Nurses Week. Always and forever.

Originally published on KevinMD

I have to work tonight. It’s Saturday. And I don’t want to go in. It’s springtime, the skies are blue, birds chirping, and the flowers show off their magnificent colors.

But it’s Saturday. And along comes being a nurse. We have mandatory weekends, mandatory holidays like Christmas and Thanksgiving and Easter and Independence Day and Memorial Day.

Mandatory.

And even on my day off when I get a real nights sleep, I think about or dream about that emergent intubation, central line insertions, propofol drips, wrist restraints, code blues, and CPR. Chest compressions and O2 sats dropping because the patient has sputum plugs, catching that patient before he falls out of bed, medicating that one that is in active DTs, and the psychotics and the hallucinations.

If it’s a dream, I wake up exhausted.

The surgical trauma unit was my nightmare as I’d stare into that 18-year-old boy’s eyes who now was paralyzed from the neck down cause he did drugs and no seat belt and crossed over the line and killed that innocent driver on the other side.

Paralyzed from the neck down. Forever.

Or that beautiful young girl that jumped out of a building and came to us dead on arrival. And the exhaustion and anxiety of 12 to 13 long hours without a break, without a lunch.

This is a pledge I request to those not in the health care field:

Stop the insults.
Stop the innuendos.
Stop the disrespect.

Unless you have breathed our life, then stop announcing what you do not know nor have experienced.

A salute to you nurses. We have a special calling of saving your life. Of bringing in new life. Of sending you off softly into the night when it is your time.

I could never acknowledge all fields of nursing, but thank you.

Spread this:

Empower.
Enrich.
Respect.

Nurse’s Week. Always and forever.

An ode to a beloved ICU nurse manager

Originally published on KevinMD

Once upon a time, I worked for a large hospital in the surgical-trauma ICU. It was just a six-month gig, and I had to travel from home further than I wanted. But my son would be starting college soon, and the $10,000 bonus was too irresistible.

Diane was the manager. The most kind, skilled, and helpful person I have ever met as an ICU manager.

She had every possible attribute as a leader that I have ever experienced.

When a patient had an “explosion” (C. diff for sure), she was there to help us with the clean-up. When there was a cardiac arrest, a code blue, she was there with her compressions or passing out emergent drugs.
She was honest and believed in positive guidance but also believed in fairly confronting the nurse that didn’t follow through on certain procedures or policies.

She remembered all on our special days! Like “how was your daughter’s birthday”?

Or “how was your son’s high school graduation”? Or is your grandmother feeling better?

We were not a number. We were a real person.

Beyond her hands-on in the ICU jungle, she knew how to run a tight ship. She had her budget, her equipment, her nurse-patient ratio up to par.

I so used to toxic management, that I thought I had died and gone to heaven.

We adored her. And the physicians adored her too.

I would have worked for this woman forever. The epitome of a nurse and a nurse manager.

A new director of nursing came to town. She was the new boss. We never saw her face. We never met her. But her presence was thick.
And this well-oiled ICU machine came to a screeching halt.

Our beloved manager, Diane, was asked to step down. We were in shock. There was no rhyme or reason. She surely was the best.

We had heard words from above, that Diane had too much control. And the director did not like that.

Diane was in shock as so the rest of us. She stepped down humbly, and went part-time in the PACU. She was near retirement.

We were now told we would have to do 3-1 assignments. This was unsafe for the patients, for the nurses and for our nursing license.

A tech was taken away from us. And the workload became unbearable.
A perfectly wonderful ICU quickly came tumbling down.

Many of us left soon thereafter. The environment became toxic. Doctors left also.

I never met another manager like Diane. Maybe I never will.

But hats off to you Diane. And I hope you are living happily in your retirement. You certainly deserve the very best. You earned every ounce of love and respect from us.

We were thankful that we mattered to you.

And you mattered to us.

We are nurses: Stop the bullying in health care

Originally published on KevinMD

The surgeon is doing a tonsillectomy on a 4-year-old boy. Dr. Jones drops an instrument on the floor of the OR. The instrument is now contaminated and has to be sterilized by a special machine called an autoclave. This was a small hospital, so they did not have a large inventory of duplicate surgical instruments. So the circulating nurse put the instrument into the autoclave. As this machine locked in with a special timer, they had to wait for the sterilization process to be completed.

It was 2 minutes, then 3 minutes. The surgeon screamed at the nurse saying it was taking too long. Dr. Jones stood up, having his sterile surgical gown and sterile gloves on, and he picked up the steel stool he was sitting on and threw the stool across the room, and it crashed against the wall, as he screamed obscenities. No one was hurt physically, but it was a verbal and a physical threat. This violent act or gesture was reported to administration. All of the nurses knew the surgeon would get away with it. He would never be reprimanded or put on probation. It all was swept under that proverbial rug. Like nothing happened.

***

The circulating nurse placed an incorrect instrument onto the surgeon’s sterile table during surgery. The surgeon was so angry, that he picked up his scalpel and threw it at the male circulating nurse. This scalpel, this razor, missed the nurse’s face by 1/2 of an inch. The nurse pressed charges. Eventually, the charges were dropped for insufficient evidence.

The administration did not blink an eye.

