Use the Call Light for Help photo: JParadisi 2010

     Blogger Theresa Brown, RN’s post for the NY Times,  Violence on the Oncology Ward  struck a chord within me. My own experiences with violence directed at nurses started while I was a nursing student during a clinical rotation over 20 years ago. Standing in the courtyard of a large urban hospital under a bright noonday sun, someone grabbed me from behind by the hair while screaming obscenities in my ear. My head was jerked backwards against my shoulder so violently that the only thing I could see was a classmate and a passerby running towards me to fend off the attacker. After the two rescuers pried the fingers that were beyond my grasp loose from my hair, I saw that the attacker was a diminutive woman dressed in filthy rags. I stood stunned as she walked down the sun-drenched sidewalk, still shouting obscenities. When I reported the incident to my clinical instructor, expecting her to warn the rest of our class to be careful, she told me disinterestedly that “It was just a crazy person, it doesn’t count.” I realized that both the “crazy woman” and myself had been dismissed.      

     Years later, in another city, a patient came to his appointment with a butcher knife in his back pocket. That hospital has a no tolerance policy for weapons of any kind, and security was quick to take the knife surrendered voluntarily by the patient so he could receive care. After security left, the patient looked coolly into my eyes and said “I don’t know why you’re worried about the knife, I could beat you to death with my crutch if I wanted to.” The security officer returned, and the patient was escorted off campus.      

      He took himself to the emergency department, and told his story to a nurse there. This nurse called my department. Listening to the story, he commented ”That’s bizarre,” after every statement I made. I finally asked him “What’s bizarre?” and he said, “That you feel he threatened you, after security took the knife.” No longer a student nurse, I asserted myself: ”He did threaten me.” The ER nurse said, “I find it bizarre. That kind of thing happens all the time over here.”       

     “What’s bizarre,” I told him, ”is that you accept it happens.”      

     Studies of workplace violence suggest that accepting  inappropriate behavior in the health care environment creates a setting conducive to more serious forms of violence. Verbal or physical threats, and carrying any weapon or item that can be used to cause death or serious physical injury are only two examples of inappropriate behavior. 

     I wonder if a sense of duty to the patient blurs what is acceptable behavior for some nurses? Despite his threatening behavior, I arranged another method of care for my patient with the knife, because he needed treatment.  

     I don’t know if enacting legislation mandating tougher penalties for workplace violence committed against nurses is the answer. It seems to me that everyone needs protection from violence. What I do know is that violence towards nurses is still accepted by many in the profession as an inevitable part of our job description, and I strongly disagree.

-Lewis Carroll  

  If you could hear this sentence, there would be a drum roll.   Die Krankenschwester is a blog exploring identity by combining blogging and visual in an experimental format. Kronkenschwester ( kron/ken/shwester) is German for nurse and translates literally to the sick sister.  Most of the art work will be created specifically for Die Krankenschwester over a not yet determined period of time. The images represent a visual exploration of nursing practice and identity through art and pop culture.  I don’t have more of a plan than that. So check in at Die Krankenschwester now and then and see what you think.  

     JParadisi RN’s Blog will continue as a separate from Die Krankenschwester.  

Die Krankenschwester blog header JParadisi 2010

Absence (installation 2009) by JParadisi

    I am five years old, lying on a mat on the floor in a darkened room. Peeking out of the corner of tightly squinted, but not quite closed eyes, I watch Mrs. Sundeman, seated at a child-sized table, place gold stars on our morning’s work. She sits on a child’s chair. With the side of my face pressed against the mat on the floor, her black shoes with stout heels are in my direct line of view. I peer up towards her face, willing her to see I am a good napper. “Pick me, pick me,” I chant silently. “Please pick me.” I force myself to lie still on the uncomfortable mat.  It’s naptime in kindergarten, and I want to be the best napper so Mrs. Sundeman, the teacher will pick me to have the magic pencil. Then I will choose, one by one among the sleeping children, who will get off the mats first by tapping them on the shoulder with the magic pencil. With the magic pencil, I choose who returns to play and who stays on the uncomfortable mats.   

