Seattle Children’s Hospital ICU nurses win a video competition singing their version of Dancing Queen. Written and Produced by Diane Gates, RN, CCRN. Directed and Edited by Jon Ward.

Blackberry Brandy Cured Everything

In my day no matter what ailed me, my father fixed it up with blackberry brandy. If I ate too much for dinner, and I swore I would explode, Daddy would give me a hefty shot of blackberry brandy. If  I suffered from the trots, out came the bottle of  brandy and I downed it in one gulp. If I complained of a sore throat, he insisted I gargle with it and the best part was I got to swallow. In moments I was singing like a canary, or so I thought.

He also used the brandy as a preventative. If we were all going out caroling or to a community sing we would all drink a Warsaw cocktail before we left the house: vodka, vermouth, blackberry brandy and lemon juice. You can’t beat that for numbing the throat, or the whole body for that matter. Now you’d never do that because you’d be charged with child abuse.

Ah, but the malady it cured best was insomnia. Before bedtime Daddy would mix up a Purple People Eater, raspberry and almond liquer, cherry and blackberry brandy, vodka, orange, pineapple and grapefruit juice, and within seconds we were so sound asleep, we often didn’t wake up until dinner time the next day, much to my mother’s delight.

Today, I wonder if the vodka had something to do with it, but my father swore it was the magic of the blackberry brandy that put us out like a light. In my day, we actually thought brandy could cure cancer and reduce tumors. It murdered our colds and kept us from murdering each other. We’ve come a long way from my day and sometimes I wonder how any of us lived to talk about it. But I certainly did, and everyone at the meetings loves that story.

Look around you, be thankful for what you have.

Missy took me back to the doctor this morning, they told her I am blind in one eye, and it can not be corrected. It is some type of eye degeneration or such, I cant remember exactly. I just laughed to myself and thought, “Thank you GOD, thank you for making me blind in one eye.” I think you are probably reading this and thinking, “Well, it’s finally happened, [she's having] an Alzheimer’s day.”

Well, let me tell you a little story. About a year ago Missy woke up one morning and could not see out of one eye, she was blind. She had to go to the emergencey room. It was a condition caused by MS. The doctors said her optic nerve or something was damaged by the MS and her sight might not return. She came home that night so upset, but laughed at my jokes of getting her different colored eye patches.

I prayed to GOD, “Please, please, I am an old woman. I have had a wonderful wonderful life. I am not questioning you GOD, but just asking you to change your mind, take my eye. You say an eye for an eye, why not in this case?”

About 10 days later, Missy’s sight came back. I was so happy that night that I reminded GOD, “I can still see. how come I can still see?”…So now a year later, I think GOD remembered. Today when they told me I was blind in one eye, it kinda tickled me, I thought GOD is listening to this old woman, Alzheimer’s and all.

Hecky, blind, that’s ok, I still have the other eye, and I still have Missy who can see for both of us.

Have a good day. Look around you, be thankful for what you have. And look around and SEE what you can do for someone else. See you later buddies.

We agree with Friend A Nurse: These nursing students have a great sense of humor about the stress of nursing school. That will serve them well once they’re in the workforce — a good sense of humor is invaluable!

Starring student nurses: Carol Madru, Emma Dubner, Laura Seabury and instructor Lianna Tibbetts

Last spring, NNU Executive Director RoseAnn DeMoro asked RNs across the nation to share stories about how the economic crisis was affecting their patients and their families. Since then, we have seen the healthcare crisis continue to deepen for millions of American patients and families, as described in RoseAnn’s commentary below.

The many heartfelt responsibilities they received were deeply moving, and we have shared many of them, with your approval, with the media and the public in an ongoing effort to urge action to protect our families and communities. As RoseAnn notes, the need for action is greater than ever, and we hope to continue to share your stories as a call to end our healthcare nightmare once and for all and to promote other changes in national, state and local priorities.

They request for you to continue to send your stories, and those from your family, neighbors, and friends. For openings, below is the personal story Donna Smith of NNU, a frequent Nurse Talk guest, who you may remember as well from Michael Moore’s film “SiCKO.”

Please share your story here! | Read sample stories

Watch and share this video:

Rose An DeMoro

The Real Cure for “Obamacare”: Medicare for All

By Rose Ann DeMoro
NNU Executive Director

With the approaching Supreme Court showdown on the President Obama’s 2010 health care law (the Affordable Care Act, modeled on Mitt Romney’s law in Massachusetts), the U.S. healthcare system remains a dysfunctional mess, as nurses bear witness to every day. In late March, the Court will devote six hours over three days to oral arguments on the legal challenges to the law – the most time the Court has given a case in 56 years – accompanied by a possible record 100 “friend of the court” briefs, Kaiser Health News reported February 16.

As nurses have observed the past year, the economic crisis has accelerated broad declines in health linked to job loss, high medical bills, and families having to choose between paying for food, housing, clothing or healthcare. More »

Donna Smith

I Dreamed About My Cancer Docs Last Night

By Donna Smith
NNU Staff, Patient

My sleep was restless last night except for the snippets of scenes where I was being tended to by my cancer doctors from some time ago. In those dreams they cared for my body and comforted my fears as we worked together to overcome my illness. Of course time had changed things a bit and their offices were interwoven with the sweet things only dreams can infuse, but it sure was nice to revisit a time in my medical life when the system was even a little less broken than it is today. Don’t get me wrong, the bills were crushing then and some of the barriers daunting, but the slide to an even more difficult healthcare system for patients and our providers continues and deepens. More »

Tell NNU where it hurts you!

The nurses will listen.  But more importantly, the nurses will make sure that the shared stories are the fabric of their truthful assessment of the broken system and that when the transformed system becomes a reality that the stories are part of history.

National Nurses United
8630 Fenton Street, Suite 1100
Silver Spring, MD 20910
www.NationalNursesUnited.org

You Nurse Talk hosts, Dan Grady and Casey Hobbs

Coming Up On Nurse Talk…oh my…Casey is trying her very best to be still but this “women” bashing thing has got to go. In order to keep Casey civil—Dan recommends they sing a song—that reflects these nasty little current events. Sing they do and the emails start rolling in. Ahhh, some agreement…yes? No! Here are just a few:

“Don’t ever sing again!”
“I had to turn the radio off!”
“I can’t tell Dan from Casey!”
“Stick to your day jobs!”

O.K folks we get the message.

Casey and Dan talk with the distinguished Doug Connor. Doug grew up in a conservative Republican family. He is a nurse, a veteran of the Iraq War, a union member, and a passionate supporter of the Occupy movement. Doug returned from the war in 2006, disillusioned by the unnecessary deaths and organizations profiting on the destruction that surrounded him as a nurse treating victims of war. Upon his return, he was looking for change. He supported Barack Obama because, he says, “…just saying the word ‘change’ was enough for me. That’s what I (was) looking for; change, hope.” But by 2011, failures to improve the economy and involvement with his nurses union took him down a different path. Connor came face to face with the Occupy Wall Street movement.

You won’t want to miss Doug’s story

AND LATER…Craig Preston from the California Clean Money Campaign. A few weeks ago we talked with California One Care’s Executive Director Andrew McGuire. Cal One Care is committed to single payer health care for all Californians. Craig Preston from California Clean Money Campaign also supports a single payer healthcare system but says we have to get the money out of politics first.

The California Clean Money Campaign is sponsoring AB 1648, the California DISCLOSE Act

THIS week...the segment you have all been waiting for...Comedian Lynn Ruth Miller's In My Day. It's a jewel!

AND LYNN RUTH MILLER IS BACK with “In My Day” stories, remedies and reflections from the past. For more information on this and many more hot topics go to the Nurse Talk Blog.

Don’t forget to play nice with others!

Note our NEW TIME AND DAY  in San Francisco. You can listen and laugh every week on Saturdays at 11 am local time  in both Boston and San Francisco. Find us in San Francisco Bay area on KNEW 960AM or live stream at www.960knew.com and  in the Boston area on station WWZN 1510AM or live stream at www.revolutionboston.com. Check out the iHeartRadio app for free and live custom radio. You can also download and listen to any show anytime here at NurseTalkSite.com or on iTunes. Like us on Facebook, and you can listen there too.

RN Theresa Brown’s latest The New York Times’ Tara Parker Pope’s On Health,Well blog:

“In the hospital, people who aren’t employees fit into one of two categories: patient or visitor. But when visiting family members or friends become ill on a hospital floor, it’s not easy to care for them…We can’t offer standard inpatient care because they aren’t registered in the system…Illness can be a bureaucratic crisis… Even inside a hospital, a sick person is not a patient if she doesn’t have an admitting physician, a diagnosis and a numbered plastic wristband.”

[READ MORE of the article, When Hospital Visitors Get Sick, posted on The New York Times web site, March 7, 2012, 2:37 PM]

Have you ever found yourself in this situation? How did the person’s status as a patient/non-patient alter the care you were able to provide?

You can't take it with you.

Oh if just for one day—24 hours—I could be young again. Let’s say 70 or 75—without Alzheimer’s, and with a healthy body—oh, what a day I would have. I would get up early and walk around the block, like I used to do when we first moved into this house. I would wave at my neighbors as they went to work. I’d take some of them their papers up to their front door, so they didnt have to walk out in the driveway in their pajamas. I would pet the dogs I passed as they were being walked by their owners. Oh, what a walk I would have.

I would come home and get in the car, and boy oh boy would I drive…I would drive to see some friends of mine and pick them up in my car and we would just drive around like teenagers for a couple of hours, going where we wanted to go, not relying on anyone to take us.

I would dance, oh, would I dance. I would twirl around, I would Cha Cha, I would Tango, do the Twist, all types of dancing. Then, I would go to the bathroom, all by myself, take a long, long bubblebath, with no help from anyone. Use the restroom all by myself, not having to call someone when I was done.

Oh, what a day I would have..I would get on a plane and fly to Florida and have all my friends and family meet me at a house on the beach. we would walk in the sand and skinny dip in the ocean. Oh, my, boy oh boy…All the things I would do, if I only had one day, one day…

Don’t put off the things you want to do, or say, please appreciate what you have now, and don’t waste today on wants and wishes for tomorrow…get off your butts and go do it. Do it while you still can. If only I had just one whole day of could have, would haves…

I want….to be able to dance again.
I want…to be able to drive again
I want…to be able to take a bubble bath by myself
I want….to be able to walk out to the mailbox by myself
I want …to be able to go to church and sit in the balconey, climb the steps
I want….to be able to get up in the middle of the night and get my own glass of water
I want….to be able to dress myself
I want….to be able to go walk by the river
I want….to be able to go to the bathroom, wipe my rear, and get up by myself
I want….to be able to remember what I had for breakfast yesterday
I want…to be able to be independent and do things by myself
I want….to not have Alzheimer’s

I have accepted that I can not do things all by myself. But I still can’t accept that I have Alzheimer’s, but I am working on it, and with all of your help, following my adventure with it, maybe I can help someone else who doesn’t want to have Alzheimer’s either.

Throughout our lives, we are always going to be in situations where we will need to deal with difficult people whether they are physicians in the work environment, co-workers or people in our personal life. In my 35 years of experience in healthcare administration and as a CNO, I never tolerated abuse of my staff in any way, and over these years I had been involved in several investigations that have led to the discipline action or loss of privileges for abusive physicians. Abuse of physicians by nursing staff was also not tolerated and probably as many nurses lost their positions for inappropriate behavior over the years. Especially with the need for healthcare workers to function as a team, it is critical for people to treat each other with respect and dignity. All that said, there are still going to be situations where nurses are abused by physicians and other people in the work environment and there are things to do to prevent, minimize and resolve such issues.

Abuse from physicians is difficult to handle because nurses are, for the most part, under pressure throughout the course of the work day. When abusively confronted, there is a loss of balance and personal control that arises first followed by an assault to the ego, which evokes an emotional response of anger, hurt and insignificance. Because the ego needs to feel accepted at all times, this response is intensely uncomfortable and painful. There are three choices when confronted with this type of situation: we can run from it or avoid it, handle it poorly or handle it well. The choice is ours but it is important to introspect and remain in control.

Patteron, Grenny, McMillan and Sentzler (2002) in their book Crucial Conversations identify several strategies to help you decrease your emotional response and keep you in control. They include:

The first step is to first introspect and analyze what the problem is and what your feelings are toward the situation, which now identifies your stand in the conversation. During this step it is critical to place the patient at the center of the conversation and the only goal being a positive outcome for them. It is important to realize that this is not about you but the patient. The next step is to find your bearings and get ready for the discussion, as well as controlling your body language to stand straight, do not retreat and continue to exude an aura of self-confidence.

Learn to Look

When dealing with difficult people, oftentimes it is not a surprise that they will act poorly and you can be ready for that. When we learn to look proactively for situations, it is easier to handle. First of all, you can watch the conditions that lead to poor behaviors. Is it a surgeon that usually acts badly when there is a difficult case on the board or when it is excessively busy? Also be aware of safety issues. Will a bad confrontation affect the quality of patient care? Will it endanger the safety of other patients or staff? How serious do you think the outcome of this communication could be? It is important to prevent silence to violence in the work environment

Make It Safe

With difficult confrontations it is important to keep the conversation safe, by establishing a mutual purpose which, in this case, is the patient. Always behave respectfully toward the physician in the hopes that mutual respect will be returned. Apologize only when appropriate and apologize only for the individual’s perception of the situation and not for something you did not do. Step out of the conversation if you need to, by simply saying “I am choosing to excuse myself and we can pick up this conversation with others in the room.”
Master Your Story

Be prepared and know your story that you will present. Also, understand your personal feelings and be aware of the fact that it is common to be upset and off balance in such situations. In the conversation, stick only to the facts pertinent to the conversation and leave other topics, especially those that are emotionally charged, out of the discussion.

State the Facts

Throughout the confrontation stick only to the important facts and keep the conversation as simple as possible. Always attempt to return the conversation to the important facts at hand and to focus on what is important for the patient.

Lastly, when all else fails, it is important to reach out for help when necessary. It is not acceptable to be treated poorly by anyone in the work environment and all organizations should have a zero tolerance policy to this type of behavior. Speak to your manager, and if the manager does not address, you need to go up the chain of command. In my experience, it always frustrated me when someone would say, “that’s just the way he/she is”. My response was always, “well, that is not acceptable”. Over time, adopting an expectation of mutual respect and dignity will tremendously improve the work environment for all.

This article was shared with us by NurseTogether.com.
Based in Charlotte, NC, NurseTogether.com is one of the fastest-growing, free online professional communities for nurses. Specializing in unique nursing lifestyle, career and professional development information, NurseTogether.com’s mission is to empower the nursing community through top-quality original content from experts, interactive web-based social media tools, and value-added services through key strategic partnerships in a variety of nursing and lifestyle disciplines.

“Perhaps our real work, whether offering or seeking care, is to recognize that the healing relationship–the field upon which patient and practitioner meet–is, to use the words of the mythologist Joseph Campbell, a ‘self-mirroring mystery’–the embodiment of a singular human activity that raises essential questions about self, other, and what it means to heal thy self.”

–Saki Santorelli

There is an old Celtic tale about 5 sons of the Irish King Eochaid.  The sons were out hunting and got lost. They became tired and thirsty and set out in search of water. Each went a different way but all ended up, at different times, to the site of the woman beside the well.

The tale tells that the woman guarding this well was hideous.  Blacker than coal was every inch of her. Her hair was a grey, wiry mass of substance that compared to a wild horse’s tail.   This hair appeared only attached at the top surface of her scalp.  Her nose was awry and held wide nostrils. Her eyes were red and smoke blurred.  Her center was a wrinkled and freckled belly that overtook warped, crooked shins, garnished with massive ankles and a pair of capacious shovels for feet and knotted knees.  Long livid nails escaped her hands.

The oldest son of the King found the well first.  Standing before the hideous woman he asked for some water.  She told him the only way to get some water was to kiss her.  He refused, vowing he would rather die than kiss her and he turned away.  One after the other, three more brothers followed the path that led them to the woman at the well.  Each refused in repulsion to kiss the women and each of them turned away.

Finally the fifth brother, the one called Niall, took up the quest and found the woman at the well.  Upon hearing the terms of the bargain, he agreed without hesitation not only to kiss her but also to embrace her.  When he had willingly done so, right before his eyes, the guardian of the well transformed from the distorted, hideous figure to a beautiful woman.  The woman introduced herself as “the King of Tara, Royal Rule.”

She gave him the water and before he left the well she bestowed on him a blessing for himself and his children; that they should be graced with the Kingdom and highest of power.

You see, Niall also saw the woman as the hideous figure that his brothers had seen but unlike his brothers he was guided by his deep and gentle heart, offering her loving-kindness rather than revulsion.  Take note from this tale, the other brothers were not cursed for turning away from the woman…instead they just remained parched, hard and dry.

