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

by Alexandra Robbins

  stay is shorter . . . error is lower. See, for example, Rebecca Hendren, “Nurse Staffing Costs Must Be Weighed Against Cost of Errors,” HealthLeaders Media, August 30, 2011.

  the fewer the nurses, the higher . . . Jeannette Rogowski et al., “Nurse Staffing and NICU Infection Rates,” JAMA Pediatrics (May 2013).

  hospitals could earn . . . and fewer tests. See, for example, Linda H. Aiken, “Investments in Nursing . . .”

  in poor nurse working environments . . . saved every year. Linda H. Aiken, “Investments in Nursing . . .” In correspondence with the author, Aiken, a leading nurse researcher, clarified that “frequently” is defined as “once a month or more often.”

  “the single most critical . . .” “HCAHPS: Hardwiring Your Hospital for Pay-for-Performance Success,” Studer Group webinar, 2011.

  check in with patients every hour Ibid.

  “The Most Bang for Your Buck” Ibid.

  “to promote higher quality . . .” Federal Register, Department of Health and Human Services 76, no. 160, August 18, 2011.

  “building a culture of healthcare excellence” Disneyinstitute.com.

  Chapter 7

  “I will abstain . . .” Florence Nightingale Pledge at the American Nurses Association: http://nursingworld.org.

  “It’s insanely easy . . .” Interview.

  “one of the most devastating . . .” See, for example, T. Monroe, “Addressing Substance Abuse Among Nursing Students: Development of a Prototype Alternative-to-Dismissal Policy,” Journal of Nursing Education (May 2009).

  “code of silence” Interviews; see also, for example, Debra Dunn, “Home Study Program: Substance Abuse Among Nurses—Defining the Issue.” AORN Journal (October 2005).

  “don’t talk rule” Debra Dunn,

  “bend rules or . . . can be difficult.” Ibid.

  nurses worry that . . . Ibid.

  quick to stigmatize . . . Ibid. See also “Substance Use Disorder in Nursing,” National Council of State Boards of Nursing, 2011.

  “Society, in general . . . grandmother’s pain pills.” Ibid.

  army medical center nurse . . . hepatitis C. Darren Meritz, “Former Nurse at Beaumont Army Medical Center Given 3½ Years,” El Paso Times, December 2, 2009.

  Nurses across the world have stolen narcotics See, for example, Clair Weaver, “Nurse Stole Pills off Elderly,” Sunday Telegraph (Australia), August 10, 2008; Myra Philp, “Missing Drugs: 6 Nurses Axed; Staff Suspended in Morphine ‘Theft’ Probe,” Sun, August 17, 2009.

  replaced or diluted it . . . during surgery See, for example, “Fentanyl Replaced With Saline Solution During Surgical Procedures,” US Fed News, November 29, 2006; Pat Grossmith, “Indictment: Nurse Diluted Drugs,” Union Leader (Manchester, NH), July 18, 2008; Roxanna Hegeman, “Kansas Nurse Gets 3 Years in Drug Tampering Case,” Capital-Journal, February 3, 2012; “Nurse gets 3 years for drug tampering,” Capital-Journal, February 25, 2012; “Woman Sentenced to Probation for Stealing Painkillers,” August 6, 2005; “Pain Medication Thefts: Nurse’s Drug Problem Was Recorded,” Daily Camera (Boulder, CO), July 9, 2009.

  nurse at a nursing home . . . for her migraines. “Former care home worker is struck off nursing register,” Wells Journal, April 28, 2011. She was accused of killing other patients, but was cleared. See “Nurse accused of murdering two of the elderly residents she was stealing drugs from.” Wells Journal, January 28, 2010.

  6 to 8 percent of nurses Author correspondence with an ANA representative. Also see, for example, Cynthia Clark and Judy Farnsworth,“Program for Recovering Nurses: An Evaluation,” Medsurg Nursing (August 2006). See also Patricia Welch Dittman, “Male Nurses and Chemical Dependency: Masterminding the Nursing Environment,” Nursing Administration Quarterly (October–December 2008); Madeline Naegle, “Nurses and Matters of Substance,” NSNA Imprint (November–December 2006).

  same rate as the general population See, for example, Thomas Zambito, “High Anxiety in Hospitals: Nurses in Drugs, Drink Crisis,” Daily News (NY), March 14, 2004; “What To Do When Confronting an Impaired Colleague,” Medical Ethics Advisor, June 1, 2005.

  between five and 100 times greater. T. Monroe, “Addressing Substance Abuse Among Nursing Students: Development of a Prototype Alternative-to-Dismissal Policy,” Journal of Nursing Education, May 2009.

  skilled, achieving, respected See, for example, Matthew F. Shaw et al., “Physicians and Nurses with Substance Use Disorders,” Journal of Advanced Nursing 47, no. 5; Jane Hedrick; Debra Dunn.

