Nurse Ratched’s Place

My apologies to James Carville. I plagiarized his tagline because the insurance industry has forgotten about sick people during our national healthcare debate.
I remember when nurses and insurance companies use to get along with each other. Back in the 1960s, these nurses even took time out of their busy schedules to pose for one of their ads. We took care of patients at the bedside, and the insurance companies paid the hospital bill. It was as simple as that, but then things started to change. It began with three little letters—HMO.

Insurance companies are spending a lot of time and money trying to scare people into opposing President Barack Obama’s ideas on health care reform. They are especially working hard to torpedo the public option plan. That plan would allow you to keep your own private health insurance policy or buy affordable health insurance through a public plan. Insurers are going all out to make you hate this idea by making claims that aren’t true. They are saying that the government is going to ration health care by dictating which doctor you can see, and by making you wait weeks to see a specialist. Ironic isn’t it? The insurance industry is already doing these things to patients everyday via their HMOs. We wouldn’t even be having this debate if they were playing fair in the first place.

Insurance companies make their money a couple of different ways. They rack in the bucks by not insuring people who are sick, a practice known as cherry picking, and by not paying out claims. They also make money by cutting out competition. This is the real reason why insurers are trying to muscle Uncle Sam out of the insurance business. Medicare administrative costs are equal to about 2 percent of what it pays out to providers. For private insurers the ratio over expenses to payments is typically over 15 percent. Why the big difference? Insurance companies have high overhead. Their CEOs take home mega-million dollar paychecks, they have to take care of their shareholders, and they have to pay for fancy ads that convince consumers that they will have health coverage when they really need it. They need those fancy ads. Insurance companies are always looking for ways to deny our claims, but I digress. Competition between private companies and a public plan would hit insurance companies right where it hurts—in their wallets. Fewer customers in private plans means less profits, and less profits, up to 20 to 30 percent by some estimates, means fewer martini lunches for those at the top of the corporate food chain. To make matters worse, those greedy folks who make money by NOT paying for care would have to lower their profit margin on the customers they do keep in order to compete with the government.

I’ll never forget the day that I learned about HMOs. I came into work and found red dots on the side of a few patient charts. My head nurse told me that the dots were put there to prompt doctors to discharge patients as soon as possible so that the hospital and the insurance company could make more money. That was twenty-five years ago and the system has been in freefall ever since. Year after year, nurses are voted as the most trusted profession in America in Gallup’s annual survey of professions for their honesty and ethical standards. We are patient advocates, and we never put anything above what’s best for our patients. That’s why I’m putting my seal of approval on President Obama’s public health insurance plan, and so are the American Nurses Association (ANA) and the SEIU. The insurance companies want your money. Nurses want to take care of their patients. We want all Americans to have affordable, high-quality healthcare.

Like most of you, I’m continuing to watch the events unfold in Iran via Twitter and YouTube. Not surprisingly, given the escalating violence, doctors and nurses are caught in the crossfire. This video was posted on YouTube on June 16th. One woman who I’m guessing is a nurse is showing a sign that says that 8 people were martyred. Toward the end of the clip the young man (whose voice breaks down many times) is saying that he witnessed the brutal beating of women and children. He speculates that the attackers were Lebanese Hezbollah. Hat tip to Andrew Sullivan, The Daily Dish.

This story really upset me because I work with medical students at UGH (Undisclosed Government Hospital), and because I have children who are the same age as these victims. The eye witnesses reports come from medical students who hid when Iranian militia and police raided a Tehran University dormitory in the middle of the night. Hat tip to Nico Pitney of the Huffingington Post. As we witness history, we will continue to witness the murder of innocent people.

(From the Huffington Post)

“At the same time, Iran’s Interior Ministry ordered a probe into an attack late Sunday night on Tehran University students in a dormitory reported to have left several students dead and many more injured or arrested. Students say it was carried out by Islamic militia and police. Iran’s English-language Press TV said the ministry urged Tehran’s governor’s office to identify those involved. Iran’s influential speaker of parliament, Ali Larijani, condemned the attack.

