I cannot believe the wide spread changes in healthcare since my retirement. The advances continue faster than I can keep up. Many of the meds I took for years are no longer available because better ones have been created. There are even new specialties that I never heard of before. But I really got my eyes opened to just how wide spread the advances are when I recently had to utilize some veterinary medical services.
My precious Bichon Frise developed a sudden and severe case of Hepatitis which ultimately took her to the Rainbow Bridge. I'll spare you the heart wrenching details of what we went through, but what amazed me were her medical treatment options.
My local vet (who is a hero in my eyes) had an array of lab tests available in-house and even more sophisticated tests available for send out. She also had an extensive pharmacy to cover all of my dog's needs. I was even offered a chance to transfer to a university veterinary medical center for more intensive treatment and care. If my financial situation had been limitless, I might have considered it. But like people medicine, the costs were too prohibitive
It wasn't until the inevitable end that I realized just how animal medicine had advanced when I was offered hospice care for my pet. Apparently, if I had chosen to let her die at home, the vet would have made arrangements for daily comfort care visits until the end came. I can see where that might be easier than that awful final trip to the office to get a beloved pet "put to sleep." Ugh. I wonder, though, is it better? Just as we tend to prolong life to avoid death in people, is it always the right thing to do? Not for me to answer. At least with my sweet Bridgette, I had the control, and I chose to let her go quickly and peacefully in my arms at the vet. I saw no point in keeping her sedated for days just to prolong the inevitable. To me, quality of life is important, no matter what living thing we're talking about.
I was visiting with my nephew who mentioned that he was gearing up for The Talk with his 11 year old son. I admit I was saddened by the news. I think so much innocence is lost afterward. But then again, it is necessary information, especially now when kids hit puberty so much earlier then they used to.
I had one child, a son, and as a nurse, I was very open about the body and human sexuality. My son often saw his father and I express affection, and when my son was a toddler with his hand down his pants, I told him that was fine to do but should be done in private, and I meant it. (He'll kill me for this.) I also had books and videos for when questions came up, but I really don't remember actually having a Talk. Maybe his dad did and I just don't recall, because those questions usually ended with, "Ask your Mother."
I was also an older Mom, so menopause was brought up in our house as much as puberty was. When he asked about menopause the first time, I just told him that when he would be getting more boy hormones, I'd be getting less girl hormones. To make it clearer, I said we'd both be getting moustaches around the same time.
When he turned 13, I gave him a condom to carry around in his wallet, with the specific instructions to let his dad know BEFORE he thought he would use it. I became the most popular Mom among boys in the 8th grade. Of course, that's not why I did it. I wasn't kidding myself...I was seeing 13 and 14 year old girls come into the ER pregnant, so clearly someone needed condoms. As he got older, he would come to me with some embarrassing questions, but I wouldn't show it and would just answer honestly.
I don't think I did it the wrong way, and I don't think The Talk is wrong either. You have to do what works for your own family, but I do think nurses are a little more relaxed about it. How did you handle it with your kids?
Have you ever had the feeling they're trying to get rid of you? Chances are if you're feeling it, it's probably true. Unfortunately, by the time you do realize it, it's probably too late.
Let's say you've been working in the same place for a few, or even many years. Your evals have all been good; you meet or exceed the standard. You get along pretty well with everyone, and for the most part, you like your job. Then one day you get a message from your manager that she wants to see you after your shift. (It's always after your shift of course.) She says that she's been hearing things that bother her. That maybe you're not happy with your job. "HUH?" Where did that come from, you wonder. You deny those feelings, she never gets specific, the meeting is brief, but now the seed has been planted. You leave feeling like you got punched in the gut. Who said that to her? What have I said? Have I said something I can't recall?
Time marches on, and then another meeting with the boss. Some co-worker heard something you said to a patient/family member/staff member, and felt the need to say something. Now you're really on edge. You don't recall anything, and of course, there is no due process, so you can't even face your accuser. And, you think, this is your second warning. How many before you get in real trouble?
