Archive for March, 2008

And then, after all the bitching and complaining I’ve been doing about nursing, and all the bitching and complaining about people who complain about people who are bitching and complaining….

comes the voice of reason.

To anyone who is considering nursing, studying nursing, or just plain a nurse, go and read this post. Thank you, Head Nurse for putting things into perspective.

Here’s one approach to ending the nursing shortage. Nurseauction.com is a new site that features an auction style marketplace where nurses can bid for shifts that employers have posted. Also, nurses can post when they will available to work, and set their price.

As you can see, I’ve already gotten in on the action:

All kidding aside, I was irked lately by something an agency nurse told me. She said she was asked not to discuss her wages with her co-workers. My feeling on that was that it’s your business if you want to discuss your wages. If a hospital will pay a nurse $33/hour for a shift and an agency will pay a nurse $46/hour for the exact same shift, who are you benefiting by keeping quiet about it? It’s really no secret that agency nurses make gobs more than staff nurses. It’s a trade-off. You trade job security, upward mobility, benefits, and vacation time for higher wages. It would be interesting to see an open market like this one show what a nurse’s services are truly worth.

So if any hospitals administrators are reading this, and know that they will have a vacant shift on April 21st, I will gladly come and work in your ICU for $1893 an hour. In fact, I’ll be there with bells on.

I read this post last night and realized it could have been written about me. I certainly have been doing a lot of complaining lately. A nursing student reading my blog might think twice before continuing with their nursing degree. My question is, what’s wrong with thinking twice about something?

I’ve seen a lot of angry nurse blogs and it concerns me too, but I don’t think the answer is to discourage angry nurses from blogging. To me, angry nurse bloggers = angry nurses, and so there are a lot of unresolved issues within the profession.

John says: “By presenting such a negative picture of our lives, aren’t we, as nurses, beating up those who read our blogs who may be just starting in the profession, or worse, considering joining the profession?”

To me, this couldn’t be further from the truth. When I voice my complaints about the profession, I feel I am doing a service to my readers who are thinking about entering it. I am telling the real story of what it’s like to be a nurse in the hospital. My BSN program did their best to fill my mind with nursing theory, nursing politics, and nursing lingo, but they did very little in explaining what it is actually like to be a nurse, and for that I feel a little cheated at times.

Another thought. The majority of these “angry nurse bloggers” work in hospitals, and hospitals are where the nursing shortage exists. To suggest that all nurses who are unhappy should simply find another specialty, is not really going to do much in the way solving the nursing shortage. There are some very real problems with hospital nursing, and within our health care system in general, and these things issues need to be addressed, not hushed up.

Yes, working as a nurse is frustrating, even infuriating at times. But it’s also exciting, meaningful, and extremely rewarding. And you can find all of these points of view by reading nurse blogs.

Nursing students and novice nurses, take these angry nurse blogs with a grain of salt. People will always complain about their jobs, no matter what profession they are in. On the same token, I would encourage you to take these complaints very seriously because they are real and legitimate. Perhaps a new generation of nurses is needed to actually change things, and to create an environment where nurses aren’t so angry all the time.

Let’s face it. I’ve been blogging about some pretty frustrating topics lately. I think it’s high time we start having some fun around here. With that in mind I will offer you the following warning about this post:

a. It’s not at all about nursing,
b. It may entice you to waste huge amounts of time,
c. It’s unabashedly girly so if you’re not into that sort of thing, feel free to check back later.

So some of you may have noticed that I created a new profile picture. In the process of doing so, I came across this incredibly addictive site, Taaz.com. It’s basically a site that allows you to upload a picture of yourself, and then try out different make-up and hairstyles.

