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joyouter

joyouter

ICU, APHERESIS, IV THERAPY, ONCOLOGY, BC
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joyouter has 30 years experience and specializes in ICU, APHERESIS, IV THERAPY, ONCOLOGY, BC.

joyouter's Latest Activity

  1. joyouter

    Hospitals Firing Seasoned Nurses: Nurses FIGHT Back!

    This article truly highlights exactly the depths of indifference, incompetence, greed and immoral practice which has been imposed upon nursing practitioners. Management has accepted all acts of power mongering and bullying tactics as key to nursing control- a form of corruption. How this impacts health care, both in quality care and cost amounts to almost criminal intent. The sub-human treatment of seasoned nursing colleagues by inexperienced nursing management with advanced degrees demands legal advice. The reality is that all nurses and patients are being placed under attack through misguided, poor managers with non existent decision skills. Health care, education and social stability are key aspects of democracy, good government and accountability. A break down in any of these areas negatively affects everyone with serious secondary run off effects. . It is time this was collectively exposed by nurses in practice to the public. Nurses are not disposable commodities and their role in healthcare cannot be underestimated. All nurses applying for Executive Management jobs in nursing need to be tested and thoroughly examined re. their ability to manage, to think and to assess problem solving and interpersonal skills. levels of reactivity, subjectivity and objectivity in practice need to be measured. This is the routine applied to other executive managers in any industry. Business managers have to be put through such testing due to the need for the right fit for the job. Nursing does not apply these rules and the consequences, having been ignored as management competency is not thoroughly examined. Rather when faced with management dilemmas, the preferred practice has been to hire externally, a non health care professional with multiple MBA or management degrees. This has proven over and over again, how incompatible this is in a healthcare setting. Nurses are educated, competent professionals and unfortunately, this often proves incompatible to new, highly qualified, non healthcare professionals who desire to see nurses as little more than bedpan givers without the ability to think, as this further feeds the new managers sense of power. The consequence as we know, is always disastrous. Nurses can make good managers. Not every nurse wants this and not every nurse can do this particular job. Two mandatory words stand out in healthcare and nursing, Experience and competence with education. If applying for management roles, nurses need to undergo similar testing for the appropriate fit. This is not to say that nurses do not make good managers, it is rather to assess where in management they actually belong, thereby ensuring continuity in best practice at all levels of the profession. WE, as nurses, know what is needed, what works and what does not. Being able to assess the right fit and have further training is crucial to eradicate the level of incompetence and quasi-corruption right now.
  2. joyouter

    Ebola: What About The Children?

    Thanks for this. I am certain that many share your frustration. There are some key points to remember when considering the epidemiological profile of West Africa. ( were you referring to this part of the continent?-not sure) The healthcare picture is not standardized, there are some state hospitals who try to do their best however, equipment is not up -to date or lacking, staffing can be short with rudimentary trained staff in greater numbers than RNs. Many hospitals are private and many cash strapped citizens have to pay up front for care for themselves and family, ie. children. If you do not pay, you will not be released or some similar reminder for the unfortunate patient that payment must be made. This in a climate which is recognized for deadly infections such as dengue, yellow fever, tomba fly infections, types of malaria with the most deadly being. malaria falciparum ( cerebral malaria - treatment is vital and spinal taps and or intrathecal tx are most effective, due to the limited transport across the brain barrier of many medications. Spinal taps and treatments are not really recommended thus westerners are medevaced ASAP. Local citizens may not be so lucky. The key to all of this is economics. ie. having enough money to care for a family, good regular hygiene, safe disposal of waste and provision of balanced regular nutritious meals. This builds the blocks of good immune systems and the ability to fight infections. Children can be afflicted with other types of malaria such as plasmodium malariae or plas. simplex which will re occur periodically and affects on-going health status. The local diet can be rich in veg. and fruit, but the favorite is yam and cassava which are filling but only part of the cycle of a balanced diet. Clean water is always a challenge and amebic illnesses remain endemic. Contamination is an ongoing cycle and affects the liver and intestinal tract, thereby negatively affecting absorption of nutrients. The lack of which over time, then becomes a vicious cycle affecting growth, development and immune response.. One cannot blame western staff on the condition of children in W. Africa. They are simply trying to bring about positive change and support in a never-ending cycle of need and to improve the lives of many people in that country. The problems can be based on any number of reasons, climate, incredible jungle growth fed by a rich eco system, plenty of non-potatble water, poverty and poor government. It is not the western care of children there rather the underlying conditions of poverty, limited education and lack of good leadership which provokes problems and epidemics of every type. We, as western nurses have enjoyed steady, nutrition and sanitation since birth. We have not had civil wars in our homes and thus our health status and ability to fight disease is quite different to most in W. Africa. That could explain in part why our nurses return home and appear in good health. One other reason offered by NYH professor is the lack of invasive procedures in the field in comparison to the intensive, invasive practice in western hospitals with intubation, dialysis, etc. which actually exposes our nurses in the west to greater risk of infection / contamination here. Thanks for listening.
  3. joyouter

