April 16, 2009, 6:36 pm

Don’t Tread on My Conscience

mdpracticeyellAh, here we see the interns taking notes during “Nurse Abuse 101”.

It seemed to be a popular elective for those doctors of the Marcus Welby era.

He was only nice to Consuelo, he yelled at everyone else.

And eighty per cent of you have no idea who I’m talking about!


I feel like I should go put in my teeth and hearing aids.

I’m not sure if I just got old and doctors now defer to my age, but with very few exceptions, you don’t hear the ranting and screaming you did in the 70s and 80s.

From the doctors.

I now rant and scream on a regular basis.

Go figure.

(Photo credit: The nurse is named Judy Strickland and the photo was taken in New York by photographer Grey Villet for Life Magazine, September, 1971)


UPDATE: The following is supposed to be an opinion piece on how I feel about the possible rescinding of the Conscience Clause.  I could have just said, “I think rescinding the clause sucks”, and left it at that. Instead, I tried to be “artistic” about how I said it.  Now, the terms “weasel” and “Nazi” are being found in association with this post.

I’d like to make one thing clear.  In thirty one years I have never refused to care for a patient.  EVER. I do not judge my patients. EVER. And everyone wants to know what I’d refuse to do, well, let me just be blunt:  I would never actively participate in the process of an abortion.


The elephant in the room has been named.  It’s the only thing I’d ever have to excuse myself from.

And it has never come up in thirty one years of nursing.  And it never will because knowing that I feel the way I do, I have steered clear of fields where that would be an issue.

I guess I need a class in writing, because what I wanted to say apparently has left people thinking I run around with my Christian nose in the air judging everyone around me and refusing care at random based on my moral whims.

Now I guess I’ll get hit for using the “A” word.

That’s what I get for putting religion and politics in a post.

Won’t happen again.

The post remains below as originally written.


To my patients,

When you present to my hospital for care, you have my utmost respect.

As a person.

As an individual.

Your race, color, religion, sexual orientation or medical issues make no difference in the quality of care I will give, or the compassion you will receive.

You see, I respect you.

Your right to live your life as you choose.

Your right to love who you choose to love.

Your right to make the decisions you choose to make.


I also have rights.

As a person.

As an individual.

The right to my own beliefs.

Personal, religious and political.

Sometimes, my personal beliefs will not mesh with yours.

There might be an occasion where I cannot participate in an aspect of your care that results from a decision you have made.

To do so would be to violate my deepest convictions of what is moral. Or just. Or right.


I’ll state this directly.

I have religious beliefs that might preclude me from active participation in certain aspects of your medical care.

This is not a condemnation of you, my patient.

You have the right to act in accordance with your beliefs.

I can respect that right.

And I have the right to act (or not act) in accordance with mine.

Ah, there’s the rub.


For you see, my patient, that you have options.

If I cannot help you in the way you desire,

If your request would cause me to deny my deepest belief system,

I cannot act.

But I can, and will, give you all the information you need or request, withholding nothing,

So that you are able to find a health care provider or facility that can help you.

And I do it without judging, trying to dissuade, persuade or throwing a guilt trip in your path.

You have options.

I do not.


You, my patient, have the option of finding a health care provider who can help you.

Of being true to yourself.

And I can assist you in doing that.

Happily and without judgment.

I do not have the option of acting against my belief system.

I do not have the option of being untrue to myself.


You see, my patient, you can get what you need from many different places and from many different providers.

You have the right to do that with a clear conscience.

I have to look at myself in the mirror every morning.

I have the right to do that with a clear conscience.

Or, I did.

Until now.


I was protected by the Conscience Clause.

President Obama is considering reversing some of its provisions.

I can live my values and allow you, my patient, to live yours.

I’ll even help you get to where you need to be.

My patient, I fight for your rights.

Your right to do as you choose, live as you choose.

Access medical care as you choose.

Who is fighting for my rights?