  67 percent of nurse anesthesia students . . . the bottom third. Jane Hedrick and Stephanie Luck, “The Alarming Trend of Substance Abuse in Anesthesia Providers,” Journal of PeriAnesthesia Nursing (October 2004).

  “intelligent, calm”. . . from their supervisors. Patricia Welch Dittman.

  “believe they have the knowledge” Jane Hedrick and Stephanie Luck.

  are much more likely . . . downward spirals in time. See, for example, Debra Dunn.

  ER, OR, PACU . . . cope with these traumas. Ibid. See also “Substance Use Disorder in Nursing.”

  “who enjoy a high degree” http://www.aana.com/ceandeducation/becomeacrna/pages/default.aspx.

  may be even more vulnerable . . . at more than 15 percent. Jane Hedrick and Stephanie Luck.

  “they’re playing with rocket fuel . . .” Interview with Art Zwerling by Eaves. Some researchers have suggested that “exposure to trace quantities of these agents in the workplace sensitizes the reward pathways in the brain and promotes substance abuse.” Heather Hamza and E. O. Bryson, “The Drug Seeking Anesthesia Care Provider,” International Anesthesiology Clinics 49, no. 1 (2011).

  Jan Stewart, a CRNA . . . a friend to all.” http://www.aana.com/resources2/health-wellness/Pages/Jan-Stewart-In-Memoriam.aspx.

  back pain so intense . . . Sarah Ruth Gomes, Foreword, in Paula Davies Scimeca, Unbecoming a Nurse: Bypassing the Hidden Chemical Dependency Trap. Sea Meca, 2008.

  died at age 50 . . . www.aana.com/resources2/health-wellness/Pages/Jan-Stewart-In-Memoriam.aspx.

  opioid hundreds of times . . . See, for example, M. A. Clotz and M. C. Nahata, “Clinical Uses of Fentanyl, Sufentanil, and Alfentanil,” Clinical Pharmacology (August 1991).

  That’s how many nurses . . . See, for example, Blythe Bernhard, “On Drugs, on Duty: Doctors, Nurses with Easy Access Can Be Vulnerable to Addiction.” St. Louis Post-Dispatch, March 26, 2008.

  . . . get most easily See, for example, Jane Hedrick and Stephanie Luck. See also “Substance Use Disorder in Nursing.”

  . . . abuse them more often See, for example, A. M. Trinkoff et al., “Workplace Access, Negative Proscriptions, Job Strain, and Substance Use in Registered Nurses,” Journal of Nursing Research (March–April 2000).

  Doctors’ substance abuse . . . Ibid.

  the nurses’ familiarity . . . the general population. See, for example, A. M. Trinkoff et al.

  tend to get sicker . . . See, for example, Blythe Bernhard.

  take patients’ doses . . . gave only one. See, for example, Brandi Watters, “Prescription Pill Abuse Surpasses Street Drugs,” Herald Bulletin (Anderson, IN), January 26, 2010; Debra Dunn.

  might sign out drugs See, for example, Anne Geggis, “2 Lose Nursing Licenses Over Missing Drugs,” News-Journal (Daytona Beach, FL), April 1, 2006; Debra Dunn,

  can steal prescription pads . . . didn’t actually give See, for example, Blythe Bernhard.

  or otherwise falsify hospital records See, for example, “Seattle Nurse Pleads Guilty to Unlawful Theft, Diversion of Controlled Substances,” US Fed News, May 19, 2009.

  take advantage when coworkers . . . Interviews; See, for example, David C. Shampine, “Nurse Charged with Supporting Her Vicodin Addiction with Forged Electronic Prescriptions,” Watertown Daily Times (NY), June 8, 2012.

  ate the gel . . . placebos Robin Stein, “Did
Nurse Take Patients’ Painkillers?” St. Petersburg Times (FL) South Pinellas Edition, December 3, 2005.

  “Often, it’s our best people” . . . “What to Do When Confronting . . .”

  don’t necessarily act immediately See, for example, Jason Blevins, “Addicts in Health Professions Flock to Get Peers’ Help,” Denver Post, July 23, 2009.

  “should incorporate prevention . . .” Interview with AACN spokesman.

