Nurses Give Their Expert Advice on Understanding the Broken Health Care System

I have been on the lecture circuit. My topic is Empowering the Patient: How to Navigate the Health Care System. Two presentations down and two to go with another in the negotiating stage.

I’m fine-tuning the presentation based on the feedback I have received from my audience each time I give the talk. Sana Goldberg’s recently released book: How to be a Patient: The Essential Guide to Navigating the World of Modern Medicine has added an extra layer of emphasis on the importance of nurses’ influence in the health care system.

She writes:

 

I believe nurses are best poised to change the future of healthcare.

Today, registered nurses spend more time physically present with patients than any other healthcare professional, and as a consequence we see and hear a lot. We maintain a vantage point markedly different from that of the MD, the scholar, the journalist, and the policy maker. We are intimately familiar with the complexity and multiplicity of the patient experience, as well as the systems in health care that fail to acknowledge it. We witness the system’s barriers regularly, and in turn we come up with creative solutions to side step its most vexing realities.

(Sana Goldberg, How to be a Patient: The Essential Guide to Navigating the World of Modern Medicine, page XXIV)

Doesn’t that last sentence remind you of Teresa Brown’s New York Times Op Ed essay that I posted just last week? Side stepping vexing realities is another way of describing the “workarounds” that Brown described.

I’m using another book written by a nurse for my talk. Finish Strong: Putting Your Priorities First at Life’s End by Barbara Coombs Lee, who besides being a nurse is a lawyer and President of Compassion and Choices.

Both books are well written and easy to read and full of great information that older readers will find helpful. And, of course, I am pleased that they are written from a nursing perspective.

A Nurse Tells it Like it Is

A nurse has called attention to our dysfunctional health care system in the OP-ED section of the New York Times. (Our Jury-Rigged Health Care System by Teresa Brown, New York Times, September 6, 2019)

Brown has hit a nerve as evidenced by the 969 comments to date supporting her stance.

Her article discusses how nurses (and physicians) use “workarounds,” that is, they circumvent onerous rules to make sure patients get even basic care.

I found the piece a frightening expose.

May more nurses speak out about our ineffective and unsafe health care system in order to educate consumers and institute functional policy changes.

 

Our Jury-Rigged Health Care

 By Theresa Brown 

  • New York Times, OP-ED Friday, September 5, 2019

 

The nurses were hiding drugs above a ceiling tile in the hospital — not because they were secreting away narcotics, but because the hospital pharmacy was slow, and they didn’t want patients to have to wait. I first heard about it from Karen Feinstein, the president and chief executive of the Jewish Healthcare Foundation, who reported it at a board meeting several years ago. I wasn’t surprised: Hiding common medications is a workaround, an example of circumventing onerous rules to make sure patients get even basic care.

Workarounds are legion in the American health care system, to the extent that ECRI (formerly the Emergency Care Research Institute) listed them fourth among its list of top 10 patient safety concerns for health care organizations in 2018. Workarounds, the group writes, are an adaptive response — or perhaps one should say maladaptive response — to “a real or perceived barrier or system flaw.”

Staff use workarounds because they save valuable time. According to Anita Tucker, a business professor at Boston University, system breakdowns, or what she calls “operational failures,” and the workarounds they stimulate, can “consume up to 10 percent of a nurse’s day.” Most hospital nurses are stretched to their limits during their 12-hour shifts. No nurse has 90 minutes to lose to a slow pharmacy or an inefficient hospital bureaucracy.

I saw the common sense that can underlie workarounds when my hospital floor instituted bar code scanning for medication administration. Using a hand-held scanner to register bar codes on medications and patients’ hospital bracelets sounds smart. But then some medications routinely came without bar codes, or had the wrong bar codes, and we nurses weren’t given an easy way to report those errors. Patients’ wrist bands could be difficult to scan and the process disturbed them, especially if they were asleep. The lists of medications on the computer screen were also surprisingly hard to read, which slowed everything down.

But the biggest problem was that the scanning software did not work with our electronic medical records — so all drugs had to be checked off in both systems. This is a huge problem when dealing with patients like those receiving bone-marrow transplants, who might get 20 drugs every morning — some of which are delivered through IVs and come with nonstandard doses. What was already a lengthy process suddenly took twice as long.

Some nurses responded to the arrival of the bar code system with workarounds, including refusing to use the scanner, or taping copies of patient bar codes to their med carts. I tried to adhere to the rules, but if I was especially busy or couldn’t get a medication to scan, I would chuck the whole process.

However, because bar code scanning has been shown to reduce errors in medication administration, the hospital officials wanted it to be done consistently. They produced a public list of all the nurses on the floor. Each nurse was labeled green, yellow or red, depending on the percentage of medications he or she administered using bar codes. Family members, doctors — anyone could see how a nurse was graded.

Over time the list worked, but the sting of it also endured. We were being punished for taking time for patients, even if it meant bending the rules. No one among the managerial class seemed to understand that nurses care a lot about patient safety. The unheard concern was that a green light for bar code scanning meant a patient could fall into the red zone for something else.

Workarounds in health care always involve trade-offs like this, and often they are trade-offs of values. Increasingly, the entire health care system is built on workarounds — many of which we don’t always recognize as such.

Consider the use of medical scribes, who complete doctors’ electronic paperwork in real time during patient visits. The American College of Medical Scribe Specialists reported that 20,000 scribes were working in 2014, and expects that number to climb to 100,000 in 2020.

