The nurse left work at five o’clock. Not the tall slender woman, dressed in her perfect white uniform, with blue eyes and a flawless minty smile. The nurse getting off at 5 A.M. was Bill, William H. Wellington to be exact. A large fellow with too much forehead and not enough chin. Bill sported a shaving blind spot that cultivated a patch of knurled whiskers to the left of his nose. Five A.M. placed Bill at the zombie end of a twelve-hour shift in a low-income area serving hospital.

Bill sees suffering and even death on an hourly basis. He sometime wondered about the afterlife but was most curious about the transition from life to death. One of his beds contained a suffering old woman; she was lingering and Bill was sure she would still be hanging on when he returned for his next graveyard shift. Normally when elderly loved ones near death grand kids, old friends and even faithful pets make the journey to pay their respects. Priest and Elders are supplied to anoint with oil and bless the soul. She had no one. As much as possible he tried to reach out and comfort her. She once asked with an breathless voice;” Nurse Bill, Will I see light?”

Bill didn’t know the answer; He wasn’t sure about the light. In fact, it didn’t sit well with him. It’s no wonder when you think about it. Bill was always under bright seemingly heavy lights. When he left for work, it was day; he would then spend the next twelve hours shuffling about under a buzz of relentless florescent tubes. When his shift was over, day light greeted him at the door.

This one morning Bill mad it home late and was thirsting for sleep. He readied for bed while his companion was reading. He crumbled into bed beside her. The one bedroom window is plastered with aluminum foil and the door shut in an effort to combat the light. The only thing keeping him from the dark he so craved was the reading light. Bill laid there thinking of the dying old woman and the dark. His wife snapped the book closed then clicked off the light on her way out for the day.

The light out, comfort rushed over him. He loved the dark and began to list its virtues in his mind. “Life”; he reasoned is conceived in the dark, our organs and bowels formed in darkness, and our first measure of conciseness realized in the dark. Naturally, when we die he deduced, we must pass through darkness.

Sleep teased him throughout his night and at his morning; Bill sat up in bed. A scrapbook of dreams seamed to slide down in his chest. He blinked, rubbed his eyes; and began piecing the disjointed bits of his dreams together. Bill dreamt he carried the old woman from the hospital down the hall to a roomful of therapeutic pools; gently he slipped her into the warm still water, the room dark. She was peaceful. He pressed on her frail shoulders and without a whimper, she rolled over face down. Her twiggy arms floated to the surface.

He suddenly realized what he had to do. Today Bill would murder an old woman.

Bill arrived for work to find the police coming out the main entrance of the hospital. He approached the door and as he entered, the cops were escorting out a tall blond woman.  It was the nurse; the one with the pressed white skirt. The nurse who always had perfect breath and a dazzling smile. Her hands shackled, they passed in the threshold. She lifted her head while turning towards Bill and flashed him her flawless smile then her head dropped and she was zipped away.

Bill followed the trail of commotion to the therapeutic pools. The lights were dim. Bill stared through the tinted glass from the adjoining office. The old woman was face down, dead in a pool. Her hair suspended in the water like a patch of silver seaweed… Bills eyes refocus and he could see his own face in the glass…

William smiled…

There have been a number of high profile disputes in UK involving nurses who have been chastised for religious practices whilst on duty. The case of Caroline Petrie who first gave out prayer cards (allegedly equating illness with sin) and subsequently found herself in trouble a second time for offering prayers is well known:

http://www.telegraph.co.uk/health/healthnews/4409168/Nurse-suspended-for-offering-to-pray-for-patients-recovery.html

More recently Helen Slatter, according to the Nursing Times has resigned rather than comply with infection control guidelines relating to her crucifix on a chain: http://www.nursingtimes.net/whats-new-in-nursing/specialists/infection-control/catholic-phlebotomist-resigns-over-crucifix-row/5003162.article?referrer=RSS

Anand Rao advised a woman with heart problems to attend church to ease stress and that if God wished she might live longer:  http://www.dailymail.co.uk/news/article-1187310/Male-nurse-40-years-sacked-urging-patient-to-church-training-session.html

It is true that some people and organisations appear to be on a crusade of some sort to prevent anyone of any faith from expressing their beliefs. However – these particular cases have a more reasonable feel to them. They are not simply about anti-religious or even anti-Christian fanaticism. These cases go to the very root of what it means to be a nurse in modern society.

