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Have you ever uttered one of these phrases to a female nurse before? I’m not going to say I did…but you won’t be hearing me say them any time in the future. This is all fun and games, of course (except for maybe #1, let’s be honest)!

1. Bad hair day today?

This is not just because yours truly has no hair (although it doesn’t help). It’s all fun and games until the ‘hair’ card is pulled – then it’s a no-holds-barred war over why you think their hair looks bad. Did it always look bad? Is it the color? Is it too short? Is it too long? Should it be pulled up?… (this list is endless)

2. Is it that time of the month?

This should only be said from afar. If you’re close enough to be hit- you will be. ‘Nuff said.

3. Oh! Hey? Do you have makeup on?

This comment ranks up there with the hair comment. The fact that you have noticed something about their complexion will start a river of questions concerning whether or not they have always looked bad and why haven’t you said something before.

4. Do those match?

I always love the ‘void of knowledge’ most male nurses – heck, most men – have when it comes to matching. Oh – wait, maybe this is just me?

5. There’s no crying in nursing.

Yes this is stolen – have you seen the movie “A League of Their Own?” You gotta love Tom Hanks. And this can be quite debilitating. Be careful.

Of course this is all in fun. Don’t take any of this seriously, nor think for one second I or other male nurses would actually these mean and horrible things. It’s just fun knowing that we men working in an obviously female-dominated profession have a good grasp on our co-workers sensitivities.

It’s kind of like a married man knowing what to say and what NOT to say to his loving wife.

Right?

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Blogging is a fairly recent form of social/political/professional communication. By “recent,” I mean since computers and smart phones became an indispensable part of daily life.

Why do nurses blog, anyway?

Most modern nurses use a computer at some point every day, whether at home, work or school. If you follow Scrubs Magazine or any other nursing site, you are aware of the wide scope of issues which nurses face. Online is where nurses can share their many opinions with each other to hopefully improve the profession and also lift their spirits in connecting with their community.

The great peril in speaking up

On any site where comments are invited, including Scrubs, you may notice a login name is required along with perhaps a bit of voluntary information. Know that what you create and share is up to you.

Be warned! You are in a sense putting yourself in great peril by speaking up: to your job, reputation and even your license, because employers, schools, families and law enforcement also look at these sites.

Many nurses choose to keep their true identity anonymous when they choose their usernames. This way you can feel a certain level of safety. You can get things off your chest with fellow nurses without giving away your real identity, as long as you are careful not to be too specific with people and places.

The benefits of staying connected

Nurses blog and join nursing sites because no one else understands better than another nurse!

Most of us gave up trying to share about our workdays with our families and significant others (unless, of course, they ALSO happen to work in healthcare!). They simply will never understand HOW or WHY we keep doing what we love to do!

How many times have we all heard someone else say: “I could NEVER be a nurse!” or, “How CAN you stand to do and see all of this every day?”

Kind of discouraging, isn’t it?

And yet, in spite of everything, there are those among us who DO keep going and doing what we love and feel that we are called to do every day. We need to support each other in this – at work and in our communities whether online or off – because it’s not easy sometimes making this choice.

When you’ve had a rough day, it can make a huge difference when no one around you seems to get it – until the person on the other end of a comment thread does!

Your profession is not simply what brings home your paycheck, your profession is what you were put on earth to do. With such passion and such intensity that it becomes spiritual in calling (Vincent van Gogh).

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There’s been a recent surge and great interest in the “incivility in nursing.” I dare ya to do a quick search–go ahead and Google it. I’ll be here when you get back…

Incivility = violence = lateral violence = disrespect = offensive= etc, etc. In fact, I read an article that spoke of incivility as simply being mean. Mean? Really?

Better yet, I read another article that talked about actions that can be interpreted as ‘”uncivil” (incivil?), such as tardiness or sending an email without a greeting (be still my heart!).

I’m poking a little bit of fun at a real and serious problem. For some strange reason, the world of nursing thinks the problem is unique to its profession. Or that the lateral violence we experience is new or, dare I say, different.

