So I see that full disclosure of medical mistakes articles are re-emerging again, like the one that NBC NEWS online just ran. Like most nurses, I have an opinion about this. I think we do a pretty good job about telling on ourselves, so we don't really need to tell on each other so much...but doctors? That's another story.
Anyone who thinks the "Good Ole Boy" network is a thing of the past is clearly naïve. And forgive me for being sexist...I'm using an antiquated term, but the meaning remains the same. They don't tell on each other, and nurses are afraid to tell on them because of retaliation. See, they SAY that there will be no consequences, but we know there always are. Certainly a grueling interrogation by risk and human resources will be had, and maybe a change in your schedule, or assignments.
I once worked in a small facility that I and others believed had a terrible postoperative infection rate, and nothing was being done about it. I had personally witnessed and reported possible reasons for it, and was ignored. Classic example: One weekend evening as the supervisor on duty, I was making rounds and entered the OR to run a machine on its cleaning cycle. After I got all suited up and gloved, I enter to find none other than an ortho surgeon with his son, another child, another parent, and a coach in one of the surgical suites. The surgeon was putting stitches in the other child. They had just come from the baseball field, and were filthy dirty. I questioned the wisdom of this decision, and was rudely dismissed by the surgeon. Later in the evening, I had the chance to tell the anesthesiologist about it, and was blown off. Of course I documented it on the proper form, and submitted it to my director and risk management. The result? I was told by risk that I wrote entirely too many risk reports, and no one addressed the issue with the surgeon.
So should colleagues tell? Yes. Will they? I seriously doubt it.
Ahoy all nurses! I just returned from a cruise with friends and I was a passenger, not a Medical Officer. I can't tell you how much fun we had. We were four nurses, out to have a ball, and we did. Comparing notes at the end of the day, we found we didn't get too far away from our RN persona. At least once a day, each of us had some sort of medical encounter.
One of my traveling companions heard the entire sexual STD history of a complete stranger. I personally advised a new graduate on ways to ensure a staff position in the emergency room. People would ask what we do and saying "I'm a Nurse" always opens up conversations...Proof again that the public really trusts us.
The public may, but apparently our colleagues don't. We visited the private island where I actually worked with my cruise line, and I knocked on the medical staff door so that I could show my friends the well equipped clinic. I was met by the ship's MD who wasn't terribly friendly, and wouldn't let me in. I guess she didn't believe my explanation...even though my name was written all over the clinic journal since 2007. No fuss was worth it, I was on vacation, and no harm done.
My friend was able to get a good idea from my description. Anyway, we had no other need of the medical team, so the slight was forgotten. The only bad thing about the trip was how sad I felt about resigning from my cruise line. I so enjoyed sailing as a Medical Officer, and I will really miss it. I worked with some amazing teams, and made what I hope will be life long friends. I wish them smooth seas and fair winds, and hope to see them again someday...as a passenger and not a sailor!
Since last I wrote, I have been giving a great deal of thought to what I want to do in my retirement. Some of you offered very good suggestions, and I thank you for them. One thing I decided to do was to stop worrying so much about it, and just enjoy what is happening in my life right now...Other decisions can come later.
I still hear from former colleagues, even if it isn't face to face, and I find my opinion is still sought on matters. I like that. (Write to me PGVRNBSN@gmail.com if you want an honest no BS opinion about nursing!)
I'm going on a cruise in 2 weeks with family and friends, NOT as a Medical Officer but as a passenger, and I'm so looking forward to being spoiled!
I actually have long fingernails again. I haven't been able to grow mine in over 25 years!
I'm watching every TV show that is suggested to me, and loving them all. I have never denied or apologized for the amount of TV that I watch. My mind has not turned to mush as the TV snobs say will happen, and in fact I consider myself exceptionally well informed because of TV! (BTW, thanks Sissy for telling me about Sons of Anarchy. Jax's naked backside is gorgeous!!)
My ex and I are back on friendly terms, and I am very happy about that for the sake of my son and my grand darlings. I've re-connected with family, and especially first cousins that a busy nursing life kept me away from for far too many years.
So I guess I will survive this retirement thing after all. Just like everything in this life, it's all about your attitude!
I wanted to continue with this blog after retirement, because I thought I would be able to tell you what it's like for an old RN like me to be out to pasture. I'm going to try, but the truth is, it's been weird in both good and bad ways.
