LadysSolo 5,136 Views
Joined Dec 17, '06.
Posts: 235 (71% Liked)
I walked onto the floor of the Oncology unit ready to start my day. It was a busy teaching facility but I had been there long enough to be comfortable in my RN role and not much surprised me anymore. It was a typical bedside RN position, little time for actually “caring” for a patient or family, just performing the usual tasks and routines. In addition to Oncology patients we also received overflow from other units including trauma patients awaiting transfer to long term care facilities.
As I got report from the night shift nurse on one particular patient I immediately thought oh no, I am not going to have time for this today. Johnny was a young man who had been in a car accident and was now brain dead. He was waiting for transfer to a long term care facility. I knew there would be family issues to deal with and sure enough I was right.
I walked into the patient’s room and was immediately met by the patient’s Dad with a barrage of questions regarding the (perceived) lack of care and his list of demands. I did my best to explain the situation to Dad but it only made him more upset. I did my work and escaped as fast as I could.
Over the next few days Dad opened up to me explaining that he felt guilty about his son because he had provided the car that his son was driving. No matter what I said to him he never wavered in his guilt. I came back to work after a few days off to again have Johnny as my patient. Dad opened up to me further explaining that he (also) felt guilty because he is a Christian and didn’t feel that he had done enough to assure that his son was also a believer and had accepted Christ as his Savior, and now that he is brain dead he is unable. I was uncomfortable (even though I am also a Christian) and turned toward the door (to again escape) but felt called back, I realized how important this was to Dad (and Johnny) and had no choice but to stop and talk with him.
We talked for a few minutes and I explained that (as a Christian) I believe since God has made us in His image we are comprised of body, soul, and spirit. And, since Johnny’s physical body was alive that means his spirit is also, and that just because our medical technology says that Johnny is brain dead that doesn’t mean that God cannot speak to and hear him. We talked a little more and eventually held hands and prayed over this young man asking God to converse with Johnny and give him the opportunity to accept Jesus as his Savior. I could feel the Spirit in that moment, and could see the wave of relief come over Dad knowing that his son was given the opportunity for salvation.
We are all taught in nursing school how to provide spiritual care (appropriate to each individual patient of course); unfortunately, because of the workload this is rarely possible. We are all human beings (body, soul, spirit) and therefore we should do what we can to provide spiritual care to all people as such. I know that there is very little time during a busy day for spiritual care; but what each of us can remember is that even 10 seconds can make a huge difference in someone’s life. It only takes 10 seconds to show kindness to others, a brief word or smile can do wonders and sometimes can be life changing. I had to overcome my own insecurities and also take time (that I didn’t have) to provide spiritual care, but felt better after doing so.
So what is the point? Realize that all human beings are comprised of body, soul, and spirit; therefore, we should care for ourselves in all three areas so we are empowered to care for others in the same way. We really do reap what we sow and taking care of other’s souls (mind/emotions) will, in the process, take care of our own souls as well, (thus providing us with the byproduct of happiness).
I know that nurses are extremely busy, but if we keep ourselves open to when the spirit calls. and fight that urge to escape, both patient and nurse will benefit greatly. I know many of you have similar anecdotes to share. If you don’t that is alright, it is never too late to start your story now, you will have opportunities. Let’s vow to make 2017 the year that we be kind to others and provide spiritual care as we are able, not just to our patients but all people we interact with.
Want to be happy…apply the 10 second rule as much as possible
They only value DAY-SHIFT workers at my facility. If you work nights or evenings, you are ignored. All the rewards or recognition are given to day-shift people, period. Or the same ones get chosen for everything, regardless of ability, experience, or education. Sorry if I sound bitter, but I have found that the ones who do the least, get the most. If you work extra, anytime you are asked, swap shifts when needed, never call out sick, you get shafted. The ones at my facility who call out weekly, refuse to work an extra shift, refuse to get pulled to another unit, etc., are the ones who get paid the most and get the most recognition. So do I feel valued by my employer? No.
Nope. Not at all. I've worked overtime for weeks on end only to be called on the carpet over failing to take a lunch break (when no coverage was provided) during times of short-staffing. I've seen incredible nurses fired over a one-time error. I've seen ancillary staff who have worked, and worked HARD on the same unit for *forty years* let go unceremoniously just before retirement age when it was decided that they were too expensive due to seniority.
I've had some good direct supervisors but not one of my employers in the broader sense has ever shown the tiniest shred of loyalty to their employees. This was a helpful lesson to realize early on, as it has freed me from a sense of loyalty to employers. I perform my job well for the sake of my patients, and I meet the terms of my employment, but if better pay or working conditions were offered elsewhere I'd go in a heartbeat. I know they'd let me go in a heartbeat if they thought they could get someone to do my job cheaper!
