Nurse Ratched’s Place

Welcome to another edition of Go Ask Mother. I’m receiving a lot of interesting questions from my readers, and I plan to make Go Ask Mother a regular part of Nurse Ratched’s Place.

Last week, AZRN from researchgrrl wrote:

MJ, in your professional opinion, are there treatments for PTSD that work well? I don’t know that much about psych nursing (it was a looong time ago )

Thanks for bringing up this important subject. I think we are going to see more PTSD as more soldiers return from Iraq.

I don’t know all the answers to this question, however, I will tell you how I help patients suffering from PTSD. Several years ago I had the privilege of meeting a psychiatric nurse practitioner who was helping Pentagon staff members deal with the aftermath of 9/11. I met with her at the Pentagon for lunch, and we talked about the techniques she was using to help staff members deal with PTSD. She said that her goal was to teach patients that they are having a normal reaction to an abnormal event, and that she used cognitive therapy techniques to achieve her goal. She said, “We are what we think,” and by changing our perceptions of the things happening around us, we can alter how we feel and, most importantly, how we act. She assisted her patients in devising strategies for dealing with their symptoms, such as insomnia and poor concentration, and she stressed that people suffering from PTSD mustn’t be allowed to fall into the sick role, or else they will not move forward with their lives.

When I work with patients suffering with PTSD, I’m careful not to demean or embarrass my patients by challenging their feelings. I tell them that they are not going “crazy,” but that they are reacting to a crazy event that happened in their life. I taught one patient who could feel himself slipping into a state of panic to repeat the phrase, “here and now.” He said the phrase kept him in the present, and helped him to refocus when painful memories started invading his thoughts.

If you have a question for Go Ask Mother, please send them to nurseratchedsplace@yahoo.com

It’s another Monday morning, and I’m currently camped out in my favorite spot at my local Panera Bread. Just like this young lady, I’m lounging in a soft and comfortable seat while enjoying my day. I’ve parked myself by the all-you-can-drink soda fountain machine, and I’m savoring a wonderful egg-bacon-spinach soufflé. As I surf the web and sip on my second refill of Diet Coke, I’m watching people as they drive off to work. Life is good.

Drug Monkey from Your Pharmacist May Hate You has posted his thoughts about this story from the New York Times. It looks like a pharmaceutical company is offering us a “helping hand” while helping themselves into our pockets. Of course the company is claiming that they only have our best interest at heart. I’m sorry, but do we have stupid written across our forehead? Mental health care consumers are the targets of this new program. I encourage you to read Drug Monkey’s entertaining thoughts on this subject.

Doctors were considered gods the year I entered nursing school. Make no mistake about it, they ruled the hospital. Nurses made coffee for for them, carried their charts as the made their rounds, and surrendered their seat in the nurses station whenever they entered the room. Oh yes, and did I mention that all the doctors were men? Of course there was the occasional lady doctor like the one on this book cover. Lady doctors were an oddity, and the good-old-boy medical establishment hated them. I remember hearing doctors at the nurses station blaspheming women who wanted to be doctors. They were angry that a woman might take a spot away from a man who wanted to enter medical school. “After all,” they said, “they are just going to quit medicine when they get married.”

I noticed that attitudes about lady doctors started changing as the years went by. Younger men were entering medicine, and they brought with them more progressive attitudes about women in the workplace. Change came slowly. Many male doctors still felt that female medical staff, like Nora Meade, M.D., should only work as a pediatrician. The attitude was, “Women are meant to have children, and if they wanted to work, they should only work with kids.” The first lady doctor I worked with treated the nurses as her colleagues. She never demanded that we wait on her, and she treated us with respect. She even said that we could call her by her first name! I know this sounds odd by today’s standards, but back then, treating a nurse as an equal was considered revolutionary. She also encouraged many of my nursing colleagues to continue their education, and to advance the profession of nursing. The women entering medicine back then were progressive, and they were fighters. They rocked the boat and bucked an archaistic medical establishment in order to get what they wanted.

I’m really happy that things are changing, and that women continue to make strides in the field of medicine. Lady doctors, you rock. Keep rocking the boat.

I saw a news story today that gave me chills. Scientists are doing research to see if Propranolol is an effective treatment for post-traumatic stress disorder. This sounds great until you look at the deeper ethical issues. Who will be put in charge of deciding what is a traumatic event? Will we have “brain police” deciding who can be given Propranolol for the treatment of post-traumatic stress disorder? In his satirical novel, 1984, George Orwell depicts a futuristic totalitarian state in which the government uses mind control to subjugate its citizens. The whole idea of erasing someone’s memory with a pill is a bit too Orwellian for me. Decide for yourself after reading this ABC news story.