The foremost thing I've noticed is how much I sleep, or sometimes don't sleep...actually, it's a total screw up of my internal clock. Never before could I sleep in a chair, but I can now. I'll be in my chair watching TV, and before I know it, I'll wake myself up snoring, and it will be two hours later! Or I'll be reading or watching TV in the evening, and suddenly it's 0530. I've talked to other recently retired nurses who say that this little game goes on for about a year, and longer if you worked different shifts.
It's also taking some getting used to not being able to "shop" when I want. I never was much of a shopper, but now I have to wait for the second Wednesday of the month when the SS check comes to see what I have left after paying bills. Maybe I can get those shoes, or go out to dinner...or maybe I can't. Regardless, this is a budget that I'll be on forever.
Another thing is how horribly much I miss my colleagues. You see, I was all about nurses and nursing. Not only was this my vocation, it was my social life. Granted, I moved 4 hours away from everyone when I retired, but I'm at home, and I waited a long time to get back here. I just wish my friends from work would visit as much as they said they would. I live in an Atlantic beach resort community, and I do dangle it as enticement, but they are all still working full time and I know how hard it is to get away. Same goes for missing my grandbabies. They're very young and it's a lot for their parents to pack 3 little ones up for a 6 hour car ride!
So what do I do all day? I walk my dog 2 to 3 times a day, and I read a great many REAL books. I'm also writing another book, of course about nursing. I spend time on Face book, which has been great fun, but I need more to do. I believe that everyone needs a purpose. Nursing was mine for 45 years, but now it's time to find another. I'm open to suggestions...
Back in February, I lamented here the fact that in order to continue my cruise job, I would have to recertify my BLS and ACLS. I thought that was over with when I retired from hospital nursing.
My main source of annoyance was that I was going to have to pay for the classes out of my own pocket for the first time ever. This did not make me happy. I also wasn't looking forward to trying to locate a class locally and in the time frame that I would need. I began the searching process where I begin everything...on the internet. It was there that I discovered online recertification classes. What, I wondered, would I get for my money? Would my employer accept it? Should I consider it? After all, we can get a BSN or a MSN online...why not recertify ACLS online?
I got several responses to that Blog primarily from ACLS instructors who didn't feel like it could be a complete or effective learning experience without the hands-on practicum part. However, I also heard from the director of The ACLS Certification Institute who made a generous offer allowing me to take their online classes in return for an honest critique here on my Blog. No fool I, I made the deal.
The site is very user friendly and has a FAQ section that covers a great deal. There is no pressure, no time limit, and a great deal of study material available. The site follows all the latest 2010 protocols, (I was comparing with my last AHA ACLS study manual as I went along) you have a 60-day risk free window, AND you can print your own card and certificate as soon as you pass. I reviewed all the material as presented, followed the site's outline, and took the exam. It took several hours to do everything in order, and I thought the test was hard! I usually breezed through my AHA tests, but I really needed my thinking cap on for this one. It felt like there were more questions on this test too. But I'm not really sure about that.
And what about the practical part? Frankly, I didn't miss it. And also being frank I don't think I needed it, at least this time. Please understand, I've been taking these classes for a very long time now, and I remain proficient at reading EKG rhythms,and my techniques for airway adjuncts, IVs, and compressions haven't changed in 20+ years.
So, what do I think? I think that if you are an experienced RN with multiple ACLS classes behind you, you'll be just fine with this online course, IF your employer will accept it. I think that it is a good alternative to the full classes that include practicum. Now, if I were still working full time and could, I would probably do the online recertification every other time.
I do not think, however, that novices should rely solely on the online course, unless it is used for additional practice and information. Novices need that hands-on experience. Besides, the classes are fun, and the support from classmates and co-workers is always a helpful bonus. Again, though, if you snooze through the drug and treatment modality classes, and keep thinking about the grocery list while you're waiting your turn for Mega Code, then this site is for you.
I'd like to offer many thanks to the ACLS Certification Institute for this very positive experience. I'll get to the PALS recertification in August!
I wasn't going to touch this. No really, I wasn't. I've written before about my own struggle with nicotine addiction (read: Smoker) so I'm pretty sure my opinion will be less influential because of it. I refer to recent headlines that have noted more hospitals are now refusing to even hire smokers.