     I am not chosen. It is not enough to lie still with squinted eyes. Mrs. Sundeman prefers children who dream unconsciously to those who like me cannot lie still without thinking. I do not know how to lie still and not think of something. Even with my eyes tightly closed, I see swirly lines and arabesques in brilliant colors against the black backdrop of my eyelids. My thoughts are full of ideas for pictures I will draw and I struggle not to tell the child lying closest to me, because we are not supposed to talk during naptime.   

     I am an adult now. I am a Registered Nurse. I hang bags of chemotherapy on IV poles and attach it by tubing to the IV sites of cancer patients looking at me hopefully as if I am administering Jesus in a bottle. They come in hoping for a cure, but many would be satisfied with simple remission, allowing them another birthday, another holiday, another anniversary with their families. I can hear the silent chants, ”Pick me, pick me.” I smile at them while setting the pump. I ask if they are comfortable in their lounge chairs. I bring them warm blankets and pillows.   

     She lies in a lounge. Her cancer refuses to go into remission, and we both know. She no longer chants “pick me, pick me.” I gently hug her body of skin stretched over fragile bones. I never had the magic pencil. I never will. I am not the one who gets to pick, and for that I am grateful.

comission (2010) artist: JParadisi

It takes a lot of time to be a genius, you have to sit around so much doing nothing, really nothing.

 

Gertrude Stein

  I don’t know much about genius, but I do know about making a painting, and it does take time sitting around doing nothing sometimes. I hate those times. I try to welcome them. I am a doer. I like waking up every morning with a list of things I want to do. Nursing is a good fit for me in that sense: there is always something to do when I’m at my nursing job. The studio is not like that. I go to the studio thinking I have several hours to make a painting. I set up my tabouret (a fancy French word for a little table or stool) with paints and medium and brushes and rags. When I can I leave a painting at a moment when I know what my next brush stroke will be. Then, when I return to the studio I have a starting point to re-enter the painting. It’s a little trick I play on myself.  Hemingway used this device, stopping at a point in a story where he knew what he would write next.  Knowing where to start does not guarantee a painting will progress, however. How many times have I spent hours applying paint to a canvas and stepped back to look at my work, disappointed? Sometimes, knowing what to do next leads to an artificial and contrived feel to the painting that I cannot stand. So out comes the palette knife and rag and I scrape and rub away all that paint and hard work, leaving me clueless how to get back into the painting.  At that point, I am Alice down the rabbit hole, forced to sit back and do nothing, really nothing. It’s painful and frustrating. The nurse in me wants to complete her tasks and check them off her list. The artist in me knows that’s not how a work of art gets made, and she laughs at the nurse’s compulsion.

This is Crazy Nurse Shoes photo: JParadisi 2010

      Artists and poker players learn to read “tells.” Tells are little gestures and habits that inform (tell) an observer how an artist made a painting or what a fellow poker player will do next.   

     Recent  conversations on nursing blogs discuss the pros and cons of  returning to the white nurses uniform. Bloggers in favor of the idea feel it sets nurses professionally and visually apart, easily identifying us to patients. If a patient is unable to read the staff’s name badges for any reason in a busy hospital environment perhaps this is a good idea. Momentarily forget about printed scrubs versus white uniforms as a nursing issue. There is another tell that non-medical people identify us by as nurses: our shoes.    

    Can any other career minded group of people use a shoe makeover more than nurses?  What other clique of educated professionals wears brightly colored, clunky footwear with patterned socks and feels good about themselves? Even during off-duty meetings at the hospital most of the feet under the conference tables are wearing comfort footwear and socks. Maybe things are worse here in Oregon where comfortable footwear is an art form.    

     The other day my neighbor who works in sales and I were collecting our mail after work. As always she was beautifully dressed, but what impressed me most was her ability to stand and walk gracefully in 7-inch stilettos. The line of her legs went on and on; she embodied fashion as art. Most artists appreciate a strong sense of style. If you look closely even at grunge artists you will see the tells of carefully calculated facial hair and thoughtfully chosen accessories. You can identify the ones with trust funds by their orthodontically corrected, perfect smiles.     