Think what you will about the economy.  The stimulus package. The War on Terrorism, where ever it is being fought today.

But, Mr. President, you rescind that clause and you destroy part of a fundamental American right.

My right.

To the freedom of religion.

What comes after that, Mr. President?

What right of mine will you chisel away next?


I cannot, nor will I, ever pass judgment on my patients.

I fight for their right to make their decisions that affect their health care, whether I am in agreement or not.

So, who is fighting for my rights?


I’m listening.

Mr. President.


UPDATE:  I’m getting some interesting feedback and thought I would link back to them, both pro and con!

5:22 am

Change of Shift: Vol. 3, Number 21


Welcome to Change of Shift, the blog carnival by nurses, for nurses and about nurses!

This week the theme is….wait for it….nursing!

Are you planning on attending the Medblogger Conference/Meet Up at BlogWorld/New Media Expo 09 in Las Vegas in October? There is a special page here on Emergiblog where I will update new information as it comes in. Registration should be up at the BlogWorld site soon, and Southwest has just started booking flights for October. Feel free to email me with any questions!


Ever stop to realize how much of our profession centers on communication? Dr. Val talked to five nurses about real-life lapses in communication affecting their practice. Read what they had to say at Nurses Dish on Communication Lapses That Harm Patients over at Better Health.

Disappearing John returns to Change of Shift with a great story of integrity, the details of which may surprise you. Check out Something Unusual Today…

Lanette Anderson became an RN at twenty, just like me! She came from a family of nurses, but it still didn’t prepare her fully for what to expect after graduation. In Becoming a Nurse – Five Things I Wish I Had Known, she shares the perspective that comes with experience. Posted at NurseTogether.com.


Barbara at Florence dot com revisits a post-from-the-past (and provides a great introduction to her blog!) in Welcome to Florence dot com. After you have read the post, go watch this video on You Tube. Take a Kleenex. This one’s for Fred.

Still holding the kleenex? Good. Medic/Nurse has submitted a post that every single ER nurse will relate to: He Said Uh-oh. You’ll need the Kleenex. Medic/Nurse has finished his/her paramedic course and is now, officially, a paramedic AND a nurse! Congratulations!

Okay, you can put down your Kleenex…well, maybe you will still need it as you will laugh so hard you will cry when you read Male Postpartum Depression over at Reality Rounds. You’ll be astounded, you’ll be outraged, and if you ever suffered from postpartum depression you will be angry, but you will laugh.


Mother Jones at Nurse Ratched’s Place is back in uniforms and has a great post on just what is available and what is appropriate for a nurse who might be just a wee too experienced for SpongeBob Squarepants in Uniform of the Day. Sistah, we are old, bold and too hot to hold! I was going to use that same ad on a future Emergiblog post, ya know. I’ve been usurped! It’s not that I’m jealous that you got a blue cape. Or anything.

Ahem, back to our carnival:

We are privileged to witness some profound, personal moments in nursing. Here’s a tale of one of those moments. From Spook, RN at Drug Pusher, read Old Lady With the Low Heart Rate. Heartwarming!

We live for those moments when we realize the result of our hard work. Jane had one of those moments! I Love My Job is posted over at See Jane Nurse.


Most of us only know our patients from their illnesses and their stay in the hospital. Kathy Patton at NurseConnect wonders As Nurses, Do We Really “Know” Our Patients? There’s a great idea to use in the ICU to help keep us focused on the person-in-the-patient.

In Artificial Nails and Ponytails, NurseConnect blogger Laura Webb looks back at her nursing school attire (and this was 2005!) and wonders about current rules and regulations regarding uniforms, hair and fingernails. What restrictions are you working under, and why?

I have to get out and around the blogs more often! I found this gem at Pixel RN, who was following the White House Health Care Summit in March. She gives a great take on who said what at .…A Nurse’s Perspective.


That’s it for this week, many thanks to those who submitted (and those who didn’t realize they submitted until they read this post!).

