Standing strong with Alex.

Two years ago, I started this blog as a place to share my thoughts on the disparaging remarks made by the women on the talk show The View about nurses. Back then, I believed we, nurses, were on the path to educating the public as to what nurses do. Unfortunately, that has not progressed as much as I had dreamed of.

When the ANA posted a video of a Utah nurse being intimidated and arrested for advocating for an unconscious severely injured patient, I was outraged. How could this happen? I joined in on Facebook with strong remarks and a posting of my own.

I was dumbfounded that this story was delivered nearly last on the national news, behind gas prices and another tragic frat hazing. It seemed like the network executives threw that in, and only because it was blowing up on social media.

Think about this: what if you were that man burned and unconscious in a hospital? A police officer arrives demanding to take your blood sample. You are not under arrest, there is no court ordered warrant. You cannot give consent even if you were asked.

You can and should expect your nurse to protect you and your rights. That is what Alex Wubbels did. And for that she was manhandled and handcuffed. Then, a police supervisor arrives and continues to intimidate her, insisting he knows more about the law and she should do what she is told.

I feel we were watching 2 men who felt their badge gave them authority that should not be questioned. If they were within their rights, why did they not wait for the hospital legal and administrative team arrive to discuss?

I believe this is not only a gender issue, but an issue of hierarchy.  I can only wonder if they would have treated a male doctor with the same disrespect.  Nurses and women have not gained the respect they deserve in our society. We need to make it clear we will not stand for this.

 All nursing organizations, like the ANA and the Utah Nurses organization, need to publish very strong statements criticising this behavior and demand protection of  nurses advocating for patients. Law enforcement organizations should acknowledge that this is NOT acceptable behavior.

Legislators, you must create laws protecting nurses. By doing so, you protect your constituency. This is about making hospitals safe havens for the most vulnerable, the sick and injured.

I hope we don't have to organise a march of the  stethoscope wearing 3 million strong who not only give comfort but protect you when you need it most. But we will, if that is what it takes to keep our patients safe.

National Patient Safety Awareness Week

This week, March 12-18, 2017 is  National Patient Safety Awareness Week. Recently, I  took the pledge for Patient Safety  and I encourage you to do so too, by taking the Healthcare Professional Pledge , "I pledge to strive to implement and follow the practices that increase the safety of my patients and my team". This is an initiative of the National Patient Safety Foundation (NPSF).

These 2 very important leaders in health care improvement and policy have chosen this week to announce that the  Institute for Healthcare Improvement (IHI) and the NPSF have agreed to merge.  This is fantastic! These 2 organizations are working hard to improve patient care, and supports the importance of clinicians' role in identify systems' breakdown. See their video here IHI-NPSF-Announce-Merger.

These are tough times for health care. With so much unknown about what the future will look, and no matter what your political view is, we can all agree it is time to join forces and focus on what is most important. Patients! Every one of us got into to healthcare because we want to help people, and we want the best for our patients. Let's continue to work together.

Guest Post on https://thenerdynurse.com

I would like to Thank Brittney Wilson, The Nerdy Nurse, for having me as her guest post on her blog.

Transparency in Healthcare

Missing: nurses on governing boards

As a member of my state nursing association, I pay attention to the emails alerting me to legislation that is important to nursing. Recently, I was asked to send a letter to my state representative and senator asking them to endorse a bill that would require the governor to appoint a registered nurse to the Governing Board of the Health Policy Commission. This seems like a no brainer to me.

What I find frustrating is that nurses are not routinely invited to the board which makes policy decisions in health care. Why is that, I wonder?

Two years ago, the home health agency I worked for was integrated into a new Division that included a clinic and the ED. On that board of directors were physicians and physician's assistants. The VNA was 1/3 of this division and yet, the COO of the Division, formerly the VP of the VNA (an RN) and the Director of the VNA (an RN) were not on the board, nor were any Nurse Practitioners from the ED or the clinic.

I found this to be unacceptable, so I wrote to the President of the Division:  "As a home care nurse, I am excited to hear that (division's) goal is to provide “integrated, seamless care". We, in home care, have been trying to overcome working in silos to better serve our patients for quite some time. At (the VNA), we have been working diligently to improve care for our patients and our providers. I would like know why nursing is missing as a colleague at the board of directors? If we are to "achieve our goal as  a team", shouldn't the team be representative of all the service providers? Certainly, our home care division should be represented on this board, I can't imagine why it is not."

