of the debate was centered more on illegal immigration rather than on current issues within the US. Not a single question was about healthcare -- the status, future, and the need for change. The Web site by the Kaiser Foundation had the same observation about the complete lack of questions pertaining to healthcare.

I have to wonder if any nursing organizations (or even nurses) submitted any questions via You Tube at all. It was surprising to see this topic omitted despite the fact that 47 million Americans are without health insurance today. Doesn’t that bother the presidential candidates? It bothers me. I’m one of those 47 million Americans without health insurance and my health depends upon an implantable device that now costs close to over $200,000 in some areas of the US. And what about the nursing shortage, staffing issues, patient care, and pay?

Maybe the solution to our nursing crisis is to train illegal immigrants to fill those slots in the healthcare system that no one wants? Now, wouldn’t that make an interesting You Tube video??? It would definitely lead to a hot debate….

The Obesity Epidemic

Beka - Running over to see Dr. Mike yesterday was difficult, as dystonia is affecting my gait, leading to an intoxicated look. Dr. Oz had autographed his latest book, You - Anti-Aging Strategies, for me. Dr. Mike wanted to see my symptoms, which had worsened ever since being placed in the wrong ICU, with variable electromagnetic forces that my brain could not comprehend. Programming was off base. It had taken over 2 years to figure out that I tolerated only low voltage levels.

Programming would have to wait until next week. Slowly walking back to my apartment, I stopped at the local deli used by many Cornell employees. Sneaking around for about 10 minutes to see what hot food was available, I was simply amazed at the enormous portions people placed in their plastic containers - some overflowing, un-closable. Aren't the next few weeks going to be overloaded with sweets, parties, meals, candy, chips, and soda pop during and after work hours?

Ahh, yes, it does seem there is an obesity epidemic in the U.S. The nation's scales are going up...up...up...and it's clear that we have an obesity health crisis on our hands. So what can we do about America's obesity epidemic? It's not just a case of telling people to eat fewer doughnuts and walk around the block each day. Any solutions you have found workable?

A couple useful resources -

Small Steps and Practical Approaches to the Treatment of Obesity
http://www.medscape.com/viewprogram/8204

Obesity Resource Center
http://www.medscape.com/resource/obesity

Daisies for Leukemia

Beka - I just finished reading one of my nursing journals. I have piles and piles of them, all untouched and unread, due to time constraints. But in the issue I got to, a small editorial focused on the use of a new study on the use of plants, specifically the daisy flower, in the treatment of leukemia. Clinical trials will begin in early 2008 in Europe and the US, at my Alma Mater - the University of Rochester. 

A new compound, isolated from a daisy-like plant, has shown effectiveness in treating leukemia in laboratory mice and dogs. Human trials are now planned, University of Rochester researchers reported in the journal, Blood. (Daisies Lead Scientists Down Path to New Leukemia Drug) Wow! Maybe medicine has been underestimating the power of plants in disease treatment?

Apparently in contrast to the standard cancer chemo treatments, which aims to kill the dividing cells, dimethylamino-parthenolide (DMAPT), isolated from a daisy-like plant known as feverfew or bachelor’s button, is believed to strike leukemia at its stem-cell level, killing both the dormant cancerous stem cells and dividing cancer cells while leaving the healthy cells untouched. It might be possible that new future cancer treatments would not have as many side-effects as today. Another Wow!

Since my own father died from lung cancer in 1992, it seems that much progress has been made in the area of cancer prevention, diagnosis, and treatment. Maybe he would have outlived the disease if diagnosed today? One has to wonder about that.

What does the future hold for cancer? Oncology Nurses – what are your thoughts?

Macy’s Parade 2007

Beka - 2007- My first Macy’s Parade. I stood in the center of 3.1 million other New Yorkers and tourists to see the famous floats and balloons. This was my very first time watching the parade live in my 9 years of living in the Big Apple. It was a 3-hour event along Broadway, beginning at 9 am. I soon found out from my counterparts that some of them had been standing in line since 5:30 am!