***

Cathy was a timid nurse, but was the kindest nurse you’d ever want to take care of you. She was very busy, as is the case in intensive care units. She was new to this hospital. Her other hospital did not have many patients on ventilators. This night was a heavy assignment. She had many IV drips running. Levophed, vasopressin, Ativan, fentanyl and a Pavulon drip. The patient had to be chemically paralyzed due to his asynchronous breathing with the ventilator. Cathy could have looked up this drug: Pavulon, but she saw three experienced nurses, and so she asked them what were the indications of Pavulon.

First, they ignored her as the three nurses “huddled” together laughing. They didn’t answer her.

So Cathy asked her question again. And outside of her patient’s room, the three nurses started to laugh and talk about her. She heard them say out loud that she was stupid and how ridiculous it was for her to ask that question. That maybe she should take remedial nursing 101.

Cathy stayed in her patient’s room, looked up the info on the computer, as a few tears slowly trickled down her face. She now knew that working in this most strategic, dynamic ICU, that she was on her own. Dangerously on her own.

A month passed, where she was shunned and ignored. She heard the nurses talk about upcoming weddings and baby showers and birthday parties of fellow staff members. She knew she wasn’t invited. They basically treated her like she was invisible.

Cathy felt degraded, isolated, lonely and depressed. She felt that the group of nurses were so negative and aggressive, that she didn’t have a chance to change the lateral violence in that unit.

Cathy transferred out of the ICU hoping she could find a place that was friendly and kind and encouraged teamwork.

***

Patty was a traveler nurse. And she loved it. She was able to travel to different cities and states and practice her emergency department Nursing specialty.

This ER was gigantic, and everything came through this door. Gun shot wounds, near suicides, heart attacks, any trauma, it was a smorgasbord for all ailments throughout this big city and beyond.
But Patty noticed that this ER lacked teamwork. The nurses basically shunned her and immediately she felt like an outsider instead of being an experienced nurse here to help them out.

She started to receive the worst assignments. The nurse-patient ratio was one nurse to four patients. Patty was given six patients at a time. All of the time.

When she called out for help, no one was there. When she needed help to pull up a 400-pound patient, no one was there. When she needed an RN to witness her mixing a vasopressin drip stat, no one was there. Patty could normally handle any situation, but now she felt overwhelmed.

She overheard a staff nurse say to the charge nurse: “Well she makes all of that money. She can do it herself. Give her the worst.”

***

So where are the bullies?

They are everywhere. In the nursing workforce, in the OR, in the emergency department, in ICUs, in floor nursing, in nursing homes and assisted living centers.

Who are bullies?

Bullies are older nurses who can be cruel to the younger nurses.
They are managers and directors that turn their backs on the nurses that plead for help.

They are physicians that belittle the nurses and put them down and are condescending to them.

They are younger nurses who feel like they have a special entitlement granted unto them, who have minimal experience but dictate to the older nurses that they are now old and “in the way.”

They are the “know-it-all” nurses who know everything, and everyone else is stupid or “special.” The list goes on and on. The situations and circumstances, unfortunately, are endless. And in the land of nurses being loving, caring. saving lives and being unselfish in all that they do, there is a percentage nationwide, universally that is destroying the core of what good nursing is all about.

What is the make-up of a bully?

Someone who may have low self-esteem, that it subconsciously makes them feel better to tear someone else down.

Someone who has narcissistic tendencies. They consider themselves infallible, above all others, including physicians.

Someone who has lived in a home environment and has learned to mimic negativities such as harassment, shunning, ignoring, and laughing at others.

This behavior affects the entire unit. It reduces morale, and the chain of comradery is broken.

60 to 80 percent of nurses nationwide have reported that at some time in their nursing career, they have been bullied. Many leave that workplace; some nurses leave their profession.

Nurses that are victims become detached; they second-guess their skills; they become depressed and withdrawn.

Who can help?

Besides confronting that person, management would be the next in command. If management is ineffective, human resources would be next. But there is always a fear of retaliation.

Some institutions have zero tolerance. This behavior is not accepted. The EAP (employee assistance program) is recommended for the victim and for the bully. EAP is a counseling service offered by many hospitals to their employees. A probation period may be recommended for the bully.

Hospitals that implemented zero tolerance, have seen a 50 percent change in the climate of the unit, for the better.

If more institutions would implement zero tolerance, we could all get back to caring and practicing what we love. And that is nursing.

Let’s put a flashlight on the bullies. Make this end. Turn your units around, nationwide and get back to empowering each other, educating each other, coming together and learning from each other and helping one another with physical tasks, and emotional tasks. We are only good if we work together. For the sake of the unit, the nurses, the physicians, the technicians and most important: for the sake of the patients. Let’s come together and make nursing the greatest profession nationwide.

Educate, teamwork, empower: That’s what makes a good nursing unit.

On behalf of the majority of positive nurses, managers, physicians, EMTs paramedics and technicians, I salute you all for relentlessly doing some of the hardest tasks a job could have. This medical profession is emotionally and physically challenging. We have to constantly stay updated on medical terminology and protocols. Every day, every minute is a new challenge. Saving lives is not an easy job. All due respect for these medical professionals.

Let’s stamp out bullying forever and go back to what we know and love.

Let’s work together. And come up with some solutions!

Empower, engage, educate, and work together as a team.

We. Are. Nurses.