    Ebola: What About The Children?

    EXcellent article- very informative, and raises reflection on the pediatric population exposed to, at risk and victims of Ebola Virus Disease. I was struck by the lack of information based on the very rudimentary level of care available in W. African countries currently affected. I am wondering if immune testing has been carried out or is this even possible there given that the immune response in children does not mature until roughly 6 yrs old or later and is dependent on development of good overall general health, nutrition, sanitation on an ongoing basis. As you know, the nutritional status is directly related to economic reality and is linked to previous health and sanitation. . Having worked in W.Africa a number of years ago ( 3 years) it is also interesting to consider the underlying high risk of malaria in these regions plus guardia, dengue, yellow fever and other tropical diseases endemic to West Africa. Young children are often affected with any of the above and sanitation, especially clean water, is being addressed by govt. but remains a challenge in remote isolated areas. The hot, humid jungle climate also contributes especially with rapid dehydration. Gastro is very common and possibly could cloud diagnosis of EVD as could malaria which starts with fever, until it is too late for active treatment. This then becomes palliative, unless the patient is fortunate. Your references and article really raise awareness and hope to see more. Thank you for this. Joy
  4. joyouter

    No Stone Unturned

    Congratulations on your incredible perseverance and above all, your fantastic ability to think and act independently to manage your career goals and on-going training. This is a very well written, heartfelt article and apart from highlighting the incredible continuum and uncertainty haunting nursing professionals who desire to learn and change specialties, it really reinforces the need for HR to leave nursing roles and hiring to nurse managers. I am so fed up of the incredible, manipulative and incompetent interfering approach that a non nurse, ie. HR, which has been allowed to infiltrate and direct nurses, without a scrap of nursing knowledge. HR is there for specific roles associated with hiring practice, not to make uninformed decisions about nursing education and training. Good luck in all future endeavors.....
  5. A thought provoking and insightful piece. Thanks jadepln for this. PR and politics go hand in hand, however how compatible or appropriate are these two issues to competence and nursing when compared to the level of real skills and knowledge which is needed for all patients today. This is rather like putting peanut butter over old, moldy bread in the hopes that no one will really notice and all will be fine. !! The reality is that Public relations in healthcare, particularly nursing is dependent on not only how professional we appear and represent our institution on the job., ie uniform, clean scrubs, proper shoes with a demeanor which will inspire confidence and reassurance to those who are ill and in need nursing. There is also the aspect which is ignored, deliberately or not, which is how does the institution treat its team, its staff members. It is difficult to hide poor management and lack of support to health team members and pretend that a positive PR approach is being practiced, in the hopes that management gaps can be conveniently ignored. PR at the present time presents a form of stop-gap just-in-time policy because restructuring with increasing financial restraints impacts the greatest source of an organisation, its staff. Without considering in-depth restructuring as to maintain quality and excellence and to promote trust, teamwork and mutual respect, politics and pr become like balloons which have been inflated too long- they collapse, ( helium meets the same fate) While no one is denying the cruel realities of economic downturn, we still have an option to use our smarts for better outcomes with humility for humanity.
  6. joyouter