It all began in the early 1920s when many of Macy’s department store employees were first generation immigrants. Proud of their new American heritage, they approached the Macy’s founders with the idea of celebrating the US holiday with a festival -- carnival-like in nature -- that their parents had instituted in Europe.

Large animal-shaped balloons replaced live animals in 1927 when Felix the Cat made its debut. Felix was filled with air, but by the next year, helium was used to fill the expanding cast of balloons.

At the finale of the 1928 parade, the balloons were released into the sky where they unexpectedly burst. The following year they were redesigned with safety valves to allow them to float for a few days. Address labels were sewn into them, so that whoever found and mailed back the discarded balloon received a gift from Macy's. That tradition no longer exists today. Mickey Mouse soon entered the parade, but by World War II, the parade was suspended for 3 years.

Today the parade is a permanent fixture in American culture and the Thanksgiving holiday. Shrek, Snoopy, various bands, artists, and clowns made their way through the packed streets. I must say it was an experience. But I think once is enough. The crowds were immense due to the warm weather. I think next year I’ll watch from my couch on television!

Visit the official Macy's Parade Site.

Thanksgiving 2007

To My Readers:

May all of you , your friends, colleagues, and family have a wonderful Thanksgiving Holiday this year filled with good spirits (mental and drinkable) and many blessings.

Gobble, Gobble
Beka

Nurses - Getting Older and Feeling Tired

Beka - Eyes closed, nurses were slumped over desks and computers, with glazed facial appearances. An air of stoicism and silence hung over the unit last night. Short-staffed once again. It is happening absolutely every single day. The desire to write nursing notes was disappearing as fatigue was rising. Several colleagues had worked 5 to 7 days in a row. Mind you - these were 12 hour shifts!

I kept focused on my two patients, doing things as needed and keeping busy. But I wondered as my birthday neared (Thanksgiving week this year) how much age was affecting nursing? I recall that when I was in my 20s, even with symptoms of dystonia, I could push myself and often work great blocks of time – sometimes 10 days in a row and not feel fatigued. I had no debt or loans at the time. By the time I reached my 30s, the hours were fewer, but if need be (for extra cash, a quick trip to Bali!), I could muster up the energy and pull off another 10-day cycle.

Now, lately, as I was passing the 40-year mark, two 12-hour shifts were enough for me. Shifts during the week had to be broken up. No longer were 5 or 6 days in a row possible. I came home, collapsing after a long night. What was wrong with me? Was I really getting old? Or was nursing becoming so difficult that it was leading to fatigue - mentally, physically and emotionally, wearing us all out? Was this a sign of the times? No wonder, my best friend Laurel, in her late 40s, was counting down to retirement at age 55! No buts, ands, or ifs!

How are you coping with long work hours as you get older?

A Wake-up Call For Nurses: Sleep Loss, Safety, and Health

Societal and Workplace Consequences of Insomnia, Sleepiness, and Fatigue

The New Epidemic: MRSA?

Beka - Tall, thin, cachetic patients would line up outside the clinic. Purplish, black irregular patches covered their faces and chests. That was the health scare over 20 years ago when a new epidemic had arrived on the scene -- a disease named with the 3-letter-acronym: HIV.

Today we are facing another new 4-letter-acronym: MRSA, whose progression through the body can be brutal and lethal if undetected. An innocent minor skin infection can rapidly progress to cellulitis, eventual sepsis, multi-system organ failure, and death.

In 1993 I was working my usual night shift when we admitted a 30-something, strapping construction worker who had bumped his elbow against a wall. His primary complaint was fatigue and a labile systolic blood pressure. Little did I know that would be my first encounter with MRSA.

Initially he was afebrile and vitals were reasonable except for increasing swelling of the left arm. Within a few hours however, his temp was over 102 F, augmented by shakes, rigors, and compartment syndrome of the left arm that soon began extending up towards the neck and across the chest area. By 4 am, he was intubated, sedated, and paralyzed with high dose pressors and Nimbex. By the morning we were rushing him to the OR to perform multiple fasciotomy procedures to save his life. There was a 3-year-old son waiting for him at home.