The Nursing & Midwifery Council (NMC) governs the registration of all nurses in the United Kingdom. They have produced a code of conduct which all professional nurses must adhere to or risk being removed from the register (struck off in other words). The code insists that nurses must not use their professional status to promote causes not related to health (Caroline Petrie/Anand Rao), must not recommend interventions that are not evidence-based (Caroline Petrie/Anand Rao) and must keep knowledge and practice up to date (Helen Slatter re. infection control/Health & safety).

It’s interesting how often such individuals claim that their human right to the freedom of religious expression is being denied them whenever they are challenged over such behaviours. However the right to freedom of religious expression (Article 9 of the European Convention on Human Rights) is a ‘qualified’ right. Article 9 does not allow for the disporpotionate interference in another person’s rights to their beliefs or indeed, to their right to treatment that is free from unnecessary risk of infection.

Earlier this year Christian bishop Michael Nazir-Ali insisted that hospitals in UK are betraying their Christian roots: http://www.christian.org.uk/news/20090210/bishop-says-hospitals-are-betraying-christian-roots/

He called for a movement of Christians that will promote prayer in hospitals, schools, prisons, parliament and other establishments so that this nation can be reminded of it’s Christian roots, thus magnificantly ignoring (or perhaps dismissing) the needs of non-Christians everywhere.  What about the rights the rest of society has to freedom of religious expression – including the right not to believe or to follow a different creed without interference?

Personally I have no faith but that doesn’t mean I can’t respect the right of others to believe whatever they want.  However the religious of this world cannot ignore the fact that the rest of us have rights too. Nurses have a Duty of Care but that duty does not include evangelism, elevated risk of infection or non-evidence based practice, religious or otherwise.

It’s not difficut to see how dangerous it can be to mix religion with medicine. This poster outside a church in London clearly demonstrates the misleading potential of religious claims and might discourage people from seeking medical help, preferring to rely upon oils or relics.

Read the news story from the Telegraph here:

http://www.telegraph.co.uk/news/newstopics/religion/6220534/Church-poster-banned-for-suggesting-that-blessed-oil-cured-heart-defect.html

Let’s stop crying foul where none exists and get back to expecting nurses to fulfil the code of conduct. Either that or, if accepting other people’s freedom of religious expression is too high a standard for some nurses, leave the profession to those of us who know how to respect the rights, views and religious freedoms of the vulnerable people in our care . After all – it’s not the job of nurses to stand in for other professionals anyway:

http://scotslaw.wordpress.com/2009/06/28/is-it-right-to-mix-religion-and-healthcare/#comment-528

Sometimes I just don’t know how to respond to the things patients say. Two recent cases:

I had a elderly direct admit with a hemoglobin of 6.6 .  I’ve got to transfuse 2 units, and I’m in his room taking his history and making a quick assessment.  As we’re talking, I ask if he’s had a blood transfusion before and when.

“The last one was in August.  I think I got some nigger blood because I’ve been craving watermelon ever since.”

He caught me off guard.  I laughed… once.  It was involuntary and out of shock over what I was hearing.  He later told me something one of his friends had said about President Obama, and we both agreed that it was inappropriate.

***

Another patient of mine had just hung up the phone after talking with her daughter.  She turned to her husband and explained that their granddaughter had skipped school again.

Her:  “And do you know where she went?  To a black boy’s house.  A black boy’s house.”

Him: (shaking his head)  “I’m not surprised.”

***

Even more amazing to me are the offhand comments patients say to me about Mexicans.  How they’re ruining the country.  How they’re taking all our jobs.  How they’re lazy. (And wanting all our jobs?)

Living in the south most people think I’m Mexican. (Colombian, actually.)  So why the hell would you say things like that to me? And even if you can’t tell what I am, I think its pretty damn obvious that I’m something different from you.

I’m not going to change my elderly (almost always Caucasian) patient’s mind-set that shift.  If there’s an actual fact I can give, I’ll give it.  I figure the best ways to combat the stereotypes is through my own actions and the patient’s experience with me.  However, they’ll probably just consider me the exception to the stereotype.

I don’t take those things personally.  Most of the time I find the situation humorous.  And then sad.  Another person living his or her life in ignorance.

I survived, though admittedly with an easy assignment — and thankfully I was nowhere near the triage desk. The emerg was actually pretty good last night. Anecdotally speaking, it seemed there was lots of r/o  influenza, but very little of the usual emergency department silliness. Maybe people are getting the message to stay out emergency unless things are dire?