This trend has slowly been creeping its way into healthcare systems throughout the country. There are now approximately 60 U.S. hospitals that would not hire me...Even though what I do in my private life, like smoking, is none of their damned business. So if I needed to work at one of these places, and I couldn't (or wouldn't) quit smoking, I'd have to lie to get a job. What a great way to start out on a new job!
The rationale is the amount of productivity in dollars lost by smokers. It's all about the money. Of course it is. It's a little under two grand a year per smoker according to the studies. I have to tell you, this really is a thorn in my side. I can swear to you with a clear conscience that I called out sick WAY less than some of my colleagues who had various chronic health issues. I doubt if their lost productivity was studied, or even an issue.
I wonder how many dollars worth of productivity asthmatics or diabetics lose? Oh, OK you want to make it a about self-inflicted negative impacts? Then let's talk about alcohol use. I wonder how many callouts there are due to alcohol consumption or prescription drug use. Particularly on Monday! Both are just as legal as cigarettes, yet some hospitals are even TESTING employees for nicotine use.
I'm glad I'm retired, but I'm telling you, they'd have to be giving everyone a breath-o-lyzer test at the beginning of each shift before I'd let them test me for nicotine. This is just outrageous to discriminate this way, and you non-smokers should agree! But I'm thinking you won't...
I know I've said I don't like EBOS (evidence-based order sets), because I don't believe that a single treatment should be used on every patient with the same diagnosis. Now having said that, I don't mean to imply that I am against the research that brings us to EBOS conclusions. I realize how important medical research is. I wonder though, if the millions of dollars designated for research are being used in the most effective way.
Let's face it, there's some pretty silly research being done. I remember a few years ago, reading a journal that described a several million dollar grant to study the effect of chocolate and salty snacks on pre-menstrual women. Seriously? Yes seriously. Listen, for $100.00 I could have told them everything they needed to know. For good measure I would have offered up the 3-11 staff in the ER as the control group.
As recently as 2 weeks ago, I read a research study that verified doubling up on Tamiflu for severe flu symptoms didn't help improve the outcome or length of illness. Duh. Didn't we know that already without a study? We tell patients all the time more isn't necessarily better with prescriptions.
But here is my all time favorite study. Someone FINALLY listened to me. I have been saying for YEARS that the passageway between the set of double doors to the ER should be like a carwash; the patient on the stretcher should be placed in the center, and then sprayed with soap, water and chlorhexidine, then rinsed, dried, gowned, and only then placed in a exam room. Hospitals aren't clean anymore because the "people we serve" are bringing all sorts of germs in! If we decontaminate them, HAIs will dramatically decrease. And again...Duh!
The social networks among nurse
are all abuzz about the new staffing ratio bill being introduced to congress by
Sen. Barbara Boxer (D-Calif.). Like the cicadas, this attempt rolls around
every few years when someone in power like the good senator tries to get this
Odds are she was recently exposed
to a hospitalization situation and saw some things first hand that didn’t sit
well with her. Maybe a friend couldn’t get to a CCU bed for 16 hours. Or maybe
her daughter had to wait and hour for pain medication, hence the bill. Or maybe
California’s strong nursing union just got to her.
Everybody is happy and
supportive, and naïvely believes this would be the answer to everything. After
all, it’s no secret adding RNs at the bedside improves patient outcomes. The
staffing ratios presented in the bill are every nurse’s dream ratios. Go here
for an easier read of the bill. You can also track the bill’s progress here. You can also see
the projected chance of the bill getting passed at that site: 0%. It’s already
Now if in some other dimension this
bill were to pass, I don’t think everyone would be as happy about it as they
think. In my long career, I have never seen an increase of RNs without a more
severe decrease in other services. Those darn hospitals have to pay all those “extra
RNs” somehow. So you begin to see CNAs and techs disappear, and those left begin
to cross-train as unit secretaries. PT/OT/RT services get cut too. Case
management staff becomes smaller, with openings not filled. Good news for new
grads though, they start getting jobs because they’re cheaper than RNs with
Yeah I know. Here I go again
spreading sunshine and cheer. Listen guys, I REALLY hope I’m wrong. I will lead
a parade if this bill passes. Hell, I’ll donate more money to Nurses House if
it even gets passed through the first committee!
In the meantime, all you
optimists out there, we need you to keep believing. Somebody has to!
My gosh, where does the time go? I almost missed my annual homage to National Nurses Week! I guess it's not on the front burner because I'm retired, but make no mistake...I still consider myself a nurse who can comment on Nurses Week.