Bobbi McCarthy Recommends

I read this tale in the book, Heal Thy Self, Lessons on Mindfulness in Medicine by Saki Santorelli, EdD, MA.  This simple story spoke to me.  When I am at work I have a choice to see my patients in this very manner. They come to me in many states of disarray…from physically repulsive to pristine…from angry to kind…from delusional to intact…and so it goes.  I wish I could say I always acted like the fifth brother and embraced each patient with my loving and gentle spirit…but I can say that when I do embrace them this way, my heart is forever changed…and when I don’t it is also changed…

When I choose to see beyond the physical imperfections, mental imperfections and bad behavior of certain patients and go to them with a kind and gentle spirit of caring I can see the change in them almost immediately. Once we establish a kind exchange my heart is changed and I see them differently.  We are a culture of what we see… I pray that I will honor each patient as they are inside and that I will then be forever blessed.

In my day my mother said baking soda did everything. She sprinkled it all over the bathroom because she said it absorbed odors. I guess it worked because our toilet seat was so gritty I always went next door. Whenever I took a bath, I looked frosted. That’s probably why I love cake. My mom polished her silverware with baking soda and cleaned out our baby bottles. That made the silver look like ivory and I still hate the taste of milk.

My mother didn’t spend money on caustic cleaners. She used baking soda to polish plastic, porcelain and glass. And when she felt a storm coming on, she ran outside and put baking soda on the car’s windshield. She said it repels rain if you wipe the windows inside and out and it keeps lightning from striking the car. When I asked her why she didn’t just pull the car into the garage, she washed my mouth out with baking soda. I think that’s why I’m afraid of thunder.

She made us gargle with baking soda, and when we got sweaty, she rubbed it under our arms. She made us drink baking soda and water if we had indigestion and she smeared it on us for measles, chickenpox and insect bites. But when my vagina itched, she just said, “Serves you right.”

My mother would have murdered me if I ever called a plumber. She saved money by keeping our drains clear with a baking soda solution and a plunger. Until my cousin Alvin got his plumbing license. Then she called him over when the toilet backed up and she handed him a box of baking soda and a plunger. I guess you had to be there.

That woman used baking soda to dissolve grease, clean the coffee pot, polish rusty pans and clean up my language. Yessir, my mom swore by baking soda. She said it would do anything but make him love you. That takes  chemistry and a little perfume.

You know you need some rest. Recharge. Get out of town. R & R for RNs is April 2012 on the southern Mendocino Coast.  2-1/2 hrs. north of San Francisco. Lodging, food & specialty discounts all month for RNs, LVNs, EMTs.

See www.redwoodcoastchamber.com/rr-rns-april for details or call 1-800-778-5252.

Listeners of Nurse Talk can enter a drawing to win a FREE 2-NIGHT STAY at the lovely Mar Vista Cottages. The drawing will be at the end of March. A winner will be chosen by random drawing.

Do you have "it?" Send us an email.

Nurse Talk is searching for the perfect co-host. That’s right, Dan is retiring, but will be with us for special segments. In the meantime Casey needs a great sidekick. Looking for a nurse with great communication skills, a sense of humor a must, and a willingness to commit to our ever-growing show.

For more information send an email to cohost@nursetalksite.com. Please include a statement about why you are interested and attach a resume.

Welcome to Nurse Talk where laughter is the best medicine! This week on our lovely “sheeew”—we talk about a customer service practice that is now being used in the healthcare field. It’s called scripting and rounding. In the corporate world scripting and rounding has been part of the customer service model for giants like Disney, major fast food chains and many five star hotels. Now—healthcare? Could this lead to the question, “Mrs. Smith would you like fries with your medication?” Or how about—“Here’s the key to the mini-bar and if you prefer you can go to the nurses station for your ice and extra towels.” What’s scripting and rounding all about? RN DeAnn McEwen gives us a “spirited” overview!

Stay tuned for this story—you won’t want to miss Phyllis Katz. Like any skilled improviser, when longtime performer and director with the famed Groundlings comedy troupe was faced with her insurance company being unwilling to pay six figures to fix her two hips, she improvised. Good-bye, Los Angeles. Hello New Delhi. Phyllis is here to talk with us about her wonderful new book Hipwrecked, My Health Insurance Sucked so I Went to India for Surgery.

A proud member of the middle class, in this wild story of courage and humor in the face of culture shock, she chronicles her sudden, improbable trip to India for medical treatment. Hipwrecked is an adventure (told partly through e-mails while highly medicated) born of the unfortunate yet laughable inadequacies of modern medical insurance—and a celebration of the joyful strength of the human spirit.

And if you haven’t heard the our new segment “In My Day” with comedian Lynn Ruth Miller--you need to. This week Lynn Ruth talks about a favorite all-purpose remedy her mother used: baking soda. Told only as Lynn Ruth could—it definitely harkens memories from the old days!

Nurse Talk is searching for the perfect co-host. That’s right—Dan is retiring, but will be with us for special segments. In the meantime Casey needs a great sidekick. Looking for a nurse with great communication skills, a sense of humor a must, and a willingness to commit to our ever-growing show. For more information send an email to cohost@nursetalksite.com. Please include a statement about why you are interested and attach a resume.

You can listen and laugh every week on Saturdays at 11 am local time  in both Boston and San Francisco. Find us in San Francisco Bay area on KNEW 960AM or live stream at www.960knew.com and  in the Boston area on station WWZN 1510AM or live stream at www.revolutionboston.com. Check out the iHeartRadio app for free and live custom radio. You can also download and listen to any show anytime here at NurseTalkSite.com or on iTunes. Like us on Facebook, and you can listen there too.

“When you look at me and say, you see a face without a name, perfect strangers in a frame…Everyday we’ll make new memories and add them to this shelf always to remind you, you are never by yourself.”

This song is a tribute to those affected by Alzheimer’s disease and their families. Half of all proceeds from this song will be donated to the Alzheimer’s Society of Canada to help continue research so one day we can hopefully cure this illness. You can purchase the song on iTunes, CD Baby, Amazon, or on the musician’s website at www.brianasselinmusic.com

With the approaching Supreme Court showdown on the President Obama’s 2010 health care law (the Affordable Care Act, modeled, of course, on Mitt Romney’s law in Massachusetts), the U.S. healthcare system remains a dysfunctional mess, as nurses bear witness to every day.

In late March, the Court will devote six hours over three days to oral arguments on the legal challenges to the law — the most time the Court has given a case in 56 years. The testimony will likely be accompanied by a possible record 100 “friend of the court” briefs, Kaiser Health News reported February 16.

While the ACA had some undeniable positive elements, such as permitting young adults up to age 26 to remain on their parents health plan, and a few limitations on insurance industry abuses, such as barring them from denying coverage due to pre-existing conditions, our health care nightmare is far from over.

And, as nurses have reported repeatedly the past year, the economic crisis has great aggravated the suffering with broad declines in health status that are directly linked to job loss, unpayable medical bills, and families having to choose between paying for food, housing, clothing or healthcare.

As to the law itself, despite its name the ACA has done little to actually make healthcare affordable. Out of pocket health costs for families continue to soar largely unabated. Nurses now routinely see patients who have postponed needed care, sometimes even life-saving or life-prolonging care, because of the co-pays and deductibles.

A Commonwealth Fund study in November, comparing the U.S. to other high income countries, found that the U.S. stands out for sick adults having cost and access problems with 27 percent unable to pay medical bills in the past year, compared to from 1 to 14 percent in other countries, and 42 percent skipping doctors visits, recommended care, or not filling prescriptions.

Nationally, premiums have jumped on average 50 percent over the past seven years with more than six in 10 Americans now living in states where their premiums consume a fifth or more of median earnings.

Universal coverage remains a far off dream. Fifty million Americans still have no health coverage. Another 29 million are underinsured, meaning they have massive holes in their health plans, an increase of 80 percent since 2003, according to the journal Health Affairs. The percentage of adults with no health insurance at 17.3 percent in the third quarter of 2011 was the highest on record, up from 14.4 percent just three years earlier, Gallup reported.

On quality, the U.S. continues to fall far behind other nations.

What should have been a shocking, underreported study from the University of Washington last Junefound that more than 80 percent of U.S. counties in free fall on life expectancy compared to nations with the best life expectancies. Some U.S. counties are more than 50 years behind their international counter parts, meaning they have the life expectancy that those nations had in 1957.

One reason for this disturbing news is the regression in death rates for child bearing women. The U.S. ranks just 41st in the world, and it has been getting worse, according to the World Health Organization. The average mortality rate within 42 days of childbirth has actually doubled in two decades, from 6.6 deaths per 100,000 live births in 1987 to 13 deaths per 100,000 in 2007. One reason, a 10 percent cut in federal spending for maternal and child health programs the past seven years.

Those who think giving more handouts to the private insurers and other healthcare corporations will improve these dreadful statistics should think again. The wholesale domination of our health by the same Wall Street types who tanked our economy is exactly what has caused the falling health barometers on access, cost, and quality.

There is an alternative which most of the rest of the world has discovered, a national or single payer system, such as expanding and adequately funding Medicare to cover everyone. Even in other countries where conservative politicians have proposed privatization or sweeping health cuts they are being met with an aroused public unwilling to trade their health systems for the broken model we have here.

Whether the 2010 law is fully or partially thrown out by the courts, repealed in Congress, or fully implemented, the need for real reform, single payer/Medicare for all, will continue to grow. At this point the fight for single payer is being taken up state by state, a movement that we will continue to proudly support.

OK buddies, I want to talk about something. Alot of you nice people that read my stories are youngsters, 40 to 60 year olds. Alot of your parents are still alive and may either live in your city or away. I want to tell you all a secret. When you talk to your parents on the phone and say, “Hi mom (or dad), how are you?” And they always answer, “Fine, just fine.” When you say to them, “Are you keeping busy, getting out doing things?” And they answer, “Oh yes, I have plenty to keep me busy.” When you ask them, “Are you lonely? And they answer, “Oh no, I have friends, I’m fine.” When you say to them, “I wish we could visit but we are just so busy,” and they answer, “Oh I know, don’t worry about me, you have your life. Don’t worry about me.” I want to tell you a secret: Your parents are not telling you the whole truth.

Barbara Taylor Vaughan

They do get very lonely, they do need help sometimes, they do want to see you. They are your parents, and if you are parents, you know that you never want to hurt your children, or want them to be put out. Us seniors want to be on our own, we want to be independent, but hecky, we miss you. SO, here is my advice, before it is too late, and just because it would be wonderful for you to do, try and see them more. If they dont live in town, go visit them, if you can’t take the whole family, YOU go visit your parents for a few days. Oh how they would love that special visit.

If you can, bring them to your house for a week, let them visit you. If you live close by, make the decision today to take them out for lunch, bring them to your house for dinner, go to the mall with them, to the show. I am sure they would love to see your whole family, but sometimes, remember back to when you were a child, there is nothing like just you and your parent doing something together, just you two.

We want our children to have their life, but we also want to be a part of it. We just don’t want you to feel guilty, so we will never tell you that we are lonely, or that we want you to visit us more often, or that we really would like to come visit you. Please, make the time, yes everyone is busy, and not all of us get along with all of our family members, but do it for you, do it for your children, do it for your parents.

Life is short, and I promise you, it might be difficult and you might think that you can’t do it, but I can tell you, you won’t regret it. It might make you remember that your old mom and dad, they were the ones that loved you first, and the most. No one, no one, loved or loves you more than they did and do. SO, be the one that love them the most in their last days, and tell them, before it’s too late. It is so sad seeing you youngsters at funerals crying, sad, and feeling guilty and telling me you wish you had done or tried to do more, but didn’t. SO do it!

Relationships can be tested to the limit when there is a caregiver and care recipient within a family relationship. In a paid caregiving position there are those who have something special within them and those who are just making an income. I think about and meet all types of caregivers on a daily basis.

At my Visiting Angels office, we are always striving to hire the excellent caregiver’s with that something special, rather than someone just looking for a job. It is much easier to control what type of caregiver’s we employ than changing a less than satisfactory family caregiving situation.

Everyone isn’t suited to provide care in a family situation or as a paid position. So what are the characteristics that an excellent caregiver has? I believe there are 5 core qualities an excellent caregiver possesses.

1. EMPATHY

My belief is empathy is the #1 core characteristic of an excellent caregiver. I often question if this is inherent within us or this is something which can be learned?

I tend to believe it’s a lot of inherent and a big mix of environment. I also believe there are degrees of empathy. Some can empathize more than others. If you can totally put yourself in the place of who you are caring for, you will do nothing but provide excellent care.

The question is always – how would I want to be treated and taken care of under these circumstances? If that is the core basis for how you provide care you will provide caring, compassionate, and dignified care with a great attitude.

2. DEPENDABILITY

Someone who is in need of care has lost some degree of independence. They have to be able to depend on the person or people providing assistance to them.

Imagine being unable to obtain your own meal, bathe yourself, get dressed, or go to the bathroom independently. Imagine the feelings involved when you lose that independence and have to ask for help. Imagine having no one to count on when you need them.

It is difficult enough for a person to lose independence without having the added burden of finding someone reliable to help them. When you provide care, it is crucial that you are dependable. So many vulnerable seniors’ lives depend on the assistance and care of another to live a safe and happy life.

3. PATIENCE

Besides children, most care recipients are elderly. As we age, our bodies no longer move the way they used to. Add an injury or physical illness and movement is more difficult, slower and may be painful.

Parts of our bodies may not work at all, such as after a stroke, or with a disease such as advanced Parkinson’s, or arthritis. With an illness of the brain, such as Alzheimer’s, there is memory loss and loss of the ability to process information.

These are some of the examples that would cause someone to move slowly, respond slowly or repeat conversations. It takes a patient person to provide care when we can move and process quickly, but the person we are assisting cannot.

I often see caregivers contribute to loss of independence because of impatience. We are in a hurried society and typically spend our lives in a fast pace. It can be difficult to slow down to the pace of the person we are caring for, but it is crucial in excellent caregiving.

A good rule is to allow a person to do as much as they can for themselves and to avoid doing things for a person they can do for themselves. Doing too much contributes to the loss of physical abilities and increased dependence. It can also damage the dignity of a person and this that is an important part of their mental health and quality of life.

Give the care recipient ample time to comfortably be assisted with their activities of daily living (ADL’s), and to complete as many tasks as possible on their own. If you aren’t patient, you will end up providing more care, not less. Use the time to slow down your hurried life and enjoy the process of caregiving.

Persons with memory loss will repeat questions, and comments. This can be enough to test anyone’s patience when you’ve heard the same question 30 times that day.

Here again, empathy is needed. EVERY single time a person with dementia asks a question, they truly believe it is the very first time they have asked it. You MUST respond as if it’s the first time you heard the question asked.

I cringe when I hear a caregiver tell a care recipient with dementia, “I just told you”, or “don’t you remember?” This vulnerable person affected by this horrible disease truly doesn’t remember you just told them, and they honestly cannot remember.

These responses typically come with a frustrated tone of voice, and sometimes anger. Again, empathy counts! Imagine asking someone a question for the very first time and they respond in an angry voice and scowl, and you know you never asked them before. Rather than getting to this point of frustration, become a pro at redirection!

Sometimes redirection can take awhile to start working because dementia can cause someone to get fixated on something, but the better you get at it, the less your patience will be tested. Direct the care recipient towards something they enjoy, or change the conversation to a joyful time earlier in their life. Photo albums are always helpful in redirection.

If the care recipient is angry and uncooperative, give them space and a bit of time. If they are not in danger of hurting themselves or others, remove yourself from the situation. Give everyone time to breathe and calm down. Wait 15 or 20 minutes and reproach in a calm and loving manner. If the source of the frustration is a task that can be put off, put it off. If it’s something that needs to take place as soon as possible, like changing an incontinence brief, try a different approach.

4. STRENGTH

As I mentioned above, caregiving can be very difficult. Whether you are paid or unpaid, there will be days and times when you feel like you are at your limit.

You may be having a bad day yourself, the care recipient may be having a bad day, or you are just burned out. Times like these call for strength.

You must be strong enough to recognize when you are in need of time off, when you need to adjust care, when you need to dig deep within yourself for patience.

Caregiver’s seem to be in a frequent battle with the outside world regarding advocacy and fighting for services, or through red tape of insurance or healthcare bureaucracy. It takes a lot of patience and strength to advocate for your care recipient.

Recognize what your weaknesses are and when to get additional assistance. If you get frustrated and exhausted it will not only affect you, but it contributes to the person you’re caring for feeling like a burden, and everyone loses.

Take time off, get additional assistance, and again put yourself in a place of empathy. Caregiving is not for sissies!

5. FLEXIBILITY

Caregivers have to be some of the most flexible people I know. Things can change in an instant when you are caring for someone.

Family members can be called home from work, need to get their loved one to the doctor, or hospital. The health situation can fluctuate, and personality and behavior can change on the drop of a dime.

Paid caregivers can lose a client to a hospital admission, have to stay on their shift longer because of a health crisis, or get a new patient at the last minute. There are constant schedule changes and client changes. You must be open to change because whether you like change or not, it will happen.

People who value strict schedules and sticking to a routine have a lot of difficulty in the caregiving role. I have spent my career knowing that as soon as I have my day planned out something is sure to change and I will have to tend to whatever has become the priority. Caregiving is best for people who can adapt quickly and accept change easily.

