Nurse Ratched’s Place

This is the Hindu goddess, Durga. Look at all those arms. This goddess gives a whole new dimension to the term “multitask.” According to Wikipedia, Durga is the embodiment of feminine and creative energy. I think she’d make a great nurse. She rides everywhere on her lion, so her legs would never get tired, and she’s apparently very good at fighting demons. I’d like to see someone from hospital administration try bullying her into accepting an unsafe patient care unit. She’s my kind of deity.

I could have used some of Durga’s energy today. I’m so tired after working my weekend shifts. I was surfing the web this morning at my favorite Panera Bread coffee shop when a very handsome, well-dressed, young man walked up to my table and struck up a conversation with me about my Mac computer. He was charming. If I were thirty years younger, I would have thought he was hitting on me, but since he was young enough to be my son, I wondered what he really wanted. I knew this kid wasn’t going to ask me for my phone number. After spending a few minutes talking about why everyone in the world should own a Mac, he said he wanted to give me a small gift. He reached into his briefcase and pulled out a DVD about his faith, and he asked me if I believe in God.

Almost everyone that I know who works in the health care field believes in a Higher Power, but they don’t talk about their religious views at work. My nursing instructors taught me that it is taboo to talk about religion, especially with my patients. Then one day I saw a surgeon kneeling by a patient’s bedside because his patient had asked him to pray with her. She told him that she was about to die. The doctor was praying and holding her hand when she slipped away from earth and entered into heaven.

I was given a copy of “The Nurses’ Pray” at my capping ceremony many years ago that asked God to provide nurses with the strength to work as subservient handmaidens. Ok, it didn’t exactly say it in those words, but it implied that nurses must meekly follow the doctor’s orders without question, and perform backbreaking labor because God said so. The prayer is outdated, so I’ve taken the liberty of updating the prayer.

The New Nurses’ Prayer

“Dear God, please get me through this shift in one piece, and keep my patients safe. Please don’t let this be the day that I make a mistake that costs one of my patients their life. Protect me from physical blows delivered by violent, unruly patients and their marauding family members who demand services that the hospital cannot or will not provide. Allow me to give good patient care because it is the right thing to do. Help me keep my sense of humor while I stand in the midst of chaos, and please keep my mind focused and sharp so I can get through another grueling shift. Please forgive me for all of the swear words I utter under my breath at work, and I humbly ask that you provide a legion of new nurses for the profession so I can retire soon.”

Amen.

I’m convinced that the only thing that keeps me in nursing is divine intervention.

I’ve always been able to pick out the new nursing graduates who report for their first day on the job. Look at this young lady. Her uniform is spotless, her cap is impeccable perched on top of her head, her hair is perfectly coiffed, and she made the mistake of wearing high heel shoes to work. Didn’t anyone tell her about Nurse Mates? She’s going to have some really bad blisters by the time her shift is over. The biggest tip off, however, is her demeanor. She has the new graduate glow. Her shoulders are pulled back, she’s standing straight and tall, and her head is held up high. She’s full of confidence and pride.

Now imagine our fair young nurse’s arrival on her unit for her first day at work. Her new coworkers, who are sitting in their faded scrubs and mileage worn work shoes, barely have time to notice her entering the nursing station. The nurses from the previous shift are ignoring the relentless buzzing of call lights in the background as they hurry to get their charting done so they can go home. Their back and legs hurt, and the last thing they want to do is make one more trip down the hallway in order to put another patient on a bedpan. The nurses reporting for work aren’t happy either. They are preparing for another long, difficult shift. In the middle of the chaos stands our perky new nurse, bright eyed and full of zip. The old warhorse nurses take one look at her and the feeding frenzy begins.

(Warning: I’m about to get on my soapbox, so watch out.)

How many times have you seen this happen at work? Experts call it lateral violence in the workplace. Nurses call it eating our young. I’ve seen it a lot. In fact, I was a victim of this phenomenon. One group of nurses that I use to work with refused to talk to me unless it directly involved patient care, and they wrote me up for any little infraction that they could find or invent. A few of them even told me that I was a horrible nurse and that I should leave the profession. I cried a lot, but fortunately I’ve always been obstinate and I told the battleaxes to take a hike. I’ve never forgotten the pain that they caused me, and since then I’ve vowed to treat all new graduates with respect. If cheerful new nurses irritate you, so be it, but look at the situation logically. Who is going to take care of you when you are old if you keep running the newcomers out of the profession? Graduate nurses deserve our support, even the perky ones who report to their first day of work in high heel shoes. I’m not forgetting the guys. They deserve our support, too.