We saved him. But he had a long hospital course and rehab at our local burn center. Six deep fasciotomies had been performed, each area requiring deep wound packing BID for several months. I had never seen an infection progress that rapidly before in my life. Now that the media is bringing attention to this new so-called “Superbug,” how many nurses have had similar MRSA experiences, before it grabbed super attention?

A Related Article: Questions About MRSA and Answers From the Experts

What’s Your Take on Medical Marijuana?

Beka - I just heard Drew Carey's pitch for the use of medical marijuana. He’s the new host of the Price is Right! (I must admit I did always somehow want to get that new car or dining set from Bob Barker though!) Apparently this new Carey pitch is causing some controversy. Should it? In Holland, you can pick up a stash at a local café in Amsterdam and smoke it on the street or in the café. Physicians providing euthanasia in Holland are listed in a separate phone book for easy access for patients as well.

People have used marijuana as a medical treatment for thousands of years. Such uses extend even to modern America. Marijuana was listed by the U.S. Pharmacopeia, the organization that sets quality standards for approved drugs in the United States, until the 1940s, when political pressure against marijuana's recreational use triggered its removal. People used marijuana for pain relief in the 1800s, and several studies have found that cannabinoids have analgesic effects. In fact, the components of marijuana (60 of them!) may work as well in treating cancer pain as codeine, a mild pain reliever. Cannabinoids also appear to enhance the effects of opiate pain medications to provide pain relief at lower dosages. Researchers currently are developing new medications based on cannabis to treat pain.

I have never tried marijuana personally, although I do know others with MS, PD, tremor, and dystonia who have. I do wonder why there is such difficulty in approving marijuana for medicinal use considering there is a FDA approved form of the marijuana – the oral drug Dronabinol, available by prescription. It's used to prevent nausea and vomiting after cancer chemotherapy when other medicines for these side effects don't work, and to increase appetite in people with AIDS.

Does anyone have patients who use the plant variant of marijuana? Should it be FDA-approved for use in healthcare?

A couple of Medscape articles on the topic -

It Is Time for Marijuana to Be Reclassified as Something Other Than a Schedule I Drug

The Legal Status of Medical Marijuana

Hurrah for John Edwards

Beka - Did any of you see the latest Democratic Presidential debate? The moderators asked the question "What would you do about the current physician shortage?" In response, not Clinton, Obama, or even Biden mentioned the issue of nurses. Biden underwent several brain surgeries a few years back. I wonder who took care of him? And who took care of Hillary’s husband in our CTICU? It was NURSES.

During the debate, Clinton kept quiet about the entire issue. Edwards took the high road and focused on the nursing shortage and crisis. Richardson followed briefly, but it seemed that Edwards knew more about current nursing issues than any of them: staffing problems, mandatory duty, and pay raises. I have to applaud him on mentioning our profession. So should you, even if you don’t support him as a candidate. The general public seems to have a skewed view of nurses – that there are plenty of us, available at all hours.

John Edwards Health Care is the site that contains the Edwards’s position statement about healthcare. Check it out, as well as the statements of the other candidates! Some have cool Web sites! What do you think?

The Oz Effect

Beka - On Nov 2, 2007, my neurosurgeon, Mike Kaplitt, MD, PhD and I found ourselves sitting in the studios of Oprah and Friends XM, ready to discuss dystonia with Mehmet Oz, MD. The studio was somewhat hidden at Lincoln Center, which was a surprise. As a CTICU RN I have worked with Dr. Oz for the past 9 years. And it’s taken that long to convince him that my disorder needed a bit of awareness. You could say that my mother was getting tired of passing out magnets about dystonia. Dr. Oz had, over the years, seen me at my best and worst.

We sat in comfortable beige chairs as Dr. Oz drank a green colored liquid concoction. Dr. Mike and I couldn’t help thinking the same thing -- it looked like green bile. Head sets were given to us and microphones placed in front of us, mixed in with plenty of monitors, wires, and speakers.