There are other qualities and characteristics I could talk about, but I believe those stem from the core 5. Being kind and gentle stems from empathy and patience. Obtaining the best healthcare possible is a result of empathy and strength. Keeping the care recipient safe comes from empathy, dependability and strength. Every situation and every caregiving moment spent will require empathy.

Whether you are providing care now or will be in the future, you have to ask yourself if you are able to put yourself in the shoes of the person, or people you care for.

This requires you to be judgment free of their situation and have the ability to understand what it must feel like in their place.

If the person has advanced Alzheimer’s, take yourself to the place it would be like when they were healthy and then started to realize they couldn’t remember things, or lost their way. Understand how it felt to receive the diagnosis of Alzheimer’s, knowing there is no cure and your abilities will most likely diminish. Think about what it would be like to have a stranger bathe or dress you.

If you can do those things, you will always provide care that is of the best quality possible. If you cannot, I recommend alternative care for a family member or another choice of career.

Care recipients deserve no less than the best we have to offer.

This article was shared with us by NurseTogether.com.
Based in Charlotte, NC, NurseTogether.com is one of the fastest-growing, free online professional communities for nurses. Specializing in unique nursing lifestyle, career and professional development information, NurseTogether.com’s mission is to empower the nursing community through top-quality original content from experts, interactive web-based social media tools, and value-added services through key strategic partnerships in a variety of nursing and lifestyle disciplines.

You know, my grandma didn’t believe in drugs. She believed in nuts. She used almonds for everything. She would slip them into everything she fed us just to be sure they did their job. We found them in salads, desserts, candy, and even our underwear. She said they got rid of warts.

I grew up during the depression. And, we spent the little money we had on food, not beauty products. When we saw a wrinkle in the mirror, we just gave up hope. But not my grandma. She made a paste of milk, almonds and rosebuds and smeared it on her face every night. She looked looked like the ghost of the apocalypse but she smelled like Almond Roca. And my grandpa loved sweets.

She had 18 children, not counting the 4 miscarriages and she wasn’t even Catholic. She wasn’t very careful either.

When grandpa lost his hair, she made a paste of gooseberry juice and almond oil. It made his scalp soft as a baby’s bottom. I think that’s why he wore a diaper on his head. He said it was to protect him from a chill. I guess you had to be there.

My aunt Hazel had teenage anemia and my grandma fed her almonds to build her up. It must have worked because she went from a 32A to a 36D in one summer and eloped with Uncle Jack in the fall.

Every night, grandma mixed almond oil with milk and made us drink it before we went to bed. She said it kept things moving. I thought that was why she and Grandpa changed neighborhoods so much but Mama said it was because of the bill collectors.

If we coughed, Grandma mixed a bubbly drink with powdered almonds and orange juice. Nowadays we use decongestants and antihistimines, but they’re not as much fun. If you drank enough of Grandma’s mimosas your cough vanished and so did your ability to stand up.

We always thought Grandma’s remedies cured a multitude of sins. But, I think they encouraged them. What else explains those 18 kids?

One bad egg can spoil the bunch. And it’s not just eggs, is it?!

One colleague on a rampage, one employee stuck in a rut, one subordinate contaminating the minds of others – sadly, it happens all too frequently. And it matters – a lot!

To create quality practice environments, everyone needs to play full on so that we can have our best foot forward for our:

• Teams to function effectively.

• Facilities to run efficiently.

• Patients to be treated with dignity.

• Selves to be able to function with excellence.

We needn’t look further than the last, and possibly most important question, on the hallowed HCAPHPS* scores, to give us our cue. The patient is asked what is their ‘Likelihood to Recommend’. Patients can choose from the following answers: never, sometimes, usually, and always. Of course, always is the answer we are ‘always’ looking for. It is no exaggeration that our jobs may depend on it.

Think about your own experience in a hospital when you were not a caregiver but a patient or family member. You expected expertly delivered and safe care. You expected accurate diagnosis and timely treatment. But beyond that, what you notice is the manners in which the staff carry themselves, conduct themselves and treat you, your family and each other.

With that in mind, here are a few ideas for you to consider:

The truly toxic people must go. Period. Keep them and you will risk losing the great people instead. If this is your situation and you are not a manager, bring this to your manager. A file must be started, discipline must be taken and after 3 strikes – you’re out. Tough love must prevail here.

Find a way for different departments/wards to connect. Work to break down silos. An ‘us/them’ environment is potential for disaster. Even starting with a few people connecting will make a big difference. It’s a lot harder to be mad at people you like.

Find the fun, the funny. The facility that plays together delivers great care together. Patients can see and feel this spirit. Look for ways to pro-actively lighten up a hard job.

Appreciate someone at work everyday. Have a stack of blank note cards, or kindness tokens or stickers and use them daily to let someone know that they made your day easy or better. It could be a Doc who respected your suggestion, a colleague who complimented you or a patient who was very brave during a tough treatment or one who told you a funny story. It’s interesting – I don’t know anyone who is too old for a sticker!

Start where you are, with what you have, and start now. If you wait for all the stars to line up to start improving your practice environment – you may be waiting a long time. Things are not expected to be perfect but they can definitely be better tomorrow than they were today. Even if no one notices, even if you think it doesn’t matter, even if you are nervous to begin. Please – you start, you take the lead, you make a difference and watch the slow but steady changes that follow to create an institution that people will want to recommend, always.

*HCAHPS stands for Hospital Consumer Assessment of Healthcare Providers and Systems, an instrument to measure patient perceptions of care that publicly reports hospital performance (quality of care as perceived by patients).

Download the Flyer

From the dangers of tobacco and trans fats to the benefits of physical activity and whole grains, much of what we know about health today is thanks to the Nurses’ Health Study.

Researchers are recruiting 100,000 nurses and nursing students to join the long-running Nurses’ Health Study and expand its landmark research on women’s health.

Female RNs, LPNs, and nursing students between the ages of 20 and 46 who live in the U.S. or Canada are eligible to join the study. More than 25,000 have signed up already, and recruitment will stay open until the goal of 100,000 participants is reached.

Researchers hope to engage a highly diverse group of women in the “next generation” of the study. For the first time, nursing students are eligible to enroll.

In order to make participation as convenient as possible for busy women, participants can join online and complete the study’s surveys through a secure website, http://www.nhs3.org/.

More than 250,000 nurses have participated in the study since the 1970s. By completing confidential lifestyle surveys, they have helped advance medical knowledge about nutrition, exercise, cancer, heart disease, and many other conditions.

“Nurses were originally recruited for their expertise in accurately reporting health data,” explains Dr. Walter Willett, the study’s lead researcher and Chair of the Nutrition Department at Harvard School of Public Health in Boston, Mass. “Their involvement has been invaluable, and their dedication is remarkable—an astounding 90% of them are still enrolled, decades later! The new group, NHS3, will allow us understand how today’s lifestyle and environment affect a woman’s health in the future.”

Nurses enrolled in the earlier studies are encouraging their daughters and younger colleagues to join. “My mom started filling out surveys when the study began,” one nurse recently commented on the NHS3 Facebook page (www.facebook.com/NHS3.org). “I am so proud to be part of this study and see what it has done.”

NURSES’ HEALTH STUDIES

Started in 1976 and expanded in 1989, the Nurses’ Health Studies have led to many important insights on women’s health, including cancer prevention, cardiovascular disease, and diabetes. Most importantly, these studies showed that diet, physical activity, and other lifestyle factors can powerfully promote better health. www.nhs3.org

SOURCE: Nurses Health Study 3

CONTACT: Laura Anatale Tardiff, +1-617-525-0353, nhs3@channing.harvard.edu

Melissa Vaughan (top) and Barbara Taylor Vaughan

I have been talking alot lately about me, and my Alzheimer’s. I looked at Missy, my daughter and caregiver, this morning so tired, and exhausted. She is 58 and has MS.  I asked her to answer a question today honestly for me and my Facebook buddies. I asked, “Missy, tell me about being a caregiver.” Here is what she said:

“First of all I hate the term caregiver. When mom fell 3 years ago and fractured her pelvis and knee she went to rehab for about 2 weeks and then it was up to us to decide whether to put her in a nursing home or bring her home. They told us she would need assistance walking short distances and be in a wheelchair for longer trips.  She cannot get up out of chair, needs help dressing and bathing, help to the restroom, wiping her rear, and making meals. Bascially, they said, it is like caring for a 2 year old.

Well, I talked to Mike [my partner] and there was never a question whether she was coming home. After the first week of getting up every 2 hours all night long to take her to the restroom and no sleep I had my first MS flare up…but we made it. When she was then diagnosed with Alzheimer’s last year, I thought, “OK, how much worse can it get?”  Well, it got so so much worse.

My biggest fear with MS is having someone take care of me, wearing adult diapers and bathing me. Caring for mom, I am living my worst nightmare. This is the hardest thing I have ever done. This is my mother, my idol, the strongest woman I know. I watch her everyday lose a part of herself.

The first time she didnt recognize me I thought she was kidding. The second time I felt a heartbreak that I can not explain.  Only others that go through this can understand the deep pain. That day when she didn’t know it was me, her eyes looked at me, but there was no light in them for me, like I have alwas seen before. Whe was not looking at her daughter–her sunshine. I was just someone. It broke me heart.

Sometimes now when I am helping her after she has fallen, or changing a dirty adult diaper because she had an accident, I will catch Mike looking at me. Our eyes will meet, and I will wonder if  he is thinking, this is going to be his future with me in a few years. Him caring for me and my MS.  I think I know he loves me, but why would I put anyone through this? Why would I want him to have to spend his life doing this?

Being a caregiver is different for each person, each case, there is history, there are different circumstances. I never thought about all of them. There is not only the care, but the financial, and emotional that goes along with it. The loss of friends, the loss of family.

So to answer your question Mommy, being a caregiver is hard for me, it is stressful. It is also the most fulfilling thing I have ever done for another person that I loved in my life. After a good day, which there are many, I say, “Wow, this was a good day.”  On the bad days, which there also are many, I say, “Well, day by day.”

So, for as long as I can, as long as Mike is with me making me laugh when I am crying and screaming, as long as it is right for you to be here, as long as I can care for you with dignity, I will be your caregiver. Because you asked me to, and it is the only thing I can ever in my life remember you asking me to do for you. On the days that I cry to you and say, “Mommy I just can’t do this any longer”, and you pat my hand and hug me, or I am so tired and sick; on days that I am a little grumpy, forgive me. For I am just your caregiver. You are the one that has the disease. I love you Mommy.”

[Editor's note: If you are a caregiver, there are a number of resources to help you. You are not alone. Get connected! Here's one: http://facebook.com/the.parent.care.giver.experience]

Mike Pope, LPN

I am a male nurse in a woman’s world. When we think about it who took care of us when we were kids, it most likely was mom. But as times change, with it the whole job market. Women can work construction and men can be nurses. But, sometimes it’s hard—and not only because I am going against cultural stereotypes about gender. When I was in school I remember some of the instructors saying nurses eat their own. I didn’t really know what that meant until I started working.

I don’t think it’s any worse for men than for new female nurses. But being a man can add another opportunity for discrimination, and gives me a different perspective about nurse culture. I believe men and women are equal. Well, women may be a little bit better than us guys at some things. Guys definitely do things differently. Guys, if we have a problem, we’re like, “Hey bud, I’ll wait for you out in the parking lot and we’ll talk.” Some women seem to be willing to spend the next twenty years messing with each other. Sometimes, I wonder what I have done to myself.

I love nursing and have met great people. Nurses that are both old school and new that have been very nice and fun to work with. I have worked really hard, I’m never late, never call in sick, and am always a team player. I’m willing to work with anybody, I just hope others will work with me too, and not treat me badly because I don’t look like the nurse they think I should—whether because I am a man, or because I am less experienced than they.

I became a nurse after I started to volunteer at the local fire department. I went on a few calls, and I really liked the feeling of helping others. I stared out as a CNA for the NOC shift at a rehab hospital. I transitioned to being a nurse. It was great being new and learning in that environment. Everyone was excited for me to make the transition to nurse. I was very eager and also very nervous. I asked lots of questions. Everyone was so helpful. We were a team for sure. NOC shift seems to be that way.

My next job was in a juvenile corrections setting. I should have run out the first week. It wasn’t the patients that were intolerable, but the mean old school nurses. They didn’t like new nurses and it was no secret. They seemed so unhappy in their own lives. Misery loves company. They put the new nurses down, expecting us to know much more than we did. These nurses with thirty-plus years experience had forgotten what its like to be new at something. They were very rude and short, saying things to each other like, “They must not teach that in school anymore,” or to us, “You would never have made it back when I went to school.” I was happy to be there and eager to learn from them, but they were unwilling to help me or share any of their knowledge. After nine months, I had enough and moved on. A few other new nurses left shortly after me.

I then signed up with an agency and started working in and around the area where I live. It seemed to me very quickly, becoming a nurse may have been a mistake. I continued to run into bullying issues wherever I went. There seem to be cliques like back in high school, and if you’re not in it well, then you’re the odd man out. In one setting, problems started by my asking two talking co-workers in front of my station if they might talk somewhere else so I could get to my computer. It wasn’t a critical work-related conversation I had interrupted. Word had got around that someone was offended. After that some other co-workers would not help me or if I brought a chart to the unit secretary she wouldn’t bring it back or sometimes wouldn’t do other of her job duties for me that she would for others. These women talked about everyone. To me, they seemed like the “Mean Girls.”

I don’t think the treatment I received in these situations was specific to me being a man. (Though, I think their are women who truly don’t like men in the nursing profession for whatever reason.) I’ve heard stories from other women nurses that had way worse things done to them by other women nurses. It’s just a nurse thing I think. But why?

I just smiled through it and worked for my patients, thinking it would go away. I have had many great experiences in my short nursing career so far, along with the some not-so-great. But I like to try to learn from them both. I sometimes ask my wife if there something about me that others might not like. I trust her, we’ve been together since high school, and were in our forties now. She said I hold myself somewhat arrogantly. But I don’t intend to project that. Nurses need to take time to to give others a chance, to see the person behind the first impression. We are all human and need to be sensitive to each other, particularly in a profession as demanding as nursing in so many other aspects.

I love it when I ride my Harley and meet others and they ask me what I do for a living. I say, “I’m a nurse.” You should see their faces. Then, I tell them I’ve been married to the same woman I’ve been with since high school, again, their facial expression is priceless. I guess if I could get anyone to learn anything here it is this: not everything is as it seems. That male nurse might look like an arrogant jerk, but he may not be. More experienced nurses, new nurses, we all have something in common, we are here to help people. He or she needs your help in feeling part of the team. Everyone wants to belong and have a place to fit in. Who knows? Maybe you can even make a new friend.

Life is short. I don’t want to have issues at work, or drama with my co-workers. I have learned much from many experienced nurses who exercised patience and acceptance with me. I wouldn’t be the nurse I am today without them. Set aside your feelings and help us newbies become better nurses and, as in my case, better men. Just one guy’s perspective.

A few years ago I came across a wonderful non-profit organization called Nurses House.  Nurse’s work very hard and make fair wages, but what happens when a nurse is injured or becomes sick?  We often don’t have the ability to replace our income, or have a huge savings account to cover our living expenses if we’re off work for an extended period of time. Whether you’ve had a serious illness or injury, you know that things happen in an instant, and one day you may be the nurse in need.  Nurses House has been a life saver for countless nurses and deserves the recognition and support from all of us.

The original Nurses House in Babylon, Long Island offered a place where registered nurses could rest and recuperate. In 1959 the beachfront home was sold. A fund called Nurses House was created to assist nurses in need.

Nurses everywhere are indebted to Emily Bourne.  In 1922, through a charitable bequest, she created a respite place for registered nurses that became known as Nurses House.  The beachfront home, a stately mansion in Babylon, Long Island, could hold up to sixty residents at any given time.  It was often filled to capacity during busy summer months as accommodations were peaceful, restful and provided privacy to nurses that came to stay.  As times and needs changed, the property was eventually sold, but the funds were used to establish a national fund for nurses in need.

Today, Nurses House, Inc. operates as the only national charitable organization assisting nurses in need.  It is run by a nurse staff and volunteer board of directors.  The organization’s sole mission is to provide short-term assistance to any registered nurse in the United States in need, as a result of illness, injury, disability, or other dire circumstance.  An all volunteer Service Program Council, made up of nine registered nurses, carefully evaluates the needs of Nurses House applicants and disperses funds to assist with everyday living expenses such as food, medicine, health care, rent, mortgage or utility bills to those in need.

One Nurse’s Story — Age 55
Guest was assaulted by a patient at work. With severe injuries to her back, it was determined she is permanently disabled. Later that year, guest’s husband was diagnosed with multiple sclerosis. With medical bills piling up, and her bank account diminishing, she applied for help with mortgage payments so that she could keep up with her other bills. Read more stories >

Over the past decade Nurses House has offered over one million dollars in financial aid, but the need has never been greater.  Nurses House depends greatly on contributions from nurses and the nursing community to fulfill its mission.

To make a contribution, to request assistance from Nurses House, or to learn more, visit www.nurseshouse.org or call (518) 456-7858.