I spent a good amount of time reading some of the leaders’ opinions, blogs, articles and presentations online. I have to admit, I’m still trying to understand the uproar here.

Incivility in the workplace is as old at time. The only difference is how it gets handled and whether or not it’s tolerated. The truth of the matter is that lateral violence or incivility will never go away. It’s everywhere–not just in the workplace, but also in our social circles, in our classrooms and in our homes. It can be less prominent or more severe no matter where you go.

I think therein lies the problem. Lately it’s become more severe in the nursing world. There are a lot of theories as to why, and they are all equally entertaining (at least to me).

1. Men vs. women (nursing is a female-dominated career)
Women are more sensitive and thus are “hurt” easily.

• How is it that women all around the world have survived in the medical community, then? Are you saying physicians are insensitive?

2. Women by their very nature can be catty
I have a hard time refuting this theory, since you don’t hear construction workers complaining about incivility. Men may resort to physical violence, but they aren’t diabolically vengeful (mostly!).

3. It’s the generation (Generation Y vs. Generation X vs. Baby Boomers)
Newer nurses feel “entitled”–they are “above” the basic bedside skills.

• I would have picked the word “spoiled.” And it’s not just the younger nurses who are guilty.

4. BSN graduates are entitled and have an ego
So you think because they advanced their degree, they forgot what it was like at the bedside? Or that they would treat a bedside nurse poorly because they have more letters after their name?

5. Newer nurses preoccupied with leapfrogging
Apparently, it’s viewed as an offense if a young nurse wants to advance his or her education? While neglect is rampant (no argument there), how is pursuing a higher education a bad thing?

6. Newer nurses have no respect
Have you heard the saying “nurses eat their young”? Since when is a bad thing if the young fight back? Respect is a two way street.

•  I think it has everything to do with you as a person (and professional) and how you deal with challenges. Period. It’s that simple. If you don’t want lateral violence to snowball, figure out a way to challenge it and deal with the root of the problem.

REALITY CHECK

We all need to grow some thicker skin
If someone offended you, don’t go tattling on them to your supervisor. Have the self-indignation to confront the assailant as a professional with your views, interpretations and explanations as well as suggestions to alleviate the occurrence from repeating. Do not turn into a high school teenager.

There should be zero tolerance from anyone holding a supervisory or leadership role
This includes every nurse who has more experience than the nurse next to them. I’ll say that again: You assume a leadership role the minute you are no longer the rookie. Period.

Newer nurses: Quit being so spoiled rotten
Just because you were coddled doesn’t give you the right to whine every time something didn’t go according to plan. Learn to roll with the punches. There is definitely a difference between self-assertiveness and immaturity.

Seasoned nurses: Quit being so vindictive and insecure
Leaving the bedside is neither good or bad, it’s just a decision to further one career. If you find it so offensive or appalling, keep it to yourself. Better yet, I dare you to try to take the same leap.

And lastly, this is for all the nurse leaders out there. If you really want to effect change, then quit with the academia-babble
Get out there in the trenches. Get your hands dirty (figuratively and literally). Quit creating new employer-based committees and developing action plans with continuum manifestos and evidenced-based theories. Walk the walk, folks.

Am I being blasé? A little too laissez-faire? Insensitive? Is it because I’m a man??!! (Ohh let the hate mail begin!) Or maybe, it’s because I don’t tolerate or accept the incivility when it shows its face.

I take a professional, head-on approach instead of whining, crying wolf and pleading with a “woe is me” attitude. There is a profound difference between being a victim and acting like one.

Let’s all put on our big-girl and big-boy pants and learn to play nice in the sand box.

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This topic in Medscape has stirred up a real hornet’s nest since two researchers published it in April 2011. It is a huge and VERY volatile issue and, like Pandora’s Box, once you open the lid…

The latter posts (since the authors “reset” the conversation due to the very large number of responses) are more of the opinion that women in the workplace generally cause the problem and that it crosses ALL professions.

Many nurses, both old and young, have experienced abuse at the hands of other nurses.

In spite of all of the advances that women have made, the problem appears to be getting worse instead of better. Perhaps it is simple biology, in which the females in the lion pride vie for top status and bite, scratch, and even kill others to achieve Alpha Female status.

