What advice would you give to new nursing students, who before they pass their examinations are not yet cynical about the industry? Do you sell them the dream picture which will evaporate before their eyes as they venture out to their first real patient meeting or do you tell them all about it as it really is, so they are potentially hardened to the problems before they begin?

Will anyone respect you?

The lack of respect is a difficult one to manage in the working life of a nurse. There are excuses for some people to treat the nurses offhandedly – the seriously ill should give you full respect, but their mind and – that of their close family or friends – is elsewhere when you suggest alcohol intervention programs or other helpful solutions.

If a patient is lying there with a serious knife injury, you can accept their lack of pleases and thank yous, but you’ll be surprised how many patients, whatever their illness, still have time for manners.

They say manners are bred into a person from a young age so why do so many other people fail to respect nurses, who carry out one of the most important functions in any hospital, care centre or nursing home? Among these you can number doctors in particular and then in a very long list, your supervisor and your manager who have probably been through that exact situation before promotion.

Patient accountability

There is a significant amount of accountability surrounding nurse work in recent years. This has probably more to do with insurance and the patient seeing who they can best take to court if anything doesn’t go according to their plans, even if it is unreasonable to expect this. Of course, accountability doesn’t come with an increase in dollars in your pocket at the end of the month, but it might mean the patients respect you more.

Too many or not enough nurses

All over the world the same problem exists; there are either too many nurses for the vacant positions or no-one can be found to fill the workload. In busy hospitals this means that nurse turnover is often high and this places a large strain on nurses trying to find suitable work.

In nursing care situations where nurses are in short supply, this will mean that nurses are expected to constantly work overtime to keep the nurse/patient ratio correct, but may lead to over-tired employees.

Morale can be low

In some institutions, morale can be low among nursing employees. When management treat nurses as just people filling a simple role they fail to see the expertise, training and care involved. This can lead to low self esteem and submissive aggression among some nurses.

Patients harass nurses

The incidence of both violence and inappropriate sexual behavior towards the nursing staff has increased in recent years. Patients and family often mistreat the nursing fraternity to achieve their own requirements. This is partly down to the public’s misinformation about how well trained nurses are and how aggression starts to erupt among patients and their family so much easier in this modern society.

Where are the men?

Men are still put off from joining the profession as so many women hold most of the available positions. Men will fear being inferior if they are the only five in a hundred available nurses. This gives the impression to the outside world that only women are of the right type and attitude to become nurses. Most male nurses will tell you otherwise.

Profit before care

There is no doubt that some hospital administrators care more about profits than the care of patients and the nursing employees. Some nurses will suggest that patient safety is compromised for the benefit of profits. Corners will be cut to save money, providing the patient doesn’t really know any better.

This situation will lead to poor retention of nurses and cause a constant flow of new nurses rather than fostering the retention of current employees. New employees cost less than ten-year experts.

The role of the nurse has changed, but they are still treated like hotel employees, having to attend to tasks that are not in the job description. It’s no wonder turnover remains high. Despite these hardships, nurses continue to provide care – after all, that’s why they joined in the first place.

I suppose other professions can seem like that, but none has the urgency or the stress associated with nursing. The point of nursing is to not try to make everyone happy, although in an ideal world, everyone would be. The point of nursing, in all its juggling glory, is to care for the patient. Sometimes, really caring for a patient will NOT make them happy (e.g. not giving narcs to drug addicts, or suctioning the nose of a preemie for the umpteenth time so he can breathe). Sometimes caring for a patient will NOT make the doctors happy, for which the backlash can be extreme.

To be an effective caregiver and “juggler,” one of the most important things to learn is the art of rapid negotiation. The ability to present a convincing alternative option in less than 30 seconds (if you’re lucky) that keeps all the above “balls” in the air, and promotes a win-win situation, is such a valuable tool, I cannot emphasize it enough. Patients often make demands that are neither safe nor feasible, and are unaware of the majority of the codes governing healthcare. Doctors often slap orders on the charts, or “make decisions” for patients, having them sign consent forms without taking the time to present ALL the options. And we, the nurses, are caught in the middle…able to see both sides, but being bound by the framework of our profession to advocate for our patient, whether that means to try to honor their wishes or educate their wishes….or both.