This article was shared with us by NurseTogether.com.
Based in Charlotte, NC, NurseTogether.com is one of the fastest-growing, free online professional communities for nurses. Specializing in unique nursing lifestyle, career and professional development information, NurseTogether.com’s mission is to empower the nursing community through top-quality original content from experts, interactive web-based social media tools, and value-added services through key strategic partnerships in a variety of nursing and lifestyle disciplines.

A ‘short’ little Breathing Break for all the nurses from The Yoga Nurse.

www.nursefail.com

What is a NurseFail?  It’s a mistake. It’s a mess up.  Sometimes it’s a desperate attempt at perfection. Other times it is an accident.  Basically it’s a sad moment in nursing.  It’s a point in time where you have failed your patient, your hospital, your coworkers, your family, and your country, but managed to provide entertainment to the rest of the world.

10/28/11
1300

INCIDENT REPORT

EXPLANATION:

Ostomys can be a little tricky sometimes, that’s why I usually get someone to help me hold stuff down.  It was busy today & I couldn’t find anyone to help, so I just did it myself.  When I was all done gluing it on, I went to turn around & I didn’t seem to be moving?  I was stuck on something?  I looked down and saw the draw string to my jacket through the plastic ostomy bag, slowly being covering in ostomy juice, because I had obviously glued it in there.  A minor detail.

REAL FAIL: Gluing Yourself Into An Ostomy Bag

Looks like this mistake came with a souvenir?

PLAN FOR IMPROVEMENT:

Oh the old glued yourself into something dilemma.  Gloves, wrappers, old dressings, scissors, I’m sure it has all been done at some point.  I guess at least you had no choice but to notice this problem?  Good thing this wasn’t brain surgery.

Disclaimer: This piece of medical fiction is property of www.NurseFail.com.  This is a fictional work of the imagination of a sick individual, with the goal of making me laugh….And well?  You too.  This is in no way related to reality, think of it instead as a stretching of possibility.

If you were to be completely honest with yourself…is there a certain patient population that causes you angst, disgust or fear, without really knowing why? I had some reflection exercises recently in my Senior Seminar class that have caused me to look inside of my thoughts and my reactions to those very situations.

Boundaries come into use for many different reasons…safety, security, independence.

The exercise that recently got my attention was that of boundaries. While reading that section in our text, many different thoughts were running through my mind. The boundaries I have set with my mother in order for us to have a relationship, actually ended our relationship all together because she was unable NOT to cross those boundaries over and over again without regard. At that point in my life was unwilling to loosen the lines of the boundaries I had made out of stubborn pride and need…maybe now.

Boundaries come into use for many different reasons…safety, security, independence. There are physical boundaries like fences and doors to keep people in or out. Rules of conduct and behavior are boundaries in civil codes of behaving. The boundaries I set with myself in my own behavior have been helpful, but I didn’t ever think of boundaries as being a place of meeting and coming together—like the shoreline and the ocean…both needing each other to make the perfect picture of co-dependence in a good way.

The words that made me stop and think the most in my reading of, Heal Thy Self, was that our roles as patients and practitioners are similar…that we are not just in a role…we are in a larger field of human connectedness, of shared humanness. Shared humanness…interesting.

I tried to keep this concept in the forefront of my mind at work this week and it helped. When one of our beloved female ER docs—who is scattered and slow but such a wonderful practitioner and patient advocate—was driving me crazy because she was sooooo behind and patients were stacking up. I thought, “We are in shared humanness right now and I will not get upset.” I instead re-organized her charts and kept her on task…she realized what I was doing and smiled at me with a nod and said, “Thank you…” Prior to this I would have re-organized her charts and made sure she realized I had done it, and done it with some ‘tude….

Yesterday I had another opportunity to realize my misunderstanding and my need for and about boundaries. We have a population of alcoholics that frequent our ER. There is one man that can drive my emotions to a red hot steam in 5 seconds flat. I know this and I try to not take that gentleman and typically swap another nurse’s patient (one she is having a time with). As I saw the name of the patient coming in via ambulance—the immediate reaction that typically rises from me occurred—disgust.

I have thought about this over time and realized that this one man reminds me of my childhood and feelings of anger, repulsion and fear surface with those feelings. It took me a while to recognize this…Just as quickly as the feelings surfaced, the thought about shared humanness surfaced. As I recognize that for the patient’s best interests and mine, letting another nurse take him is usually the right thing to do…

Yesterday I chose another option. I took the chart and went to prepare the room for him. I prayed. I asked God to show me how to care about this person as His child…in our shared humanness…I asked God to show me what boundaries to place on his behavior and mine in our ER today without any of my own emotion behind them. Typically and shamefully I would do the bare minimum with him and give nothing of myself while doing it…I asked to see the boundaries as shifting and moving as needed.

When the patient arrived in his usual state and with his usual rude, foul-mouthed demands I watched him…I listened to my thoughts and let them pass without judgment…I felt my breathing quicken with my heart rate, I felt my face start to show disgust, but I said to myself…”Shared humanness.” I let the paramedics get him off their stretcher and onto mine and for the first time I noticed something in me—fear.

I could be him…my disgust came from the PTSD-type recall of seeing my father drunk and acting in this way over and over again while growing up…My fear was no longer that I could be harmed—because I was in control here—I had the power to make strict boundaries on this man’s behavior! The fear that I recognized now was that I could have ended up like this man…it was in me, the compulsion to drink….he could be me…shared humanness….

I prayed continually as I assisted him to change, offered him a washcloth and soap to clean up…and tended to the carrying out of MD orders. I prayed while he flung insults and threats at me and I continued to pray while I set boundaries that were fair and not out of my need…but both our needs…shared humanness…

I noticed that during my interactions with him I felt nauseous at times, SOB, and irritated. I felt my pulse race and my stomach clench. I prayed for strength…so much of this patient and my guttural reactions were related not to him at all, but to my cellular memory of home…BUT despite this, yesterday I was able to be present and focus on the care of the patient despite my need to flee. I noticed my thoughts, and reflected on them. I noticed the reactions physically and applied lavender oil to my wrists and neck…I breathed deeply and continued. I will most likely continue to swap patients when he returns again…but I am thankful for the exercises in this book I am reading for class that are allowing me to slowly chip away at the protective layer that I have built over time and to understand why it is there…and flirt with the possibility of thinning it out!!

The fans of Dance Out Diabetes (DOD) wanted to take on Ellen’s Dance Dare challenge, wherein she challenged viewers to submit video of themselves dancing behind people. They did it San Francisco style and with a double dare back to Ellen.

We like your style Theresa Garnero, APRN-BC-ADM, MSN, CDE
(Advanced Practice Registered Nurse, Board Certified in Advanced Diabetes Management, Master of Science in Nursing, Certified Diabetes Educator) Theresa is founder and executive director of DOD (and a fine dancer). Learn more about Dance Out Diabetes at www.danceoutdiabetes.org.

Well, I want to tell you, it has been a strange strange day. There is nothing so strange as making all your funeral arrangements and talking about your own death. I hear all these commercials on TV about how you should make your arrangements to spare your family in the future. Wow, it is very very strange to really do it. I dont know what was worse, making my arrangements, or listening to Missy [my daughter] make hers. We have talked with attorneys and funeral home people.

Photo Credit: Bruce McKay

I told Missy when we were done, “I’m not a drinker, but I think I could use a stiff drink.” So we went through McDonalds drive thru and I got a large Coke…so large, I could not even hold it. We parked the car down by the river and put both our straws in the big cup of Coke and shared it as we giggled and watched the river.

Just like my husband, I am not have a funeral, or a viewing, and at my request, I will be buried next to my husband in a family plot in Illinois. No service, just whatever family wants to see me put into the ground. I have also requested that Missy not even put my death notice in the paper ’til after I am buried. I then want her to get out of town, leave, go to Florida, stay a couple of weeks…I dont want her to have to deal with all the calls, and have to talk about me dying until she has had some time to herself.

Since Missy has MS, and there is a possibility that she could go before me, Mike asked if he could adopt me in that case. That made me cry. I thought, “Oh how I love that boy…He is not my son, not a relative, not even Missy’s husband. But he wants me to feel safe…not even my own family has ever really asked what would happen to me. Mike has made sure I will go with him…No one can make me go to a nursing home, no one can make me do anything that me and Mike do not want. I have no money, I have no properties, I have nothing but a few treasures I keep in a box in my room, and all the video memories that I have been making for Missy.

I am alot to take care of, I am getting worse day by day…but Mike wants me, he loves me. Maybe if I were rich, there would be a big fight for me, maybe then all my family would want me. But since I am not, I know he wants me because he loves me and he really really does want me to feel safe at home with him, like I do now.

Sometimes your life takes a funny turn..I never thought I would be unable to care for myself, I have always be so independent, I never thought that someone other than my immediate family would want me so bad, not because it was their responsiblity but because, when asked, he said, “It’s you, me and Missy…we are a package deal.” So tonight I will sleep well, knowing that I dont have to worry anymore, in case something happens to Missy, I still have a home, I know at some time in my Alzheimer’s, I will have to go to a nursing facility. I know that in the end stages that it is just too much for family members to take care of. But at least I know how much I am loved by Missy and Mike.

Ha ha. He wanted to adopt me. I just love that boy.

[You can watch a video by Carol Gino about the Amanda Trujillo case to get up to speed.]

A long time ago when I was in nursing school and then when I taught nursing, I remember making care plans. A large portion of the work our student nurses did was to make care plans for their patients. This was an integral part of their clinical experience.

During post clinical conference, which was at the end of each clinical day we went over what happened that day. We also discussed how well the students were able to follow the care plan. How we could improve our care and make patients feel better?

The main focus of our discussion were the patients, their symptoms and how to help them feel better. Each one of our care plan goals started with, “Patients will…..”. We emphasized patient education and their well being.

That was a long time ago. I’d think that nursing would have come a long way by this time. I’d think by now nurses would be celebrated as patient advocates and liaison between all the different groups that come in contact with the patients, including the physicians. Unfortunately, this is far from the truth.

Unfortunately, the clock has turned backward on nursing in a lot of ways. Yes, we have more nurses with advanced degrees. We have nurses in very influential positions in healthcare with a lot of clout. However, it is the clinical bedside nurse who has lost out during this “advancement.”

The patients in hospitals are much sicker than they used to be a few decades ago. As a result, their needs are more emergent, more intense and more difficult to take care of. No wonder nurses hop from room to room, patient to patient trying to meet all those needs.

Typically, if a nurse has five patient for an eight hour shift, she has less than an hour and a half per patient to address all their needs, pass out meds, take calls from their family, communicate with the doctor, help the CNA as needed, finish their documentation and oh yes, attend any mandatory inservices their company requires them to take and still be done without any overtime.

Sorry… what??? You think I left something out? Oh yeah… the pee break, right? Well they are few and far between for a typical nurse. Does anybody see anything wrong with this picture?

Despite all the chaos and running around, most nurses can’t stand to see their patients suffer. So we make sure that we advocate for them. We try our best to educate them on their treatment plan, because its ingrained in us.

We have been taught over and over again that our patients are our primary responsibility and their well being and education is our primary job.

This is what Amanda Trujillo of Arizona did not too long ago. A patient requested information and she provided hospital approved material along with a request for more information from hospice as per patient’s request.

This is not unusual for a nurse. In a typical day we do a lot of teaching to our clients, their families, CNAs and anyone else who needs information. The only difference this time perhaps was that the doctor’s idea of what the patient needed to know and what the patient actually wanted were different.

This is not an unusual scenario. Communication gaps happen often. The only way to prevent a communication gap from becoming a disaster, especially in a healthcare setting where life and death decisions are made every minute, is to have checkpoints.

Yes, someone has to go after a doctor to ensure that patient and the family actually did understand what they had been presented with but to also provide more information and listen to their concerns.

At one of the hospitals I worked for, our case managers, who were also nurses, routinely spoke to patients undergoing surgeries and treatment to make sure there was no communication gap. In addition, these case managers communicated with the staff regularly to alert them of issues and help them continue the conversation as needed. This way we all were on the same page and our patients made informed decisions.

In case of Amanda Trujillo and her patient, the patient obviously had concerns. Any nurse, anyone who considers themselves a patient advocate, would have provided more information.

It is heartbreaking to see that instead of being praised for her concern for the patient, she was fired from her job and may even lose her license. It is also sad to note that the outburst by the physician at the nursing station was not addressed as unprofessional.

Currently Amanda Trujillo awaits the Arizona board of nursing decision on whether she should be able to keep her license. Her act of advocating for her patients could result in her inability to work as a nurse and earn a livelihood.

This is an outrage! An atrocity that will put nursing in dark ages. This one decision, to take away Amanda Trujillo’s license would make the nurses nationwide fear for their license. They would fear that their license could be snatched from them for doing the right thing for the patients if it does not sit right with those in power.

The nursing profession will definitely lose if this were to happen, but the biggest loser will be patients. There might be people who would set their conscience aside to be able to feed their family. But there will be no patient advocates!

Everyone, nurses and non nurses, patients and future patients, doctors, NPs, PAs etc, are going to be on the receiving side of healthcare. Therefore, we all have a great deal to lose from such an action.

I urge each one of us to stand up for our rights to receive compassionate and competent healthcare. I urge everyone reading this to contact Arizona Board of Nurses and ask them to clear Amanda Trujillo’s license and compensate her for all the pain she has been put through.

Carol Gino, New York Times’ bestselling author and nurse leader advocating for Amanda Trujillo.

THIS week...the segment you have all been waiting for...Comedian Lynn Ruth Miller's In My Day. It's a jewel!

Have you ever listened to a baby laugh? You know, the kind of laugh that is so contagious YOU start to laugh? Well, who knew laughing was so good for you! We thought we’d reminder ourselves and our listeners that laughter really is the best medicine. As more and more research is done, there are now many published studies that prove the positive mental and medical effects of laughter.

Studies show that laughing lowers blood pressure, reduces stress hormones, increases muscle flexion, and boosts immune function by raising levels of infection-fighting T-cells, disease-fighting proteins called gamma-interferon and B-cells, which produce disease-destroying antibodies. Laughter also triggers the release of endorphins, the body’s natural painkillers, and produces a general sense of well-being. Now that’s an impressive list of accomplishments!

Association for Applied and Therapeutic Humor's 25th Conference is Coming Up. Hurry! Early bird registration ends Feb 18th.

And if there’s anybody who knows the positive effects of humor (and music) it’s RN Deb Gauldin. Deb is the incoming president of The Association for Applied and Therapeutic Humor and has long practiced what she preaches. She is a professional humorist and entertainer specializing in health care morale and women’s well being. Deb joins Casey and Dan to talk about humor and the upcoming 25th annual conference where all they do is laugh and talk, and laugh and talk, and then laugh some more.

Why quit your job as an English professor to become an RN? Theresa Brown did. Before becoming a nurse, Theresa obtained a Ph.D in English from the University of Chicago and taught literature for three years. After being an RN for four years, she’s written a book called, Critical Care: A New Nurse Faces Death, Life and Everything in Between. She’s also a contributor to The New York Times‘ Tara Pope’s health blog, Well. We’ll talk with Theresa about her career and her very interesting and poignant book.

“A must read for anyone who wants to understand health care. This extraordinary book will open your eyes to the reality of nursing. If you or your loved one ends up in the hospital, you’ll wish you had someone like Nurse Brown at your side.”

–Elizabeth Cohen, CNN Senior Medical Correspondent

And we share a recent interview (from our friends at Labour Radio) with RN Karen  Higgins. Karen addresses questions about the proposed Financial Transaction Tax. .50 per $100 ? Wow, so little could raise billions of dollars for vital health care education and other services. Why is this so hard?
Check it out: http://www.nursetalksite.com/KarenHiggins-LabourRadio

And we’re gonna get all nursey on you because even the Nurse Talk Golden Bed Pan Award this week goes to a nurse. Courageous RN Allison Bates takes home the prize. You might remember her in last month’s news for donating a kidney to a patient.

Happy News: RN Allison Bates donates kidney to a patient

A big “hello” and “thank you” to all our listeners out there and a salute to all the nurses that make the world a better place!

You can listen every week in the Boston area on station WWZN 1510AM every Saturday at 11 am EST or live stream at www.revolutionboston.com and in the San Francisco Bay area Sundays at 2PM PST on KNEW 960AM or live stream at www.960knew.com. Check out the iHeartRadio app for free and live custom radio. You can also download and listen to any show anytime here at NurseTalkSite.com or oniTunes. Like us on Facebook, and you can listen there too.

NURSE TALK IS GROWING…GROW WITH US. ADVERTISE to our active and engaged audience. Email to reserve your spot on the air or online: pattie@nursetalksite.com.

Ah…nothing sets the tone like a little music before all the talk. In radio they call that a “cold open”! Who knew? Here’s Casey and Dan…

“Of course that was the unmistakable voice of Patsy Cline the great country legend. That song came out in 1957 and like a good Cabernet—it just gets better with age. 1957…Dan…you weren’t even born then. I thought it might be fun to take a quick look at what was happening in 1957—here is what our crack research department found: The Space Age began by the launch of Sputnik I, interferon was discovered AND THE MOST IMPORTANT THING THAT HAPPENED…”beatnik” entered the vernacular as a description of the emerging “Beat Generation” counterculture movements.”

