Are You a Good Samaritan?

Our local newspaper has a daily feature, snidely referred to as the Whine Line, whereby readers may call a number and comment on any subject they like. The caller doesn’t have to identify himself in any way (although I’ve wondered if the newspaper office uses Caller ID), nor is the caller required to have his facts straight regarding the subject about which he comments.

The newspaper then chooses certain comments—the most outrageous, the most sensible, the most humorous—on a variety of subjects, and prints them in the newspaper. Complaints make up the bulk of the calls, but occasionally a positive remark, or two, will break through the wall of negativity. One of the calls in yesterday’s paper was from a woman who had fallen on a downtown sidewalk a few days earlier. She called to thank the RN who had stopped to assist her, remarking that the nurse had been a great help.

It got me thinking about jumping in to help strangers in accident or other medical emergency situations. I have never come across a life or death situation but I have stepped up to help with several non-life threatening injuries. I tend to be cautious and assess the situation before I offer my services. Be assured that I would move more rapidly in the case of a severed artery, for instance, but in these less serious cases I like to see how things are shaking out before I make my move.

My hesitancy stems from having worked in the days before Good Samaritan Laws were common. Back then, if a medical person helped in an emergency situation outside the hospital and there was a bad outcome, a civil law suit was not out of the question.

All states now have some version of a Good Samaritan Law. They are designed to encourage people to offer assistance to those in need of help by reducing the fear that, if they do so, they could be sued in the event that they inadvertently make a mistake that further harms the person they are attending. The laws also serve to legally protect rescuers in the same situation. The laws vary from state to state. Nevada’s apply to all citizens, while California’s are written specifically for physicians.

My husband is a bicycle racer who seems to have a knack for crashing while out riding alone on training rides. In the process, he has managed to break a number of ribs, a toe and clavicle, puncture a lung and acquire an abundance of scary-looking road rash and lacerations. Someone has always stopped to help him.

When I arrived at the scene of his last crash, less than a year ago, I found three people, including a RN, tending to him on the side of the road. I’m grateful there are folks out there who are willing—and I suspect that is most of us—to help when the occasion presents itself.

Do any of you have Good Samaritan stories to share?

Veteran Denied Admission Due to Family's Bad Behavior

There is almost always more to any situation I read about in the newspaper than is revealed in the article, but I am troubled by an item that appeared yesterday in my local paper. The as yet unresolved story is playing out here in Colorado, where I reside.

An 88-year-old WWII veteran, a survivor of Japan’s attack on Pearl Harbor, is being denied admission to one of six state-operated nursing homes dedicated to the care of veterans and their spouses. The reason? The nursing home administration says that during the veteran’s six-day stay at the nursing home in December of 2006, one or more (the article didn’t say) of the veteran’s family members were unpleasant and difficult. Administration feels they have the right to deny admission to anyone they deem a bad fit with their nursing home community. The nursing staff concurs.

The man suffers from Alzheimer’s and other physical ailments. When he falls at home, his 83-year-old wife can no longer lift him, or even assist him, off the floor. His care has become more than she is able to give and it is taking a toll on her health, as well. The nursing home suggests the family seek admission to a facility 45 miles from their home. If placed there, his wife could no longer drive to see him, something she could do daily if he were cared for locally.

It must be noted here that much of the state of Colorado is remote and rugged. Compared to many other states, there are few large cities and the smaller towns are widely scattered, with large, sparsely populated areas between them. This describes the area where the veteran lives. There are, therefore, no other practical or convenient care options available to this family.

The veteran’s son admits that, because of a bruise on his father’s body, he did accuse the nursing home of physical abuse and also suggested the possibility of sexual abuse. The son feels his parents are being punished for his actions.

I have never worked in a nursing home. Is it common practice to admit, or not, based on the compatibility of the staff with the patient and/or the patient’s family? I agree that a tough job is made tougher when dissatisfied or hard-to-please families are thrown into the mix. But, three things bother me about this situation. One: the facility is set up to serve veterans and the man is a veteran, so serve him. Two: it seems cruel to separate these two elderly people who, based on their ages and fragile physical states, might not have much time left to spend together. Three: are we not allowed to question the care our family members receive?

It will be interesting to see how this situation is resolved.

Want to Trade Places With a Nurse in Baghdad?

I recently read an account of an American RN who accompanied her freelance writer husband on his one-year assignment in Baghdad and her attempt to find work there as a nurse. Her aim was to help, by the presence of an extra pair of trained hands, an understaffed medical facility and perhaps impart more advanced techniques to the existing staff.

She hit dead-ends at every hospital at which she inquired. What it seemed to come down to was that hospital directors feared having an American on staff would bring about hostility and make their hospital a target for retaliatory bombings.

In the course of her job search, the nurse observed conditions within the hospitals. Because there is a war being fought there, none of her observations come as much of a surprise. But, how much thought have any of us in this country, so fortunate to have the most cutting-edge of everything, given to what working in those conditions might actually be like? It’s easier to just not think of it.