His reply: "Your question raises a great point as we build the (Division)  into an organization that focuses on improving the transitions of care in an effort to improve our patients outcomes and care experience.  I want you to know that I feel the Home Care Division will play a very important role in helping us achieve this vision and is currently represented at each Board Meeting.  The COO of the Division and former VP of the Home Care Division is in attendance at each Board Meeting and just recently we have invited the VNA Director to attend all future Board meetings.  Both the Board Chair, and myself will be working closely with (them) to ensure “the voice” of the Home Care Division is heard at our Board meetings and is an integral part of our strategic plans moving forward.

As we continue to build this new enterprise, we will also be looking at the Board structure and its members to ensure it is aligned with the vision we are trying to achieve.    I will certainly carry your suggestion forward as we do this work."

I checked again today, the VNA is no longer under that division and has reverted to its own division, as it was before the changes. I checked all of the Boards that lead the organization, lots of doctors but no nurses to represent the 1,500 nurses within the organization.  Apparently, it must be legislated to get nurses at the table. Excuse me, I believe it's time to email my legislators.


 3/9/17 Update: Today, I received a newsletter from the organization I was referring to in this post. I am thrilled to report, the organization has elected a nurse working at the organization to the board of trustees. Progress is being made!

Zika Zinger

Well, I have ended my 19 year stint as a home care nurse with a bang. The very last patient I called to arrange a visit informed me they thought they had "Zinker" Virus. Turns out it was probably food poisoning or some GI virus but definitely not Zika here in the northeast. With great restraint, I reassured the patient by educating them in the fine points of Zika and the usual symptoms (in which this patient did not have a single one). It reminded me of what my grandmother use to say when someone was whining complaining about coming down with some ailment. She would calmly reply " Well, if you want it bad enough, you can have it."
Good luck to all of you caring for our in hospital and community patients. I am sure we will be hearing this refrain a lot, I am afraid. And I am sure someone eventually will get Zika, but I am not so sure they really wanted it.

Dream Job

Today I am basking in that wonderful feeling of having landed the perfect new job. I am excited, nervous, and anxious to begin. I will be leaving an organization I have worked for the past 19 years. I've worked in several positions there;  some staff, and briefly in management. But, it is time for me to move on.

I am no stranger to taking on a challenge. This will be the most challenging yet. All those other experiences have taught me I can do this. Imagine becoming an OR nurse right out of nursing school! Yup, did that. Then, 2 years later I walked into a busy Boston hospital, thinking I was experienced enough for that. Of course, I found out it was like starting all over again.

Later, after I became an expert in that field, I longed to be a critical care nurse. How naive I was to think I could do that job. But learn it I did. And for 15 marvelous years I worked with the best group of nurses I have ever met.

Of course, commuting to the city was taking up too much time away from raising my girls. So, on to home care I went. I remember looking into that blue bag with a stethoscope and blood pressure cuff and thinking I had lost my mind. I was going to take care of cardiac surgery patients discharged home after 5 days! However, that experience was the most rewarding of my nursing career. I learned that my assessment skills went way beyond the technology I was use to relying on.

Now, I will be going back to the technical. This position will be improving patients early recovery at home with new technology. It seems I have come full circle.

Are we making progress?

Are we making progress in nursing on incivility and lateral violence. I hope so. Every nursing publication and web site I subscribe to has brought it to the forefront. Since nursing has once again achieved the most trusted profession, we have  a lot to live up to. Treating each other with respect and kindness has a rippling effect. Let's pay it forward to one another. We've worked too hard for too long to let bickering amongst ourselves tarnish this great opinion others have of us, because we are better than that.

The Magic Word

Ok, time to get back into this blogging thing.

So today, I am reflecting on The Magic Word or actually words, for dealing with unpleasantness found in this little video. I saw this on Workplace Diva' s blog. I must remember these the next time I find myself in a distressing situation.

https://youtu.be/g5RknemM8Hw

How many times have I been insulted by patients or their family members? Too many times, and afterwards I am left wondering
1. What did I do to provoke them?
2. How could I have handled that better?
3. How can I fix this relationship so we can work together harmoniously?

I know I will continue to work with patients, families, and co-workers that I don't like, but I know I can make it  work if I can understand where we went wrong.