Then the rumors begin. Someone said or saw something, now you're either a junkie, alcoholic, sex offender; or worse, you pissed off some important doctor. Due to confidentiality policies, you aren't allowed to say anything, so you can't even address the rumors that are now rampant. You get so paranoid you can barely function. You begin to make little mistakes, which all get reported. You are so stressed out you really see no other course to take, so you consider resigning. And they get what they wanted in the first place.
Sound familiar? If it hasn't happened to you or someone you know yet, you're lucky. I am convinced there is a hidden bunker somewhere known only to hospital administrators where they all go to learn these types of tactics. Called "Throwing Staff Under the Bus 101." All administrators, managers and directors must attend this particular class. They learn specifically how to keep the blame for anything off of themselves and the hospital, and place it squarely on the shoulders of those working the hardest. I've seen it too many times.
Is there anything you can do? Well, yes. Like driving, practice defensively. Keep notes of interactions. If you think something might come back to bite you, write it down after you get home. Don't keep your notes at work. If it's in their building, it belongs to them. Also, and this is the best advice I can give you, get familiar with your Human Resource Policy Manual. You would be AMAZED at how often facilities do not follow their own policies when they try to pull one over. That is your best defense. Use their rules to save yourself. And I hope you never have to!
I happen to consider Nurses Week my own personal holiday. It's more important to me than Easter, July 4th, or Memorial Day. I feel this way because I know I came into this world 63 years ago just to be a nurse. It is who and what I am, and aside from people I love, it means the most to me.
Even though I am now retired, my nursing career still means a great deal. I often think back on it as if I were reading Dr Seuss' book, The Places You'll Go! Oh the places I went, and the things that I saw!! Consider yourselves lucky if you see and do half of what I did in my career. I was fortunate enough to have started at the end of one nursing era, and the beginning of another.
I began my career as a 17-year-old nursing assistant, using enamel painted bedpans, excited to modernize to the shiny new stainless steel ones, long before plastic pans came along. And some patients back then actually brought in their own personal ceramic pans from home!
My first lifesaving class, the precursor to CPR, still involved placing the patient on their stomach with the rescuer pulling the victim's arms up and back. Defibrillators? The first one I ever saw maxed out at 200 joules and only doctors were allowed to use them. Drainage canisters were huge glass bottles that had to sit on the floor using only gravity, and suction machines were all steel, glass, and rubber hoses built on their own rolling carts.
Steam tables were still used in clinics and doctors offices, with foot pedals that flung open the tray lids. Everything got sterilized and nothing was thrown away. Trachs were made out of real silver, and cleaned with peroxide and silver polish.
Long before hand-held nebs, and even before respiratory therapists, nurses rolled in tall and uncooperative IPPB machines. They looked like huge metal flamingos, and when in use, spewed out enough mist to fog up an entire ward. Everybody coughed!
I can still remember my excitement at no longer having to crank the heads of beds up manually, or watching amazed as a push of a button actually raised the knee gatch too!
I witnessed the miracle of the gigantic Circ O' Electric bed for hands-free turning of burn or paralysis patients. And speaking of burns, those of us who remember silver nitrate soaks will never complain about Silvadene cream being messy! The soaks stained everything white an ugly brown, and was the source of a great many new graduate nurse's hazing. It happened to me. I showed up my first day of work a blinding vision of white...uniform, shoes, pantyhose, and cap, and received my first assignment; the burn patient with silver nitrate soaks every 2 hours. By the time I left my shift, I looked like I had made mud pies all day.
I saw heart monitors with a single rhythm line move away from the bedside to a central monitoring station, and I was thrilled that I no longer needed a yardstick and a glass monometer to read intracranial pressures.
But more importantly I saw nurses become the most valuable team member rather than a handmaiden, with educational and practical knowledge advancements elevating the profession to new and grand heights. I'd like to think I helped make that happen in some small way, along with those who came before me, and those who walked the path with me.
