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This was kind of a rough week at work.  I was rushing around trying to get things done since I was going to be out of the office for a few days.  Getting the schedule out to my staff (have I ever told you all how much I truly hate the schedule), making sure everything was off my desk before I leave for this trip I am taking and then having to terminate two of my employees.

This week I had to let two of my employees go.  One had it coming, it was really just a matter of time until he had to move along.  But the other was tough.  The other was a great nurse who was a great leader on my team, was a resource to the younger staff and was dependable.  Unfortunately for her and my team, things in her personal life started to spill over into her professional life and that affected her ability to work.

I know this is part of my job to deal with these kinds of things, that doesn’t make it any easier.  I get paid well to solve problems, and unfortunately to help people move on to another job from time to time.

Just one week I would love to not have any drama.  I would like to have everybody come to work, do their job and get along.  Is that too much to ask for?

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How long am I going to be here? How long does the surgery take? How long do I have to take this medication? How long do I have to wear this thing?

I often get these type of questions asked quite a bit from patients and their families. I get questions asking for ‘time frame’ specifics regarding any and everything about their care. Unfortunately, there really is no recipe for success in health care is there?

If I can, I always answer these questions with a bit of humor. A quick witted, “whenever the doctor says so”, seems to bring a smile to most faces. Yes, it may very well be a sarcastic smile, but a smile nonetheless.

(Oh, c’mon you know you’ve used that one before)

Isn’t it ironic that we constantly require our patients to adhere to a time schedule, yet we never can give them a straight answer about ‘how long’.

After my quick rebuttal to most of these questions, I give the long drawn out speech about how there is no recipe for success in healthcare. A + B does not always equal C. While we always have the best intentions, time is not something we can ‘predict’. Not even in the most ideal conditions.

The ‘real’ answers:

A perfectly performed surgery without any complications can still have scheduling delays. There are always emergent cases that take priority in the echelon of care. You can’t preventing the unforeseen.

Being in the hospital can be as short as 1 day and as long as 3 months (or more). There are a myriad of factors that determine whether or not the issues that brought you into the hospital can be resolved. Most of which we have no control over.

Some medication can be a lifelong venture, some can be taken for a specific time frame, while others are taken until your supply runs out.

What you are required to ‘wear’ is serving a purpose to help aid in the healing process or to probably prevent further damage. So it will be worn until it is no longer needed.

Oh, and don’t think for one second that just because you have a friend or family member that was treated for the same thing means that you’ll get the same treatment in the same frame of time. Uh-uh. No-siree-bob.

I wish I could make up a recipe book, I really do. It might make our jobs a lil easier, and I’ll bet the patients would love it!

This is one of those situations where you really cannot understand or appreciate the humor unless you happen to be a nurse or a health care professional. The following paragraph is something that we might actually write, read or say nonchalantly during a typical day on the job. You know you’re a nurse when you can understand this jargon:

44 YR male. History COPD, CHF, HTN, CAD, AFIB. Previous surgeries of CABG X4, R TKR, L THR. Also history of MRSA, VRE. Pt c/o of CP, SOB. JVD also present. Admit from ED for possible PE vs MI. Have not R/O PE or DVT. Labs: Trop, CBC, BMP BNP pending. Scheduled for CT, MRI probable. Cardiology consulted for possible TTE after EKG with numerous PVCs, PACs. No VTACH, but widening QRS and questionable prolonged QT. No U wave noted.

Pt became confused in ED. SPO2 89%declined fast. No history of CVA. Desaturated. Pt intubated. ETT placed. Vent setting AC 12, TV 450, FIO2 50%, PEEP 5. SPO2 95%. EEG will be ordered per PCP’s CRNP. Covering MD also notified. On call PA-C present.

If CVA confirmed, possible EVD placement.

I &O recorded. No BM.