Am I an excellent negotiator? I have been in nursing for going on 13 years now, and I still don’t feel like I have the knack of always saying the right thing at the right time. But…I’m better than I used to be. You see, one of the first steps to being a good negotiator is the willingness to be rejected. Patients, doctors, managers, institutions, and boards of nursing will often refuse to see any other point of view other than their own. But that does not excuse us from our responsibility to stand up and present alternatives, especially in the interest of the patients. I’m a better negotiator today because I realize that staying true to the core of my profession and my beliefs about patient care are more important than just safely fitting in with the status quo.

One of the most important tools in being a good negotiator is having an excellent knowledge base from which to present alternative options. If you don’t know what other options, and what other outcomes are possible, how will your suggestions be valid? Hence, the importance of keeping up with the development of new treatments, research, and nursing interventions every chance possible!

The juggling act is not easy, and balls will get dropped. Those balls may even begin to seem like swords…miss, and they can really hurt you. The key is to not leave those balls lying on the ground or swords sticking in you, but pick them up and continue on, knowing that if you do, you are being true to yourself and your profession.

*This post dedicated to Amanda Trujillo, who has not left balls to lie on the ground or allowed painful swords to cause her nursing spirit to die, but continues to pursue patient advocacy and excellent nursing care.*

The truth has been exposed. We who have been in the nursing profession know it, and now it is time to take the truth to the public. FACT: Nurses and the core of our profession–patient care–are at the mercy of the medical and political powers-that-be when we interfere with the revenue of hospitals, doctors, and the government, including the boards of nursing that govern our practice in each state.

I cannot possibly present the information or the case better than it already has been by numerous other bloggers, and by Amanda herself. So, I will simply direct you to the posts and sites from which you can continue to follow the developments.

Currently, the hearing before the AZ Board of Nursing has been delayed for two months for a psychological evaluation of Amanda.

The best places to get more links and information include:

The #NurseUp Facebook page

Blogger/Coach Anna Morrison’s Facebook page

Emergency Blues blog (contains numerous links to other info on Amanda’s case)

Amanda’s own words

Please sign the petition here to the AZ BoN to clear Amanda’s license.

Thanks to everyone who has participated already. It makes me proud to be part of our nursing profession when we are able to realize what’s really important and stand up for it!

We have the thinkers and the doers…in life and in our nursing profession.  I consider myself more of a thinker. I admire those who can just jump in and DO, although sometimes not necessarily being able to describe the WHY of what they do; they just DO. My husband, a paramedic, is a doer. Case in point:  one evening I was attempting to cook taco shells in my toaster oven. One fell down between the grate bars, landed on the red-hot burner coil, and promptly burst into flames…which then set the other nearby taco shells on fire. So, I’m standing there debating the pros and cons of using either the fire extinguisher or water from the faucet to put out the flames (meanwhile making strangled screeching noises), when my husband calmly walks into the kitchen, closes the door of the toaster, yanks the cord to the toaster out of the wall, and carries the whole smoking contraption outside. The fire died out, and the smoke dissipated without ado…and there wasn’t any mess from water or fire extinguisher residue in the house. Ah-MAZ-ing. Breathed a sigh of relief.

And then, I was frustrated…at myself. Why didn’t *I* do that??? 

I always wondered how to be more like a DOER, having confidence in my practice, and being able to react with a clinically appropriate intervention at the drop of a hat (or blood pressure, as the “hat” may be). In the past few years, I have come to the conclusion that the nurses that actively renew their knowledge through nursing continuing education or in-services, share their experiences with one another on a regular basis, and who are firmly grounded in the basics of nursing are the ones who frequently find the DOING of nursing comes more naturally and smoothly. 

Too obvious? Perhaps. But maybe some of us discount the value of nursing professional development. How many times have I sighed at the obligations in my unit to attend in-services, or balked at completing nursing CEU, or resented the requirement to attend staff meetings at inconvenient times? Lifelong learning and the sharing of information regarding our profession is essential to maintaining our competency as nurses…not just to increase confidence, but to ensure the safety of our patients, their families, and ourselves. 

The point is that even those who are skilled at DOING must not discredit the value of learning and thinking. It’s all about balancing the need to be functional in the DOING without neglecting the THINKING. Indeed, those that I have observed to be the best DOERS are usually the ones who are heavily involved in teaching others. Funny how someone asking questions will make us take a step back and really think about what we’re doing, but often we do not take the time to think about what we’re doing within our own personal practice if no one is hanging over our shoulder asking the big “why” questions. And those, like me, who relish in sitting back, thinking and questioning many things regarding nursing practice, must not become bogged down in constantly second-guessing ourselves, but take what we already know and apply it in our daily practice without fear.

