Текст книги "The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital"

Автор книги: Alexandra Robbins

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Текущая страница: 26 (всего у книги 33 страниц)

MOLLY

  August

Two weeks after Molly’s IVF, she decided to take a home pregnancy test, even though she had read that because of the hormones in the ovulation trigger shot, urine pregnancy tests could result in a false positive. She tried to wait for Trey, who was finishing a night shift, but the test instructions said to use her first morning urine, and Molly couldn’t hold it any longer.

She stared at the stick as she waited for the three minutes to pass. The test line slowly began to develop, like an old Polaroid picture sharpening into focus. And—was she imagining it or was a second line forming, too? She tried not to get her hopes up, but she allowed a tiny string of excitement to loop around her heart.

The next day, after Molly’s official blood draw at the clinic, her nurse, Jennifer, called her at home. “Molly! Molly, Molly, Molly!”

“Jennifer! Jennifer, Jennifer, Jennifer!”

“Sorry! I was so excited I couldn’t get it out. It’s just so great to say this nurse to nurse. I have great news for you! You’re pregnant!”

“Hooray!” Molly whooped. She wanted to shout from the rooftop. She was ecstatic that something she had wanted so strongly for so many years would finally come to pass. Her mother had been such a fabulous mom. Molly’s best memories of her had nothing to do with “fancy activities,” she said, but centered on simply being together, much like her mother’s nurse coworkers had written to Molly about how dearly they cherished simply being with her. Molly got choked up thinking about how she would now be able to build on those memories with her own son or daughter.

She was going to be a mom. This changed everything.

Worldview Hospital

The agency sent Molly to a new hospital that bordered the city and the suburbs. Worldview was known for what healthcare workers colloquially called “concierge medicine”: The hospital took care of people with money and high expectations for customer service. Molly arrived early to take five written tests on medication administration, safe transfer/lifting, EKG interpretation, fire safety, and patient privacy. She scored 100 percent on all of them. Afterward, the staffing office representative walked Molly to the ER and introduced her to the charge nurse. Molly was impressed; at other hospitals, busy staff had pointed her in the general direction of the ER and left her to navigate her way alone. The charge nurse gave Molly a tour of the department and assigned her to a zone.

The Worldview staff was amicable, the ER manager was ever-present and interactive, and all of the doctors introduced themselves by first name. Molly couldn’t believe the contrast between Worldview and her other hospitals. The staff was happy because they were not overworked. She had only three patients at a time because two float nurses and several techs picked up some of the workload. Because the ER was relatively slow, Molly had enough time to spend with each of her patients, which made her feel like a good nurse.

Not long into Molly’s shift, the charge nurse, who had been watching her, said, “You have your act together. What are your scheduling preferences? When we have needs, I’ll call you first.”

In the middle of Molly’s shift, the computer system went down for several hours. Doctors could input orders, but other departments couldn’t view them. The radiology department didn’t know when the ER wanted to send in patients for exams, the lab wasn’t notified when nurses ordered tests, and the Pyxis didn’t have access to patients’ names for nurses to pull out drugs.

At every other hospital where Molly had worked, this shutdown would have been catastrophic. But no one at Worldview batted an eye. The nurses pulled out paperwork and charted manually.

At the end of Molly’s shift, the charge nurse wrote her a spectacular review for the agency’s required first-shift evaluation. She marked “exceeded expectations” for each of the dozens of skills listed, and added a note about Molly’s quick learning curve and willingness to take on anything. She also wrote that the nursing staffing office should make sure that Molly returned.

Was Worldview the hospital Molly had been looking for? Over the next few weeks, she took several shifts there. She learned that Worldview doctors and nurses were kind to each other and there was no nurse bullying. Patient flow was quick, with low wait times and not much volume. Techs did their jobs without being asked, and other departments pitched in; radiology picked up their own patients, for example, rather than waiting for nurses to bring them. The charge nurse told Molly that she was her favorite agency nurse because she was independent and didn’t complain.

But there were downsides to Worldview. The hospital didn’t see trauma or cardiac patients, so the ER transferred the sickest patients elsewhere. And, as at Academy, the work was so slow that the job, for Molly, was boring.

