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lemur00 BSN, RN

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  1. lemur00

    Nurse Charged With Homicide

    Extenuating circumstances are a thing when it comes to real justice. And the purpose of law is ostensibly meant to be justice (though it rarely is). This is why most law systems have moved to a focus on rehabilitation rather than retribution. Retribution might feel right, but it rarely serves anyone. For those who said it, it means nothing to justice that you personally wouldn't "forgive". That's simply an emotional reaction. Justice is also rarely cut-and-dried. Nor is the justice system always concerned with justice. Many missteps from the war on drugs to life sentences for felony murder to notorious plea bargains show this. Much of it is politics used by the powerful against the powerless, as it's quite clear this case is. Because we know how the health system really works, I think most of us are capable of seeing through the smokescreen the hospital is using to deflect any blame from its own practices. If several people in administration were also charged for the decision-making structure that led to the nurse being unable to perform certain parts of her duties (specifically the monitoring), that might change things. But they aren't. Additionally the charges do not appear to fit the crime. Claiming "reckless" homicide clearly is making a judgement about the thought process of the nurse that I'm not sure can be supported. This requires that she knew she was putting the patient at risk and proceeded knowing this. I think that would be very difficult to prove, especially if they're using pyxis override to do it. They *should* be fully aware that everyone needs to do this all the time simply because pharmacy hasn't processed stat orders. Pushing in this direction anyway suggests strongly that this is an intentional deflection and that she is their scapegoat, just as every poor person with a crack rock was to the "tough on crime" advocates of the 90s. Sure they did something wrong, but they were punished in proxy so that the real problems that put them there would not have to be addressed. Iirc, this same hospital was forcing nurses to do housekeeping duties. This would be at least one systemic contributing factor, and I'd guess there is likely no real union in this hospital either. How many tasks was this nurse expected to do in 12 hours that she felt she needed to hurry the process on in this way? I think this shows there is a discussion that needs to happen and that is how we as nurses are shouldering the Sisyphan burden of jobs that multiple people couldn't get done, plus everyone else's jobs, plus dealing with assaults and harassment and then blamed for all of them when we simply couldn't do the impossible. And now charged. It's very much a reality of nursing that we were taught "best practices" and then quickly learn we will never be allowed to practice that way by hospital administrations. I am personally convinced best practice guidelines exist solely to provide a framework for blaming a single nurse when things go bad due to systemic failures, as I suspect had happened here. They don't want you to actually follow them. As I've said previously, I think this can be proven by the fact that "work to rule" is an effective labour resistance technique. Nursing is like spinning straw into gold. This situation shows it and raises the question, how do we say "enough"? How do we protect the lives of patients and ourselves against what the profession is being turned into? It's something we need to answer sooner rather than later.
  2. lemur00

    Are We Too PC?

    Yeah, most discussions of "PC" succumb quickly to the "no true Scotsman" fallacy. It's helpful to actually define political correctness. Political correctness in the 90s had to do mostly with allowing marginalized groups to have a say and was concerned with diversifying conversations and education in particular. It eventually came to mean being considerate of the cultural differences between oneself and others. Since then it has become an epithet for anyone who is more sensitive than I am on a subject, like it's twin term, "snowflake". No one applies it to themselves. It has also basically become a tool of manipulation, as this controversy showed. No one cared about this tacky song until the ominous banshee wail of "political correctness" threatened to steal it away from us! DUN DUNDUN. To arms people! Save the saccharine drivel! What's interesting about the song controversy is that it could have just been dropped quietly. Times change. People used to keep slavery memorabilia that makes their grandchildren cringe. It's schlock and schlock doesn't age well. No one would have missed it much. But that's not what happened. Instead it was played for outrage and attention, and of course the ominous spectre of "PC" was dragged out like a modern krampus to terrify everyone. Christmas is always ripe for exactly such schemes, which is why we need to be wary of them. The real "sensitivity" was on the part of those manipulated to be sooo upset they were going to lose a cheesy song no one cared about the year before (I note cynically that the popularity of the song also soared--suddenly it was being played everywhere as an act of "resistance"). It's not like something as culturally significant as Handel's Messiah was being threatened, just this song written in a time when wife beating was played for humour and women were portrayed as idiots who needed a man to tell them what to do. It isn't even a Christmas song. So what exactly are we losing again and why does it matter? Oh because we don't want evil "PC" to win. Right. It seemed to me this was simply another divisive social media manipulation devised in time for Christmas and had nothing to do with being considerate of others but was designed to do the opposite. In fact social media tends to exploit the more tribal and antagonistic aspects of human nature in exactly this manner. Then the anti-pc brigade, having chosen their "side", complain that everyone is too sensitive. The irony is more tangy than miracle whip. Maybe the acceptance of differing points of view starts with you and me, and not those other people. And maybe it's not going to kill us if one cheesy song doesn't get constant rotation. Maybe there are more important things to worry about.
  3. lemur00