OK. OK. Now my lil paragraph there doesn’t make a great deal of sense for those of us who understand the jargon (take it with a grain of salt please), but you get the idea. I spit out that ‘mock’ scenario in 5 minutes using all those acronyms from memory. If I sat here long enough I could keep adding more. The list is really endless.

Just imagine how the layperson feels whenever we talk to colleagues or fellow health care professionals in our native tongue.

Take this quiz on healthcare acronyms then share your favorites in the comments!

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My hospital has won all kinds of awards for customer service–and we are continuously told that nurses are essential to patient satisfaction. Because the reality is that patients see healthcare as a product they are buying–and they want their money’s worth. They want a good value.

Recently I applied for a per diem job which listed “good customer service skills” ahead of all the other qualifications they wanted from an RN. Hospitals want good nurses that not only provide perfect care, but ones that smile while doing so. On the other hand, nursing blogs and message boards are buzzing with nurses who think customer service is secondary to safe care–and that the two have a hard time meshing. Why is that?

Well, take for instance the patient who is NPO either pre or post OP, but demands to be fed. Throw in the family members who not only refuse to leave the bedside of the patient waaaaayyyy after visiting hours are finished for whatever reason, but also state that the nurses and docs are “starving” the patient by keeping them NPO. And even with education, the patient and family members don’t get the big picture. Many hospitals expect nurses to find a way to make people happy in these kinds of situations, and yet we nurses just see the priority: patient safety at whatever the cost–even to the point of angering patients and family members.

Having a background in retail, I was told that the “customer is always right.” Now we are told as nurses that our patients are customers and that we need to provide excellent service so they will maintain loyalty to our hospitals.

Patient=customer=patient is always right?

While I am all for safe, quality care given in combo with kindness and compassion, it seems like a stretch to expect the retail model of customer service to fit hospital needs. I mean really, the patient is NOT always right. They just don’t have the knowledge and training to be so.

Hospitals have an answer to the problem: “customer service reps” who wander the halls trying to mediate comfort issues so patients feel like they are getting “good service” or their “money’s worth.” Meanwhile the nurses are taking away warm blankets given by customer service reps to febrile patients, wrestling away complimentary milkshakes from NPO patients, and insisting family members leave during invasive procedures even though they were told they could “stay continuously with the patient because of the new 24 hr visitation policy.”

I’ll admit, as a recent patient in a hospital I LOVED the customer service rep who checked in on me–it DID make a positive impact on my view of the hospital. So, I can see the point. But can we as nurses really mesh safety with this kind of thing and why does it always have to be a fight between the two?

Yes, I understand the hospital business means big money, I understand that health-care is ultimately about dollar signs in our country today, yet my nursing practice dictates safety. As a licensed registered nurse, I am NOT all about making money for my hospital. But I do work for the hospital: they sign my paycheck.

While I do tend to bend over backwards for my patients to make sure they are “happy” with their overall experience, what I am really about, as an RN, is keeping people alive. If this means withholding milkshakes and warm blankets, well, I’m there. And yes, I will try to do it with a smile.

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Over the course of the last 20 years as a mental health nurse, I have seen a lot of true mental illness issues. The staff on board, the public and even the doctors at one time or another have called some clients “nuts.”

Mental illness has a very long history of being a hidden and shameful illness that has been around since the Bible was written. It’s the most stigmatic illness in the medical field. It’s an illness that no one really wants to talk about.

It’s sad to see someone come into the hospital who is so sick that she can’t even keep her own body clean, take care of daily functions or have someone to call on the phone to listen—even when she is in control. The families of the mentally ill persons are tired and sometimes just don’t bother to call or visit because they don’t know how to handle the behavior.

When someone goes into the hospital for open heart surgery, has a stroke, is involved in a car wreck or has a brain injury, that person’s name will be placed on the prayer list at churches. The patient will get cards, flowers, phone calls and many visits that sometimes wear him out.

When a person is newly diagnosed with bipolar, depression or schizophrenia, there are very few flowers, cards or even phone calls. The community still doesn’t understand the disease, so they do nothing. The person with the mental illness now feels even more confused and more alone.