I have heard doctors say they need a scribe to keep up with electronic medical records, the mounting demand of which is driving a burnout epidemic among physicians. Scribes allow doctors to talk with and examine patients without having a computer come between them, but at base they are a workaround for the well-known design flaws of electronic medical records.

As a nurse, when I first learned about scribes, I was outraged. On the job, nurses hear repeatedly how health care companies can’t afford to have more nurses or aides to work with patients on hospital floors — and yet, money is available to pay people to manage medical records. Doctors who use scribes tend to see their productivity and work satisfaction increase, but the trade-off is still there: Scribes demonstrate the extent to which paperwork has become more important than patients in American health care.

The Affordable Care Act, which I support because it has made health care available to millions of previously uninsured Americans, is also an enormous workaround. The act expanded Medicaid, protected patients with pre-existing conditions and offered subsidies to make private insurance more affordable. Obamacare, though, was never intended to make sure that all Americans had affordable care; it works around our failure to provide health care to all our citizens. In its own way, the Affordable Care Act is as jury-rigged as using ceiling tiles to stash medications.

The United States spends more per person on health care than any other industrialized country, yet our health outcomes, including overall life expectancy, are worse. And interventions like bar code scanning are a drop in the bucket when it comes to preventable medical mistakes, which are now the third-leading cause of death in the country. Our health care nonsystem is literally killing us.

As the workarounds accumulate, they reveal how fully dysfunctional American health care is. Scribes are workarounds for electronic medical records, and bar code scanning is a workaround for our failure to put patient safety anywhere near the top of the health care priority list. It’s a values trade-off that the nurses on my floor instinctively understood.

Theresa Brown is a clinical faculty member at the University of Pittsburgh School of Nursing and the author of “The Shift: One Nurse, Twelve Hours, Four Patients’ Lives.”

 

 

New Nursing Show on Netflix


I intend to watch this show. Sounds fascinating.

Reblogged from Truth About Nursing:

Tiempos de AmTor

Netflix show provides limited glimpse of 1920s Spanish wartime nursing, but it does offer one fearless nursing leader

January 2018 – This month Netflix released to the U.S. market the first season of Morocco: Love in Times of War, a 13-episode Spanish drama about nurses setting up a hospital for wounded Spanish soldiers in the North African city of Melilla during the 1920s Rif War. The show, originally titled Tiempos de Guerra, is basically a wartime soap opera. The nurse characters seem more like nursing students, at least for a while, since they have been drawn from upper class Madrid families without much training. There is one big exception:  the Duchess of Victoria, María del Carmen Angoloti y Mesa, a real person played here by Alicia Borrachero. Carmen Angoloti is an expert, all-business force of nature. She doesn’t just train and lead the inexperienced nurses under her. She also fights the military/physician power structure to establish the hospital care systems as she sees fit, arguing for the independence of nursing and not hesitating to go over the military physicians’ heads to her ally the Queen of Spain. Angoloti considers herself to be rightly in charge of the hospital and tells the lead male officer and physician as much. Yet she displays a measure of compassion, avoiding the battle-axe stereotype. So the show offers one pretty great nurse leader, reminiscent of Florence Nightingale in her determination to help wounded soldiers overseas and not let male physicians get in her way. Angoloti’s status in the aristocracy doesn’t hurt her cause, of course. As for the other nurses, they mean well and do seem to learn over time, but they are pretty deferential and overwhelmed. And the show seems more focused on their romances with soldiers and physicians. There is some resemblance to The Crimson Field, the 2014 BBC series about nurses near the front lines in World War I. This Spanish show may have a bit more current resonance: Melilla remains a part of Spain to this day, despite being located on the Moroccan coast, to Morocco’s evident displeasure. And Tiempos de Guerra was supposed to be back for at least one more season, but it doesn’t seem like that ever transpired.

The show was created by Teresa Fernández-Valdés, Ramon Campos, and Gema R. Neira.If you have seen the show, please send your thoughts to Executive Producer Teresa Fernández-Valdés. She can be reached at teresafv@bambuproducciones.com.

Please copy us on your letter at letters@truthaboutnursing.org, so we know what you think. Thank you!

Pope Francis Recognizes Nurses’ “Healing Power of Listening and Touch”

This story reblogged from nurse.org.
NEWS
March 6, 2018

Pope Francis Calls Nurses, “Experts In Humanity” – Thanks Nurse Who Saved His Life

Pope Francis Calls Nurses, "Experts In Humanity" - Thanks Nurse Who Saved His Life

By Angelina Gibson 

VATICAN CITY, Mar 3, 2018 – “I thank her and I want you to know her name: Sister Cornelia Caraglio,” said Pope Francis as he remembered the nurse who saved his life at 20 years old.

“When, at the age of 20, I was on the verge of death, she was the one who told the doctors, even arguing with them, ‘No, this isn’t working. You must give more,'” the Pope said during a meeting with thousands of nurses – members of Italy’s national association of nursing professionals.

“And thanks to those things [her suggestions], I survived,” recalled the Pope.

The Pope Thanks Nurses

Pope Francis thanked all nurses in attendance, “you are there all day and you see what happens to the patient. Thank you for that!” he continued, “many lives, so many lives are saved thanks to you!”

He spoke about the importance of the nursing profession and the unique relationships nurses form with all members of the healthcare team – patients, families, and colleagues. Pope Francis stated that nurses are at “the crossroads” of all these relationships.