I enjoy reading a good book, and it looks like this nurse does, too. I found a book on eBay that made my heart gallop with glee when it was delivered to my postal mailbox. It was the ultimate handbook for nurses who were preparing for their state boards back in 1929. The book is full of tricks of the trade from the turn of the century. It’s entitled State Board Questions and Answers for Nurses, Being the Actual Questions Submitted at the Examinations of 31 State Examining Boards For Nurses, With Answers. It was compiled and edited by John A. Foote, M.D., and it was published by J. B. Lippincott Company. The previous owner, Miss Estey C. Cox, a student nurse at St. Elizabeth Hospital in Lincoln, Nebraska, wrote notes about her days as a nursing student throughout the book. In the chapter about psychiatric nursing, she wrote, “Hardest of all. More power to me.” Some things never change.

I’ve read this entire book and I have concluded that I would have failed the boards. But really, did you know that the active ingredient of Dover’s Power was opium and that Fowler’s Solution was made from arsenic? And I bet none of your nursing instructors taught you how to give your patient a sulfur bath, or how to prepare a cream enema. I’m sure that this young nurse knew all of that stuff. Doesn’t she look confident? I bet she could have answered this question from the book:

QUESTION:
As a district nurse, how would you give a sweat-bath with dry heat in the patient’s home?

ANSWER:

To give this bath, a small alcohol lamp will be required, also several blankets, rubber sheeting, ice-cap, towels, a piece of stovepipe elbow and, if procurable, a piece of asbestos. Place a rubber sheet covered with a blanket under the patient, remove patient’s gown, place several chairs over patient to form a cradle for the blankets, place a blanket covered by a rubber sheet well over these chairs, standing well below patient’s feet and up to his chin and coming well down on either side so that a closed chamber will be formed. Arrange lighted lamp on chair beside the bed, place stove-pipe elbow over the lamp and let the other end pass under the blanket near one of the chairs, about three or four inches over patient’s feet, being careful not to leave the blanket over the opening of the pipe. Tuck the blankets around the patient so as to leave no opening and place a towel between the blankets and patient’s neck. Wrap asbestos or a wet towel around the end of the pipe as it passes under the blankets and fasten blankets about the pipe in an airtight manner.

Place ice-cap on patient’s head, and thermometer, if obtainable, in an accessible place under the blankets. The temperature should be 130-150 degrees F. Holy cow! An alcohol lamp and flames near bed linens? Asbestos? I wonder what JCAHO would think. I enjoy learning these old fashion tricks of the trade. This is just one question out of my 582 page book, so be looking for more test questions soon.

You don’t need to be a monkey to enjoy blogging, but there is one famous Monkeygirl in the nursing blogosphere that you really need to visit. She’s the host of this week’s Change of Shift. Monkeygirl will make you laugh with her quick wit and her insightful comments about the state of our country’s health care system, so make sure that you drop by Musings of a Highly Trained Monkey. And when you’re done reading Change of Shift, you must drop by and see Drugmonkey, who is my all time favorite pharmacy guy at Your Pharmacist May Hate You. I’m trying to talk him into running for President this year, but he’s not interested in running for public office. It’s too bad. I think he’s just the guy for the job.

If you’re old as the hills like I am, you might remember hearing about an old radio show called The Shadow. According to Wikipedia, Walter B. Gibson created The Shadow in 1931, and the character skyrocketed to super stardom thanks to Orson Welles. He was the original actor who played the character in the popular radio series. Each show would begin with the phrase, “Who knows what evil lurks in the hearts of men? The Shadow knows.” Here’s a new twist on the old trademark phase. It goes like this: “Who knows what goes on behind the scenes on a psychiatric unit at a major East Coast hospital center? The Shadow Nurse knows!”

A couple of weeks ago I started looking for a PRN position at local hospitals in an effort to subsidize the meager paycheck that I earn at Hospital X. The hospital where I was interviewing has a stellar reputation in the community, and I was looking forward to checking it out. During my initial job interview, the unit manager, who incidentally is not a nurse (this is NOT a good sign), looked at me and said, “I bet you could really give me a tough time if you really wanted to make my life rough.” I couldn’t understand what he was talking about. Yes, I’m seasoned, intelligent, assertive, and a patient advocate, but I’m not impossible to work with. I had no idea why he was being so defensive. All I did was say hello when I handed the guy my resume. He just stared at me for a few seconds, and then we chatted about why I wanted to work on his unit. After about a thirty-minute interview, he said he wasn’t sure if I was a good fit for the unit, and he said he wanted me to come back one evening so I could shadow his nursing staff. That way I could see what it was like to work on the unit, and the staff could decide if they wanted me onboard.