So I charge you to keep our lamp burning, keep moving forward, and here's hoping you will be as lucky as I was to have a wonderful career that you can look back on with pride.
Happy Nurses Week!
I am a supporter of the Affordable Care Act. I have waited a very long time to see the availability of reasonably priced insurance come to pass. I never actually believed it would happen, so I tried not to get my hopes up. It did happen, though, and I am very happy, even though I am worried.
What has me worried is the fear that it will be taken away just as quickly as I got it because of people stereotyping those who need it.
I know there are many people who are not as pleased as I am. I'm seeing the negative stories in the news, on TV and all over social media. I feel terrible for the people who have lost insurance, blaming the ACA. Or the people who have seen rate increases and services decline from their current providers.
The blame, however, belongs to the same group it has always belonged to, and that is the Insurance Industry. Along with Big Pharma, I believe they are responsible for 99% of all the evil and woes of healthcare. Insurance companies are using the AHA as an excuse to drop clients and charge higher deductibles. The government has given them a perfect scapegoat, allowing them to look innocent while doing what they have ALWAYS done.
I know for a fact that hospital benes were changing and shrinking long before the ACA was even a twinkle in Hillary's eye. When I first began working in hospitals in the 1970s, we had 100% health and dental coverage, and a 50% discount for any employee using their hospital's services, including pharmacy. I watched benefits shrink over the last 45 years to almost nothing. So no, you won't see me blame the ACA for that.
When I moved from Virginia to Maryland in 2009, my insurance company, BC/BS Care First, a minimum plan with huge deductible, said they would no longer carry me, and that I would have to apply to Maryland Care First. I did, and they turned me down for coverage because of pre-existing conditions. I tried many other companies, but the word was out-I had PExC and no one would cover me. I contacted Virginia Care First and asked about coverage if I still worked in their coverage area. Ah HAH! Yes! I could get coverage with my former plan as long as I worked in Manassas, but my rate would be increased from $233/mo to $476/mo. I couldn't possibly afford that, so I did without.
Now with the Affordable Care Act, I am insured with health and dental for the first time in 5 years at a rate, that while not cheap, I can afford. I'm not a junkie, an illegal, or lazy. I'm retired. I worked hard all my life, and I am happy I had this choice. I'm not the only one either, and we don't deserve to be made to feel badly about it.
A laboring mom in Florida was left alone in her room, and the baby was born in the bed without staff present.
I know babies are born safely all the time outside of hospitals, but people who don't want that to happen, go to hospitals!
Thank heaven the baby is OK as far as we know. That's the good news. The fact that the story went national, in my opinion, is also good news. It SHOULD have, because the public needs to know how things are. But I want to talk about some other things that I really dislike about this particular story.
What I dislike are the words "abandoned" and "flee." I think that implies intent, or negligence. I don't believe that was the case here. I also dislike that I hope to really shame Dr. Elana Deutsch for throwing the nurse under the bus like that. Here are her remarks:.
“It must have happened very rapidly, because I was only in the C-section for 30 minutes,” obstetrician Dr. Elana Deutsch told the Post, adding that a nurse should have stayed with the couple but was likely “nervous” about being there alone. “By the time she [the nurse] was back in the room, the baby was in the bed,”
The thing I dislike the most though, is that the people who are really negligent will share none of the responsibility, or blame.
You know as well as I do that this unit was not well staffed. I don't care how they crunch the numbers to make it look like they had the necessary FTEs on duty at the time, they obviously didn't, or that couple wouldn't have been left alone.
Listen, you can't fool me. When I was still working as a supervisor, I got more than one call to go to the labor unit because the staff had to attend a stat C-section. And often I was the only RN on the floor. Hell, sometimes I was the only PERSON on the floor...left with laboring moms...and I'm no OB nurse. I've actually "fled" to the OR Suite to demand someone come back out because of impending birth.
That just isn't right. The American Hospital Association needs to re-evaluate their priorities and get back to the business of patient care instead of the business of business, because, believe me, the two are not the same, and hospitals are failing dismally at so called customer service!
