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Everyone needs to be able to confide in someone. Can you be trusted to keep another person’s information to yourself?

We hear so much these days about patient confidentiality, keeping medical records from being compromised, what constitutes “consent” to release information, and so forth. But can our own friends and associates count on us to keep their trusted information from becoming public knowledge?

To have earned the confidence of another person is a great honor indeed. It is difficult to find someone with whom one can share, and perhaps take counsel from, matters of a personal or professional nature. Most of us have experienced the fallout from gossip in the nurse’s station or at the lunch table. Information which has passed from one set of lips to several others is rarely the same as when it was first shared and can have very unpleasant consequences for the one who initially let slip whatever was given in confidence in the first place.

Previously I wrote an article on why nurses blog. In it I suggested one reason for blogging is the perceived anonymity which one hopes to achieve by using an avatar or user ID instead of one’s own name. As it is practically impossible to share “confidential” information on the Internet with anyone, it is more important to find someone with whom you can share your thoughts and problems without fear of exposure or betrayal.

There are times when being approachable is not only an honorable thing, it can also seriously impact another person’s life and limb. Particularly when one is dealing with teens and young adults who often desperately need to talk to someone outside of their own family or circle of friends.

Anyone who “accepts” the role of counselor, formally or informally, is subject to the same ethics as a priest, psychiatrist or therapist. There are only two occasions when a sacred trust can be broken: When there is knowledge of a crime or when there is a threat of danger to oneself or to others. In most cases, it is usually best to encourage the person to self-report the problem if no one else is in peril. Offer to go with them. Such honesty can go a long way toward someone keeping a job and getting whatever help is needed.

As nurses we have a professional responsibility to ensure patient safety. If we have knowledge that an error has been made which could potentially cause harm to someone, we have a duty to see that it is reported to the proper authority. This does NOT mean we go and gab about the person who made the error to the rest of the staff. He/she is probably upset enough from making a serious error in the first place. It is management’s job to address the problem with that person.

So, before you allow someone to confide in you, ask yourself if you can deal with whatever the secret is. If you can’t, encourage them to find someone else. Above all, do NOT use a person’s trust for any other reason than to help!

The human voice can never reach the distance that is covered by the still small voice of conscience (Mahatma Gandhi).

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Here at Scrubs you are NEVER alone!

Occasionally we get a request for advice from a nurse who is having some difficulty in his/her job situation or home life. We will ALWAYS keep the identity confidential and will respond as best we can by drawing on our highly diverse family of writers.

This is one that we received recently:

I have been an RN for two years, and lost my previous job back in July 2011. I have been unable to get a job since then. I feel like my former employer has been dragging my name through the mud. Either that, or nobody wants me after finding out I lost two jobs. The first job was right out of nursing school and turned out to not be a good fit. I had trouble learning cardiac rhythms and they fired me because of that, even though I asked for help. The job I lost in July was basically because my boss treated me like an outsider and treated everything I did and said as wrong. I never ever harmed a patient or put a patient in danger in either job. This is wreaking havoc on me not only career-wise, but emotionally as well. What can I do? All I know is how to be nurse and I don’t want to give that up. I just don’t know what to do anymore.

Sound familiar? It did to ME! Once upon a time, an RN could leave one job, walk across the street and land another right away with no delays. Unfortunately, in today’s job market we no longer have that kind of clout. Facility administrators are under orders to cut costs by any and all means possible and that usually means staff reduction.

Even older, experienced RNs who have done it ALL find themselves having a harder than usual time getting an interview after sending out dozens of resumes and filling out countless applications. Employers do not seem to value the quality of care as much as they do the bottom line. This is a real slap in the face for those who have dedicated their lives to being the best that they can be and going above and beyond so many times.

The more time that passes takes its toll on your psyche, self-esteem and physical well being. Any nurse in this kind of situation should see a doctor or therapist to deal with the depression and feelings of helplessness and hopelessness that begin to emerge. No one should have to suffer with these drains on your life!

If you have the flexibility to relocate or to work in a different community, it is worth considering, especially if you feel your name and reputation have been “blacklisted“ where you are.

Also, it never hurts to look into other avenues of nursing such as home health, school nursing, hospice care, outpatient surgery or even medical coding and billing specialties. There are a lot of continuing education and technical training courses online which can open up new doors without you having to take on the burden of yet another college degree. Take advantage of the free continuing education offerings in order to stay current on issues and changes in practice.

Managers and employers who treat nurses as you have described usually have their own bad reputations around the area. Most likely there are other nurses who have suffered the same type of abuse and they are usually easy to talk to.

