Friday, November 28, 2014

Another Rehab Thanksgiving

So much talk this year about how stores shouldn't open on Thanksgiving because their employees should get to celebrate the holiday.  Seems like there's been even more talk about it than last year.  Pledges on Facebook, stores advertising how wonderful they are for not opening on Thanksgiving, etc. 

When I was first confronted with this issue I was as indignant as those Facebook pledgers.  Of course they should get to be home with their families!  Then I thought about it a little.  Nurses have ALWAYS worked Thanksgiving.  So have firefighters, soldiers, paramedics, and everyone else who works in health care or defense...oh, and those in the hospitality industry, gas stations, state parks, public transportation, private transportation, airports, and even toll booths.  So why not retail? 

Anyway, as I looked back at last year's post on Thanksgiving, I realized that I was thankful last year for the people working at the rehab where my mother was recovering from a broken hip.  As (bad) luck would have it, she's recovering from a second broken hip this year.  So...thank you to the people at Gateway Vista Rehab for taking are of my mom yesterday.  Thank you also to my brothers and sister and their spouses and kids who took an entire Thanksgiving dinner over to the rehab and had dinner with her.  I love you all.

Wednesday, November 19, 2014

Should Patients Get to Choose Their Nurse?

Should patients be able to choose the nurse they want?  How about families?

Keeping the patients happy and satisfied means more now than it ever has.  It's about the financial bottom line now.  Happy patients = more money for the organization.

We all know that we sometimes click with patients and we sometimes don't.  Everybody has their strengths and weaknesses and everybody has that patient and/or family that we just don't get along with.  If it works out with staffing and if it's not a hardship for other patients and families, why not try to comply with the patient's wishes for a particular nurse?  Chances are, nobody else wants that patient anyway. 

The challenge comes when the nurse the patient or family requests isn't really appropriate for that patient's level of care.  How do you tell the patient and family this?  "You are too sick for Susie."  Or when that nurse is really needed to care for a more complex patient. "You are not sick enough for Susie."

How about when it's a personal preference based upon the patient or family's prejudice?  Should that be considered a cultural preference or religious preference?

Having been in the position to make nurse-patient assignments, I've had times when I've had to find a way to explain to patients that I couldn't comply with their requests AND I've had to tell nurses that the patient/family has requested to have a different nurse and change assignments.

It's not an easy issue.  Thoughts?

Wednesday, November 12, 2014

Brain Drain

Talking about a bunch of shift work
A big ol' pile of shift work
Seven to three
Three to eleven
Eleven to seven
                        From “Shift Work”, Kenny Chesney

So, we already knew that working shifts leads to increased chance of cardiovascular disease, breast cancer, and reproductive dysfunction.  We can now add shrinking brains to that delightful list.

An article this month in the Journal of Occupational and Environmental Medicine reveals that a study showed that working shifts leads to cognitive impairment.  The authors don’t specify what kind of shift, but the assumption can be made that it’s “off shifts”, nights and evenings, as it is attributed to circadian rhythm disruption. 

Goodie!  It’s not just nurses’ bodies but also their minds that go bad from doing nights. 

Tuesday, November 11, 2014

Thank You

A big THANK YOU to the nurses who have served in the Armed Forces in this country.  So much of nursing, what we do and how we do it, comes from military nurses who paved the way for us.

Happy Veteran's Day and we appreciate all that you've done.

Monday, November 10, 2014

Violence Against Nurses

Watching the video out of a hospital in Minnesota where several nurses were violently attacked by a patient wielding some sort of stick or pole is horrifying.  If you haven't seen it, watch it Here.

I can't imagine what these nurses are going through, the attack looks like it came from out of nowhere.  They are charting, entering orders, calling about changes in patient condition, doing any number of things and suddenly realize that a patient is charging toward them with a weapon.  Their reactions give me chills, the brutality with which they are hit is unbelievable.

Nurses are the largest segment of health care providers and violence against nurses is on the rise.  Being pinched, hit, slapped, punched, and kicked shouldn't be a part of our every day practice.  The Minnesota incident shows how bad it can become, but even the "small" acts of violence every day are not recognized for their impact.

What would we say to the people who are getting hit, slapped, punched, and kicked from somebody in their own home repeatedly?  Would we make excuses for that person because the violator was under the influence of drugs or alcohol?  I don't think so.  We'd say that the person is crazy for staying in the situation. 