I was a bit overwhelmed by the fact that Dr. Oz was featuring a discussion on dystonia. This was too much success! After releasing a press announcement about the event the evening before, I had received plenty of emails and phone calls from board members and PR Agencies involved with the major drug manufacturers. They all wanted to promote their product and/or cause. Suddenly everyone was becoming my best friend. What would happen after the interview?

During the interview we covered multiple aspects of dystonia: misdiagnosis, symptoms, treatments, toxins (Botox, MyoBloc, NT201, and PurTox), multiple forms of dystonia, DBS selection for PD, tremor, and how location of DBS leads differs for dystonia and gene therapy.

We also talked about the need for more diverse research monies. Personally, I couldn't help it, but said that “Dystonia sucks. It ruins lives, goals, hopes and dreams. It does what so many chronic illnesses do emotionally, socially, and physically. " I let Dr. Mike take over from there. XM Satellite Radio has close to 6 million listeners. Dr. Oz actually spelled the word "dystonia" for listeners, to emphasize the disorder. Smart guy!

Overall it was a great experience, but I do like working with television better! I wonder what Dr. Oz will say now that I have mobilized over 15k newsletter subscribers of Care4Dystonia  to write to him. He’ll be receiving plenty of thank you emails this weekend. Maybe too many! Next step – O-Magazine!

I remember Dr. Oz’s words of advice to me after he had read my books in 2000: Better to be self-less than selfish. I have always remembered those words.

Contract Negotiations

Beka - Finally -- a quiet moment on the day shift, with four more fresh open heart cases to come. It was only 4:10 pm.

A list had been passed around all day. It was my turn to look at it. It was a list of nurses’ wants and desires for the upcoming contract negotiations between the hospital and the union that represents us. Were we really going to accomplish all this?

1. 5% pay raise (Was that really going to be enough in context of our cost of living in the tri-state area?)
2. No mandatory overtime (But if no mandatory overtime, no nurses, and too many patients, what then?)
3. Greater tuition reimbursement (I’m all for this, considering a doctoral degree would be nice to have! Law school is becoming more of an interest for me though.)
4. Closed contained units (I support this, as then we can control our own staffing levels without having to float to other units during low census periods).
5. Increase staffing levels (How can we accomplish this when there are no nurses out there? We all are already spread too thin.)
6. Cut the 13th shift of the month (This issue didn’t affect me, but affected those who worked full-time).
7. Improve health benefits (Well, I could say a lot about this issue considering right now, as a per diem employee, I have no health insurance. It is simply too expensive for single coverage in NYC.)
8. Increase salary ranges (Doesn’t money always talk? Wasn’t there talk of an impending recession on Wall Street? )
9. Add on part-time positions (The facility has only a handful of PT positions. They had never viewed P-Timers as useful. I really thought otherwise as they could minimize the overrun budget by a good few thousand bucks, at least! And might bring back those retired from nursing.)
10. Respect (I wonder who wrote this issue down? Truthfully, don’t we all deserve this from one another -- colleagues, physicians, and administrators? )

The list of issues went on and on. My colleagues had really thought about the current contract, future trends in nursing, downsizing of ancillary staff, lack of optimal equipment (even linen and toothpaste) and more. Our contract expires in December. What was coming? Hopefully, not a strike…

Bombings and Sun

Beka - A deadly bomb just blasted in Karachi, Pakistan, a violent haven for fundamentalists. The scenes were frightening -- horror, screaming, fires, noise, chaos, children running, police shouting, and banners flying fanatically in the dark night. I can’t imagine young children being exposed to such violence on an almost everyday basis. Can you? But, then again, here we are experiencing repeated school shootings and nooses hanging on major University campuses.

In a couple days, I am taking advantage my free Jet Blue ticket. My anticipation is high -- I want to avoid the violence portrayed each night on television -- those images that can’t be erased from the mind.