I encourage all nurses to become more involved in learning, teaching, and mentoring, even virtually through our nurses network, for example. GROW at every opportunity. Stay informed about new technologies, legislation, government regulations, practice guidelines, and research. Invest in THINKING, and your DOING will benefit exponentially! 

Several years ago, I experienced severe back pain. The neurosurgeon I saw diagnosed me with a textbook case of a herniated disc. L4 looked like the side wall of a tire that had blown out.

I woke up after surgery with little pain other than that inflicted by the scalpel. Shortly after I returned to full awareness, the nurse on duty, “Pat,” dropped by. She was 50ish, short, friendly, but definitely no nonsense. (If nurses had rank, I’d say she was like a sergeant.)

After a few questions about my general well-being, Sgt. Pat performed a kindness of great nurses everywhere: encouraging good post-surgical bladder habits.

1)  Great nurses know how to motivate (and warn before doing something painful!).

Pat smiled in a commanding sort of way. “Have you been to the bathroom yet?”

I knew where this was headed. “No,” I sighed.

She looked at her watch. “I’ll give you another thirty minutes, then we’re gonna put a tube in you.”

I grimaced. “Thanks.”

Bladders can be motivated. As soon as Sgt. Pat left the room, I grabbed the chin-up bar hanging over my bed and hoisted myself up. My wife jumped from her chair.

“What are you doing?”

“I’m going to the bathroom,” I announced. “Help me out of this bed.”

With an arm around her shoulder, I hobbled to the bathroom where I stood over the toilet for twenty minutes. In twenty-five, I was back in the bed, greatly relieved. Sgt. Pat showed up as advertised. She opened the door and poked her head in.

“How ‘bout it?”

I gave her a huge smile and a thumbs up.

“Well done,” she said, and left.

2) Great nurses connect with their patients.

Shortly afterward, Sgt. Pat came back to record blood pressure, temperature, and pulse. While she held my wrist and counted out the seconds on her watch, she asked what I did for a living.

“I fly airplanes,” I said.

“How exciting! I’ve always wanted to do that.”

“Never too late,” I said.

As she let go of my wrist, a little smile spread across her face, and she got a far-off look in her eyes. She was dreaming. We all do. She finished her chore with me, then put her hands on her hips and asked a question I don’t often get from women.

“You play golf?”

“I play at it. I’m not very good. You play?”

Like me, she was a duffer. We named a few local courses we’d played, and then talked like we were pros about the intricacies of the golf swing. She left with a word of encouragement.

“I think I can help you get back in shape.”

3) Great nurses know that real medicine does not always come in a bottle.

The next day she showed up with a putter, three balls, and a Styrofoam cup.

“Think you can get out of that bed?” she asked.

I’d already been up a few times. Each one became a little easier. At the foot of the bed, she handed me the putter, placed the balls on the carpet, and walked to the other end of the room with the cup.

“Let’s see how steady you are,” she said.

I drew a bead on the cup and tapped the first ball. It actually nicked the cup. Like any golf fool, I thought I had it in my sights. A dozen attempts later, I finally sunk the first putt. Sgt. Pat let out a whoop! We fooled around like that for about ten minutes, then she had to go. But she left the putter and one small challenge.

“Tomorrow, we compete.”

I can’t remember who won the putting contest, but I can tell you what nurse hit a hole-in-one with her patient care. Sgt. Pat goes down as one of the great nurses of all times. She knew how to motivate, how to connect with her patient, and above all, she knew that real medicine doesn’t always come in a bottle.

~Jim is a professional pilot and writer. For thirty years, he’s flown all over the continental U.S., Canada, and the Caribbean. You can peek at his novel at Graceful Word. He’s had no trouble with his back since the surgery. And while he doesn’t recommend back surgery as treatment for a bad golf swing, his swing has greatly improved.~

I think we approach any new moment or change with hope and ideals. In perusing the comments on these blogs and pages, some nurses have lost their hope. I see the cynicism come out…the bitterness that spews out across the page. And I’ve been there too.

