Would you like fries with that?

I recently overheard a conversation in which a patient was berating the nurse for the temperature of the food on his tray and that he could not see outside his room from where he was sitting.

Disclaimer: I am huge patient advocate and in most cases will look at a situation from the patient’s point of view as they are most vulnerable and it is our responsibility as nurses to provide competent care, ensure their safety and preserve their dignity and rights in the process…however in this particular case, the patient was treating the nurse more like a waitress than a professional. The part of the conversation I encountered upon was only a small part of the patient-nurse dynamic that had been transpiring. The tone of voice and demanding attitude towards the nurse were inappropriate and belittling. She felt that everything she did was not good enough and was spending an inordinate amount of time trying to please him, meanwhile getting behind in her medications and patient assessments. This nurse handled herself with great poise and patience, yet he continued to be demanding.

Nurses are not waitresses. Nor are they babysitters or activity directors. Yet, much of a nurse’s shift is spent making sure the patients are happy instead of cared for. I understand that the role of the nurse is multifaceted and must care for the whole patient, however there comes a point when fluffing pillows and entertaining patients interferes with real nurses work – taking care of patients. The quest for patient satisfaction has perhaps swung the pendulum too far. I am sure some would argue that is part of a nurse’s job. I would however challenge that if nursing has truly become no more than providing hospitality services, then why do we expect nurses to be educated, make critical decisions, provide complex care and so much more around the clock?

I think this situation is a symptom of a bigger problem…entitlement. Everywhere people go, the customer is always right, the service must be outstanding, the product must be perfect and if not the right to complain about it is theirs. Healthcare is different and hospitals are not hotels. There is no room for social admissions anymore; beds are tight and resources are short. If you are well enough to notice the food is cold and want to see into the hallway to people watch you are most likely too well to be in the hospital (this a perfect example of healthcare waste) and would be better off going to Burger King where you can have your way.

It's a new day

and I am back...or at least I hope to be. I cannot believe it has been nearly a year since I last posted to my blog. So much has changed in these past 11 months, but wasn't hasn't changed are my passions: nursing/patient care and coastal living.

Stay tuned as I find my way back to the blogging world!

the right words

The five rights of patient medication safety include: the right person, the right drug, the right dose, the right route and the right time. It seems pretty simple enough. The last piece critical to medication safety is the right/write documentation. Not just because of the fact that if it is not documented it is not done, but if it is not documented what is stopping someone from giving the medication again.

I am continually amazed when doing case reviews at the lack of documentation. Besides the obvious legal peril that not documenting may leave someone in, the safety implications are often overlooked. And don’t forget the issue of payment and reimbursement. How can you bill for services that there is no record of? More than once I have I seen charges written off because after reviewing a medical record the “patient’s story” is not clear – there are pieces missing and the care that was provided, however appropriate and safe is brought into question because the proof is not there.

This does not just apply to nurses….physicians, respiratory and physical therapists, social workers, paramedics, and anyone who provides care to patients. A hospital defense attorney’s worse nightmare is to have to defend a hospital or provider using a chart that is missing notes and documentation. Documentation is just as important as performing the five rights.

Connect the dots. Close the loop. Write it down. Take credit for the care or treatment that was provided.

Of course, make sure what is written is both legible and spelled correctly.

Happy Birthday

May 12th, 1820 - August 13th, 1910

Nursing and healthcare have certainly changed through the years, but what hasn't changed is the impact of examing practice to improve clinical outcomes. Florence Nightingale was on to something all those years ago using science and statistics to effect patient outcomes; she positively impacted the face of nursing.

Thank you Florence.

Times have certainly changed

Perhaps it is that I can barely remember being 13 or in middle school for that fact, but I do not understand in a world jam packed full of technology such as cell phones, iPods, computers and Wii games why kids feel the need to take cold medicine to get high. Ok so I was not perfect growing up, but I was too busy in middle school going to slumber parties and the mall and the movies to wonder to myself what it would be like to take some random OTC cold remedy.

My favorite part is the attitude that accompanies these pubescent, hormone-intoxicated kids when they present to ER with a chief complaint of an overdose. Seriously? What do they honestly think is going to happen when the nurses and physicians in the ER ask them why and when and how much they took? Of course you are going to be stuck with needles and asked to pee in a cup and drink activated charcoal with Hershey’s syrup over ice! And mom, please do displace your anger towards the staff trying to undo the damage 24 cold and flu tablets with acetaminophen can do.

Then there is the burning question in my mind – What happened to stealing cigarettes and sips of alcohol from your parents’ liquor cabinet? I am not as old as you think – I was just too scared to try anything else, because my mother would have killed me if ever I got caught! But I guess the times have changed and each generation has their own sense of what is cool and the thing to do. This nurse just does not get it; but then again would I want a cranky nurse taking me after I got caught chewing cold tablets like candy or some compassion – hmmm, the jury’s still it out on that one.

Blood, bandages & bedpans

It seems a little odd that a job that almost broke me is still my most favorite. I had not realized how much I missed working in the emergency room until I pitched in the other day for a couple hours as they were bursting at the seams. Sure the very short shift consisted only of pushing one wheelchair-bound female to her family’s car, cleaning and making numerous stretchers and removing one IV. I did triage from EMS the very pleasant gentleman that was the unfortunate recipient of a head bleed. It was rather uneventful. I have missed the commotion, the noise, the smells…yes, all of them; there really is no other place quite like it.

I returned to my regular job just as quickly as I arrived to help out in the ER. It occurred to me when I was back in my very quite, feng-shui office that you may take the nurse out of the ER but can’t take the ER out of the nurse.

Counting Calories

So apparently we need an official research study to tell us that eating less calories will result in less body weight (see “Fewer calories = less weight” posted by theHeart.org). In a society obsessed with outward beauty, it is hard to fathom that over 66% of Americans are obese. Obesity is defined as being 20-25% over the ideal body weight; so why then in a time where fad diets are all the rage are there so many overweight people and even more that are perpetually dieting? There is the Atkins diet, the South Beach diet, the Nutri-system diet, the Jenny Craig diet, the Weight Watchers diet, the Slim-Fast diet, the Acai Berry diet, the Pink Grapefruit diet, the Flat Belly diet and the numerous other diets that claim to give you the stealth body you have always dreamed of. No wonder we need medical research to clarify that consuming less calories combined with exercise is the sensible way to lose or maintain one’s weight.

For me, I will happily stick to my “no meat, low fat, whole, no processed or refined foods diet” - of course until medical research proves I should be eating something else.