  AACN doesn’t monitor whether schools comply. Interview with AACN spokesman, who said there is too much variability between nursing programs to comment further.

  “enables an abusing nurse . . . there was a problem.” Debra Dunn.

  license suspension . . . penalties are possible. See, for example, S. Trossman, “Nurses’ Addictions: Finding Alternatives to Discipline,” American Journal of Nursing 103 (September 2003).

  again work in healthcare See, for example, “Nurse Gets 3 Years for Drug Tampering.”

  Nursing boards are . . . out of the field. Debra Dunn.

  “The good news is . . . problem it becomes.” Interview, Al Rundio.

  Los Angeles Times and Pro Publica investigation . . . “impose discipline.” Tracy Weber, Charles Ornstein, and Maloy Moore, “Loose Reins on Nurses in Drug Abuse Program,” ProPublica and Los Angeles Times, July 25, 2009.

  California eventually imposed stricter rules Tracy Weber, Charles Ornstein, and Maloy Moore, “California Adopts Stricter Rules for Drug Abusers in the Health Industry,” ProPublica, November 20, 2009.

  ended an anonymous . . . surgeries. See, for example, Blythe Bernhard.

  forty-one have non-disciplinary . . . “Discipline/Continued Competency/Assistive Personnel Practice,” National Council of State Boards of Nursing.

  fewer resources than doctors . . . severe professional sanctions. See, for example, M. F. Shaw et al., “Physicians and Nurses with Substance Use Disorders,” Journal of Advanced Nursing 47, no. 5 (2004). Despite the discrepancies between services for nurses and physicians, by focusing on treating a healthcare professional and getting her back to work, these programs at least encourage more people to seek help, rather than to continue to cover up their abuse and put patients at risk by working while under the influence.

  “The rate at which nurses . . . representation.” Ibid.

  fewer than 1.5 percent of nurses See Cynthia Clark.

  140,000 nurses . . . what they’re doing. Interview with Douglas McLellan by Eaves.

  compassionately mentioning the topic See, for example, “What to Do When Confronting . . .”

  “The best recommendation is . . .” Interview with Julie Rice by Eaves.

  “It is every nurse’s responsibility . . .” “ANA Unveils Bill of Rights for RNs,” American Nurses Association, cited in Debra Dunn.

  legally responsible to turn in . . . See, for example, Jane Hedrick and Stephanie Luck.

  “the nurse becomes [the] nursed.” See Patricia Welch Dittman.

  Chapter 8

  “Nurses are frequently put” The American Nurses Association’s Code of Ethics For Nurses.

  “Somewhere along the line” Interview.

  “So many things are just simply . . .” Interview.

  “on day one new interns . . .” Robert S. Huckman and Jason R. Barro, “Cohort Turnover and Productivity: The July Phenomenon in Teaching Hospitals.” NBER Working Paper Series 11182, National Bureau of Economic Research.

  “The July Effect” . . . in August. See, for example, John Q. Young et al., “‘July Effect’: Impact of the Academic Year-End Changeover on Patient Outcomes: A Systematic Review,” Annals of Internal Medicine, September 6, 2011.

  harms patient care . . . hospital stay. Ibid.; See also Robert S. Huckman.

  U.S. death rates . . . 2,750 deaths. Robert S. Huckman.

  “spike by 10 percent in July” David P. Phillips and Gwendolyn E. C. Barker, “A July Spike in Fatal Medication Errors: A Possible Effect of New Medical Residents,” Journal of General Internal Medicine (August 2010).

  August mortality rates See, for example, Simon Rogers, “Will Patients Really Die This Week Because of New NHS Hospital Doctors?” The Guardian (London), August 1, 2012.

  “beyond their capabilities.” Rebecca Smith, “Thousands of Juniors Start Jobs in NHS ‘Killing Season,’” Telegraph (London), August 1, 2012.

  in English hospitals . . . previous Wednesday. M. H. Jen et al., “Early In-Hospital Mortality Following Trainee Doctors’ First Day at Work,” PlosOne.org, September 23, 2009.

  “Nurses are correcting . . .” Interview.

  not the problem here Interviews.

  “I have had doctors . . .” Interviews.

  25 percent of the hospitals Author correspondence with American Hospital Association spokesperson.

  checking the “About Us” page Author correspondence with Association of American Medical Colleges spokesperson.

  “My reflex was as if . . .” Interview.

  “box shape . . .” Interview.

  “tell you the truth.” Interview.

