I’m a Nurse, not a Saint


Priest (Photo credit: Wikipedia)

I am continually amazed and astounded by the things patients feel comfortable saying to me. It’s as if they think a nursing degree is equivalent to a counseling degree, a white set of scrub pants akin to a white collar, and a hospital or outpatient clinic room is the same as a confessional. It’s not.


Confessional (Photo credit: cliff1066™)

Don’t mistake my words for a renunciation of confidentiality. My lips are sealed when it comes to protected health information and you, but, as in real life, there are times when people provide too much information. I’ve provided some examples so you can judge whether you need to be a little more discreet on your next hospital or doctor’s visit.

When I ask you to undress down to your underwear and cover yourself with a sheet, you don’t need to tell me, “I don’t wear underwear.” That is a surprise best left for the doctor. I’m not coming back in to check that you disrobed appropriately.

If I ask you to take off your shoes to be weighed, don’t apologize for the holes in your socks. Our office is only responsible for checking sock holes on alternate Thursdays in months that end in -Z. Any other time, don’t worry. We won’t be putting it in your permanent record nor will I be calling your mother (or the Emergency Room) to rat you out.

If I come in with an shot for your child, don’t tell them it won’t hurt. Chances are it will. I’ll try to minimize the pain, but since I can’t tell them to “suck it up, buttercup,” I’m hoping you’ll have your big girl panties on and shush them rather them tell them you’re sorry the “mean nurse” hurt them.  The mean nurse can’t do shit unless you give me permission, but I’m not telling your toddler “your mean mom made me do it.”

If I do a cervical check on your pregnant girlfriend, don’t ask her if she’s enjoying it. She’s not. Neither am I. Creep.

Never ask me to rub “extra hard” down there if you’re unable to clean yourself off. There are non-medical devices and non-medical personnel who can meet your needs much better than I can. Once you ask, the only “happy ending” I’ll think of is your discharge or death.

Don’t ask if you can strip down to your underwear to ensure your weight is “accurate.” I personally don’t want to see you half naked and believe stripping down for non-medical reasons should happen in your home, not in the exam room.  You can buy your own scale for the cost of a co-pay.

Going Down?

Going Down? (Photo credit: billhd)

Don’t expect me to believe that you need an early refill on your methadone, oxycontin, oxycodone, percocet or vicodin because the bottle you just filled fell into the toilet with the cap off, ruining all of the pills. Unless a major study at a prestigious medical center proves that toilets have a preference for narcotic painkillers, I’m suspicious. This never happens to anyone’s heart, allergy, or diabetic medicine. If you have to lie, go big or stay home. Don’t let drugs kill your creativity.

Remember I’m a nurse, not a saint.

Patient’s Rights Shouldn’t Be at Nursing’s Expense

Group of nurses, Base Hospital #45

Group of nurses, Base Hospital #45 (Photo credit: The Library of Virginia)

Providing nursing care is an intimate business. Nurses are at the bedside for births, life-threatening injuries, chronic conditions, and death. They become familiar with both a patient and their family. Helping people navigate these life changes takes compassion and empathy. There are days it is damn hard to be a nurse.

Twenty-four hours a day, seven days a week, if you’re in the hospital there will always be a nurse on-site. Budget cuts, staffing issues, increasingly complex machinery and treatments all contribute to the stress that nurses must deal as well as twelve-hour shifts, mandatory overtime, and working holidays and weekends.  Nurses are expected to keep patients safe, use resources wisely, and provide culturally competent care. The nurse is required to respect each patient as a person.

That makes it even more distressing when a hospital disrespects a nurse and her rights as in a recent lawsuit against a Michigan hospital.

The lawsuit alleges that a nurse of 25 years standing in a Neonatal Intensive Care Unit was told by her supervisor she would no longer be assigned to care for an infant because the baby’s daddy didn’t want African-American nurses caring for his child. The man showed the supervisor a swastika-type tattoo in relating his request. According to the lawsuit, the baby’s chart was prominently marked to indicate no African-American nurses were to be involved in this infant’s care. This was honored for a month before the hospital attorney stepped in and had the notation removed.