Two weeks later I walked onto a unit that was in total chaos. JCAHO was inspecting the unit, and one of the day nurses had been a no-call-no-show for her shift again. Things became more interesting when it became apparent that one of the evening shift nurses was also going to be a no-call-no-show for her shift, too. I offered to come back on a day that wasn’t in the crapper, but the charge nurse said that this was a typical shift and that I should stay to see what happens. I stayed on the unit for four hours. During that time, the nurses asked me their questions. Welcome to the Inquisition:

A nurse asked me if I had any restrictions on my nursing license. She explained that the last psych nurse that the hospital had hired couldn’t pass meds because of a history of drug abuse, and that they caught her shooting up Dilaudid in the med room after the Board of Nursing lifted the restriction off of her license. No, I do not have a restriction on my nursing license, thank you very much.

Another nurse asked me how I deal with patients who have personality disorders. I responded by saying that I am a disciple of Skinner, and that I use behavioral modification techniques when dealing with patients who are impulsive and self-destructive. I gave a few examples of how I have used behavioral modification techniques in the past. The nurse smiled and thanked me for the information. She said she was going to use my techniques the next time she saw her mother who suffered from Borderline Personality Disorder. She continued to tell me things about her mother that I didn’t want to hear.

Then it was my turn to ask questions. I asked if there was a place in the hospital where I could sleepover just in case I had to come in early in order to beat bad weather that was moving into the area. I explained that I lived many miles from the hospital, and that I was worried about driving in icy weather during the winter. Everyone at the nurses station just glared at me. Finally the charge nurse said, “Look, we don’t want anyone working here that’s going to make us look bad. No one comes in early, and no one stays late. Got that?”

I don’t think they need anyone to help them look bad. I think they are doing a fine job on their own. I have no plans to work on their unit, and my quest to find PRN hours goes on.

Here’s a book that my husband picked up a long time ago. Ernest Callenbach wrote the book, and it published in 1972. I think Callenbach was a hippy. This is the book’s introduction:

Poor Is “In”

“Millions of Americans have discovered how to be free. And to be that, they are willing to be poor: to drop out of the corporations and universities and official culture and instead try building up a life-style that will suit them. This can mean scrounging, scavenging, welfare, do-it-yourself, subsistence farming, communes, odd jobs, and part-time jobs. It’s not an easy life. But it can be a real and personal satisfying life—fit for man to live. This book has been written to try and bring together information that can be useful in living this new life.”

I’m glad that I have Callenbach’s book. It is going to come in handy after my yearly employee evaluation. This is going to be interesting. Mr. Gringe isn’t happy that I keep pointing out issues regarding patient care that the hospital chooses to overlook. I refuse to wear rose-colored glasses to work. On a brighter note, Mr. Gringe has also announced that the nurses working a Hospital X are getting a “substantial” pay raise this year. That’s the good news. The bad news is that he is playing down the fact that our big, fat, raise won’t cover the increase in premiums that we pay for our health insurance, nor will it cover the increase in copays associated with our new policy. My coworkers will need a pair of rose-colored glasses when they start reading the fine print on their insurance policy.

If poor is in, then I’m living the highlife. Like the majority of Americans, my family and I are struggling to make ends meet.

I saw a news story that made my stomach turn. Bob Woodruff reports that more than 22,000 Iraq war veterans are being discharged from military service due to a “pre-existing” personality disorder. Why are our war heroes being branded with this diagnosis? It’s simple. Our government has found a way to deny mental health benefits to veterans who are suffering from mental health disorders related to their time in Iraq.

HMOs have been playing this game with patients for a long time. It’s the game of “Plausible Denial.” I’ve seen insurance companies cook up all kinds of reasons to deny people mental health care services. I once cared for a woman who wanted to kill herself by jumping in front of a train. She was serious, but since a train couldn’t possibly come through our hospital unit, her insurance company said that the patient was no longer an imminent risk to herself, so they refused to pay for her hospitalization. Now the military has adopted the same HMO mindset, and is screwing over our service men and women who are coming home from Iraq. Please read Bob Woodruff’s story about our government’s latest shenanigans, and then write a letter to your member of Congress. Tell them to court marshal the people who came up with this bright idea. I’m sure whoever came up with this plan will have a bright future with an HMO one day whenever they leave military service.