Furthermore, Pope Francis acknowledged the “truly irreplaceable” role nurses play in the lives of their patients. “Like no other, the nurse has a direct and continuous relationship with patients, takes care of them every day, listens to their needs and comes into contact with their very body, that he tends to,” stated Pope Francis.

The Pope called nurses, “promoters of the life and dignity of the persons.”

He spoke about the sensitivity they acquire from “being in contact with patients all day,” and addressed the healing power of listening and touch. Calling touch an important factor for demonstrating respect for the dignity of the person.

He praised nurse’s continuous and tiring commitment to their individual patients despite the patient’s societal status. Calling a nurse’s care particularly important in a society which often leaves weaker people on the margin, only giving worth to people who meet certain criteria or level of wealth.

Pope Francis called the nursing profession “a real mission,” and referred to nurses as, “experts in humanity.”

When speaking of touch, Pope Francis told the story of when Jesus healed the Leper through touch. Encouraging the nurses, “we must recognize the importance of this simple gesture,” Pope Francis said. “Mosaic law forbid touching lepers and banned them from approaching inhabited places. But Jesus went to the heart of the law, which is summarized in love for one’s neighbor,” stated Pope Francis.

While acknowledging the difficulty of the nursing profession, Pope Francis encouraged patients to have patience with nurses, to not demand things from nurses and to smile more at their nurses.

The Pope reminded nurses, “a caress, a smile, is full of meaning for one who is sick. It is a simple gesture, but encouraging, he or she feels accompanied, feels closer to being healed, feels like a person, not a number.”

Pope Francis encouraged nurses, to not forget the “medicine of caresses.”

How PTSD is hurting nursing

I came upon this post on KevinMD.com, written by a nurse. I am pleased that a physician has provided a vehicle for nurses to tell their stories and, in this case, share the heavy toll that working in a hospital setting can have on nurses. 

How PTSD is hurting nursing

ANNE NAULTY, RN | POLICY | MAY 22, 2019

Every time I hear that there is a nursing shortage in America, I feel myself cringe. There is not a shortage of nurses in America. There is a shortage of nurses who choose to work at the bedside. There is a reason, and it is called post-traumatic stress disorder.

Medically, we have learned that PTSD can occur after a single event or as a result of chronic stressors for a period of time. As a living organism, we know that the body can only sustain so much stress before it starts to break down. These ailments can be physical and/or mental. Sometimes they happen over a period of time, however often times we do not even realize the symptoms until they have forced us to take notice. As a nurse, I know when our bodies have had enough, and they need to rest, they will make us rest.

Bedside nursing is hard and very stressful. The bedside nurse is responsible for caring for multiple people every minute of every shift. That is, multiple sick and potentially dying people. The nurse is responsible for monitoring the patient’s response to treatment, the patient’s condition, the patient’s mental health, the doctor’s orders, assisting the patient with activities of daily living, and being there for the family.

Bedside nurses are the coordinators of care. We are the ones who make sure that all parts of the care plan are being carried out and that the system is working the best it can. We are the ones who comfort the patients when they need us the most.

We do not mind doing all of this. In fact, this is what we signed up for when we graduated from nursing school. We can handle these tasks if we have a partnership with the hospitals that we work for. This partnership all starts with the nursing grid. Each unit in a hospital has one. It is basically a chart that states how many patients each nurse should have. It is a chart that is supposed to indicate the safe number of patients that each nurse should be assigned every shift. It is a topic of heated discussion in the nursing world.

Normal patient-to-nurse ratios depend on the unit and the acuity of the patients. For instance, most nurses agree that in the intensive care unit (ICU) nurses should not be assigned more than two patients each. If a patient needs continuous dialysis or another procedure that needs to be monitored, then this ratio goes to 1:1. This is a common theme. If a nurse is assigned to a critical care unit or cardiac unit, then the patient to nurse ratio is acceptable and safe at 3:1. This means that each nurse on the unit should only have three patients. Acceptable medical-surgical unit ratios are usually either 4:1. This means that for every four patients, there should be a nurse. Another rule of safety is that there should never be only one nurse on a unit. Too many things can change quickly, and safety comes in numbers. Remember we are talking about human life.

When these basic rules are followed, then nurses and patients have better outcomes. Nurses stay at the bedside longer and patients do better overall. The problem that nurses are having is these basic safety numbers are not being followed, and we are burning out as a result. This has to change if we are going to keep our valuable nurses at the bedside. It has to change if people are going to receive the care they deserve when they are in the hospital.

Nursing salaries also need to be increased. Most nurses have their bachelors in nursing degree (BSN). Many hospitals require it as a condition of employment. A bachelor of nursing degree takes about five years, and the cost of the education starts at $50,000. Many nurses have to take out loans to pay for school. If we look at a 10-year repayment plan that does not include interest — a $50,000 loan means a monthly payment of $417.00.

I work in the Midwest. Our new nurses start at $22.00/hour. Some nurses earn a differential for working nights and weekends, too, although those shifts come with health and family costs. If we multiply $22.00/hour by the average 160 hours that most full-time people work each month, we end up with a gross monthly salary of $3,520. Most accountants say that taxes and benefits equal at least 30% of our pay. This means that on average, a new nurse can expect to bring home $2,464 a month. If we subtract the student loan payment, this means a new nurse will need to live off of a little over $2,000 a month. Trying to pay for housing, food, transportation, and utilities each month, forces many nurses to choose to work overtime.

