Recently there was article being linked to on Facebook by a few of my coworkers titled “Patient Satisfaction is Overrated” written by Dr. William Sonnenberg. Here’s a link to the article. A few years ago we were called to staff meeting and some changes being made to how Medicare reimburses hospitals and doctors were explained to us. Basically, Medicare is now holding back a portion of what they would normally pay to a hospital or physician for a certain hospital stay or procedure. The hospital or doctor can then earn back that percentage of payment by having high/good patient satisfaction scores. The reasoning is that Medicare wants hospitals and physicians to provide not just mediocre, decent care but quality care. They want health care providers to not just do their job, but to do it well. I can understand that reasoning and in theory completely agree. Hospitals and doctors who skate by and provide just the minimum level of quality of care considered adequate should be told they need to improve. But as with many theories, putting it into practice has a few problems. The biggest ones were hit on perfectly by the author of this article. By being essentially forced to bend over backwards to give the patient exactly what they want and keep them happy, we’re not always giving them the best care we can. Sometimes not even the appropriate care they need, in the case of overprescribing antibiotics when they’re not necessary. It ends up putting the emphasis in the wrong place. It takes the emphasis away from patient teaching and preventative medicine and places it on what amounts to customer satisfaction. While listening to our patients and their needs is definitely a positive thing, making what they think they want and are asking for such a priority is not. It ends up creating frustration in doctors, nurses, and others directly involved in patient care. I’ve seen changes come and go over my years as a nurse. I hope this change goes… the sooner the better.
I have a guilty pleasure when it comes to television… True crime shows! I find them fascinating for one simple reason. As Mark Twain said, “truth is stranger than fiction.” Watching these shows, I realize just how very true that is. I could not possibly make up some of the stories I’ve seen profiled on these shows. (Maybe all that proves is I should stick to being a nurse and not a novelist.) At work I also get to see this statement proved correct. A few coworkers and I were recently discussing the fact that if the general public was told some of the stories about what we see and do and hear in a shift, they would think we were making it up. Things patients do and say are sometimes almost unbelievable, and probably wouldn’t be believed by the general public. There happen to be some pretty significant laws in place to protect patient privacy that prevent us from sharing these stories, but trust me when I say these stories are sometimes sad, sometimes funny, sometimes shocking, and always interesting. Just one more thing I love about being a nurse! There is truly never a dull moment.
So, I’m sitting at home today not feeling well and bored out of my mind so I was just perusing some websites to kill some time. I came across a link on aol.com that caught my attention… a link to an article titled Why Does the U.S. Overspend on Health Care? One Simple Reason. (Here’s the link to the article should you want to read it yourself: http://www.dailyfinance.com/2013/10/19/health-care-why-america-overspends/) As a nurse, I am interested in different observations and opinions about our health care system. So, of course, I wanted to read the article. And it was definitely interesting. In a nutshell, the author theorizes that the amount of money we spend on end of life care, trying to buy a patient more time when they are going to die in a matter of a short time anyway, is how and why we’re overspending on health care. He writes “The U.K.’s National Health Service, for instance, is known to practice “denials of costly treatments for life-threatening diseases” toward the end of patient lifespans — a decision necessitated by “resource constraints.” But that’s not necessarily a bad thing.” I’ve worked with dying cancer patients, dying patients who’ve had terribly debilitating strokes. And yes, sometimes the aggressive treatment the medical community uses to prolong their lives is futile. They are going to die with or without the treatment; it’s just a matter of how soon. And sometimes that probably isn’t the best use of our resources and health care dollars. Sure, it’s easy for me to sit here saying that as it’s not my family member or loved one we’re talking about. I guess I’m saying, in theory, I understand and even agree with what the author of the article is saying. But I’m admitting I may very well feel differently if it were my family member or loved one we were discussing treating aggressively. I think the ethical problem that comes into play is already touched on when it comes to organ transplants. We only have so many resources to go around and who exactly gets to make the decisions about how those resources are allocated? Who gets to make the final decision about when a patient should be denied costly/aggressive treatments towards the end of their life? (That’s provided we know the patient’s wishes and they would want the treatment, of course. Otherwise it’s a moot point.) Those are the kinds of decisions that are incredibly delicate ethically speaking and letting the wrong people make them could be a very slippery slope. But who, exactly, are the “right” people? Not an easy question to answer at all.