    Does Gender Affect Our Views On Pay?

    I noted in another thread that nursing is a high paying profession for a woman. There are various reasons for that, but generally women aren't expected to make that much, unless they go into a traditional "male" profession. I mentioned that traditionally they were second incomes in the other thread. I also think the work women do (those noted are all "caregiving" professions in one way or another) is just not valued in our society as something that deserves monetary reward. But most of all, people often regard female dominated professions with a jaundiced eye of martyrdom and submission. As they are usually caregiving professions it becomes easier to manipulate the often altruistic personalities attracted to them. People who want to make a difference because they care can be pretty easily duped by a plain old guilt trip. My father was a teacher and union rep and was always annoyed at how his profession could be bullied by employers intimating they were bad or lazy teachers for just wanting to be paid (sound familiar?). Teachers MUST do extra things they don't get paid for...or they would if they really cared about our poor children's future!! He of course was not taken in by this rhetoric at all, but many of his co-workers were. They refused to play hardball (teachers strike in JUNE) and never really improved their situation. That kind of manipulative behaviour has unfortunately always worked on the people attracted by these professions (most of whom are women), and being taken in by it means you lose respect from others. No one would say "Lawyers should do extra things for free...or they would if their clients mattered!" Lawyers would probably say "yeah, well I'm not here to care. So here's your bill". Interestingly, to the op, there are a few studies I've read showing that men who nurse often excel where women don't, and not because they are necessarily better at the work. At my old facility we called it "cock of the walk syndrome". Men do sometimes command a certain amount of respect just because they are male, especially with older persons. And as a woman who isn't particularly feminine, I know the social sanctions for going against type are many.
  4. lemur00

    My Reasons For Avoiding The Acute Care Hospital

    Around here, public health is the position to covet. One usually has to have years of seniority to get into it. In nursing school our entire program was geared toward community nursing. Public health nurses are also on a higher pay scale than other nurses. We got the distinct feeling that while we would have to do our time in acute, if we really wanted to be on the forefront of nursing we should go into community as soon as possible. That said, new nurses are usually encouraged to start in acute, if not to stay there. The prevailing logic is that with a couple of years of acute experience, a young nurse has more options because she has a skill base on which to draw that she wouldn't if she only worked LTC. And I certainly saw the reality of that in the LTC facility I worked in. RNs basically do nothing but paper work and a number of them were afraid to work elsewhere because they felt their lack of skills. Some pick up shifts in acute just to keep skills current. So it's more about taking advantage of options rather than saying this type of nursing is superior. I do know there is a real distaste for LTC in general however. Agreed that the non-stop parade of other disciplines, families etc is the worst thing about working acute, however working nights on a less acute unit helps with some of the issues. That said, I've been told many times that nursing in general is completely unsuited to my personality (I come up in myers-briggs as an INTP--all the career advice says the worst job an INTP could do is caregiving--a list of all the things INTPs are utter crap at basically describes nursing). All through nursing school I was struck by the fact that people like me should not be nurses. But it turns out doing things I'm not naturally good at has been an incredibly valuable growing experience. And that's the other side of things, it is possible to learn a lot by doing the things that are uncomfortable and don't come easily. That said, the field I would never work in is psych. I hated that with every fibre of my being and was lucky to even pass the clinical. It was my lowest mark in nursing school. I think it's great that some nurses love psych however because it means I don't have to ever work there ever.
  5. lemur00

    The Slow Code: Justified?

