WAS I DREAMING? PART TWO

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TEAMLast week, I attended the second and last part of the TeamStepps workshop. In another post (“Was I Dreaming?”) I described the first workshop and my surprise at how the doctors willingly and enthusiastically participated in the dialogue and group activities. What would I find this time around?

TeamStepps is a program that promotes teamwork and teaches “team strategies and tools to enhance performance and patient safety.” The audience was a group of professionals who worked in the surgical area of a large teaching hospital. I volunteer at the hospital and attended as an observer, although I did participate in some of the exercises.

The first thing I noticed when I entered the room was the empty chairs at each of the four tables. After we finished with introductions, it was clear most of the absentees were doctors/surgeons. I felt disappointed. Was their eager involvement at the last meeting just a charade?

This seminar was pivotal for implementing TeamStepps. The group in attendance—nurses, OR techs, surgeons, anesthesiologists—were to be the “coaches” who would model effective team work and help “change the culture” of the hospital. The leaders of the workshop, two doctors and four nurses, were poised to teach how to be an effective coach. Furthermore, there had been homework. Each table had been given a “discussion question” at the end of the last meeting with the expectation that the group would present a three to five minute demonstration. The occupants at my table included two nurses, one OR tech and an orthopedic surgeon who was preoccupied with the open laptop in front of him. I had already excused myself from participating in the skit.

When time came for the demonstrations to begin, those at my table seemed to be looking at the question for the first time. The other three groups appeared to be scrambling also. In the meantime, some doctors had slowly been slipping into their seats. Two appeared at our table and joined the activity. The surgeon at the end of the table had closed his laptop. Unbelievably, to me, each group, in turn, stood in front of the room and showed, as instructed, the right and wrong way to address their question.

(Our table was to communicate how the team would handle a situation when a necessary piece of surgical equipment fell to the floor and was contaminated).

In the skits, the surgeons played nurses, the nurses played doctors, OR techs were the anesthesiologists. The shows prompted much laughter and recognition of obnoxious and unprofessional behavior in the “wrong way” skit and applause for “right way” team interaction.

For the remainder of the meeting the leaders introduced peer-to-peer feedback, not easily understood by some of the surgeons who saw themselves as designated leaders and superiors and staff as subordinates. The coordinators, especially the nursing coordinators, gently suggested that the team was made up of peers regardless of occupational titles.

Like the first TeamStepps session, I was impressed with the positive vibes and enthusiasm from the audience. My world of hierarchical structure and deference paid to the medical staff was changing. I believe that this change in culture will bring a safer patient environment.

On the last page of the handout this statement stood out:

Important that staff realize this is not a passing phase—it is our model for patient safety moving forward.

 I think this model will indeed move forward at this hospital even though the ride may be a bit bumpy.

WAS I DREAMING?

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I have been a nurse for eons. Sometimes I feel I go back to Flo’s era. Even though I have been retired for ten years, I try to keep current with nursing/health issues. One evening two weeks ago I attended a TeamStepps workshop sponsored by the large teaching hospital where I volunteer. The purpose of the seminar was to promote teamwork among the hospital staff to ensure patient safety. As a member of an advisory committee, I was encouraged to attend in order to learn about new initiatives at the hospital. I walked out of the workshop four hours later wondering if I had dreamt the whole scenario.

There were about 50 folks in attendance. I approached my assigned table where one woman was seated, a nurse who worked in the operating room. Attendance was mandatory, she told me. She was paid for her time. A few minutes later a skinny guy in scrubs plopped down next to me and said, “What the hell is this all about?” I answered his question by introducing myself. He was an orthopedic surgeon, as were two other men who later joined our table.

Would any of the three last the whole four-hour session? I braced myself for a lot of muttering and antisocial behavior. In my biased mind, orthopedic surgeons stand out as the most paternalistic of all the medical specialists.

A second nurse and a cardiologist rounded out our group.

After we finished introducing ourselves, I realized most worked in surgical areas (The cardiologist inserted stents, a surgical procedure that he performed in the OR).

What followed was not what I expected. The main leaders, one older orthopedic surgeon, who asked to be called by his first name, and two nurses, led the group though team building exercises, videos and discussions. The nurses, OR techs and doctors in the audience, including those at my table, participated. To my surprise, my table built the highest Lego tower demonstrating our superior use of “team work.”iLEGO TOWER

'Relax - we're all in this together.'

‘Relax – we’re all in this together.’

What the workshop demonstrated to me was that the team had replaced the doctor as “Captain of the Ship.” Or at least team members had a say in what happened at the bedside, or in the OR. All professionals were encouraged to speak up if they saw something that would negatively affect a patient outcome. In fact, a bright yellow card to wear hidden behind the staff’s nametag was inserted into our handout folder. It said “I Need Clarity.” It could be flashed at the attending/surgeon, or any team member, so as not to cause a patient anxiety. The team would then go out of earshot of the patient and family to discuss the potential problem. Every team member’s input was important.