A nurse friend of mine told me that there was a fire at her hospital and they had to evacuate several floors, including the one that she worked on. There was extensive smoke and water damage. All the PR from the hospital said, "Everything is fine, no injuries!"
At least two nurses and several RTs had to be seen in the ER, and one was admitted to the hospital. So I guess what they meant was that no one who mattered was injured.
Very nice article. I just want to point out a major difference.... As licensed professionals, we have much more to lose than Hospital Administrators. We must always abide by our Nurse Practice Act, even in the fact of vague and arbitrary staff cuts, supply shortages, and seemingly inane policies. Our first loyalty must be to our profession, not our employer.
In my experience, Administrators just don't get this. They readily prioritize non-clinical preferences and don't bother to review nursing professional requirements before making new rules. - true example: "flexing" staff for low census leaving only one RN in the department -- forcing the RN to violate practice standards by inappropriately delegating nursing tasks to other staff. When push comes to shove, we know that it's better to lose a job than lose a license. Organizations that do not ensure operational alignment with nursing standards will never have our trust.
I believe the main reason newer nurses leave is because of the "moral distress" that comes from working in corporate healthcare. Hospitals are being run by rich people trying to squeeze huge CEO pay out of Medicaid and Medicare patients. You can't run a hospital like a Walmart and expect thing to go well. If a Walmart employee gets overworked and shelves don't get stocked, no one dies.
Every time the hospital that I work at has gone through low staffing times, staff have been required to do more than is really safe for the patients. But all of these low staffing times have been their own fault. A few years ago, we had a massive lay-off because we had one summer of low patient census. Things picked right back up again (duh), and suddenly everyone is supposed to handle a full patient census with way less staff. They eventually started mass hiring, but the staffing ratios never actually went back to what they were. Once the big wigs see that nurses can handle stupid patient assignments, they keep it that way. Nothing ever gets any better.
So everyone with experience continues to leave. A 12 hour shift shouldn't feel like a 12 hour Crossfit workout. You should be able to walk without limping when you clock out. You shouldn't have to clean incontinent bed-bound patients by yourself all the time because everyone else is also so busy running around like a chicken with their head cut off that if you waited for someone to be free to help you, the patient would have already lost the first several layers of skin.
The hospital is evidently content to just keep bringing in the new grads. I personally suspect it's because they're cheaper than the experienced nurses anyway. I have worked for one hospital in the little over 2 years since I became a nurse. I started on a progressive care unit and then moved to an ICU (both day shift positions). On both units, I was made a preceptor within 6-8 months of being off orientation. Think about it - with less than a year of experience being an RN, I was teaching new grads how to be nurses. In a cardiac surgical ICU, a new grad gets 8 weeks of orientation on the unit. They're being trained to take CRRT patients and VAD patients before they've been there 6 months total. They're receiving fresh open heart surgery patients within their first few weeks off orientation. I can distinctly remember times of trying desperately to keep a fresh open heart patient alive in the midst of significant hemodynamic instability and looking around for anyone to help, only to realize everyone around me was newer than I was. Add in the fact that in a teaching hospital, the residents don't know much either and it's terrifying.
I've been to ortho docs and physical therapy for issues that I believe are directly related to lifting too much and putting an average of 18-20K steps on my poor tired feet every shift. I dread going in to work most days. I hate that I don't have the time to do what I have started to consider the "fluffy nursing stuff" like patient mobility, patient education or making a human connection with patients or their loved ones. Things that should be standard nursing stuff, not "extras" that I rarely have time or energy for.
I personally have a very high level of self-confidence and am assertive by nature. I'm no wilting flower type. I was flat-out bullied by my preceptor on my first unit. Directly confronting her about, and directly reporting it to my educator and manager accomplished nothing. I have witnessed bullying of other nurses by the few experienced ones that are still around. I've stood up to the bullies, I've comforted the victims. I have brought these things to the attention of management over and over and seen NOTHING done about it. I have seen shift coordinators (who function like assistant managers) do some of the bullying. It keeps happening. I've seen patients suffer because of bullies refusing to help newer nurses. In this female-dominated profession, there is a lot of back-stabbing, bullying, favoritism, and general meanness that reminds me of junior high and high school. Only back then such problems didn't adversely affect the health and well-being of innocent by-standers like they do our patients. It's sickening. And anyone who wants to deny that this happens is delusional.