Now let me make myself clear. I have seen many clients who pluck my last nerve after I’ve worked a 13-hour shift, and I totally understand that their families and friends are sometimes at their wits’ end. However, as mentally ill patients get better and are under better control of their illness—whether by using prescription medications or a natural vitamin mixture—they will heal better if they have a support system to lean on once in a while. If they don’t, they don’t have the motivation to get better because no one cares. Then the illness really takes over.

Mental health is at the beginning of a new era. Mental illness is being seen as a medical condition like any other condition. The idea that the family or the individual is to blame for mental illness is slowly fading. We are at the stage where people with mental illness can get the same kind of respect, care and services as other people who have a disability. Training the people who receive care and the people who work in the mental health system about what prejudice is and how to cope with the stigma of mental illness is important.

If you know someone who has mental illness, take the time to learn more about the disease. Instead of reacting in fear, get educated and understand more. If you can’t bear the thought of seeing her in person, send a card.

What else can nurses do to cope and help others cope with mental illness in the family?

Angela Brooks has worked in a state-funded psychiatric hospital in Kentucky for 21 years as a nurse, assisting sometimes-dangerous patients who come in shackled and cuffed. At angelabrook.com, she offers stories of life on the inside of a psychiatric ward, and the site, as well as her company, offers support for nurses in the mental health field and helps them bring passion into their role at work. She is also a natural health expert.

Too often, the report says, artificial barriers keep advanced practice nurses from practicing to their abilities. “The IOM report notes that the evidence regarding the safety and effectiveness of the care provided by these professionals is overwhelming and describes the numerous antiquated state and federal laws and regulations blocking the way,” said Lorrie Kaplan, CAE, executive director of the American College of Nurse Midwives. “It also describes the systems that reinforce turf battles and discrimination against entire groups of clinicians.”

While the report recommends that Medicare reimburse advanced practice nurses and physicians equally for equal work, it also recommends increased education and training for nurses, especially in the area of leadership. Nurses, the report says, should be full partners in redesigning healthcare — so “nursing education programs need to embed leadership-related competencies throughout…in order to assure that nurses are ready to assume leadership roles.”

Other recommendations include an improved education system that promotes seamless academic progression and better data collection to facilitate future workforce planning and policy.

What do you think of the Report’s recommendations? Would you add any others?

Up until about a year and a half ago I was probably the guiltiest.  I brought junk to eat, I ordered out all the time, and I drank soda all day, not to mention happy hour after work.  I then decided I was going to make a change in my life….exercise and eating well.

I started easy; I quit eating fast food and pot lucks.  Pot lucks were easy, I never liked eating food other people prepared in a kitchen I have never seen, with cats walking on the counters and dirty counters and so on.  But fast food was tough.  I love French fries.  But it got easier.

The one thing that was really tough was snacking.  There always seems to be snack food sitting around anywhere I work.  Chips, cookies, popcorn and baked goods.  Always sitting around, especially around the holidays, calling out my name.

I have finally got past it the temptation.  I have learned to bring my own healthy snacks like veggies, almonds or fruit, so when that junk starts calling me, I can go my “stash.”

It’s been a tough road, resisting the temptation, but it has worth it.

Image: bestcnatrainingschools.com

Looking for an entry-level job in the healthcare field? Consider becoming a Certified Nursing Assistant (CNA). The U.S. Department of Labor estimate that demand for CNAs will grow by 21 – 35 % in the next decade, as the population ages and life expectancy increases. And the pay’s not so bad either!

CNAs provide basic care to elderly, hospitalized or other incapacitated patients. They assist patients with the activities of daily living (dressing, eating, bathing, toileting) and monitor vital signs, measure input and output and assist nurses with cares and procedures, such as dressing changes. The work is often physically and emotionally demanding. Repositioning heavy patients and dealing with confused or demented patients is often part of the job.

