Think About Who Might be Listening

Perhaps you were walking down a deserted hospital corridor, discussing in quiet tones the details of a patient’s care with a fellow RN. Maybe a similar discussion took place with one or more nurses during a regular shift change report. Whatever the situation, the absence of visibly obvious "listening ears" does not mean no one is hearing your words.

A neonatal intensive care physician, who was hospitalized for three months after being severely injured in a bicycle accident, learned a lesson during her recovery that is of value to all who are involved in patient care.

Because of her injuries, including fractures that required traction, the doctor was limited to lying flat on her back, unable to see much of what was going on around her. She was also intubated for a time, which temporarily curtailed her ability to speak. Despite the doctor’s limitations with verbal communication and visual observation, her sense of hearing was not compromised and she did plenty of listening, often hearing conversations not intended for her ears.

A dramatic example of what can happen when nurses let down their guard when discussing patient care occurred early in the physician’s recovery period. Her injuries were severe and required several surgeries in the days following her accident. Her condition stabilized but she still required intensive care. As she lay in the ICU she overheard a conversation coming from the nurses’ station questioning the care being given a patient: "Why are we continuing to (life) support her? Shouldn’t we let her go?"

The doctor, her thoughts muddled by the effects of narcotics and the anesthesia administered earlier in the day, was convinced that she was the patient the nurses were discussing. Overcome by anxiety, she summoned a nurse and, although it was near midnight, insisted that her husband be called. She urgently asked him, "Am I going to die?" He calmly reassured her that, although her injuries had been life threatening initially, she was improving and making progress every day and she needn’t worry about dying. Although the incident was at the forefront of her mind, it was weeks before she revealed that it was the nurses’ words that had prompted her to make that frantic phone call.

Her lengthy recovery period gave the doctor more than ample time to relive the upsetting incident and she realized that she, too, had probably conducted sensitive conversations within earshot of families and patients who overheard and misinterpreted her words. She vowed that she would, thereafter, be actively aware of what she says and where and how loudly she says it.

It is good to be reminded that we need to be vigilant about privacy when engaged in confidential conversations. As nurses we know the importance of patient privacy and that of reassuring patients and family rather than upsetting them, so why do we so often slip up?

The doctor mentioned here thinks we unwittingly fall into a sort of complacency. Nurses are busy, and dealing with the immediacy of life and death must come first. As a result, we may unintentionally allow the finding of an optimum time and place for such discussions to drop a few notches on the priority list. Perhaps we think that a certain noise level—one caused by respirators and monitors—will drown out our words. The doctor’s frightening experience should be the cliched wake-up call for all of us to be mindful that listeners, intentional or accidental, are everywhere whether or not we can see them.

Bad Behavior in Medical Facilities Revisited

Has anyone else noticed that a certain subject will be covered in a magazine article, for instance, and then over a span of several days the subject will be covered on TV, in the newspaper and online in pieces that are seemingly disconnected? This happened several months ago in regard to medical personnel and hand washing, or the absence thereof. Now, the same is occurring on the topic of bad behavior by medical professionals in employment settings.

Julie Salamon, author of Hospital, spoke to the issue in her recently released book and later wrote a piece on the bad behavior/lack of respect problem in hospitals that appeared in the Los Angeles Times. It was my reading of that article that influenced my writing a post to this blog on the subject.

Shortly after that, an RN friend who manages a surgery center lamented that she was stressed by a situation in her workplace involving a surgical tech’s bad attitude toward her. The female tech doesn’t hesitate to voice her displeasure regarding decisions made by the RN, doing so in a hateful tone of voice. She turns on her heel and stomps away like a spoiled child when conversations end in her not getting her way.

Two days after hearing my RN friend’s story, the New York Times ran an article that addressed bad attitudes within the medical community. Now, I’ve received an e-mail from a friend in another state who commented that she had read with interest a piece on the NurseZone Web site about bullying in hospitals. Disrespect is a problem in the OR where she works, she said, and her director is constantly trying to keep the troublemakers in line. She expressed amazement that two-year certified scrub techs (all male) are talking down to the surgeons and getting away with it.

