Let's Get Back to the Basics We All Learned (or should have)

As I’ve mentioned here a few times before, my nursing school experience occurred in the mid-to-late 1960s. Back then, a list of duties expected of a nurse 40 years before our time would occasionally surface. My classmates and I would hoot and holler over the absurdity of all the things required of a nurse that had nothing at all to do with nursing—such as janitorial duties. We chuckled about it but also thanked our lucky stars that we were being educated in a more enlightened era without all those ridiculous rules.

Now I wonder if today’s students and recent graduates look back at the 60s and think some of the rules we had to follow were just as unreasonable. Yes, we were required to keep our nails clipped short and our hair had to be off our collars (the guys’ too), either pinned up or cut short. Believe me, those mandates, as well as the one banning the wearing of fragrances, were enforced!

I recently learned of a patient who contracted a near-fatal infection while in the hospital for a routine surgical procedure. Because of her bad experience, she has taken it upon herself to promote safeguards that will help curb the incidence of hospital-acquired infections. I was surprised—shocked would be a better word—to read that she encouraged health care workers to tie back long hair, clip nails short and, as a courtesy to patients, to not wear colognes in the work setting.

What? I thought those three things were set-in-stone must-dos. Obviously this patient witnessed situations that would indicate that is not the case. Are such simple safeguards no longer being stressed in schools of nursing and in hospitals?

There is constant publicity about hospital-acquired infections being on the rise and the increasingly virulent and antibiotic-resistant strains of bacteria that cause them. Could laxity on the part of health care workers regarding what amounts to the ABCs of presenting oneself for patient care be a large part of the problem? Are medical personnel choosing to ignore what they were taught? Are hospital supervisors reluctant to risk upsetting their employees by calling them to task? Remember the old adage, ‘there are rules for a reason?’ I vote for getting back to basics.

Big Hearts, Warm Hearts---Always a Good Thing

We’ve heard all the cliché terms: compassionate care, random acts of kindness, going above and beyond. In the past several weeks a plethora of stories have popped up in the media regarding nurses doing these very things. That nurses go the extra mile (yes, another cliché) is nothing new, but their doing so seems to have become big news lately. Whatever the reason, I am happy that nurses are getting more recognition for having big hearts. My enthusiasm, however, flies in the face of certain professional groups that contend the portrayal of nurses as angels of mercy promotes a negative stereotype, an opinion with which I take umbrage. Yes, I happen to think big hearts should be celebrated, so I’m going to celebrate two very big ones.

Despite the recent spate of stories, the one that has made the biggest and longest lasting impression on me was reported several years ago in The Denver Post. The newspaper ran an article, with photos, about two women who were health care workers at a nursing home in a small town in southern Colorado. It tugged at their hearts that some of their patients, primarily elderly patients, had no family to be with them in their final hours of life. They felt that no one should die alone and they asked to be notified by fellow staffers when it became apparent that such a patient’s death was imminent.

Often, the calls would come in the middle of the night, which did not deter them. I don’t recall how it was decided which of them would make the trip back to the nursing home to sit with the patient or how often the calls came, but that is not important. What is important is that one or the other would selflessly leave her warm bed and her family to hold the hand of a dying patient, keep the patient comfortable and pray for a peaceful passing. I am touched each time I think of their sacrifice, which they didn’t consider a sacrifice at all. Both felt honored and privileged to be at the bedside of patients who had no one else to be with them at the end of their lives.

I clipped the article, saved it and reread it many times in the following years. Unfortunately, in one of my frenzies of reducing the volume of paper that had accumulated in my house, I included that clipping among the items of which I divested myself. I’ve regretted doing so many times since. I need the reinforcement such stories give me to be ever mindful of the truly important and humanitarian acts that have a positive effect in this world. And, I like having evidence that there are angels here on earth.

Medical Errors--Is There Anyone Who Hasn't Slipped Up?

I wonder if there’s a nurse out there who hasn’t made some sort of preventable medical error. Does that nurse exist? If so, I am not that nurse.

When I first started a three-year hospital-based diploma nursing program, students, no matter what our level of education, were not permitted to have jobs, period. Just prior to my second year, there was a significant change in the cost of the program (upward, of course) and administration decided to loosen the reins a bit and allow us to work, ostensibly to help our families foot the bill for the increase.

Still, there were restrictions. We could only be employed by the hospital, junior students could work as nurses' aides and seniors could work as medication nurses. I began as an aide in the emergency room and loved it so much that I wasn’t interested in moving up the career ladder to a job passing meds. Believe me, the pay increase was not that attractive. But, one evening I caved in to the pleading of a supervisor and reluctantly agreed to give meds on a neurosurgery floor with a full census—about 40 beds.

With all those post-op neuro cases (cervical fusions, laminectomies, Crutchfield tongs), you can imagine the numbers of requests for pain medication. It was overwhelming—to the point that I was soon behind with all the scheduled meds and frantically running sprints up and down the unit’s long hall, while trying to juggle it all. I was 19 years old, new to the unit, unfamiliar with all the patients, and dodging angry family members demanding I deliver the pain med that was requested 10 minutes ago. Not that any of this is an excuse for what came next.