As I walked to the parking garage at the end of the class, I wanted to call my old nursing school classmates so they could appreciate along with me how far physicians had come in becoming team players. My classmates and I came from the old school when nurses stood when doctors entered a room. We endured prima donna surgeons that had temper tantrums and threw instruments in the OR when they were angry. The doctors I had just observed took part in an effort to discard old actions and engage in team building behaviors.TEAM BUILDING

Well, things were changing. Okay it’s only one workshop, but it so impressed me.

I am going back for the second half this week. Let you know if I had been dreaming.

Why Caring Lessons Goes to Printers Row Lit Fest

Marianna Crane:

My very good friend, Lois Roelofs, says “Too few nurses write their stories.” Read about her interaction with the visitors that come to her table at the Printers Row Lit Fest in Chicago.

Originally posted on Ramblings by a Retired Nurse (in Chicago):

“Pardon me,” said the well-dressed older man. “But could you tell me when this festival got so big? Last time I was here, there were only a few tents. And today,” he paused, his smile wide, “this is huge, and so many people.”

imageSo began a conversation with a visitor from the East Coast last Saturday at the Printers Row Book Fest, the Midwest’s largest outdoor literary fest. His surprise and enthusiasm is one reason I’ve gone for several years and then displayed my nursing memoir, Caring Lessons: A Nursing Professor’s Journey of Faith and Self, for the past two.

I get excited already when I approach the street where it starts. There are several blocks full of tents with tables lined up on the sides of the streets. You hardly know where to start. Plus there are large outdoor tents and indoor venues for author presentations. When I’m…

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I’M ON VACATION

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painting of house and boatsI am at the beach with my family—our annual get-together. We found a new rental house, one with enough space for the grandkids to enjoy time away from the adults. Need I mention the adults enjoy this situation, too? We are thinking about renting this house next year.

As I type, the sound of the ocean competes with chattering from the birds. This idealistic scene is so unlike what my husband and I left behind in our new community. We are the second wave of about fifteen residents to move into the future eighty-three-townhouse neighborhood. The remaining homes are in various stages of completion. Recently, the most active construction surrounded and bombarded us daily with noise. Cement trucks blocked access to the street and the roads were covered in mud from multiple plantings of trees and shrubs.

Here I feel tranquil. The deck where I am sitting is sheltered from the sun and cooled by a gentle breeze. I can hear my grandkids laughing down by the water. It’s time to put away the computer and slip on my bathing suit and join them. After all, I’m on vacation.

Florence Nightingale: The Crucial Skill We Forget to Mention

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Marianna Crane:

Read this wonderful post about all the compelling reasons nurses need to write.

Originally posted on Off the Charts:

“Suppose Florence hadn’t been a writer? Think about it…”

Karen Roush, PhD, RN, is an assistant professor of nursing at Lehman College in the Bronx, New York, and founder of the Scholar’s Voice, which works to strengthen the voice of nursing through writing mentorship for nurses.

karindalziel/ via Flickr Creative Commons karindalziel/ via Flickr Creative Commons

When we talk about the diversity of what nurses do, there is no better example than Florence Nightingale herself.

She was an expert clinician working in hospitals in Europe and London and caring for soldiers in military hospitals during the Crimean War. She was a quality improvement expert, implementing improvements in military hospitals that had a major impact on patient outcomes. Her work as an educator created the very foundation of nursing as a profession. She was a researcher and epidemiologist, using statistical arguments to support the changes she demanded. She was a public health advocate, campaigning for improvements…

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NEW OLD AGE

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I usually have several topics twirling in my head the days before my bimonthly post is due. I’m never sure which direction I am going until the last minute.

First, I thought I would update you on my cell phone case that Connie Burns had made for me. (See last post: PRIMARY CARE PROVIDER: MD OR NP?) In fact, when I picked

Connie Burn's Custom Creations

Connie Burn’s Custom Creations

up the case, I took her picture at her stand in the Farmers Market and asked permission to use her name and picture, handing her my card with my web site to check this Sunday. Her creation, so beautifully made is also practical. Now I can wear my phone around my neck when my clothes haven’t any pockets rather than leave it somewhere in the house, not able to hear it when a family member desperately needs to reach me. (That would be my husband from the grocery store with a question about which brand of laundry detergent to buy.)