I went into nursing as a second degree student in my 30s. Going back to that rather assertive personality of mine, I got all the experience I could during my nursing school clinicals. I had the experience of taking full med-surg patient assignments and full ICU patient assignments with my preceptors during school. I wasn't clueless when I walked into this field. I just sold my soul to the devil of corporate healthcare - I took a scholarship with a work requirement because I was broke. Thank god that's over now. I'm a damn good nurse and I've excelled under the ridiculously poor conditions that have comprised my first two years in this profession. I do all the stuff that makes the office-types happy - I've got a bunch of extra letters I can string after my name; I go to conferences; I sit on hospital wide committees and have unit-specific extra responsibilities. None of it actually matters down in the trenches. Now that I have that magical "2 years experience" under my belt, a lot more is available to me and I have a far more options in choosing my employer and my workplace. Never again will I work somewhere without a union. Never again will I work somewhere with high turnover rates. Never again will I work somewhere that hires almost entirely new grads. And just in case anyone is wondering, Magnet designation, Level I everything certification, and top rankings that are plastered all over town on billboards don't necessarily mean anything for nursing work conditions. I believe this is just the state of most of corporate healthcare nowadays. And anyone who sits around wondering why nurses are leaving in droves needs to get out of their ivory tower office and take a typical patient assignment for a shift or two. They're figure out the answer quite easily.
But I will tell ya what....it has done nothing. The numbers of prescriptions hasn't fallen, overdoses hasn't changed, people selling prescriptions hasn't changed nor the price of them or quantities.
The only thing that has, is people with real problems are being left in the void or have gone to use illegal drugs. [I] have been to nearly every pain management center within 400 miles....
My last pain mang doc told me if I came in without the right number of pills he would report me to a database in Tennessee as a pain pill abuser and doc shopper and I am supposed to speak with him with trust? I am supposed to trust doctors who expect me to stop what I am doing at anytime during the day to come to their office with my pills so they can count and if not I am reported or kicked out?
I beg of you to go hang out at a pain clinic for a day and see what folks ask you or you hear. Asking who was doing the pee tests, if they can borrow 1 pill because they had a bad day or dropped one down the sink.
I believe this is a consensus throughout the US now, at least the people I have talked to at pain clinic waiting rooms. Its horrible but as long as one bad dude doesn't get 30 tablets while the 900 good folks others go through that its ok right?
The addiction pretty often starts as acute management when narcs and other drugs with high addiction potential are given for no good enough reason.
The thing is, pain relief 30-40% (i.e. to 4/10 from 7/10, 10/10 being extremity amputation "as it is") is what considered by experts to be "adequate" in majority of cases. The people, though, expect and want 0/10, 10 being whatever hurts them now. That is simply not possible without narcs. So, a 17 y/o given given 30 pills of Norco5 to begin with for sprained ankle. Norco is hydrocodone. She feels 1) wonderful feeling of being OK in all capiral letter, and 2) no pain at all, so instead of RICE she goes back to her busy life and uses not yet healed joint, which thus never heals.
The PT/OT plus some Motrin would be more than adequate, but the nearest PT clinic is in 30 miles and works 9 to 5. The patient has a job, the employer won't let her get off early, won't find light duty, will just throw her out. School is of no help. And, yeah, her mom's insurance doesn't cover PT for dependants.
To cope with all that at once, she is given 30 of "nerve pills" (Xanax). And then things just go underhill from there.
Christmas of 1981 -- it had been a horrible year. In May, I found my husband of three years, the church choir director, in bed with the soprano. In the wake of that disaster, we pulled up stakes and moved three thousand miles so that we could "work on our marriage" in the absence of what turned out to be Gerry's many mistresses. I was young and more or less fresh off the farm when we moved to the Big City. I didn't know anyone in the city except Gerry, and after I caught him cavorting with his boss's wife at the company barbeque and ejected him from our home, I didn't have him to talk to either.
The patients and co-workers I was meeting in the Big City were SOOOOO different from the folks I'd grown up around on the farm, and even from the folks I met at the State College where I got my BSN. Nurses wore make-up to work and heels to go out for a drink on their weekends off. They called dinner (the noon meal) lunch and supper (the evening meal) dinner. They had more sophisticated tastes in music and books than I, had more sophisticated wardrobes and no one admitted to knowing how to milk a cow or fix a barbed wire fence. I had nothing in common with them except the 40 hours a week we spent together at the hospital.