Salary varies by employer, location and years of experience. Most CNAs make between $18,000 and $30,000 per year. CNAs employed by the state, local or federal government tend to earn more than CNAs who work for school districts or in private practice. A CNA with less than a year of experience can expect to earn up to $30,000 in her first year — depending on where she lives and works. Salaries are highest in Alaska, California, Connecticut, Hawaii, Maryland, Massachusetts, Nevada, New York, North Dakota and Washington. CNAs can also expect to earn more as they gain experience. Some CNAs with 20 years or more of experience report earning up to $35,000 per year.

While many CNAs continue to work as nursing assistants throughout their careers, some decide to pursue additional education. Experience as a CNA looks wonderful on nursing school applications, and it’s not uncommon for a CNA to pursue a degree as an LPN or RN. Many “work their way up,” with some CNAs eventually serving at Directors of Nursing where they first began their careers.

See an infographic of CNA salaries by state and employer.

Source:

www.bestcnatrainingschools.com

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What if your employer insisted on radio frequency identification tags (RFID tags) for all nurses? Would you object to wearing the location-tracking technology?

RFID is an up-and-coming technology in healthcare. So far, healthcare organizations have had the most luck using it to track equipment. RFID-tagged IV pumps, for instance, are essentially self-tracking. Because the technology allows authorized users to track the pumps’ whereabouts at any point in time, nurses who need an IV pump no longer have to spend time searching from room to room or floor to floor for an available pump. RFID technology has also been used to fulfill some more mundane responsibilities, such as tracking the temperature in medication refrigerators.  Before, nurses used to waste precious minutes every day observing and recording the temps; an RFID tag can do it automatically.

RFID technology is also being used to enhance patient safety. RFID-based medication administration systems are easier to use than older, barc0de-based systems. And RFID tags can help staff keep track of patients prone to wandering.

But when it comes to using RFID technology to track an organization’s most valuable asset — its employees — the reaction is mixed. In a recent editorial, Frank Pasquale, JD, a Schering-Plough professor of healthcare regulation and enforcement at Seton Hall University, wrote that many nurses find the idea of such constant tracking oppressive.  “Inserting a watchful electronic eye to monitor what is already an extremely stressful job may create many unintended consequences, or deter people from going into nursing all together,” said Pasquale. On the other hand, he says, “the nurse-cam may be seen as a way to protect vulnerable patients (and perhaps increase the accuracy of evidence of malpractice cases).”

Some nurses seem to welcome the idea of RFID-tracking, in hopes that the data will provide administrators with concrete data regarding nurses’ work days. Others shirk from Big Brother-style surveillance. What do you think? Is RFID tracking of nurses a good idea or a bad one? Why?

Source:

http://www.concurringopinions.com/archives/2010/06/rfid-tags-for-nurses-then-everybody.html

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Sadly, we’ve been in last place for awhile. The Commonwealth Fund analyzes and compares the health systems of seven industrialized countries each year — Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom and the United States. The US was last in 2004, 2006, 2007 and 2010, despite spending almost twice as much per capita ($7290 vs. $3837 for the Netherlands).

Researchers observe that the universal healthcare systems in the other six countries encourage a close relationship between patients and a medical “home base.” Many are also ahead in the use of information technology, which can streamline patient care and improve diagnosis and treatment.

Interestingly, some Americans believe nurses can act as “home base” for patients here in the United States. A recent New York Times article detailed the efforts of one insurance company to cut costs. They did it by hiring nurses. According to the Times, the nurses “full-time job is to help patients with chronic diseases stay on top of their conditions, and, ideally, out of the hospital.” So far, it’s worked: hospital admissions are down 18 percent, while medical expenses decreased seven percent. Patients are pleased with the system as well.

What do you think of the “home base” idea? Do you believe nurses are key to real healthcare reform?

Sources:

www.commonwealthfund.org

www.nytimes.com