The Building as Character

 

Nightingale Tales

My new project involves interviewing my classmates from nursing school. We “older nurses” are dying off. Who will be around to tell our stories?

As I gear up to start this project, I’m educating myself in the art of interviewing. In the meantime, a serendipitous thing happened. Lynn Dow, RN, wrote about her long career in nursing in a new book: Nightingale Tales: Stories from My Life as a Nurse.

Lynn Dow entered nursing school in 1956, three years before I did. She attended the diploma program at the University of Rochester, which like my diploma program at Saint Peter’s School of Nursing in New Brunswick, New Jersey was three years long without any summer vacation breaks. The stories she shares of her nursing school days entertained me the most since my experiences so mirrored hers.

In her book, she reminded me that after a patient went home we had to strip the bed and then wash it. Yes, the plastic coated mattress and exposed metal coil springs were washed by hand. When the bed dried, we made it up for the next patient. There were no housekeepers at this time. Two cranks at the foot of the bed were used to raise up the head or to “gatch” the knees so the patient wouldn’t slide down. Later, a third crank was added that raised or lowered the bed. I remember having black and blue marks on my shins from hitting the cranks that were left on the bed instead of taken off and stored somewhere, like on a window sill.

Lynn recalls when cardio-pulmonary resuscitation was still in its infancy, a surgeon might bypass this effort and “crack the chest.” This rarely was successful. Once when I worked in the recovery room my patient went into cardiac arrest. Her surgeon dragged her off the stretcher to the floor, cut her open and pumped her heart with his bare hands. She was an old woman and I felt at the time he did this for the experience rather than to revive her.

Commonly, student nurses staffed the hospitals because there was a shortage of registered nurses, and students were a cheap substitute. In the third year of school, students were put in charge of a ward on the evening or night shifts. Lynn reminds the reader that the student nurses were “teenagers, too green to realize the extent of our responsibilities.” Sometimes the students worked a “split shift,” covering baths and meds in the a.m. and returning to help with dinner trays and get the patients ready for bed in the evening. Before I graduated from nursing school this “abuse” of student nurses was no longer allowed.

Nightingale Tales goes on to cover Lynn’s long nursing career and is filled with educational information and surprising vignettes. While I am especially glad she shows us nursing in the “olden days,” her book also depicts the advancements in current nursing practice. But she feels that possibly “the nurturing aspect of nursing has given way to technology.”

Read her book and decide for yourself.

Nurses Save Lives

 

 

What a pleasant surprise to read that nurses save lives (italics mine) in a news article yesterday, September 21. Unfortunately, the story was not a happy one. The Raleigh, NC News & Observer detailed the memorial service for the crew of a Duke Life Flight Air Ambulance that crashed on September 8 killing all aboard: pilot, patient and two flight nurses.

“Like all medical personnel at Duke, Life Flight’s Crew ‘have a strong desire to save lives (italics mine),’” said Irene Borghese, program director. She goes on to say “what sets this group apart is their desire to do so (save lives) while putting themselves in harm’s way and without the safety net of an entire health care team . . . They simply depend on each other.”

What she is saying is that the nurses can rely on their own knowledge and expertise when they deal with difficult patient problems on a flight mission and not have to follow doctor’s orders, although there probably are protocols when needed.

The nurses who died, Crystal Sollinger and Kris Harrison, had worked together on a flight “that wound up saving the life (italics mine) of an infant . . .that baby is now 3 years old, and her family brought her to” the service.

We all know that in most instance nurses are not recognized for the intelligent, caring and competent health care providers that they are.

In a post I wrote in February 2013, Businessweek reporters gave doctors credit for caring for Hillary Clinton while she was admitted to the hospital when she had a blood clot. Nurses were never mentioned. I can’t imagine a doctor was around to do vital signs on the night shift.

Thank you to Ray Gronberg and Tammy Grubb, the authors of N & O piece, for giving credit to Crystal and Kris for doing what they really do: save lives.

 

 

 

 

 

 

 

 

A Nurse’s Hands

I came across this post on All Nurses. It’s too lovely not to share.

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A Nurse’s Hands

by VivaLasViejas, ASN, RN Guide Mar 16 2016

I’ve been retired for over two years now, but in a rare contemplative moment, here are a few thoughts on what being a nurse meant to me.

Lately I’ve taken to looking at my hands, which appear to have morphed into my grandmother’s in recent years. They are well-worn and the skin is thinning rapidly, much to my dismay. While a layer of fat fills in the lines in my face, the same thing can’t be said for my hands, which tell my life story without words.