Working 12-hour shifts are rough. In fact, 12-hour shifts often are 13-hour shifts, and many times, nurses do not get breaks. We want breaks, we do! They just become impossible with the increased patient loads and the increase in patient illness that we see. If a nurse somehow gets to leave to go on break, the relieving nurse needs to assume the responsibility for double the patients for the period of time. If that nurse is already having a hard time staying afloat of the assigned tasks at hand, then giving this nurse more responsibility doesn’t make sense. Bedside nurses are tired.

We also are often asked to float to other areas of the hospital — without training. Yes, I learned about basic orthopedics in nursing school; however as a neurology nurse, my knowledge of repairing bones is limited. Nurses should never be asked to float to another unit of a hospital unless they receive adequate training. This is a matter of safety. No other professional business would do this. A payroll accountant would never be asked to float to the sales department. A salesperson would never be asked to work as an architect. A cardiologist would not be asked to fill in for a neurologist. It just isn’t done. Why do nurses have to risk their licenses to do this? It is not safe patient practice.

We get scared.

When nurses have all of these stressors constantly, they may not even realize that they are having symptoms of chronic stress that can lead to PTSD. It sneaks up on us as we are caring for our patients. We learn to compartmentalize the constant stress and emotions that we feel, as we chalk them up as “another part of the job.” We suppress them, until one day, all of a sudden, the compartment opens, and we find ourselves overrun with anxiety and depression. We find ourselves having flashbacks, feeling guilty and having trouble sleeping. We begin to doubt our ability to be a nurse. We begin to question everything. We find ourselves unable to work, at least at the bedside at least until we heal, maybe never again.

Nurses need support from our hospitals, our government officials and our communities. We need regulated patient ratios and increased pay. Hospitals need to stop floating us to other units unless we are trained in that area of nursing. We need classes on caring for ourselves, and we need to take advantage of employee-assistance programs that offer free, confidential counseling. We need hospital-provided exercise rooms. We need to learn coping skills. We need to be able to process all of the emotions that we feel that have always been discarded as, “part of the job.” We need to talk about our issues, and we need to feel like we are being heard. We need to heal.

Anne Naulty is a nurse.

Nurses Week–Here We Go Again

Here we go again. It’s Nurses Week and we are still battling a misguided perception of nurses.

This isn’t just a week to celebrate nurses for all that we do to keep patients well and safe, not only in hospital settings but on the world stage, and to remind ourselves that for 52 weeks a year we need to be vigilant and proactive to maintain our autonomy.

This time a politician shows her ignorance regarding nursing practice in hospital settings. The following is an excellent response by two nurses to the offensive comment:

Nurses aren’t sitting around playing cards, they’re working to fix global health

165

Nurses aren't sitting around playing cards, they're working to fix global health

© Getty Images

Washington State Republican Sen. Maureen Walsh’s recent comment  that nurses “working at hospitals in rural regions probably play cards for a considerable amount of the day” is offensive to nurses regardless of nursing role or practice setting.

While Walsh has apologized and many nurses have expressed their disgust for her statement, voicing their disdain on social media, via emails, letters and even sending  1,700 decks of cards to Walsh, nurses can seize this moment to educate Walsh, policymakers and citizens on the role and contributions of nurses who daily care for individuals and communities worldwide to help people achieve health.

As nurses with decades of service to the profession, we know firsthand the tremendous work that our colleagues do as clinicians, researchers, educators and policy advocates. On a daily basis, we work alongside and in collaboration with very talented, educated and committed individuals who consider it an honor to serve in this capacity.

Whether in rural or urban areas, the demands associated with providing quality care require that we spend our working hours doing just that, not engaging in activities that do not lead to better outcomes for those we serve. To do otherwise would be disrespectful to the profession and would violate nursing’s contract with society.  

We do not take the distinction of being the most trusted profession lightly. For 17 consecutive years Gallup poll results revealed that more than four in five Americans, or 84 percent, rated nurses’ honesty and ethical standards as very high or high compared to 20 other professions.

Yet, the misrepresentation of nurses is not new.

For years the profession has worked to elevate the image of nursing and reverse the stereotypical images depicted in the media. Sandy Summers and Harry Jacobs Summers, authors of the 2009 Saving Lives: What the Media’s Portrayal of Nurses Puts Us all at Risk  provide examples of  the dangers of inaccurate portrayal of nurses.

As a profession, nurses have made progress highlighting the tremendous role nurses play in caring for those need of health care services. This month, Oprah magazine featured  five nurses who “just might save the world”.

Globally, nurses such as Dr. Sheila Tlou, a former UNAIDS Director for Eastern and Southern Africa and former Minister of Health in Botswana, raise awareness of the critical role nurses play in health policy. Tlou used her expertise as a nurse to develop and lead a nurse-driven intervention to decrease the maternal mortality rate due to HIV/AIDs in the region from 38 percent in 2004 to 9 percent in 2008. These interventions reduced  mother to child transmission of HIV from 40 percent to less than 4 percent within four years.

Members of the British monarchy have recognized the contributions of nurses in protecting human health and wellness. The Duchess of Cambridge, Kate Middleton, helped launch the campaign Nursing Now. The campaign is based on the triple impact report identifying the need to develop  the profession of nursing in order  improve health, promote gender equality and support economic growth.

Nursing Now, recently launched in the U.S., is committed to elevating the status of nursing globally and helping people understand how important it is to have the expertise of nurses in their communities and in positions of decision making on health care initiatives.