And so starts another episode of Nurse Talk.

Nurses keep up the fight for RN to patient ratios…we should all be very glad they do! We thought we’d check in with our friends in Massachusetts who are working on legislation—so Casey and Dan visit with RN and president of Massachusetts Nurses Association, Donna Kelly Williams. Donna brings us up to speed on current issues—with a central focus on staffing ratios.

2nd Annual Marin Advocates for Children Heroes for Children Gala March 3, 2012. Cocktails, auctions and dinner benefit a great cause.

Expert says compassion is key. Have you ever witnessed a parent or guardian verbally or physically abuse a child in a public setting? Did you walk away because you didn’t know what to do…or did you intervene? Find out what our expert has to say about what you should do. Cyndy Doherty, executive director of Marin Advocates for Children joins Casey and Dan to talk about what her organization is doing to help and prevent this epidemic. You won’t want to miss her advice and insights.

AND—We’ll have some fun as we continue our look back at callers from the early days of Nurse Talk. Lucille Jones and her cross-country trip with her ill mother. Oh, she was priceless! You can find this and more at Nurse Talk’s Comedy Pharm.

AND take a sneak peek of our resident funny lady Lynn Ruth Miller‘s new segment,In My Day. It’s amazing she lived to tell about it!

You can listen every week in the Boston area on station WWZN 1510AM every Saturday at 11 am EST or live stream at www.revolutionboston.com and in the San Francisco Bay area Sundays at 2PM PST on KNEW 960AM or live stream atwww.960knew.com. Check out the iHeartRadio app for free and live custom radio. You can also download and listen to any show anytime here at NurseTalkSite.com or on iTunes. Like us on Facebook, and you can listen there too.

And, remember, laughter is the best medicine!

Yes! a non-profit subscriber supported magazine, with in-depth analysis, tools for citizen engagement, and stories about real people working for a better world recently published The Yes Breakthrough 15 their list of people transforming the way we live.

Dr. Deb Richter, Photo by Kurt Budliger

Dr. Deb. Richter made their list for her advocacy of single payer healthcare in Vermont. Last May, Vermont became the first state in the nation to pass a single-payer health care plan.

“I never felt like I had a choice about getting involved in this struggle … I couldn’t stop and I never will.” —Dr. Deb Richter

In her interview with Yes!, Dr. Richter explains, “A lot of my patients didn’t have insurance. I would prescribe medicines for patients but they wouldn’t be able to afford them, and then they would just get sicker. I was mortified…I knew I couldn’t continue to practice if this situation continued. I didn’t want medicine to just be for wealthy people.”

“This will be an enormous change for people without insurance,” says Richter of the Vermont bill, which will guarantee every resident an essential health benefit package from birth. “Now that we have this in Vermont, we need to make sure it happens everywhere.”

Read the whole article from YES! Magazine, Oct 31, 2011 >  http://www.yesmagazine.org/issues/the-yes-breakthrough-15/deb-richter-a-cure-for-broken-health-care

In my day, safety was your responsibility. We didn’t have laws to take care of us. No seat belts or warning beeps. Either you held on, or you went through the windshield. But that was easier too, because we didn’t have double-paned glass.

When I was a kid, I could jump on my bike without worrying about helmets or shin guards. If I fell off, mama put an ice pack on my head and told me to stop complaining.

We didn’t bother with little lights on our shoes either, when we walked around at night. If someone jumped out of the bushes you just nodded and looked the other way because he was probably going to the bathroom. It was always a he. Trust me on that one.

I never thought of using mace or pepper spray to protect us. If someone scared us, we screamed and there was always a neighbor with a loaded gun. In my day, neighbors really did take care of each other. We used to give strangers at the bus stop rides and sometimes we even invited them over for dinner. But they had to eat what we gave ‘em. One guy said he was a vegan and my mother put on a mask. We didn’t know what vegan meant. It sounded like an STD. We trusted people even when they complained. I guess you had to be there.

But nowadays I dont leave my house without my lipstick, my Lipitor and my Taser.

I have been thinking a lot about death and funerals today. Missy’s best friend’s father died, and also her first boss at her first real job after college. I listened to her order flowers for each of them, and talk to their family members on the phone last night and today. She is going to both visitations and funerals in the next couple of days.

I thought about all the funerals I have been to in my life. A lot of people now put in the paper that they request no flowers, a donation to their favorite organization. I still always send flowers…I cant help it, I just know that all of the funerals I have ever been too, or involved with, that we always went around looking at the flowers, “Oh yes, those are from so and so, aren’t they beautiful?”, or, “Look at those roses, they are from so and so…oh how the deceased loved roses.” I always think too, walking into a funeral home and seeing the flowers just makes me smile. It’s kinda like…once you are in a room full of beautiful flowers…celebrating a life, anyway. I just like flowers.

My father died on Christmas Eve, and way back then the funeral was held the day after Christmas. My father was my hero, and it was a terrible winter when he died, lots of snow, and I remember being at the funeral home and thinking, “He won’t have any flowers, because people won’t see his death notice because of the holiday. The florists were closed for the Christmas holidays…” I was so happy as I sat in the funeral home before visitation and the flowers started arriving, one florist said he was called at home to please come in to make arrangements for [my father]. Another florist told me he drove back from another city to make all the arrangements. I was thrilled to go and read all the cards on the flowers. I remember crying as I read the cards, and my mother hugging me.

So just to let you know, if you put in the paper not to send flowers…sorry, I can not grant you your wish, it’s just still one thing that I want to do for you and your family…flowers, and a card…and oh, how I love gardenias.

Rallies Tuesday, 12 Noon, Kaiser Oakland, Kaiser South Sacramento

Kaiser Nurses Show Support of Striking Co-workers, Patients and the Community

OAKLAND—Registered nurses and nurse practitioners at Kaiser Permanente hospitals and clinics across Northern and Central California will honor the picket lines Tuesday in sympathy and solidarity with other frontline Kaiser staff who will hold a one-day strike Tuesday to protest Kaiser demands for substantial cuts in healthcare coverage, retirement benefits and inadequate staffing for mental health services.

RNs will complete final sympathy strike preparations Monday 3:30 p.m. at the Oakland headquarters of the California Nurses Association/National Nurses United, which represents 17,000 Kaiser RNs.

Media Availability Today:
California Nurses Association, 2000 Franklin Street, Oakland, 3:30 p.m.

Tuesday Schedule:
Picketing Begins: Tuesday, January 31, 7 a.m., Kaiser Permanente Facilities
Rallies: Tuesday, January 31, 12 Noon
Kaiser Oakland: 3801 Howe St., Oakland
Kaiser South Sacramento: 6500 Bruceville Rd., Sacramento

RNs will be supporting mental health clinicians, clinical psychologists, licensed social workers and opticians.

The nurses say they understand the concerns of their co-workers about the erosion of services that affect the quality of patient care, especially in mental health, as described in the report Care Delayed, Care Denied. It asserts that Kaiser has frequently failed to comply with California laws aimed at protecting patients’ timely access to appropriate services despite receiving more than $10 billion annually from Medicare to provide a full range of services, including mental healthcare.

“It is disappointing that Kaiser is refusing to bargain for sufficient staffing for mental health services, and a secure retirement and accessible health coverage for its frontline caregivers despite its record profits,” said Zenei Cortez, RN, CNA Co-President, who works at Kaiser South San Francisco. “We will continue to honor the basic tenets of nursing and stand in support of our colleagues, our patients, and communities.”

Read more >

Does your life feel like a tug-of-war? Nurses continuously juggle the demands of their personal and professional lives. At work, they provide high touch-high tech care for sick and dying patients. In addition, many nurses perform ‘double duty’—caring for friends and family members when not at work. Being pulled in so many directions can seem overwhelming. Learn how to manage stress and regain your balance by taking a few small steps each day.

Kayla is a nurse on a busy telemetry unit; she is married, has two school-aged children and helps care for her aging mother. Today she agreed to work another double shift to cover a last minute call-in. Kayla slammed the phone down after arguing with her husband Mike—he resents Kayla choosing her job over the needs of their family. Kayla was already feeling inadequate when her friend Terry excitedly announced, “I passed my certification exam.” Although Kayla bought a review book six months ago, she hasn’t started studying yet. She worries, “I hate not being there for my family… I am falling behind in my career and I never have time for myself.” Kayla felt a wave of nervous tension in the pit of her stomach. Tom, the patient care technician, interrupted Kayla’s thoughts, “Mr. Rodriguez is having chest pain.” Kayla mindfully refocused her attention to her work taking slow deep breaths on the way to Mr. Rodriguez’s room.

1. Take five deep breaths: to elicit the relaxation response

Deep breathing is a simple stress management technique that can be practiced almost anywhere. It can help quiet your mind, release tension, and decrease the symptoms of stress by eliciting the relaxation response. The relaxation response is the opposite of the ‘fight or flight’ stress response.
Take five slow deep breaths, whenever you begin to feel stressed. Breathe in through your nose and out through your mouth. Your abdomen should expand when you breathe in and flatten when you breathe out. Focus on your breathing until you feel calmer.
Integrate deep breathing exercises into your daily routine to decrease your stress symptoms before they occur.

2. Spend five minutes in nature: to experience mindfulness

Stress can promote automatic thinking or mindlessness. After a busy shift at work, have you ever arrived home without remembering the drive? This is a classic example of mindlessness—performing a task while preoccupied with other thoughts. Being distracted during patient care can lead to serious omissions and errors. In contrast, mindfulness is the ability to focus your attention fully in the moment.

A simple exercise for developing mindfulness is to spend five minutes in nature every day. Find time to go outdoors before work, on a break or after work. Be present in the moment and engage your senses. What do you see, hear, smell, or feel? During this exercise, do not think about the past or worry about the future—experience now. In addition to becoming more mindful, you have just taken a mini-break from the stress in your life.

3. Pause five seconds before responding: to avoid over committing

How often do you agree to help only to regret it later? Due to their helpful caring nature, most nurses have difficulty saying “no” to the requests of others. This can lead to fatigue and resentment from over committing. Learning to say no to out of balance requests frees you to say yes to your own needs.
Before agreeing to work an extra shift, babysit your friend’s children or bake cupcakes for the entire third grade, pause five seconds before responding. Five seconds is long enough to gather your thoughts. If you are willing and able to help—say yes. If agreeing is over doing—say no. If you are uncertain, a possible response is, “Let me think about it and get back to you.” If you are pressed for an answer before reaching a decision, it is generally safer to say no—you can always say yes later.

4. Record five thoughts or ideas: to process your emotions

Journaling is a simple yet underutilized stress management tool and path to self-discovery. A journal is more than a diary to record events—it is safe a place to process your emotions. Nurses are held to the highest moral, ethical and legal standards. In addition, they regularly witness the emotional and physical suffering of others. Nurses have a lot of daily stress to process.
Commit to recording five thoughts or ideas in a journal each day. Allow your thoughts to naturally flow onto the paper. Do not judge your handwriting or your feelings. Your feelings are your feelings—they are not right or wrong. Discover patterns of thought and behavior as you write. Periodically re-read your journal entries—you will be amazed at your progress and insights.

5. Read five pages a day: to promote life-long learning

All major goals can be broken down into smaller steps. Kayla could prepare for her certification exam by reading five pages from her review book a day. Reading is the fastest and least expensive method of becoming an expert in your nursing specialty. Imagine the knowledge you would gain by reading five pages from nursing journals or books each day.

Commitment to life-long learning is essential to the professional development of a nurse. The rate of change in health care is constantly accelerating. In order to remain relevant and keep pace with new technologies, techniques and trends—nurses must stay informed. Reading from a variety of fields can inspire creative solutions for the challenges facing the nursing profession. Readers are leaders.

Utilize the simple strategies of taking five deep breaths, spending five minutes in nature, pausing five seconds before responding, recording five thoughts or ideas and reading five pages each day to produce big results in your life and career.

This article was shared with us by NurseTogether.com.
Based in Charlotte, NC, NurseTogether.com is one of the fastest-growing, free online professional communities for nurses. Specializing in unique nursing lifestyle, career and professional development information, NurseTogether.com’s mission is to empower the nursing community through top-quality original content from experts, interactive web-based social media tools, and value-added services through key strategic partnerships in a variety of nursing and lifestyle disciplines.

Barbara's husband and daughter Missy at the Illinois State Fair

Oh what a day, a day to just relax…very rainy and dark here in Newburgh Indiana.

Last night I had a bad Alzheimer’s night. I was very tired this morning, so I knew it had been a long night. Missy told me I was upset over not being able to see my husband. I have been thinking a lot about him lately. Missy said I was crying saying, “I know you are not telling me that he is gone.”

Missy does not smoke, no one does in our house, but a friend told her that sometimes smells help Alzheimer’s patients. My husband smoked, a lot, so Missy told me that last night she lit a cigarette and smoked a little of it to get the smell in my room. She then told me that my husband was in the bathroom shaving, he always smoked while he shaved…she said she told me, “Don’t you smell his cigarette smoke?” That calmed me and I went to sleep.

She showed me the video today. So sad. I am just a another person in my body…the same in looks, but my mind is not my own. I wish I could explain how scary this is. I never was a drinker, but it must be kind of like a drinker’s blackout…with little memory the next day. I told Missy that I do not want to see any more video, that she can continue to video, that maybe in the future it will help someone else, but I do not want to see anymore.

I am glad to be back to myself today, happy, listening to music, and thankful.

Missy looks tired today, but she hugged me extra long this morning when I got up, and kissed my forehead twice, and told me loved me more than usual today. If you knew how she hates to smell cigarette smoke, and how she doesn’t let anyone smoke in our house…makes me love her more and more and more.

For me, she will do anything…I knew that.

Dan and Casey say they have really made an effort to stay away from the presidential primary but sometimes it’s hard. Roll clips of two presidential hopefuls with one having more hope than the other! We’re just sayin’—one of these men might need to look into “anger management.” Just sayin’. Check it out…on the show this week.

AND we talk with Rob Horgan. Rob is a recruiter for the University of San Francisco School of Nursing and Health Professions. “As nurses” Casey comments, “we just happen to think USF’s nursing program is among the best in the country.” Rob joins Casey and Dan in studio (true) to share about the Master of Nursing Program USF offers at their Santa Rosa, California campus. We just found out a few months ago they had a Santa Rosa, California campus. P.S. Rob, if you are out there, thanks for being such a good sport and boy, are you quick on your feet!

Check this out! We share a great video that is up on a site called ProtestINTheUSA.org. The video titled “A Nightmare On Wall Street” depicts an imagined encounter between a Wall Street banker and the victims of financial misdeed. Oh, the horror!

And as the assault on public healthcare workers continues—things are heating up in Fresno, California with major cuts proposed by that county’s Board of Supervisors. RN Mary Morrison joins us to talk about the proposed cuts and the potentially devastating impact on yet another community.

Available now on Amazon

And later we’ll visit with one of our favorite people RN, MSN, Karyn Buxman. Karyn has been on the show before. You might remember her as a great nurse and public speaker—as well as a humorist who really does employ humor in the healing process. Her mission: To improve global health through laughter and help heal the humor-impaired! She’s here this week to talk about her new book “What’s So Funny About Diabetes.”

MYTH: Popping your knuckles will give you arthritis? True or False? The answer is planted somewhere in the text of this blog post. Find out!

And remember you can listen and laugh every week in the Boston area on station WWZN 1510AM every Saturday at 11 am EST or live stream at www.revolutionboston.com and in the San Francisco Bay area Sundays at 2PM PST on KNEW 960AM or live stream at www.960knew.com. Check out the iHeartRadio app for free and live custom radio. You can alsodownload and listen to any show anytime here at NurseTalkSite.com or on iTunes. Like us on Facebook, and you can listen there too.

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Author, Spearker, Nurse Karyn Buxman, RN, MSN, CSP, CPAE

I’m super excited to tell you that my latest book, What’s So Funny About Diabetes? A Creative Approach to Coping With Your Disease is now available!

What’s so funny about diabetes?

Maybe nothing. Then again, maybe everything.

Especially if you understand the premise that so much of our humor comes from pain and discomfort—our own, or somebody else’s. And let’s face it; if you’re a diabetic, you’ve got more than your fair share of pain and discomfort.

Currently one in 10 US adults has diabetes, but those numbers could go as high as 1 in 3 by the year 2050. A long-term solution can only come from getting people to change their lifestyles: better diets, exercise and coping mechanisms to deal with this serious illness.

Available now on Amazon

The good news: Humor and laughter have been shown scientifically to have positive benefits for diabetic patients. Laughter has been shown to lower blood glucose in diabetics, as well as decrease hormones that can be harmful. Humor is recognized as a healthy coping mechanism. And humor has also been proven to increase the retention of information.

For these reasons, and more, author Karyn Buxman has written the first in a series of books for patients with chronic illness: What’s So Funny About Diabetes? When you’re a diabetic, you need to arm yourself with all the tools that you possibly can to become the healthiest person that you can be. You need a large repertoire of skills. Humor isn’t the be-all, end all; it’s not meant to replace your medical regime, but rather to be a complement to all the efforts you’re already making.