And then I remember: these hands have held new life, and comforted the dying.These hands have given the first bath…and the last.

They have been washed literally hundreds of thousands of times in the service of people I didn’t give birth to.

They have administered the first feeding and the last dose of morphine.

They have rubbed sore backs, dressed wounds, smoothed fresh linens over feverish bodies.

They have fed, cleaned, stopped bleeding, performed CPR. They have also prepared the living for surgery, and the dead for their final journey.

They are the hands of a nurse. And even though my career is over, my hands will forever bear the marks of the noble work they once did.

And somehow, that makes the wrinkles OK.

PERSISTENCE

“It’s Like Déjà Vu All Over Again.”
-Yogi Berra

I should’ve guessed that writing “in spite of myself, I persisted and finished” my book last year would have guaranteed that I would be rewriting my book yet again.
As of today, I’ve revived it, adding what I had left out, and changed the title for the eighth time.
As I reread that post, I am humbled by the process of writing but still remain determined in completing, and getting the book published—hopefully this year.
I have made the same New Year’s resolution as last year—to keep up my persistence and determination in getting published. I’ll keep you posted.
Happy, Healthy, and Peaceful New Year to you all.

Nursing Stories

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In 2014, I finished my memoir.

In spite of myself, I persisted and finished.

Ten years ago, I left a full time nurse practitioner job and began to write in earnest. The book I just birthed is not the one I started then. It has been configured many times: moving chapters, changing tenses from past to present and back to past again, deleting some stories and adding others. I went through seven titles.

I recognize now that I did everything to prolong that actual moment when I would let the book go. But then 2014 came along. A busy year of interviewing realtors, decluttering our old home, making improvements to increase the potential for the house to sell. And sell it did—quickly.images-3

Somewhere in the midst of all this, I managed to keep writing, gave the manuscript to two more beta-readers and hired a line-by-line editor. And even settled on…

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Just a Nurse

bookmrk-sm1This is from Suzanne Gordon’s Blog. Ms Gordon is a journalist and stanch supporter and promoter of all things nursing.

Recently she asked nurses to respond with their version of “Just a Nurse.” I am delighted to see their feedback. May nurses continue to tell the public what they do and how important their job is.

 

I would like to post all the ” Just a Nurse” submissions people have sent me.  See below.  What do you think?  I think they are all great.  Thank you so much, all of you.

Suzanne Gordon

I’m just a Pediatric Intensive Care Nurse. I just manage my patients’ drips to keep to their vital signs in a stable range. I just make sure their medications are safely administered. I just make sure the physician is informed of any small but meaningful change in their condition so we can work together to prevent catastrophes. And I just make sure that the patient and family aren’t terrified by all of the beeping alarms and alarming equipment. Kateri Allard, RN

I am just an Emergency Department nurse who recognizes that you are short of breath, listens to your breath sounds with my stethoscope, checks your oxygen blood saturation, and with my expertise and knowledge on how to treat respiratory distress, immediately initiates appropriate, life-saving treatments. But, hey, I’m just a nurse. From Kathleen Burke, RN

I am just a pediatric nurse practitioner. I immunize your child against life threatening diseases. From Suzanne Malloy, RN

I’m just a Nurse I make sure my patients do not die alone. From Aimee LeVasseur Desmarais, RN

Just a Nurse

it was JUST a nurse that held my hand when I got sutures for the first time

it was JUST a nurse that gave me a lollipop when those sutures were removed

it was JUST a nurse that explained in layman’s terms what my injury was

it was JUST a nurse that took away the butterflies before surgery

it was JUST a nurse that held my Mom when she was told Dad’s cancer was terminal

it was JUST a nurse that brought coffee and comfort during those long visits to the hospital

it was JUST a nurse that gave us smiles and understanding

it was JUST a nurse that gave Dad the dignity he deserved while he was dying

it was JUST a nurse that said “I’m sorry for your loss.”

it was JUST a nurse that said it was ok to cry when Dad passed

it is JUST a nurse that wears a uniform

and like most anyone in uniform, they are JUST heroes

From Liam Downey, RN

I’m just a nurse. I just help patients and families in their last hours of life and I just am there to welcome new babies into the world, and I just take care of everyone in between of every culture, race, socioeconomic status with love and acceptance. I am just a nurse. From Deborah Kloos, RN

Well, I’m a pediatric nurse. I just hold a crying parent in my arms after the doctor informs them that their child has a brain tumor…From Charmain Berrian,RN

I’m just a nurse, I’m the one who will make sure your surgery team knows everything about your history before you enter the OR suite. From Susan Bartlett, RN