My advice is this: Know that you are a person who is worthy of respect and that you must first love and respect YOURSELF. Get the professional help you need for the depression.

Be still and listen to your inner self. You may be nudged into something you have not even considered. I happen to believe there is a higher power that uses all of us, sometimes in ways which we could not have imagined. Be open to other possibilities even as “temporary” measures.

Most importantly: Do not give up on yourself! You are a worthy person who has made it through a difficult course and you have a license to practice. You are on a rough road that WILL get smoother eventually. Nurses are nothing if not resilient!

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As National Nurses Week swings around yet again, one expects to feel appreciated in some way. For some of us, it means a free meal in the cafeteria, a gift with the hospital logo on it or a “Happy Nurses Week” ad in the paper. Administrators and management smiling at you for a change…

For most of us, the one week observance is quaint and expected, while at the same time feels a bit awkward given all of the “niceness” that seems to pop-up and, just as quickly, disappear when the week is over.

But what about the REST of the year?

Most hardcore clinicians, myself included, will tell you that the much-hyped appreciation of Nurses Week does little to make them feel valued. Let’s face it: We chose a very difficult career that’s hard on the body and the soul. Relationships suffer and we have anything BUT normal work schedules. How many times have we heard someone say: “I don’t know HOW you do it–I could NEVER be a nurse!”

Nurses can tell you true stories that are so amazing, wild, incredible and ridiculous that no one could possibly make them up. No fiction writer could imagine the things we see and do on a regular basis. No movie or TV show can come close to the reality of life nurses know.

We are the ones who are privileged to be present at all stages of the lifespan. To be there for families when they experience joy as well as tragedy. To be willing and able to break the rules for the sake of making our patients’ quality of life better, even if just for a few hours.

Nurses make a difference…for somebody, in some place, at some point in their life’s journey.

Whether it is in a modern hospital, on vacation, in a shack with no supplies or running water, in a desert aid station, on a ship, in a POW or concentration camp, on board a jetliner over the ocean, in a rural health clinic, or (fill in your own blank space) wherever there are human beings in need, there have been and always will be nurses.

Doing the work. Making it better. Every hour of every day. 52 weeks a year.

Knowing that we made a difference at the end of the shift just by being there for someone.

And THAT is why we do what we do!

The best and most beautiful things in the world cannot be seen or even touched–they must be felt with the heart (Helen Keller).

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Graduation is approaching–you have the finish line in sight and are SO ready to be done! Of course, most new grads still have the NCLEX to look forward to and to prepare for, but school is almost over!

Now, having made it through and done things you once thought were absolutely impossible, you know you are not the same person who entered nursing school so long ago. You are about to enter the workforce as a professional. No longer a student with an instructor watching over your shoulder, you’ll have your own license and will be responsible for what you do in your own right.

Responsibility is what having a license is all about. No one has the right to practice certain trades, drive a car or fly a plane without providing proof they can do it safely. Successful completion of a course of study from an accredited school is the first of the necessary steps to becoming a nurse (passing the NCLEX is the other).

Why then, should nursing school be so difficult? Hard to get in, even harder to make passing grades and to keep up with your clinical hours! You’re constantly evaluated, not only on tests but also on a personal level by those who observe the way you dress, speak, interact with others and carry yourself as a potential professional nurse. And a social life? Forget about it!

Nursing is a different discipline from any other degree program at a college or university. You are being prepared to literally hold another person’s life in your hands one day. You learn how to resuscitate a person, give drugs that can be very dangerous, perform a physical exam and develop critical thinking skills so you understand what you are doing and why. You learn to be an educator and advocate for patients, their families and other health care providers. Even doctors will learn things from you!

Nursing is not a good career choice for the faint at heart, nor is it a route to snagging a doctor to marry (aka getting an MRS degree). The soap opera depictions of romantic merry-go-rounds do not happen in real life. Nursing is extremely hard work that can be so profoundly exciting and unique, people actually get a high from it!

Is it fair for schools to weed out students who do not have the right stuff to do this kind of work? I happen to believe that it IS–because when all is said and done, it is not about US but about patients’ needs being met. We are not doing anyone a kindness by encouraging people who do not have what it takes to stand and deliver good patient care to stay in the profession.

In most schools, students who figure out that nursing is not for them after all usually drop out of the program. And many who stay in because of a false sense of job security from a recession-proof career and other such notions find themselves miserable and going from job to job, seeking the satisfaction and happiness which never was guaranteed in the first place.