Now Karyn Buxman shows you how you can strategically use humor everyday to better manage your diabetes and live a healthier and happier life. And you don’t need to be funny. You just need to be able to see funny.

“If we took what we now know about laughter and bottled it, it would require FDA approval,” says psychoneuroimmunologist, Dr. Lee Berk. The perfect gift for yourself or someone you love, this book is filled with wise, witty, and life-saving advice. Whether you are a diabetic, a pre-diabetic, or the cheerleader for a diabetic, there is something in this book for you.

This article was originally posted on Karyn’s site at www.karynbuxman.com.

Vinnie Jones shows how hard and fast Hands-only CPR to Stayin’ Alive by the Bee Gees can help save the life of someone who has had a cardiac arrest. The Hollywood hardman is starring in a British Heart Foundation TV advert urging more people to carry out CPR in a medical emergency.

Author, Bobbi McCarthy

I was supposed to fly to Virginia on Jan. 13th with my son to be with my daughter, her husband and baby, (my 7 week old grandson) BUT I contracted strep throat and became quite ill rather fast on Jan. 12th. By 8pm on the 12th I was having bilat. ear pain, was feverish, chilled and having a hard time swallowing. By the time 330am on the 13th rolled around and I was supposed to get in the shower and get ready to leave, my fever was 102 and I ached all over! Needless to say I’m still home and NOT with my beloved children and grandchild in Virginia.

The lesson learned you ask? Stress and lack of Self-care WILL make you sick…and you WILL end up missing out on life’s fun during that time!

Prior to going back to college to obtain my BSN, I had not been introduced to the subject of nursing burnout and self-care. I have since been educated on the crisis of burnout in our nursing profession and one of the biggest weapons against burnout being self-care. Nurses as well as women (double jeopardy if you are a female nurse!) tend to put other people’s needs ahead of their own. We are taught this concept as young girls and we have it reinforced in nursing school! (Up until now that is) The other lesson that we are taught is that if we do not put other people’s needs ahead of our own we are NOT nice girls…hence if you take your breaks at work you are not tending to the needs of your patients and if you take your breaks during a busy day…you are a slack off!

Nursing educators and theorists have been writing about the effects of stress on the nurse and the eventual burnout that occurs from that repeated, prolonged stress for many years. Self–Care is now a term used to describe a variety of things a nurse can do to relieve stress and thus bring more balance and peace to our nursing lives…thus bringing us out of burnout or keeping us from becoming burnt out.

Now “taking care of myself” was certainly something I always thought I did~ you know…sleeping, having fun, eating right most of the time…etc. The term Self-Care encompasses a much bigger meaning than just taking care of myself. It means realizing that I am worth taking care of~ that if I do not take care of myself chances are no one will do it for me~ that in order for me to perform at my highest and best level I have to infuse peace, fun, love and balance as well as proper nutrition and sleep. It also means that I need to have boundaries and limits around my life…work hard AND play hard…give love and receive love…be creative and expressive. It also means that during a 12 hour work day I MUST eat and rest in order to recharge…I could also inhale some lavender and orange incense to promote relaxation or energy as I need it.

Another area that I have been learning about in the realm of Self-Care is being present…present in the moment~ Instead of running to catch up with my thought, allowing my brain to observe my thought without judgment and then moving on to the next thought, allowing my heart to feel the pain, the sorrow or the fear and then letting it pass. I tend to stuff things during my work day, (and in my home life)…in order to keep moving on to the next patient and the next issue. Once in a while I have a patient or family issue that forces me to stop~ observe~ feel and be present. These moments are the most rewarding so why do I run from them most of the time???

I can honestly say, as I have in this blog, that I have been in varying stages of burnout during my 21 year nursing career. When I began instituting self-care measures a year ago I felt the burnout lift and shift to a less severe burn. (Maybe it is now just smoldering but no longer a burn). I learned Reiki and went to yoga at least twice a week and I started eating better and drinking less wine. I felt happier and more able to face the long 12 hour ER shifts. At work I started taking my breaks for the full time and trying to get off the floor…I brought lavender and orange scents to work to sniff during the day for the calming or energy effects and I ate more healthy foods.

During the last several weeks I have let that slip greatly. I’ve been eating poorly and drinking more wine again at night “to de-stress” and sadly the yoga went to the wayside. I also have been allowing an emotional issue in my life to control me and to worry me…hence I let my energy level dip…my defenses break and just when I needed my health to be pristine…WHAM!!! It wasn’t.

I will take this illness as a learning moment. As painful as the moment is…it is necessary to learn that in order to be our best we have to give ourselves the best care! We can only give what we give ourselves and we can only be as strong as the strength we infuse ourselves with.

Self-Care…a much needed reminder for myself this week.

Video of Timm Sinclair, the son of a Kaiser mental health patient.

Kaiser nurses will be holding the sympathy strike on Jan. 31 to support their co-workers who are members of National Union of Healthcare Workers who charge that Kaiser Permanente, California’s largest HMO, systematically understaffs its mental health services in violation of California state law, leaving some patients to suffer delays in receiving treatment they have already paid for and urgently need.

The subject of  articles in USA Today and the Huffington Post,  A report by the NUHW “Care Delayed, Care Denied” documents the problem in detail.  To learn more and see the report visit: http://www.nuhw.org/caredenied.

From the Executive Summary:

“With more than 6.6 million members, Kaiser Permanente is California’s largest HMO and plays a massive role in the state’s healthcare delivery system by operating more than 35 hospitals and several hundred clinics across the state. Less well known, however, is Kaiser’s role in providing mental health services to Californians. Ranking perhaps second only to the State of California, Kaiser is one of the state’s largest providers of mental health services. The Oakland-based company guarantees its members a full array of inpatient, outpatient and emergency mental health services provided by several thousand mental health professionals. Each year, thousands of Kaiser’s members seek treatment for conditions ranging from autism, anxiety and bi-polar disorder to depression, schizophrenia and suicidal ideation.

Despite Kaiser’s pledge to provide comprehensive mental health services to its members, an in-depth analysis suggests that the HMO’s mental health services are sorely understaffed and frequently fail to provide timely and appropriate care. Patients often experience lengthy delays in obtaining services, an overreliance on “group therapies,” and frustrating obstacles that push many patients to forgo care or seek treatment elsewhere at their own cost…

Kaiser’s substandard care also comes at the same time that the HMO is reporting record profits of $5.7 billion [emphasis ours] since 2009.”

View Statements of Concern by the National Association of Social Workers – California Chapter, California Psychological Association and CAMFT.

Kaiser clinicians, patients and families can submit their stories too.

California’s senate appropriations committee voted 6-2 to pass Senate Bill 810,   introduced by San Francisco Senator Mark Leno.

Senator Mark Leno leads a rally with the California Health Professionals Student Alliance on the steps of the State Capitol for SB 810, the California Universal Health Care Act in 2011

At the request of millions of single-payer health care advocates, Leno authored SB 810, also known as The California Universal Health Care Act, “because it is the only health care reform that can truly contain health care costs and provide every Californian with comprehensive, quality, affordable health care,” according to his office. He says, “this “Medicare for All” type of program works by pooling together the money that government, employers and individuals already spend on health care and putting it to better use by cutting out the for-profit middle man.”

“California is being overrun by out-of-control healthcare costs, which have a significant impact on families, businesses and the state budget,” Leno said. “By guaranteeing universal access for all Californians, our single-payer plan will reduce the healthcare burdens that are hurting families and our state’s economy.” – Sen. Mark Leno

You can read more about the program and ways to help support it at  HealthCareForAll.com.

Well, this week we continue with our little walk down memory lane. We’ll hear from a caller named Mary Ellen who by the end of the call was not very happy with us. She recently sent us an email telling us her legs still hurt and we are crackpots!
For more where this came from check out our Comedy Pharm at nursetalksite.com.

And we share with you “Is Anybody Out There Laughing?” our campaign to change the world with laughter one person at a time. We’ll share the exciting response of a cashier in a pizza parlor when he is asked, “Is anyone in your place laughing right now?”

RNs from Chicago's landslide vote to join National Nurses United

And joining Casey (Dan was excused to go to Chuck E. Cheese with seven 8-year olds) is RN Dorothy Ahmad. Dorothy is a CCU nurse at Stroger Hospital in Chicago. Recently registered nurses at Jackson Park Hospital and Medical Center on Chicago’s South Side voted by 85 percent to join National Nurses United, the nation’s largest union and professional association of RNs. The Jackson Park RNs voted 94 to 16 to join NNU. The secret ballot election was conducted by the National Labor Relations Board. NNU will represent some 150 RNs at the hospital. “This is a victory for the nurses and the South Side of Chicago,” said one nurse.

Support Team Nurse Talk | Austyn's Allstars in the walk for a cure for MS.

Casey then visits with Jennifer Gainza, the communications director for the Northern California chapter of the Multiple Sclerosis Society. We asked Jennifer to come on the show and talk with us about MS, the signs the symptoms and current treatments. Approximately 400,000 Americans have MS- Multiple Sclerosis, and every week about 200 people are diagnosed. Worldwide, MS affects about 2.5 million people.

We were recently prompted to inquire about Multiple Sclerosis when our Nurse Talk web producer Tonia McCallum’s 20-year-old niece Austyn was diagnosed. Nurse Talk is sponsoring her team for the 2012 Walk MS in Santa Rosa, Calif. funding research for a cure. You can donate to Team Nurse Talk | Austyn’s Allstars or join a walk or volunteer in your town this spring by contacting the Multiple Sclerosis Society.

And of course we’ve got the Golden Bed Pan Award—no hints on the winner but we do get a call from a female media mogul thanking us for the award. Hmmmm. There’s also the Phobia of the Week and some email questions.

You can listen every week in the Boston area on station WWZN 1510AM every Saturday at 11 am EST or live stream at www.revolutionboston.com and in the San Francisco Bay area Sundays at 2PM PST on KNEW 960AM or live stream at www.960knew.com. Check out the iHeartRadio app for free and live custom radio. You can also download and listen to any show anytime here at NurseTalkSite.com or on iTunes. Like us on Facebook, and you can listen there too.

It’s all here on Nurse Talk where laughter is the best medicine.

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As a companion to their recently released comic book, M.I.T. health care economist Jon Gruber and illustrator Nathan Schreiber teamed up with the Center for American Progress to produce an three-minute animated explanation of how the health reform law works:

Originally posted at the Washington Post’s WonkBlog.

Around three hundred million people live in the United States. About three million of them are nurses. I make that one in a hundred.

This demographic worried me a bit when I first retired. Nurses just don’t share a shift or a workplace. They share a culture and a lifestyle. I wondered—and fretted—about what life would life be like when I wasn’t around a lot of nurses anymore.

What was I thinking? If you are a nurse, and do not live on a desert island, you cannot escape other nurses. And they cannot escape you.

The rule of Chaos Theory known as ‘strange attractors’ states that there is really focus and magnetism to seemingly chaotic and random social patterns. Nurses definitely have something like that going on. The only other thing similar to it that I can think of is gaydar.

Gaydar is the ability make an intuitive identification. The nurse-strange attractor thing is like that, but different. Consider this.

It is child’s play to pick working nurses out of a crowd. Once a nurse isn’t working, though, the characteristic nurse outfits, accessories and shift-related circadian rhythms are no longer in play.

How, then, do I always find the retired nurse in a crowd without even trying? For lack of a better word, I’m calling it radaRN. No offense meant to our LPN/LVN brethren. It’s my word and I’m counting you in it too.

When I first joined my new church, I was told to look out for someone named MaryAnn, who was a retired nurse. Two weeks later I tripped in a church hallway and fell at the feet of a 60ish blond woman. You know who it was.

Not much later, I plunked down onto a van seat for a day trip. The woman I chose to sit next to turned out to be a retired nurse too. Not MaryAnn. Another one. My new nurse friend and I decided to buddy up for yoga classes.

One day, my yoga nurse buddy couldn’t make class. I struck up a conversation with the woman on the yoga mat next door. She turned out to be a soon-to-retire OR nurse.

In another yoga class, I mentioned to a friendly fellow-yogi that I had worked as a psychiatric nurse. Her face lit up. “Are you a nurse too?” I asked.

“No”, she said, “but my husband is a psychiatric pharmacist.”

OK, so radaRN isn’t perfect.

Florence Nightingale advocated for her patients. Today, as in the day of Nightingale, the nurse is the patient’s voice. The nurse speaks for the patient, mediates between the patient and others, and/or protects the patient’s right to self-determination (Ellis and Hartley).

Too often competing priorities, the hurry to complete tasks, or to complete documentation, take precedence over advocacy. Yet, advocacy is an ethic of practice and integral to a philosophy of nursing rooted in caring. Heightened nurse advocacy contributes to making the health care system less intimidating, makes the journey of patient and families less lonely, and improves the image of nursing.

Patient Advocacy has long been a focus in nursing but with the increasing complexity of health care, the need is even greater. Roles for patient advocacy range from assisting patients with the transitions from hospital to home maintenance to lobbying government agencies for health care issues. Advocacy is a concept involving analyzing, counseling, responding, and, if need be, whistle-blowing (Beyea, 2005). Advocacy in nursing has its theoretical roots in the field of ethics. The ANA’s Code of Ethics states: “The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.” The American Nurses Association (ANA) included advocacy in its definition of nursing in the words “the protection, promotion, and optimization of health…through…and advocacy in the care of individuals, families, communities, and populations.” (ANA Social Policy Statement, Second Edition, 2003, p.6)

Patients are vulnerable. This is particularly true if a patient with under-certainties of illness, undergoing surgery, altered level of consciousness, or is too ill or sedated to speak up for themselves. Clinicians sometimes decide what is best for a patient, sometimes without considering the patient’s wishes but also out of necessity. When the family care provider or the patient is afraid to speak, the nurse must advocate for the family. In some cases it can mean life or death. In other instances, it can provide the support for patients and families to help them cope with the uncertainties or inevitabilities that they face. Quite commonly, nurses translate, interpret and help patients and their families to understand what appears as healthcare gibberish. But, as Malik points out, although nurses are in the best position to act as advocate, “it can be a risky role to adopt” (Malik, 1997). As the nurse explores, informs, supports and affirms the choices of patients when conflicts arise, the nurse must remain the patient’s advocate even when it may not be the decision the nurse would make (Malik).

The challenges of advocacy became clear when I was put into the position of advocating for members of my own family. As a medical-surgical nurse for 30 years, a faculty member of a Health Sciences University for 20 years and a specialist in gerontology, I found the role of advocate not only risky but a lonely one. As nurses we are assumed to be able to manage the system, yet as I struggled to advocate, I appreciated how much more difficult this must be for many of our patients.

Recently, my husband, a 72 year old proud, strong man with a history of hypertension and Type 2 diabetes, was found by his endocrinologist to have a very high blood pressure and an elevated creatinine blood level. As luck would have it, this took place on a Friday. Of course, while my husband knew, he, like so many men of his generation, maintained his stoicism by not telling ME anything.

The next week, as he became more uncomfortable, I went with him to see an internist who promptly palpated the abdomen (at which point my husband tells us, “It feels like I have a football in my belly”). From the internist we were referred to the nephrologist, but as luck would have it, his was out of town. After a search for another, we hurriedly travel to another city to see him. The “stranger” nephrologist took a 2 minute history, as he was due in surgery in another city, and as he examines the prostate, states, “Whoa! THAT’S ONE BIG PROSTATE!!” I detected pride in my husband’s face.

The office nurse immediately catheterized his bladder and collected 1800 ml of urine! Though she used lidocaine jelly, the experience was excruciatingly painful. His BP went from 185/100 to 125/80 and he lost 5 pounds. The urologist quickly announces that my husband will need to catheterize himself (HIMSELF) daily, take three new medicines several times a day, and cancel all other medicines. As this plan was announced, my husband was experiencing profuse bleeding resembling thick tomato juice.

Home we went with trepidation and prescriptions in hand. Shortly after, the bladder spasms began and became unbearable. After four attempts to reach the doctor for his blessing to give over-the-counter pryridium for the pain, he prescribed it 10 days later.

From here we became very busy with:

• Catheter and leg bad by day and large bag by night, for six weeks
• Daily lab tests
• CT scans (when we met for the results of the first one, the nephrologist looked at the cd and said, “Did they use contrast?” “No”. “Well this is no good to me. If there are cancer cells I won’t see them!” He then rushed out of the office to reprimand the radiologist.
• KUB ultrasounds
• Cystoscopy (I held the information of what this procedure would entail)
• MRI for 2 hours

He refused, with a look that would kill, the urinary flow study. Some seven weeks after the initial symptoms, the diagnostic tests confirmed that there was a problem. The diagnosis now was to our great surprise, an enlarged prostate complicated by a “complex cyst” and a large kidney stone.

Eventually, a TURP was performed successfully. But like many older adults, my husband became somewhat “altered.” I spent the night at his bedside.

The postoperative surgery phase was a roller coaster ride. Vicodin for pain led to constipation/digital dis-impaction, the use of a catheter and leg bag for another week, three urinary tract infections (during one he had “rigors”, sudden paroxysmal shivering, teeth chattering and high fever), two trips to the Emergency Room, a lithotripsy, a disgusting intractable odor of putrid urine in the home. Can you feel it?? Frustration. Confusion. Exhaustion. ANGER.

