Jacqueline.Damm

In recent weeks I've studied the clock a number of times while watching a family member sleep restlessly in their hospital bed as I wait hopefully for the doctor to come through. Rounds are few and far between you know. I can see now how waiting really affects families when they are hoping for just a little bit more news. Labs, once a day. Just once. Unless there's something else to check, to monitor, you have to wait. Everyone wants you to wait. And so you do. Because there's nothing else left for you to do. And so, my family and I trade places to wait things out, to keep watch, to pray that the nurse has an easy day, a good assignment. We hope in the care one expects a beloved family member to receive. But with the chiming call bells outside of this hideous room with the bright window, and the rushing feet down the hall, I know in my stomach that they are just as pressed for more time in a day as I am. They are fighting the same battle I fight every day. Because they are nurses, and I am a nurse too. But today, for today and in this moment, I am family. I've been the bearer of bad news on more than enough occasions. It's just difficult when your loved one is on the receiving end. That statement. That statement that no one wants to hear. And yet, it still comes. Rushing into the room as the floodgates fly open. "There's nothing else that we can do," the doctor says. I knew that it was coming, I think everyone else knew. To know and to hear it are two totally different things. My throat closed up and I felt like I could get sick on the floor that was barely supporting my feet. People can't live forever, but deep down, I know that we wish it in one fantastical way or another that it was possible. The doctor continued the lingo that only I understood. Why do we do this? I thought. Why do we spout abbreviations and medical jargon when most don't understand this realm? It's a habit. We are habitual in our motions. And in this moment I realized that more than likely on enough occasions, I could be faulted for the same. The double vision started. I could see my family in this room, their needs, their fears, and I could see myself in another's hospital room acting on the same infarctions I sensed now. It felt ugly. I felt even more sick for it. Our "mundane" everyday tasks can be the catalyst of someone else's pain. To be quite plain, today did not feel mundane for me. Today was the end of an era of trying to get well. It was the start of comfort care for this loved one of mine. Of which they were ready, but in the moment I realized I was not. The rest of the day dragged on as we waited so impatiently patient for the hospice team's arrival. We needed to hear the plan. We needed something tactile to hold on to.It is a beautifully raw thing, hospice. Having the gift to pass with comfort and dignity is priceless. But regardless of how your loved one departs this world, the pain is still there. It is visceral and it is raw. It leaves an imprint on your soul. My family has been empowered by this gift, and yet, being on the side of the conversation where we are being instructed and educated felt numbing. Normally the tables are turned. I realized that this is moment when I recognized fear in people's eyes. I remember seeing it there, and I remember feeling it. I can see you now. This part makes more sense now. I feel it now. I was beginning to feel a slightly double existence. My nursing brain was running while I was trying to remember to be myself, outside of scrubs and unit routines. Here I am the family member providing support and love. It is a terribly strange place to be. Between both worlds. I was hyper aware and yet I felt as though all of my education and experience didn't fit here in this middle dimension. Discharge day came. I watched as my family member navigated the paperwork and we both attempted to digest all of the information at hand. It's mind boggling, nursing education in the hospital. We want to take our time and do the best for the patient and their families in order to provide ultimate care, yet on the flip side, you are pressed for time. The nurse phones ring while you talk. So much information is shared. There is so much noise and talking. And then it's over. Just like that, it's over. What just happened? I could sense that the room felt uneasy. It was up to us as a family. And it was up to visits from hospice and aides. The transition home has been a rocky one. Preparation of the home isn't really taught in the sense of what to expect. What to expect in the sense of how you will feel. How time seems to stand still but speed heavily ahead like a bull in a china shop. It's easy to feel uneasy, on pins and needles, waiting for when you may be needed to help in any situation that arises. And this happens. To many. To everyone in this boat. I can see where desperation can sneak in. How sleeplessness can raid your schedule. How worn down isn't just a feeling, it's a symptom. Can you imagine doing this alone? People DO do this alone. Without a support system. I can't even imagine a walk in those shoes. My family has been amazingly supportive like an unforgiving assembly line. Just moving, moving, going, and going. But it's hard. It's hard coming to terms with a ticking heart that does have to stop at some point. Lungs do give out you know, even when you don't want them to. And I know this. I truly do. Because I am a nurse. I know this. But it's different when it's personal. So I can see you. I can see all of you who struggle, who hurt, who have pain, who are coping with loss, who are coping with illness, being a caregiver and those just trying to make sense of what's happening. I can see your desperation, your agitation, your frustration. I can see where I have fallen short as a nurse in your eyes and how I can fix it. This side of the tracks is teaching me far more than I ever expected. But most of all it is teaching me, reminding me, of the sanctity of life, how precious it is, and how time is of the essence, because at some point, it does run out for each one of us.