Why, all of a sudden, is bad behavior a hot topic? Are incidents more prevalent? Are we, like Peter Finch in Network, mad as h*ll and not going to take it anymore? Or, as in my case, are we simply incredulous and outraged that bad behavior is being tolerated, even a little bit.

I realize that legalities have put a stranglehold on management where swift termination is concerned, but surely a surly employee could be put on probation or "written up" in some way in a prompt fashion.

When I questioned the out-of-state RN as to why continuing problems in her OR are not squelched by firing, she mentioned the fine legal line management must walk and the mounds of documentation required to take such action. She also revealed that some surgeons put up with bad attitudes because the techs exhibiting those attitudes possess excellent technical skills valued by the doctors. Her director, she says, does not want to incur the wrath of prominent surgeons who want exceptional assistants and is, therefore, reluctant to tell the offenders that they must change their behavior or risk being terminated. As a result, the techs wield a surprising degree of power and control in the OR.

The most important point that this RN made is that resentment and avoidance among the surgical team damages communication and a lack of communication can lead to a sentinel event (an accident or near miss) during surgery.

"Communication is vital," she said. "We have a set surgical team in every room and if even one person isn’t communicating it is a problem."

Is bad behavior a problem in your work place? Are solutions being attempted? Tell me about it.

Practicing Medicine Without a License

I suppose at one time or another every nurse has been called upon to dispense medical advice to family and friends. Even though I haven’t had hands-on patient experience in many years, I still get the occasional phone call requesting a medical opinion.

Recently a friend brought her son, age eight, to my home to have me look at a splinter in his thigh. It was more than a splinter. He’d fallen from a tree and in doing so a twig had somehow run under the skin of his leg for a couple of inches. When the boy saw it, he freaked and tried to pull it out but broke the twig in the process, leaving a portion of it in his leg.

It was easily visible beneath the skin but it seemed a stretch for me to attempt removing the twig with pointed surgical tweezers. Besides, the child was not thrilled to have me do so much as touch it so I was pretty sure that the idea of pulling it out with a sharp instrument was not going to be a winner in his book.

My decidedly non-medical husband got in on the act and we pushed (gently—but still the child protested) on the back end of the twig, trying to ooch (a certifiable medical term) it back through the channel by whence it had entered. No luck.

The mom was reluctant to go to the ED because it wasn’t an emergency and it would be expensive.

"Well," my husband and I opined, "you could just leave it alone for a couple of days, let it fester and then it should be easy to push out."

The mother was doubtful. Recognizing her hesitation, I called my standby medical consult—my brother-in-law, who’s an ED doc. There was no answer so I left a message explaining the situation, including our recommendation regarding festering.

The ED doc soon returned my call, emphasizing that the twig needed to come out but that it could wait until the next day when the procedure could be done in a doctor’s office (and would be covered by the family’s co-pay) and that an antibiotic might be required. Then he made a snide remark about our treatment of choice—festering—as though it was akin to voodoo.

I was quick to remind him that he was talking to someone whose brand of medicine is a blend of folk and traditional. I didn’t dare tell him that I know coal oil (kerosene) to have amazing healing properties, treating everything from simple cuts to copperhead bites. He’s a city slicker who grew up on Long Island so he doesn’t know or believe in the make-do treatments that my backwoods granny so expertly practiced.

A few days later, in the company of several women (one a practicing RN), I told the tale of the twig-under-the-skin incident. I wasn’t far into the story when two of the women (one the RN) said, almost in unison, "It would’ve come out in a couple days, after it festered." I had a good laugh and wished my bother-in-law had been there to hear their totally unprompted responses. The kerosene treatment was also familiar to them and the RN wondered aloud, "Why did it work? It has no scientific basis that I know of, but it worked!" None of us had an answer.