It is time to erase the inaccuracies and re-examine the prevalent image of nurses in this country. The opportunity to elevate the conversation extends beyond our elected officials. Everyone could benefit from knowing our commitment to advancing a nation’s health.  

This is not a game to us.

Janice Phillips, RN PhD, is an associate professor at Rush University College of Nursing and the Director of Nursing Research and Health Equity at the Rush University.  Medical Center. Colleen Chierici BSN, RN is the president of the nursing staff at Rush Oak Park Hospital and working towards her doctorate in Family Nurse Practice.  Both are Public Voices fellows through The OpEd Project. 

Meeting Nancy Panko

I was one of about thirty authors who attended the program, Authors in Your Backyard: A Celebration of Local Writers, held at my neighborhood library on a Sunday afternoon not too long ago. I arrived with copies of my book: Stories from the Tenth-Floor Clinic, and the syringes

Highlighter Syringes

to lure readers to my table. I didn’t know to bring a pretty colored cloth to cover my part of the table that I would share with another writer. Before the program started—a keynote address by a well-known mystery writer and five randomly selected readings—I roamed the room meeting the other authors.

At the very first table by the door, a woman about my age set up her books beside a poster publicizing her work. She had brought a table cover onto which she pinned a large sheet that announced: “Nancy Panko, author of Award Winning “Guiding Missal.” Her display could have been inside a book store. She had done this before.

While Nancy’s book was not about nursing, we soon discovered we were both nurses. She became a nurse in her late 30’s. She has been published 10 times in Chicken Soup for the Soul. Her 11thwill be in the next Christmas edition.

Nancy Panko epitomized the type of nurse I have long promoted. One who writes about her life as a nurse. Plus, she is an older woman. A great role model.

So, I asked her if I could spotlight her in my next post.

Here are two of her Chicken Soup stories and a link to her award-winning book: Guiding Missal.

Guiding Missal

Click here to order.

At the end of the stories, Nancy answers two of my questions:

Why do nurses need to publish their stories?

What has nursing done for you?

 

A Journey of Healing

On a sunny July day, my younger brother Terry was killed as he attempted to cut down a tree. He died instantly of traumatic head injury. In the blink of an eye, I no longer had a brother. He wouldn’t be in my life to tease me, give me advice, or to make me laugh. He was just gone, leaving a huge hole in all our hearts. The pain was unbearable.

As I grieved, I found I wanted to pay tribute to my brother’s life. At the age of 14, I announced to my parents that I wanted to be a nurse. As I grew up that goal got pushed aside, I got married and had children. I prayed that somehow I could find a way to go back to school to realize my dream of being a nurse. My husband and children were very supportive and we all prayed that God would show us the way…and he did.

I enrolled in nursing school, achieved good grades and made Dean’s List. In my Junior year, I began carpooling with Jeanne, one of the Intensive Care Unit (ICU) instructors. Driving fifty miles a day, we shared confidences and family stories. She became a mentor and a friend. I explained how Terry’s death affected my decision to return to school and how fragile I was just thinking about treating a traumatic head injury patient. She listened intently and seemed sympathetic.

The day before our senior year ICU clinical experience, Jeanne, my mentor and car pool friend, assigned me a traumatic head injury patient. I was in shock and disbelief. I prayed silently for help. I could not let my emotional, personal experience interfere with giving this patient the best care possible.

Upon entering the ICU, I learned that my patient was in surgery, having his second operation to relieve pressure from a blood clot on his brain. The doctors had given him little chance of survival. Terry had no chance at all, but this guy does, I thought. He’s still here, fighting for his life, and I’m going to do everything in my power to help him. I prayed for my patient and his family in the waiting room.

That afternoon and evening I studied the patient’s chart. His name was Sam, he was nineteen years old, the youngest child of a large close knit family and his accident was eerily similar to Terry’s. He worked for a tree-trimming company and while strapped in his safety harness perched in the tree to trim branches, he was hit in the head by a falling branch. He hung upside-down in the tree for nearly an hour before being extricated. He suffered a fractured skull with a large blood clot on his brain. A device was in place to relieve and measure the pressure inside his skull. A ventilator helped him breathe, he had arterial lines, IV’s and a urinary catheter. He had been given The Last Rites. Twice.

The next day, just after dawn, I saw Sam for the first time. His head was swathed in bandages, he was unresponsive and motionless. His tall frame completely filled the length of the bed, no sign of awareness in that young body.

My knees were weak, but I knew every detail about his physical condition, medications, procedures and his monitors. In ICU, the details can mean the difference between life and death. I can do this, I said to myself. All my hard work to this point comes down to this day and this patient. I laid my hand on Sam’s arm. “Good Morning Sam. I’m your nurse for today, my name is Nancy.” I told him the day of the week, the date, the time, what the weather was like. I chattered on while gently caring for him. There was no response. After morning care and charting I took time to speak to his family.

Out in the waiting room, I approached a tired-looking woman and introduced myself to Sam’s mother. She told me all about Sam and the family. I asked her to join me in a plan to stimulate her son and, hopefully, lighten his coma. I asked her to bring in a radio to play his favorite music and family pictures to tape in easy-to-spot places around his cubicle. I shared my nursing care plan with her and she felt included. This plan was also a prayer. Sam’s mother had a glimmer of hope and was pleased that she could help.

Each day we carried out the plan. I talked to Sam and played his favorite music. While completing all my nursing duties, I told him about the leaves changing colors and about the apples and cider for sale along the roadside. His vital signs were stable, no signs of infection but there was no response. It was hard to see this young man remain so still.