I am a nurse…I care about people…I take care of people…it is not a job it is my life…24-7.  From Donna DiRusso

I’m just a nurse. I held my patient’s hand as she cried wondering how she would ever heal her debilitating wound. From Toni DiMar, RN

I’m just a nurse, I fixed a bowl of mixed up medication to be in a med organizer so my patient would take her proper meds and not die of an overdose. From Toni Di Mar, RN

As professional nurses we do “listen to the heartbeat,” not only of individual patients, but of entire communities. Nurses look for, find & care for the forgotten people. We advocate for homeless families and campaign for social justice. We practice compassion with persons affected by addictions. Nurses tend to the needs of people experiencing mental health challenges. We step up to the podiums at town halls and at our State Capitals. We are indeed front-line healthcare providers. Every Nurse a Leader! #rockthestethoscope  From Barb Enos, RN, MN

I’m just a nurse, I teach patients about their disease process, how their medications work alone & in combination with each other, review symptoms to monitor, and listen to their fears as they progress on their health journey while taking care of four other individuals. From A. B. Fay,RN

I’m just a nurse, when I nurture new interns and new nurse graduates, socialize them to the complexity of healthcare, and care for a full patient assignment. From A. B. Fay, RN.

I’m just a nurse. I translate medical jargon into simple understandable terms that people can understand.

I am just a nurse. I breathe life into people who have died.

I reduce the suffering of people who are dying making their last days comfortable.

I help families to share a common goal making their experience of a dying parent/child bearable.

From Patricia McNair, RN

I’m Just a nurse…I informed the ED attending that the patients cardiac monitor pattern had ST elevation and was a STEMI. I’m just a nurse….I questioned the dose of a resident’s order for a beta blocker that was more than double what should be given.  From Elissa Aldred,RN

A Physician Finally Gets Nursing

I couldn’t write better coverage about Dr. Arnold Relman’s comments about nursing, so I’m reblogging this Post. The comments he made are both “good” and “bad.” Good: Dr. Relman, physician and former editor of the New England Journal of Medicine, stated “When nursing is not optimal, patient care is never good.” Bad: Dr. Relman finally recognized this at age 90!
This just reinforces my belief that nurses need to make themselves more visible (see my post “I was the only one.” )

DOCTORS

A Patient’s-Eye-View of Nurses

By LAWRENCE K. ALTMAN, M.D. date published FEBRUARY 10, 2014 3:37 PM

 

February 10, 2014 3:37 pm

 

Dr. Arnold S. Relman, 90,  fell in June and suffered multiple fractures.

by Tony Cenicola/The New York Times

 

Last June, the month he turned 90, Dr. Arnold S. Relman, the eminent former medical educator and editor, fell down a flight of stairs at his home in Cambridge, Mass. He cracked his skull and broke three vertebrae in his neck and more bones in his face.

By the time he arrived at the emergency room, blood was flowing into his brain and impinging on his windpipe, leading to severe choking and dangerously low oxygen levels. Surgeons cut into his neck to connect a breathing tube from his trachea to a mechanical respirator.

Amid the disciplined medical havoc, his heart stopped three times. Resuscitation efforts saved his life, but at the cost of several broken ribs. His condition remained precarious as he developed complications and endured still more medical procedures.

Astonishingly, he lived to write about all this. After a painful 10-week hospital stay and months of rehabilitation, he can walk — gingerly, with a cane — and is largely recovered, with his mental faculties intact.

His riveting account of the medical adventure, in the Feb. 6 issue of The New York Review of Books, is a testimonial to the best emergency medical care and a tremendous will to live. At the same time, however, it betrays a surprising lack of awareness of some critical aspects of the medical profession and the nation’s fragmented health care system.

Despite decades as a medical educator, researcher, author and editor of The New England Journal of Medicine, Dr. Relman confesses that he “had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled.” Nor did he appreciate the hypnotizing effects of technology, which robs patients of the physician’s bedside manner and affects the training of younger doctors.

How is it that a leading medical professor like Dr. Relman — who has taught hundreds of young doctors at Boston University, the University of Pennsylvania (where he was chairman of the department of medicine) and Harvard — might not have known about the value of modern-day Florence Nightingales?

A number of doctors who have talked to me about Dr. Relman’s article suggest that the culture of medical education may be largely to blame. For example, younger doctors in hospitals spend part of the day on rounds, following professors in their long white coats. Many of these august figures are supremely confident in their observations and opinions; others are more compassionate.

What professors impart on those rounds can have a major effect on the behavior of younger doctors when they go into practice and teach succeeding generations.

