May, 2007 Archive

May 21, 2007, 9:26 pm

Nurse Retention: Say It If It’s Worth Savin’ Me


“Mommy, where do nurses come from?”

“Why dearest, they are grown in cala lillies and when their caps are totally formed they are picked for hospitals.”

“But the caps are all different!”

“Yes, Davy. Each variety has a different cap. You know where they were grown by what their cap looks like.”

“But mommy, how can you tell a boy nurse from a girl nurse?”

“Go ask your father….”


Shameless self-promotion: my column on nursing history is up at Nursing Jobs. org. This is the link to the blog itself, so you can check out my writing colleagues, too!


How important is it to you to have positive feedback about your job?

I don’t mean the yearly evaluation that wants to know if you meet the “Mission Statement”, or evaluates how Joint Commission compliant you are. You know the kind. Check boxes. “Meets Standards.” “Exceeds Standards.”

(I’ve never “exceeded” a single standard. Oh, I “meet” them, but the only areas I’ve ever “exceeded” in are customer service and charting. Customer service is probably because I actually like my patients. The charting is only because I’m anal-retentive with my writing. Lord help those who mess with my charts…)

I’m talking about the “Great job!”, “Nice catch!”, “Good show!”, “You rock!”, “Have you lost weight?” sort of feedback.

Okay. I’m kidding about the losing weight.

But really.

Do you need to hear that you are doing a good job?

Does it matter who gives you the feedback?

Is it more important to hear it from your manager, as opposed to a doctor or a colleague?

And are you more likely to stay in a job if you receive external recognition?


I believe it has to do with the individual.

If someone has less experience in a position, they need more feedback on how they are doing. That feedback could be positive or negative, but it’s the only way to know if the requirements of the position are being met.

To someone with more experience, there is an intrinsic knowledge of a job well done. It has been my observation that someone with experience is more likely to hear when they aren’t performing up to par than to hear kudos when they perform as expected.

Then there are the “off” shifts. Many shifts don’t even see their manager, let alone get feedback on a regular basis.


That’s where our co-workers come in. It’s up to us to give each other feedback. That pat on the back for a difficult IV start. Recognition that the rapport with an angry patient diffused a potentially violent situation. A few high-fives in the break room after a particularly horrendous shift. Some time to recuperate after the death of a patient.

Managers certainly want to support their staff and if you need feedback you can always ask for a conference.

But for me personally, when all said and done it isn’t manager feedback that “retains” me.

What is important is the support of our colleagues, and the occasional “Good work!” from someone who understands the pressures of the job can mean more than any check mark on an evaluation six months hence.

It’s the support, camaraderie and respect that develops between colleagues on a unit that generates the positive feedback that “retains” nurses. We need to take care of each other. No one else knows the pressures we are under.

Foster that supportive environment and you will keep nurses forever.

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May 20, 2007, 11:14 am

The Wong-Baker Pain Scale: It Works!


I just have one question.

Why would anyone take a perfectly good cap and ruin it with an over abundance of stripes?

You could play tic-tac-toe on these caps.

I also had another thought (my brain is smokin’ !). Two thoughts in a row on a Sunday morning!

Every time I see a nurse in an ad, they are taking something for a headache.

What message did that send out to all the young people of the time?

Be a nurse, suffer from “nerves” and a headache, receive drugs from your co-worker and get back out on the ward.

Cherry Ames never needed Bromo-Seltzer.

I’ll admit there are shifts where an aerosol form of Ativan would be nice……


Man, it’s a really good thing I’m not watching American Idol this year, or I would be totally ticked that Blake is in the top two. But I don’t care because I’m not watching it! (Okay, I did watch when Barry Gibb was on…sigh!)


Isn’t it ironic (doncha think…): I waited all year for National Nurses Week to wear my cap. Last year my hubby got sick and I was off work. This year I was on jury duty the two days I would have worn it. Somebody does not want me in that cap!


It is time to throw the verbal pain scale out the window.

There is nothing wrong with the idea of a patient rating their pain . We are all different in our ability to tolerate pain. (I have a huge tolerance for pain…unless it is dental pain, whereupon I become a whimpering puppy.)

This week I sat with a trauma patient who shattered/demolished both ankles. When she rated that pain a 7/10, I was dumbfounded. No one believed that she could only be a 7/10!

I am usually trying to make myself believe my patients are the 10/10 they describe as they talk on their cell phone and joke with their friends.

I began to question the utility of the verbal pain scale.


I’m not saying I don’t trust my patients’ truthfulness when describing their pain.

I don’t think patients understand the pain scale.

Ideally, a patient is supposed to rate their current pain when compared to the worst pain they’ve ever experienced. And yet, when I presented to the emergency department for chest pressure a year ago, I rated my pain an 8/10.

I’d had headaches that hurt worse, and yet that particular discomfort as it stood alone was an 8/10. It was a different sort of pain and I rated it without comparison to any other type of pain.

And I was able to joke and talk with the staff while I was having it. Give me a headache that is 8/10 and I am in a dark room with an ice bag on my cranium.

If a health care professional who deals with the pain scale every day could not intellectually compare the intensity of two different types of pain, how can we expect our patients to do it?



So I say drop the verbal pain scale.

Ask the patients to rate their pain using the Wong-Baker pain scale (no matter what their age). I often see adults looking to the visual scale on the wall before rating their pain.

It is amazing how well having a visual representation works for patients who need an easy understanding of what rating their pain really means.

Like yours truly, who would have rated her pain a 3/5 (or 6/10) using the above scale.

Our scale at work uses the Wong-Baker scale up to ten (with the odd numbers in between the faces).

The Wong-Baker pain scale. It isn’t just for kids anymore.

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May 17, 2007, 8:05 am

Change of Shift: Vol. 1, No. 24


…is up at Nurse Ratched’s Place!

The theme revolves around TV nurses and I’m heading over there right now to start my “channel surfing”!

Many thanks to the always entertaining Mother Jones for hosting this week.

Next week CoS will be right here, so as of now all submissions can be sent to me via my contact button or Blog Carnival.


And don’t forget to check out today’s column at Nursing Mother Jones dons her real persona as Terri Polick in her column “Follow the Leaders“.

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About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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