October 14, 2008, 7:56 pm

Time for ‘Rounds and Browns!

Sigh!

Any excuse for a Brady Quinn photo!

The good news is that the Browns pounded the Giants last night.

My thanks to those who put up with me live-twitting through the game! Where were all the Browns fans on Twitter? I was all alone!

The bad news was that Brady did not play because Derek Anderson decided to play really well. I shan’t comment further.

Oh well. Brady is only 24 so he’s got a loooong career ahead of him. Makes me wish I was 30 years younger.

(Many thanks to Barry at the Orange and Brown Blogs for the okay to use this AP photo from their site!)

********************

From Cleveland to Casablanca…

Grand Rounds shows up with a bit of a movie theme over at Notes of an Anesthesioboist.

“T” quotes her favorite movies, one of which is “Independence Day”!

Would have been a great excuse for a Jeff Goldblum photo, but I didn’t want to overindulge in one post.

Bogart outshines them all, anyway!

His daughter Leslie is an RN.

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Don’t forget!

Change of Shift will be at Nurse Ratched’s Place on Thursday, and the theme is education.

Send your nurse-related submissions to “motherjonesrn at yahoo dot com”.

She’s got some vintage nursing photos I’d kill for!

We just might see what Mother Jones looked like at her nursing school graduation!

Not that I’m I’m saying her photo is vintage.

Or anything…

(ducking!)

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Don’t forget to vote for your favorite topics for the Medical Bloggers track at BlogWorld09, to be held in Las Vegas next October (and don’t forget to request that vacation time!).

The poll will be up until the end of November, so vote early and often! Okay, vote once, but you get the idea!

October 12, 2008, 9:10 pm

The Nursing Shortage: A Sticky Wicket

Cherry Ames, Podiatry Nurse?

Yuck.

The poor nurse in this photo can barely contain her true feelings.

Obviously, she doesn’t relish her job, but that poor doctor actually has to do the exam.

Without gloves! I hope he washes his hands between patients, especially since he is looking for athlete’s foot. Major yuck!

At least the nurse is wearing a decent cap.

******************************

And that’s why I became a nurse. I wanted the cap. And I got it!

And now there’s a nursing shortage.

*****

Ask ten people why there is a nursing shortage and you’ll get ten different answers.

The best post I’ve ever read that addresses the real reasons for the nursing shortage was sent to me by Shane. Now, it isn’t unusual for me to give Shane information about nursing, but it is unusual for him to send me stuff.

The Mission-Critical Sticky Factors in Nursing is a provocative post (and on a site about online nursing degrees, of all places!) You need to read it before you finish this post. I’ll go grab my coffee while you do that…..

Basically, the nursing shortage is caused by a number of factors leading to one conclusion:

We quit.

*****

Why do nurses quit?

Well, perhaps because the salary sucks in the majority of the country. A pittance of a check for one hell of a lot of responsibility. You know, accountability without any power.

Or maybe we feel stuck because there is nowhere to go once you are in the profession. Oh, you can climb a clinical ladder, if your hospital has one, and make one or two dollars more per hour. It’s not standardized between hospitals so if you change jobs, you lose that “Clinical Nurse” distinction and have to start all over trying to earn it at your new facility.

Or maybe you can obtain an advanced degree, your BSN or your MSN or even a doctorate.

It won’t mean any more responsibility in your position as a staff nurse. If you don’t want to be a nurse practitioner or a nurse anesthetist, you will have just spent a ton of money and a great deal of time for a few more letters in your personal alphabet soup and zero increase in your pocketbook.

You want to become a nurse educator? Good for you. You’ll be living on about one-third of your staff nurse salary and working many more hours, but hey! Weekends and holidays off, right?

You want to be a researcher? I hope it’s just for the love of learning because it isn’t going to profit you in any other way.

*****

That brings us back the the “Mission-Critical Sticky Factors” post.

Nurses quit because there is little in the profession that causes them to “buy-in”, to be loyal to the profession. Oh, we all start out like that. We “buy-in” to the altruistic, self-sacrificial, “angel of mercy” persona for awhile.

But within a few years we find our altruism singed around the edges. We have increasing responsibility with very little power to control our work environments. There is little incentive to advance our education, as if we had the energy to actually do it. The patients are emotionally demanding. The work is physically demanding, especially for those of us (cough!) who are veterans of the profession.

Assuming we last that long. Too often, especially these days, when the younger, newer nurses realize the reality of the profession, when they experience what Marlene Kramer referred to as “reality shock” as far back as 1974, they don’t put up with it. They no longer have to; there are too many other opportunities.