One day, as I struggled to put one of his heavy, long legs into his pajama bottom, I said, “Sam, it would be great if you could help me. Can you lift your leg?”  His leg rose five inches off the bed. I tried to remain calm. “Thank you, Sam. Can you raise the other leg.” He did it!  He could hear and follow commands, he had bilateral lower extremity movement, still, he had not regained consciousness or opened his eyes.

The next morning, I was told that during the night Sam had started breathing against the ventilator. As I came into his cubicle, I put my hand in his and told him I was there for the day. Sam squeezed it! I grabbed his other hand and asked him to squeeze again. He obeyed. Both hands and arms working on command. Praise God! I encouraged Sam all day. By the afternoon, he was breathing totally on his own and no longer required the ventilator.

Still his eyes remained closed. As I worked with Sam the next day, he turned his head from side to side to follow my voice wherever I was. I brought his mother into ICU.   “Sam,” I said, as his face turned towards me, “Your mom is here.” A tear slid down his cheek. “Sam,” I repeated firmly, “your mom is here. Please open your eyes.” We watched him struggle to lift his eyelids. Finally, his eyes fluttered open, but he looked toward the sound of my voice. “Sam,” I said, walking around the side of the bed to stand behind his mother, “look at your mom.” Suddenly, recognition dawned in his eyes as he gazed at his mother’s face and began to sob. The staff and my instructor, Jeanne had gathered to watch this miracle unfold, they were all crying. I partially lowered the bed’s side rail for a long awaited mother and son embrace. I felt so blessed to be a part of this journey of healing.

Sam continued to improve rapidly and was soon discharged from ICU to the Rehabilitation Unit where he had to learn to walk, talk and perform all his activities of daily living. His mother was at his side every day.

In caring for Sam, I had dealt with my grief, loss, fears and emotions. I was able to do for Sam what I couldn’t do for my dear brother, Terry. Against all odds, Sam survived.

A few weeks later, while walking through the Rehab Unit, I heard someone call my name. It was Sam’s mother. We hugged, she was smiling. I saw a tall, handsome young man standing next to her. His formerly shaved head had grown a crew cut beginning to hide the many scars. I barely recognized him.

“Hi Sam, how are you?” I said. “Do you remember me?”

He cocked his head and spoke haltingly.  “Your voice sounds so familiar.”

The lump in my throat only allowed me to respond, “I was one of your nurses in ICU.”

His words came out haltingly, “You..are..Nancy..My..mom..told..me..all..about..you.”

Here was a true miracle standing before me. For two weeks, my life was intertwined with Sam’s as we each experienced joyful healing.

One day, while Jeanne and I were driving to school, I gathered the courage to ask her why she blindsided me by assigning me a traumatic head injury patient, when she knew my story. She explained that she believed in my nursing skills and even more so in my character. She wanted me to face my fear while she was there to watch over and support me. I was emotionally touched to feel her kindness.

A few months later, at my graduation, I received flowers from Sam’s family. The card said,” To our Angel!” On this journey of healing, I believe that both Sam and I had the divine blessing of someone watching over us.

Chicken Soup for the Soul—Find Your Inner Strength, November 2014, 303

 

 

 

 

 

A Cast of Characters

It was the first week of September, a beautiful late summer evening that made you glad to be alive. I wanted to be outside, but I sat at the kitchen table studying for a biochemistry exam. George was relaxing, reading the newspaper. Our fourteen-year-old daughter was attending the first high school football game of the season and our seven-year-old son was in the front yard playing soccer with a friend. Suddenly, a blood-curdling scream outside had us jumping up and racing toward the sound. My gut churned hearing the agonizing howl of pain coming from our child.

George and I burst through the screen door running toward our boy who was lying on the ground screaming, “My leg, my leg.”

Rushing to his side, I cradled his head and told him to lie still and not move. Tears streamed down his face, as he reached toward his contorted leg.

“Call 911,” I said to my husband. I was sure his leg was broken.

At the first sound of sirens and sight of flashing lights, many neighbors flooded into the street. The ambulance and EMTs pulled into our driveway and promptly got to work. They splinted the lower half of Timmy’s body and moved him onto a stretcher.

A nurse neighbor approached me and offered to call the surgeon she worked with to meet us in the ER. Gratefully, we said yes. Timmy was loaded into the ambulance. We followed in the car.

The ride was a short one and the surgeon was waiting for us. Technicians whisked our frightened seven-year-old off to x-ray, George and I trailed alongside the litter, holding his hand.  Minutes later I stood next to the doctor as we looked at the films. “A spiral fracture of the femur is serious business.” I could see exactly what he meant. There were a good three inches between the ends of the broken bones.

I faced the doctor. “What does this mean as far as treatment and hospitalization?”

“He’ll need a pin in his leg then two weeks in traction. When the bones are aligned I’d put him in a hip spica cast.”

“What’s that?”

“It’s a little smaller than a full body cast, starting just under his rib cage extending to his toes on the fractured leg and to his knee on the uninjured one. A stabilizing bar will be attached as part of the cast to keep his legs in alignment.”

I felt weak in the knees and my mind was racing. I was in my first full year of nursing school twenty-six miles away. The only prayer I had of staying in school was to have Timmy transferred to an orthopedic specialist at the hospital in which I was doing my training. I could stay with him when I wasn’t in class and do my homework in his room and spend nights in the nurse’s residence. The surgeon respected my wishes and gave the order for the transfer.