I’m going to Aruba -- a small island near the coast of Chavez’s oil rich Venezuela, independent but very Dutch-oriented, and often crawling with nude Europeans. I’m remembering the sea, as blue as a sea can be, waves gently roaring, swiping the fine white sand. I called the hotel where I often stay, which is usually all occupied with Germans. I look forward to talking with my fellow travelers.  Reviewing the latest news of the European Union is not easy in the States. I relish this information since I hold dual citizenship. And I even got a 20% discount!

I began packing my backpack. All I really need in Aruba is a swimsuit.

Ahh – I’m ready to go…..A quiet haven that I desperately need at this point.

Dystonia Hurts: Part 2

Beka - I haven’t felt like talking about this, but now think that it is a valid question. Two weeks ago, a nurse manager bluntly told me that “Maybe your career as an ICU nurse is over” in the context of my DBS and difficulties with dystonia. I was completely stunned by the words, never expecting them. I had not turned into an invalid, I excelled in ICU nursing, I could still think critically, and I could still stand and walk and carry my and other nurses’ assignments when warranted (such as during a resuscitation, when I often picked up a third patient).

I have wondered what this manager was trying to say. Should I leave ICU nursing? Should I allow someone else to dictate to me when to leave ICU nursing? I think NOT. Was this a form of silent discrimination, in effort to make me leave the ICU setting? This was going to be another battle.

For a week, I cried everyday long distance to my mother, often turning hoarse and asking her “How could someone say something like this to me?“ She had no answers, but somehow consoled me long distance via the phone. I have always planned to decide when to leave ICU nursing. As long as I could still perform, I was going to remain in the specialty. I have been told to “use my other assets such as my writing skills or Master’s degree.” But, currently, I am most satisfied with clinical bedside nursing. Is there anything wrong with that?

Readers -- How would you deal with this situation?

What If We Never Had Plastic?

Beka - Last night at work I was wondering what our work would be like if plastic had never been invented. It seems like the healthcare system consumed massive amounts of plastic in the forms of intravenous tubing, isolation forks and knives, plastic pillows that crunch, clear chest tubes, and so much more.

The first man-made plastic was created by Alexander Parkes who publicly demonstrated it at the Great International Exhibition in London in 1862. This material, called Parkesine, was an organic material derived from cellulose that, when heated, could be molded, and then it retained its shape when cooled. Celluloid is derived from cellulose and alcoholized camphor. John Wesley Hyatt invented celluloid as a substitute for the ivory in billiard balls in 1868. He first tried using collodion, a natural substance, after spilling a bottle of it and discovering that the material dried into a tough and flexible film. The new celluloid could be molded with heat and pressure into a durable shape.

Besides billiard balls, celluloid became famous as the first flexible photographic film used for still photography and motion pictures. John Wesley Hyatt created celluloid in a strip format for movie film. By 1900, movie film was an exploding market for celluloid. It is from that moment and the use of formaldehyde that plastic became routine in the American market -- no longer were glass milk bottles found outside your doorstep. And it was only in 1953 that plastic wrap was introduced to the world!

So what did nurses use to run intravenous fluids before the invention of plastic IV tubing? Maybe that’s a ridiculous question, but changing 10 lines last night made me think about this and the value of plastic. Flexible plastic!! Older nurses -- If you remember, tell us!

PS -  Fall is here!

Dystonia Hurts

Beka - Another battle is coming. I feel tired, frustrated, and miserable. I was told on Friday that I could no longer directly sign-up and fill in staffing holes in one of the main ICUs. It is now expected I go to the nursing office to be reassigned to any one of the 4 ICUs. Defeat.

Over the past 9 months I have solely worked in a particular intensive care unit. I felt good and proud to work in this unit. They all knew me, understood my dystonia and DBS. I felt safe there. No questions asked. My brain had adjusted to the electromagnetic interference in this ICU; I no longer left my shifts suffering from brain fog or terrible pounding DBS headaches or dyslexia.

