November, 2011 Archive

November 16, 2011, 9:02 pm

A Message From “Rank and File, RN”

Looks like Mr. Administrator has some ‘splainin’ to do!

And I suggest he be straight with my colleagues, because a nurse can sense BS before it is even spoken.

I am not in management, and I never will be.

No, I am one of the “rank and file.” And right now, this member of the “rank and file” is hotter than hell.


What set me off?

A comment in a post on the Health Leaders Media website, entitled Top 5 Challenges Facing Nursing in 2012. The article, written for nursing management, refers to nurses as “rank and file caregivers” and disparages their understanding of the importance of the “patient experience” to reimbursement:

If you haven’t found a way to drive home the importance of patient experience to direct-care nurses, find it now. You know how much reimbursement is at stake, but the rank and file caregivers still don’t get it.

The author goes on to state:

In fact, the nurse-patient relationship has always been about patient experience…Your best nurses instinctively know this. They already create a good patient experience. They help patients understand their care, involve families in decision-making, coordinate multidisciplinary care, sit with patients to explain complex diagnoses, and even, occasionally, have time to offer a quick hug or hand to hold.

What? This is like punching someone in the face and then offering a compliment.

I have a revelation for you – we all know it. We understand what the requirements are for a “good” patient experience and it is what we have been doing as nurses since the dawn of time.

Since “the nurse-patient relationship has always been about patient experience,” why is this a “challenge” at all? This is nursing care, and always has been!

Why are administrations freaking out now that patients will be evaluating their nursing care?

Suddenly, all these new programs are flying into place. Educate! Communicate! Medicate! Smile!

What do you think we, oh, excuse me, the “rank and file caregivers” have been doing all this time?


Let me tell you what the “rank and file caregivers” have to deal with in terms of the “patient experience”.

There is a hospital in my area that has switched their meal service into something that looks, and tastes like the old airplane food from the 1970s. It comes in segmented cardboard trays and is microwaved.

As you can imagine, these meals are not popular with the patients. They give the meals poor scores on the satisfaction surveys.

At a recent meeting, the “rank and file caregivers” were lectured by the food service department that these low scores were the fault of the caregivers for not presenting the food in a pleasing manner, laying it out nicely on the table, and describing it with glowing adjectives.

That’s right, the same “rank and file caregivers” who are managing complex medical problems on multiple patients, coordinating multidisciplinary care, educating patients and family on medication side effects and complex diagnoses and documenting until their fingers are numb were lectured for their lack of culinary presentation skills.

Who is running the freaking show, Gordon Ramsay?

No wonder morale is in the toilet.


Well, I’m off to take my blood pressure meds, and maybe some Ativan.

All I can say is this “rank and file caregiver” is going to keep on doing what she has been doing for over 30 years. They can call it “patient experience” or HCAHPS, or give it any project title they want.

I call it good nursing care, and the patients will finally have a say in what that means.

Don’t worry, admins, if your bottom line depends on the nurses, it’s gonna be alright.

Rank and file, RN, signing off.

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November 14, 2011, 8:41 pm

Blog World Sessions Online!

Get in on BlogWorldExpo!Couldn’t make it to BlogWorld Expo in LA this month?

Wish you could have been in the front row of each keynote, attended every session, had a chance to hear the superstars of the blogosphere?

Me, too! There were sessions I missed!

This is year is different – over 100 sessions of Blog World New Media Expo 2011 are available online through the new Blog World Virtual Ticket!

This means you can still “attend” the same conference that was held in LA for a fraction of the cost!

This includes all the Social Health sessions, including the HIPAA session I co-presented with Jamie and Terri and the fantastic Whiteboard session.

You can get all the information by clicking on the widget in this post or the link above, they will take you to the Blog World Virtual Ticket page.

(I’m a Blog World affiliate gal, so if you buy through the link/widget I receive a percentage.

Not enough to make me rich, but hey, anything will help get me back to Charlotte Motor Speedway for the NASCAR All-Star Race and the Coca-Cola 600 in 2012.

Kasey Kahne tends to win when I’m there.

Just sayin’.)

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November 11, 2011, 8:53 pm

50 Nursing Secrets? 48/50 Ain’t Bad….

I’m using my favorite ad council promo, the one that made me realize that I was damn proud to be a nurse.

Because right now I don’t feel like posting something funny, or cute.

I need to see this ad again.

Having a bit of a burnout/compassion fatigue/why-the-hell-am-I-still-working-in-ER-at-my-age life crises.

Been there, done that a few times.

A case manager is in this ER nurse, why is it invisible on my resume?

Feel like chucking it all and moving to Portland and being a totally cool full-time grandmother who takes her grandson to all the NASCAR races…

Okay, he isn’t born yet, but you get the idea.


Reader’s Digest has published an article, “50 Secrets Nurses Won’t Tell You“. The link will take you to the article itself, and Sandy Summers has written a review of the article at The Truth About Nursing.

There are some interesting “secrets” here – and you’ll recognize a few of the names!

Gina from Code Blog is in there, and so is Jo from Head Nurse!


I’ll be the first person to tell you that I am not a perfect person, and not a perfect nurse, but two of these “secrets” really ticked me off.


The first one:

3. “Feel free to tell us about your personal life, but know that we’re here for 12 hours with nothing to talk about. So the stuff you tell us will probably get repeated.” A nurse in St. Petersburg, Florida


I have steam coming out my ears.

Maybe my colleague works in a thumb-twiddling clinic, but we have plenty to talk about in my emergency department. We talk with the patients, not about them, and we are too busy hauling our derrieres around to gossip. When we do, finally, have a chance to sit down, the last thing we think about are the personal lives of patients, unless it directly affects their care.

But thanks, now everyone who reads this “secret” thinks that nurses are lazy asses who have nothing to do but gossip on their 12-hour shift.

Good stuff.

Remind me to stay away from St. Petersburg…

4. “A lot of my patients are incontinent, and I’m supposed to just use a wet washcloth to clean them. But if it’s a patient who’s been really nice and appreciative, I’ll go all the way to intensive care to get some of the heated wet wipes, which are a lot more gentle. Somebody who’s constantly yelling at me? I just use the washcloth.” A nurse in St. Petersburg, Florida

So… excellent patient care is only given to those who “deserve” it. Everyone else gets “good enough.” Got that, general public?

They didn’t teach me that in nursing school, good thing this “secret” filled me in.

For anyone in the general population who is reading this – these are not nursing “secrets”. These are descriptions of the personal practices of one nurse. I read all 50 secrets and I’ll go with the other 48.

Rest assured, your personal life is not customarily dismantled at the nursing station and your care is not based on your disposition.

Nurses are too damn busy to gossip and too damn professional to base your care on how nice you are.

I guess 48/50 ain’t bad.

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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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