Another possibility is that it’s a side effect of the overall deterioration of behavioral norms and work ethics in the post Baby Boomer generations. “Failure to parent” and “spoiling the child” have been cited as causative factors

Researchers have noted a general decline in basic manners, disregard for others and a strong sense of entitlement in the children and grandchildren of the Boomers.

Nursing education programs have changed significantly from the two- and three-year associate and diploma programs to the bachelor’s degree for licensure. A great many of nursing’s most revered traditions and expectations fell by the wayside in the process.

And very few people who have a four-year university degree want to do basic nursing care (i.e. cleaning up poop!). Many feel that their BSN entitles them to a “more important level” of nursing than bedside clinician, regardless of their lack of experience or expertise in the work environment.

A British study published in 2009 reflects this attitude and is entitled “Too Posh to Wash”(“Nursing Times,” November 2009).

Fair warning: The Brits are not nearly as politically correct as Americans are!

The British report was quite condemning and very pointedly described comments made by students and their attitude toward basic nursing tasks. It even described the modern nursing student thus:

Nowadays, they get up at 11am from a drunken stupor and, on the rare occasions that they can be bothered to go to work, demand a lift from their long-suffering parents and show up in hotpants and leather boots.

A gross exaggeration? Perhaps. But the attitude of superiority is still there, just under the surface. We have all seen these people as new grads. Unfortunately, many of today’s young nurses are going back to obtain master’s degrees and move into positions which are far beyond their level of experience and knowledge to get away from basic patient care.

The danger lies in patients being subjected to advanced caregivers who have more ego than ability, but who will aggressively push their way to the top because they believe that they are superior to other, more experienced nurses.

This is, of course, one way to view the issue. Blogger Sean Dent also offers his thoughts on this topic.

What are the answers? If there are any?

What started as a whisper, slowly turned in to a scream. Searching for an answer where the question is unseen (Ben Harper).

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Very often, nurses find that their work seems to follow them–on vacation, to the store, at the kids’ soccer games. After awhile, we begin to accept this as par for the course.

Several years ago, I had the opportunity to travel to Germany with my husband and a group of his coworkers. THEY had to work while I would get to tour the city of Cologne.

Or so I thought.

On the plane, about an hour from the coast of Scotland, a flight attendant requested a doctor to the rear of the aircraft. We were seated directly in front of the rear restroom, and the only people who seemed to be headed toward the rear were lining up to use the facility.

After a minute I got up and went back. I found a middle-aged German lady seated with oxygen on and two flight attendants present. They told me that she had made her way to the rear of the plane after “waking up, not feeling good, and having wet her pants.”

There also was a young man seated beside her who did not appear to be related. I asked if he was a doctor and he responded, “Yes ma’am.” (You know that you have been a nurse for a while when the doctors start calling you ma’am). “But I work for the CDC and haven’t done any clinicals since I was a resident.” I assured him that I was an ICU nurse and we would get through this together.

I started the usual assessment with vital signs, history and meds–fortunately she spoke English!–and ascertained that she probably had experienced a TIA (transient ischemic attack or “pinstroke”).

After ensuring that she could safely swallow and noting that her blood pressure was a bit low, I instructed the flight attendants to give her a full bottle of water every half hour for two hours, then every hour until landing.

I then explained to the patient what had happened and offered her four baby aspirin (which I have learned to carry at all times–this once happened to a priest with whom I was serving the Holy Communion in the middle of a service!).

I administered the aspirin and filled out a medical form the flight attendant gave me. (Paperwork is ALWAYS part of the job-even at 35,000 feet over the Atlantic!)

A few minutes later, I felt a tap on my shoulder and looked up to see the flight attendant handing me a card: “Thank you for rendering medical assistance to a passenger in flight. Please accept these 5,000 Sky Miles as a token of our appreciation.”

A nice, unexpected “reward” indeed!

However, the REAL reward came just after sunrise when we landed and were getting up to leave the plane. My patient was seated in the middle of the cabin and she reached out, grabbed my hand and thanked me. She promised to see her physician and hadn’t experienced any further symptoms.