This is a very unusual meme, and I am honored. Kim at Emergiblog has tagged Nurse Ratched’s Place and now I must tag 5 other blogs within the medical blogosphere that make me think. This is going to be tough because everyone has interesting things to say.

The recipient of this award must follow these rules:

Acknowledge the origin of the meme/award

If you are tagged, write a post with links to 5 blogs that make you think.

Optional: Display the “Thinking Blogger Award” with a link to the post that you wrote using either the gold or silver versions of the award.

Here are the next five recipients of the “Thinking blogger Award.”

Digital Doorway
Scalpel or Sword
Doctor Anonymous
Your Pharmacist May Hate You
The Angry Medic

Thank you, Kim, for listing Nurse Ratched’s Place.

This Princess and I have a lot in common. We both like lounging around while other people wait on us. Yes, we’re spoiled Princesses. She has slaves, and if you ask me, they aren’t doing their job very well. She has to wait while they bring her a Diet Coke. They should have anticipated her every need. I don’t have servants or slaves, but I have a Prince who treats me very well, but unfortunately he’s at school today, so I have to wait on myself before I go into work. I love taking care of my patients, but since I work for Mr. Grinch, I’m sure that I’ll feel like a slave by the end of the day. What is a Princess Nurse to do?

Princesses know how to have a good time when they aren’t at work. This Hawaiian Princess is relaxing by a lake while playing her ukulele. She looks happy and stress free. Her servants are preparing a pig roast in her honor as we speak. I also hear that she looks great on her surfboard, and that she really knows how to shoot the curl.

Since I don’t how to surf or play the ukulele, I have found other ways to spend my time at home. Most Princess Nurses that I know love to blog, and I am no exception. You might say that I’m obsessed. All right, I admit it, I am obsessed, but since I don’t have a lake in my backyard to sit by, or a pig roast to go to in my honor, I’ll just keep blogging.

This Indian Princess is modeling an outfit that she picked up at her local thrift store. She loves finding bargains at the Salvation Army Store. Doesn’t she look pretty sitting by the waterfall? This Princess also loves to shop at flea markets, garage sales, and consignment shops. These places make up her happy hunting ground. When my Prince and I have time off together, we drive many miles to find our happy hunting ground in Virginia, just outside of Washington, D.C. I’m always amazed by what I find there. There are a lot of very wealthy people who buy expensive items, and then never wear them. I find designer clothes on the racks that still have their store tags still hanging on them. I am a very happy Princess Nurse when I find these bargains. And as you may know, we are always hunting for books.

I’m not looking forward to what awaits me at work. Maybe one day I can live like these other Princesses. Until then, you’ll have to excuse me because I have to start getting ready for work.

It’s finally happened. The corporate insanity overtaking my hospital is driving me nuts, and I’m looking for a new job. I sent my resume to these nurse recruiters and they are trying to help me out. I told them I want to work in a place that truly values their nurses, and they understand that I’m not a corporate drone. I won’t sacrifice patient care in order to make someone else rich. I hope these gals can help me find a job like these nurses have. Take a look.

Here’s Nurse Nan delivering bedside patient care. Forget irksome JCAHO regulations, Nurse Nan hates VMAR machines, and she passes medications with the use of an old-fashioned pill tray. She is smiling, and there is a spring to her step. She only has four patients today, and she really loves her job. I love her cap. I rate her cap a 10 based on the
Emergiblog nursing cap scale. Nurse Nan has a collegial relationship with the doctors. They never scream at her or try to belittle her at the nurses station. Doctor James is assessing his patient, and he asked Nurse Nan for her opinion about the patient’s condition. Dr. James understands that nurses are intelligent professionals, and that they are the cornerstone of good patient care. This sounds like a dream job, but on second thought, I’ve been away from medical-surgical nursing for a long time, so I don’t know if I could do this job.

Here’s a job that looks intriguing. I want to work where people notice my special talents. Look what happened to Student Nurse Kitty Walters. She’s not even out of nursing school yet, and some hotshot movie producer wants to make her a star. Every nurse is a star in his or her own right, and fewer nurses would leave the profession if employers appreciated them and treat them with respect. Perhaps I should send my resume to a talent agent. Maybe some movie director is looking for an old burned out psychiatric nurse to play the role of Nurse Mildred Ratched in a remake of One Flew Over the Cuckoos Nest.

I’m ready for my close up Mr. Demille.