Then I wanted to write about my good friend, who finally decided to lose weight and succeeded. I had been worried about her for a while as she struggled with chronic health issues that now have moderated with dropping extra pounds. She can walk up a flight of stairs without losing her breath. And best of all, her thoughts on future living options have been revised from an assisted living facility to an independent apartment. The gerontological nurse practitioner in me cheers.

imagesI also thought of mentioning something about Nurses Week: May 6 to May 12. But I am having conflicting thoughts about the purpose and relevance of this celebration. So much so that I decided to spare you my rantings.

Last night I watched two episodes of Grace and Frankie on Netflix. If you haven’t been following the hype about this new comedy series it is about “older stars” not “cast as crusty grandparents or needy neighbors.”

I remember all the ballyhoo about the Golden Girls, which premièred in 1985 starring Bea Arthur, Betty White and Rue McClanahan. They were advertised as older, racy free spirits, behaviors inconsistent with their age. So I thought they were ladies in their 80s. I was absolutely shocked that Arthur and White were 63 and McClanahan was only 51. That was NOT old!

This time the cast really is older. The two female leads, Jane Fonda and Lily Tomlin, are 77 and 75, respectively. The men in the series, Martin Sheen and Sam Waterston, are both 74.

Finally, we have a show that aims to reach older viewers. What I do hope is that it catches the attention of a younger audience so that they can watch a program with an older cast, which doesn’t center on disability, dementia and constipation.

I hope you find time to check the show out for yourself.

PRIMARY CARE PROVIDER: MD OR NP?

13080945-farmers-marketMy husband and I moved to Raleigh four months ago. Yesterday, I went to the Farmers Market for the first time. It had opened just the week before. It was more eclectic than I imagined. Besides spring onions, sweet potatoes, a bunch of radishes, strawberries and a baguette from the stand of a local French bakery, I commissioned, for ten dollars, a cloth purse that would hang from my neck and hold my cell phone, and I got the name of a female health provider.

I was happy I didn’t buy more produce than I could reasonably cook. I love nothing more than talking with the farmers about various ways to deal with, to me, an unfamiliar vegetable only to have it sit, forgotten and rotting, in the refrigerator.19826120-fresh-produce-on-sale-at-the-local-farmers-market

At one stall in the market, a woman was selling handmade cell phone cases along with drawstring cloth purses. At the airport on our way to Costa Rica in February, I watched an older woman pull out her cell phone from a small purse that hung about her neck. What a practical way to have a cell phone handy when you haven’t pockets in your slacks but you do have a family that worries when you don’t answer their multiple calls. Only later do they find out you couldn’t hear your cell phone left in the kitchen because you were upstairs in your office. Together, the woman and I designed a Velcro sealed pouch that will hang around my neck or over my shoulder like a handbag. I’ll pick it up next Saturday.

Next, I noted a stall with the sign: “Duke Raleigh Hospital.” Duke sponsors the market. A young woman sat at a table with stacks of brochures. My husband and I hadn’t, as yet, found local health care services.

“We live just a few blocks away from the hospital,“ I said to the woman. “Is there an outpatient clinic there? I need a new provider, preferable a female.”

The young woman smiled. “Yes, there is a clinic. In fact, I go there and see Mary Smith (not her real name). I just love her.” She continued to tell me how wonderful Mary Smith was as she searched for a pen to write down Mary Smith’s name and phone number. She handed me the card, which also had the Duke website for further information.

When I went home, I unpacked the produce, told my husband about the solution to the cell phone issue and that I had the name of a new provider. Upstairs in my office, I checked the Duke web site. I clicked the link “Doctors“ and there was Mary Smith. But she wasn’t a doctor—she was a nurse practitioner. She was listed among other NPs and physicians.

I sat for a moment appreciating the immensity of this: that NPs were listed along with MDs, therefore allowing patients to choose either as their primary provider. Knowing how some physicians still try to limit advanced nursing practice, here was a site, at a major teaching hospital yet, that treated both equally. And the young woman who gave me Mary Smith’s name never thought to clarify that Mary was an NP, not a doctor. How refreshing.

Then the reality set in. Why I didn’t think my primary provider could be an NP? Was it because I had seen a physician for the past fifteen years? However, I was a retired NP. I had my own patients, albeit in collaboration with a physician. I had been in the trenches during my long career fighting against limitation of the NP role and dominance by medical organizations. I promote the contribution that nursing makes to health care. I support the independent role of the NP.

I was appalled at my sudden amnesia.

PICTURE OF NP

While I try to explain this lapse, I’ll call the clinic to find out if Mary Smith is accepting new patients.

CANDICE BERGEN, MURPHY BROWN AND ME

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On the front of The Arts section of the New York Times this past week was a picture of Candice Bergen. Candice BergenOlder (aren’t we all?) but still lovely even carrying thirty extra pounds. Making no excuses for the weight gain, she says, “I live to eat.” (I can relate to that.) She had written a memoir, her second, which is titled: A Fine Romance.