I had my 9 p.m. meds doled out into their little soufflé cups, positioned on the appropriate medication card, all on a single tray (remember, this was the Dark Ages). I’d become exponentially behind schedule as the evening wore on, so I was still playing catch-up (unsuccessfully) and rushing from room to room. I whipped into a private room to see a young man of about 21, sitting up in bed watching TV, obviously lucid. "Mr. Smith?" I asked. "Yes," he answered. If I couldn’t trust an alert 21-year-old to know his own name, whom could I trust? So, not taking the time to check his wristband, I dropped the med into his open palm, handed him a cup of water and he dutifully swallowed the capsule. All good—until I walked into the next room to discover the occupant was Mrs. Smith. I’d given her sleep med to the young man next door and his name wasn’t Smith.

I was lucky that it was a harmless way to learn a tough lesson. The only result of my negligence was that Mr. Smith likely got the best sleep of his life and I got an incident report tacked onto my personnel record. I learned a lot that night. Most important was that I never again gave a med without checking off all the safeguards. I learned to say no to the powerful and not allow myself to be bullied (no matter how sweetly) into something I knew was beyond my capabilities. I also learned that the regimented schedule of bedside nursing was not for me. I happily stuck to jobs in ambulatory care for my entire 10-year hospital career. Both patient and nurse were better off for that decision.

Want to Look Professional? Scrubs are the Answer!

Ordinarily, I agree with the opinions of the Center for Nursing Advocacy, (CNA) the watchdog group that keeps an eye on how nurses are portrayed in the media and takes to task the perpetrators of the infractions by rallying nurses to join in letter writing campaigns of protest.

In this week’s CNA newsletter, however, there is a campaign with which I’m not in total agreement. Perhaps it’s not so much a matter of disagreeing as it is bafflement on my part. The newsletter ran a story, that later in the article was described as an inflated rumor, of a clinic in Spain that insisted its nurses wear miniskirts at work or have their pay docked. It turns out that the clinic’s edict was that its nurses wear traditional uniforms with skirts of modest length, not minis.

The CNA newsletter expressed an opinion that read, in part, "But, this would still force female nurses into regressive outfits that suggest they are not modern professionals." WHAT? Have I been living under a rock? True, my days of hospital nursing ended many years ago but I’m a news junkie who reads two newspapers per day, magazines of all kinds, watches a variety of news programs, and am in frequent contact with friends who are working RNs. I should’ve known before now that the uniform I wore for all those years marked me as something less than a professional—and an archaic one, at that. Am I the last to know?

So, let me get this straight. By dressing in pajamas—OK, scrubs—I will present a more professional image? I agree that scrubs are more comfortable and they would make jumping onto the bed, straddling the patient and doing chest compressions before the crash cart arrives a lot easier—but indicative of professionalism? I don’t think so. I was recently hospitalized for surgery and I have not a single complaint about my care, but, based on what they were wearing, I couldn’t tell the nursing staff from housekeeping.

Bottom line? I don’t get it. I am not suggesting stripping nurses of their scrubs and putting them in white uniforms with (oh, the horror!) skirts of modest length. I just want to understand how a traditional uniform would diminish my professional image in the eyes of others. Enlighten me, please.

Does Hospital Adverstising Really Work?

A fellow RN told me about a recent conversation that took place in her hospital unit in a highly respected facility that's part of an equally respected hospital system.

The conversation went something like this: "So, we have a low incidence of medical errors, our infection rate is low, we have a stellar record of patient satisfaction, we appear to be doing everything right. Now, how do we market ourselves? How do we draw in more patients? How do we promote our hospital as the go-to, primo facility in our area?"

I’m assuming that many of us have noticed advertising of hospitals popping up on television, in newspapers and in magazines. Does all that advertising really have patients stampeding through their doors? I am not an advertising expert—far from it, actually. While I might admire a certain hospital’s beautiful, state-of-the-art facilities as pictured in a print ad, I don’t choose my hospital that way.

In fact, I don’t choose my hospital. I choose my doctor and, then, if I need hospitalization, I go to the hospital where he or she has privileges.

In the area where I live, the small cities scattered about have one hospital each, with no in-system options. When I choose a doctor in a certain town, it’s a given that I will go to the hospital in that town. I suppose, if I were looking for a new doctor and had a preference for a particular hospital, I might restrict my doctor search to those who practiced at that favored facility. But, for me, a doctor’s expertise is what comes first. My supposition is that excellent doctors would demand their hospitals be excellent as well. Am I wrong?

Advertising is expensive and those who control the hospital’s purse strings are not likely to spend money on efforts that don’t pay off in some way. Advertising must be producing positive results for some hospitals, otherwise their continuing to appropriate funds to ad campaigns couldn’t be justified.

Does anyone have insights to share?