       My neighbor stood as lithe as a bamboo reed.   

      I wear street clothes under a white lab coat at my nursing job. I am not a complete fashion slouch, but despite wearing skinny jeans, and a european cut pea coat, my clogs were the tell announcing I too had just gotten off  work.   

      Shopping in a swank shoe department in the mall I over heard a husky young man loudly announce to his girlfriend  ”This is crazy, those are nurse shoes.”  My attention immediately diverted to the couple standing next to a display of brightly patterned, patent leather clogs. Yep, nurse shoes. My favorite brand in fact. The very first pair I ever owned are in my studio, splattered with paint and gesso. I wear them when I paint. Comfortable shoes are another crossover between my nursing and artist careers.   

     Just for fun I removed my boots and socks and tried on a pair of 7-inch stilettos in the swank shoe department.  The line of my legs went on and on. I stood without teetering, but realized if I took a single step forward I might fall to my death or at least twist an ankle, rendering me unable to work my nursing shifts. Instead, I settled for 2 1/2-inch, sexy little peep- toe booties. I can’t wear them to work, but maybe to one of those off-duty meetings…  Paired with skinny jeans, my legs look longer and I’ll learn to be content with that.

photo: JParadisi

     You can file this post under shameless self promotion:

  The website When Health Freezes Over  includes JParadisi RN’s Blog on their list of 50 Best Specialty Blogs. JParadisi RN’s Blog is #22,  under the subheading Cancer Nurse.

     Thank you When Health Freezes Over!

 

 

 

 

Persephone (2009) oil on unstretched canvas by JParadisi

One of the pleasant things those of us who write or paint do is to have the daily miracle.  It does come.

                                                                          Gertrude Stein

 

                                                                                                

 

An Unexpected Discovery photo: JParadisi 2009

     A friend of mine told me about his experience a few weeks ago at a dental appointment. He arrived on time for a scheduled cleaning with his hygienist. After waiting five minutes, the hygienist came to the door of the waiting room. My friend stood up to follow her, but the hygienist called the name of a woman sitting across the room instead. My friend sat back down. Puzzled, he assumed the hygienist would return for him shortly.  My friend works in health care. The doctor’s office he works for sometimes runs late, and patients wait. He figured it was Karma.  After staring mindlessly at the pages of a six month old tabloid magazine, he checked his cellphone for messages and noticed  half an hour had passed. He requested a day off from work for this weekday appointment. Anticipating it to last an hour he scheduled other appointments and mundane errands after the routine dental cleaning. He wasn’t going to finish his errands that day.     

     Finally, a dental technician called his name. Once he was in the exam chair, the technician told him the appointment changed. He was rescheduled for an exam with the dentist instead of the hygienist. The technician readied to take a full mouth of x-rays.  My friend asked about the cleaning  he  scheduled the appointment for, and the tech told him not to worry about it.  He told the tech that  he only had time for a teeth cleaning, and this was his priority for the appointment. Could he reschedule the exam with the dentist for a later date? Annoyance reverberated throughout the dental office like an earthquake measuring 8.8 on the Richter scale. Eventually his teeth were cleaned. The appointment lasted two hours. My friend left puzzled by the entire scenario. Weeks before this appointment, the office called him twice with reminders that he needed to call within 24 hours to avoid an office charge if he wasn’t there.  Why was his appointment changed without his permission, my friend asked?  Why wasn’t he at least informed a change was necessary with one of those phone calls?     

     There are lessons to extrapolate from my friend’s story into my nursing practice.  Occasionally my patients wait beyond their scheduled appointment times too.  Events occur or sometimes patients are late, causing unexpected delays. More intriguing is the chasm between the expectations of my friend and his dentist, leading to an unhappy encounter for each. I imagine that the dentist and my friend both felt disrespected.     