In speaking to a friend (a U.K. citizen) about this article I was informed that the U.K. National Health Care System is very focused on preventative medicine and treatment of diseases rather than maintenance. That focus makes sense on many levels. First of all, it makes fiscal sense. It’s much cheaper in the long run to prevent a disease than to treat, cure, or manage it. And it just makes for a healthier society to prevent diseases so they’re not spread through the society. I don’t necessarily know if I think a national health care system is the right answer for the U.S.; but I do think there are some positive things about having one in place.
Several years ago when I was in nursing school I had an experience with an Emergency Room doctor that was less than positive. In fact, it was downright hurtful because of a just plain wrong assumption he made. It was the operating room rotation of school and I was spending half of the term observing in an operating room. I had been watching a surgery standing on a small stool so that I could see over the surgeon’s shoulder. I was fascinated by what I was watching and standing very still… unfortunately, with my knees locked. I stood too still for too long and the circulation to my legs decreased and my blood pressure dropped. Any guesses what came next? Yes, I fainted. I landed flat on the floor and the next thing I knew one of the OR staff members was waking me from my nap. My instructor arrived and I was taken to the ER to have a doctor make sure I was alright. The doctor who came in the exam room to see me wasted no time in jumping to the conclusion that because I was 20 to 30 pounds overweight I must have skipped breakfast and that was what lead to me fainting. And he told me this conclusion he came to not terribly politely at all. I insisted that yes, I know I am overweight and yes, I am attempting to lose weight but I did not skip breakfast. I had, in fact, had a snack of peanutbutter and crackers just before going into the OR to watch the surgery. My instructor and one of the OR staff tried to explain to him that I had been standing with my knees locked on that stool for at least an hour. He chose to completely ignore the perfectly valid physiological reason for my blood pressure to drop. Instead he continued to harp on the issue of my weight. I remember being very angry, hurt, and offended. I shed a few tears of anger, hurt, and humiliation later that day. But now I’ll share the humorous part of this story. Before our OR rotation the instructor had told all of the students that if we were going to faint, do not fall into the sterile field. Very sage advice. Well, my first words to her after I was awakened was “I didn’t fall into the sterile field!” She got a grin on her face and began to chuckle at that.
I came across this news article this evening that at first I was sure had to be hoax. So I did some quick searching and it only took me a moment to find it on a reputable news site (MSNBC). Here is the link to it.
In a nutshell, a 24 yr old Dutch nurse was asked to provide services of a sexual nature for her 42 yr old male disabled patient. She refused, and the patient had the woman fired from his care. The nurses union got involved and has started a nationwide campaign against the practice of patients demanding sexual favors from nurses. There are apparently a number of these patients who claim it is within the standard of care for nurses to provide these services. Oh, but I’m quite sure it is NOT part of the standard of care, and that is just the stance that the nurses union is taking. We, nurses, are NOT prostitutes. What we ARE is professional, educated health care team members. And I can’t believe in this day and age, the public needs to be reminded of that fact… no matter what country you live in. To think that we as nurses are responsible for providing sexual services to our patients is demeaning and insulting. It essentially says we are nothing but prostitutes, who provide those services for pay. I don’t know a single fellow nurse who would at all be ok with being seen this way or treated this way. It’s absurd to me that this topic even needs to be discussed. Helping a patient gain sexual satisfaction is so far across any line of professionalism that it shouldn’t need to even be discussed. It is so incredibly inappropriate that I’m astounded it goes on. But according to the young lady who was fired from this particular patient’s care, it does happen. The news article states that she witnessed “some” of the patients other nurses providing these services to him. I don’t know how many others she witnessed or in what manner they were doing this, but neither of those things are important. What’s important is that this inappropriate, unprofessional and flat out wrong behavior happened. Wow. Apparently, according to the nurses union, the police are now investigating. I’m happy to hear that. So… feel free to add your thoughts and comments. Always happy to hear from my fellow bloggers.