I was able to function as an ICU nurse relatively well at very low DBS settings although this had taken Dr. Mike well over 2 years to figure out. Now, I was being asked to sign in upstairs as some mangers felt that this one Unit was monopolizing their only float pool ICU RN. My answer to the problem: Find more nurses!

Friday night the tears came, my mother could not console me. I was going to have to relearn each ICU, each environment, each area where electromagnetic interference came from along with dealing with the reoccurrence of side effects mentioned before, which I had combated nicely by working solely in one ICU, my favorite – the CTICU. Things were going to have change and I was tired of constantly adjusting, constantly changing.

I spent 45 minutes on the phone with Dr. Mike (or else my mother was going to call him) crying, whimpering, and becoming half hysterical over the present situation. I was sooo tired of it all, of having a cureless disease, of not having people understand what dystonia was, what DBS and its environmental effects were on me. As Dr. Mike spoke rapidly, I could feel myself falling into a dark black pit. Towards the end of the conversation I never heard what he was saying.

It didn’t matter. It was useless. Fear began eating at my soul. People just didn’t understand the toll a movement disorder causes on a person or the strain associated with it every single day, whether it is physical, emotional, or functional strain. It required constant adjustments. Nor did many want to understand these effects.

By the end of the weekend I was calling all my friends in NYC and upstate asking them what to do about new unexpected situation. They were all working. I wanted to work, to give good care to my patients too. I just wasn’t going to be able to do so -- not on a consistent basis and in a consistent environment. I felt rotten and ate very little during the weekend. People understood cancer, diabetes, high blood pressure, but when were they going to understand the word “dystonia?”

It seemed to me that another lesson about dystonia and DBS had to be directed towards nursing administration with Dr. Mike leading the way this time. He had enough of all this as well. Letter writing explaining details of the procedure and side effects were not being heeded to and shuffled into my file. When were people going to GET it? Depression began setting in by Sunday afternoon, or was it disease desperation.

You tell me -- am I in for another battle? Nurses with disabilities – any advice on coping?

Fed by a Family

Beka - Have you worked one of those weekends where you aren’t able to sit down during the entire shift? Last weekend was one of those for me. It has been busy for the past 3 weeks in the ICU. From the minute I walked in, all I heard were alarms, ringing monitors, bells, and whistles. We had two young 30-something patients on “bypass machines,” and we couldn’t wean them then due to massive heart damage. We all were hoping time would offer healing as their hearts “remodeled“ from the damage that had been done.

Yom Kippur, the Jewish holiday, had just come to an end. My patient was surrounded by her 10 children, each taking their turn through many shifts to be with her. They came in quietly and left unassumingly at all times of the night. But each one helped me with their mothers’ care whenever I asked. We talked about “dangling chickens“ -- a custom among the Orthodox Jews that required prayer and eventual sharing of the deceased chicken with a needy family or charity. We talked about Kosher food and world events.

Then came Sunday evening and I found my work area laden with food, forks, knives, and plates, along with a cooked chicken. My grandmother had practiced Orthodoxism during the Czar period -- one practiced what religion was in style according to the wishes of the Romanov family, the royal Russian family. So, I was familiar with the “dangling chicken” practice.

Ahh -- the food was good that night. I ate all night, carting leftovers home with me and eating the rest during the week. My patient had told her family to bring in food to “fatten her up a bit.” I am thin, partially due to the effects of Deep Brain Stimulation -- 30 % of people who have DBS lose weight after the procedure. I surely was in that category at 5’8” and 117 pounds. In between bites, I carried on with my patient, her supportive children, and my other patient.

Yes, it was very busy, but a good weekend, and I was fed exceedingly well by one loving family.

Harassment and Health

Beka - Harassment takes many forms. I can recall several personal incidents at one area hospital where I worked for 6 months. I was the only white nurse working during the night shift. The other staff members were of varied ethnic backgrounds -- both African-American and Hispanic. Over time I would find inappropriate comments and drawings on the front of my locker; soon I began avoiding my locker.  I was given the worst assignments and not a soul would help me during my shifts, especially when patients required resuscitation care. I would be ridiculed and laughed at because of the way I walked and the way my body moved from the effects of dystonia. I have to say my body did look odd and twisted and I was often embarrassed.