  “Sometimes physicians practice . . . but staff knew.” Interviews.

  . . . wagered on patients . . . arriving via ambulance. Interviews.

  “games of chance . . .” See, for example, R. T. Penson et al.

  Different “codes” mean . . . Interviews.

  Some hospitals further . . . Interviews.

  Mr. Firestone . . . unresponsive patient Interviews.

  Ohio’s Cleveland Clinic . . . take it easy. Interview, Rev. Amy Greene. See also, for example, Carolyn Gregoire, “The Amazing Way This Hospital Is Fighting Physician Burnout,” Huffington Post, December 2, 2013; Katie Sullivan, “Hospitals Try Holistic Approach to Treat Docs’ Stress, Burnout,” FierceHealthcare.com, December 3, 2013.

  Cleveland Clinic’s healing . . . in times past. Ibid.

  Code Brown . . . a break to eat. Interviews.

  “Parents call to ask . . .” Interview.

  several props . . . down hospital hallways. Interviews.

  Plenty of nurses admit . . . “something with poop.” Interviews.

  occasionally use larger needles . . . Interviews.

  If breaking a rule . . . Interviews.

  “. . . few rings is a mistake.” Interview.

  personal interaction is against policy Interview.

  “We are working fourteen to sixteen hours” Lois Berry.

  without a strong support system. Interview.

  Even if I haven’t. See Michelle Crouch, “50 Secrets Your Nurse Won’t Tell You,” Reader’s Digest, November 2011.

  “We usually know the results . . .” Interview.

  toilet humor . . . Interviews.

  “Nurses are gross.” Interview.

  “happens all the time.” Interviews.

  The most common . . . plan of care. Interviews.

  “. . . lose-lose scenario.” Interview.

  “and not really. . . . counts the same.” Interview with Arthur Caplan.

  If there is time . . . choose differently. Interviews.

  slow codes Interviews.

  “There are lots of unsavory . . .” Interview.

  “Code 55” Interview.

  Some physicians will unofficially call . . . Interviews.

  “Responders literally walk” Interview.

  “It’s often for the sake . . .” Interview.

  “not ethically appropriate” Interview.

  “. . . as comfortable as possible.” Interview.

  Respectful patients might get . . . Interviews.

  “I’m always happy . . .” Interview.

  “rest assured that every single . . .” Interview.

  Many hospitals also treat VIPs . . . Interviews.

  John’s Hopkins Marburg Pavilion. www.hopkinsm
edicine.org/the_johns_hopkins_hospital/planning_visit/room/marburg_enhanced_amenities_program.html.

  Nurses described accommodations . . . “because they aren’t famous.” Interviews.

  “The doctor is at your bedside . . .” Interview.

  “Half of the hospital is unavailable . . .” Interviews.

  If a hospital’s technicians . . . “it can be bad.” Interviews.

  Nurses have strong opinions . . . Interviews.

  “Studies show that patients . . .” Interview.

  patient with a history Interviews

  If you say something . . . “getting better service.” Interviews.

  “Sadly, doctors and doctors’ offices . . .” Interview.

  “If I could talk to” Interview.

  nurses do cry . . .“home from work.” Interviews.

  don’t portray hospital . . . “make orders, and leave.” Interviews.

  “make their rounds in the morning.” Interview.

  patients who survive . . . “Even in a hospital.” Interviews.

  “Doctors and nurses”. . . she has insurance. Interviews.

  “After that talk . . .” Interview.

  appreciate the fragility . . . “holy profession.” Interviews.

  California nurse Jared Axen Interview.

  transplant nurse Allison Batson Alicia Tejada, “Atlanta Nurse Donates Kidney to Hospital Patient,” ABCNews.com, January 17, 2012; Helena Oliviero, “Nurse Donates Kidney to Patient,” Atlanta Journal-Constitution, January 29, 2012.

  Batson saved his life . . . to help people. Interview with Clay Taber.

  Chapter 9

  “Nursing is a calling” See, for example. www.hhsnalumnae.org/TheNightingaleTribute.pdf.

  “Nurses are the glue” Interview.

  At six feet two inches . . . “sisterhood without any issues.” Interviews with Dean Visk.

  330,000 are male U.S. Census Bureau, “Men in Nursing Occupations: American Community Survey Highlight Report,” February 2013.

  41 percent of CRNAs are male Ibid.

  lingering public stereotypes Interviews. See also Eve Tahmincioglu, “Men Are Much in the Sights of Recruiters in Nursing,” The New York Times, April 13, 2003.