So yes, nursing school is about teaching you critical thinking, meeting patient needs, and being an advocate. But it’s about making sure you’re ready for the truly difficult task ahead: Recognizing that you’ve entered more than a career…you’ve entered a calling. Even at times when things were truly bad and I desperately wanted to get OUT of the profession and prayed for guidance toward something else, the answer was a firm NO and I was steered back into nursing, whether I liked it or not at the time.

So, as you prepare to receive your diploma and school pin, be happy and proud that you are embarking on a journey into one of the toughest jobs you will ever love!

What lies behind us and what lies before us are tiny matters compared to what lies within us (Ralph Waldo Emerson).

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This is a (true) story about a Young, Brash, Cocky and Arrogant doctor, heretofore referred to as YBCA. Most of you know these types in your own practice. Very often they are their own worst enemy. This was one of those times:

Once upon a long and busy ICU shift, we had a patient who finally decided to go into a full-blown cardiac arrest. (Sometimes I get the idea that people do this for lack of anything else to do or just to aggravate us!)

Now, when a code is called in a teaching hospital, all of the residents come running in their various degrees of attire, desperately wanting to show off their newly acquired ACLS skills for the chief. Most are in scrubs with lab coats, but occasionally you get one who has just bought his/her first really nice suit…

On this particular day, the first to arrive was, you guessed it, our favorite YBCA. He showed up in a nice new three-piece Brooks Brothers suit complete with the “good” leather shoes and his class ring to complete the ensemble. (Do not discount the importance of the class ring. This MD has always been one to shove it into everyone’s face and say “Do you know what this is!?” Most people know what a ring is and he is NOT the Phantom!)

Looking very much like the Important New Urban Doctor, he immediately took up station at the side of the bed and began to give orders. Around the time his colleagues and the chief resident got there, it became necessary to “shock” the heart.

Now, we all know that someone yelling “CLEAR!” means that you get away from the bed.

Well, on this day our YBCA didn’t move–he was too busy lecturing the other interns on how the code was being run.

When run through a body, electricity does all sorts of interesting things. It can stop or start a body process, which is what you are trying to do with the heart. On this occasion, it triggered an involuntary URINATION on the person who was still standing with his leg touching the bed.

Yep, the yellow stream ran right down the pants leg of the new suit and into the “good” leather shoes. Right there in front of the chief, the nurses and everybody!

Nobody had to look at “the ring” that day…

I’ve got those yellowstain blues, those silly yellowstain blues (The Caine Mutiny, Columbia Pictures, 1954).

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It’s remarkable, when one reflects back, that we baby boomer nurses actually lived to adulthood! And everyone knows we’re still waiting for that mass exodus when they’ll all retire, creating that nursing shortage we keep hearing about. For the time being, it seems baby boomer nurses just keep going and going!

Just for fun (and shock value!), here’s a list of practices that were the norm when we were children.

1. Baby boomers were born to mothers who may have taken hormones to prevent miscarriages, who smoked and drank wine with dinner, who ate canned tuna and blue cheese dressing “for two” and didn’t get tested for diabetes. They took aspirin for headaches and had “twilight sleep” for childbirth (a most barbaric thing to witness!). They were expected to stay in bed for at least three weeks after giving birth.

2. C-sections were rare and for emergencies only. Premature babies had very little chance at survival as there was no neonatal therapy back then. JFK’s last son died as a result, as did my own brother. However, the Rh Factor problem was finally identified and a vaccine developed in the mid-1960s. Progress!

3. Many of us were bottle fed because the belief that science could make anything better than Mother Nature prevailed; breastfeeding was not popular because it might “ruin one’s figure.”

4. Glass bottles with rubber nipples and black plastic rings were boiled after being washed to “sterilize” them before the baby touched them.

5. We slept on our bellies in cribs adorned with brightly colored paints, often lead-based.

6. Our cloth diapers were bleached with Clorox every week and delivered by a diaper service. Those who lived outside the city limits did their own laundry and hung clothes out on a line to dry in the sunshine.

7. There were no “childproof” caps on medicine bottles or baby locks on cabinets or doors. No child seats, airbags, or even seat belts in cars. A whole bunch of us considered a ride in the back of a pickup truck the norm for going to the river for the day.

8. We ate white bread, bacon, real mayonnaise and drank Kool-Aid sweetened with white sugar with our bologna sandwiches. A Coca-Cola from the “filling station” with peanuts poured into it was a special treat. Often Daddy would bring home a Hershey bar which was shared with the family dog.

And we were NOT overweight!

Why? Because we spent our free time outside playing! We had our chores to do, but after they were finished the day was ours–so long as we were home by suppertime. TV was something the family watched TOGETHER between supper and bedtime. The shows back then were ALL “prime-time” because that was the only time they were on the air!