English: The Neonatal Intensive Care Unit (NIC...

English: The Neonatal Intensive Care Unit (NICU) at Kapiolani Medical Center in Honolulu, Hawaii (Photo credit: Wikipedia)

I don’t know what the hospital was thinking, other than to make the customer happy, but they should have told the man that they weren’t going to allow his hateful beliefs to compromise the care of his child and demean their employees. They could have offered to transfer the child to an institution willing to make those choices, if they could find one. They could have had their Ethics Board review the case and come up with an appropriate plan of care that didn’t imply that African-American nurses were any less competent, worthwhile, or caring than their white, Hispanic, or Asian counterparts. They could have done something.

Woman at work--registered nurse

Woman at work–registered nurse (Photo credit: yooperann)

Instead they bowed down to the demands that were not only hateful, but illegal. If the allegations are true, for an entire month qualified, trained nurses were told they weren’t the right color to provide care and that’s just plain wrong.

When Your Employer Won’t Take No For an Answer

English: This is CDC Clinic Chief Nurse Lee An...

English: This is CDC Clinic Chief Nurse Lee Ann Jean-Louis extracting Influenza Virus Vaccine, Fluzone® from a 5 ml. vial. (Photo credit: Wikipedia) You go, girl!

The recent firing of 8 healthcare workers who refused to get a flu vaccination at Goshen Hospital in Indiana is not surprising. As influenza season kicks into hyper-drive, hospitals unleash the latest public relations strategy in making patients believe they are safer – mandatory flu vaccination for healthcare workers. The reasoning is that hospital inpatients are already vulnerable to infection and preventing healthcare workers from infecting them, because the healthcare worker has immunity due to the flu vaccine,  will save lives.  This mindset has a few flaws.

First, the flu vaccine is not 100% effective. That’s not to say I don’t get one myself, but, as the Centers for Disease Control (CDC) website points out:

“The effectiveness of influenza vaccines varies from season to season, and depends upon a number of factors. One factor is how well the vaccine strains match the viruses that actually circulate during the season. In addition, vaccine effectiveness is affected by the recipient’s age, immunocompetence, and previous exposure to influenza viruses.”

No 100% guarantee there.  In fact the CDC notes,  “Recent RCTs (Randomized Control Trials) of inactivated influenza vaccine among adults under 65 years of age have estimated 50-70% efficacy during seasons in which the vaccines’ influenza A strains were well-matched to circulating influenza A viruses,” “a study of Dutch community dwelling people aged 60 years of age and older reported a vaccine efficacy of 58%” and “study among 92 healthy adults aged 18–41 years, the efficacy of inactivated and live attenuated influenza vaccines in preventing laboratory-confirmed influenza was 71% and 85%, respectively.”

With the average age of registered nurses at 46 and doctors at 51, I’d guess the vaccination effectiveness is in the 50-70% range. Oh, and did I mention if you’re going to get immunity,  it can take up to 2 weeks after the shot to get immunity?

Even if it did confer immunity to 100% of the healthcare workers who received it, they are not the only carriers of influenza. Since the infected are able to infect others one day BEFORE getting symptoms and up to seven days AFTER getting sick, think of all of the other traffic in a hospital including visitors, admitted patients, and vendors. Are they all vaccinated against flu? Who knows. Can hospitals require them to receive vaccination? I’m guessing the answer is no. This means in a perfect world, with every healthcare worker not only immunized but also immune, there would still be potential flu carriers wandering the halls every single day. Since the flu can be spread to others up to six feet away, a vendor or visitor at the nurses station can infect a patient who is walking nearby for physical therapy. Unless hospitals go into lock-down at the start of flu season, a strategy of mandatory vaccination leaves plenty of room for infection.