Nurse Marcie is a very lucky young woman. She has a dream job complete with her own island and her own yacht. She also has a cute guy waiting on her hand and foot. He is at her beckon call. Nurse Marcie has the luxury of working in a serene environment, surround by nature. She works independently, and her patients treasure her. I’m asking my nurse recruiters to start looking for an island that needs a psychiatric nurse, but I’m not holding out much hope. I doubt that too many people become depressed while living in an island paradise. Drat!

While the recruiters are looking over my resume, I’m going to start looking for my dream job at nursingjobs.org. They have a lot of listings, and you never know what you can find until you start looking.

Remember this Chinese Proverb at the end of the day:

You cannot prevent the birds of sadness from passing over your head, but you can prevent them from making nests in your hair.

Have a nice weekend.

I went to a staff meeting today, and I left feeling angry. I’m in a sour mood.

The meeting started off fine. We ate cookies, and talked about a few problems that popped up during the week. Most of us hate the new VMAR machines. JCAHO mandated that we use these things when we pass medications. We were told that the new system would make passing medications less cumbersome and improve patient safety. Someone told us a big fat lie. We are now spending less time with our patients and more time trying to figure out the machine. VMAR is a piece of crap. Thanks, JCAHO.

Then we moved on to the hospital’s new pet project. We are now going to run our adult day treatment program during the weekends as a way of generating more revenue for the hospital. Our boss gave us some written information about the expanded program. You would think it would mention how this is going to benefit our patients, but it didn’t. The first item on the sheet revealed how much more money the hospital would glean off of each patient per month. Yes, I understand about needing to meet payroll and paying for other expenses like Mr. Grinch’s expensive new office furniture, but can we still please pretend, just a little bit, that the patients are still the focus of the program? And of course, we were told that we will be doing this extra work with less staff. The hospital can’t make extra money if they have to pay for additional staff.

Here’s what I see: More patients – additional nursing staff to help run the program = burnout. Here’s what the hospital sees: More patients + more billable hours = more money. I call this bottom line therapy. And people wonder why nurses are leaving the profession.

Here is Nurse Kay Landon in her sporty red convertible talking to Doctor Peter Hayes. He is the dreamiest doctor at Lakefront Hospital. Kay was born with a silver spoon in her mouth, and she is burning out after working at a public hospital. She is wondering how she’s going to last another day at work. It seems like her biggest challenge, however, is going to be keeping her nurses cap on her head once she hits the accelerator on her speedy little sports car. It’s quitting time, and she really wants to go home. Who can blame her, especially after a hellish shift?

Dr. Hayes and Kay have a “history.” He insulted her, and told her that she was “spoiled, a snob—in short, the sort of girl who is not much use in the world.” She was offended, and to show him how wrong he was, she enrolled in nursing school:

“Kay Landon had enrolled for nurses’ training and turned her back on her easy luxurious life. Her family and friends were horrified, but she was braced for their disapproval. Now she must tell her fiancé, wealthy Nicky Fairchild.

“But you can’t, Kay.” Nicky’s firm jaw was stubborn. “I won’t let you do it!” What on earth made you ever consider such a thing? You’re lovely and fun. This crazy mixed-up world needs girls like you.”

It sounds like Nicky adores spoiled, rich party girls. He thinks the world needs more rich chicks like Paris Hilton. Maybe he’s right. Imagine how things might change if Paris Hilton, like Kay, wanted to become a nurse. I can see it now. Paris attends Celebrity University and graduates top in her nursing class, and after a long night of clubbing, she goes home and gets ready to go to work. She slips on her Gucci scrubs and Jimmy Choo nursing shoes, grabs her Louis Vuitton handbag, hops into her limo, and goes into work with her posse in tow. The Paparazzi snap pictures of her as she enters Hilton Hospital. Young girls yearn to be a nurse just like their role model, Paris.

During morning report, a makeup artist reapplies Paris’ lipstick. Paris goes to assess her patients after report, but she quickly becomes overwhelmed with work. Seeing that Paris is about to throw a temper tantrum, her personal secretary starts taking off orders that are piling up at the nurses station while Paris’ personal trainer turns her bedridden patients every two hours. Paris is popular with her coworkers because she hires everyone their own personal staff. She’s a team player. Other celebrities soon follow in Paris’ footsteps and enter into the nursing profession. One day Brittany Spears, Nicole Richie, and Lindsay Lohan will be working as nurses. Of course someone will have to tell Brittany that she can’t go “commando” at work.

If you are a hot young doctor like Dr. Hayes, please, step up to the plate and help solve the nursing shortage. Insult a rich chick, or rich dude, and convince them that they, too, want to become a nurse.