Hey everyone, I had a question for you. I recently have been given the opportunity to sit for an interview for a NICU position at my local hospital. I was surprised (it was a bit of a shot in the dark for me) seeing as my experience has not been of pediatrics in any way shape or form. I've been a nurse for almost 4 years and have had the chance to work both in Med/Surg, Hospice/Palliative, Oncology and for the last few years Cardiac Progressive/Step-Down-- obviously all positions concerning caring for adults. I have always had interest in post-partum, neonates, pediatrics (basically all nursing falling under that general umbrella...) But I've never had the opportunity to sit for an interview with a position in either of these realms. With that said, how did you all head into the NICU? Was it fresh out of school or did you have backgrounds in other things? How was your transition? How long was your training? Did you find your backgrounds assisting you in your position or hindering your learning? Do you find that a strong background in pediatrics prior to the NICU is more beneficial? I know that I'm only heading into the interview at this point, but my excitement (and fear) of this possible change has made me want to reach out to all of you more than ever. Any feedback or guidance is more than welcome. Thank you for your time!

Thank you for this inspiration! You are awesome!

I love that you said this. It cracks me up because it is so very true! People mistake sarcasm for seriousness, bold texts and exclamations like one is screaming... etc. I like to write very Helen Fielding-esque (in a sense). She used ridiculous editing to give her stories life and her characters more character. I think it's fun to reach out to readers with spunk, goofiness, with a little bit of attitude and hilarity. Nursing is TOUGH. So when we can be silly when talking about something serious, we should DO IT. We all need a laugh! It's healthy for us! What I have learned in sharing more of myself and my stories (as well as others' stories) online is that no matter what, people will troll the internet to find you, latch on to you, and say just the most unbelievable things. The goal of their approach, I am unsure. All I know is that I prefer to treat others the way I want to be treated, INCLUDING ONLINE. It's childish to hide behind a computer screen to dish out inappropriateness because one is feeling haughty that day or as if you have something to prove. We all have experiences that warrant telling. More people should be writing on here! There is always more to learn in life. I'm not saying that the comment above falls into the category of which I speak, but I definitely think that instead of slamming people, the purpose of AllNurses is to initiate conversation so that we can rally and learn from one another. Much of the modern World is not on our side in supporting us, while we do TONS of supporting in the World. So why don't we support each other? I've seen some really nasty things on AllNurses (not just in my threads). It's really sad that we as a collective have chosen (at times) to tear each other down instead of build people up. It is actually really sad. Life is hard enough without nasty phrases and blatantly sharp-edged sarcasm directed at hurting someone. In the end, if someone has a major problem, why not be professional and go to the person about it in a personal message. Maybe there was a misunderstanding. There is no need to blast ugliness on a public board. No one needs such negativity. It's ugly and truly, it's very boring. Thanks for the laugh, and the very very good point you made! I love seeing all of you with your open hearts and support. Friendship in nursing is a powerful thing. Happy Reading!

I didn't even think of the glue! Good advice! I still won't wear my shoes in the car (like I said, over active imagination on my part) but leaving them in the car in extreme temps was so not something I've thought of! Thank you for this!