So, a few weeks ago towards the end of night shift as I was preparing to leave work my nurse manager for our floor informed me I wasn’t allowed to leave, we may need to mandate someone from night shift to stay in overtime for day shift. She had been phoned by our staffing office at 4:30am letting her know we’d be very short staffed for day shift and to get her ok to call anyone in they could get to volunteer, even if it put them in overtime. This was three hours later and no luck with getting any additional staff. She was saying she hated to do this, and I could see the anguish in her eyes. It was not a pleasant situation for her. A few minutes later she told us (staff from night shift) that we were allowed to leave, no one was being mandated to stay. So, of course, we all ran out of there before things changed. In an interesting coincidence, I was riding the elevator down to the parking area with someone on the staffing committee for the whole hospital. She explained to me that for a nurse manager to put someone into mandatory overtime the approval has to come from her, the hospital wide nursing supervisor on shift, AND a member of the hospital executive team. It has to go through three layers of approval before it actually happens. That was comforting. It was nice to know that mandatory overtime is something all levels of management take seriously and it can’t just be done on a whim. It truly is a last resort. And that’s the way it should be.
I got some happy news tonight I’m excited to share. I’ve been wanting to go on another medical mission to Guatemala (I’ve been on two) for a while now and praying about it and looking for the right opportunity. Well, I found the right one! I’m going in October with a small group from a Methodist church in Arizona and couldn’t be more excited. I got an e mail from the man leading the team tonight and he said they’d love to have me join them and sent me the application packet to get filled out. So it’s looking like it’s a go. It may seem like I’m doing a good thing, helping those less fortunate than myself. And I suppose I am. But the real reason I’m so excited to go is how much I get out of it. I come home feeling renewed and excited about my work again and feeling very blessed and spoiled. I’m reminded of all of the blessings in my life after these trips. So I have my own selfish reasons for wanting to do this, I admit.
The search phrase that most often leads people to my blog is “benefits of being a nurse.” I once wrote a post with a similar title , but it was just about a particular situation with my doctor. It didn’t actually spell out what I think are the benefits to being a nurse. It may just be time for that post. After 11 years, I feel as though I have some idea what I’ve gotten myself into and what I like about it. So here are what I consider to be the top 5 benefits to being a nurse…
5) Location, location, location
All 50 states in the United States make it very easy to get a license. Once you have your initial license in whatever state you originally take your state boards in, you can seek reciprocity in any other state. Say you live in Washington state and want to move to Oregon. All you have to do is check with the board of nursing in Oregon and fill out an application for reciprocity. You will also have to send them some other forms, sometimes school transcripts, and some states wish you to be fingerprinted at the time of application, as well. Just send the fees that the state requires along with all of the required application forms and the state BON where you wish to relocate will verify all of the information and verify that you currently don’t have any disciplinary action against your license. When everything is in order, they send you a new license for that state. As a nurse, it’s easy to relocate from state to state and find employment.
4) Flexible schedule
In virtually any hospital in the country there are a large variety of shifts and number of hours per pay period for a nurse to work. 8 hour shifts, 10 hour shifts, 12 hours shifts. Days, evenings, nights. And those could be anywhere from 20 to 80 hours per pay period (a 2 week pay period). Or a clinic or school nursing works for those who want a more traditional schedule. There are just a lot of choices available to find the schedule that fits you best.
In nursing there are so many settings to work in. A hospital, a clinic, a school. And within those there are a lot of specialties to choose from. Pediatrics, oncology, urology, neurology, and on and on. There are a large variety of choices available to find the area you enjoy the most. And then there are nursing positions to choose from. Staff nurse, floor charge nurse, floor unit manager, educator, hospital wide nursing supervisor, research nurse, and on and on. It’s all about choices and options.