So what do you think nurses? Is the typical American family healthier now than the baby boomer generation in their youth? Or are we, ironically, a special breed?

Where we love is home, home that our feet may leave, but not our hearts (Oliver Wendell Holmes).

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When I first started nursing school, I revered the older and highly experienced Registered Nurses who represented what we all aspired to be. I recall seeing the letters R.N. on their name tags with great admiration. THESE people were the “Real Deal!” They had the designation that I so desperately wanted one day! They had earned the right to wear The Cap that I had yet to deserve!

The RNs who were our clinical supervisors on the floors knew stuff. Things that were not in the textbook–like the early warning signs of a patient going downhill. Back before nursing practice was research-based and there were Rapid Response Teams. Back before there was ACLS and all of its variations. Their hard-won and finely tuned “gut instincts” were respected by the doctors because they had experienced the consequences of ignoring a nurse’s “bad feeling” about a patient.

In the years that have passed since those first quarters of nursing school, we have seen incredible changes in our profession. And through it all, those of us who DID make it through school and work at the bedside became every bit as intuitive and skilled as those who were our role models. Even more so, we had the benefit of the huge changes which took place when nursing practice finally started utilizing scientific-based research as the basis for standards of care.

At long last, WE were the ones who knew stuff. WE were the “go-to” resource people! WE had earned the right to wear The Cap and the designation of Registered Nurse!

And even more of us became nationally certified in our fields  and went on to more advanced roles in the new areas of treatment gleaned from the ever-expanding advances in technology.

So WHY are so many nurses over the age of 50 having such a hard time finding jobs in areas where we have so many years of experience?

It isn’t because we have lost our knowledge and dedication to patient care. Nor is it because we are no longer, in most cases, unable or unwilling to do the work.

It is, in my opinion, simply because we are too valuable. As in: We cost too much to hire! In addition, when an over-50 RN who meets ALL of the qualifications (and then some!) for a position is passed over for a younger and much less experienced nurse, it can only mean one thing: Discrimination based on a person’s AGE.

It is happening all over the country, even in areas with critical shortages of experienced RNs. HR departments have developed a system for exercising this illegal practice of not hiring qualified candidates based on age. It is much more “cost effective” to hire a new grad for half as much as an experienced nurse would cost. Never mind that patient care will be affected–what counts is the “bottom line.” And age discrimination is almost impossible to prove unless some brave soul is willing to risk his/her own job by testifying that it is so.

It is a shame, really, to waste so much talent and experience that is waiting and willing to put on The Cap!

The pioneers of one generation are forgotten when their work has passed into the accepted doctrine and practice of another (Edward Cook, “Florence Nightingale”).

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I was born in the late 1950s, so I’m a baby boomer–part of one of the largest population increases ever recorded following World War II (before birth control and Women’s Lib caused the birthrate to level off and actually begin to decrease).

Life back then certainly was different, which got me to wondering: How has childcare changed over the past 50 years? Let’s take a walk down memory lane…

Back then, kids played outside from daylight to dusk when it wasn’t raining or too cold. We made forts out of old parachutes from the Army/Navy store and large cardboard boxes from construction sites.

When we got thirsty, we drank well water from the garden hose. We ate blackberries that grew down at the edge of the woods and along the dirt roads. We picked the garden vegetables every morning–always making sure to lift up the yellow squash leaves and be alert for the diamondback rattlesnakes that loved the shade of the large leaves. (This is why you often see people who were raised in the country walking with their heads and eyes looking at the ground–watching for snakes!)

We shot rifles and shotguns, learning gun safety at our fathers’ sides. I remember when Mama shot a rabid fox that was out in the road–it was like a scene out of To Kill A Mockingbird.

First aid for cuts and scrapes was Mercurochrome and a bandage, unless you were at your grandparents’ house–they used kerosene. For upset stomachs, Mama kept a bottle of paregoric and would put the dose into a little stale Coca-Cola. We took baby aspirin for fevers and pain (Tylenol was not yet on the market). Wasp stings were treated with a piece of wet tobacco from a cigar after the stinger was removed. A “shot” of Penicillin was used to treat most everything else.

We had the vaccines of the day: smallpox, DPT (1 dose) and typhoid. When the polio vaccine became available, the whole family went to the local elementary school and got our “sugar cube” doses from the county health department. Chicken pox, mumps and measles were just things that kids “had” at some point. The first vaccine–for rubella only–did not appear until 1969.