Next edition, Gina at Code Blog will be hosting, so you can send your submissions to “codeblogrn at gmail dot com”.  Thanks Gina!

And, remember, Change of Shift now has subscription options; you can follow by email or RSS feed. An aggregated feed of credible, rotating health and medicine blog carnivals is also available. Many thanks to Walter Jesson at Highlight Health for setting those feeds up!

April 10, 2009, 1:47 pm

And I Begin to Wonder Why You Came

bob-evans-uniformsI tell ya, I was born thirty years too late!

Are these elegant, or what?

Of course, by the time I was wearing white, the dresses were mini-skirts (don’t ask how we bent over in those things!)

And I was never 5’11” or had an 18-inch waist like these nurses did.

(They aren’t bad, they’re just drawn that way…)

But oh, how I would have basked in these dresses back in the old days!

Now I wear scrubs.  I’m comfortable, but I look like I’m working in pajamas.

Apparently Bob Evans is still around, or at least the company is.

They make restaurant uniforms


Okay!  By popular demand (and a suggestion by Doctor Anonymous on his radio show last night), there is now a special page for the BlogWorld/NewMediaExpo 09 Medblogger Conference here on Emergiblog.

If you click the button up top that says “Blog World” it will take you to a dedicated page where you can comment, tell us you are going to be there, talk with those who are,  nag those who aren’t and stay abreast of all the news.

As registration begins or Southwest starts taking reservations, I’ll post it right on the page.

Oh, and no, I don’t get paid by Southwest for mentioning them.

I just think they rock!

Won’t fly with anyone else.


“Why the hell do people get out of bed in the middle of the night for nothing?  I mean, who in their right mind visits an ER at four a.m. for a freaking paper cut?  Are they nuts? What possesses a supposedly rational adult to wake up their spouse and all four of their children and come to the ER because they have a fever of 100.7? Don’t they know Tylenol is over-the-counter, or is it now a controlled substance?”

“They can’t cope.”

“Huh?” I looked up from the stack of charts I was trying to finish.  It had been a very busy shift.  A very busy clinical shift. Not an emergent complaint within ten miles of the joint.  I had smiled through the role of compassionate nurse for six hours and I was not in a good mood, hence the rather rabid rhetorical rant.

The ER doc repeated his answer.

“Patients come to us when they have reached the end of their ability to cope with a problem.”

“Are you serious? Keith, it was a paper cut, for god’s sake!”

“Sure, I’m very serious.  Paper cut, toe pain, headache, abdominal pain.  Everyone winds up here for the same reason.”

I dropped my pen and turned around.

“Think about it,” he continued. “It’s really what we are here for.  When the patient comes in with their problem, they are able to share it and it then becomes our problem. We take it on with them. Their coping skills are depleted, they rely on ours to help them get through the crisis.  Yes, even if it is a paper cut.”


Dr. Keith was right.

That’s exactly why people utilize the ER.  They are unable to cope.  With pain, usually.

But when I really thought about it,  maybe there were other issues, too. Perhaps they were unable to cope with waiting overnight for an answer from a clinic that may or may not give them an appointment. Perhaps they were unable to cope with the fact that they didn’t feel well and had to be at work by 7 a.m., or else.  Maybe they couldn’t cope with what they didn’t know; what if the paper cut was infected or the ankle was broken?

And then I realized something else.


What do nurses do?

Really, at the heart of all patient care.

We help people cope.

With illness. With disability. With fear.  With pain.  With loss. With change.

And then we take it one better.

We give them the skills  to strengthen their existing coping mechanisms and to learn new ones.

By listening. By teaching. By supporting. By encouraging.

It’s what nurses do.


So I came away from my shift with a clearer focus.

I realized I had always known the truth of what had been discussed that night,  but I had lost it in the hectic bustle of numerous non-stop shifts.

Dr. Keith had it down.

I also realized something else.

Nurses don’t have a monopoly on compassion.

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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