Nurse Ratched’s Place

Photographs by Mother Jones, RN

A bag lady is talking to herself as she sits on a park bench. She hears and sees things that you and I don’t hear or see. She looks strange and tattered as people rush by her, barely noticing her existence. A Chicago policeman pulls his car over to the curb. It is ten degrees below zero outside, and she willingly gets into his car when he asks her if she wants to get out of the cold. She doesn’t speak. The voices are telling her to stay quiet, and she complies with their commands. She is brought to the hospital, and I am her nurse. Strangely, she reminds me of an abandoned house. Like the dilapidated Victorian houses that line the streets where she lives, the shopkeepers and other residents of her neighborhood view her as an eyesore, but if you look closely, you will see her beauty and strength. Once gracious and handsome, her frame is now weathered and old, and yet, even after many years of neglect and adversity, she is still standing on a strong foundation. She has not crumbled away.

She sat and stared at me as I tried unlocking the secrets of her life. Trying to get inside of her head was like trying to crack open a door that was bolted shut. She wouldn’t let me in. I had no idea what the voices were telling her, or what wisdom she had learned out on the streets. I thought that perhaps she was refusing her medications because she didn’t want the voices to go away. The voices may have been her only friends. I knew she had a history, and maybe a family, but now all of that was lost in time.

She followed me closely as I made my rounds on the unit. Her dark brown eyes tracked my every movement. Perhaps I reminded her of someone, a daughter, a sister, or a friend she once knew. She also liked sitting in the unit’s kitchenette. I wondered if she had enjoyed cooking at one time, and that by sitting there, she was transported back to a happier time. Sometimes she responded to the voices by calling out names. “I said stop that, Hank. Sarah, come here! ” Once I thought I heard her calling her children to come into the house for supper. One morning she came to me and pointed to the unit door. The weather was starting to warm up and she wanted to leave the hospital. The doctor wrote a discharge order, and the social worker gave her a token for the bus. I gave her my sack lunch. She smiled and patted me on the cheek before returning to the streets. I’ve seen so many other bag ladies throughout the years, and every time I look at them, I see another abandoned house with a story waiting to be told.

Some nurses are big fans of something called evidence based nursing. According to this school of thought, nurses should not make any patient care decisions without at least having two research references in their hip pocket to backup their plan of care. I, on the other hand, subscribe to “old school” nursing. Sometimes these two schools of thought collide.

Don’t get me wrong, I think evidence based nursing is valid, that is, until it gets in the way of patient care. One of my patients went ballistic one day while I was working as the unit charge nurse. She was yelling and screaming as she scratched her wrist with a paperclip. I walked over to the patient, told her to stop, and escorted her to her room. The patient and I had a brief discussion about what constitutes appropriate behavior on the unit, and how she could ask for help the next time she had the urge to act out. As far as I was concerned, the incident was over.

When I returned to the nurse’s station, my boss and one of my colleagues were busy developing a patient treatment plan based on evidence based nursing. They were talking about what to do next, and they were blaspheming my approach with the patient. My boss said that, according to research data, the patient needed to be watched 1 on 1 by a nurse due to her impulsive behavior, and he questioned what research theories I used when I took my patient to her room. Say, what? I giggled to myself, paused, and then started sniffing the air like a hound dog tracking his prey. My boss peered at me from over his glasses and asked me what I was doing. I told him I was doing research. I said that I theorized that I could smell an out-of-control borderline personality that needed limits set on her behavior, and that I had concluded that watching the patient 1 on 1 would give the patient positive reinforcement for negative behavior. I told him that I wasn’t rewarding the patient’s bad behavior by providing her with a private audience. End of discussion.

An anonymous reader responding to my post about Clara Barton observed that you can’t be a good nurse without caring, but neither can you be one without knowing a lot, and that new knowledge is derived from research. The reader went on to say that theory is supposed to lead to better nursing practice, but that falling in love with theories isn’t anymore helpful than falling in love with our patients. I couldn’t agree more.

Sometimes common sense trumps a hypothesis.

Photo: Hospital Ghost by Dionizije

Did you know that nurses witness “unusual” occurrences that they rarely talk about with others? They won’t discuss these events because they are afraid you won’t believe them, or you’ll think them mad. At the risk of sounding crazy, I’ll let you in on a secret. I believe in ghosts, and a lot of other doctors and nurses do, too.