Students’ Web sites reported mass resignations by Tehran University professors outraged over the incident. One medical student said he and his roommate blocked their door with furniture and hid in the closet when they heard the militia’s motorcycles approaching. He heard the militia breaking down doors, and then screams of anguish as students were dragged from their beds and beaten violently.

When he came out after the militia had left, friends and classmates lay unconscious in dorm rooms and hallways, many with chest wounds from being stabbed or bloody faces from blows to their heads, he said. The staff of the hospital where the wounded students were taken, Hazrat Rasoul Hospital, was so shocked that they went on strike for two hours, standing silently outside the gate in their white medical uniforms.”

I’ve been reading the Tweets coming out of Iran today, alternating between hope and despair. One tweet caught my eye. Someone who said they saw police keeping patients from entering a hospital in Tehran wrote it. The tweet said that police had surrounded the hospital. It also said that police were beating doctors who tired to give aid to dying patients. I can’t imagine what those people are going through. God help the Iranian people.

Do you remember this person? She is a bedside nurse. She walks up and down hospital hallways in her white nursing shoes all day long while caring for her patients. She is trained for active duty. I’m asking you this question because nursing researchers have had an epiphany. They believe that they have discovered something new in the field of bedside nursing.

Over the years I’ve observed that the more degrees and letters that a lot of academic nurses get behind their name, the more out of touch they become with bedside nursing. This came to light once again when I attended a mandatory inservice at work. I was told that we were going to talk about an innovative concept that was going to revolutionize patient care and the nursing profession. Imagine my surprise when the speaker talked about hourly rounds. Did you know that nursing researchers have discovered that patients are happiest when their nurses spend time with them at the bedside every hour, and anticipate their needs? Wow, what a concept. Academic nurses living in the ivory tower of higher learning have discovered through years of painstaking research that patients also want nurses to answer their call light promptly when they need help getting to the bathroom. Holy cow! Hourly rounds decreases the amount of time patients spend using their call lights, decreases injuries due to patient falls, and increases patient satisfaction while they are in the hospital.

Did I miss something? I remember learning all this stuff years ago when I was attending a lowly diploma nursing program. We were always walking up and down the halls in our nursing shoes. No one conducted studies on how to make patients happy back then. A little common sense goes a long ways. The formula to good patient care starts with clean bed sheets and a filled water pitcher, and ends with a connection to your patient. That’s not new. That’s nursing.

Life is good. I’m settling into my job at UGH (Undisclosed Government Hospital) and I have a couple of days off from work. I’m using my time constructively. My house looks like hell, but I am doing other important things like writing, reading blogs, and visiting Twitter.

Yes, I’m addicted to Twitter. I started tweeting when I hooked up with Pixel RN and Dr. Val at BlogHer last year. They showed the joys of micro-blogging and it changed my life forever. Twitter is great place to meet people using 140 characters at a time. You can hangout in cyberspace with people like Ashton Kutcher, Lance Armstrong, and Stephen Colbert. You can also hangout with a lot of great healthcare providers. I make new “friends” by putting the word “nurse” into the Twitter search engine. Then I sit back and see what pops up.

Yesterday, something very interesting caught my eye. Dr. Hess, a plastic surgeon, tweeted that nurses were being offered free plastic surgery. I love free stuff, so I followed the link in his tweet, and checked out his blog. He wrote a great post. I also checked out the link in his post to the New York Times. The upshot of the story is that some places in Europe are offering plastic surgery as a recruiting tool for nurses. The story talked about the enormous social pressure that some nurses are under to look good. It’s true. Even some hospitals in the United States are using young and beautiful nurses as a marketing tool to entice more patients into their facilities. Age discrimination is rearing its ugly head. I wrote this post about a nurse who lost her job because she was getting old and because she wasn’t pretty anymore.

