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

by Alexandra Robbins

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

  Use first names.

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

  Prioritize security.

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

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

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

  Talk about substance abuse.

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

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

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

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

  For the public

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

  Appoint one family spokesperson.

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

  Ask questions.

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

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

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

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

  Be prepared.

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

  Your hospital is not as clean as it could be.

  Bring hand sanitizer and antibacterial wipes. Use them.

  Stay with the patient.

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

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

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

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

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

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

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

  Understand that a nurse’s schedule is complicated.

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

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

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

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

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

  Write to the administration about your care.

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

  For aspiring nurses

  Nursing is the fastest-growing occupation in the country, according to the Bureau of Labor Statistics. Between 2014 and 2022, the United States will create 574,000 new jobs for nurses, many of them in the growing sectors of home health services and outpatient centers. The field needs more smart, dedicated workers. “The profession is exciting and fulfilling. This is a tremendously fabulous time for nurses because of the vast opportunities that exist,” said Terri Weaver, dean of the University of Illinois College of Nursing.

  This book describes some negative issues in nursing in the hopes that readers will lobby hospitals and lawmakers to fix these problems. But it is crucial to know that despite these issues, nurses love their jobs and will enthusiastically persuade potential recruits to join the field. Please read the nurses’ testimonials at the end of this chapter to learn more about the rewards of the job.

  One resource for aspiring nurses is Johnson & Johnson’s Campaign for Nursing’s Future. The campaign, which focuses on recruitment and retention of nurses and nurse educators, aims to “make nurses feel really good about what they do,” said a spokesperson, and raises funds for scholarships, fellowships, and grants. The campaign’s website, Discovernursing.com, offers steps to take to become a nurse, day-in-the-life videos, career development help, and other interactive tools for nursing students and managers.

  For additional advice for aspiring nurses, I asked several nursing school deans what they tell their students and new graduates. Here are some of their tips.

  Know your options.

  Nursing is a practically limitless field. “Choosing nursing as a profession means that you will have career choices for a lifetime without changing professions,” said Joan Shaver, dean of the University of Arizona College of Nursing. “We practice everywhere—hospitals; retail clinics; community centers; home care; urgent care; hospice; in the military, corporations, and government; in the air, on the water, on the road, on the Web; and more.”

  Nurses can also work as scientists, engineers, policy makers, lawyers, researchers, professors, administrators, and businesspeople. “As you learn the basics of nursing practice, observe and learn about where nurses work, their opportunities and impact, and what patients need in each. Your preferred forte will emerge,” Shaver said.

  In a hospital, shadowing on various floors “gives you a chance to see how the nurses interact with each other and physicians,” said the Oklahoma nurse supervisor. “We have senior nursing students who will work as nurse techs and float to different floors to check them out. There are so many different job opportunities for nurses that it helps to take some time at the beginning and check out different options.”

  Kathleen Potempa, dean of the University of Michigan School of Nursing, recommended that all aspiring nurses “consider no less than a baccalaureate program, which is now required for work at many top hospitals and clinics,” she said. “Studies show that baccalaureate-prepared nurses are first in line for jobs, are best prepared for the challenges of the field, and are exposed to a wide range of options for learning and research.”

  Nursing involves more than you might have thought.

  Students commonly arrive at nursing school expecting to learn about performing certain tasks. “They have the same perception as the public, that nurses ‘do things’ to people. That’s actually only a very small part of what nurses do,” said Bobbie Berkowitz, dean of the Columbia University School of Nursing. “Most of nursing involves thinking critically, understanding the human condition and how people respond to illness and health, being a mediator, helping people understand what’s happening, and minding the environment and the technology. These are skills that are often hidden from the public. We try to help students understand that nursing is more than giving an injection. It’s a lot more complex than that.”

  Never stop learning.

  For nurses, learning is a lifelong goal, said Mary Kerr, dean of the Frances Payne Bolton School of Nursing at Case Western Reserve University. Linda Norman, dean of the Vanderbilt University School of Nursing, agreed. “Be avid readers of the latest evidence out there related to healthcare delivery in your practice. You don’t stop that reading and learning when you graduate. To be a great nurse, you’ve got to be able to know what is the best evidence for the care that you’re providing,” Norman said.

  Be a team player.

  “We’ve got to get away from the doctor–nurse game. Today’s world of healthcare is all about teams; nurses work with a lot of other decision makers,” Norman said. “Nurses need to be comfortable in their own professional skin, and we’ve got to b
e able to appreciate everybody. We have to be able to appreciate the physicians’ position, but they’ve got to be able to appreciate nursing and that the nurse’s role has changed drastically over even the last five years.”

  On giving advice . . .

  “Never give advice unless it’s asked for and always give it when it is,” said Judith Karshmer, dean of the University of San Francisco School of Nursing and Health Professions. While some nurse faculty members tell students never to give advice to families or patients, Karshmer had a different take. “People take advice from a lot of different sources. When patients or family say, ‘What do you think I should do?’ if they are asking for expertise from a nurse, it is your responsibility to provide that.”

  For nurses

  Find your A-team.

  “The best coping resource is my fellow nurses. We are dragged through the mud together during these tragic events; who better to debrief with? And my boyfriend, who listens to me go on and on, particularly after a really hard shift,” said a New York pediatric ICU nurse. “I think that’s one of the most important things for a nurse. You need to figure out who your A-team is outside of work and allow yourself to rely on them, because you can’t hold this stuff inside your chest forever.”