When I was a young girl, I went to nursing school at a very old hospital in the Midwest. The hospital celebrated it’s centennial the year I entered its nursing program, and I worked the evening shift on the weekends as a nurses aid to help pay for my education. I worked under three veteran nurses; Lilly, Norma, and Ruby. They were “old school nurses,” and they had seen it all. One night while I was charting vital signs at the nurse’s station, a call light came on at the end of the hallway, but the room was empty. Lilly looked up and said, “Girls, she’s at it again.” “Who’s at it again?” I asked. The three nurses quietly looked at me and at each other before Norma broke the silence. She asked, “Do you believe in ghosts?”

Norma told me that an old woman had died in that room years ago, and that she didn’t know that she was dead. Each of the nurses said that they had seen her spirit walking the halls, and that the call light started lighting up whenever she was restless. Ruby added that this sort of thing isn’t unusual, especially in old hospitals. She told me that while death is a part of life, not everyone is willing or able to leave the earth after they die. She also told me that I could expect to see supernatural things during my nursing career. Fortunately, our ghostly patient calmed down, and there was no further activity in the empty room that night.

After I graduated from nursing school, I moved to a new town and settled into a job working as a med-surg nurse. One of my favorite patients was a young woman name Dixie. She had multiple surgeries during her hospitalization, and I had been her primary care nurse during her extended stay at the hospital. The night before she was supposed to go home, Dixie called me into her room. She asked me to escort the woman who was sitting in the chair by her bed back to her own room. The chair was empty. Dixie was adamant that an old woman wearing a black dress was in the chair, and that the woman was telling her “she had come for her.” I went to the desk and called the surgeon. I prayed he didn’t think I was nuts when I told him that Dixie was having a conversation with the Angel of Death in her room. He didn’t question me, and said that he would be right in. When the doctor arrived on the unit, Dixie started bleeding internally and went into shock. Fortunately, she survived surgery and was discharged from the hospital several weeks later. Dixie’s surgeon told me later that he also believed in the Angel of Death.

Every nurse has a story. Check out these links for more hospital ghost stories.

Queen Alexandra’s Royal Army Nursing Corps

Hospital Ghost

The Operating Room

A spooktackular guide to some ghostly fun around town

My blog buddy, Christopher, from Trading Faces is on a crusade to save women from cervical cancer. Christopher told me that the Family Foundation of Kentucky is lobbying against a bill in the Kentucky legislature that will add the cervical cancer vaccine girls are required to get while in elementary school. The foundation claims that this FDA-approved vaccine that prevents HPV, a virus that causes almost all cervical cancers, will encourage girls to have sex. The fact is 74% of Americans carry HPV. Regardless of when a woman decides to become sexually active, she is most likely going to get the virus that can lead to cervical cancer. Christopher has set up a new blog called Kentuckians Against Cervical Cancer, and he is collecting stories and photos of Kentucky families touched by cervical cancer. Christopher wants to hear from you, and if your state is proposing similar legislation (California and Michigan are at the moment), he encourages you to support it in any way you can.

Juliette from The Various Ramblings of Juliette told me about a very important petition. This petition is in response to the false imprisonment of 5 Bulgarian nurses and of a Palestinian doctor who have been accused by Libya of transmitting AIDS to children in a Libyan hospital. These individuals have been sentenced to death in the face of overwhelming evidence that the children were infected with the virus due to poor hygienical conditions in the hospital long before these individuals arrived in Libya. Please click here to sign the petition.

National Nurse has told me a little known fact about one of our country’s most famous firefighter, Dennis Smith. Dennis, a member of the 9-11 Commission and the author of Report From Ground Zero, is a huge supporter of nurses and of the National Nurse Act.

Dennis has created a financial and insurance company for law enforcement officers, firefighters, EMTs, and nurses, and he is offering free and important benefits to all first responders. This program allows nurses and other first responders to receive up to 40% off at The Sharper Image, PetCo, Blue Nile, Target, and hundreds of other retail outlets. Click here to find out more about this free benefits program.

Thanks, Dennis. Nurses love good deals!

If you have any announcements, please send me an email and let me know.

Sincerely, your humble public servant, Mother Jones, RN.

When I was a little girl, I use to think that the term “the library” was another way of saying someone was in the bathroom. That’s because my father did most of his reading while sitting on “the throne.” He didn’t have a lot of money, but he would have given me his last dime if I wanted to buy a book. Do you remember Dick, Jane, and Sally? I was obsessed with reading, and he wanted to encourage my love of books.