This week, I have no catchy quotes to post, no great words of wisdom, no inspirational song-and-dance.  In no other profession as a whole except medicine (or maybe the military?) do people enter it with grandiose and worthy ideals, and become so jaded with the realities as time goes by. Some survive somewhat by becoming robots, shutting off feelings, and just doing the job in order to earn a paycheck (that “the 99%” of nurses think should be larger).

But some nurses keep their hope. Mixed in with (and thankfully outnumbering) the vitriolic comments are the comments about wanting to make the agony and struggles of patients more bearable in the year ahead. Not to solve all the illnesses and problems, not to change the world…but to lessen someone’s suffering. When we are able to do that, hope remains alive and we become just a little bit less jaded.

Sure, you answer, but what sort of superhuman device will you utilize to grant this type of wish?

Well, I’m not handing out genie lamps, waving fairy wands in your face, or selling “as seen on TV” fix-alls, but what if I said that becoming involved in investigating or implementing true evidence-based practice (EBP) has been shown to increase nurse satisfaction?

(Insert collective groan)

Really, it does! But I think the term has been so overused as an excuse for administrative cost-cutting and/or legal measures that are sometimes inconvenient (at best), that the mention of it may currently induce gagging spasms in the nurses faced with multiple changes in their day-to-day practice as a result of these measures.

The term has been beat to death, I agree. It has been abused. Adulterated to the point where we wonder if it’s really worth all the hassle. Oh, and by the way, does it really benefit the patient if the hoops we have to jump through in order to have EBP make us cranky and overwhelmed?

While my goal here is not to address all the nuances and difficulties of basing the entirety of our practice on legit research that accounts for all variables (would REALLY need that magic wand…AND an alternate universe), I hope to encourage my fellow nurses to not become complacent and fall back into robot mode, just getting through the day.

Just staying in touch with other nurses and discussing current issues, research, observations, and practice differences will contribute to our own encouragement. Getting the results of internal studies, focus groups, round tables, etc. out in the open to give all of us the opportunity to approach our respective facilities with information that has the potential to change our practice for the better—for both our patients and ourselves. Robots unite!

So, if you could change one thing about your current practice regarding patient care, what would that be? Have you researched solutions to the problem or discussed the issue with peers? What have you learned?

Surgeon Generals (SGs, for purposes of this post) come in several forms.  The Army, Navy, and Air Force have these SG officers that oversee medical issues in each of their departments, and the US has a Surgeon General as well, one that functions in the Public Service Health Commissioned Corps (PSHCC) branch of the uniformed services.  The US SG is not that heavily involved in policy-making, but has a presence and a voice regarding health issues that affect those in the US and around the world.  Most of us should be familiar with the “Surgeon General’s Warning” on every box of cigarettes warning people of the hazards of smoking.

On the other hand, the SGs for the military branches seem to have a lot more clout regarding the care of our soldiers.  Case in point, the man Lt. Gen. Eric Schoomaker that Lt. Gen. Patricia Horoho replaces has been quite influential regarding reforming care for traumatic brain injuries, blast injuries, and pain management.

Because of this recent promotion for Horoho, I have great hopes for the ongoing improvement for healthcare for our troops.  She stated the Army would “sharpen its focus on prevention, wellness and healing troops’ physical and psychological scars.”  I like it.  I like her.  I was reading her bio, and this woman gets her hands dirty in true nurse fashion.  She’s been to Haiti and Afghanistan, was lauded for her actions at the Pentagon during 9/11, has received all sorts of medals, has worked as a staff nurse, has taught nurses, and has counseled nurses.  I can only assume she understands nurses, especially those who work with our troops.  What could be better?

May the care of our troops get better and better, because those dedicated Army nurses are cared for and understood as well. I cannot speak from experience, but I expect Army and other military nurses see the devastation that war wreaks on healthy bodies, even if the devastation is only in the mind. Any Army nurses out there that can weigh in on this?  What is your outlook on Horoho and her plans for Army medical care?  Are you doing the happy dance with me?