I am SOOOO with you there! I was in a respiratory code the other morning with a VERY complicated intubation that was just not working.... You wouldn't believe the spurting things in that room.. All I could think of (besides the obvious!) was... please don't get into my eyes, please don't get on my face, please please please... ewww juicyyyyyy.. ; )

Thanks SeattleJess! Good luck in school. I'm glad you enjoyed the seriousness and the humor in my article. It was in clinical I learned about the shoes also! Amazing isn't it? ; ) Thank you for the read and kind words.

I haven't even heard of Sockwell! Thank you for the input. I hope this article leads people to lend their advice on the issue that so many nurses face! It's a big issue that warrants a decent amount of attention. Our bodies are all we have. Thanks for the read.

Dear, dear friends. We all hate being "under the man". I get it. But goodness. Let's face it. Protective gear is a rule because it is so very necessary. If you are ever fearing a back spray, please, wear the gear to protect your ever-absorbing skin and EYES. We touch some of the most unruly things in our profession. In the longest run on sentence I would love to share with you some of my icky-stickiest: maggots in the feet, wounds to the bone, explosive clostridium difficile, excessive lice that took over a week to treat (HEAD TO TOE), tunneling wounds in the peri-area that exceeded 8 inches in depth, infected boils bigger than golf balls, dehisced abdominal surgical sites (staples flew across the room), goopy tracheostomies that hadn't been cleaned in so long they were almost cemented in place, shingles galore, meningitis with fevers of 104, tuberculosis with projectile sputum that was yellow/green, anything sputum (makes me cringe), explosive bloody diarrhea, Mount Vesuvius-like blood spurts when inserting an airway while in a code, removing feeding devices thus spurting bile, etc, etc, etc. Did you turn a little green yet? If you're a nurse, I am sure the answer is no. For me, sputum always makes me a bit (more like a LOT) nauseated, and sometimes uncontrollably gaggy. Funny and so not funny all at the same time. It's kind of embarrassing. I'm always afraid it will make my patient feel bad (in any way shape or form). Moral of the story above is that PPE is not just a GREAT choice when dealing with our usual: MRSA, VRE, Cdiff, Meningitis, Tuberculosis, Shingles, etc. Any time you are coming into contact with flaking skin, excessive wound drainage, foot care, you name it, WEAR SOMETHING TO COVER YOURSELF. We all know that Cdiff has legs. The spores have legs people. It attaches to things and it clings on for dear life. Do you not realize that this advanced bug has the ability to live on surfaces for extended periods of time unless it's given a proper clean? Seriously. If you can't imagine anything else, imagine these microscopic critters sticking to you, your hands, your clothes and shoes. Now think of what you touch. Your face, phone, private parts (you gotta pee at some point), say you pick your nose for that stubborn boogey, or capture a stray eyelash, or even chew a nail.. Yum yum, nom nom, right? Wrong. Disgusting. Hospitals are cesspools. May I remind you that everyone is sick? (That or asking for Aunt Dilaula, but that's a different issue). It is OVERLY tedious to gown up, remove, gown up, remove, and go from room to room. I guarantee that your neutropenic patient who is crazy sick (or may even have cancer) greatly appreciates your attention to detail when washing your hands in between patients. It's easy to get cavalier when moving fast, rushing or just thinking that hand sanitizer will do the job. If I could give you a sad face/awkward frown, I totally would right now. The thing is that we all know this is necessary, an issue, and a PIA, but we have to do it. Personally, when I get home and hug my love, I don't want to pass someone else's poo to his lovely person. It's rude. And it's just down-right gross. What do we do then? Comply comply comply. Wash your hands. Comply some more. We are a profession that washes our hands before and after using the bathroom. It's just the way we need to conduct ourselves. I personally don't want to go to the bathroom