    The Best Defense is a Good Offense

    A well written article which highlights the weakness in organizational knowledge and management development. We are well aware of the damage a poor nursing manager can produce, the permanent damage they can leave behind and the expectation of the floor nurse to accept harassment, micromanagement and lack of judgement, and skills. The second aspect is the nurse who feeds into this cycle of negativity, protecting her position and fermenting problems with destructive and disasterous results. Nursing must improve its organizational knowledge to better address the gaps and weaknesses within the profession. All organisations essentially function in similar ways, the difference in nursing is that we at the patient level hold a special role in quality care and will not speak out in fear of retaliation or job loss. This is not professional caring, this is bullying and coaptation - we need to learn how to recognize symptoms, and to change - education being one of many methods.,
  7. joyouter

    A Plea to Nurses Everywhere

    An excellent article. describing varying symptoms seen in all areas of healthcare today. Two salient points mentioned; 1. Description of lack of knowledge around the art and science in communication. Communication is a core study subject at many levels. The lack of knowledge of how we affect ourselves and anyone around us when we inadvertently raise our voices in frustration, fatigue, overwork and being just dog-tired from trying to meet every request thrown our way and the fallout resulting in hostility, more fatigue, greater confusion and finally, discouragement and burn out is a topic overdue for students and professionals. Contrary to popular opinion, affective communication skills are not taught. In fact, it is a competence which is largely taken for granted. ie. `everyone knows how to communicate`- a belief which is very misleading. Body language, expression, raised voices and hostile tones also signify the levels of frustration and failure of the nursing profession to offer its professionals support and training around developing effective every day communication skills in the front line. We are human beings and work in environments which are designed to give healing, hope and support to those in need. WE, as professionals are also in need of support, Nurses are not robots, in fact, this profession contains many levels of abuse and violence. Nursing leaders, academics and researchers are needed in this area more than ever.- and the starting point should be effective communication from its multiple asplects 2. Nurses eat their young. I find this term an obnoxious and appalling statement which by right, should not exist as an excuse or reason. This statement actually allows, and even condones the rotten behaviours of nurses at all levels and is in direct violation of our professional objectives. If we can accept this as a raison d;etre, we inadvertently also condemn ourselves and perpetuate the problems of dysfunctional communication, lack of understanding, support and respect which we seemingly can supply to our clients but sadly fall short of among ourselves. The statement borders on violence and cruelty and should not be flaunted in any context. It is a sentence used repeatedly, without a valid defense..........
  8. joyouter

    Nursing Academia: We Need New Blood!

    Excellent points. Nursing education, management and development paradigms must adapt to the realities of today. Many nursing schools maintain a curriculum which is out of touch with today's needs. This does not mean that the traditional caring qne evidence based research approach has to be replaced. Rather the fact that the glass ceiling of senior nursing management and educators seemingly elect to keep that in place- why or why eat your young.! Bright, reflective, nurses with lots of EQ and oriented to the professional practice leave, possibly with foregone conclusions about a limited future. The politicization of nursing is one of the most damaging shifts imaginable, fostering unhappiness, punitive behaviours and bullying within the profession at all levels. We need to identify our weaknesses, address them,, learn how to correct them in order to be enabled to move past this dark side of nursing towards positive change and dynamics.
  9. joyouter

    What is up with these Sickle Cell Patients?!

    Just to add, a nursing colleague and friend described her family member's illness. Chronic illness and chronic pain. She stated that he grew very quiet for many years until he passed away. As she suffers from what I suspect will also be a chronic pain issue (genetically related) , she said to me that now she knew why he was so quiet. She is not treated with narcotics yet, but the internal battle in chronic pain is an exhausting one, moreso when other physical conditions eg. respiratory illnesses or COPD, do not allow administration of narcotics which can suppress the respiratory system. A complex, thought provoking and sorrowful condition.
  10. joyouter

    What is up with these Sickle Cell Patients?!