Candice Bergen played a television reporter in the situation comedy, Murphy Brown, from 1988 to 1998. I loved this show and watched it faithfully. The show resonated with me. Murphy Brown, an independent, smart and tough woman, was in control of her life and took responsibly for her actions. I wanted to live next door to her.

But it was when Murphy Brown was diagnosed with breast cancer the same time as me in October 1997 that I felt a simpatico relationship. As you know, October is Breast Cancer Awareness Month—did the Murphy Brown producers do this intentionally? th-1I wasn’t the only one fixated on Murphy’s cancer—“The show’s handling of the subject was credited with a thirty-percent increase in the number of women getting mammograms.”

One night, I remember sitting in the burgundy recliner with Mittens, our cat, on my lap, in front of the TV watching Murphy deal with her diagnosis. Murphy was shocked and secretive at first, as was I. In that show, she was being carted around in a wheelchair (I think she was being discharged from the hospital) And I don’t know why at that moment she decided not to keep the diagnosis to herself. What I do remember so vividly was that she was stopping people who passed her in the hallway of the hospital, telling them that she had breast cancer. You can imagine the blank look on some faces and on some, fright as if saying, “Let me get away from this lady ASAP.” I nearly fell out of the recliner laughing.

The next day at work I began to share my bad news. I told one of the administrative assistants as she walked out of her office that I was just diagnosed with breast cancer without any preamble. Her face showed a mixture of fright and surprise as I moved on not waiting for her to respond. Later that evening I chuckled at myself.

Thanks Murphy Brown for giving me a reason to laugh many times but especially at a dark moment in my life.

Thank you, Candice Bergen, for ignoring your thirty-pound weight gain in spite of Hollywood’s “beauty standards” and good luck with your new memoir.

NURSE PRACTITIONER VERSUS PHYSICIAN’S ASSISTANT

Marianna Crane:

tmpAdapted from a post first blogged on May 27, 2012.

Originally posted on Marianna Crane: nursing stories:

Last week in a restaurant in Lyon, France, my tablemate turned toward me and asked, “What’s the difference between a nurse practitioner and a physician assistant.”Lyon

My husband and I were on a tour. Our traveling buddies consisted of older folks like ourselves. The woman knew I was a retired NP and had told me she frequently saw either an NP or PA when she went for routine medical appointments. She was satisfied with either but didn’t know the difference.

I became an NP in the early 80s and worked in Chicago when NPs were trying to expand our practice by gaining prescription privileges. We were much maligned by the traditional medical establishment. “If nurses want to act like doctors, let them go to medical school” or something to that effect seemed to be the mantra of the American Medical Association. (Both the AMA and the Illinois Medical Association…

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IT DOESN’T LOOK LIKE MUCH

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Last Saturday, toward the end of a daylong workshop, Carol Henderson, our leader, gave the last prompt. Where is home?

However, knowing we only had a few minutes left, I believe we seven women wanted to share our appreciation with Carol, and with Mamie Potter who hosted the event, before we left.

That prompt fell to the floor, unnoticed.

Afterward, maybe some of the others came back to visit the prompt and, like me, to mull over its meaning. I can hear Carol say, “It means what ever you think it means.”

I’m glad I didn’t write that day about “where is home.” I’m glad I didn’t hear anyone else’s take on it. I glad I didn’t write any cerebral philosophical theory that may have moved my pen knowing I was writing for an audience.

As thoughts of home drifted into my consciousness the following week, I found myself looking for a picture I had taken of an apartment where I had lived from the age of two to twenty-two.

Back in July, 2009, I visited Summit Avenue in Jersey City with my Aunt Anna. (I have already written about her.)

When we drove by, I attempted to take a picture. There just wasn’t a moment when a passing car didn’t obstruct the house. Because of heavy traffic I needed to keep moving. As usual, parking places were scarce. I gave up after circling the block four times.

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It doesn’t look like much. It’s the house on the right, 262—the middle apartment. The gate in front of the stairs was recently added. That gate would have limited the flow of social activity that took place on the concrete steps whenever the weather cooperated. Many of my memories of home when I was growing up happened on the front steps.

On the steps:

 I listened silently at age eight to the neighborhood women as they sat on the steps and talked of childbirth, raising their family and problems with their husbands.

little kids sat while I told spooky stories until the streetlights went on and we all had to go home.

the boy next door knelt on one knee and asked me to marry him when we both were in the third grade.

I walked shoeless from July to September.

my first date gave me my first kiss when I was sixteen.

I trekked on my way to my room to sleep in the mornings after working the night shift at the Jersey City Medical Center around the block.

my husband-to-be didn’t kiss me after our first date.

I know the steps aren’t a home, but they hold pleasant remembrances of growing up.That’s as close to a definition of where is home to me.

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