My manager at the time did nothing despite my complaints. Eventually I began receiving death threats via the telephone at 8 am for several days in a row. This occurred each day for an entire week. I dreaded picking up the phone at 8 am. The phone calls became routine and had an impact -- fright, terror, constant anxiety, dread, and panic.

I finally quit after filing a complaint with the local NYPD precinct. A police officer told me “Oh, death threats happen all the time at that place. The white and black nurses have been doing this forever. It’s nothing new.” Really, I thought as I folded a copy of the complaint into my back pocket.  I knew I gave good patient care; I talked with my patients while avoiding many of the staff so that I would not have to face the laughter that would echo in the unit. Did I really look that bad? Was this harassment because of my physical disabilities or racism?

I’m still not sure. It was easier to avoid the issues than address them. My priority was that the patients came first for me. It always had in the past; it always would in the future. Eventually I slipped a resignation note under my managers’ office door. A few months later I heard that he also had resigned. Maybe he had been a victim as well?

All I know today is that today I feel safe and embraced in the environment where I work closely – with all my colleagues.

Racial Harassment and Nursing

Beka - Now, I know, as I write this post, many of you may not wish to respond. Others may want to comment or maybe even share your own experiences regarding this volatile topic. But, I couldn't help asking a similar question about our own profession as I watched the milling demonstrations that occurred in Jena, Louisiana last week.

I remain somewhat surprised that three braided nooses were hung from the school yard tree. Maybe I’m naïve, but didn’t those kinds of activities end in the 1960s? The idea of lynching or any reminders of it is rather appalling today. The incident is one of many racially charged events that have occurred in the town since the hanging of nooses on the "white tree" on the Jena High School campus. Some have called this a prank and others say it is racism. One has to wonder how far have we come, or contemplate whether we are moving back in time.

Have similar types of incidents occurred in nursing in the past? Or even today? I must admit, in truth, that I really don’t know much about nursing history and African-American nurses. Were they barred from nursing schools as segregation reached its peak in 1950s? Did they have deal with daily injustices? How did colleagues treat them on a personal level? Were jobs easy to obtain for African American nurses? I would love to hear more about the history involving African American nurses, especially during the time of Martin Luther King, Jr. and the Civil Rights Movement.

Readers – can you fill me in?

Tribute to Diana

Beka - Sitting in the crowded Toronto International Airport, waiting for my flight back to New York’s JFK Airport, I watched the latest news on CNN. News focused on the scandal regarding the Senator from Idaho and the push for his resignation. I had just spent 5 days in London, walking around the Kensington Palace gates, the last residence of the late Princess Diana of Wales. Flowers were already being placed by both Londoners and tourists. Many were paying homage as the 10-year anniversary of her untimely death was being noted in the newspapers, the tabloids, and even by some of the paparazzi.

Silence marked the iron gates as the number of flowers, cards, and candles increased during the week. A new photo display showing Diana in black-white images was circulated among the museums. They were astonishing photographs that truly displayed her beauty. She certainly grew out shyness into the hot spotlight of cameras, lights, and action.
   
She was truly loved by the Brits – she was the people’s princess and remains so to this day. If she had lived I wonder what else she would have accomplished. What would have the future held for her?

I remember that it was a quiet night in the ICU at Highland Hospital -- the night we heard of her death in Paris in 1997. All of us were is shock as we watched the news in an empty patient room. We watched the news and the funeral from the ICU 5 days later.

Do you remember where you were on that Paris night 10 years ago? Tell us your thoughts.

Alternative Care Choices

Beka - I got an email today from a patient with generalized dystonia who was interested in alternative medicine, asking specifically about stem cell therapy.