We all know that our skills and experience can be called upon at any time and any place. Sometimes it is in the one that you least expect! What’s the quirkiest reward you’ve ever received for being a nurse?

You make a living out of what you do. You make a life out of what you give (Winston Churchill).

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I actually read a post a while back from some nurse who wanted to know “the best place to work so that I can find a doctor to marry.” Seriously?

Those of us who have worked with doctors wonder WHY? After all, doctors are “on call” and, especially when in residency, often see more of the hospital than their own apartments. Women are always around and temptation is everywhere. A single male MD, for whatever reason, is a prime target in any town.

And nothing is worse than seeing someone go after a doctor who is already married. If he will leave his wife for YOU, the day may very well come when you find yourself on the other side of the fence, being traded in for a “newer” model.

The societal prestige held by MDs is widely perpetuated by the medical associations and local communities. A doctor can build a fine home in the “right” neighborhood and belong to the local country club the minute he sets up shop, especially in the Deep South. Naturally, his wife is accorded the same considerations. What woman wouldn’t want a piece of THAT?

Unfortunately, these girls are easy to spot. Eternally “stalking” their doctor target, always with makeup and hairdo “just so,” and flirting shamelessly. She most likely will stop working as soon as possible after the wedding, or will work part time in his office. And the poor “mark” never seems to know what hit him!

I have painted a very ugly picture of behavior stemming from a comment that I, frankly, could not believe I was reading.

In my opinion, the whole purpose of going to college is to prepare oneself for a CAREER, and not simply a means by which to marry well. For such a person to take up a nursing school space which might have gone to someone who really DID want to make it his/her life’s work is wasteful at best.

My daughter calls it “seeking an MRS degree.”

This article is by no means intended to convey that all doctors’ wives do these things, but it is a bit of an “expose” on the ones who DO.

What are your thoughts on this, working nurses?

A woman must not depend upon the protection of man, but must be taught to protect herself (Susan B. Anthony).

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I was inspired to pay tribute to the men of nursing after reading this recent comment from one of our brothers in the profession:

I am a nursing student, and about the “man card” thing. I am a former Corporal in the Marine Corps infantry. I first got interested in healthcare in Iraq doing combat medicine, like taking care of bullet wounds, burns, and fragment wounds from IEDs. I know who I am and if someone gives me a hard time about being a nursing student, it just show me that they are overcompensating for something. As long as I am providing for my wife and son, I don’t care what other people think. I want to be a flight nurse because I like working in high-pressure jobs.

First, THANK YOU for serving, Corporal!

Second, does everyone realize just how new women are to nursing? Particularly trained, educated women from all walks of life?

2000 years ago, nursing school was for men only!

Most of the first nurses in recorded history were members of male religious orders. Many hospitals still bear their names. Some are even canonized as Saints.

When Florence went to Scutari in the Crimean War, she had to integrate her nurses into a system in which only MEN had cared for other soldiers. So men were the first military nurses–in part because only men were permitted to serve in the Army. Also, Victorian beliefs did not permit close physical contact between persons of the opposite sex unless they were married.

During the Civil War, more women worked on the front lines caring for the wounded. Many of these nurses were private citizens whose homes stood on the battlefields and had been pressed into service at field hospitals. Able-bodied men were needed for the fighting. The names that we recall from history–Clara Barton, Mary Ann Bickerdyke, and Dorothea Dix–were mostly volunteers who simply managed to outlast the doctors who opposed them.

During the two World Wars of the 20th century, men were still the only battlefield nurses, while women served in hospitals and on ships. The same continues today. The difference is that a field medic is more of a surgeon who administers lifesaving treatment according to protocols and does not have to wait for a specific order from an MD. He does not have time to wait for orders, as he is working within that Golden first hour of trauma care which makes the difference between life and limb.

Somewhere in the Baby Boomer generation, nursing became known as a “womens’ profession.” It seemed that nobody remembered that it was a male domain for most of its existence! (Perhaps it was the sexy white uniforms and caps that did it?)