Yet, violence toward nurses is widely tolerated.  And it's not only female nurses.  We expect that the men in our profession are going to step in and respond when a patient becomes violent; we often put male nurses in even more danger than the rest of us. 

Friday, November 7, 2014

A Little Perspective

One of the gifts we get from being a nurse is the lesson we learn that there's always somebody worse off than us.    No matter how bad things are at work today or tonight, we leave the patients there when we head for home.  And if we were late getting home or late getting to work because of a crash blocking the road, we're not the person in the back of the ambulance or on the stretcher in the trauma bay.

Whatever your position on assisted suicide, a 29-year-old woman who was in the position of deciding to end her own life because she had a terminal illness was worse than any of the decisions the majority of us made this past week.  Rest in peace, Brittany.

Thursday, November 6, 2014

Ebola: Not Bringing Out The Best In Us

Another nurse, Briana Aguirre, has been in the news following the death of an Ebola patient in Dallas.  She was on the Today show criticizing her hospital’s handling of the isolation procedures when the patient was cared for there.

Now, I’m all for nurses being protected and I do think it’s important for organizations to have the appropriate equipment to protect all health care workers, but I’m disappointed in this nurse’s behavior as well as Kaci Hickox’s behavior.  

Briana Aguirre said on the Today show that she “threw a fit” when the right equipment wasn’t available to her.  I would really rather the public see us as the smart and professional people that we are – not as those who throw a fit when things aren’t as we feel they should be.

Let’s face it, outside of the few hospitals in the country that have actual bio containment units, NOBODY in this country was prepared to care for an Ebola patient.  Not even the CDC really knew what to do.  

All Briana did as risk her own job and make us look bad as a group.  There are more professional ways to go about getting changes made. I wish Briana had employed one of them.

Wednesday, November 5, 2014

File This Under: We Needed A Study For That?

Healthcare-associated PTSD is getting a lot of press lately.  We used to think we could just tie them down, sedate them, and paralyze them and when they left our care, they'd go right back to their previous state of existence.

Oops - we were wrong.  And, in retrospect, how could we not have known that these traumatic events - coding, being intubated, being chemically paralyzed, and being tied to the bed - wouldn't have lasting physical and psychological effects? 

There's been a lot of literature published lately about this issue, which is necessary so we change practice and make things better.  I'm all for that.

The one thing I really do not think we needed to doing a study on, though, is whether or not awareness during surgery causes post-traumatic stress disorder.  To use an overused word:  DUH!!

Being awake and aware while somebody is cutting through my skin to get to my internal organs?  Yep, I'd be scarred (no pun intended) for a long, long time.

Don't think we needed a research project to figure that one out.

Tuesday, November 4, 2014

What's Her Deal?

I'd like to say that if someone suggested that I stay in my house for 21 days, I'd be thrilled.

Kaci Hickox apparently feels differently.  She's the nurse who was mandated to quarantine herself after returning from West Africa. 

The comments on the various websites and social media reports about her outrage against being quarantined are interesting.  Many nurses seem to feel that she's not representing us well by not taking threats to the public seriously.

I tend to agree. What's the big deal? 

Now today I see that she's reached a "settlement", that she's allowed to "roam free" but has to monitor her symptoms.

Is she shining a negative light on nurses?  Possibly.  Should we be doing all that we can to protect the public?  Yes.  I tend to hate all politicians, but they'd be in a much worse situation if they did nothing.

Get it together, Kaci, stay home and keep your mouth shut. Honestly, how would you feel if you did infect someone else?  Pretty bad, I hope.  You can't turn back time, do what you have to do to keep yourself and other people safe right now.

Monday, November 3, 2014

Really Good Idea or Really Creepy?


A hospital in central Florida has electronic trackers placed on nurses to track their “workflow”.  It’s not mandatory, it’s voluntary, and the nurses are told that the tracking won’t be used for any punitive purposes.  In addition to nurses and nurse leaders using it for workflow issues and acuity patterns, patients can access the data to see how many times their nurse has been in their room and for how long.  

Hmmm…I’m undecided on this.  I couldn’t care less if someone is reading my emails or monitoring my online purchases (they’d get bored fast), but the electronic tracking thing feels a little different to me. I can see their point that it might help new nurses see their own workflow patterns and help them become more organized, but I also think that this is not something we would ever ask of physicians or other health care professionals.

What do you think?