That short term plan would suffice as long as he was hospitalized, but what would we do when he was discharged in that hip spica thing? George calmly reassured me we’d take one day at a time.

As soon as our parents heard what happened they said, “What do you need? And how soon do you need us to come.” We were relieved at their generous offer to help and set up a tentative schedule, to be firmed up as soon as we had a discharge date.

Two weeks later, we were given instructions for home care: two people had to turn him every two hours because he was no longer a featherweight little boy, but a large bulky plaster boy. At all costs, we could not jostle the metal skeletal pin apparatus protruding from the cast. We had to make sure he was adequately hydrated to help prevent blood clots due to his inactivity. He had cut-outs in the cast to allow for bodily functions using a bedpan and a urinal. We borrowed a mechanic’s creeper so we could place him on his stomach to play. Elevated on pillows to keep the metal apparatus from touching the floor, it was easy for him to pull himself around on the ball bearing casters while he maneuvered his little cars and army men. We alternated him between a sofa bed downstairs during the day and his own bed at night.

Our parents lived with us and cared for Timmy for three weeks. Everyone had the tutorial on how to care for the boy in the cast. George came home for long lunches to pitch in. However, weeks loomed ahead where we had no help.

When our wonderful neighbors heard there was a possibility I’d have to leave school to take care of Timmy, one, in particular, became a lifesaver setting up a schedule of volunteers to help during the work week. A nurse herself, Lynne was eager to assist. She was a Godsend. Words can never express how grateful we were for her help. She brought a red stake body wagon which was padded with many pillows so she could pull Timmy around the neighborhood on nice days. She set up a chaise lounge in the shade of the front porch with, you guessed it, lots of pillows, and Tim would color or read books.

For three weeks my neighbors covered Monday through Friday so I didn’t have to take a leave of absence from school. My heart burst with thankfulness for their sacrifice and kindness.

After six weeks in the cast, Timmy was admitted to the hospital to have the contraption removed and begin physical therapy to learn to walk all over again. I stayed in the nurses’ residence until he came home using a tiny walker. He was not allowed back to school until he could manage walking with crutches. When that goal was reached, George drove him to school in the morning and Lynne picked him up in the afternoon. Both the kids got home about the same time and Margie supervised her little brother until I got home at four PM. It was a team effort.

One afternoon in the first week of December, three months to the day after the accident, I came through the door to see my two beautiful children sitting at the table having an after school snack. “We have a surprise for you, Mom. Close your eyes.”

“Okay, they’re closed.”

Several seconds passed. “Open your eyes now.”

I opened my eyes to see both kids grinning from ear to ear. Timmy was standing unassisted and slowly walked toward me. I began to cry as he reached out his arms for the best hug ever.

Three years later, I graduated from nursing school, having made the Dean’s list six times. It humbles me to know my achievement would not have been possible without the kindness and sacrifice of family and friends to get us through a most difficult time.

Chicken Soup for the Soul—My Kind of America, August 2017, 240

 

Why do nurses need to publish our stories?

Nancy: As helpers, we know that there is more than one way to heal the body, mind, and soul. In writing fiction, we entertain while providing information and giving the reader a chance to escape reality – temporarily. Non-fiction can be instructive, informative, and educational in a private non-threatening way. Nurses on the job are creative, improvisational, and innovative, not only caregivers. Nurses are often underestimated but everyone knows that it is the nurse who is with the patient for 8 – 12 hours a day, not the doctors. The nurse is the patient advocate, she is the communicator of the patient’s condition while under her care, she is the liaison between the doctor and the patient. She is the glue that holds the entire hospital system together. If a nurse also has a penchant to write, those qualities come through onto the page.

 

What has nursing done for you?

Nancy: Nursing has enriched my life beyond measure. I returned to University 17 years after I studied the first time. At the age of 35, I was the oldest in my nursing class. It was the hardest 4 years of my life but I wouldn’t change it for anything. I graduated the spring before my 40th birthday and watched as my family cried when I walked across the stage to accept my diploma. Non-traditional students, that’s what they called us, are typically more motivated and focused in their studies and on each clinical rotation and that was true for me. As a well-educated nurse, my basic knowledge and ability to reason have never left me. Nursing is like the mafia, I can’t get out even in retirement because family and friends always ask my opinion on health-related issues. I’m always having to palpate bumps and lumps and looking at spots and rashes. My stock advice is usually, “I think you should see your doctor” or “put some calamine lotion on that poison ivy.”

Patron of Nursing

Barbara Jonas, 84, collector of art and patron of nursing, died on October 23, in Manhattan.  I had never heard of her. But the heading of her obituary in the New York Times on November 9th grabbed my attention. She was a patron of nursing along with her husband, Donald Jonas.

In 2016, the couple sold off half of their art collection to form the Barbara and Donald Jonas Family Fund, earmarking their first contributions to nursing, which Mr. Jonas described as “the most undervalued profession.”

This is a quote on the fund’s website:

“Nurses are the backbone of the American healthcare system. It is essential that we support nurses and the vital role they play in our hospitals, schools, clinics, nursing homes and on the battlefield.”      —Donald Jonas, Co-founder, Jonas Philanthropies

The couple also “sought to encourage connections among players in the health care system.” You could think here of hospitals and medical schools but the couple choose nursing schools to connect with hospitals.