The war has affected health care in Baghdad on every level. Hospitals, because of war-related injuries to civilians, are terribly overcrowded and having to treat horrific injuries without proper supplies and equipment. There is a shortage of everything. Most equipment was significantly outdated to begin with and, now, when equipment breaks down, it is virtually impossible to find anyone who can repair it, let alone replacement parts.

The hospitals are short-staffed, complicated by so many things going on in the city. Nurses often can’t get to work because of roadblocks that pop up as a reaction to terrorist acts and curfews that don’t exempt health workers.

The nurses who do manage to get to the hospital are assigned total care for 10 or more patients, a task made more daunting by entire large families crowding around the patient and impeding the nurses’ ability to do their jobs.

I know the US is not Iraq. We want, expect and deserve the best working conditions. We are spoiled. That’s not a criticism, just a fact. A fact I never even consider until I hear of the hardships under which nurses in other parts of the world must work. I’m not saying that forced overtime, understaffing and numbers of other issues aren’t important. They are. But, Iraqi nurses, no doubt, would gladly trade their problems for ours. The comparison certainly brings about a different perspective for me and I need that thump on the head from time to time.

Medicare Says No Bread for Blunders

Medicare has announced that as of October 1, 2008 it will no longer reimburse hospitals for extra patient care costs brought about as the result of certain oversights and errors that Medicare deems preventable.

The tightening of the Medicare purse strings is, no doubt, bringing administrators disturbing visions of dollars sprouting wings and flying out of their hospitals’ coffers. Hospitals will not be allowed to charge the patient for the additional costs of treatment brought about by those errors, either.

On the do-not-pay list are urinary tract infections from catheters, bloodstream infections from using catheters, falls, pressure ulcers, objects left in a patient during surgery, transfusions of incompatible blood, air embolism and mediastinitis following heart surgery.

Given that the extra-care costs can add an additional $10,000 to $100,000 to a patient’s tab, hospital bigwigs will not be sitting idly by, hoping for the best. We won’t know for a while what changes will be in store for hospital personnel once administration decides on ways to staunch the hemorrhaging of money.

Obviously, there is already protocol in place that should keep most of these errors from occurring, but failure to follow that protocol, or the need for more effective safeguards, has resulted in too many oversights and errors.

How can this be fixed? What can be done that isn’t being done now? I wonder how it all will affect nurses? It seems it can only be a good thing for patients, as any steps taken (other than staff reduction, which would be counter-productive) will be directed toward patient safety. Nurses and other health care workers will certainly be asked to assist in revamping procedures and be held more accountable for safely carrying them out.

Let’s hope for wise and thoughtful decisions leading to safe and effective changes. We need to eradicate that oft-heard saying, “Hospitals are not safe places for sick people.” It goes without saying that we want our patients helped, not harmed. And, let’s face it, if new measures don’t work, hospitals will find ways to cover the lost Medicare revenues and that means that the costs of other services are then bound to climb even higher.

The Need to Keep Aging Nurses in the Work Force

Baby Boomers, those born from 1946 to 1964, make up 29-percent of the American population. There are about 75 million Boomers in the United States and they comprise the country’s largest age-related demographic. This year, 2008, the age range of Boomers is 44 to 62. The Boomers are growing old. Thanks to medical advances, they will also be living to increasingly advanced ages.

Guess who else is growing old (in working world jargon)? About 30-percent of practicing nurses nationwide are over the age of 50. I am a Boomer myself and I see a problem. Certainly, I've not discovered anything new but the problem becomes scarier when it becomes personal. At precisely the time I’ll be reaching an age when I likely could need more medical care, one-third of the nursing work force will reach, or be approaching, retirement age right along with me. We all know that the supply of new nurses is not keeping up with demand, so the nursing shortage will become even more critical as these older nurses leave the profession. So, who is going to take care of me?

The answer to that question is up in the air and probably will continue to float around up there for several years. For one thing, there is not a single solution to the nurse shortage, nor will there ever be. Solutions will have to come from a multitude of directions, focused on individual facets of the crisis.

To help chip away the problem comes the Aging Nurse Project at Massachusetts General Hospital, the brainchild of 64-year-old RN, Ed Coakley. Simply put, the project takes information gleaned from interviews with older nurses, evaluates their concerns and develops plans to mitigate issues the nurses find disquieting. It turns out that a significant number of older nurses want and, in some cases, also need to continue working. But, they have concerns about the physical demands that are inherent to the profession, particularly lifting and moving patients. They fear back injuries and the lack of stamina required to perform their jobs well.

In an effort to retain that group of nurses, some hospitals have made concessions for them that include shorter work shifts and flexible hours, retraining for work in less strenuous work settings and pairing them with younger nurses to create a more functional intergenerational staff.

All are forward thinking moves that the Boomer nurses are embracing. Massachusetts General reports that about a third of its nursing staff are over 50 and their turnover rate is about 4-percent, a good indication that the older nurses are happy with the changes and content with their jobs.