Something very strange has happened to me. As you know, I have an opinion about everything. And for some reason, people often seek my opinion on matters, which I happily, and admittedly, often haughtily give. I am currently stumped on a recent development in medicine, and actually, in our country. I am speaking of the legalization of marijuana. Medical marijuana. Even the name confuses me. I just see an oxymoron.
Oh I know what it is, but I remember (sorta) the ‘60s when it was named pot...weed...maryjane...grass...wacky tobaccy. I am really struggling with the stuff from the ‘60s being seen as a serious weapon in the arsenal of treatment modalities. Yes, yes, I know it's true, but my twisted brain can't get past, well, the past.
I can't help but thinking that patients will still have these illnesses, but after a few tokes, (I mean therapeutic inhalations) they just won't care anymore. Or they'll giggle incessantly about being sick. I see progress notes saying things like, "the patient no longer suffers from her high-atal hernia." Or "the patient's kidneys are now successfully re-stoned." And "the patient reports no more nausea, but has developed a severe craving for Cheetos."
So I've decided all I can do is just sit back, fire up the pipe (um, I mean woodstove pipe) and wait for the re-make of Reefer Madness 2015. I have my Cheetos ready.
I cannot believe how much things have changed in a year, and yet how much they've stayed the same. Since I retired, hospitals are laying employees off again, nurses are looking for new jobs in what seems like record numbers, and everyone blames everyone else.
I spent the biggest part of my career working in Virginia, and things there are changing fast again. For example, one of my former employers, Valley Health System, made personnel cuts affecting all SIX of their hospitals. They acquired six hospitals because they wanted to. When the news of the cuts was reported in the local paper, the comment section almost caught fire.
The remarks were almost identical to the ones that were made when the 90s layoffs occurred. People complained that the CEOs unnecessarily made 6 figures, a fortune was spent on things like artwork, aquariums, pianos, and other aesthetically pleasing items rather than needed equipment and supplies, and that money was just plain wasted instead of being used where it was needed. It seems to me that this is just a cyclical purging. Hospitals spend money until they're broke, they blame the economy, or Obamacare, and the staff pays the price.
My question is, why isn't a CEO ever laid off? Why is it NEVER poor management? Lose him and keep the 33 other people you just let go. I'd rather have a good experienced nurse in the house than some CEO. Believe me, I've known a few CEOs, so I can tell you...they aren't all that. And in the case of hospital layoffs, the good of the one NEVER outweighs the good of the many. They should be ashamed.
This is the season to wonder. And I'm faced with wondering what the heck to write about. I really wanted to talk about joy and family and cookies and puppies and elves this year, but I just can't shake off the blahs.
I think part of the problem is that I'm not busy anymore. Since retiring, I don't have the concern of having to be somewhere at a specific time, and I don't have to try to find the time to shop and wrap gifts. No more Secret Santa, no more traveling hospital dinners, or the big party; no more schedule-swapping or arguing about which holiday you worked last year. Can it be true that I miss all that? It's like when you graduated from high school. You couldn't WAIT to get out of there, and the following year, you go back to check out what's going on since you left.
Not being busy leaves me way too much time to think about what I miss. I want to love the holidays again but thinking about it has made me a little sad. I can't remember the last time I bought a live tree, and it's been almost 5 years since I put one up at all or even decorated. I do have a wreath on the door, and a stocking hung over the woodstove, but that's it. I live alone, and away from my family, so if I want to spend this special time with them, I have to travel several hours to do so. And I do so gladly, because I love my family, but there's no point in my decorating my house just for myself.
I do, however, take great joy in knowing that I do have a home I could decorate, and a family that I will get to spend time with. Oh the love of my sister's homemade cookies, and the joy of watching the wonders of the season as seen through the eyes of my three perfectly wonderful little grand darlings. Shhhh! The elves are bringing them a puppy this year!
And would you look at that! I did write about wonder, joy, family, elves and puppies after all!
Happy Holidays everyone!
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...