"That's interesting, tell me more." Or "That's interesting, why would you say that?"  Are definitely great ways to get the conversation going and find out where that person is coming from. Then, I can turn the relationship around  (pun intended). Simple, yet effective.

Health Care Conundrum

There is a quandary that comes up frequently for me as a visiting nurse.  It occurs when a patient has been hospitalized for a life threatening illness, recovers and is sent to a rehab/skilled nursing facility to convalesce. When discharged home the patient is given the meds that remain from a 30 day supply used in the SNF, but no prescriptions.  It is expected they will see their own doctor to get their prescriptions.  Usually, these patients have not had a primary care doctor prior to this event.

I call and plead with the physician to call in scripts to the pharmacy so the patient will not suffer a relapse.   Most insist on seeing the patient first, I can understand that. What frustrates me most, is when the patient sees a provider who is not the pcp, and they do not write the patient any scripts. The patient is told to get them from the PCP. The number one reason patients get re-hospitalized is not taking their medications correctly or in this case not at all.

This reminds me of our yearly safety teaching.  Every year we are asked "Who is responsible for safety?" The answer is " everyone".  So I ask, who is responsible for making sure there is continuity of care? All of us. If health care providers truly care about improving outcomes and lowering the cost of medical care, they need to stop passing the buck. There has to be a change in the culture of medicine that puts all the responsibility on the primary physician. No patient should be left behind.  No patient should have to navigate our complicated web of health care alone.  Everyone is accountable. Everyone should treat the patient in front of them as if they are their primary patient.

This happens in nursing, too. How often have patients been told they have to wait for their assigned nurse to minister to their needs? Too often.  It also happens in home care. Nurses visiting patients as a substitute for the primary nurse sometimes leave important tasks for the primary nurse to complete. This is not the expectation and holding those accountable has proven difficult.

What is the solution? I think we need to hold each other accountable and making the commitment to putting the patient first and foremost.  When we do all we can to assure the patient is going to be successful in mastering their health challenge, patient satisfaction will rise, emergency care will decrease, and costs will become more manageable.

Its not difficult, and its the right thing to do.

Learning from mistakes

Failure is a great teacher and motivator.  We are all afraid of making mistakes or looking foolish, myself included.  But I have to remember that no one tries something new and masters it on the first attempt, so why should I expect learning about blogging would be any different? 

I am no stranger to taking on challenging assignments. When I graduated nursing school I started out working in the Operating Room of a community hospital.  I had no idea what I was getting myself into.  Many a day and night I was terrified I would make a mistake.  I did not have a preceptor and I was expected to figure it out.  After 6 months, the head nurse informed me my performance was sub par.  I had to agree with her, I offered that I was trying as best as I could to learn the job by reading OR texts and observing as much as possible, but without more support, I could not learn the job.  She agreed and with more support I was able to take on any assignment with confidence.  Eventually, I moved to Boston, where with support and experience, I mastered the role.  Several more times in my career, I moved into areas that required special skill sets. The key to success for me has been to get past my fear of failure and working hard to mastering new skills.  

I have lived through the dawn of electronic charting.  For those of you who have always charted in a computer, you may not be aware of the difficulty it was to transition.  Great and experienced nurses were reduced to tears and some even quit nursing.  Even for those of us with some computer skills, the software was poorly designed and did not take into account the needs of the clinician.  This was before Informatics Nurses and why informatics became a specialty.   About 5 years ago, the organization I work for  changed over to a new computer software package.  The leader in charge of educating all the staff in using the program had a saying “You have to make the same mistake six times before you can master it”.   At the time, I found that prediction to be very annoying, but unfortunately, she was right.   I would keep making the same mistakes until finally, I figured it out and it became second nature.  

So here I am, making the same mistakes over and over again.  This time, that prediction of making  mistakes  before mastery is more amusing to me.  It has helped me to be more patient with myself as I try to master the skill of blogging.  Just using the blog program is a struggle for me. The writing is easy and fun, but creating the page is a whole new skill set.  Blogging has opened up a whole new world for me of what is going on in nursing.  And for that I again thank The View.  If they had not started the firestorm over Kelley Johnson's monologue, who knows how long it would have taken me to discover all those great bloggers and try it for myself.