While learning about the Jonases, I am re-energized that their foundation is supporting nurses but I know that there still are a large number of folks in the public sector that do not appreciate or understand what nurses do. Or even if nurses make a difference in the health care system.

 

There are two nursing efforts currently promoting/supporting nursing practice that you may find interesting.

1. Coalition for Better Understanding of Nursing.

The Coalition, recently launched, seeks to unite hospitals, nursing schools, and other nursing organizations in a robust effort to strengthen nursing and improve health care by educating decision-makers about the value of the profession.

(This is a working group of The Truth About Nursing, founded in 2001, to increase the understanding of the role nurses play in modern health care.)

2. Nurse Manifest

Established in 2000 is a call to conscience and action to:

  • Raise awareness,
  • Inspire action, and
  • Open discussion of issues that are vital to nursing and health care around the globe.

 

May these venues and others that promote the profession of nursing help to increase the value of nurses and the number of patrons of nursing.

Firing My Doctor

 

 

 

More Voices: Worry

 Firing My Doctor

Marianna Crane

31 May 2018

 

I didn’t decide to “fire” my doctor on the spot.

During my last appointment with her, I’d filled Dr. Green in on the details of my mastectomy. I happily reported that the surgeon had declared me “cured”–the tumor’s margins were clear and my nodes were negative. Because I had large breasts and wanted to avoid wearing a heavy prosthesis, I’d had a reduction on my healthy breast at the same time. A routine biopsy of that tissue had showed dysplasia–abnormal cells. As a nurse, I’d researched this finding and found scant evidence that it would develop into cancer. My surgeon had concurred.

As I sat on the exam table while Dr. Green stood by the sink drying her hands, I told her I’d decided not to worry about it.

Without making eye contact, Dr. Green said, “I’d worry.”

I froze.

Never one to have a quick comeback, I left the office without a word about her offhand remark. It wasn’t the comment itself that concerned me, but her apparent indifference to my feelings. Plus, what good would worrying do?

Having a potentially life-threatening illness had boosted my resolve to surround myself with people who would cheer me, not depress me. Dr. Green was a competent doctor technically but lacked sensitivity–something that I value in a patient-physician relationship. I decided to look for another primary-care provider.

After calling Dr. Green’s office to cancel my next appointment, I requested that my records be sent to my new doctor. The receptionist asked if I would tell Dr. Green why I was leaving. I agreed, and before I could get nervous Dr. Green was on the line.

I relayed the incident at my last appointment; I said that her “I’d worry” statement had left me shaken and disturbed. Whether I was right or wrong, what I wanted from a provider was someone who cared for my physical and mental needs.

Surprisingly, she thanked me. I hung up the phone feeling rattled that I had voiced such a candid assessment. Gradually, however, jubilation replaced anxiety. I realized that I had control over my life and those whom I allowed into it.

I can only hope that my forthrightness with Dr. Green improved her communication skills.

Marianna Crane
Raleigh, North Carolina

Are Nurses Losing Ground? Part 2

In my last post I discussed the Woodhull Study that was published in 1998, which showed nurses were quoted in the media (newspapers) 4% of the time. The 2017 replication of study showed a drop to 2%.

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Click here to view a video discussing the study, findings, limitations, and input from a panel of journalists/media experts. At the end of this post, I’ve listed some suggestions to improve nursing presence given by the nurse researchers and media panel (In no special order).

But before I get to the list, I was heartened in the last few weeks to note nurses quoted in the media:

In the Nation, May 3, 2018, Nurses have a prescription for the Democratic Party: Back Single Payer, by John Nichols citing nurses as experts in knowing what will help their patients achieve optimal health and what will benefit the health care system.

In letters re: Children of the Epidemic,a nurse wrote to the editor in the New York Times Magazine, May 27, 2018 describing her work with women addicted to crack cocaine during the AIDS epidemic in the ‘90s. During a span of two years, the babies followed by the nurses were on target developmentally. They were not “medical burdens.”

In my local paper, the News & Observer:

  • NPs step up as demand for doctors outpaces supply. (Reprinted from the Star Tribune in Minneapolis) by Jeremy Olson, April 29, 2018
  • Midwives say they can help fill gap in women’s health care,by Anna Douglas and John Murawski, May 20, 2018.
  • Medicare for all,letters to the editor, Patti Rieser, RN, FNP “supporting all medically necessary care, including dental, vision and mental health services and cover everyone from birth.” June 2, 2018.

Now back to the suggestions to improve nurse input and visibility in the media:

  1. Nursing leaders should meet with the PR department of their institutions to inform them about what nurses can contribute.
  2. Schools of nursing can provide media training for students and “media competencies” for nurse instructors/clinical experts.
  3. Nurse researchers should write press releases to the media about their study findings.
  4. Nurses need to make themselves available to journalists; develop a relationship so when a spokesperson is needed, the journalist will think of the nurse.
  5. Increase education in health care policy across nursing educational programs.
  6. Nurses should register with SheSource as experienced experts on health topics.
  7. Nursing schools/colleges are encouraged not to limit communication to other nurses and nursing sites using “inward tweets,” but cast a wider net to contact the non nursing sites/individuals or “outward tweets.”(Journalists look at both Twitter and Facebook for inspiration and sources.)

Remember:

There are 3.5 million nurses

Physicians are not the center of the universe

Of course, I am always advocating that nurses tell their stories using every media venue available to educate the public, and especially the journalists, about who we are, and what we do, and how we make a difference.

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