I tweeted Dr. Hess. I told him that there wasn’t enough plastic on the planet that could make this sow’s ear into a silk purse. I also told him that I look forward to tweeting with him in the future. He wrote back and told me that he thinks that I’m charming. Just wait till he really gets to know me!

I’m going to Twitter my way through life.

Check this out. Massachusetts General Hospital nurses rocks! Don’t forget to wash your hands.

Cal-Stat Rap from WBUR on Vimeo.

I wrote this post a long time ago when I first started blogging. I’m recycling the post because this information bears repeating. I’ve been seeing some behavior lately that is inappropriate, and I’m telling you this stuff for your own good. Please, never roll your eyes at a nurse who is old enough to be your mother. She may be going through menopause, and it could be the last thing that you ever do. Just sayin.’ Don’t make waves at the nurses station.

I worked as a neurosurgical nurse many years ago at a teaching hospital in the Midwest, and twice a year a new crop of interns descended upon our unit. It was the best show in town. The spectacle began with the chief of neurosurgery, Dr. Holier Than Thou, strutting on to the unit with his entourage marching behind him. He stood before the crowd in his impeccable white lab coat, telling everyone within earshot of his importance, and how he held the power of life and death in his hands. I would sit at the nurses station and snicker at the biannual parade, and remembered my first day in the hospital as a nursing student. Two interns had asked me to go into a patient’s room to get a set vitals signs. They didn’t tell me that the patient was cold, stone dead. I walked into the patient’s room, saw the dearly departed, and calmly walked back to the nurses station to find the interns laughing their fannies off. I told them they were going to make damn good doctors one day, but first they had to learn what rigor mortis looked like. Nonetheless, because every new group of interns looked like lambs being lead to slaughter, I pitied them, and I gave them information to use as a survival guide. These are the rules I taught them about working with nurses.

1) Nurses deserve respect. We are with the patients twenty-four hours a day, seven days a week, while doctors are only able to see patients a few minutes a day. Smart interns forge alliances with the nursing staff, and understand that nurses can save their butts when something goes wrong with one of their patients.

2) Don’t take the last piece of pizza in the nurses lounge unless you are invited to do so. Nurses are territorial about food.

3) Nurses do not tolerate interns with a budding God complex. Nurses have no problem calling arrogant interns every hour on the hour for Tylenol orders, especially at night. Arrogance breeds contempt.

4) Don’t be stupid. If you want to complain about nursing care, be careful when you approach a nurse who is working the last half of a double shift. Refer to rule #3.

5) Nurses are your friends. We want to see you succeed, and if we like you, we will make sure that Dr. Holier Than Thou doesn’t find out that you order Demerol 1000 mg, instead of 100 mg, IM q 4 hours PRN because you were dead on your feet after being on call for three days in a row.

Nurses are experts at navigating through rough waters. We are always there for our patients in their time of need. Check this nurse out. She is using her critical thinking skills while she sails her boat through a stormy ocean. It’s true. Nurses can do just about anything, just so long as they have a good mentor to show them the way.

From time to time, I get letters from new psych nurses asking me for advice.

I was very lucky when I first started out as a psych nurse. Nurses and doctors who gave me valuable tips when I was new in the field surrounded me on the unit, and made sure that I didn’t get myself into trouble. Here are some pearls of wisdom that my mentors passed onto me when I was the new kid on the block. I hope they help you, too.

Pearl of wisdom #1: The first rule that I learned was that I never was to accept abuse from a patient. Patients may be angry about how things are going in their life, but they must learn to vent their anger appropriately. That means no hitting, swearing, or throwing stuff at other people. Period! Just because someone has “problems” doesn’t give them a license to act inappropriately on the unit. Seriously. Nurses are not punching bags. We have rights. Nurses must teach their patients to function in the real world, and we do them a disservice if we allow our patients to act out on a psych unit.