Forcing people to get immunized for flu or lose their job is easy. In my book, proving that it is the best and most effective option to save patient lives is a little bit harder. Having worked in a number of healthcare institutions, I know most healthcare workers work sick for a number of reasons including managers who penalize them and co-workers who resent working short-handed. I also know that hand hygiene, considered the baseline measure to prevent the spread of disease, is nowhere near 100% in organizations. Instead of picking the low hanging fruit of vaccination, organizations should look toward preventing all healthcare acquired infections. I’d love to see someone fired for not washing their hands.

Instead, Goshen Hospital fires 8 out of 1300 people who refuse vaccination. It makes me wonder about the 1292 workers who didn’t get the vaccination, but were allowed to keep their job. Maybe the excuse was they don’t provide direct patient care. Maybe the hospital couldn’t take the financial hit of losing certain positions, such as doctors, surgeons, and top administrators.  Firing front line staff, such as nurses, therapists, housekeepers and food service workers,  has always been easier than the politics of firing the rainmakers of healthcare.

Perhaps this is just the first salvo organizations will fire in the crusade to show their commitment to patient safety. Imagine a hospital website proclaiming, “100% flu vaccination rate” instead of “71% rate of compliance with washing hands between patients.”  The illusion of safety provided by mandatory immunization shouldn’t be confused with the reality of 1.7 million hospital-acquired infections and 99,000 associated deaths each year.

For now, firing a few employees for show will have to do. I know I feel safer.

Fired red stamp

Fired red stamp (Photo credit: Wikipedia)

Let’s Call A Dick A Dick

English: "No Swearing" sign along At...

English: “No Swearing” sign along Atlantic Avenue in Virginia Beach, Virginia. (Photo credit: Wikipedia)

For me, fall is a time of reflection and contemplation. I don’t know why fall has such an effect on me, but nine out of twelve job changes have occurred during the fall. While dusting off my resume recently, I looked back and thought about how lucky I am that I can count the number of disruptive physicians I’ve worked with on one hand.

Disruptive physician is code for doctors who are dicks. Whether it’s the surgeon who picked up a nurse manager and put her down in a sink or the neurosurgeon who had to be removed from the Operating Room by the police after flipping out when his request to use unsterilized instruments on a patient was ignored. Some doctors believe they can act in ways that would get them punched or arrested in the real world, but in the hospital, they can do no wrong.

The problem is so pervasive that in 2009  The Joint Commission, a voluntary accreditation agency for hospitals, started requiring hospitals to have standards in place and procedures to deal with disruptive behavior, including physician disruptive behavior.

Unfortunately, some physicians believe there is an ulterior motive to disruptive behavior policies. In 2008  American Medical News.com has these two quotes:

“If somebody’s not a ‘team player,’ individuals will try to remove them from the team, and the disruptive physician policy is one mechanism by which that can be done,” said Dr. Gregory, a general surgeon and trustee at the Muskogee Regional Medical Center in Oklahoma

Interesting perspective. I’ve just never worked in a hospital that targets well-mannered, kind, respectful physicians who aren’t team players.  Oh, unless not being a team player is a code word for a doctor who’s a dick.

During my nursing career, I’ve had a surgeon approach me in the nurse’s station and loudly yell that it was my job to fill out the preoperative consent and, when I refused, accused me of doing it for the other surgeon.  He thought the nurses played favorites.  Luckily that was at a hospital where our policy was to laugh at dicks in person and hang up on them when they called. Really.

I’ve also had a specialist scream at me in a hallway because no one told him I would be observing in the clinic he worked in that day. He (not the owner of the clinic, just another hospital employee) didn’t think anyone should be allowed in the clinic without his permission. Every time I tried to (politely) interrupt, he yelled louder until I walked away.

Did these doctors suffer any ill consequences from their dickish actions? No. Most hospitals will forgive physicians who bring in business. Sort of like your top used car salesman. If he sexually harasses the secretary, do you really want to lose him to keep her?