Retirement has been interesting. I've slept mostly. (Don't let anyone tell you that you can't catch up on sleep.) I've also been working on the yard, playing with the boat, and oh yeah, I rescued an older dog. Two old gals together.
Anyway, I know I've taught you about the history of Nurses Week, how it relates to Flo, and how interesting and wonderful we are. Enough of all that. I have a slightly different and fun way to celebrate this year. My Facebook colleagues and friends have been joining me in posting photos of ourselves in the workplace since and including graduation. (See below.) The pictures have been wonderful! I urge you and your friends to do the same. You still have until May 12th.
I would also like to plug my favorite charity this week; Nurses House Inc. This should be your favorite charity too. I urge you to donate to them in honor of our profession, and if you can't donate, at least promise me that you will get familiar with this fine organization for Nurses. You will feel very good afterward! I have been donating annually for years, never thinking I would need them, but I did. I became a grateful recipient of their generosity after my hip fracture a year and a half ago. Ya never know...
So play on Facebook, donate to Nurses House, hang in there, and remember that you are an elite group of people. Nurses are simply the best.
A friend and colleague came for a visit recently, and as he read the newspaper, he commented on the fact that a baseball player had renewed his contract for several million dollars. My friend is good at math, and calculated that the ball player would get roughly $130,000.000 each time he got up to bat. I don't know a lot about baseball salaries (or math for that matter) but even my brain recognizes that as a bit excessive. We then began a spirited dialogue regarding this unbelievable salary...Who in the world deserves that kind of money!?!?
I felt really stupid, because my motto has always been that all salaries are negotiable. I never accepted the first salary I was offered when I applied for a job. Never. And if I was to discover that another nurse made more than me, I was glad, because that meant I could negotiate for more. We KNOW what we're worth, and yet we don't demand our worth. I don't understand why we aren't outraged that a ballplayer makes that kind of money, and we don't. I can save a life AND hit a baseball. That should make me worth more. And while I'm at it, I'll add police, firefighters/EMS, and teachers to the more deserving list.
Do you agree?
I dream at night. In fact, when I sleep, it's a guarantee that I will at some point, be the star in my very own subconscious movie, in vivid color. It's reported that all of us dream, but surprisingly, a number of people believe they don't. A number of people say they don't remember their dreams either. Not me. I remember most of mine.
I also have several dreams that recur, but I only have one recurring work dream. It's an interesting one to me for several reasons, but mainly because it has nothing to do with hospitals. You would think that after so many years in hospitals, it would just certainly be in the dream. No. My recurring dream involves my cruise job.
Short version: I board the ship, meet my colleagues, and then go to my cabin. I'm never scheduled to do any work the first day (believe me, that IS a dream!) and after attending a few mandatory meetings, I have the rest of my time to myself until 1600 the next day. I go about the ship, casually enjoying and indulging in things like a passenger, when abruptly, I realize its 1555 the next day, and I'm nowhere near ready for duty. In fact, I'm not even on the ship! Mad dash to the ship, can't get in my cabin, can't find my uniform, haven't showered...anyway, it's a real drama; I'm terribly late, and in serious trouble with the boss. That's it. Then I always wake up. I'm sweating and my heart is pounding. I'm sure I could figure out what it all means, (and now that I've written about it, I'm sure I'll try to!) but what about you? Do you have a dream that involves work? I'd like to hear it. Maybe we can work them out together.
I have been sitting on this story for a week now. I had a real hard time not knee jerking an opinion like I usually do, because I wanted to see if my knee jerking predictions were going to be correct concerning the outcome. All were, except one.
The story I'm referring to is the one about the nurse who allegedly refused to do CPR on a resident in a senior living facility in California. The resident died at the hospital after EMS transport.
There are so many issues here and just as many opinions! Of course, most fellow nurses were horrified at the alleged refusal. Then the legal-eagles and the ethicists chimed in. They were horrified too. But wait a minute, was she right or wrong? Well see now, that's the thing. She said was following her facility's POLICY. Hmmm...And at first, her facility released a statement that the nurse had acted according to their policy. Of course after a few days of national news and outcries of righteous indignation, the facility back-pedaled and stated that the nurse "Misunderstood the policy."
Baloney I say. I believe the ONLY way a nurse would refuse to give CPR is if it was drummed into her not to by the facility that employed her.