The few men who bothered to attend nursing school in the latter part of the 20th century had to put up with all sorts of restrictions: they weren’t allowed in the delivery rooms when a woman was “exposed” (although male doctors were!); they had to have a female “escort” for performing catheterizations; and they were barred from certain clinical areas, like labor and delivery.

And, of course, there is the sexual assumption that became pervasive in the late 1970′s–”He’s a nurse? Well, he must be gay!” I have no doubt that most of our guys have been subjected to this. Isn’t it odd that we never seem to make the same assumption about women? (“A female doctor? She must be a lesbian!”)

Hang in there, Marine! This profession needs a Few MORE Good Men such as yourself. I wish you “fair winds and following seas” as you move forward in your career.

And, as always, Semper Fi!

        “But we in it shall be remember’d;
We few, we happy few, we band of brothers;
For he to-day that sheds his blood with me
Shall be my brother”…   -William Shakespeare, Henry V

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This semester starts the strong wave of clinical hours for my Nurse Practitioner program. I’ll be spending many, many hours in the hospital as a student…again.

I’m just a tad bit nervous.

Okay, let me re-phrase that. I’m scared outta my mind!!

I feel like I’m back in nursing school–learning the ropes, talking the talk. Just when I started to find my own walking pace, I’m back to crawling at the next level.

I can’t help but wonder how different things are now from when I was in my diploma program. (I cannot believe it’s been seven years since I became an RN?!)

Here are a few comparisons between me as a basic nursing student and me as an advance practice nursing student:

1. If you don’t know it, know where and how to look it up!

When I was in nursing school, I carried around an average of four textbooks that totaled more than 75 lbs. I lugged my bookbag full of textbooks, notes, and drug reference guides everywhere I went. I can remember trying to figure out how I was going to stash my book bag while on clinicals, because students didn’t get lockers.

As an NP student, I’m still utilizing all the above, but now we have these things called smartphones–all 75 lbs worth of reference material in the palm of my hand. You gotta love technology.

2. The 7 P’s

Prior Proper Planning Prevents Piss-Poor Performance. (I think there are different versions, some more colorful than others. You can blame my time in the armed services for that one.)

I still remember the sleepless nights prior to a day of clinical. I would be up all hours of the night researching my meds, checking and rechecking contraindications, checking and rechecking the whys and why nots of a patient’s care. Oh, and care plans. Gooooood grief. I remember having to write them out. Objectives, interventions, outcomes…they still haunt me to this day.

Now as an NP student, I’m verifying evidence-based nursing and medical research management of care, risk reduction, test sensitivity, outcomes, and physiological response techniques. The game hasn’t changed, but the level of play is elevated beyond my imagination.

3. Stranger in a strange land

I remember the first time I set foot onto the clinical floor as a new student nurse. I was terrified. People were speaking a different language than me; they had a level of familiarity I could only dream of; and ultimately, they didn’t look scared and nothing shook them. I was in awe.

Boy, I can’t wait to feel that way again, let me tell you. (I hope you caught the sarcasm!)

In the end, I’m equal parts nervous, scared, anxious, excited, eager and motivated. Only time will tell how this first round of clinical rotations will go. Wish me luck.

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We sometimes hear a nurse referred to as “old school.” I take that to mean “in practice before the 1980s,” since that’s when I started!

Here are a few observations which may help define the old school nurse!

The old school nurse:

1. Still wears her hair ABOVE the collar at work.
2. Knows how to use a bath blanket and still prefers soap and water to body cleanser wipes.
3. Owns a case of white leather shoe polish for a VERY distinctive pair of lace-up nursing shoes.
4. Keeps a pack of mints in her pocket for post-op patients who have sore throats from the intubation.
5. Wears ONLY two pieces of jewelry to work–a wristwatch and (if married) a plain wedding band.
6. Keeps her school cap in a clear plastic tote on the shelf of her closet and her Nightingale Lamp in a glass display case.
7. Makes hospital corners on her home bed sheets.
8. Always carries an extra pen–with BLUE ink to distinguish an original form from a copy–just in case the doctor “forgets” to return the one he or she borrowed.
9. Looks the other way if something which breaks the rules is in the best interest of the patient.
10. Believes that nursing is a calling.