Fast-forward about forty years. When I first met my husband, we immediately hit it off. We had so much in common. He adored me and I love being adored. He took me to a bookstore on our first date, and he bought me a book. He once owned a used bookstore and his house was filled with thousands of books. I had found my prince.

Our collection is stored all over our house, and the vast majority of the books you see on my blog come from our collection. My haunts include used bookstores, thrift shops, and I’m addicted to eBay. Every nurse needs a hobby. It’s a good thing that my husband is handy in the workshop. He makes all of our bookshelves. Here’s a small sample of our collection. This is a corner of our basement. Bookshelves line all four walls of the basement, and books are stacked to the rafters. Some of you have asked me if I read all of the books I review. I don’t read every Harlequin Romance book. The plots are thin and if you’ve read one Harlequin Romance book, you’ve read them all. Otherwise, I read the books I write about. Reading helps me relax after working at the hospital. It’s a great escape. Currently, I’m reading a book about Mary Roberts Rinehart. She was a nurse who became a famous mystery writer. I’ll be writing about her soon.

Hello, I’m Mother Jones, RN and I’m a bookoholic.

Do you remember your days as a student nurse? It was stressful. I remember staying up all night writing treatment plans and learning everything there was to know about my assigned patient’s medical condition. Our nursing instructors would drill us unmercifully about our patient’s condition, and about their nursing needs. And God help us if we didn’t know the clinical implications of the medications we were giving to our patients. If we didn’t know the answer to a question, we were one step closer to being kicked out of school. Ahh, those were the good old days.

Here’s a book about a student nurse. Doesn’t she look professional? I think Kim from emergiblog would love her cap. She’s thinking about her boyfriend, and obviously has good taste in men. He’s hot! But, she too, is under a lot of stress. Here’s her story:

“Every moment is an emergency when you’re training to be a nurse!

In nursing school, every day was plagued with the constant pressure of life-and-death crises, the unrelenting fear of failing the patient, the frantic pulse of the hospital heartbeat. Student nurse Carol Welles was determined to become a self-assured professional, but she was a woman as well, who wanted her relationship with medical student Duane Duran to become something more permanent.

From Obstetrics to Intensive Care, from her first injection to her first catheterization, Carol tried to cut down on human suffering…and caused her personal life to suffer at the same time. She was in the field of saving lives…could she discover how to save her own life, too?”

Poor Carol. Not only does she have to stay up all night writing her treatment plans, she has to worry about saving her own life, as well. What’s a girl to do?

I’m sure like other nursing students, Carol is also worrying about where she’s going to find the money to pay for her education. A nursing education isn’t cheap. Fortunately, the good people at Nursing Jobs.org are giving away three nursing school scholarships totaling $5,000. If you like to write, and you are currently attending, or planning to attend, an accredited U.S. nursing program, this contest is for you. Entering is easy. Click here for more details about the contest. Good luck!

Hmmm, Hmmm…Good! Grand Rounds is up and it’s looking mighty tasty. This week’s host, Dr. John La Puma, has created a beautifully presented buffet of posts related to food. Go check it out.

Bon appetite!

What do you get when you cross a former nurse who has long sultry legs with a detective agency that investigates insurance fraud? You get Pauline Sokol, detective extraordinaire. Pauline Sokol is the creation of author, Lori Avocato who has also worked as a nurse.

In her newest addition to the Pauline Sokol mystery series, Nip, Tuck, Dead, the sassy ex-nurse-turned-medical insurance fraud investigator’s latest case goes beyond skin deep when she goes undercover at a plastic surgery spa for the rich and powerful.

In her latest case Sokol investigates cosmetic surgery fraud in Newport Rhode Island, the surgical playground for the rich and famous, by assuming the role of a private duty nurse, but what she needs is a suitable patient to attend to. Luckily, her best friend and colorful co-worker “Goldie” is a flamboyant cross dresser who jumps at the chance for a nose job. During her time undercover, Pauline uses her astute nursing powers of observation and her critical thinking skills to escape from the jaws of death, solve a murder case, and put a few shady characters behind bars. It just goes to prove once a nurse, always a nurse. Bravo, Nurse Sokol!

This is a great book for those who like a quick read. I finished the book cover-to-cover in two evenings while my husband was busy watching televised football games. I can’t wait to read Lori’s book, One Dead Under the Cuckoo’s Nest. I want to see what kind of trouble she uncovers on a psych unit.