     How many times do patients say, “I didn’t realize this was going to take so long”? Immediately, we have different expectations for the appointment. I don’t remember any patient expecting a different treatment than the one I expected to administer though.     

     The story reminds me of how important communication is when managing expectations for both the patient and the care provider.  Unexpected changes without explanation during a medical (or dental) appointment are rarely appreciated.  The Human Resources woman is right about this:  managing expectations is an important factor in customer service and satisfaction.

     On Tuesday, February 16, 2010, JParadisi RN’s Blog had the most site hits since its debut in January, 2009. The day is notable, because the blog’s post Whistle Blowers & Patient Advocates: When the Nurse Stands Alone was mentioned by Shawn Kennedy on the AJN blog, Off the Charts.  I assumed the two events were connected. Imagine my surprise: they are not. The stats for JParadisi RN’s Blog show that the most popular post on February 16 was an older post:  Not a Wonderful Life: No George Bailey for Pharmacist Eric Cropp or His Patient. For the entire week that post and the posts with updates about Eric Cropp were the most viewed on my blog.

     Eric Cropp served 6 months of imprisonment for involuntary manslaughter in the death of 2 year-old Emily Jerry. Emily Jerry died when she received a chemotherapy solution containing a lethal dose of sodium chloride mixed by a pharmacy technician at the hospital where Eric was the supervising pharmacist. The Ohio Board of Pharmacy stripped Eric of his license prior to his conviction.  Now a convicted felon, he will never practice pharmacy again.

     Why the renewed interest in the Eric Cropp case, during the immediate aftermath of the Anne Mitchell trial? Anne Mitchell, RN was publicly supported by the Texas Nurses Association and the American Nurses Association. The TNA donated funds for Mitchell’s legal defense, and the Texas Medical Board acknowledged Mitchell’s duty as a patient safety advocate. Mitchell was found not guilty. There were no fatalities in the Anne Mitchell case. The most obvious difference drawn from a comparison of the two trials is that a child’s death initiated the criminal charges against Eric Cropp. Perhaps this explains why pharmacist professional associations appear silent on the matter. Searching  two prominent organizations websites with the keywords “Eric Cropp” I found only one article about the case on one site, and none on the other. Granted, defending a person accountable for the accidental death of a toddler creates an unpopular challenge in public relations. 

     Physicians are familiar with lawsuits involving the death of patients.  It is rare for a doctor to go to prison or be stripped of his or her license in such a case.  Eric Cropp was convicted of criminal charges in the absence of public support, except for  Michael Cohen of ISMP.  Whether this is right or wrong is a matter of opinion.

     The  pharmacy profession lost an opportunity to speak about patient safety systems, staffing issues, medication compounding practices, pharmacist to technician ratios, and other problems similar to those nurses have brought to public attention for years.  In contrast, the TNA, and ANA used Anne Mitchell’s trial to educate the non-medical public about the patient safety advocate role of nurses. It is important to remember that the non-medical public is unfamiliar with common hospital practices. In my opinion, there is an expectation for professional organizations to educate the public on the scope of practice of its members. It is unfortunate that this opportunity was missed during the Eric Cropp trial. 

     Did a lack of support and public education lead to the setting of  a disturbing  precedent: the criminalization of medication errors? (Will the Criminalization of Medication Errors Make Patients Safer in Ohio?).           

     Eric Cropp was released from jail on February 15, 2010, and this explains the increased traffic to JParadisi RN’s Blog on February 16, in the aftermath of the Anne Mitchell case. It was only a coincidence. Whether or not pharmacists compare the two very different outcomes of these trials, I do not know.

      I am married to a pharmacist.  However, for most of my career, I was a pediatric intensive care nurse dedicated to saving the lives of children like Emily Jerry. I saw firsthand families devastated from losing a child under less unusual circumstances. The opinions expressed in this post do not diminish my sympathy or empathy for the family of Emily Jerry.

   For you can look at things while talking or with a radio going full blast, but you can only see when the chatter stops.

 Frederick Franck