The Nurse as Darth Vader

Every time we speak she has a horror story to share about yet another incompetent nurse who has crossed her path.  I dread these encounters. When the conversation heads down this particular path I want to start breathing like the Dark Lord himself …’yes, the nurse as Darth Vader, card carrying member of the Dark Side, ready to do harm at any moment of an 8, 10, 12 or 16 hour shift!’.  It is an impossibly immature response and I do not give in to it but I WANT to do so!  Not because I believe that there is 'no such thing as an incompetent nurse' but because I know there is a mix in each professional group: exceptional, average, and yes, poor to incompetent ~ nurses, doctors, pharmacists etc...  Long Term Care is a particular struggle.  Long Term Care manages in part because most of the personal care (which is most of the hard physical work) is done by nursing assistants and nurses are relegated  passing meds, doing some treatment and documenting care.  Those nurses have patient loads of 20 to 30 patients (double and triple that of their acute care counter parts) and manage the nursing assistants as well as the patients, their families and medical staff.  Many, if not most, of the nurses are LPNs.  Most would say that staff management is not a large part of the curriculum for LPN’s (nor is it for many RNs for that matter).  So, I ask, is anyone out there ready to pay more for the care of elders, more for on-going staff development? Are stock-holders ready to give up investment money for the same thing?  My gut tells me the answer is a resounding “NO”. In the mean time, 1000's of nurses will do the best they can given the limitations of time, money and resourses to fulfill their duties.

If she is right about the lack of competency ~ the next time you visit a loved one in a nursing home…watch out for weird breathing coming from the nurse!

Early Morning Musing...

All the plants in the photo above have been"re-homed". The back yard is barren - well not quite, there is a plethora of tumble weeds but they will die and blow off with this new wave of heat. But at least the patio plants have a good home with another plant lady! :) The many shelves of books are almost packed - then it is on the the kitchen. Only the essentials will be left out. With the passage of time, a busy life and living as a single person I find I like cooking less and less. Other than when someone comes to visit I simply don't cook any more. It is primarily cook books that have gone on to be recycled too.

Leaving the Central Valley is not difficult. Too hot, too arid and too dusty for me - perfect for growing allergies. Leaving the people is another matter. This morning however, I realized that one of the wonderful things that my profession has given me is a wealth of daughters. Perhaps now more than any other time, as I am an older nurse. Most of my career goals have been met and now I spend my time not only working on work but also helping younger women (nurses and other administrative personnel) obtain their goals. In the process, I have a rich opportunity to get to know them as people, to see their lives in the context of family, problems, victories, joys and sorrows. It is a special joy to bear witness to their lives. To help them grow stronger as health care professionals and to make good friends along the way. It is a special blessing and one for which I am deeply grateful.

Have a peaceful day and I hope you have weather temperatures less than a 104F! :)

When It Goes Wrong

A man lies in his bed dying. A relative sits stoically next to the bed bearing witness to the end of his time on this earth. The Nursing Assistant assigned to his care - nowhere to be found. The Nurse Supervisor is buried under the month end paper work and cannot see her absence. The medication nurse, brand new to her license, has thirty patients to attend. She frantically passes 350 doses of medication to her patients over the eight hours of her shift. She visits the man once during the day. His pain in control and she moves on to the next person. She assumes the Nurse Assistant will do her duty. The man dying harbors a bacterium that terrifies the Nursing Assistant. She tells no one that she is afraid. No one knows that she has decided to refuse to care for him. The relative of the dying man watches the minute hand on her watch and becomes angrier with every passing second that this dying man receives no care. The relative is angry but tells no one of the over sight. She is afraid to leave his bed side. She does not think to ring the call bell. Eight hours pass and no one enters the room. It is not until the next group of workers arrive that the care begins. The evening Nursing Assistant listened to her trainer and knows how to protect herself and her patient from the germs lurking in the dying man’s body. She comforts and sooths this dying man. A nurse with many years of experience assesses his needs and renders care to him. Some balance is restored in a system out of tilt – dignity and compassion again find their places at the bedside. The other Nursing Assistant calls in sick for her next shift. There is a reckoning awaiting and she knows it.

The End of Nurses Week

"...a good nurse is of more importance than a physician."
~ Hannah Farnham Lee 1844

A week of celebrating the LPNs and RNs who do the work of caring for a nation of frail, sick or recovery human beings draws to a close.

Odd to have been in nursing so long that it seems as if it was only yesterday that there was no national day of recognition ... let alone a week. Old enough to remember being taught the sexist heresies in "Nursing History" that Florence Nightingale was a 'loose woman' and a camp follower - nothing about her strong mind and determination of will. Old enough to still remember my nursing instructor telling her all presumably all white class of students that black patients had inferior nervous systems and therefore required less pain medication. When no one questioned her statement and I spoke up, my Georgia classmates rolled their lovely eyes and murmured "well y'all she's a Yankee - what do you y'all expect". That same nursing instructor taught me to stay on my feet for ungodly numbers of hours and stay focused on the job and my patients no matter what. Old enough to remember being in nursing school (not far from his own Atlanta) when Martin Luther King was killed and watching the other students, some still in their pretty white frock uniforms stand and cheer. Old enough to know long term care before OBRA and the pressure ulcers in frail elders that had excavated tissue to the hip bone. Old enough to have developed a disdain for the very regulation and regulators that a much younger nurse once thought were essential to quality care.

This week we created moments to honor the women and men who drop children off at day care at ungodly hours to care for your grandmothers. We reminded them that their work is blessed and scientific. We praised their ability to endure assignments of 30 patients to a nurse and not flinch when family members complain that they are lazy or slow. Thirty to one and they still maintain quality. We left candy, cookies, cards, pens, pizza and a homemade breakfast to in some small way say Thank-You for Caring: Professionally, Scientifically, with Respect and Compassion.

When you next enter a hospital or clinic or doctor's office, remember this - if you have a friend who is a nurse, take her along with you...your health care outcome will be better.