Practicing my new blogging skill, adding hyperlinks

  I love this site, Better after 50 has great relationship, fashion and health tips. Besides being very funny, it is geared to those of us who are of a certain age.





My favorite nursing blog is The Nerdy Nurse, this is where I did my research on blogging, I still have many more to view.

Becoming a Deviant

I recently learned about an interesting concept: “positive deviant”.  I first read about it in Atul Gawande’s book:  better: A Surgeon’s Notes on Performance,  How can someone be a deviant and positive?  I realized that that is my bias, in my mind deviants are bad, criminals, rule breakers. What I learned is that positive deviants are those who are doing something well, or “make a worthy difference”.   

Isn’t that a beautiful notion? How different that is from my definition. It reminds me of how I enjoy it when my library books are overdue and the librarian tells me I am “delinquent”.  All my life I have been the good girl, the rule ranger, Miss Goodie Two Shoes.  Being a deviant or delinquent feels risky and exciting.   I don’t mind being a deviant or delinquent if it means I am becoming a better person or nurse.  

Atul Gawande gives 5 suggestions for how one might make a worthy difference. I love them all. I am familiar with them and have been working on them individually, but I never put them all together as he did.

1. Ask an unscripted question.  This is the best part of my job, getting to see patients in their homes and learning about them as individuals.  Just as he describes, I am often pressed for time: the cell phone rings or the pager goes off in the middle of taking care of a patient, I am already 30 min to an hour behind, I have calls to make and other patients to see.  But, I make time to talk about something completely unrelated to my purpose, it is the best part of my day. It does “make the machine feel less like a machine.”

2.Don’t complain. Gawande is completely correct here, no one wants to listen to the complaining. Not your spouse, or your boss, nor your colleagues, and it does “get you down”.   This one I am still working on. Having seen it written in the book as eloquently as he wrote, makes me realize I need to work harder on this one.

3. Count something.  I realized that a long time ago, just keeping track of something was a way to get me thinking of how to work on the problem.  I like to do math in my head, it is a satisfying exercise. I think it also makes your brain mull the problem over and search for solutions.

4.Write something.  My husband remarked the other day how I rarely ask for him to proof my papers I write for school.  When I was completing my BSN 20 years ago, I would suffer trying to put my ideas on paper and he was an enormous help at the time.  Now, I volunteer to write, I feel very comfortable with writing.  My first experience with journalling was in one of my grad school classes.  I enjoyed it and I meant to continue, but… life, school, work got in the way.  After losing someone close to me, I took up journalling to process the conflicted and painful feelings I have. This is another example like don’t complain, people around you, no matter how much they care, get sick and tired of hearing about your grief.  Except for those who share in the grief.  However, we try to lift each other up more than use one another as a sounding board. 

5. Finally, Gawande suggest we Change.  I do so want to be an early adopter, I want to make positive change, count my successes (and failures), write about it and not be afraid to ask people what they think.  I do so love school, it gives me an opportunity to explore ideas I would not normally explore and challenges me in ways I would never challenge myself. I am sharing my reflections as Gawande suggests.  “The published word is a declaration of membership in that community…”.

Why nurses should be thankful that The View insulted nurses.

The View, inadvertently, has given nurses across the country a platform to share what is that nurses do and how they feel about nursing. Every day we go quietly about our business taking care of patients as if they were our own family members. It is high time the public got an education about what we as nurses do, how dedicated we are to our profession and how important we are to their health. If the View stars had not made their insulting remarks, Miss Colorado's monologue would have faded away.  It is because of those careless remarks, millions more watched her performance and were treated to a wonderful example of  what it means to do the work of nursing: caring. Not only that, nurses rose up to support one of their own, they found their voice to express what it means to be a nurse. I have never been prouder to be a nurse than I am now. Let us hope this camaraderie continues and spills over into treating each other better. Just as we did not stand for anyone to diminish one of our own, we must not allow lateral violence and incivility among our ranks.  Now that we know others are listening and are interested in what we have to say, what should we speak up about next? Safe staffing, creating a better work environment ? What do you think?

10/03/15
I was happy to find this answer to an interview question on the The Mighty Nurse

Mighty Nurse: If you could say one thing to the women on ‘The View’ what would you say? 

Kelley: I would say thank you. They have unknowingly banded an army of nurses together, given new life to our profession, and provided an opportunity to educate the world on the importance and necessity of each role within the healthcare team