So my first instinct was to try it out and see if it really worked, and I was pleased to see that it did! You can add lipstick, eye make-up, and foundation, and it actually looks somewhat real:

But then I got all crazy and tried to make myself look like a goth girl. Instead I think I ended up somewhere between Loretta Lynne and Kate from the B-52’s:

Then I got even crazier and started photoshopping my new goth girl look:

And now I’ll probably spend the rest of the day playing with this totally addictive site, because that’s just the kind of self-absorbed girl that I am. Hey, at least you will be spared another rant as to why I want to leave nursing, right?

At the end of my rant about sloppy physician’s orders, I asked the question, “How do you get beyond that kind of apathy?”

May, whom I have a great deal of admiration for, said,

“i know that clearly looks like apathy, but it could also mean something else. i maybe apathetic about the issue, but i know i still want to take care of sick people most of the time, despite the challenges…”

May, I want to thank you for reminding me that the nurses I work with are very caring and compassionate people, and so apathy may not be the right word to use at all.

Perhaps it’s simply a matter of economics.

So the nurses have voiced their complaints. They have staff meetings, they have a nurse manager who supposedly advocates for them. So why does nothing change? Perhaps it’s just the balance of economic power that exists within the hospital.

Doctors who do expensive procedures bring big gobs of money to the hospital, therefore they have power. Nurses, on the other hand, don’t really bring any money into the hospital and so they have very little power.

It’s a very simple concept: money equals power. You can complain all day long about doctors who are sloppy about writing orders, but what incentive to they have to listen to you? I suppose one incentive is that they might miss out on having a top-notch nursing staff, because they will only attract nurses who will put up with sloppy orders, but does that really matter to a radiologist or an interventional cardiologist?

Maybe not. It doesn’t take much to do my current job. I monitor vital signs, and I tell people to lie flat until their groin site heals. I hand out generic discharge instructions. I occasionally transport a patient to the floor. It’s pretty simple stuff.

That’s not to say that I don’t work with some top-notch nurses in the recovery room. Quite a few of them are excellent. But I think the reason that most of them work there is because it’s a wonderful thing to have a nursing job with no night or weekend requirements.

So what’s my point anyway? Why am I complaining? Why am I so frustrated?

Mark Graban made an interesting point: “It requires Leadership! This isn’t something that Lean can solve if there’s not leadership and a drive to fix problems like this.”

Unfortunately, I have no desire to be some sort of visionary leader who will solve all of the problems in the recovery room. Rather, my instincts are telling me to get as far away from the recovery room as possible. Maybe the answer lies in the fact that my job would be vastly improved if we used a CPOE system. And yes, I have thought about working for a company that sells CPOE programs, because I am truly an evangelist when it comes to using them.

Hmmm. Now there’s something to think about.

From A Scanner Brightly:

“Health care currently consumes 16 out of every 100 dollars in the USA, but electronic health records are next to non-existent. The few that are in existence don’t talk to any of the others.

If we ran banking like that we’d be… oh wait a minute, we did run banking like that. About a million years ago. Well, thirty anyway.

16% of the US economy runs on scrawly, handwritten notes.“

I would like to expand this thought to computerized physician order entry systems and here’s why:

I made a mistake yesterday. I didn’t just miss one order. I missed A WHOLE PAGE OF ORDERS.

Why? Because the doctor wrote them on a separate page and stuffed them into the side pocket of the binder, rather than putting them in the proper place.

I looked through the chart five different times, looking for an order and I couldn’t find one. There was nothing but blank orderset sheets, and a blank order page. I wasn’t too surprised though. This kind of made sense to me because there was no fellow in the case, and usually the fellow writes the orders. In fact, if you ask an attending to write an order they kind of turn away in a huff and say “I don’t do that. Get the fellow to do it.” In this particular case, I just followed the basic (unofficial) protocol for this procedure (Vital signs Q 15 minutes x 4, then q30 minutes x2, then Chest X-ray after 2 hours, then page the physician after the CXR has been read.)

I did all of that and paged the Radiology attending. He never responded. So after about 20 minutes I paged the urology attending. He called me right away and asked, “What about the CBC?”