Ok, so…resolutions. It makes sense, if you’re following the “wisdom of the day,” that if you’re trying to concentrate on improving five, ten, or more things about your life all at one time, it is easy to fail. Drop the ball. Decide it wasn’t so important after all. Or…just forget one or two…or all of them. How do we prevent losing our motivation?  Back to that in a minute, but first, just out of curiosity, I looked up the definition of “resolution” online. Did you know that this one humble word has anywhere from five to ah, eleven definitions? I like this word already. It multi-tasks! Ha! One of the definitions listed for “resolution” pertains to its use in medical jargon and goes like this:

“The subsiding or termination of an abnormal condition” (http://www.thefreedictionary.com/resolution)

For some reason, I love this. It just seems to catch the essence of what a New Year’s resolution should be about. Don’t we make most resolutions in order to attempt to fix something we find to be “abnormal” in our lives? Resolutions are our chance to make us, our circumstances, our experiences, our relationships….better. They come from a desire to terminate the undesirable…the painful, the unhealthy, the ugly, etc.

What about our nursing careers? Have you ever made a specific resolution that pertains to your career? I’ll admit, before I started writing this article, I never really thought about it. If you take the definition above as a jumping-off point, what is it about your career that you would like to see subside or terminate? Perhaps the distance between you and the nursing community at large needs to decrease? Perhaps your fear of new processes, different paperwork (computer charting, anyone?), or complex patients needs to be terminated? What about your career is abnormal, and shouldn’t be that way? This year, perhaps a career-oriented resolution is in order. What is stopping you from becoming the nurse you envision yourself to be? Give yourself this year to work toward your ideal.

How can we keep up our motivation? How can we break our resolutions down into manageable, non-multi-tasking (*twitch, twitch*) bites that we can chew successfully without making our figurative jaw tired? I’ve heard many suggestions over the years, but this one stuck in my mind:  Break down your resolution into 12 goals, and focus only on ONE goal a month that will move you toward completing your resolution. A month still too long? How about weekly goals? Whatever your choice, post your goal in a very obvious location (computer wallpaper? refrigerator?), and put reminders on your calendar, computer, or phone to change your goals as the year moves along.

At the end of the year, look back and see how far you have come!

When it comes around to this time of year, one is always expected to appreciate family, show kindness to the less fortunate, and give generously to all, blah, blah, blah.  We have the bell ringers at store fronts, billboards for orphan children, and boxes for soldiers overseas.  I mean, we are guilted into a lot of the activities and the “giving” of the holidays.  We are overshadowed by constant reminders that the less fortunate will have nothing unless we, the fortunate ones, empty our proverbial pockets into coffers.  Now, before you close your computer thinking that this is a selfish, negative post….read on.

Perhaps other nurse blogs will take a significantly different tone than this one, but I say a colloquial “bah-humbug” to the holiday spirit of giving, because where is it the rest of the year?  Is it necessary to associate this type of cheer and goodwill to only holidays?  What about the plain, ordinary days that aren’t blessed with a special designation? 

Consider this quotation from John Barrymore, an actor and the grandfather of Drew Barrymore:

“I have always been subconsciously embarrassed by the “function” of Christmas and New Years.  The spirit of “loving kindness,” that is presumed to come to a head like a boil once a year, when it has been magnificently concealed up to that moment!”

We, as nurses, are given opportunities to minister to people in great need…constantly. Those ordinary days with no special designation continue to feel like we’re giving “Christmas goodwill toward men.”  WE are the ones who DO give the spirit of “loving kindness” year-round!  (Yes, there are exceptions…which I’m ignoring for purposes of this article…lol.)  We can’t conceal it, because that goodwill is an essential part of a nurse’s caring.  I don’t know about anyone else, but it does wear me down. (Are we afraid to admit this sometimes?) Seeing other people in dire straits makes me feel guilty for complaining about my life, my finances, my whiny kids, or my health when it’s not so great. 

The point is…as long as we live here, we’re never going to have the world exactly as we want it.  There will always be the poor, the orphaned, the needy, the lonely, etc.  Perhaps the holidays are a time to release the burdens, enjoy what we have (yes, even those mother-in-laws), and just live in a few moments without hate, regret, or guilt.  These three emotions are devastating.  (It’s been postulated that most mental illnesses involve one or more of these…is it any wonder that the holidays are the worst time of year for some?)

When our celebrations are over, we can return to the world of nursing as we know it with all of its sickness, suffering, and death.  But for a few moments during the holidays, let your heart and soul be free from the crushing burden of actual (or imposed) obligations, breathe in the smells of crisp winter air (for those in the northern hemisphere), light a candle or a crackling fire, and breathe a word of thanksgiving for just being alive.  Take a vacation from negative emotions, draw on the spirit of loving kindness that floats around from other people this time of year, and fill your tank while you can.

Enjoy your holidays: guilt-free!