Molly had come to realize that there was no Holy Grail of ERs. “I liked some of the patients at South General because they actually listened and saw the nurse as a person to learn from. I like Academy because some of the staff is really nice. I actually do like Citycenter because of the ridiculousness that happens there. I like Worldview because it’s a welcome break from super-hard work,” she said. She decided to continue as an agency nurse so that she could work at the variety of hospitals on her own terms.

It had been a full year since she quit Pines Memorial. She was not wrong to leave. In an arena that mattered greatly to Molly—“being held accountable and doing your job well because it’s the right thing to do”—Pines was the worst of the bunch. At the same time, because of the high numbers of septic nursing home patients and highway-speed car accident victims, Pines treated some of the sickest patients in the area, which Molly valued because of the intellectual challenge. And Molly appreciated Pines’ experienced nursing staff because she learned something new every week. “That hasn’t existed at any other hospital,” she said. “If they could stick Academy management into the Pines ER, that might be the ideal place to work.”

But maybe the trappings didn’t matter so much. Molly hadn’t become a nurse because she wanted an ideal place to work. Ultimately, the tensions among nurses, disrespect from doctors, and bureaucratic inconsistencies weren’t what mattered. Ultimately, what mattered was helping people. That was what her mom had loved about nursing. That was the priority Molly wanted to pass on to her own child. Maybe it was time to let everything else go.

One night, Molly took a shift at Avenue Hospital. At 11:00 p.m., an elderly couple came in. The man, who was on hospice care because he was dying of cancer, was having trouble breathing. Typically, hospice patients didn’t come to the hospital, but sometimes families panicked and brought them in. Because Avenue had no beds available on the medical floor, the man boarded in the ER.

All night, the man drifted in and out of consciousness. His wife of sixty-eight years never left his side. At dawn, when Molly’s shift ended, the patient received a medical floor bed assignment. “I’ll come get him and take him up,” the oncoming nurse said over the phone.

“No, I’ll bring him,” Molly said. “I’ve been with them all night.”

As the elevator doors opened on the seventh floor, Molly saw the sun just beginning to glow through a tall window at the end of the hallway. She knew it would be the patient’s last sunrise. She turned to him. “Would you like me to take your bed to the end of the hall so that you can watch the sunrise together?” she asked.

The man nodded feebly. His wife whispered, “Yes.”

Molly wheeled the bed past the man’s assigned room and parked it at the end of the hall. On the bed, the couple held each other for the last time. As the sunrise unraveled warm pastels across the sky, Molly stood silently behind the head of the stretcher.

“Oh, John, isn’t it gorgeous?” the woman said to her husband.

He smiled weakly. “It sure is,” he whispered. He closed his eyes and passed away peacefully in his wife’s embrace, his needs met, his end loving.

That was why Molly had become a nurse.

Chapter 10

What You Can Do

:

Advice and Inspiration for the Public, Patients, Families, Nurses, Aspiring Nurses, Managers, and Others

“Nurses can work individually as citizens or collectively through political action to bring about social change.”

–Code of Ethics for Nurses, Provision 9.4

“Our clinical skills are essential in carrying out high-level nursing care, yet the complete package that defines nursing is one human being reaching out to support another.”

–a family nurse practitioner in Michigan

A solution to many of the issues in this book, and one that would go a long way toward fixing American healthcare, is relatively clear: Treasure nurses. Hire more. Nurses are perennially the number-one most trusted profession in America, according to an annual Gallup poll rating honesty and ethical standards. They are called to an exhausting commitment in which mortals must sustain an unwavering grace at the edge of life and death, almost divinely slowing heartbeats, hurrying them along, or pounding them back into existence. Nurses are exceptional. So why aren’t they treated accordingly?

As new healthcare laws funnel more patients into the system and 6 million baby boomers are reaching the age of greatest healthcare need, nurses are absolutely vital to the health of the country. Every year through the end of this century, 2 to 3 million people will age into Medicare, which increases demand for services.

While hospital finances are tight, the margins are still positive in most institutions, said ANA senior policy fellow Peter McMenamin, a healthcare economist. “Hospital finance people are skittish particularly when it comes to uncertainty, and the monster under the bed is what’s happening with Medicare,” he said. Hospital administrators fear further Affordable Care Act cuts in payments to hospitals, which could explain why hospital industry employment numbers that were increasing in 2012 and 2013 were virtually flat in 2014. But over the next several years, hundreds of thousands of RNs and APRNs are expected to retire. “A hospital that now may be seeing two to three longtime staff members retiring [per] year, eventually could be holding retirement parties once a month,” McMenamin said. “Hospitals should be looking at the longer run. If they wait five years to get back into the job market, they’re going to be competing with all the other hospitals that waited five years and they’ll be competing for the same cohort of experienced nurses. If they start hiring new nurses today, they could be developing their own experienced workforce. It’s a sound long-term strategy.”