and take care of MY business after putting a suppository up someone else's end. Just saying. Your poo-poo platter doesn't need to be on my platter. Okay okay. Enough puns. Things are becoming more and more resistant to antibiotics. When in doubt, don the yellow gown (or whatever color your hospital PPE is). When there are creepy crawling things that are jumping, break out the hazmat and have no shame. I've worn hazmat and I felt so so SOOOOOO blessed. I did NOT want to bring that ju-ju home with me. I love my job, but I don't have to love the bugs involved. What can be a controlled infection can turn to sepsis quickly. Be aware and seriously, just wash your stinking hands! I will never forget how horrified I was when palpating an abdomen that I didn't know had a tunneled wound down to the patient's infected stomach appliance from bariatric surgery. Let's just say that warm puss from someone's insides on your bare hands is enough to make you want to autoclave your body for the rest of the shift. Believe me when I say that I love wounds and wound care. I find it fascinating. But when I'm assisting on an Unna boot and physical therapy is blasting off dead skin with their crazy machine, I'm covered with PPE head to toe. Because as rewarding as it is to heal wounds and assist in curing the sick, I'd rather not have your skin flakes in my hair (thank you very much). There have been times when a culture has come back and I wasn't sure if the patient needed contact precautions or not. The navigator for that is literally a phone call away. If night shift can't get ahold of someone who knows for sure then a 'cheat sheet' needs to be made. For you and your safety, always err on the side of caution. Two last things to keep germs at bay... REMOVE your shoes before getting in the car. If I had a dollar for every time I stepped in poop, pee, vomit, spit, blood, or found those things clinging happily to my shoes, I would have paid for all of your school loans and probably paid off your mortgage (you're welcome). Leave those nasty buggers in the TRUNK of your car in a box. It is NOT necessary for those shoes to see the light of day besides fluorescent lights at your job, and then the brief walk to your car. You don't wear shoes in the house? Good for you. I don't either, but! Wearing work shoes home with first driving, then leaving them wherever you do and then driving the next day while (you're off) in your awesome civilian kicks, heading to a friends house and walking into their door... You're welcome. Whatever grime was on your work shoes, can make a lovely imprint on your car's pedals and excitedly await another shoe to make close friends with. It's truly that simple. Lastly, my dear dear germ-ED family, our scrubs. Our scrubs. They need their own planet. If there was a laundromat in space, we'd need it for frequent use. Since that is not (yet) a possibility (let's go NASA!) we have to wash our scary things at home. Rule number one. I don't care how much you paid for those super cute/stylish/comfy Grey's Anatomy scrubs (they are my favorite too), if you get excessive bodily fluids on it. Trash it. End of story. Buh-bye! I had Cdiff pooped down my leg once. I bought the scrubs the DAY BEFORE. Guess where they went? BIOHAZARD. OR scrubs the rest of my shift, for the win! Rule number two. Scrubs need to be cleaned on HIGH heat and washed separately from the rest of your gear. Think about it.. Wash your washcloths with your scrubs. Later on, wash your face, bum, etc with that washcloth... I don't think I need to elaborate more. I make my own detergent and use essential oils for their antimicrobial properties in my fabric softener. Then I do an empty cycle behind my scrub laundry to clean out the machine. Do what you need to do friends, the bugs we deal with daily are serious. Unfortunately, the germs we work with, deal with, fight with, all deserve respect beyond what we've been giving them. I'm sure we are all walking around carrying something or with some antibodies of some sort... But for me, I'd rather win than have to deal with MRSA boils, or Cdiff diarrhea.. Personally, I'd also like to refrain from nursing my own tuberculosis. We need to have compassion for our patients. Not the germs.

