The World Health Organization designation of 2020 Year of the Nurse and Nurse Midwife has taken a back seat to the sensational political news alerts that fill our lives as if nothing else is important. This post is just a reminder that nurses still are on the front lines of COVID-19 and make a difference in our lives every day.
Reflections in the December issue of the American Journal of Nursing had an essay by Mark Darby RN, ARNP: The Way of Johnson Tower. Johnson Tower, a public housing building, sounded very much like the Senior Clinic I worked in and wrote about in my book: Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers. Seems that the only difference between the residents of the buildings was that Mark’s building housed adults, mine was limited to residents over 60. Otherwise, both sets of folks who sought care from either of us nurse practitioners were mostly marginalized, underserviced, and poor—and gutsy.
Mark didn’t identify the location of his public housing building but I can surmise that it was in an unsafe part of town, on the first floor and, like my clinic, had been a converted one-bedroom apartment. He says the clinic has . . . “one exam room” and is “below the building laundry. If more than four people use the washing machine, water will drip into the centrifuge.”
Mark describes four of his patients, each with their own challenges but each reaching out to help others. Getting to know patients as intimately as Mark does is facilitated by caring for the patients on their own turf. Mark and I get to know first-hand what challenges our patients face and we know the strengths they gather up to face them.
I bet Mark’s clinic, like the Senior Clinic, promoted low tech/high touch. Here is a copy of the brochure from the Senior Clinic that a friend who had worked with me sent recently. He had been sorting through “memorabilia” from over 30 years ago!
A murder due to a drug deal gone bad occurred just outside Mark’s clinic. Those who planned my Senior Clinic decided to place the clinic on the tenth floor to avoid any drug seekers trashing our clinic looking for narcotics. Neither clinic would attract patients with medical insurance who had a choice of health care facilities.
I especially liked Mark’s answer when asked how he could work in such a setting. He said, “One thing I learned in NP school is that I am a nurse first and an advanced practitioner second. Nurses are supposed to look at the whole person—mind, body, and spirit—as well as the environment. I have found that the residents of Johnson Tower teach me more about being a nurse and a human being than you would imagine.” Amen I say to that.
I’m not exactly sure when my clinic closed. When I went back to Chicago in 2007 the building was no longer a public housing building but was run by the Hispanic Housing Development Corporation. It looked well cared for. I called their office soon after that visit and was told there was no longer a clinic there.
I can’t believe I was the only one.
In my last post I referenced The Truth About Nursing blog in which we are asked to write to two journalists who did not mention nurses in their article in Businessweek about Hillary Clinton’s hospitalization. The story read as if doctors were the only health professionals caring for her.
I’ve always been angry about how we nurses are represented in the media and, in this case, how we are ignored in the media. On February 5th, I wrote the journalists the following and copied The Truth About Nursing.
Matthew Lee and Marilynn Marchione,
As a long time nurse I am always sad when I read stories related to health care that omit any mention of the contribution of nurses. In your December 3, 2012 article: “Hillary Clinton hospitalized with blood clot,” you stated Hillary needed hospitalization. Indeed she did. The main reason a patient is hospitalized is to receive the oversight, management and personal care from professional, knowledgeable nurses.
The general public relies on well informed reporting and accurate facts. The doctors were responsible for Hillary’s care in conjunction with nursing care. It is a disservice to the largest group of health care providers that they are dismissed without a mention in your timely and well presented story.
My hope is that in the future you will give credit to the role nurses play in our health care setting.
I received the following email from Sandy Summers, co-founder of The Truth About Nursing.
I’ve been meaning to write personally, I’m sorry for the delay. You were the only person out of the 10,000 on our list who wrote a letter to these two journalists. We were thrilled to get your letter and also to read your blog, which laid out so well the problems of the media. Thank you, and keep up the good work!
I can’t believe I was the only one.
The scenario continues.
On May 14, 2018 Shawn Kennedy wrote in AJN, Off the Charts: The Continuing Invisibility of Nurses in the Media
. . . “The 1998 Woodhull Study on Nursing and the Media: ‘dismal’ results.