It’s also a way to quickly improve patient care. Researchers have proven that patient-to-nurse ratios directly affect patient mortality; medical errors and adverse events; patients’ length of stay; risk of heart attack, hospital acquired pneumonia, or infections; failure-to-rescue rates; patient falls; readmissions; nurse retention; and patient satisfaction. Lightening patient loads reduces nurse stress, burnout, bullying, and exhaustion.

The bottom line is that hospitals could save money, patients, and nurses by investing in staffing. Policymakers could help by providing grants, fellowships, and other subsidies for additional nurse hires.

Before hospitals implemented the checklist mentioned in Chapter 5, medical professionals couldn’t imagine reminding physicians to wash their hands. When infection rates dropped to zero, the checklist ably demonstrated that small changes can have big payoffs. Here are additional tips to help people receive—and staff provide—better healthcare.

For hospitals and managers

Involve nurses in decision making.

Directly involving nurses in decision-making processes is a good strategy for developing efficient policies, making nurses feel like valued workplace contributors, decreasing occupational burnout, and increasing morale. As frontline healthcare providers, nurses have important insights and day-to-day perspectives that can inform everything from patient-care procedures to workplace policies. Currently, many workplaces do not include nurses in these strategic meetings.

Appoint a contact person to objectively handle nurses’ concerns.

Inter-office politics affects patient care, as evidenced by Dr. Bitch’s and other doctor bullies’ power plays over nurses. One strategy to curb bullying is to establish a contact person or inter-staff committee to whom nurses can report disruptive behavior without risking retaliation, according to the Online Journal of Issues in Nursing. This point-person could also handle reports of assaults by patients and visitors as well as concerns about physician mistakes. Nurses will be far more effective at checking doctors and caring for patients if they are expected to speak up. They must feel empowered to protect their patients. Hospitals can develop protocols for nurses to report urgent concerns to an administrator who can and will intervene. As the Institute for Safe Medication Practices suggests, workplaces should have a no-retribution policy for employees who report worrisome or disrespectful behavior.

Provide debriefing/counseling resources.

It’s unrealistic to expect even seasoned nurses to recover immediately from handling trauma victims or unexpected patient deaths or complications. A range of resources could help nurses cope with tragedies and/or manage burnout, second-victim syndrome, and other longer-term work-related emotional issues. Accessible on-site counseling would be ideal. Debriefing sessions can help to find lessons, meaning, or closure after certain patient cases.

Some hospitals have trained colleagues across departments to provide support, comfort, resources, and counseling referrals to any staff member dealing with a difficult situation; a liaison is on call at all times. At the least, hospitals could provide a quiet room in which nurses can relax and compose themselves. Ohio nurse practitioner Barbara Lombardo has suggested soothingly colored walls, comfortable chairs, and relaxing music to relieve stress. Advocate Lutheran General Hospital in Illinois gave nurses a small budget to furnish a retreat in a break room; the nurses purchased a massage chair and some puzzles, if only to refocus coworkers’ thoughts with a brief distraction.

Compassion fatigue, stress, burnout, and other mental health issues not only wear nurses down but also drive them out of the field. Administrators’ efforts to prevent these issues could demonstrate care for their employees and save money in absenteeism and job attrition.

Use first names.

In many workplaces, nurses are called by their first names, while doctors are not. Requiring doctors, nurses, administrators, and other staff members to call each other by their first names is a no-cost strategy to reduce the appearance of hierarchies among the professions. One of the reasons Pines Memorial nurses liked working with Dr. Preston was because they could call him Clark, which blurred the doctor–nurse tiers. “Using a colleague’s first name can help break down artificial barriers that may impede effective communication,” the ISMP recommends. This simple way to help equalize the playing field could help to decrease disrespectful and disruptive behaviors and lessen the “us versus them” attitude.

Prioritize security.