    Yeah it's likely the same thing (pt orders for life sustaining tx? We call it my voice or MVLST). The protocol here is that the proxy usually only speaks for the patient if the patient's wishes aren't known. So if they have already filled out specific orders, we only go to the proxy if there's a situation that arises that wasn't covered by the forms or is ambiguous. If a proxy isn't chosen the closest living relative is automatically the proxy (and there's a list--for example the eldest child of a patient with no spouse will be the proxy, even if a younger child actually looks after the parent). That's the main reason we encourage the patients to designate someone of their choosing.
  6. lemur00

    The Slow Code: Justified?

    Yeah the ones whose families want us to do everything while they pray every day that God will "take me home". Painful. Not entirely convinced that a slow code is a terrible ethical violation in those cases. Our health region is moving away from the language of DNR altogether. We now go through advanced orders as part of the admitting process (if we can get them to do it) with patients in essence writing their own orders. There are sections pertaining to CPR, treatments, antibiotics, and nutrition specifically. They are also encouraged to designate a proxy. This paperwork follows them wherever they go in the region and can be changed at any time they want. We've gone this route because of many of the problems brought up in this thread (living wills being in legalese and disregarded, lost because they are in a safety deposit box somewhere, Doctors who don't treat etc.)
  7. lemur00

    A Nation Of Nonreaders

    Some are given mercy passes. Others have a friend who needs them to stay in school to give said friend a ride to school (this may or may not be based on personal experience ). The question of standards does come to mind as well. That said, I used to work with an older nurse who was clearly dyslexic. In her day she was simply labeled a "slow learner" and no one really expected much from her. What got her through was pure determination and hard work. She read as much as she could to practice, worked twice as hard as everyone else to complete her education (which those around her told her she was simply incapable of doing) and went on to have an almost 50 year career. She never did read or write well but did well enough. I was always impressed at her work ethic and her willingness to do what it took to become a nurse, despite the difficulties. Many people in the same situation would have quit and accepted that they were simply too "stupid" to continue. Heck how many people quit with half the obstacles?
  8. lemur00

    Why In The Heck Should I Be A Loyal Nurse?

    A related article. (pdf) One of the things that I found most interesting is that while baby boomers and gen x both really want autonomy, millennials really just want to be paid. Leaves one wondering where a profession like nursing is going to be left in a decade or so, especially given other work that shows incentives and bonuses do not make people better workers in the end (but autonomy does). Secondly, I think it's pretty standard that health care tends to be quite conservative and I think that plays out here. Management often expect younger employees to be the same as all the previous generations and find themselves puzzled when it doesn't work. I think the perceived lack of loyalty is probably the biggest difficulty. Neither gen x nor Millennials really consider their job to be their primary source of identity the way older generations did, and therefore won't do whatever it takes to maintain that. So it's imperative that to retain younger staff, employers become more flexible (for example, implementing self scheduling). But management is quite loathe to relinquish control and it won't become a frank necessity until more baby boomers retire, so I wouldn't expect to see it any time soon. That said, I think we need to be wary of employers who are more progressive in appealing to younger generations. One of the more insidious ways this is often done is by allowing employees to have more home time or work from home or make the work environment more like a social environment. This blurs the line between time on and off the clock. They actually can get more work out of you than they would by having rigid limits and infringe on your life in other ways. Definitely something to watch out for in the new workplace.
  9. lemur00