I look at the list of vaccines that are now required for my grandchildren and wonder: Were we just lucky? Or tougher back then? Or perhaps we developed a natural immunity from our environments?

One thing I know for sure: We were raised with common sense, respect for our elders and basic human survival skills (how to find water, grow or hunt food and stay strong and healthy). Our parents raised us–not the school, church or government, although we were taught to have respect for those institutions.

There are a lot of things we never would permit our own children or grandchildren to do these days, and laws have been enacted to try to save some people from their own ignorance (for example, using seat belts, child safety seats and bicycle helmets).

Were we just lucky? I think it was simply that we had parents who paid attention to what we were doing and were not afraid to be parents!

Raise up a child in the way that he should go, and when he is old he will not depart from it (Proverbs 22:6).

• My colleague and I were eating lunch in the cafeteria when we overheard one of the unit clerks talking about the sunburn she got on her weekend drive to the beach. She was in a convertible, but didn’t think she’d get sunburned because the car was moving.
• My friend has a lifesaving tool in her car which is designed to cut through a seat belt if she gets trapped. She keeps it in the trunk.
• I was hanging out with a friend when we saw a woman with a nose ring attached to an earring by a chain. My friend said, “Wouldn’t the chain rip out every time she turned her head?” I had to explain that a person’s nose and ear remain the same distance apart no matter which way the head is turned…
• I worked one summer as a cook at a pizza joint while I was in nursing school. One day, I observed a man ordering a small pizza to go. He appeared to be alone and the manager on duty asked him if he would like it cut into four pieces or six. He thought about it for a moment before responding: “Just cut it into four pieces; I don’t think I’m hungry enough to eat six.”
• The all-time pièce de résistance: I once called a surgeon who had, earlier in the day, performed a gastroscopic exam on a tiny alcoholic woman who had started bleeding profusely from somewhere in her mouth. Now, we were always taught that a surgeon will get excited if you call and report arterial bleeding. The other myth is that he/she would come in straight away and fix the problem. In this case, the surgeon responded quite seriously: “Well, just keep suctioning. It’s got to stop sooner or later.” (Yes, gentle reader, ALL bleeding eventually will stop!) So I simply called a different surgeon who located the bleed–in a gum where she had a tooth removed two weeks earlier–and stopped the bleeding by suturing the artery.

Mama always said: Stupid is as stupid does! (Forrest Gump)

My father-in-law had a vision of the old-time horse and buggy doctor making house calls and taking medical care out to the people in the idyllic countryside.

Little did they know…

Back in the 1970s, most of our home health patients were card-carrying “frequent flyer club” members at the local hospital. The most common diagnoses were: Diabetes, hypertension, heart disease, sores that were treated with wet-to-dry dressings (the moist dressing standard was yet to come) and surgical wounds that had dehisced and/or become infected. The magical, marvelous wound vacuum systems had not yet been invented.

Instead of fancy mansions, most patients lived in mobile homes, housing projects or structures that could almost not be referred to as dwellings for humans. One patient lived in a converted tobacco barn that had one light bulb and a fireplace. A cat literally crawled through a hole in the back wall and birthed a litter of kittens.

Lack of indoor plumbing was still not uncommon in the country. In some cases, neighbors would share a well by running garden hoses across the yard or road to the next house or trailer. Sears still printed a catalog that was put to use in the outdoor loo.

Some of the older family doctors still accepted whatever the family could afford in lieu of payment: eggs, pecans or a side of beef, depending upon what was in season at the time. Nurses would bring in bags of squash, peaches, and onions to share with the rest of the office.

Directions to patients’ homes were very often dependent upon the location of dumpsters or old landmarks such as abandoned gas stations. (This was before 911 systems made it to the Deep South and all of the roads were given names.) There was no GPS to guide you and heaven help you if the county moved a dumpster!

We once had a patient who went to the hospital with what was finally diagnosed by the CDC as Rocky Mountain Spotted Fever. It was discovered that he lived in a tent just outside the city limits and had probably contracted the disease from a tick bite.

All of the paperwork was done by hand, in the pre-HIPPA era, and only two pages of documents were necessary for Medicare. This was BEFORE Congress “improved” things with the Federal Paperwork Reduction Act. Now we have 15 pages of OASIS to complete!

Today, I work for a small agency and we often get the cases that have been turned down by the “big dogs” in the home care industry. You know the ones: people with horrendous circumstances, no money or insurance and who don’t qualify for Medicare or Medicaid yet.

Sounds ancient, doesn’t it? But consider that this was only about 35 years ago!

 To Boldly Go… (Capt. James T. Kirk, USS Enterprise)