I get bored easily. It’s a fact. And that’s one reason nursing is such a good fit for me. There is never a dull moment, no matter what area you work in. No day is ever quite the same. Each day and each area and each nursing position has it’s own set of challenges. And as you move from area to area, there are new skill sets and new information to learn. Nursing is a profession that will continue to always provide a challenge.
1) Something to be proud of
I don’t mean this to demean any other profession or occupation, but nursing is a career you can take pride in. It’s an opportunity to make a difference in the lives of others. I consider myself lucky to feel that way. I consider myself lucky to be a nurse. I had an instructor in college tell the class “Being a nurse isn’t something you do, it’s something you are. And years later, I know she was right.
You might notice I didn’t mention money/wages as a benefit to being a nurse. That’s not to say the pay is bad. I’ve always been able to support myself on what I earn just fine, even though I may never be wealthy by some people’s standards. I just didn’t mention the pay because nursing is so much more than a paycheck to me, and there are so many more valuable benefits.
As anyone who knows me knows, I love being a nurse. I really do. It’s what I’m meant to do and I can’t imagine what other career I would be in if I weren’t a nurse. But there is something about nursing that I don’t think the general public is aware of. It’s hard work. And I’m not complaining about that. I accept that fact as just part of the whole gig. But it is not a profession for the wimpy or lazy. I don’t mean just physically hard. I mean mentally draining at times, too. The physically hard part is the walking (or sometimes running) from room to room, lifting patients, transfering them out of bed and back into bed, repositioning them in bed, all of that. Then the mentally tiring part is the constant pressure to meet the needs of a group of usually five to six patients for eight hours straight. And frequently two or three or even the whole group may have needs to be met all at once. (Ok, so that part of nursing may not be so different than being a parent or a handful of other careers that I can think of.) Besides the needs of your patients you also have phone calls and new orders from physicians to act on. So you have to be very good at prioritizing. And then there are the family members… The majority of time, family members are just great and helpful and it’s nice to have them there. But once in a while you can have the family member or member(s) from hell. The ones who think their loved one is in a hotel, not a hospital. The demanding ones who want you to be at their beck and call every moment. I completely understand that it’s scary to have your loved one ill enough to have to be in the hospital. And I understand they’re maybe not at their best under that stress. But the other side of that coin is that as much as I would like to devote all of my attention to their loved one, I have four or five other patients to also care for and THEIR loved ones feel they deserve the same amount of attention. And I agree with them. So a good nurse is definitely a diplomat. Soothing ruffled feathers is just a part of the job. I know this may sound up to this point like I don’t actually like my job so much. But that’s really not true. I do. I had a shift one night that was just a disaster… one problem after another to deal with, crazy-busy, short staffed that night, just a Murphy’s Law kind of night. And I very clearly remember thinking “I still wouldn’t want to be doing anything else.” After almost eleven years of nursing I still get excited to go to work and learn new things every night. The fulfilling part is the happy stuff… The patient who had a stroke who calls you into their room at 4 am to show you how much better they can move the side that had been previously almost completely flaccid because they know you’ll be as happy about it as they are. Or the patient’s sister who thanks you for being with her sister while she took her last breath. Or just a simple “Thank you for being my nurse” from a patient. The reward to nursing is knowing you are making some degree of difference in the lives of your patients. Maybe not a huge, life altering difference, but some difference. To my way of thinking, that’s a pretty huge reward. And it’s what keeps me coming back night after night, year after year.
My job really is fun most of the time. My patients can say the funniest things sometimes. The other night a patient on our floor was walking around the hallways at 4am because he couldn’t sleep. I asked if he was tired. His answer? “About as tired as you are tall.” (For those of you who don’t know, I’m only 4′ 10″.) My reply was to laugh and say “Then you must not be very tired.” As I walked around the corner the charge nurse for the shift was laughing and said that little interaction was one of the funniest things she’d heard in a while.
And a question to throw out there… I recently read an article addressing this question and was wondering what you guys thought… Are gift cards a good idea or a cop out? Personally, I like them for those hard to buy for people who you just can’t figure out the right gift to give. But I can see the argument that they’re cop out and taking the easy way out. Yes, I’m sitting right there on the middle of the fence. lol