They quit.

The revolving door of nurse-retention spits them out faster than new ones can be hired.

*****

Sound depressing. It is. Is it how I feel right now about nursing?

No.

Is it how you feel about nursing? Have you “bought-in” to the profession or are you biding your time until you can escape? Are you new and wondering “what the hell did I get myself into?” or are you a seasoned veteran counting the days to retirement?

If you are thinking of leaving the profession, what would keep you in? More money? A sense of being valued by your patients or hospital administration? More benefits? Tangible incentives for more education?

*****

Maybe I’m rare, maybe I’m a dinosaur, but I “bought-in” to this profession long ago.

Oh, there were times it looked like the grass was greener outside of nursing and I thought about what it would be like to do something else. But nursing is in my blood at the genetic-molecular level; map my genome and you’ll find it. My chromosomes are shaped like tiny nursing caps.

Nursing isn’t something I do, it’s something I am.

I guess I “bought-in” to the caring aspect on that front porch in the summer of 1966 when it was just Cherry Ames and me.

And not just because I’d get a cap out of the deal.

That was just the icing on the cake.

October 8, 2008, 12:21 pm

Are You “Just” a Nurse?

Whoa.

Excuse me while I get my smelling salts!

A veritable cornucopia of nursing caps!

I love it!

I see about ten I would wear, and some that are beyond the pale!

One looks like a gas station attendant should have it on (circa 1950s) and one looks like a paper airplane. There is one in the middle, third row from the top, that looks like conjoined caps. Methinks the designer must have been chemically impaired!

I still like my own cap the best!

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My forays into recent BlogWorld and ENA conferences have left me with a plethora of ideas and inspiration. This post is one of them, directly inspired by the keynote speaker at the ENA Scientific Assembly in Minneapolis, Dr. Joseph Michelli, PhD.

**********

For some reason, I am occasionally mistaken for the doctor. I’ve overheard it happen to colleagues.

And if I hear the phrase, “Oh, no, I’m just the nurse” one more time, I am going to explode.

But then I started thinking, are you “just” a nurse?

***

“Just-a-Nurse” is competent. They come in, they do their job. They do it safely, they do it correctly and then they go home. They are on-the-clock until they are off-the-clock. “Just-a-Nurse” goes through the motions. They look like a nurse, they act like a nurse and they do the work of a nurse. Their goal is to get through the tasks of nursing. That’s their job. Whether they like it or not.

Or is it?

I guess it depends on your definition of nursing.

Nursing is something you do for and/or with a patient. It’s not something that you do to a patient. The former requires that you become engaged in what you are doing and engaged with the patient. The latter is simply the quickest way to complete a task so you can turn the bed over to the next patient.

My trust Mac widget dictionary defines “engage” as “establish a meaningful contact or connection with” a person. Is that not what professional nurses do when they care for a patient?

“Just-a-Nurse” cares about getting the work done. A professional nurse cares about the focus of the work – the patient.

The professional nurse engages the patient.

*****

It doesn’t happen spontaneously.

It takes an active, personal decision to commit to being engaged. As nurses, we are responsible for that commitment, because it makes for a better experience for the patient.

It’s not as easy as it sounds.

We are caught between two competing forces. On the one hand, we are supposed to work faster and move the patients through quickly to either save money or make money. On the other hand, a very high value is placed on patient satisfaction. Some may even believe that one leads to the other.

They’re wrong.

Patient satisfaction scores are related to the level of engagement of the nursing staff. Competence is great, but when you engage a patient, when you embrace the task at hand and tailor it specifically to that patient, you create an experience for that patient.

You make them feel valued. A patient who feels valued is a satisfied patient. Isn’t that our goal as nurses?

But, in engaging the patient, you are doing something else. You are engaging the profession. And when you engage the profession, you automatically engage the patient because that is what professional nurses do. It becomes a feed-back loop.

*****

This message resonated with me because I spent many a year of my career as “Just-a-Nurse”, and it had nothing to do with where I stood on Benner’s novice-to-expert continuum. Usually it meant the arrival of burn-out and/or time to make a change.

A professional nurse needs to be engaged with their profession, leading to engagement with their patients.

How much responsibility are we taking for the state of the nursing profession? The answer lies in how engaged we decide to be.

So…at this point in time, are you “Just-a-Nurse” who can’t wait to punch out for the day or a professional nurse engaged making your patients feel valued?

It’s a conscious decision.

A decision we make every day of our career.

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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