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.
I hate being mad at a Kennedy. I'm from the generation that got caught up in the whole "Camelot" illusion of our young President and his family. We were, and still are, fascinated by every aspect of the name, and those who bore it. We worshipped the "Greatest Generation" of them, and watched as their kids were born and grew up...but as we later realized, it was all an illusion.
Apparently though, the recent arrogant behavior of Mr. Douglas Kennedy, son of the late Robert, shows that he actually is still buying into the whole American Royalty garbage. To refresh your memory, last year, Mr. K tried to leave a hospital OB department with his newborn son without following the protocol. It didn't occur to him to check with the nurses to see what might be required to do so. Anyway, I'm sure all kinds of alarms went off when he tried to leave with the baby and the nurses did what they were supposed to do; they tried to stop him. Rather than calmly returning to the department to discuss his options, he chose to show off his Kennedyness that no one could tell HIM what to do. Unfortunately, it got physical, and two nurses were hurt. The nurses sued him and lost, so now he's counter-suing for, get this, defamation and malicious prosecution.
That's just silly, because it's all on the security video, and clearly shows Mr. K doing exactly what he was accused of doing. He should not have been acquitted in the first place, and even if money had not been awarded, an apology should have been. Nurses should not have to be worried about getting sued for following protective policies, or instincts. But it's New York, and the judge probably plays poker with a Kennedy.
I knew I would always care about nursing, but I really
didn’t think that I would get as riled up about stuff now that I’m retired. Oh,
did I mention that? Finally, after 44 long years working in hospitals, I
retired December 31st, 2012. And I turned 62 yesterday. Hello Social
Security and AARP, goodbye The Joint Commission and satisfaction scores. I was
all ready to sit back and say, sorry, not my problem, UNTIL I read this story
from ABC news about a
nurse getting fired for refusing the flu vaccine.
Read it carefully. There’s a little more to it. I thought my
head would explode by the time I finished the article. First of all, it appalls
me that an RN’s 22 year career at the same facility can hinge on something as
personal as choosing not to take a flu shot. It is also ludicrous that her
hospital would use that as a reason to terminate an experienced critical care
nurse. Did you notice the word “veteran?” That’s who the hospital fired for not
taking the shot. Veteran nurses. Veteran is merely another word for expensive.
Do they really think we’re too stupid to know that? I hope these nurses sue for
wrongful termination, because I believe they would win. I hope someone, some
organization, or just some wonderful law firm will finance this case, because no
one, especially nurses, should be treated this way!
Rotten last few days, huh? That horrible event in Connecticut really knocked the wind out of everyone's Holiday Spirit, that's for sure. I have nothing to add to all that has been said or left unsaid...God. The horror.
I dealt with my own trauma as well. Not that I would dare compare the events, but I had to put a beloved pet to sleep. That can really knock you down too. Not to mention those poor terrified souls who believe the world is ending in a few days, and the ones who fear the U.S. is about to plunge over a fiscal cliff.
I'm just plain exhausted from all the bad things going on.
But let's remind ourselves that this is the time of year for peace on earth and goodwill towards men, followed by the New Year that brings a chance for new beginnings. We cannot stay in this negative groove forever. We must grieve and mourn, and then get back on track to move forward. Slowly, yes, but forward none the less.
Nurses are usually quite good at this. And while this time it might be a little more difficult than usual, we will press on, our nursing hearts and hands continuing to go out to all who are in need. And as usual, most people will follow the example we set. So lead the way.
Happy Holidays to all my friends and colleagues.
Since the baby Jesus didn't let me win the $550 million Powerball lottery, I'm going to have to rely on you again to take care of my holiday dreams and wishes. Here's what I really want for Christmas this year;
- Doctors who actually have respect for the nursing staff.
- Bosses who don't tell lies about how everything will be so much better with the latest vogue staffing model. We have brains. We can see through it.
- Enough supplies and functioning equipment to do what's required.
- More time at the bedside, and less time in front of a computer lying about what we've done, when there really isn't time to do it all.
- A clinical ladder committee that isn't made up of BFFs who want to keep everyone else out.
- Benefits that grow, instead of shrink every year.
- The return of the well deserved employee discount for medical services.
- Enough nurses on the floor to practice safely.
- More nurses at the corporate level and on boards giving input.
- The return of decent merit raises and competitive pay instead of "fair market analysis" salaries. Come on. We know hospitals talk to each other and agree to lock salaries.
Thanks Santa. I hope you can manage at least one of these things for me and my colleagues. It just might help keep us in the profession. Otherwise, I wouldn't be too sure.
Happy Holidays Everyone!
Cultural sensitivity training in hospitals has been around for a few years now. Several people thought it was a waste of time, citing basic manners as the only requirement for getting along. It was just another bunch of customer service babble that we were required to sit through.
Being blatantly honest, I admit I occasionally had the same thought... until recently. As the world watched this Frankenstorm Sandy rip across the Caribbean toward our Eastern Seaboard this week, I heard some unbelievably stupid remarks come out of the mouths of supposedly intelligent professionals. No amount of training is going to fix stupid, so you kind of just ignore those. I can't even repeat some of them, but I can tell you that surprisingly, it was the most innocent stupid remark that affected me the most.
As a group of us watched CNN coverage of the storm as it took apart Haiti, a colleague said, quite sympathetically and seriously, "Poor Haiti. It should just sink completely and get it over with." Every single person there knew exactly what she meant, and agreed. Or should I say, we knew and agreed with what she intended it to mean. But after a few minutes passed, another colleague rose and excused herself saying she needed to call home and check on her family. She was asked where her family lived, and her tearful reply was, "The island you all want to sink." She was from Haiti.
We obviously needed that training...and maybe some more.
Every election is important to true patriots, and this one coming up is no exception. I admit my primary interest is in each candidate's approach to healthcare. I don't want to argue politics here, or talk about who has the best plan for heathcare. Each accuses the other of plans that will bring us to Armageddon. My poor brain wonders how it could possibly get any worse.
Just in my small world of friends and acquaintances, healthcare is already in the toilet. I have a friend with a suffering symptomatic child who can't get in to see a specialist until January 2013. This is with insurance, and a referral from her PCP. Another friend has a new grandchild who had to return to the doctor at 2 days old and had to be hospitalized for 21 days to treat an infection NOT acquired from the mom. Then the baby's mom required hospitalization a day later for a post-partum infection. Grandma is an RN. Asking around, she discovered her loved ones weren't the only ones back in the hospital. That has to be from a dirty O.R. And of course, I had my own negative experience with my family's C. Diff crisis, not to mention my failed pursuit of temporary assistance after my hip fracture.
The fact that the candidates are even discussing change to our healthcare system makes this the most important election to me. PLEASE review each candidates platform carefully, and then go be a patriot, and vote your choice in the upcoming election. Anything has to be an improvement over the way things are now!