Dr. Relman’s initial care was in a major teaching hospital, Massachusetts General in Boston, where the kind of doctors he taught — students, interns and residents — provided the round-the-clock attention that kept him alive. Yet he did not write directly about their role, referring to them only as “a team.”

On their rounds, some medical professors prefer to talk in a hallway just outside the patient’s room as they discuss test results that are crucial in planning further care. Such behavior appears impersonal, perceived perhaps as a way of shielding bad information.

But many doctors see it as efficient, because they can note the information they deem most important — like heart rate, blood pressure and rate of intravenous drip — by standing at a patient’s door and looking in at the monitors. Feeling no need to go to the bedside, they do not. Instead they rely on nurses, failing to recognize that such behavior omits crucial elements in patient care — the physical touch and the personal touch.

Dr. Relman owes the extension of his life to drugs and devices that did not exist in their present form, if at all, when he was younger. Over the years, the surge in the number of such advances, and most importantly in their hazards, has made work vastly more complicated for doctors, nurses and other health workers. Despite the advantages of technology, tender, loving care from family and nurses is priceless, as is the bedside manner of a sympathetic doctor.

But technology’s monitors, images and devices can deflect that doctor’s attention, as Dr. Relman learned when he reviewed his hospital records and the notes he wrote to nurses and his wife, Dr. Marcia Angell (particularly while he was unable to speak because of the breathing tube).

Instead of descriptions of his appearance and feelings, the doctors’ progress notes in his electronic medical records were filled with technical data. “Conversations with my physicians were infrequent, brief and hardly ever reported,” he wrote, adding:

“What personal care hospitalized patients now get is mostly from nurses. When nursing is not optimal, patient care is never good.”

Many hospital administrators have cut nursing staffs. They say it is to make ends meet; many doctors say it is usually to increase the bottom line.

Nurses’ observations and suggestions have saved many doctors from making fatal mistakes in caring for patients. Though most physicians are grateful for such aid, a few dismiss it — out of arrogance and a mistaken belief that a nurse cannot know more than a doctor.

In many ways, Dr. Relman’s insights reflect changes and generational gaps in training doctors, nurses and other health professionals. Because these disciplines have traditionally been taught in separate silos, they often do not work as tightly as they should.

Now, as health care financing changes and doctors spend more time training in outpatient settings, a growing movement demands coordinating the education of health professionals to prepare them to work more smoothly in teams. If these efforts succeed, perhaps the next generation of doctors will no longer be surprised at the importance of nurses and other allied professionals.

UNCONVENTIONAL NURSING

 

 

NAKED IN THE LABOR/DELIVERY ROOM

Written by Ruth DonoghueRuthie

Time: December in the early ‘90’s.

Place: Nursery in a Catholic hospital where 5,000 babies pass through in a year.

The call came from unit secretary.

A nurse was requested as soon as possible to pick up a baby in delivery/labor room three. (Every newborn baby was sent to the nursery to be bathed, examined and observed).

Request the nurse be naked.

I believed this was a religious event, since it was permitted in the Catholic hospital where I worked. It was a time when we were trying to be more understanding of other religions and promoting better relations. Recently our department had finished seminars on religious and lifestyle diversity. Any employee not willing to extend understanding would be sent for counseling. Since I was close to retirement, I volunteered to take the call.

I grabbed two surgical masks, stapled them together and applied them as a bra. Disposable mother mash pants served as bottoms. A heavy starched doctor’s coat was applied for traveling.

Upon arrival the whole family—mother, baby, grandma, grandpa, father and sibling—was present, smiling and naked. The doctor had managed to skillfully leave.

The thermostat was set at 90 degrees. I removed my doctor’s coat. Nobody noticed.

They allowed me to place their beautiful baby in a blanket. I quickly donned my heavy doctor’s coat and departed, pushing the baby in the crib.

It was an accomplishment because now I wouldn’t have to go for sensitively counseling in contrast to some others.

On a cold January day, a month later, in the hospital elevator, I encountered a couple, lightly dressed, carrying a baby in a blanket only. Smiling, happy and healthy. They didn’t recognize me.

THE AMERICAN NURSE PROJECT

The American Nurse Project aims to elevate and celebrate nurses in this country by capturing their personal stories through photography and film. Photographer Carolyn Jones and her team traveled to every corner of the U.S. to record the unique experiences of nurses at work. The photographs and narratives shed light on what it means to be a nurse in our country, and who the women and men are who have pledged their lives to the care of others. It’s a story worth telling—it’s a story we all should hear.

http://americannurseproject.com/about/