    Thanks for this, Your observations are very accurate. The pattern you described is the pattern of chronicity, both from a) the disease and complications and b) the negative effects of pain management which at present, has a greater success rate using narcotics, and consequently, the pattern of secondary effects. Pain is a powerful phenomena and has been described as " leaving a memory in the spinal cord, or perhaps, the subconscious. Neurological pain is similar, and nurses are often at a loss to understand if the patient is describing actual physical pain or the pain memory embedded in the neurological system. The approach is to recognize and honour the patient as they describe their pain and treat it as such. The overall approach is to respect and treat what the patient describes which is often why nurses become frustrated and angry when we might interpret this as treating a "habit" rather than an entrenched memory of pain, which to the patient remains real. There remains so much research and work about pain, effects from Sickle Cell and nursing knowledge and practice. :heartbeat Just a thought.
  11. When professionals such as nurses and teachers spend a small fortune on their education, in professions which are to serve the public and maintain a western standard of democracy and development, they do not merit being treated in this manner. When organisations encourage cavalier attitudes, which are quickly adopted, seen as a position of power and fear inducing desperation, the cycle is destructive and complete. The organisations eventually lose out, the managers who behave as such, also lose and the overall affect is the loss of skilled services to the unsuspecting public. Whether one chooses to inform the company of its tacky, unprofessional tactics or not, over time, the negative effects will triumph. Good karma starts with one person or better yet, don't do unto others what you would not consider doing to yourself. There is nothing new under the sun:uhoh3:
  12. joyouter

    What is up with these Sickle Cell Patients?!

    I can empathize with your frustration when meeting rude and manipulative patients. It is also worthwhile remembering that such behavior is not exclusive to the disease as this behaviour can be seen in many illnesses. You have stated that you are a new grad therefore, you are learning on the job as such. I have worked with Sickle Cell patients. There are significant points to remember. 1.Pain both chronic and acute pain plagues all Sickle cell patients. The goal is therefore good and effective pain relief. Along with this is the obvious risk of narcotic dependence which develops from continuing use of narcotics. Pain is a debilitating symptom, and can be viewed as a disease in itself, which is why in dealing with Sickle Cell, you are looking at not only hematological changes, ie. red cell anemia, oxygen carrying capacity and the pain to joints and tissues caused by malformed red cells, you must also consider the psychological impact. I found it helpful to address these issues respecting both the patient's fear of labeling "addict" which is an unfortunate and common stance taken in the disease. Historically, Sickle Cell disease and Sickle Cell Trait, as you know, developed in Africa, as a natural defense against malaria. When slaves were transported to the US, they came with the disease and its genetic pattern. Therefore, what was nature's way to protect against deadly tropical malaria became a debilitating, crippling disease with unfortunate outcomes, affecting a patient's economy, status and inducing a dependence on narcotics for relief of pain. There is some interesting research for treatment and cure on the disease, and it would be helpful to research the subject. There is also the relation between Sickle Cell and Thalassemia, another red cell disease affecting Mediterranean and middle eastern populations. African American persons or offspring of persons with African Americans can be carriers of the gene, which by the way, is passed through the maternal gene. So when you next see your patient, recall that you are looking at a complex history and unfortunate consequences. Pain relief has specific patterns for care, including psychology and illness produces poverty, depression and fear. Just food for thought.
  13. joyouter

    Nursing service reaches higher level with doctorate

    The idea of mandated BSN at entry level is laudable. The hard reality is that right now, in a climate of economic uncertainty, how many diploma RN's can afford university tuition, a reduction in salary and all of the accompanying economic challenges. I don't know if the career would actually be better respected, with mandatory undergrad and grad. degrees. The broader educational rewards are certainly excellent, but as has been said so often, do nursing programmes really produce excellence in practice? Upon reflection, the problem appears to how nursing as a professional body presents the profession, and I have said before, there is an overwhelming need to reorganize the practice, profession and rethink how it is represented at upper levels of power. There are 2 separate but important aspects being addressed. 1) Standardization of education and entry level nursing. 2) Being able to take our rightful place among leaders in health care, being a recognized and respected body of professionals who are able to dialogue and present a concerted effort in all health care discussions at national levels with influence for real workable change. That also requires a different approach from us as individuals and as a professional body
  14. joyouter

    You Want Me To Do WHAT??!