Instead of trying to get rid of disruptive physicians, most hospital administrators would rather keep the doctor. Even when there are multiple complaints. Even in the face of staff turnover. Even when patients get hurt because of the doctor’s behavior.

When doctors whine, yell, threaten and bully other healthcare workers with questions or concerns, those questions and concerns are going to dry up. Pretty soon no one’s going to be calling them in the middle of the night to deal with a rapidly deteriorating patient because no one wants to take the verbal abuse. Rapid response teams were formulated because too many patients died while physicians blew off concerned hospital staff and family members.  That’s why in a hospital with three wrong side brain surgeries, no neurosurgeons lost their jobs. Instead the nurses were told not to give the scalpel to the surgeon until he verified he was on the right side or the nurse would be punished. When that didn’t work, they hired staff to go into operating rooms and monitor that doctors were properly identifying the correct side.

There is a price to be paid for healthcare’s refusal to address the problem of disruptive physician behavior and the price is paid every day by patients as well as by the people who leave healthcare careers. I think that calling the problem what it is might be a step in the right direction.

Let’s call a dick a dick.

Keep Your Merit Badge, I’m Not a Boy Scout

Portrait of Miss Georgina Pope, head nurse of ...

Portrait of Miss Georgina Pope, head nurse of First Canadian Contingent during the Boer war. Possibly in her nurse’s uniform from Bellevue Hospital, New York (Photo credit: Wikipedia)

Last week Nurse K posted on her blog about a patient‘s last phone call. Read it here.

After wiping away some stray moisture from my eyes and clearing my nose (allergy season, you know), I thought about the moments that define us in our healthcare role.

Hospitals seek out touching stories to bolster their application for Magnet status or adorn their website. Their stories of how the healthcare staff went above and beyond to help a patient usually end up being fairly run of the mill. More in the vein of “the nurse took the time to ensure I knew how to make the bed go up and down” and “the food service staff cheerfully exchanged my tray to accommodate my gluten-free diet” than “someone did something totally unexpected and above/below their pay grade that mattered.” In my hospital experience of being on the receiving end of management’s praise, I’ve found the successes I’ve been credited with are the ones that least define who I am as a nurse.

I was acknowledged once for my help in cleaning up flooded exam rooms after someone left a faucet running over a weekend. The sad truth was administration had made deep cuts in the housekeeping department and there was no one available to clean up the mess. I picked up a mop and started in because we had a waiting room of patients to be seen. Eventually the housekeeping supervisor, embarrassed at his lack of employees, showed up to help. Administration congratulated our team effort to fix the problem. I got official recognition for going above and beyond and a free lunch in the cafeteria. Rather than being thrilled with the “honor,” I was incensed. Of all of the things I did in my job that were truly worthy of recognition, I got an attaboy for pushing a mop for two hours. Two hours I wasn’t available to triage or educate patients. Two hours I didn’t use any of my nursing skills. That is what administration deemed worthy of recognition.  It didn’t go over well when I told them instead of praising me, they should be asking themselves why they didn’t have enough housekeeping staff to handle emergencies.

Instead of addressing the underlying problem many of us face, too much to do with too little time and staff to do it, hospitals try to boost morale with meaningless honors and remain oblivious to the day-to-day things that really matter. And though we are more than willing to share our crazy stories, commiserate over the sad ones, and bemoan the incompetence of administration, we’re not willing to let down the walls and talk about the parts of our job that hit us in the gut and the situations that make us turn our heads so the patient can’t see our tears. We’re professionals. That stuff isn’t supposed to get to us.

But, it does. It stays with us.

And they are the moments I don’t offer up to the public relations machine of the hospital and I suspect many others do the same. Moments that remind us there is more to our job than tasks and checklists and documentation. Moments when we know that our lives will go on, but our patient’s will be changed forever. Because sometimes, in the confusion, turmoil and noise of our professional lives, we take a step back and do the right thing.

Those are the moments that define us.