If you listen to the 911 call carefully, she never actually REFUSED to turn the phone over to another person, there didn't seem to be another person there willing to start CPR. She also remained calm and professional throughout the entire call. I'm not sure I could have, with the dispatcher putting pressure on me like that. (But then again, I would have been doing CPR and not heard her.)
One of the biggest surprises to me was that the family stood behind the nurse and the facility. That's where I was wrong. I thought sure they would sue. Call me an optimist, but I'm going to say there is no lawsuit because the daughter of the deceased is also a nurse and is showing compassion for a colleague.
But I promise you, this isn't over yet. Why? Because the California State Board of Nursing hasn't been heard from yet. And I bet that's when the CPR will hit the fan.
It doesn't happen often, as my friends will tell you, but I find myself without an opinion on something. I'll give you a minute to absorb that...
Now that I am no longer affiliated with an institution since retirement, I've realized that I will actually have to PAY for any classes I want to take. For example, if I want to continue my cruise job, I will need to re-certify my ACLS before the end of May. To do that, I will need to actually find someone and pay them to re-certify me. I've never paid for a class like that before. The boss has always covered it from the budget.
I have heard that there are actually online classes, so I started a search, and found several ranging in price from $129 to $179. The trouble is, I really have no idea if it's worth it or not.
What exactly will I be getting from an online ACLS class? Am I just paying for a bootleg card? Does the AHA recognize this type of re-cert? And more importantly, will my cruise line?
Obviously I still need to do some more research, and when I decide, I'll let you know how it all worked out. But in the meantime, I am open to suggestions. Anyone?
My friend Tamara Mareno just had a heartbreaking, sudden job loss because her unit was being closed. She had worked there for 30+ years. With her permission, here are her thoughts at this time.
Now that all of my friends know what I will miss about the job I loved, here is what I WON'T miss...
1. I won't miss getting up at 0400...oh I'll be awake, (my husband isn't retired yet) but I won't have to get up, get dressed, get ready.
2. I won't miss planning holidays and family events and dinners and parties and cookouts around *MY* weekend to work and holiday schedule.
3. I won't miss "covering" my weekend myself when I take a vacation.
4. I won't miss A&T policies...I can be sick when I'm sick for as long as I'm actually sick. Yea...they had some weird rule about not wearing your jammies to work.
5. Purell can kiss my ass.
6. I won't miss white-knuckled drives in from where I live at 6 am when it's snowing, blowing, sleeting, freezing raining.
7. I won't miss CPR renewal days....yea...gettin' too old to spend 4 hours on the floor pressing down with all of my non-upper body strength on plastic people.
8. I won't miss holding my water some days until I no longer have to go....that's kinda scary, because....where did it go?
9. I won't miss night shift. Did more of those the past 6 months than ever. While I absolutely LOVE the staff on nights....not remembering how I got home in the morning frightened me.
The day finally arrived! This past December 31st, I retired from hospital nursing after 44 long years. Friends and co-workers threw a wonderful going away party for me, with great food, funny jokes and yes, alcohol was involved. It was a day to remember.
SO... what now?
I will continue my cruise nursing job as long as I can, but while fun and interesting, even that is beginning to lose its thrill. I always swore I would stop nursing when it stopped being fun, and that's the main reason I left the hospital. I've made no secret of the fact that I think our profession is suffering entirely too many indignities and I believe it keeps getting worse.
At my retirement party, I was asked to say something, and while normally I would have said something funny and entertaining, I just didn't have it in me. Instead I told the truth. Yes, I'm 62, and yes I'm in pain. The hallways were getting longer all the time. But in honesty I just couldn't keep watching the staff suffer the way they did. Everyday.
My position was as a supervisor. It's a HUGE responsibility. I loved the job, and the people. I considered most of my responsibility to be a NURSING advocate. And I'd like to think I was effective as one, at first. But it just became more and more difficult for me to say I'm sorry all the time. I'm sorry that you're 4 RNs short, or don't have the supplies you need, or that you fear for your job if you complain. I'm sorry that you feel as though you have no support from management. I'm sorry you go home in tears, and you're not a new graduate. (You know they cry.) I'm sorry the rules are becoming more ridiculous everyday.
Additionally, I'm sorry for myself. I'm sorry the profession that choose ME all those years ago finally became too hard for me to endure, but here's another reason for my sorrow: only one of my superiors from NURSING administration (my own department) wished me well, thanked me, or even said goodbye. Only one.