I’m impressed by the willingness of the hospitals to be flexible and to seek and initiate these changes. Despite their having little choice, really--all are scrambling to maintain staffing levels--it is always a challenge to move away from the procedural norm. The changes are not the be-all and end-all in fixing the nurse shortage but they make perfect sense and are proving to be effective. Maybe there’ll be a nurse to take care of me--and you--after all.

Double Standard in Dealing with Incompetence

I admit I wasn’t a fly on the wall in the labor and delivery suite of Kaiser Permanente Hospital-Fresno, where a series of negligent decisions and actions by a perinatologist there were witnessed and reported by not just one, but several, nurses and other staff.

Nor was I a fly on the wall in the administrative offices of Kaiser-Fresno where, it seems, those in charge decided not to take immediate action against the doctor, even in the face of repeated complaints going back at least as far as 2004.

True, I am not privy to all the details. I do know, though, that two infants died. I know that despite Kaiser-Fresno’s mid-2005 mandate that the doctor be supervised by another physician or advanced practice nurse, and a 2007 requirement that he be accompanied on rounds by a high risk nurse specialist, he did not comply. I know Kaiser-Fresno failed to actively enforce the restrictions placed upon him by hospital administration, even as nursing staff continued to report many incidents of non-compliance.

A spate of complaints to a national health agency by nurses, patients and medical staff resulted in the agency’s investigation of the issue, beginning in October 2007. In a recently released report, the agency cited both the hospital and the doctor for gross negligence resulting in death. As a result, a hospital administrator has resigned and the California medical board is seeking the revocation of the doctor’s medical license.

Can any of you imagine that a hospital administration, presented with repeated evidence of a nurse’s negligence or blatant endangerment resulting in the death of one or more patients, would allow that nurse to continue working for several more years, collecting even more perfomance complaints along the way? I can’t. I feel certain that the nurse would’ve been shown the door early on, and rightly so. What’s up with that? Why the double standard? Do hospitals fear taking a hard line with doctors because doctors wield more power than nurses? Doctors and nurses should be held to the same performance standards. In light of hard evidence, hospitals need to grow a spine and protect their patients by dismissing—and quickly—incompetent and reckless physicians. Lives are at stake.

Parent-Shift Options Lure Inactive RNs

Nursing, particularly hospital nursing, has long been viewed by working moms and dads as an ideal job for giving them the flexibility to pursue a career and to spend time at home with their children. Three-day workweeks (12 hour shifts) have created the possibility of a nurse’s being able to enjoy full time employment along with increased family time.

Recently, an increasing number of hospitals across the country have begun instituting additional flexible work options for RNs. Nurses who have been out of the workforce for several years while rearing their young children are being lured back into the hospital by Parent Shift programs. These programs offer shorter shifts of four to five hours, refresher orientation and preceptors to ease the nurse back into the work environment and no requirements to rotate shifts or work holidays or weekends. The trade-off for the ability to design one’s own work schedule is that the mini-job does not come with a benefits package.

Some parent-shift nurses initially worried that the programs would prove too good to be true. Perhaps the attractive hours would morph into longer and more frequent shifts. Would there be hostility on the part of the regular nursing staff because of the much less demanding parent-shift hours? According to feedback from the parent-shifters, that has not been the case. Work hours have remained as promised and units are happy to have the help, no matter where it comes from.

The nursing shortage being what it is, it’s refreshing to see that hospitals are beginning to accommodate nurses who, if faced with an all or nothing work policy, would likely not return to the bedside. One good thing about a crisis—and the nursing shortage certainly qualifies as one—is that, in seeking solutions, innovation and creativity are forced into play.

Knowledge Gives Our Patients Power & Confidence

I have touched upon the subject of health illiteracy here before and mentioned the vastness of the problem. And, because of that vastness, the problem has no single solution. I am going to make an assumption that nursing education today continues to place great emphasis on nurses as educators, as did my nursing program years ago. The concept was pretty much pounded into our heads, as it certainly should have been.

Most of us don’t have a TV show, radio program or other big stage from which to reach and educate a large audience in one fell swoop. Yet, we nurses have tremendous opportunity to teach and inform our patients and their families. Yes, our efforts are usually focused on a rather narrow slice of the literacy pie and deal with medical issues specific to a given patient, without much chance of improving medical literacy across a broad swath of the population. But, I believe in the power of educating one patient at a time, and that one patient will, no doubt, be grateful for the confidence to better manage his health due to your empowering him with knowledge.

Jeanette Lancaster, RN, PhD, Dean of the University of Virginia School of Nursing, advises that when professional issues are so large as to seem unconquerable, try looking at the smaller picture. “Do all you can do within your realm,” she says. That sage and practical advice can and should be applied to the enormous task of improving medical literacy by educating individual patients regarding their health care. A lot of ground can be covered by taking small steps.