I drove around relentlessly for days, walking in and out of shoe stores trying on every pair of Zapatos (shoes in Spanish...seemed fitting) that I could get my hands on. Yes, I was absolutely being selfish in the fact that I needed COLOR in my life (well, on my feet) in order to purchase some shoes for work. My hilariously hot pink Nike Vormeos were actually beginning to cause me leg PAIN. Uncool shoes. Uncool. I couldn't bear to have a lack of color on my feet since my wardrobe 3/7 days of the week was white or navy blue. Across the board, I had an idea of my shoe size. Before we get into what I did (seriously, just did), let's talk about the journey of nurse feet! Nurses shoes over the years have ranged from hard shoes with heels, leather loafers, and now the very interesting realm of professional shoes specially made for health care workers. Amazing right? For me, NO. I have an issue with TOO many options. It is a blessing in disguise. Sometimes I want someone to throw shoes at me and say "WEAR THEM!" and then I do. With no other decision making what-so-ever! But... We can't do that. It's our body, our feet, our alignment and our body mechanics that are at risk. Unemployment due to injury isn't particularly in anyone's books as a plan, so we might as well take the leap and see what's appropriate for us. Right? I've tried anything from Danksos to Vibram (AKA crazy toe shoes, but I was just left in pain with shin splints, lower back aches, tension headaches, etc). Since this little lady hasn't cracked the big 3-0, I felt that these symptoms were pretty unacceptable for a fairly active woman. SO! I went back to basics. I headed to a special shoe store that assessed my gait. Did I over-pronate? Did I swing my legs in any strange ways that needed correcting? Was I a total git that needed to see a chiropractor and learn how to properly walk? Let's just say that all of these things were actually a bit true! I ended up finding a neutral walking shoe that saved my scoliosis and horrible back pain. I could sleep without gasping because I wasn't hurting ALL over after a long day on my feet at the hospital. Silly thing was, it was pretty simple. The process that is. The next order of business was my LEGS. So pooped after the end of the day (yes I said poop--nurse humor)! My body wasn't particularly tired, but holy smokes my legs were d-e-a-d. I would often just SIT in my car after a shift and consider sleeping there, and not driving home. Poor legs... Right? Well, I honestly believe that perfusion was an issue. Gravity is an angry force sometimes. It does unruly things to our bodies in old age, and not to mention makes blood pump against resistance (while standing excessively). The answer? Compression socks. You know.. The super "cute" ones that the nurses with the starched caps once wore. I'm kidding. They really are pretty cute these days. Plain colors and patterns abound, which is awesome because my legs don't want to fall off anymore. (Seeing as this would be a terrible dilemma). Buy multiple pairs! As many as you have scrubs for the week. Done! Since finding the appropriate shoes, I bought special orthotic inserts that have extra bounce in the heel. It takes some of the pressure off as well as help distribute weight evenly. The compression socks (I think I've chosen 14-20 mmHg) keep my legs from aching. I even pay attention when I walk. Am I rolling off my foot wrong? Am I using awful body mechanics that make me look like a circus act when I'm reaching for things? Oddly enough everyone, as silly as it sounds, these are really important things for us. We can truly hurt ourselves. I've had friends who did get hurt at work (from poor body care/mechanics). They retired early. It's a thing. Don't think it can't happen to you. We are all vulnerable. To reel this all in, I bought two pairs of shoes on Amazon. Once I knew what to look for I could snatch up some amazing deals and steals. But to be honest, if there's one thing I don't scoff at is spending money on things that truly HELP me and my body do its day-to-day work. If you calculate it, it's priceless being healthy and safe. Lastly my dear friends. Eat. Well. Actually. EAT GREAT. Stop the shenanigans already. I can say this because in the last year and some change I've put on a significant amount of weight compared to my norm (give or take 15 pounds). It feels so rough on my joints, my gut (insides), and my overall wellness. I wasn't sleeping/resting as well and not to mention a severe lack of energy that was almost depressing me to the point that getting out of bed sounded totally and utterly crap-tastic. Not the best feeling. I was reaching for pizza, doughnuts, excessive caffeine. Funny thing is when you have zero energy, you don't want to work out. What happened next you ask? I stopped working out, packed on some more weight, and then lost muscle tone. Our body goes full-circle friends. No movement = pain. End of story. My body felt like it was dug into a deep hole and I just wanted to sleep down there. Sleep in the mud. Blegh. Not good. SO! To get out of the grump... More like slump (though I was horribly grumpy too) I stopped reaching for the doughnuts, added greens to EVERY meal (yes, including breakfast). And cut back immensely, I know you're already thinking of it, on alcohol. Tough day at work, get a glass of wine.. Turns to two. Now you can't sleep because your body has to flush all that stuff out. Now, I'm Italian. I LOVE my wine. But seriously people, think about it. Be kind to your body. You're stuck with it until the end of your days. Put the GOOD stuff into your Boca (Spanish again)! If you can't pronounce the ingredients, it's probably not a good call. PREPARE your food, stop eating in the cafeteria (if you can help it). I swear by, "a little chocolate at bay keeps the crazies away". So have your indulgences, in stride. Get my drift? Remember, when it comes to work, work in order that you may "play". I work so that I CAN LIVE. This is what life is about for me. Experiences, people, travel, food, drink, fun, outdoor activities and the list goes on. If you don't care for those angry feet, legs and hungry tummy (hunger for REAL food people!) then you will run into a slew of issues. Learn from my mistakes, and maybe some that you've made already. It's never too late to change things up!