Change of Shift is up over at NursingJobs.org Go check it out!

My favorite Monkeygirl from Musings of a Highly Trained Monkey will be hosting the next Change of Shift on July 26th. I can’t wait to see what she comes up with. Her blog is a blast! Love ya, Monkeygirl! Send your submissions for the next Change of Shift to ermonkeygirl (at) hotmail (dot) com.

And don’t forget to check out Nursing Voices. There is a lot going on over there, and it’s a great place to meet!

Check out this nurse’s crystal ball. Nurse Sue Whittier has a dilemma. Should she tell her dying former sweetheart the truth about his scheming wife? Apparently, the evil wife is having an affair, and the other man is the father of her son. Hmmm, decisions, decisions. May I suggest that she just go kick the wife’s butt and be done with it, or is that too un-nurse like for me to say? I guess she’ll just have to gaze into her crystal ball to find the answers to her problems. She also needs to stop pining over her old flame. Nurse Whittier, get a life. He’s married and he’s dying, so get over it. Yes, I’m feeling rather cranky today. I looked into my own crystal ball and I don’t like what I see. America has a growing dilemma. It’s our health care system. The dilemma has to do with the Baby Boomers who will one day overwhelm the health care system.

We geezers are growing older, and as we age, we start outliving our usefulness to the insurance industry. The cost of our health care goes up, and we all know how happy insurance companies are when we ask them to pay our bills. And who can blame them. Health care is expensive, and what good are old people anyway? We just take up valuable space. My crystal ball showed me that the insurance industry is going to solve this dilemma. One day, when you least expect it, the insurance companies will get Congress to pass a law that will legalize assisted suicide in our country.

Science fiction writers have already figured this out. Do you remember a movie called Soylent Green? The movie takes place in the future. It is a dismal time when there are too many people on the planet, and there isn’t enough food, water, and housing to go around. There’s a scene in the movie where an old geezer, played by Edward G. Robinson, just can’t take it anymore, so he goes to an euthanasia clinic and is put out of his misery. The scene was disturbing, but I’m sure that his HMO was happy because they didn’t have to pay his expenses anymore. I’m positive that they preauthorized his extermination. I bet you’re thinking, “Life is sacred and this will never happen in America.” I’m sorry, but I have to disagree with you. In the view of the insurance industry, life is sacred as long as it’s not too expensive to keep someone around.

Here’s my suggestion for their future slogan: Say yes to death.

I’ve always said; if you want to play the damsel in distress card, tell people that you are a nurse.

My 4th of July literally started off with a bang when my back rear tire exploded while I was driving to work. I was on a busy two-lane highway traveling 60 miles an hour when I ran over a nail. Damn nail! The car swerved into oncoming traffic, but I was able to get the car under control, and coasted to the side of the road. I kept my cool until the car stopped, and then I freaked out. Unlike the rest the of civilized world, I don’t own a cell phone, so I was basically screwed. After I calmed down, I decided it was best to keep limping down the side of the road on my rim and look for help.

Less than a mile down the road I saw a big white farmhouse with rows of pickup trucks appointed with gun racks parked in the front yard. I noticed a group of men mulling around a barbeque grill, so I pulled off the road into the driveway and walked up to the gathering of good old boys who were guzzling their 4th of July beer. I had a feeling this was going to be my lucky day.

Me: “Good afternoon gentlemen. I’m sorry to intrude on your party, but I’m a nurse going to Hospital X, and I have a flat tire.” I smiled while pointing to my hospital ID that I was wearing on my sweater and I said, “Can one of you gentlemen help me out?”

Good Old Boy #1: “Shoot little lady, you’re a nurse?” Everyone jumped to their feet. “We’ll be glad to help you out. Come on guys. Someone throw me another can of beer and let’s go!”

While I was standing around watching my newly acquired pit crew of slightly tipsy men change my tire, Good Old Boy #2 brought me a hot dog off the grill and a diet soda. He apologized for not bringing me a beer, but he said he knew I couldn’t drink because I was going to work. He said that he and his wife really appreciate the nursing care they always receive at Hospital X, and that he and his friends were really happy that they could help out a nurse. The good old boys changed my tire in less than twenty minutes, and I was back on the road again.

I’m writing this post from my Toyota dealership while I wait for my new tire to be mounted on the car. The old tire is DOA. I’ve gotten the word that buying a new tire is going to be an expensive proposition. Too bad the Toyota mechanic wasn’t at yesterday’s picnic, because everyone, especially drunken good old boys, love nurses.