To all of the old school nurses who are still out there: Thank you and wear the cap proudly! What would you add to this list?

Instead of seeing it as one more thing to cross off your to-do list, what if you considered it a vital means of communication? After all, isn’t that the original purpose of charting?

In this four-part series (scroll to the end for the rest of the articles!), Dr. Brady and Nurse Rebekah explain the secret of charting the right way: It’s called “conspiring.” And conspiring with your colleagues can improve patient care, make the doctors happy, and keep you out of court.

Dr. Brady: No, I’m not planning on writing a book called The ER Conspiracy. The books I write are actually all about doing your job better. In fact, by “conspire” I don’t mean the first definition in Merriam-Webster’s dictionary, which is to scheme or plot, but rather the second, which is more true to the verb’s etymology: from the Anglo-French conspirer, from the Latin conspirare, to be in harmony; conspire, from con = together + spirare = to breathe. The second definition is “To act in harmony toward a common end.” People, I just want us all to be in harmony and “breathe together.”

In medicine, we need to conspire or collaborate more. When different healthcare providers act together in harmony, patients will more likely be satisfied, rather than confused—and if something goes wrong and we all end up in court together, we’ll be less likely to have helped the plaintiff’s attorney.

Why will patients be more satisfied? The reason is simple. If everyone tells a patient something different, she doesn’t know whom to trust and gets confused.

Here’s an example. A patient comes in with cough and shortness of breath. The ER nurse does her assessment and tells the patient it’s probably a virus, but that she needs a chest x-ray to be sure. Then the ER doctor comes in, does her assessment and tells the patient it’s probably a virus and she doesn’t need a chest x-ray or any antibiotics.

Two days later, she’s not better and goes to her doctor, who tells her she has bronchitis but doesn’t need an x-ray, and writes her a prescription for antibiotics. If she’s in the top fifth percentile for IQ, she’ll probably realize that differences of opinion are not uncommon in certain conditions. If she’s like the other 95 percent of your patients, she’ll probably be confused and assume that two of the three people who gave her advice are incompetent. If only everyone had acted in harmony, the patient might have instead been satisfied and content while the virus ran its course and she recovered completely.

Nurse Rebekah: Most of us want to be the expert at something in our lives. Some people just pretend like they’re experts on everything—which we all know is totally implausible. (My hubby calls these people “Mr. SMITH,” which stands for Smartest Man In The Hemisphere. Try that on your next know-it-all…it’s hilarious.) But many people spend the majority of their lives honing their craft, knowledge and career. Whether you’re a working nurse or doctor, a Starbucks employee or an electrician, at some point you’ll probably know more than other people who may or may not be in your field, and your advice will be sought out. Therefore, because people are seeking your advice, you should make sure you know what you’re talking about—and if you DON’T know what you’re talking about, heed my mother’s advice to “keep your pie hole shut.”

I say this because patients look to us for guidance about their health. Sure, they may have had a prior appointment with Dr. Google, but they’re looking for your professional opinion. Stick to the facts. Using Dr. Brady’s example, I might say, “Mrs. Smith, because of your cough and fever, I’m going to order a chest x-ray per our protocol to expedite your care in the emergency room. The doctor will look at it and tell you what he thinks.” Leave it at that. Don’t claim virus or bacteria—because unless you brought your microscope with you, you won’t be able to defend that claim. And the physician should have the foresight to look in the chart and not say, “Oh, I don’t need a chest x-ray…why did that silly nurse order that?” Don’t staff-split. Leave that to the psych patients and four-year-olds.

Starting to get the idea? Only say—and write—exactly what you observe. Anything more is just speculation and can confuse and frustrate both patients and staff.

The Essentials of Nurse Charting

Part 1: The Secret of Successful Charting

Part 2: The One Thing Nurses Should Never Assume About Charting

Part 3: How to Avoid Lawsuits with Charting

Part 4: How to Choose the Right Words When Charting