Compliments, which any emergency RN will tell you, are few and far between, and are always viewed with a very large grain of salt. “You’re the best nurse I’ve ever had,” usually translates into “I want something from you” or something equally as manipulative. But I was discharging this patient last night, with whom I spent a lot of time doing health teaching, explaining the care plan, and reassuring, and as he was leaving, he said, “You are the best nurse I have ever dealt with. You are really good.”

I was so taken aback, I was left speechless. No mean feat. I don’t do compliments well, especially from patients.  And genuine compliments are generally rare birds. Being older and cynical, I’ll take what I can get.

Registered Nurse
Facility: Parkwood Behavioral Health System
Location: OLIVE BRANCH, MS US
Travel Involved: None
Job Type: Full Time
Job Level: Experienced (Non-Manager)
Minimum Education Required: Certification
Skills: Health Care -> RN
Customer Service -> Face-to-Face Support
Category: Nursing
FTE: .9
Position Summary:
The Registered Nurse provides professional nursing care on a designated unit in a manner consistent with the philosophy and objectives of Parkwood Behavioral Health. The Registered Nurse prescribes, coordinates and delegates nursing care utilizing the nursing process that is integrated into the multidisciplinary treatment team plan of care. The Registered Nurse is accountable for assigned nursing care activities on a shift basis and is responsible for promoting and enhancing professional nursing practice on the unit. The Registered Nurse also may assume Charge Nurse Responsibilities as required.
Requirements
Graduate of an accredited nursing program. BSN preferred.
Experience: One year prior psychiatric experience in mental health nursing preferred.
Licensure/Certification: Licensure and registration by the Mississippi Board of Nursing as a registered nurse, or multi-state license as approved by NCSBN.
Knowledge: Must possess knowledge of general and psychiatric nursing processes, therapeutic relationships and processes, age specific growth and development, limit setting, crisis and behavior management and CPR training.

I found this question online and was struck with how brief the answer was:

What does a nurse do for the people?

A nurse gives: medicine, shots, hangs iv drugs, gives baths, checks orders, double checks medicines and doses, alerts doctors to mistakes, checks tests, checks results, assesses patient, keeps patient comfortable, starts iv’s, draws blood, monitors patients condition, notifies doctor of changes, evaluates what is and isn’t an emergency, answers patients questions, problem solves, deals with families, cleans up vomit, and feces, and assists patient in everyway.

I don’t think this even begins to cover the subject.  Nurses do all those things, yes; but what do they really do?

Nursing is about caring–sounds trite, but nonetheless it is true.  A nurse cares for her patients and does everything she/he can do to improve the health and well-being for each patient.  However, how do you quantify all of the other things that nurses do instinctively for patients?  We hold hands, we listen, we laugh at jokes, we talk with families, we educate, we advocate, we stand up for those who cannot stand up.  We worry about patients after we go home, we help with tasks no longer easy or painless, we give encouragement, we watch for signs of problems so we can head them off, we quite simply care.

Nursing is not so much in the tasks we do, but more in the way we do them.  Nursing is alot more than just going through the motions.  Nurses are present in the moment with the patient; nurses are connected to our patients in a way that no one else cares to be; nurses accept both the good and the bad and try to find common ground.  So, I don’t think the answer above is quite all there is.

Here is an excerpt from an article on the website of The Center for Nursing Advocacy:

What does a nurse really do?

/signed/ ……………..

This one comes just a little closer to the truth, but in my opinion still leaves out something.  What do you think? Won’t you leave me a comment telling me what you think a nurse does?

The fourth night shift at the tent field hospital went out quiet also. We had a fewpatients who came from the concerts, but the rest were not really complicated cases, nothing major. I was not sure about the name of the band who performed last night, but I heard they were an Arabic band.

I met some more new nurses who joined our team for the first time. Apparently, they were pulled out from the hospitals where they were working, and were made to come here in the island. The authorities here are really expecting the worst case scenario, so they were adding up more staff, to make up with the additional beds that were set up.

At this time of writing, the qualifying race of Formula 1 is being held and I could hear the buzzing sounds of the cars from my hotel window. I am not planning to watch the race live now, coz I really need to catch up on my sleep. Anyways, I opened the tv and the race is being shown live at Abu Dhabi Sports Channel. Now,  I could here the cars live from the tv, and live from my window. Isn’t that cool?!

Performing at the concert arena tonight will be no less than AEROSMITH! Of course, I will not be able watch again, and I will be left treating concert casualties at the tent hospital tonight. Are Aerosmith fans the war freak-types? Head-bangers and stuff? Hmmm… we’ll see tonight.