I was no stranger to working Christmas, but I'd never been alone on the holidays before. Since I had no seniority, I was working Christmas and since I had no money to fly home for a visit any time during the holiday season, I volunteered to work all of the holidays. It was the only place I've ever worked in a career that has spanned three decades so far where there was no holiday potluck planned for Christmas Day.
Christmas morning dawned cold and clear and I had been up most of the night sitting alone in my living room, crying and feeling sorry for myself. I dragged myself into work and greeted my patients with a profound lack of enthusiasm. Late in the morning, a very well dressed middle aged woman appeared at the nurse's station where I was going over new orders asked me "where do you want me to set up the buffet?"
"HUH?" I asked, articulately. "What buffet?"
"Why the Christmas buffet, of course," she said. "Every Christmas I bring food for all the people visiting patients in the hospitals, and to the nurses, too. It's my way of saying thank you." She went on to tell me that "In the old building we used to set up in the waiting room between the ICU and the step-down unit, but this new hospital is laid out so differently I'm not sure where I can plug in my crock pot."
No one had said anything to me about a potluck, but the nursing assistant working with me that day greeted the woman like an old friend. Together, they figured out where to set up the buffet, plug in the crockpot and seat the diners.
When my turn to eat came, I was astounded to see the well-dressed woman with her husband and a grown daughter serving Christmas dinner next to a very shabbily dressed older woman and her family. I found myself sitting all alone to eat my Christmas dinner with all the trimmings, and obviously taking pity on me, the well dressed woman sat down to chat with me while I ate. After a bit, the shabbier older woman came to sit with me as well, and then her younger daughter-in-law. Bit by bit, the story emerged.
The week before Christmas some years ago, the 18 year old son of the well-dressed woman had shot himself in the head while they were vacationing on the seashore. He was airlifted to our ICU, but it turned out that he was brain dead. In the same ICU was the other woman's 30 year old son in end stage congestive heart failure with no hope for survival other than a transplant. I'm sure you know where I'm going with this. Although we try to keep donors and recipients out of the same ICU, it didn't happen that way. The well dressed woman sat next to the family of the other patient in the waiting room and they began to talk to one another. As families sometimes do, they bonded. As they eagerly awaited news of their individual sons, they rejoiced at each tidbit of good news together and mourned together when the decision was made to let the 18 year old go.
"I wanted to donate his organs," the boy's mother said. "I wanted something good to come out of this horrible situation." It turned out that the other woman's son was a match. If this were fiction, I'd have the teenager's heart transplanted into the young father of three and have him do well and live happily ever after with his wife and children. But this isn't fiction and it didn't turn out that way.
After making the wrenching decision to say goodbye to her son and give his organs away, the well dressed woman found out that his heart was going to the son of the woman she'd been waiting with hour after hour, day after day. So after saying goodbye to her son, she sat with the other man's mother and his wife, waiting helplessly while the surgical team worked on the young father. It was her son's heart after all. She wanted to hear it beating in the other man.
Things didn't go well in the OR that night -- and as Christmas Eve turned into Christmas morning, the young father of three bled out on the operating room table. All through that night, the three women sat together holding hands and praying together, and when the surgeons came out with the horrible news, they cried together.
The following Christmas, the three woman found themselves in touch once again, grieving over the loss of the 18 year old with so much promise and the young father who would never see his children grow into adults. They claim not to remember whose idea it was, but the idea was born to serve Christmas dinner to other families stuck waiting for news on Christmas day, and to the hospital staff who tried so hard to save both men. "We can't do much," they said, "but we can make someone's Christmas a little less bleak."
And so it was that every year the three women and their families put together a Christmas dinner with all the trimmings and served it to the staff and visitors in the waiting room of the hospital where they'd lost so much. It turned out to be the last year for the elderly woman.
How could I continue to feel sorry for myself after hearing a story like that? As I swallowed my turkey past the big lump in my throat, I felt my spirits lifting. It proved to be, it seems, that the big city women weren't all that different from the women in the small farming community where I grew up. They love their families, they pray with strangers and they give back whenever they can. That was the turning point for me -- I resolved to stop feeling sorry for myself, stop looking backward and to move ahead with as much grace and dignity as I could muster. As long as I live, though, I'll never match the grace and dignity of the three women I met that Christmas Day.
You maybe need more experience behind you (?)and (GOD forbid) some pain of your own! Maybe your provider will say to you...you're functioning at an 8/10 so that will be our goal.
Listen of course I dont expect to live my life without any discomfort. I am realistic enough to know that to think I or anyone else is going to go through life never having a ANY pain or discomfort isnt going to happen. I am speaking of so many patients, friends, family that have legitimate pain issues that affect their lives significantly that for whatever reason can not get their pain controlled adequately...lets not get so literal.