In 1998, Sigma Theta Tau International commissioned a study—the Woodhull Study on Nursing and the Media—to examine how the media portrayed nursing. The results were dismal—after examining over 20,000 articles in newspapers and magazines, the researchers found that nurses were mentioned in only four percent of articles about health care
New study. Even worse results.
Last year, Diana Mason and a team from the Center for Health Policy and Media Engagement at George Washington University and Berkeley Media Studies Group replicated the Woodhull Study as part of a broader study on nurses and the media.
The summary of the results, fittingly released at the beginning of Nurses Week when the media does pay some attention to nursing, were disheartening: nurses are still essentially invisible in the media and rarely sought by media as sources or experts on health care topics. The current analysis is more disappointing than the original: nurses were quoted or appeared as sources in only two percent of articles examined in September 2017. We’ve lost ground!
Why the media ignores nurses.
Other parts of the study looked at why journalists did or didn’t use nurses as sources. Findings:
• they don’t really understand all that nurses do
• the right nurse is hard to find
• public relations staff don’t offer nurses as experts to media
• nurses may be reluctant to speak with media”
My next post will discuss suggestions to increase nurse visibility in the media.
I have been thinking for a long time about the fact that we older nurses are dying off. We will take with us our memories of nursing history. I have always loved to hear from other seasoned nurses about how they size up their nursing careers as they look back. What was important at the time, what were they happy to see disappear, and how do they assess current nursing practice and the future of the profession?
So I decided I would weigh in, occasionally, by spotlighting a nurse of a certain age, i.e., sixty and older, whether this is through an article I have read or by interviewing someone, or through my own stories.
This post is prompted by an article: Diane Saulecke, “There from the Start: A Hospice Nurse Looks Back,” American Journal of Nursing, 7, July 2017, 56-57.
The article features Dianne Puzycki, an 82-year-old nurse, who began to work with the hospice movement when it first started in the early 70s. She still works “the night shift at Connecticut Hospice once a week. ‘I want to be part of it as long as I can,’ she says, ‘It’s become part of my life, my philosophy.’”
After graduating from nursing school in 1955, she started her career at Memorial Hospital (now part of Memorial Sloan Kettering Cancer Center) in New York City. There she cared for patients with cancer, many of them young women.
“At that time, we didn’t talk about death and dying,” she says. “We weren’t allowed to talk about that. It really haunted me for years.”
I remember those restrictions well. The diagnosis of breast cancer was withheld from my beloved Aunt Lena. I was in the first year of nursing school but never visited her in the hospital. One evening, when I was talking to my mother on the phone, I asked, “How is Aunt Lena?” “Just fine,” my mother said. That’s when I knew she had died. My mother would give me the bad new when I next went home to visit.
Puzycki mentions that she heard both Cicely Saunders, a doctor who founded the first hospice, and Elisabeth Kübler-Ross, who opened up discussion on dying through her 1969 book On Death and Dying. The early 70s were heady times in health care as discussion heated up regarding the previous taboo of being honest with patients by telling them their cancer diagnosis.
Kübler-Ross’ book was the subject of a workshop for the medical staff at the time I worked for a community hospital in the early 80s. To this day I remember one of the surgeons storming out of the classroom after loudly protesting, “my patients don’t want to hear that they have cancer.”
Being present for patients and “picking up on the little things” is to Puzycki the key to hospice nursing. And she says that seeing the compassionate actions taken by her colleagues, especially the younger ones, makes her feel hopeful about the future of the profession. She recently saw, for example, a fellow nurse lean down and kiss an elderly patient on the head. “I said, ‘That’s a good hospice nurse.’”
Excepted from Off the Charts, May 31, 2017
AJN Facebook Readers on Influences, Public Attitudes to Nursing, Practices of Yesterday
by Betsy Todd, MPH, RN, CIC
What do you remember from early in your career that would never be seen or done today?