Got to crash on my bed now!

Canadian Registered Nurse Examination As of February 2008, the Canadian Registered Nurse Exam (CRNE) will consist solely of multiple-choice questions. For details about the exam, please read the information below.

Each provincial or territorial nursing regulatory body in Canada is responsible for ensuring that the individuals it registers as nurses meet an acceptable level of competence before beginning to practise.

The level of competence of registered nurses in all provinces and territories except Quebec is measured, in part, by the CRNE. The Canadian Nurses Association (CNA) develops and maintains the CRNE through its testing company, Assessment Strategies Inc., and in collaboration with the regulatory authorities. The provincial and territorial nursing regulatory authorities administer the exam and determine eligibility to write it.

The purpose of the CRNE is to protect the public by ensuring that the entry-level registered nurse possesses the competencies required to practise safely and effectively.

Examination Length and Format
As of February 2008, the CRNE will consist of multiple-choice questions only. There are about 300 questions on the exam.

Question Presentation
Of the approximately 300 multiple-choice questions on the CRNE, about 40 per cent are presented as independent questions and 60 per cent are presented within cases. Case-based questions include a set of three to five questions associated with a brief health-care scenario. Independent questions contain the information necessary to answer the questions.

What Is Tested
With the CRNE The following text is taken from the Canadian Registered Nurse Exam Prep Guide (2005). There are 194 competencies that make up the content domain for the CRNE. Each question on the CRNE is linked to one of these competencies.

Competency Framework
A framework was developed to identify and organize the competencies the CRNE should assess. The resulting framework reflects a primary health care nursing model. The framework and definitions of the four framework categories are presented below. The number of competencies in each category is indicated in parentheses following the category name. The number of competencies in each category does not necessarily reflect the importance each area of competency has in the practice of nursing.

Professional Practice (44 competencies)
Each nurse is accountable for safe, competent and ethical nursing practice. Professional practice occurs within the context of the CNA Code of Ethics for Registered Nurses (2002), provincial or territorial standards of practice and legislation. Nurses are expected to demonstrate professional conduct as reflected by attitudes, beliefs and values espoused in the Code of Ethics for Registered Nurses. Professional practice in nursing involves the demonstration of teamwork, leadership attributes, basic management skills, advocacy and political awareness. Leadership attributes such as vision, knowledge, initiative, integrity, confidence, communication and innovation are necessary for the advancement of nursing practice, the nursing profession and health care delivery systems. Entry-level management skills involve the ability to work within an organization, using appropriate resources to achieve the organization’s mission and vision. Professional practice includes awareness of the need for, and the ability to ensure, continued professional development. Professional development involves the capacity to perform self-assessments, seek feedback and plan self-directed learning activities that foster professional growth. Nurses are expected to know how to locate and use results of research findings to inform and build an evidence-based practice.

Nurse-Person Relationship (21 competencies)
The nurse-person relationship is a therapeutic partnership established to promote the health of the person. This relationship is based on trust, respect and sensitivity to diversity. An essential element involves gathering information that reflects the uniqueness of the person. It involves therapeutic use of self, communication skills, nursing knowledge, and the facilitation of empowerment to achieve collaboratively identified health goals.

Nursing Practice: Health and Wellness (46 competencies)
Nursing competencies in this category are focused on recognizing and valuing health and wellness as a resource. The category encompasses health promotion, illness and injury prevention and the implementation of community or societal approaches. Practice is guided by the principles of primary health care. Nurses work in partnership with communities to influence the determinants of health, with the goal of enabling people to increase control over, and improve, their health. Nurses partner with the person to: develop personal skills, create supportive environments for health, strengthen community action, reorient health services and build healthy public policy. Practice reflects changes in cultural composition, demographics, health trends and economic factors (e.g., aging population, globalization).

Nursing Practice: Alterations in Health (83 competencies)
Nursing competencies in this category involve care across the lifespan for the person experiencing alterations in health that require acute, chronic, rehabilitative or palliative care. Such care may be delivered across a range of institutional and community settings. Essential aspects of nursing involve critical thinking, problem-solving and decision-making in providing care. Using current knowledge, nurses collaborate with the person and other health professionals to identify health priorities. In responding to and managing health issues, the aim of nursing is to promote maximal independence and to maintain optimal quality of life or ensure that individuals at the end of life experience a peaceful death.

Stay Safe . . .

.  .  . you never know what’ll happen