Many years ago when I started working as a psychiatric nurse, I was assigned to teach a class about healthy eating. It was back in the days when patients spent weeks in the hospital and we had the luxury of thoroughly teaching our patients everything they needed to know before they went home. It was also during a time when MAO inhibitors were frequently used to treat depression.

The dietary department sent up a fruit, vegetable, and cheese platter every week for my group. They would also send up a variety of snack crackers and a few bottles of carbonated grape juice. I served the juice in plastic champagne glasses as I talked about the dangers of drinking alcohol while taking MAO inhibitors, and other psychotropic medications. The bubbly juice taught patients about the alternatives to drinking alcohol. I used the cheese on the platter as a prop when I talked about foods to avoid when taking MAO inhibitors. Patients not on MAO inhibitors would nibble on the cheese during group while those on MAO inhibitors were invited to snack on the fruits, vegetables, and crackers. The food was good—a welcome change from regular hospital food—and my group was well attended.

One day a patient with a huge chip on her shoulder came to my group. She was prescribed a MAO inhibitor, and she started complaining bitterly about the dietary restrictions associated with her medications. One of the other patients teased her by asking if she wanted “a little WHINE with her cheese.” She said she’d skip the wine but would take the cheese. Then she grabbed a handful of cheese cubes off the food platter and stuffed them into her mouth. After she swallowed, she looked at me, smiled, and said she wanted to die if she couldn’t eat what she wanted. I called the doctor and my patient was treated for a sharp rise in her blood pressure.

The patient later told me that she was sorry for her impulsive behavior during group. She said, “I don’t know why I ate that stuff. I don’t even like cheese.” She later came to realize that she acted out as a way of rebelling against her mental illness. I also believe my patient had a personality disorder.

Here’s what I learned from the incident:

1) Self destructive patients are angry people. They need our support, but they must face the consequences of their actions. My patient had a killer headache after her blood pressure hit the ceiling. She wanted narcotics for the pain. We gave her Tylenol.

2) Patient education about good nutrition is a key factor in helping patients stay healthy. (My goodness, these ladies look healthy.)

3) Keep food out of the reach of patients during group. Impulsive eating is emotionally based, and acting out behavior can be deadly.

I’m very worried. When our unit’s medical director leaves in June, I might be without a job. He’s quitting because he can’t stand working for our hospital administrator, Mr. Grinch. The hospital is looking for a new doc, but right now, things aren’t looking good. Mr. Grinch’s reputation precedes him, and no one wants to work for a jerk.I’ve decided to help out. Instead of hiring a headhunter, I’m posting a help wanted ad. Here are the qualifications I’m looking for in a doc.

The ideal candidate puts patients first.

I nearly died one day when I heard our nursing director described our hospital’s psychiatric unit as a “product line.” Say, what? I’m not a factory worker, I’m a nurse. I know that health care is big business, and I understand the need to be fiscally responsible, but it would be nice if we could stop focusing on profit margins and start focusing on providing good patient care. I’m looking for a doc who is dedicated to the welfare of our patients.

The ideal candidate must believe in the power of Haldol.

I’m really amazed by how many doctors are afraid of using old time medications. There are some positive things to be said about using tried-and-true meds. I had a doctor tell me once that he didn’t prescribe Haldol anymore because it isn’t “politically correct.” He said that research has shown that new antipsychotics are more effective than Haldol. I bet a lot of those research projects were sponsored by the pharmaceutical industry. I’m not a big fan of many of the newer antipsychotic medications. They aren’t cheap, and many times they are less effective than older, less expensive medications. I’ve also seen doctors back away from giving hefty doses of medications when patients need them because they don’t want to be accused of using “chemical restraints.” Oh, please! When a patient is psychotic and out of control, they need drugs. Pharmaceutical wimps need not apply.

The ideal candidate must have balls of steel.

I want to work with a doctor who has moxie and who isn’t afraid to standup to Mr. Grinch. Sometimes Mr. Grinch tries to bully our current doctor into admitting violent patients who are totally inappropriate for our unit while trying to cut nursing staff at the same time. Our current doc isn’t afraid of telling Mr. Grinch to go to hell, and the ideal doc needs to be able to do the same.

The ideal candidate will make his or her own coffee and must be willing to bring in breakfast for the nursing staff every Saturday morning. I work every Saturday, and I have my standards.

If you are truly the ideal candidate, be assured that the nursing staff will stand behind you and work with you as a team. We are incredibility loyal to anyone who is loyal to us.

Please e-mail me if you are interested in this position.