    Bullying--The Other "B" Word

    Yeah that's what I mean about social control. This is the same pyre satire has been hoisted up on (how many people out there think satire is noble and moral? Yet its whole purpose is to moralize). No one can make another person feel bad without obviously being a fat ugly jealous loser. Yet there are certain things people need to "feel bad" about, and the people with more social power I think have a responsibility to use their influence to curtail bad behaviour. The problem is that when group leaders shirk this responsibility, the true bully "gets away with it" and is never forced to take responsibility for his actions. At the same time, everyone feels vaguely bad but feel powerless to stop him. Of course as I hinted, the other side of that is that bullying in some ways is becoming more common because direct confrontation is increasingly becoming frowned upon, and fewer people know how to do it well. If healthy ways of dealing with conflict and negative feedback aren't encouraged, they are replaced with unhealthy ones.
  10. lemur00

    Bullying--The Other "B" Word

    I realize this is an old thread, but thought I'd necro to add my thoughts. The apparently rampant bullying problem has come up a lot lately in my circles and like the OP, I think a lot of the apparent increasing frequency has to do with the redefining of what it means to bully. In conversations I have stated people with more social control must rebuke bullies for their bad behaviour; the rejoinder I often get is "but you can't bully them back". But shaming someone for bad behaviour isn't bullying. It's a way of laying down the ground rules for the group culture. And if it's not allowed, well no wonder no one knows how to act appropriately. However I think that brings us to a bigger root problem. Rebuke is seen as "bullying" because it's negative and "not nice". I think a lot of these problems stem not from the fact that we're meaner but from the fact that North American culture has elevated an insipid "niceness" to the supreme virtue. A friend once told me "niceness is just kindness minus any honesty." That's the rub I think. Kindness is a virtue. Nicety is an empty facsimile of it that has been stripped of all realness and truth. Kindness refers to being gentle and considerate while niceness has the connotation of being "agreeable". So while kindness is honest, nicety requires a lot of dishonesty and pretense. A direct and blunt person may be kind, but is never nice. Yet we confuse the two and want people to be nice all the time (this can also be seen in debates where people assume everyone who disagrees with them is mean and a h8r. Really they're just not playing nice.). In reality they are very different and produce very different sorts of behaviour. In addition, Kindness is directed outward in concern for others, while niceness is always self directed. For example, the kind person will rebuke or disagree with others because his concern for the other is greater than his concern about whether that person likes him or is a friend. These people disagree with you because they want you to get better at what you're doing--if that means you get angry at them, so be it. Yes they try to handle conflict in a gentle manner, but they don't back away from it if it means a better outcome. On the other hand, the nice person will just let you continue on, try to "get along", never say anything negative or "mean" and hope everyone likes him--these people care about themselves and their image more than they care about you. The side effect of this is that all negative emotions to go underground which creates a culture where they are expressed in increasingly passive aggressive ways. The "nice" person won't tell YOU what you're doing is wrong, but he will tell everyone else. And as this behaviour is rewarded and accepted, it becomes more and more entrenched. The perpetrator can then claim "but I've always been nice to her" even if they've been targeting you with passive aggressive obstruction for months. I've noticed that people often say "bullying" of this passive aggressive type is one of the pitfalls of a female dominated profession and to an extent I agree with that. I do think that's going to change in the next number of years, because the reason this behaviour is more common amongst females is that they have always been enculturated to be "nice" while men have been enculturated to be direct. This is changing and now everyone is expected to play nice all the time, both male and female. Make no mistake, it has nothing to do with sex and everything to do with gender education. As a woman who is not and has never been nice, I have definitely seen the repercussions of going against the norm. Not surprisingly I think the antidote to niceness is kindness. The PA behaviour needs to be handled directly and honestly, with gentleness and consideration. But it must be handled and boundaries must be set, understanding that avoiding the problem (whatever it may be) only perpetuates it.