We “nurses of a certain age” remember!—and we’re amazed at how far our profession has come. As one nurse commented, in response to early nursing practices that seem primitive today, “Oh my goodness, how has humanity survived?!”
There were, of course, our caps, white dresses, white hose, and white shoes. One nurse recalled that we always wore our school pins on our uniforms. These seem not much in evidence these days, but were always a source of pride and connection (and sometimes, lighthearted rivalries) back in the day.
In addition, nurses pointed out that the scope of practice has certainly changed. Nurses mixed soft soap for enemas, mixed weak solutions of Lysol (!) for vaginal douching. Wound care has, shall we say, evolved. Nurses recalled packing wounds with eusol (chlorinated lime plus boric acid—“cleaned wounds by removing patients’ flesh with it!”), Savlon (chlorhexidine combined with a chemical later used for disinfecting floors), Milton (a bleach solution), or sugar mixed with Betadine or egg whites. Some remembered “vigorously rubbing talc onto bums to relieve pressure” or “Maalox and heat lamp for sore butts.”
Are automated medication dispensing systems (for example, Pyxis machines) and bar codes part of your daily routine? Several comments described pouring meds from stock bottles on the unit or mixing chemotherapy solutions in the medication room. There were no medication carts, just medication trays with cups and handwritten cards for each patient (different colored cards for b.i.d, t.i.d., etc.).
“Point of care” lab testing didn’t include quality checks. One nurse remembered “burning urine samples in a glass tube over a Bunsen burner to check sugar levels.” DeLee suctioning of newborns—“I ended up with a mouth full of stomach contents more than once”—or pipetting blood and urine samples for the lab via mouth suction were also routine.
Many comments reminded us of tools rarely seen in today’s hospitals. There were time-taped IV bags, glass syringes and IV and chest tube bottles, mercury thermometers, crank beds and egg-crate mattresses, “gloveless everything,” and no hand sanitizer.
Routines and work practices of years ago may be hard to imagine today. Nurses recalled smoking during report, and patients smoking in bed. Patients were admitted “just for observation,” or a day or two prior to surgery. Each shift charted in a different color of ink. Nurses recalled time to talk with patients, and actual “acuity-based staffing” (“RIP,” as one nurse commented).
Another nurse summed up a certain sadness as she described some lost aspects of patient care:
“morning care before breakfast, clean sheets every day, evening care with back rubs, trash emptied, fresh water and being aware of the patient’s environment. [We] took time to assess the patient by the RN and listening. The care was impeccable because of the nurses who controlled the patient experience.”
Here’s a great example how one nurse saved a patient’s life.
Speaking Up to Save a Life
Diane Szulecki, Associate Editor
American Journal of Nursing
A nurse’s advocacy alters the path of a patient with locked-in syndrome.
On a winter day several years ago, critical care nurse Katie L. George began her first of four day shifts in a row. Among her tasks was taking over the care of Ms. A., a young woman who had a traumatic head injury after being involved in a car accident. Ms. A. had been sedated for several days to allow for intracranial pressure monitoring; her fiancé had stayed in the room with her the entire time.
At the start of George’s shift, Ms. A.’s physician decided to stop her sedation so she could undergo a neurologic exam. Within an hour, Ms. A. opened her eyes and her fiancé jumped up, grabbed her hand, and began talking to her. But the initial assessment George conducted yielded troubling findings: Ms. A. had no spontaneous movement and her heart rate didn’t elevate in response to noxious stimuli. She appeared, however, to be looking around the room and tracking George and her fiancé.
Ms. A.’s physicians repeated the assessment and arrived at the same conclusion. Magnetic resonance imaging revealed that she had sustained a severe C2 fracture in the car accident and that her spinal cord was nearly severed.
Ms. A.’s parents, who lived abroad, were en route to the hospital but wouldn’t arrive for another day. In the meantime, Ms. A.’s fiancé stayed by her side and quickly established a way to communicate with her. He would read her the title of an article from her favorite magazine, then tell her to blink once if she wanted him to read it to her or twice if she wasn’t interested.