On the day following his fall, before my festering theory could be tested, my tree-climbing, gravity-challenged young friend was surgically divested of the souvenir of his fall and left the doctor’s office with three sutures, no antibiotics and an excellent prognosis.

Do any of you have experience with or amusing stories involving home remedies? Please share them here.

Do Correct Pronunciations Matter? I Vote Yes!

Yesterday, while scanning a nursing-related forum, I came upon a thread that deals with mispronunciations of medical terms. Well, it started out as medical term errors but then moved on to pet peeves regarding all kinds of pronunciation and grammatical faux pas. The thread began a month ago and now has almost 400 posts, so it has touched a nerve with readers.

I am one of those annoying people who must exercise extreme control in order not to correct the errors I hear. Sometimes the control fails—that’s what makes me annoying. I have a list of pet peeves as long as my arm: the word picture being pronounced as pitcher, the use of less when it should be fewer and (in my #1 spot) using I when it should be me. A certain Harvard educated late night TV host consistently says such things as, "My in-laws are visiting my wife and I." I actually yell at the TV, "My wife and ME!" That particular misuse is becoming so common that soon everyone will think that I’m the one who is slipping up by using (correctly) me. We can’t have that, now, can we?

The thread notes several examples of how patients and their families can skew medical terms into quite amusing pronunciations, such as "cadillac (cataract) surgery" and "suggestive heart failure." Those things don’t bother me at all. Medicalese is a difficult and complicated language for the uninitiated and I never fault patients or families when they trip over words they rarely use or may never before have heard.

It’s quite another story when I hear nurses and other medical personnel mispronounce medical terms. I am not referring to the occasional twisted tongue kinds of mistakes but the consistent mispronunciation of frequently used terms such as defribrillator (sorry, no r after the f), can-oo-la (canula should be pronounced can-you-la), and phenegran instead of phenergan.

Am I being nit-picky? Maybe. But, nursing is a detail oriented profession. My hearing a nurse bungle common words time and again causes me to think he/she is of the ‘close enough is good enough’ mentality and wonder if that attitude carries over into his/her nursing practice. As one contributor to the thread pointed out, people make judgements based on how we present ourselves and our speech is one component of that presentation.

Does anyone else agree that we should strive for correctness, or do I have a retentive problem? Let me know what you think about this issue. Do you have a pet peeve when it comes to pronunciation?

Hospital System Awards Nursing Scholarships to Combat the Nurse Shortage

The projected shortage of nurses in the next decade is a hot topic in the health care realm these days. A number of ways to attack the problem are being bandied about, but Infirmary Health System (IHS) in Alabama is being proactive to help ensure its five facilities are adequately staffed.

IHS, in a partnership with Bishop State Community College, will provide up to 100 nursing scholarships each year, beginning in the fall of 2008. The generous scholarships, which cover tuition, books and fees, are aimed at warding off a nurse shortage in south Alabama; one that is already occurring in other areas of the country. Financial need is not a consideration in the awarding of the scholarships. Most of the recipients’ clinical training will take place in IHS facilities and they will have the opportunity to have part-time employment within the system while attending the two-year RN program. Recipients are then required to work in an IHS facility for a prescribed length of time following graduation.

Perhaps other hospitals are instituting similar programs, which I believe to be inspired thinking. It has been a long held notion that nurses tend to work where they train. That is why, for so many years, hospitals maintained their own three-year nursing programs. There were exceptions, of course, but the new RNs most often would stay in the setting that was familiar to them and the hospital had a steady annual infusion of nurses. I did just that. I chose to stay at my ‘home hospital’ because I liked the work atmosphere there and I was comfortable in it.

Maybe more hospitals should take a look at the IHS scholarship plan as a method of maintaining adequate staffing. I would advise them, "Treat the students well and they’ll stick with you."

Is your hospital using innovative programs to attract and keep nursing staff? Tell me about them.