Getting assaulted by patients and visitors should not be tolerated as “part of the job.” Hospitals have had success by assigning uniformed security personnel to make frequent rounds in patient care areas. The Joint Commission recommends wand-screening visitors for weapons or conducting bag checks. Some hospitals also might consider installing metal detectors. Within six months after Detroit’s Henry Ford Hospital began using metal detectors, staff had confiscated thirty-three handguns, ninety-seven chemical sprays, and more than 1,300 knives.

By requiring staff to report all violent acts and threats, administrators can track the events, deduce patterns, identify frequent aggressors, and better prevent future incidents. As mentioned in Chapter 3, the computer database identifying violent patients at the VA Medical Center in Portland, Oregon, reduced attacks by 91.6 percent. If other hospitals implemented this successful program, countless nurses could be spared injury and suffering.

OSHA states that “at a minimum, workplaces should ensure that no employee who reports violence faces reprisals . . . [and] place as much importance on employee safety and health as on serving the client.” Separately, all states should make it a felony to assault any healthcare professional on the job.

Talk about substance abuse.

The most important step employers can take to reduce narcotics addiction among their staff is to make sure that addicts can easily get the help they need. “A lot of nurses get caught and no complaint is filed. Whatever was driving them to use comes back at their next job and they steal drugs again,” said Douglas McLellan, RN Coordinator for Massachusetts’ Nursing Substance Abuse Rehabilitation Program. “The best thing is for nurse managers to file the complaint, get the nurse into a program, and let her be monitored.”

Prevention strategies could include more vigilant monitoring of medication disposal and placing posters in staff areas that list signs of possibly impaired colleagues and ways to help them. All nursing schools should teach a unit on chemical dependency and intervention strategies. This type of instruction would help to prevent addiction and lessen the stigma associated with chemical dependency. Addiction is an illness, not willful misconduct. If healthcare providers view nurses with chemical dependency issues as patients with a treatable problem, they may be more likely to assist them rather than stigmatize them.

Don’t automatically or exclusively fault nurses for medical errors.

Nurses are blamed for medical errors too often when doctors or hospital policies are at the root. If a medical error occurs because of a nurse whose unit was short-staffed at the time, the hospital should accept some responsibility. Even when nurses do make a mistake, as in the case of Kimberly Hiatt, the nurse who committed suicide after her hospital blamed her for an infant’s death, rather than scapegoating and/or firing them, administrators could tap them to help devise a system that would prevent similar errors. As an American Association of Critical Care Nurses study points out, “A mistake does not mean a bad practitioner . . . not correcting a mistake does.” When Montreal’s Jewish General Hospital launched a “no shame, no blame” campaign to track errors, staff was able to reduce bed sores (which can develop quickly when a patient can’t change positions on his own) from 25 to 6 percent.

For the public

There are many things that loved ones can do to improve a patient’s healthcare. Here are some tips that nurses mentioned most frequently in our interviews.

Appoint one family spokesperson.

Several nurses, as well as the networking website allnurses.com, offered an excellent suggestion to streamline hospital visits: Families or patients can designate one family member to communicate with nurses. This tactic saves nurses from having to take time away from patients to repeat themselves to various loved ones and ensures that one visitor is completely informed. Family members can write down all of their questions and the spokesperson can ask them, then relay the information to rest of the visitors.

Ask questions.

Patients and family spokespersons shouldn’t hesitate to ask doctors and nurses questions about their care and about the specifics of and reasons for procedures. “Even if you’re worried about annoying a doctor or nurse, if you have questions, you should ask them,” said a psychiatric nurse in Hawaii. “The patient and patient’s family need to know enough about what’s going on to advocate for the patient’s well-being. It could save your or your family member’s life.”

When asking questions, avoid asking “Why,” which can put healthcare providers on the defensive. Instead of inquiring, “Why did you give him that medication?” try “Help us to understand why he’s getting this medication,” a Texas family nurse practitioner suggested. Also, double-check the identification information on your armband or make sure your family/visitors know to check it for you. “Patients get better care when their family is involved, actively,” said a Virginia nurse practitioner.

Try to keep a list of questions so that you can ask them at one time; you can even write them on the whiteboard in the room. And don’t be intimidated to ask the doctor. “Countless times, the doctor has asked if there are questions, the patient and family timidly say no, and as soon as he leaves, they turn to the nurse and say, ‘What does that mean?’ ” said a Washington State nurse.