Overall, the patient was very weak, anemic, depressed, and worried.

Cancer cells?

As his nurse advocate, I created a file for the hundreds of papers, some of which I had to demand. And I spoke out and questioned when the approaches to health care did not make sense. Our favorite frustration was the office staff who, for example, repeatedly explained that he would need to drink 1500 ml of water before the test to fill up his bladder. I repeated “He has a catheter.” “He HAS a catheter.” “HE HAS A CATHETER!!!” It appeared that THE HELPERS IN THE NEPHROLOGIST’S (8 nephrologists) OFFICE know little about nephrology!

My husband, like so many of our patients, was in pain, overwhelmed, and in denial. Of course, NOTHING would have happened without my consistent presence to translate, clarify, repeat, and advocate for my husband. I could barely follow all of this confusion, dates, times, preparations, follow-up. I have finally returned to work. When my husband appeared for his most recent exam, everyone asked, “Where is your nurse?” Irony to be sure. I was often angry, yet knew that it would be counterproductive to show it. I was not as successful with the patient.

Despite my frustration, I recognize that we are among the fortunate. We are well educated, intelligent, healthy people with excellent health insurance, outstanding physicians and facilities available to us. I am very aware of pathophysiology, medications, and treatments. I am a pleasant, agreeable person. Yet, overall, I felt that I was either expected to perform miracles in the way of communication or I was in the way. Not once did I feel useful or appreciated. The reality was that my husband was very ill and unable to think clearly. I cannot conceive of how anyone could have maneuvered our health care “system” on his own. Swimming through a maze as an outpatient!!

Tate, RN, states that not advocating on a patient’s behalf is a deviation from the standard of care (Tate, 2005). Yet, as she notes, far too many nurses have never learned or practiced this critical skill. She states, “I believe that no hospitalized patient should have to advocate for himself—ever. Nor should any family member or significant other ever be expected to have to have to advocate on behalf of their hospitalized loved one. This is a nursing responsibility” (Tate).

As a nurse educator for many years, I have reflected on my family’s experience and the lonely road of advocacy. I understand that advocacy must be taught. At my institution, the notion of advocacy may only be included in Health and Human Caring class or referred to at times in nursing classes. Learning about advocacy best occurs by observing other nurses or through experience.

Advocacy is a skill based upon a body of knowledge. Yet, the concept does not appear in the educational literature to the degree that it should. Among the current foundational resources available to nursing faculty, “advocacy” is hardy mentioned at all. In 2009, based on the Institute of Medicine competencies, Quality and Safety Education for Nurses (QSEN) faculty and a National Advisory Board defined the Knowledge, Skills, and Attitudes (KSAs) necessary to continuously improve the quality and safety of health care systems. These KSAs are to be developed in Nursing Pre-licensure, Transition to Practice, and Continuing Education programs.

Advocacy is mentioned in the first of six categories, “Patient-centered care”, defined as “recognizing the patient or designee as a source of control and full partner” in providing compassionate and coordinated care based on respect of patients’ preferences, values, and needs. This implies seeing “through the patient’s eyes.” Exploring ethical and legal implications of patient-centered care is another knowledge expectation.

Of the four Major Client Needs categories of the 2010 NCLEX test plan, the first is “Safe and Effective Care Environment”, enhancing care delivery to protect clients and health care personnel. One subcategory is “advocacy”. Advocacy should be implicit if not salient in ALL NCLEX categories.

Too often competing priorities, the hurry to complete tasks, or to complete documentation, take precedence over advocacy. Yet, advocacy is an ethic of practice and integral to a philosophy of nursing rooted in caring. Heightened nurse advocacy contributes to making the health care system less intimidating, makes the journey of patient and families less lonely, and improves the image of nursing.

This article was shared with us by NurseTogether.com.
Based in Charlotte, NC, NurseTogether.com is one of the fastest-growing, free online professional communities for nurses. Specializing in unique nursing lifestyle, career and professional development information, NurseTogether.com’s mission is to empower the nursing community through top-quality original content from experts, interactive web-based social media tools, and value-added services through key strategic partnerships in a variety of nursing and lifestyle disciplines.

REFERENCES
ANA Social Policy Statement. 2nd Ed. Retrieved from www.QSEN.org, 2003 Code of Ethics for Nurses.

“The Nurse’s Role in Ethics and Human Rights: Protecting and Promoting Individual Worth, Dignity, and Human Rights in Practice Settings” ANA Policy Statement. Retrieved from http://www.nursingworld/MainMenuCategories/HealthcareandPolicyIssues, June 14, 2010.

ANA Position Paper, “Workplace Advocacy” retrieved from /ANA Position…6/6/2011

Beyea, Suzanne C. “Patient Advocacy. Nurses keeping patients safe.” AORN Journal, May 2005.

Cronenwett, L., Sherwood, G., Barnsteiner, J., Johnson, J., Mitchell, P. et al (2007). Quality and Safety Education for nurses. Nursing Outlook, 55(3) 122-131.

Ellis,J., and Hartley, C. (2008). Managing and Coordinating Nursing Care (5th Ed.). Philedelphia, Lippincott.

Foley, B.J., M.P. Minnick, C.C. McKee “How Nurses Learn Advocacy” Journal of Nursing Scholarship 34 no.2 (2002) 181-186.

Institute of Medicine. Health professions education: A bridge to quality. Washington, DC: National Academies Press; 2003.

Malik, M, “Advocacy in Nursing—A Review of the Literature,” Journal of Advanced Nursing 25 Jan 1997;25 (1) 130-138.

National Council of State Boards of Nursing, 2010 NCLEX-RN Detailed Test Plan for the Educator, Chicago, Illinois

Scandanavian Journal of Caring Science 2006 September 20 (30): 282-292.

Tate, RN. “Patient Advocacy: The Nurse’s Responsibility”. Topics in Advance Practice Nursing eJournal 8/2005;(2).

“Welcome to Nurse Talk where laughter is the best medicine. I’m Casey Hobbs.”

“And I’m Dan Grady and we are two of the thousands of nurses on duty today.”

And so the show begins.

Laughter is the best medicine. Check out Nurse Talk's Comedy Pharm Funny(?) calls, stories, outtakes and bloopers

Let’s take a little walk down memory lane and listen to some old stories we told when Nurse Talk was first on the air. We think they are at least amusing—funny? Well, that is in the eyes of the beholder! Not sure any of you remember RN and co-host Maggie McDermott. Maggie comes back to visit from time to time and she always has a story about a funeral she just attended or a “fender bender” that wasn’t her fault, or a souvenir from her latest trip to the Great Wall Of China, (where she, of course, most likely offended someone). Oh, we love our Maggie. You’ll hear she and Casey in the early days on this week’s show and you can check out more clips on our website at the Comedy Pharm.

Moving on—Lost for many observers in last month’s end-of-the-year hullabaloo was the annual Gallup Honesty and Ethics Survey which by a wide margin again ranked nursing as the most honest and ethical profession.The survey found that 84% of Americans believe that nurses have “very high” or “high” honesty and ethical standards. It marks the 11th straight year—and the 12th time in 13 years—that nursing led all professions in the survey. Gallup says the only time nurses haven’t topped the list since they were included in 1999 was in 2001 after the 9/11 terror attacks, when firefighters were No. 1.

RN and co-president of National Nurses United Karen Higgins is with us to talk more about the survey and what it means for the nurses, health care and social activism.

“We hold that trust as a sacred bond with our patients and our communities. Patients and their families expect nurses to fight for them at the bedside, even when it conflicts with the profit motive of far too many hospital managers, insurance companies, and others in the healthcare industry who put the bottom line above patient interest,” said Higgins in an article about the survey on the NNU web site.

Author, Joann Spears

AND we share a wonderful story from RN, writer JoAnn Spears. JoAnn has generously contributed some stunning blog posts about her life and career as a nurse. On a recent post she describes what she learned from a mute patient in a chronic psychiatric ward. She writes, “One night, I was working on charts at the nurses’ station when I felt eyes bearing down on me. Looking up, I found the patient with the blue eyes looking down at me. I asked him what he wanted, a rhetorical question with no answer expected.” We’ll talk more with JoAnn about her post, Behind Blue Eyes | A Life Lesson from a Patient.

And Casey and Dan get a few email questions that are…well…both about feet. Ever have an in grown toenail or a heel that hurts so bad you want to cry? All I can say is God love the people who have enough nerve to send in their questions! Remember—the nurses cannot prescribe, diagnose or treat and you should always consult your physician! Now that is something we NEVER leave out of the program.

You can listen every week in the Boston area on station WWZN 1510AM every Saturday at 11 am EST or live stream at www.revolutionboston.com and in the San Francisco Bay area Sundays at 2PM PST on KNEW 960AM or live stream at www.960knew.com. Check out the iHeartRadio app for free and live custom radio. You can also download and listen to any show anytime here at NurseTalkSite.com or on iTunes. Like us on Facebook, and you can listen there too.

Remember, laughter is the best medicine.

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Ah, the possibilities of an open mind.

Other rich countries have universal health care. FRONTLINE teams up with T.R. Reid, a veteran foreign correspondent for “The Washington Post,”   in “Sick Around the World,” to find out how five other capitalist democracies–United Kingdom, Japan, Germany, Taiwan and Switzerland–deliver health care and what the United States might learn from their successes and their failures.

Watch the whole show online at http://www.pbs.org/frontline/sickaroundtheworld/ Share widely.

Virtually every other consumer sale is taxed. Why not Wall Street’s?

A robust tax on Wall Street transactions would raise far more revenue – as much as 17 times as much – than more limited proposals, even accounting for the worst case scenarios of reduced trading as a result of a tax. That’s the findings of an important new research brief from prominent University of Massachusetts Amherst economists Robert Pollin and James Heintz.

This study is the most recent serious effort to quantify current, actual costs and evaluate the impact of the trading costs on trading volume. It can be viewed at: http://www.peri.umass.edu/fileadmin/pdf/research_brief/PERI_FTT_Research_Brief.pdf

The data in the study come from three sets of sources: the most recent academic and financial market research; a 2011 survey study by the International Monetary Fund; and the most up-to-date and comprehensive data on market trading from specialized firms that obtain these figures directly from the financial market trading businesses themselves.

One of the stories of the past year has been the growing international and U.S. movement for a financial transaction tax (FTT) on the trading of stocks, bonds, and other financial instruments.

An international coalition of labor, environmental, and non-governmental organizations have prodded the European Union to adopt a continent wide FTT, also referred to as the “Robin Hood tax.” Several European governments, including conservative leaders in France and Germany support the FTT and the EU which is predicted to adopt the tax by the end of this year.

In the U.S., a renewed push for an FTT has also mushroomed, encouraged by a campaign led by National Nurses United as a vehicle to raise badly needed revenue for healthcare, jobs, and other basic needs. NNU last year sponsored protests advocating for the FTT on Wall Street, the White House and Treasury Department, outside Congressional offices, and while participating in Occupy Wall Street protests throughout the fall.

Titled “Transaction Costs, Trading Elasticities and the Revenue Potential of Financial Transaction Taxes for the U.S,” the paper by Pollin and Heintz analyzes potential revenue from three different FTT proposals.

The three are a new bill in Congress introduced by Sen. Tom Harkin and Rep. Peter DeFazio, which would levy a miniscule .03 tax on stock and bond trades, or 3 cents on every $100 of trades, the main proposal in the EU for a .1 tax or 10 cents per $100, and a .5 tax, or 50 cents on a $100 transaction, favored by NNU and other activists.

The U.S. had a FTT from 1914 until 1966, and following a market crash in 1987, former House Speaker Jim Wright proposed reinstating a fee of .5, which was endorsed by leading Republicans as well, including top economic advisors to President George H.W. Bush.

Opponents of an FTT have claimed that any tax on Wall Street activity, which, unlike virtually all consumer sales is presently untaxed, would so discourage trading that it would substantially reduce any potential revenue – thus the reason given by proponents of the Harkin-DeFazio bill for introducing such a small tax.

However, examining existing FTTs currently in place in other countries and reviewing data on current U.S. private transactional fees on market activity from two firms private business firms, Pollin and Heinz reach a far different conclusion. They find:

A tax of .5, such as favored by NNU and presently in place on stock trades in the U.K., would generate as much as 17 times more revenue as the .03 tax included in the Harkin-DeFazio bill.

Additionally, Pollin and Heintz cite little evidence that a FTT would substantially reduce trading activity, as claimed by its opponents.

Pollin and Heintz note the work of one researcher cited in a paper from the International Monetary Fund which found no decrease in trading with the introduction of a transaction tax in some Asian markets. “Elasticity,” the term of art referring to the responsiveness of trading to a change in the transaction costs of the, “was zero in these markets when transactional costs rose as a result of an FTT,” the authors write.

Additionally, the UK market remains the fourth largest in the world, and transactional costs of .5 have “not prevented the City of London from operating as one of the world’s leading stock markets.”

Overall, Pollin and Heintz survey a number of potential scenarios that could occur from introduction of an FTT in the U.S. Even in the worse case scenario, a highly unlikely event, a .5 percent tax would still raise more than three times as much as the minute .03 tax, they conclude.

“There is no scenario in which a 3-basis point FTT (.03) [as proposed by the Harkin/DeFazio bill] will generate more tax revenue than a 50-basis point (.5) FTT,” write Pollin and Heinz.

Focusing on stocks alone as taxable entities, Pollin and Heintz conclude the Harkin/DeFazio proposal of .03 would raise just $8.1 to $9 billion a year, compared to from $24.6 billion to $150 billion every year with a .5 tax.

NNU and many other activists favor applying the FTT to currency trades, derivatives, swaps of all kinds including credit default swaps, and other Wall Street activity, which could produce revenue as high as $350 billion a year in critically needed revenue, says NNU.

“With so many Americans struggling with lack of healthcare, high unemployment, foreclosure, and other family crises, we need a meaningful way to heal our nation,” says NNU co-president Karen Higgins. “It’s time for the Wall Street banks and investment firms to pay to rebuild the economy they did so much to run. The small tax on major trading that we propose is a critical first step.”

###

For Profs. Pollin or Heintz, contact Debbie Zeidenberg, at PERI, dzeiden@peri.umass.edu or 413.577.3147

Nigerian children Photo credit Joe Carey

Founded by Christy Turlington Burns, Every Mother Counts is an advocacy and mobilization campaign to increase support for maternal and child health. They have created a new blog series called Tales From the Field stories from the front line where inspiring and dedicated people can share their experiences. The first installments feature Betsy Freeman, a nurse midwife who has spent the past 10 years working with underserved women, both in New York City and throughout Africa. They are heartrending:

I am two months into my six-month mission in northern Nigeria. My world here is small: base, hospital, base. I walk the path between them several times a day. At night our beat up Land Rover shuttles me back and forth bleary eyed. We work six days a week and I’m on call for two nights as well. Most calls I’m at the hospital for most of the night.

Our two main services here are emergency obstetrics and obstetric fistula repair. I spend my days and nights supervising the local midwives and managing the emergencies that come through the door. I have to step back from the experience from time to time.

It is, in a word, mind-blowing. Here’s a snapshot….

Last night I’m on call after working my usual day shift. I get called in around 11pm because there is an eclamptic patient who has blood pressures of 220/140, already being treated with magnesium sulfate. We give her hydralazine to bring the pressure down. She is fully dilated but comatose so we do a vacuum delivery with fundal pressure to get the baby out. As we are doing this delivery, I watch as the patient beside her, a postpartum eclamptic also starts seizing, also already on magnesium. We turn to her for five minutes push more mag, then the other one has a full on postpartum hemorrhage. We get both of them stabilized and I leave the hospital for about 30 minutes. Just as I’m turning off the light to go to bed, they call me back in.

This time I arrive to a woman sitting up in bed in respiratory distress. She is sweating, incredibly anxious, and has a hemoglobin of 1.7; she’s in pulmonary edema. Her oxygen saturation is 50% on oxygen. We give her lasix, blood, then more lasix. We roll her to our ICU, which is essentially a room very similar just down the hall. She lies next to the woman who is status post uterine rupture and hysterectomy and the postpartum para 16 (that’s 16 pregnancies!) who has malaria and typhoid and a suspicious chest infection. I’m home by 2am and have dreams all night about triage.

Read more about Betsy’s experiences or if you are someone you know would like to contribute to “Tales From the Field” you can submit your essay to info@everymothercounts.org. Every Mother Counts seeks to engage new audiences to better understand the challenges and the solutions while encouraging them to take action to improve the lives of girls and women worldwide.

Rep. Alan Grayson, former US Congressman, wrote in the Huffington Post this week, Rick Santorum is Wrong. As reported by ABC News, in a speach at Christian college, a student citing a Harvard study published in the American Journal of Public Health, asked Santorum how he thinks God feels about all those Americans dying because they lack health insurance. Rick Santorum “replied, “I reject that number completely, that people die in America because of lack of health insurance.”