What you think is adequate to function may not be so for someone else. Also when we ask a patient to rate THEIR pain on a scale of 1-10 ~ 0 being no pain and 10 being the worst pain THEY have ever experienced that is just what we are asking...in their experience. I, in my 30 years experience, have never seen or even heard of someone having an opioid script for 0 pain!
If you have that is more than mind boggling and if it is something you have only heard or read about I would say more investigation should be done because I just don't think it happens.
But I digress, Pain control is so individual for TPTB to now say that everyone must be under a certain, and btw arbitrary, MED per day is utterly ridiculous.
As to your last question well personally I dont really care but I would like to see where exactly you have acquired that data however, I would hazard a guess that it may have something to do with the US being a compassionate country. I find you and I have very differing opinions so I will say we need to agree to disagree because I have no desire to go back and forth with you any longer.
Reality check! Over the years we have negatively altered the supportive and progressive model affecting nursing in the following ways:
1) STUDENT SELECTION: Schools placing a high priority on "A" students who can memorize materials. In practice, I'll take a "C" student with good people skills and common sense any day of the week. Let's face it, having a higher level to pass the boards tends to be a driving force.
2) ATTEMPTED KILLING OFF LPN/LVN PROGRAMS: With the "better care with all RNs" rhetoric we have decreased options for upward transition from CNA to LPN/LVN to AS-RN to BSN, etc. Over the years many RNs would have been better served as an LPN or an CNA than in a position of responsibility. Not everyone was meant to be an RN. CNAs, LPN/LVNs and AS-RNs really understand the basics of patient care where BSN focus is more admin. The transitional stair-step model of the past helped weed out those not suited for nursing early, rather than going 4 years and then quitting.
3) PRIMARY CARE MODEL: The less than brilliant idea of changing from the supportive team nursing model to the more isolating primary care model may have looked good on paper but in practice patients are getting poorer care now. It is an expensive choice and had decrease the continuity of care.
4) NOT STARTING AT MED/SURG: If you don't give nurses a basis for making decisions on the big four: COPD/CHF/DM/Renal diseases, how do you know they can recognize a problem? Developing self confidence by sheer repetition is a good thing. The basics can be scary as heck by themselves and then you throw someone into a critical situation...many run like hell.
5) NURSING APTITUDE: Part of nursing is to weed out those without the aptitude for nursing. It is more than showing up for work and collecting a paycheck or assuming you will be the boss. It is emotional, or should be at the gut level. It is service with a smile, or it should be. It is staying that extra 5 minutes holding a hand even if you aren't getting paid for it or it should be. Nurses have to have inner strength to act calm on the outside even though being scared within. It is being a teacher, a confidant, a cleric to all religious need prn, or it should be. It is learning to listen to your gut instinct and be willing to act even if you are proven wrong, cause one time you might be right. It is learning to face your fears of not knowing and trying anyway. There are times you will second guess your decisions and hope you made the right one - yes you will be uncomfortable and you should be...for to be overly confident has even more risks. Nursing is not always hearts and flowers. It is sometimes emotionally painful as well as rewarding. Nursing is not for the faint of heart. I would say that many nurses who leave have difficulty acting in one or more of these roles or instances.
6) IS IT A PROFESSION? When I started on the first day our instructors advised us were were nurses 24/7. We had a standard to uphold while at work and off hours in the community. Dress appropriately, act the part. BE a professional. Today, I'm amazed how nurses want to demand others respect them, when they have little respect for themselves shown by their actions and appearance. Is nursing these days still a profession or just a job?
7) LIFE IS UNFAIR: If you work in this profession long enough you will have an issue with staffing, poor supervisors, overtime, and a hundred other injustices nurses face. In reality, we make a good living, are respected by our community, do good things in service to others, and hopefully when we lay our heads down at night, are happy.
Yes, there are probably some things we as nurses can do to keep people in nursing but the question really is, do we want to? If you are not cut out for our profession, isn't it better to leave and change your path sooner rather than the potential harm of doing it later? And for those with unrealistic expectations, the 'school of hard knocks' is an unrelenting teacher.
I agree with most all of your post but wonder if there is data to support that the problem started with poorly managed chronic pain patients.
The other thing that I will say again and again is there is absolutely no data I am aware of that indicates opiates are appropriate for long term pain treatment and can in fact make the chronic pain loop worse, opioid induced paradoxical hyperalgesia. This has nothing to do with appropriate, short term post op treatments with narcotics.
Advertise With Us