“I didn’t draw a CBC.”

“Well I ordered one hours ago.”

“I’m sorry but I didn’t see any orders in the chart.”

“Well I ordered it.”

“Okay, well I’ll check the chart again, and in the meantime I’ll draw the CBC.”

I went back to the chart and low and behold there was an entire page of orders, stuffed into the side pocket, where miscellaneous patient info usually goes.

Fortunately no one was harmed, although the patient did have to stay in the recovery room for an additional hour because I didn’t see the order.

This was my mistake and believe me, I owned up to it. I apologized to the patient for creating this delay and I apologized to the attending for missing his order, but I know that this mistake could have been avoided if the recovery room used a computerized ordering system.

So this brings me to reason #2 I am thinking about leaving nursing: Being a nurse in the hospital is essentially about carrying out orders. You can sugar coat it all you want, and talk about how there’s a big difference between nursing care and medical care, but in the end, physicians write orders, and nurses carry them out. (And by the way, my BSN program did their best to convince me that this is not the case, but after three years of working in the hospital, I’m pretty certain that this is the case.) And yet there is such a lack of standardization in the way that doctors write their orders, so it can be difficult to carry them out. Do the recovery room nurses care about this? The answer appears to be no. Whenever I ask the nurses about this situation their reply is this, “Oh we’ve been fighting this battle for years. Nothing ever changes.”

How do you get beyond that kind of apathy?

Here’s a daunting question:

Is the convenience of taking a verbal order worth your nursing license?

When you practice nursing, you kind of have to look at each patient as a legal liability for yourself. At least that is what you are advised to do from the very beginning. Every order that isn’t written correctly, or doesn’t make sense has the potential for turning into a liability for your license. That is why nurses document the crap out of everything, and that is why our motto is, “CYA.”

So in the ICU, you typically have two patients. In the recovery room you might have 10-15 patients (or more) in one day. So does that mean your legal liability goes up accordingly? Not exactly. The ICU patients are much more sick and you are completing many more orders per patient, so most likely it equals out.

But this is the part that scares me. Part of a nurse’s job is to make sure the doctor’s orders are written correctly. In the ICU this is a lot easier. In the recovery room it’s not. I get really tired having to remind the MDs to write a “discharge to home” order. It’s usually pretty obvious that the patient is going home, yet if the doc doesn’t write for it, and I send them home and something bad happens, I am potentially liable.

It seems like I carry out tons of verbal orders in the recovery room, and the physicians rarely cosign these orders. So from a legal point of view, it’s like the order never happened.

A minor annoyance? Not really. It’s actually one of the reasons I am considering leaving nursing, because if a physician is too busy to write or cosign an order, and I have carried it out, my license is on the line, and I’m not cool with that.

In a perfect world it would be the other way around.

Fortunately, my husband has just landed a sweet new job and will be compensated enough so that I no longer have to work. (Don’t hate me, please.) It’s brought about an interesting question:

Would you continue to be a nurse if financially you didn’t have to?

In my case, I’m not quite ready to figure out what I will be doing with this new financial freedom. My full-time contract will be finished on April 12th. There are so many options. For now, I will definitely be spending a lot more time at home with baby Ben, and I will continue to work 1-2 days a week at the hospital, just to stay in the game.

In the meantime this is what I’m considering:

• Full time mom (and blogging as much as I can)
• Picking up where I left off with web/graphic design (freelancing maybe?)
• Graduate school (In what though? Health care IT? MBA? MFA? I’m all over the place with this one)

Notice the lack of the word “nursing” in any of these options.

Yes, I’m afraid it’s true. I’m kind of losing my passion for nursing. It might simply be that working in the recovery room is less than inspiring. When my contract is up, I’m going to try and pick up some MICU shifts to see if that sparks my interest in nursing once again. In the meantime, I will try and blog about what it is about nursing that’s starting to bother me, and maybe the blogosphere can help me put things in perspective.