I have heard about a clinic in Mexico that provides stem cell therapy. It draws many Americans for treatment. The stem cells are actually sheep cells. No human embryos are involved in the treatments. Little research has been conducted on this form of therapy, which is illegal in the US. The FDA does not support it. I really didn’t know what to tell this patient other than the therapy was highly caustic, yet patients extolled the benefits of it -- offering tales of health rejuvenation and disease cure. Average costs for 1 therapeutic session range from $ 700 to $1000.

I also know that many snowbirds from Arizona cross the border into Mexico for chelating therapy, which is being studied by the National Institutes of Health. I’m wondering -- do these drastic alternative measures really work, especially the sheep stem cell injections? Couldn’t a reaction of some sort occur in patients such as long term anti-rejection? Are the risks worth any possible benefits? But I guess when quality of life is at stake, patients will try just about any form of treatment. I’m just wondering whatever happened to first trying healthy food, exercise, common sense, meditation, yoga, and other aspects of well being?

Somehow we must support people even if we disagree with the choices they make. Who are we to decide on choices made by patients? Should we be the “deciders?”

What do you do when people ask about unproven and potentially risky alternatives?

The Autism Spectrum

Beka - Autism is now considered to span a number of neurologic and behavioral disorders. A friend contacted me last week. Her 18-year-old daughter, who needs almost total care, has autism, behavioral problems, OCD, and seizures. The daughter has been “acting out” a great deal lately. For example, the pool furniture was thrown into the family’s swimming pool last week.

My friend describes scratches on her face and black and blue marks on her arms as a result of her daughter’s outbursts. Toward the end of the school year, the behavior got very bad. She was even asked to stay home from school a couple of times. There seems to be no pattern, no antecedent, no consistent time of day, no provocation. Day camp (where she has gone for years) won't take her back.

So the family is now home all day trying to maintain their sanity. It has been difficult for the parents, perhaps especially because my friend is a nurse. On a "bad" day the daughter may have 2 to 3 outbursts or tantrums.  She throws lamps, flips her mattress, and bangs on walls and windows. She threw the patio furniture in the pool again this week. The outbursts usually last about 10-15 minutes; then she is back to normal, as if nothing happened. It seems that things have escalated beyond belief. I was beginning to wonder about triggers – could any of this be the result of the new guide dog that joined the family?

Are there any other nurse Moms out there in a similar situation? When does residential long-term care become a choice for a child? Or perhaps a necessity? Any suggestions?

Medscape's Resource Center on autism: Autism Spectrum Disorders

Mean Streets…Mean Stories

Beka - These have been weeks of meanness, sadness, and devastation. A bridge in a large metropolitan city collapses. Families are still waiting for their loved ones to be recovered from the cold waters of Americas’ widest and longest river. One only sees metal and concrete on the TV screen.

A New York socialite/philanthropist has died. Brooke Astor was 105-years-old, giving away over $200 million dollars to support New York Art Projects. Prostate cancer brings an end to Merv Griffin, a television icon, creator of Jeopardy. It all came as a surprise. I never even knew he was ill. How little we know about others…

And in Newark, NJ, three teenagers are lined up against a fenced wall, and killed execution style. All three were college students trying their best to start a new life. Who would have thought that executions would become part of American life? Gangs and associated murders have risen over the last year. What are we to do as a society?

A 91-year-old frail black gentleman with stories to tell of slavery and Martin Luther King is beaten by a nurse. The video shows her beating him senselessly during a time of ease – the morning bath. He is admitted to a local hospital for ICU care.

Six miners are hidden somewhere amongst the hidden mine caves in Utah. Families wait, agonizing, wanting for good news. But none has come yet. Yes, it’s been a bad few weeks of “mean stories.”

How have your recent weeks been? I do hope much better than what I have seen on TV. I think the beach await s me tomorrow.

And If Not Now, When?

Beka - Returning to New York last week brought about unexpected change -- a report of a bridge collapse in Minnesota. CNN initially focused on the shock of the story and then refocused on the blame game of Americas’ infrastructure status.

As the horrible carnage of vehicles and concrete bypassed the TV screen, I was simply left wondering