For my earlier post-- Anger from the patients/their families.. Thanks for that-- I was a bit general.

Your stories are blowing my mind! I thought I had a pretty good collection, but man! Keep up the comments, I am sitting to read multiple times a day everyone-- Thank you! You are giving me much food for thought. Does anyone else feel as though they are strong in the workplace, standing up for the right thing, but then find themselves derailed when you have been told that in being honest that your customer service is poor? (I've heard this on multiple occasions, mind you-- which is why I feel inclined to ask!)

I am LOVING these responses! I think the greatest idea that seems to spring forth from the majority of all of your posts have to do with the nurse being expected to handle every situation of which leaves a "bad taste" in someone's mouth. I do believe that we are the first to the front lines when it comes to issues for those in our care (duh, we are there ALL the time!) How do you all think we can help situations without having ourselves get burned out? Because we WILL get the brunt of everything, this will not change because our roles place us at the bedside frequently. Food for thought! Keep up the great responses. I'm loving reading all of them!

It's 0700 and the night shift is scrambling to give report as us day-shifters struggle in with our coffee breath and slightly askew hair. Part of the way through the patient history of the terrible triad (coronary artery disease, diabetes, COPD...) I hear through the grapevine that not one, but BOTH of our CNAs have called out. My ears perk up like a hunting dog and I scramble. I interrupt my own report in order to find the best-working COW (computer on wheels) and a fully functioning dynamap. Of which I sadly realized was nowhere to be found. It makes for a terrible time post cardiac cath if all the MP-5s are claimed and there are no dynamaps equipped with all of the appropriate fixings (temperature, blood pressure, oxygen monitor). Needless to say, I felt as though I was drowning before the day had truly started. As report finished and we had rounded in each room, I could see the gleaming flat screen TV, the arm-chair full of overstuffed pillows, toiletries strewn about the room, and our 6-page menu stuck to the floor in some sort of goo. The manual blood pressure cuff on the wall was either falling off, missing parts, or not there at all and the thermometers on the walls wouldn't turn on. We were operating at a 5 to 1 flex ratio with patients post cardiac procedures, on a multitude of drips, BiPAPs buzzing, and rapid responses flooding in. Where did this money come from?! I am no expert in funds when it comes to profit and not for profit hospitals. My father always corrects me on the rant of "where did this money come from?!" "Where did THAT money come from?!" (He would tell me that it's from a different allocated fund). To be completely honest, I am sure that it does. What I would like to know is when did flat-screen TVs with more than just local cable and overstuffed armchairs become more important than an extra doppler on the unit? Or maybe an extra staff member? A Shift In Healthcare There has been a shift in healthcare in the last couple of decades (even the last hundreds of years). I sit and talk with my grandmother often who was a nurse when they sterilized the baby bottles in the NICU and had steel bedpans for the adults. Then, thermometers were made of glass (eek! mercury) and there were visiting hours. She explains the vast differences between the times on many accounts, and seems perplexed with "the way things are going". In truth, there are many things that we are doing right. What I think is a good reminder to patients and their families is that we are at work to help heal and to help give comfort. Sometimes this means that you are going to miss your 2100 showing of "Blue Bloods" (though I do love a good mustache)! It's not that we don't want people to feel safe, comforted with mutual trust but we ALL do want to do a great job. Personally, I want to have the opportunity to catch your sepsis before your blood pressure tanks and your organs start to shut down. Is that so much to ask? I know that nurses have difficulty allocating their time with the increased pressure from patient flow coordinators to "treat and get them out" or to address multiple social concerns and battles between family members. It's not for lack of trying. As a floor nurse, I get more calls about a TV not working, anger at not being able to have a diet with salt, frustration that someone forgot