    You are so very lucky and I am sooo jealous!! Seriously, the working environment and your boss seem to be heaven sent. The reality of how many poor nursing managers are out there, wrecking havoc, causing hell for others who are trying to do their jobs and seem to find senior positions, no matter what the sin - is pretty overwhelming in numbers. Regardless of the plethora of management training, skills asessment etc. etc. we witness a never ending repetitiveness of nursing managers who should not be in that role. I was reminded of my own experience where I had a similar director who encouraged all of us, recognised our skills and was always ready to teach and support, most of all, to joke, laugh and support our endeavours. Our unit was also growing rapidly and its success was due to the constant, positive vibes and feedback from managers and patients. Only many years later, do I realise how much missed this, as I have never had a similar experience where I would enjoy working 7 days a week if needed! With such support and mentor, You will do well because you love what you do which injects into whatever type of presentation you choose to make, Congratulations and continue along the path.
  15. joyouter

    Tips For Human Beings Entering Nursing

    This story provides more than a human tragedy- it presents a poignant, sobering lesson for all, from students in nursing, medecine or other subjects involved with the humanities.. The reality is that we can all be affected by fatal illness at any point in our lives. Can one imagine her fear of failure, the cost of discovery and most heartbreaking, the knowledge of the inevitable outcome? This example should be incorporated into medical and nursing education where the aspects of compassion, understanding and a broader consideration of cause and effect arise from human tragedy of HIV or other fatal illnesses. Thank you for sharing this unforgettable experience.
  16. joyouter

    Nursing service reaches higher level with doctorate

    There are excellent arguments here re. the historical lack of respect, power and ownership of the nursing profession. Some facts stand out. 1. Nurses are professionals and nursing is a professional practice, separate to but in conjunction with medical practitioners towards holistic team care for optimum patient care. Nursing practice is as separate as medical practice- key to this is that knowledge bases are different yet they are inter supportive. 2. Nursing managers are in need of thorough skills and competence checks as managers. Management skills are unique and require a lot more than clinical knowledge, Poor nursing managers can do a vast amount of damage to those whom they "control" - and what is more, they are encouraged to act in this way without impunity - an ongoing practice of divide and conquer. There are far too many excellent nurses forced out of the profession due to incompetent, abusive and unskilled managers. All managers need to be thoroughly assessed before assuming roles of power and their understanding of management practice is no different to any other CEO or middle or senior level management. 3. Nursing unions are not the answer. Unions and their history have evolved to represent workers who have been throughly disempowered and abused. Yes, nurses have been abused and lack power. WE must be able to develop an alternative, one which speaks with a powerful voice, representing a level of professionalism, education and the demand for respect and to occupy a permanent place in health care governance. Personal experience with union or non unionised nursing positions apply more a set of rules which are more in keeping with management than with nurses needs. Union representatives can vary with experience and competence and may or may not be effective. This needs to start with nursing education, one which builds solid knowledge base and management introduced as electives in the final year. Management testing and personal skills should be introduced as a broader base to educate nurses re. the existence of this level of personal analysis. The tests are also useful to assess our strengths and weaknesses in multiple areas. Not all nurses are managers just as not all doctors are managers. Therein lie manifold weaknesses in the nursing dilemma. Medical schools still play significant roles in nursing education, impacting how syllabuses are designed. Does this influence nursing knowedge and practice? This is too long, so......just some food for thought:idea:
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