Pearl of wisdom #2: The second pearl of wisdom has to do with the myth that nurses can say something wrong to a psych patient. Many nurses are afraid that a patient will crumble if they say the wrong thing to the wrong person. I’ve never seen this happen during my nursing career. Just listen to your patients with your ears and with your heart. Everything else will fall into place.

Pearl of wisdom #3: Never turn your back on a patient. This is self explanatory. Psych units are unpredictable.

Pearl of wisdom #4: Don’t get offended if a patient hates you. That probably means that you are doing your job. Many patients come to the hospital because they have boundary issues, and issues involving the need for immediate gratification.

Pearl of wisdom #5: Never forget that you are a REAL nurse. You aren’t caring for a wounded body, however you are caring for a wounded soul. Don’t sell yourself short. Psych nurses rock!

My husband and I did something amazing last weekend. We went out to see the new Star Trek movie before it came out on DVD. You may not find this to be mind-blowing, but we are frugal people. We don’t part with our money easily.

At first I hadn’t planned on seeing the movie. I was afraid that the new movie was going to be a crappy sequel, so I wasn’t going to waste my money on it. Like I said, I’m cheap. Then I heard some of the younger nurses on my unit talking about the movie at work. These kids couldn’t stop talking about the movie. I was amused by their verbiage as they described the movie. One nurse said that the movie was “new, different, and completely groundbreaking.” I just rolled my eyes. I guess they forgot that old nurses like me were watching Star Trek back in the 1960s on our black and white television sets. I just smiled and flashed them the Vulcan peace sign and said, “Live long and prosper.”

My husband and I bit the bullet. We bought our movie tickets, along with a $20 bucket of popcorn, and we walked into the theater just in time to catch the 11 AM matinee. There weren’t too many other people in the place, and the ones who were there were all AARP eligible just like us. I guess my husband and I weren’t the only two old timers who wanted to see what all the fuss was about. I’m not going to give away the plot, but the storyline delves into how the characters first meet up. Unfortunately, Nurse Chapel was nowhere to be seen in this movie. Maybe she’ll show up in their next movie as a student nurse. I’d love to see her in her student nurse pinafore and wearing her nurses cap. They just better not make her into some sort of sex kitten. See my previous rant about Nurse Jackie.

I give the new Star Trek Movie an arthritic thumbs up. Geezers, impress your younger coworkers at the nurses station and go see the movie. They will find it quaint you know about Captain Kirk. You don’t have to tell them that you knew who he was before they were born.

This is a picture of an antique compass that has been passed down in my family. It first belonged to grandmother. She told me that she received it as a gift when she was a young girl, and that she gave it to my father when he became a cross-country truck driver when he was a teenager. She said that she gave it to him so he could always find his way back home again. I think that I’m going to put it in my car this week. I’m going to need all the help I can get so I can find my way back home, too.

No, I’m not dead yet, but I am a zombie. I’ve been getting up at 3AM since starting my hospital orientation at Undisclosed Government Hospital, and the commute is starting to wear me out. The good news is that my 12-hour shifts are starting soon so I’ll have more days off during the week to rest. The bad news is that I’m going to have to drive myself to work. Traffic in Big City is notorious, and I have a serious phobia about getting lost. I get panic attacks when I don’t know where I’m going, so I’ve been making practice runs into Big City this weekend with my husband acting as my copilot. Today however, just before sunrise, I made a solo trip into Big City. I made one wrong turn, panicked twice, and found my way home all within 90 minutes. That means I was speeding. Hopefully I can get this down to a fine art by the end of the week without getting into an accident and without getting a ticket.

I want to wish all you moms out there a Happy Mother’s Day. Now I’m going to lay down and start breathing into a paper bag. I’m still feeling a little panicked from that last practice run into Big City. Bear with me while I try to pull my life together. I promise I’ll start blogging again on a more regular basis once I learn the ropes at UGH.