According to the study, 44,789 Americans die each year because they have no health insurance. That’s 1 out of every 6 Americans. Rep. Grayson put it this way, “If you take two Americans who are physically identical — same age, same gender, same race, same weight, same smoking history — and one of them has health insurance and one does not, then the one without health insurance is 40 percent more likely to die each year.”

Public health care option naysayers like to point out that people are not turned away at an emergency room. Grayson says, “I ask them to show me an emergency room that will provide chemotherapy to a cancer victim. There isn’t one.” He continues:

To answer that challenge, I started a website called www.NamesOfTheDead.com. I invited surviving family and friends to tell me about people whom they had loved and lost, because they had no health coverage. And they did — thousands of them.

Every single other industrialized country in the entire world has universal health care. Why can’t we? How many more people have to die? How many more sacrifices on the altar of Almighty Greed?

Any health care system that denies necessary care on the basis of wealth is evil. It doesn’t matter how you micromanage it, or tinker with it. It’s evil.

When Justice Harry Blackmun began voting against death in every death penalty case, he gave this simple and eloquent explanation: “From this day forward, I no longer shall tinker with the machinery of death.”

We need to reach the same kind of realization in health care. Forget about the tinkering. This is America, not Myanmar. People who are sick need to be able to see a doctor. Because we are human beings, not cattle. End of story.

Read Grayson’s whole article and the study for yourself and share the facts widely.

By John Commins, for HealthLeaders Media, January 3, 2012

Lost for many observers in last month’s end-of-the-year hullabaloo was the annual Gallup Honesty and Ethics Survey which by a wide margin again ranked nursing as the most honest and ethical profession.

The survey found that 81% of Americans believe that nurses have “very high” or “high” honesty and ethical standards. It marks the 11th straight year—and the 12th time in 13 years—that nursing led all professions in the survey. Gallup says the only time nurses haven’t top the list since they were included in 1999 was in 2001 after the 9/11 terror attacks, when firefighters were ranked No. 1.

Not surprisingly, National Nurses United is well aware of the survey results and appears poised to capitalize on that hard-earned public regard.

“We hold that trust as a sacred bond with our patients and our communities,” Karen Higgins, RN, co-president of National Nurses United, said in a media release. “Patients and their families expect nurses to fight for them at the bedside, even when it conflicts with the profit motive of far too many hospital managers, insurance companies, and others in the healthcare industry who put the bottom line above patient interest.”

“For nurses, that obligation also goes beyond the bedside,” Higgins continued, citing the NNU campaign for “sweeping changes to heal our communities and nation, with a program for a Main Street Contract for America premised on jobs with dignity, healthcare for all, a safe environment, and support for public education.”

The union is also pushing for a Robin Hood tax on financial transactions to be levied against “Wall Street banks and other financial firms who created the current pain and suffering in our communities….”

NNU has smart, tough leaders and compelling “us-versus-them” and “patient-first” messages that resonate not only with the nurses they hope to organize, but with tens of millions of Americans who play by the rules and still feel like they’re getting a raw deal.

The union has gained considerable success and notice since it consolidated the California Nurses Association/National Nurses Organizing Committee, United American Nurses, and Massachusetts Nurses Association in December 2009. The “super union” now boasts more than 150,000 members within a national network and has won most —if not all—of the organizing efforts it has undertaken.

Savvy leadership and a compelling message—while important—are not the only keys to NNU’s success. Seasoned and tough leaders can be found in other unions that have not fared as well. In 2010, only 11.9% of the U.S. workforce was unionized, down from 12.3% in 2009. Unions have seen a mostly steady decline in membership since 1954, when about 28% of the workforce was organized, according to the Bureau of Labor Statistics.

Union supporters believe that more U.S. workers would join unions if they could. They don’t, the explanation goes, because these workers haven’t the leverage to bargain with management, especially in a weak economy plagued by high unemployment.

The frustrations and pressures that nurses encounter on the job can be shared with workers in other sectors from agriculture to retail to heavy industry. Bad bosses, declining wages, and benefits, job instability and lousy hours are not unique to a particular sector.

Nurses, however, know they are in high demand. They know they are not easily replaced. They know their skills—for the most part—cannot be outsourced. Because of all that, they know they don’t have to tolerate a dysfunctional workplace. They can vote with their feet and find a new job elsewhere, or they can vote to organize.

NNU’s success suggests that when workers are given the chance to organize, usually they will. That annoys a lot of people who want to believe that unions are no longer needed in this era of enlightened management.

Instead, union successes are dismissed as some sort of trickery such as heavy-handed organizing efforts that pressure non-affiliated workers to join. How else to explain the failure of management to contain NNU’s organizing efforts, other than to acknowledge the failure of management?

If NNU’s only purpose were to increase dues-paying membership, as some critics suggest, that is not necessarily a grand deception on its part, and it does not explain their success. Nor is it explained by the suggestion that unions now hold some momentary advantage thanks to a temporarily pro-labor tilt on the National Labor Relations Board.

The explanation is simple. NNU is succeeding because many nurses—like many workers in many sectors—believe that nobody else in a position of power and influence is looking out for them. The only difference is that nurses are in a position to do something about it.

John Commins is an editor with HealthLeaders Media. He can be reached at jcommins@healthleadersmedia.com.

Author, Bobbi McCarthy

The ER was in a rare state of calm…several patients being tended to but NO chaos!!  I was assigned to the patient coming in by Delta~ I prepped the room and waited. The patient arrived, awake but tearful.  His wife was with him. It seems the patient was having pain in an area that he hadn’t had pain in a while—his cancer treatments had been over for several months—he is awaiting a second opinion. His complaints were pain, loss of appetite, and dry mouth.

As I cared for him he talked to me. He told me of his life, many children and several new grandchildren, how he and his wife cared for his ailing father who recently had passed away.  He cried, a lot.

He began to tell me how he felt failed by the caregivers in his cancer care.  He shared with me that he only saw the primary doc 4 times in his many months of treatment and that he was seen by varying other PA’s or NP’s.  He was very upset over the “many times the doc would see him in the waiting room and just walk by, without a handshake or a how are you?”  We talked about this…he told me that very few of his doctors and nurses had the “gift” of bedside manner.  “So many nurses and doctors just see me as a pain in the ass and someone to rob them of their time.”

Two liters of saline, pain meds and many minutes of hand holding at the bedside garnered me the real reason for his ailing health.  Four days ago his 2 teenage grandsons were killed in a car accident…Christmas day. (I do have his permission to talk about this.)  The tears would not stop…his pain increased…but he continued to tell me about them.  His wife sat off to the side, wiping her own tears.

I was granted an unusual amount of time to spend with this man that night in the ER.  He needed me; he needed my hand, my heart and my time.  I thanked God several times while this man was talking to me—for the gift of time. Time is so unusual in the ER…but this is the treatment that this man needed.  Sure the narcotics and the fluid replacement helped…but it was the human experience that made the difference.

When he was in the wheelchair ready to be discharged home he hugged me and looked me in the eye and thanked me for my “bedside manner” and for “caring about what happened to me.” “You, my dear, have the gift of bedside manner,” he told me.  It was my turn to shed a couple of tears!

I don’t tell this experience to toot my own horn.  I tell it because it is such a powerful example to me of what you see at first is not usually what the problem really is, and how important it is for patients to feel cared about by their providers. It is a rare blessing for my ER gang to have the minutes they need to sit with a patient and have the time to establish a relationship so that the patient feels comfortable enough to share the real reason they are ill. Unless we have to intervene with life saving measures initially, we need to remember that they need our presence first…

Much like a forest fire, our spirits can experience a natural disaster.

A forest fire is destructive and dangerous, it wipes out all that is good and healthy and beautiful. It exerts its power and overwhelms everything in its path.

In nursing many of us come to a point in our career where the fire has overwhelmed our soul and we haven’t realized it or stopped to take a moment to appreciate the toxicity of the smoke surrounding us. We may fail to do the important growth work that is so integral to how we care for others. We forget to periodically evaluate our own forest—to look for the old and the brittle, the dry bushes, the dry earth, the lack of flora.

When we care for others it is so easy to forget what your forest looked like when you began your walk on the nursing trail. Our time is devoted to service for thirty six hours and then we go home for four days and spend half of that catching up on sleep and then the rest of it running around like mad to get all of our errands taken care of, the bills paid, the kids to where they need to be. Keeping our insides nourished is not on the priority list.

Combustion in nursing can have many causes. There are issues innate to the work. We care for our fellow man…and care….and care…and care some more. At the end of the day…or six years…or twenty years, we may have lost the vitality and possibility that were once in abundance in our own forests. The shady trees are gone, the creeks have emptied of fish and water. As he does in nature, man can keep taking until everything is gone and then stand before a desert and wonder what happened. Our patients take from us—our strength, our love, our hope, our compassion, our patience and they forget (as do we) that our resources can run dry.

If  you’ve taken a look inside and realized there’s only a desert left…well then, it’s time to plop down in the middle of that desert and look around you for signs of life. It’s there, and when you find it you will know what to do to grow your forest again. Is it time for a change in nursing specialty? Are you passionate about educating nurses or people? Maybe you’ve been ignoring the desire to get involved and learn more about nurse politics. Whatever that little piece of greenery inside of you is—don’t underestimate its strength and possibility.

Not only can we be drained by caring for patients, we drain each other by the way we treat one another. Humans are very good at setting fires not just in nature but on the inside of each other. Nurses are experts. If rangers knew about us we’d be banned from natural parks all around the country. Instead of helping to put out fires within each other to save the good things and help them grow stronger—we may throw matches in the middle of the beauty and watch destruction happen.

It’s called HORIZONTAL VIOLENCE…STOP!…. Look at the nurse next to you and don’t look at him or her as merely a person, but as a very important part in the balance in nature. When you do this it’s a reminder that all living things need nourishment and careful attention and handling. What can you do to add to another nurse’s forest so it flourishes? Make an effort to discover something new about the nurse next to you. What’s unique about them? As you would stop and admire a rare flower on a trail, admire the something new and different about the nurse sitting next to you. “Wow, look at this rare flower, there aren’t any others like it! How cool is this!” SHARE admiration with the nurse next to you. You’ve just now made a small contribution to their spirit and to the resources he or she will have to provide care to others.

Amid the destruction, fires also clear away what is no longer useful. They can be a source of renewal. They rid the earth of the old so that creation can begin again. Where there is destruction and ruin there is also the possibility of creation. Things may never grow back the same or in the same place, maybe there will be some completely different species of plants that crop up that have never been seen before. There is beauty in a recreating oneself after a fire, reevaluating the remnants, deciding what’s necessary to keep and what’s necessary to “let go.” Our work as humans is not static. Life and change are one in the same. You will change, your heart will change, your colleagues will change, and your dreams and goals pertaining to nursing will change. We don’t have control of change, for the most part. But as nurses we can put out the forest fire burning its way through our profession.

The next time you are at work, GET OVER the workplace politics, the gossip, who is answering the most call lights or who is getting the best assignments, who got to be resource nurse for two days in a row, or who took five minutes too long on their lunch break. These are the matches and the gasoline in our profession. When you find yourself engaging in these behaviors—remember you have the power to save and nourish the forest around you or the power to contribute to its destruction and the depletion of your own inner forest. It takes a few seconds to water a plant or flower at your house. If we all took just a few seconds a day to provide some water and nourishment and soil to one another as nurses…just imagine how insanely, blindingly, beautiful our forest would be…and its future.

Happy New Year. We wish you lots of laughter and renewal in 2012. We will do our best to contribute toward the tickling of your funny bone. Take on caring for yourselves as well as your patients. We liked a post by our Facebook friend, Nurses Interrupted with some ideas on how to make microchanges to help transform the workplace through transforming our relationships with one another:

Ask yourself this question before you go in for a shift: “When was the last time I put my hand on someone’s shoulder and told them thank you?” Its okay to nurse each other—it just takes a simple touch, making eye contact, a smile of reassurance—all those things take just a moment in time, but they have the power of changing your workplace…and your profession. You never know who might *really need* that reassuring human contact from a colleague…

On the show this week we replay of our interview with Dr. Connie Mariano who was nominated to the rank of Rear Admiral by President Bill Clinton and eventually served as the White House Physician for President Clinton and President George W. Bush. She has written a wonderful book called The White House Doctor, a riveting look into the personal lives of our presidents. Dr Mariano has also achieved an impressive list of “firsts” that include being:

• the first military woman to become the White House Physician to the President,
• the first woman Director of the White House Medical Unit, and
• the first Filipino American in US history to become a Navy Rear Admiral!

The White House Doctor by Dr. Connie Mariano

NURSE TALK IS GROWING…GROW WITH US. ADVERTISE to our active and engaged audience. Email to reserve your spot on the air or online: pattie@nursetalksite.com.

You can listen in the Boston area on station WWZN 1510AM every Saturday at 11 am EST or live stream at www.revolutionboston.com. Our San Francisco Bay area station is the same, but with new call letters: we broadcast on Sundays at 2PM PST on KNEW 960AM or live stream at www.960KNEW.com. You can also download and listen to any show anytime here at NurseTalkSite.com or on iTunes. Like us on Facebook, and you can listen there too.

Fighting the fight is all well and good until the fight needs to be ended…ended in time to allow for time…

I cannot get into specifics but I have a question for all of you fellow nurses. What do you do when you have a patient that is young, experiencing end stage metastatic cancer and they do not know it. The oncologist has not given them the realistic and total picture of their disease process NOR have they been given the tools to deal with the fact that the treatment they are undergoing IS NOT WORKING.

I worked in hospice many years ago and I had a bitter taste in my mouth then, as I do now, when the oncologist continues to throw one chemo/radiation therapy after another at a person who is just getting worse… and then they die in the midst of treatment and everyone around them, including often times their children and spouse are left with the thoughts of “but they were getting better….the doctor said the treatment was hopeful.”

While I was a nurse in the hospice world I had a voice and I could council my patients as they directed me to…I could also have a voice with the team that was treating the patient. I often feel left out in the wind while working these people in the ER. My role as the ER nurse is to deal with the situational issues that arise with this patient population, not to have a role in their treatment plan. I feel like I’m standing in the corner of the room with duct tape on my mouth and my hands tied behind my back…watching from afar as this confused, sick and often times dying patient enters our doors and needs help…and the most sickening part is they and their families are so unaware of what is truly happening.

As a nurse we have the obligation to provide the total and holistic range of care that each of our patients needs and deserves…I cannot help but wonder where the moral compass points on this issue for both nursing and with the medical professionals who treat these types of patients. The “never give in and never say die” attitude with which many oncologists practice is all fine and good to encourage hope and strength in the patient population, but when is it okay to tell the patient the truth from the facts of their case… I know that it is a struggle of thought that when you tell the facts…the patient may lose the will to fight or may give up…but what if that patient and their family needs that information to stop the insanity and come together for some last weeks of time with saying goodbye?

Each person that we come in contact with has the right to be told the truth of their situation…and sometimes that truth is, “we have done all we can do and now we need to make you as comfortable as possible so you have some good weeks left to be with your family, free from treatment and free from pain, to have the strength and mind to say goodbye. Fighting the fight is all well and good until the fight needs to be ended…ended in time to allow for time…

What is your experience?

Before I was a nurse, I had occasion to be a young patient.

I had a brief but painful procedure to undergo. My nurse was named Anne. She told me that if it hurt, I should just go ahead and scream.

It was nighttime, and all the other patients on the floor were asleep. It must have been the incipient psych nurse coming out in me; I was determined that those other patients not be woken up.

“I’m not going to scream,” I said gamely.

“Well, then, here’s my hand, squeeze it really tight if you need to,” Anne said, resting her right hand in mine.

I needed to, all right. I squeezed really hard, and I screamed anyway, waking all the other patients and probably a couple of the dead down in morgue, not to mention shattering a few glass pipettes down in the lab. I also suspect that I broke a couple of small, unnamed bones in Anne’s hand; as soon as it was all over, I could see that it was already turning purple.

I remembered Anne when I was a student doing a rotation through a same-day surgery unit. They were preparing to do an I&D on a man with a badly suppurating scrotal abscess. It was a dead heat as to what was absolutely the worst thing about the situation: the sight, the smell, or the man’s embarrassment at having a skinny little nursing student in the room. I remembered Anne, gave the man my hand, and told him to squeeze it if it hurt.

It had to have hurt him, bad. He squeezed my hand, hard. Really hard. Hard enough to keep himself from screaming. The fact that he was able to endure the pain in silence seemed to give the man some of his dignity back. The fact that I hadn’t flinched in spite of a badly bruised hand somehow righted my own undignified scream of years before.

Lots of research has been done about the occupational hazards of nursing. Back injuries in our Orthopedic colleagues. Workplace violence experienced by our ED sisters and brothers. Teratogen exposure faced by our Oncology nurses. The effects of shiftwork on the graveyard crew and the Baylor cohort.

I don’t think anybody’s ever put any research effort into our hands, though. Since the ‘squeeze my hand’ thing is so intuitive and universal in nursing, I think it bears investigating. Maybe we could all volunteer our hands for X-ray, and see how many of us are carrying around old fractures of our phalanges, carpals, metacarpals, and sesamoids. I have a feeling that many of us would turn up positive for Big Squeeze Syndrome.