“Throughout the day it became clear to us that she absolutely could understand what we were saying,” said George. Ms. A. was suffering from locked-in syndrome—a condition in which the patient is conscious and certain eye movements remain functional despite full body paralysis. When her parents finally made it to her bedside the following morning, they faced devastating news. The attending physician informed them that because of the severity of Ms. A.’s injuries, she was unlikely to regain movement of her extremities. She would always be dependent on a ventilator and she had a high risk of dying within a year from complications of immobility such as pneumonia.
Ms. A.’s parents were advised to take some time to think about how to move forward. The next day, they decided to have their daughter withdrawn from life support. Despite Ms. A.’s apparent cognizance, George said, “I think her family was trying to do what they thought was best. In their minds—and understandably so—they didn’t want to put her through this.”
But, according to George, Ms. A’s fiancé pushed back on his future in-laws’ decision. “This isn’t right—I think she’s in there, and this should be her call to make,” he said to George. George agreed, and scrambled for a solution: Ms. A. was due to be removed from life support that afternoon.
First, George discussed her concerns with the attending physician. He agreed with her, but emphasized that since there was no way to determine Ms. A.’s mental capacity from a legal standpoint, the decision of whether to continue life support remained with her family.
Despite the physician’s response, George was determined to find a way to help give Ms. A. a voice in deciding her own fate. So she reached out to a colleague in palliative care, who referred her to a speech pathologist. Over the phone, the pathologist confirmed that Ms. A.’s capacity could, in fact, be legally validated through the blinking of her eyes.
“At that point I went to the attending and the resident and said, ‘Here are the calls I’ve made; we can prove her capacity by doing this,’” said George. “They weren’t happy that I had persisted after they’d said no, but they were receptive.”
A plan was made for Ms. A.’s parents and fiancé to gather in her room along with her physicians, a chaplain, and George, her nurse. Once assembled, they explained her condition and prognosis to her, and reassured her that she wouldn’t be in any pain if she chose to discontinue life support. She was instructed to blink once if she wanted to continue life support and twice if she preferred not to. Everyone in the room let out a collective gasp at Ms. A.’s response: “She blinked once and opened her eyes so wide—it was very clear what she was telling us,” recalled George.
After that, the situation resolved uneventfully. Ms. A.’s parents supported her choice, and the decision to continue care was formally made. Eventually, she was transferred to a rehab facility in another state. It was the last George would see of her patient for a long time.
A few years later, George was at work when one of the attending physicians who had cared for Ms. A. called her over. The physician had come across a recent video of their former patient.
George watched the footage, in shock. Ms. A. had made enormous progress in her recovery: she was now able to move most of her extremities and no longer required a ventilator or a feeding tube. The footage showed her dressing herself, using various tools to help her perform basic tasks, and getting around in a motorized wheelchair. Her mental capacity was fine, and her fiancé was still by her side, now as her husband. “You did this,” the physician told George. “She’s alive because of you.”
Looking back on the situation, George said she never doubted that getting involved on behalf of her patient was the right thing to do, despite facing pushback from some of her colleagues. “This was something that was way too wrong not to stand up for. I was sick knowing what would take place that afternoon. It really made me feel like, ‘OK, this is what we have to do.’” Taking a stand was intimidating, she said, but her instinct reassured her. The experience exemplified what she called the gray area of nursing: being uncertain of one’s “moral role,” and wanting to tread carefully.
George says the experience of advocating for her patient and witnessing the rewarding results has kept her driven, both personally and professionally. “It’s given me the motivation to keep challenging things even when they’re tough, and in my day-to-day patient care, not to sit back if I feel something is truly wrong,” she said. “You can’t pick every battle, but you need to pick the ones that matter and stand up for what’s right.
From boliston, via Flickr Many years ago, I was given the greatest gift by a patient who had no idea he would change my life and define my professional outlook as a nurse. While not every nurse will be fortunate enough to have such an explicit experience of the effect of the care they provide…