their iPhone cord and their phone is dead, or that the internet is terribly patchy and they can't watch Netflix. Like I said before, how do we fix the idea that hospitals are not hotels but rather places of healing that warrant a focused approach on labs, tests, assessment, addressing a plan of care, holistic approaches to care and outpatient follow up? Where is the line drawn? In the past year I've had patients elope for cigarettes who've had NSTEMIs, invited friends to visit at the bedside to give heroin or cocaine IV through a PICC line (by barring the door, mind you), and get in a full-on yelling match with nurses because we sent a patient for an ultrasound and they missed "The Price is Right". It is a difficult line for each one of us to walk. Communication is always key, but sometimes words can fail. I've explained on multiple accounts why we do the things we do, and how our number ONE priority is patient care and prevention. At times that trumps an extra lounger in your room, or me refusing you to have take-out when you are going for an EGD in the morning. Do Patient Satisfaction Scores Improve? Always in the back of my mind, I want to know when (if it hasn't already happened) will our interventions of prioritizing register in our patient satisfaction scores? Is there a differentiation between patients being dissatisfied with their stay due to things in the hospital's control, or rather that they didn't get to maintain their normal routines that warranted a hospital stay that likened a Hilton experience? I don't write any of these things to accuse patients in any way or to declare that our duties as nurses do not include ADLs and kindness in our daily care. But the chatter continues between nursing professionals of the staffing shortages, equipment issues, and the stress of meeting expectations that seem to be near impossible to fulfill. Where do we go from here? Where is the line? What is our place? Should the nurses get surveys concerning how their hospital allocates funds and writes up scopes of practice? Should there be a public service announcement video for each patient and their family upon arrival notifying them of the hospital's roles in patient care and what their satisfaction surveys really mean for healthcare? I know that this article is loaded with multiple issues, it is difficult to stay on task when one thing reflects another. But with all that said, the issues facing us today ARE focused on money, are reflected by patient satisfaction surveys and are loaded with resources dwindling and the expectations rising. So, my friends, what do we do next?

You make some very good points banterings, for sure. I have to agree with macawake with the below stated: I think it's important for people to remember that the decisions we make and the things we say and do can cause PTSD for those we come into contact with. I hope and pray that this patient from the GI suite did not suffer from those who made fun in the room as I stood there stunned. (Maybe patient advocacy education in all forms needs to be a MAJOR piece of nursing school education)-- where to go, what to do, what to report, when, by what means, etc. All of your points go to show that there is room to grow, for everyone. For us to point fingers and say that x, y, and z are the exact culprits is a bit extreme. I honestly believe that behavior in the workplace is just as much a trickle down situation as it is with one's own ethical standards. What happens at the top will also occur at the so called "bottom". Big whigs are just as responsible as the bedside, no matter what we all face on a day to day basis. What we are given has to be put to the test with what we KNOW is right. We ALL need to perform to our best ability and also be willing to accept when we're wrong. Our role models and our own ethical standards make us who we are. We have to choose what we will do with that power. One of the greatest tools I've come into contact with when concerning patient safety has been a SAFE report (not sure what this is called at other facilities) and furthermore contacting unit managers and as high up as the chief of medicine (yes, I've also asked for an audience with the President of the organization). It's important to face the truth with professionalism and protect what is important. I encourage all to utilize this. Either way, I am glad that we all can see what the problem is here. That there IS complacency and YES it comes in MANY FORMS. So there it is folks.. There's work to be done! (Really, it feels like there's ALWAYS work to be done!) : ) Being aware is the first step!