The best time to ask a nurse questions might be during the nurse’s second visit of her shift. At the start of her shift, she might be particularly busy visiting each patient; by the second pass-through, she should have more time to focus on your questions.

Be prepared.

To speed up wait times, maintain a written medical history complete with current prescriptions and dosages, vitamins, over-the-counter medications, allergies, diagnoses, and contact numbers so that you can hand a copy to your healthcare provider. Or take cell phone photos of medication labels and lab and diagnostic results so that they are handy at all times. In triage, be specific about the type and location of your pain or complaint.

Your hospital is not as clean as it could be.

Bring hand sanitizer and antibacterial wipes. Use them.

Stay with the patient.

“It is really important to have someone stay in the hospital with you. Nurses may not always be able to keep a close eye on each of their patients,” said a Pacific Northwest PACU nurse. “Sometimes, the aggressive patients needing more nursing care take time from the quieter patients. It’s like the squeaky wheel gets the grease.” A Washington State nurse instructor suggests that relatives take turns so that someone is with the patient at least sixteen hours per day.

It’s helpful for the patient if you can be in the room for the doctor’s daily rounds. Ask the staff what time these rounds occur and let them know that you plan to be present for them.

Watch carefully when staff members enter your (or your loved one’s) room.

Not all doctors and nurses remember to wash their hands when entering a patient room. Nurses encourage patients and visitors to speak up if someone forgets. “I would just be direct about it: ‘Could you please wash your hands?’ ” said a physician for the U.S. Navy. “You might append it with something like, ‘I’m just nervous about catching something in the hospital while we are here.’ We all still slip up, so the reminder is actually appreciated, not awkward.”

Do as much as you can for yourself and for the patient.

Bring or find your own food and drink if you are staying with a patient rather than asking the nurse. If you want to help the nurse, ask what you can do for the patient. “It’s hard to lose control when someone is sick, and many times, visitors want to do something. Let us know that and we will gladly give you a task,” said an Oklahoma nursing supervisor. For example, visitors can keep a record of the patient’s fluid intake and output on the whiteboard.

Family members can give patients baths, brush their teeth, take them on walks, participate in therapies, and handle feeding, for example. “I’ve given a bath to a child while the parents sat there and watched,” said an Arizona pediatric nurse. “Nurses do not give magical baths. We give fast ones when we are busy. Any type of care that can be done by the family is not just a help to nurses; it aids in the healing process. Who better to care for someone than the people who love them most?”

Understand that a nurse’s schedule is complicated.

Even if your hospital medications are due at 6:00, you might not receive them at exactly that time because your nurse could have several other patients with medications due simultaneously. “When we’re passing meds on schedule, we usually have to get all of our patients medicated right then. 9:00 a.m., 12:00 p.m., 3:00 p.m., and 9:00 p.m. are very common massive medication times,” said a North Carolina ER nurse. “We usually have six to eight patients and some need ten medications. Some patients can take only one pill at a time, or all of their medications may have to be crushed and put into applesauce and painstakingly fed to them.”

Also, your nurse may be late answering your call light because “she was just holding the hand of a patient breathing his last breath; someone who just lost their mother, father, or spouse was crying on her shoulder; she was elbow deep in stool; or she was being verbally and physically abused by a drunk,” said an Illinois ICU nurse.

Most of all, be respectful, grateful, and kind.

Hopefully, this book will help the public to understand what nurses go through to provide the best possible healthcare. “Most nurses bust their asses taking care of their patients,” said a Maryland medical/surgical nurse. “Hospital administrators are cutting aides, receptionists, and other ancillary help, forcing nurses to do more work without more pay. Nurses are skipping lunches, getting UTIs from being too busy to go to the bathroom, and staying long past their twelve-hour shifts to finish documentation. Be nice to your nurses. They work so hard with little thanks. It means a lot when patients say thank you.” And if you want to go the extra mile, bring them treats.

If that’s not convincing enough, patients and visitors who are unkind can delay processes like repeat pain medication, a Washington, DC, nurse said, “because the nurses don’t want to deal with them.”

Write to the administration about your care.

If you have a wonderful nurse, write him or her a note; even better, write her supervisors about how much you appreciated the nursing care.