Tag Archives: nurses

This Ghoul Will be Your Nurse Tonight: Should Nurses Wear Halloween Costumes to Work?

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This IS My Costume. photo: jparadisi 2011

I dodged a bullet this week. My coworkers are wearing costumes to work on Halloween. I was scheduled to work that day, but on Friday a nurse asked to trade shifts, so I don’t have to decide whether or not to wear a costume. This year I won’t feel like the spoilsport among my coworkers. Don’t get me wrong, I like Halloween, costumes, jack o’lanterns, and all that. I just wonder if they are appropriate in patient care areas?

Nurses wearing costumes to work on Halloween aren’t limited to my unit. The entire hospital celebrates with costume contests (individual and department categories), decorations, and special treats. It’s intended to build enthusiasm and rapport among employees. There are written guidelines about what sort of costumes and decorations are not appropriate. Respect for gender, race, political, and religious beliefs is emphasized. Costumes and decorations cannot be gory or represent death. They cannot interfere with patient care either.

Earlier this month, Buckman elementary school principal Brian Anderson, in Portland, Oregon was included in an article in The Huffington Post because he banned costumes at the school. He took heat from parents, and sparked a national controversy on whether he was being fair.  The Portland Mercury quotes Anderson as saying:

For many reasons, the celebration of Halloween at school can lead to student exclusion. There are social, financial and cultural differences among our families that we must respect. The spirit of equity has led most PPS (Portland Public Schools) schools, including most elementary schools, to deemphasize the celebration of Halloween at school.

He has a point. Critics argue that banning Halloween costumes from schools is taking political correctness too far.

But what about hospitals and nurses?

Halloween costumes are allowed in every hospital I’ve worked for, however, I never wore one to work. In the PICU, there were so many painful situations that, for me, costumes felt out of place, yet I don’t recall a single patient or parent expressing disapproval of nurses dressed as witches or scarecrows. Now that I am an outpatient adult oncology nurse, I still don’t wear costumes to work. I have not heard complaints from our patients about the nurses who do.

What do other nurses and health care providers think about this? I also wonder what patients and people from other walks of life have to say.

Nurses’ Week: Sometimes The Best Recognition is None at All

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The Broken Elevator photo: jparadisi 2011

Saturday morning, David and I woke to a noisy buzzing alarm coming from the elevator in the hallway of our building. It was stuck on our floor with its doors half open. Because it’s the weekend, I’m not hopeful of it getting fixed promptly. Next, as if we are under attack from a conspiracy of machines, our normally silent dryer started making a loud thumping noise, like tumbling canvas shoes, but all that’s in the drum is a small load of delicates. David is on his computer, looking for a repairperson as I write this post. The coincidental mechanical malfunctions remind me that as long as things meet my expectations, I often take them for granted.

At a social event, I was surprised to see an ex-patient and his wife also in attendance. I remembered them vividly, because of the longer than expected amount of time spent admitting him to our unit. The husband had the misfortune of being discharged from the hospital on a Saturday evening. Commonly, hospitals have a minimum of discharge planners on weekends, and the discharge planner’s job is frustrated by the fact that most of the outpatient services he or she needs to coordinate are closed. Also, he did not have a primary care provider, meaning no physician or nurse practitioner was in charge of his outpatient follow-up. To fix this problem, he was given a physician referral, and a phone number to call on Monday.

He arrived in our ambulatory clinic on a Sunday morning for daily treatment in pain, after a difficult night at home.  His wife and son accompanied him. The son was concerned about the eschar on his father’s wound, and I agreed with his assessment. Eschar is a dark, leather-like tissue formed on the surface of a wound. In the worst- case scenarios, it creates a tight band around an extremity, cutting off the blood flow to the body part below it. It increases the patient’s pain by preventing oxygen-rich blood from reaching the affected area. Fortunately, the body part below the eschar of this patient was warm to touch, with strong pulses, and a brisk capillary refill, so he wasn’t in imminent danger. He didn’t have a fever, and his vitals signs were normal, so pain control and obtaining a surgical consult became our priorities. We needed a doctor to write orders.

Luckily, the resident who treated my patient in the hospital was still there. I paged him, and told him what was happening. He agreed to see the patient in the clinic. This was generous of him, because once a patient is discharged from the hospital, technically, he is no longer responsible for his care. He wrote a script for breakthrough pain medication, and made a phone call for a surgical consult to address the eschar. In this way, the patient avoided a trip to the ER, the only other option on a Sunday. On Monday morning, a surgeon removed the eschar. I was pleased with myself for mobilizing the necessary resources on a weekend. The rest of the patient’s course flowed uneventfully until discharge.

The Dryer: Things That Go Thump photo: jparadisi 2011

At the social event, I approached the former patient and his wife to say hello. Looking at me blankly, they reciprocated, then awkward silence. Realizing I’d made a mistake, I said, “I didn’t mean to bother you. We’ve met before. I just wanted to say hello.” “Really?” said the wife. “Where would that have been?” Uh, oh. I mumbled the name of the hospital, but not the unit. Even the name did not prompt a recollection. They continued to stare blankly.  I desired to end the interaction, unsure if I was circling the drain of a possible HIPPA violation. Complementing the wife on her earrings, I retreated to another part of the room.

Later, it occurred to me that their discharge ordeal wasn’t an ordeal to them, because by means of coöperation and teamwork, I fixed it. They expected a smooth discharge with seamless follow-up care, and they got it. They took it for granted, because they didn’t experience the frustration of falling through the cracks. They didn’t recognize me, because I hadn’t stood out. They did not experience poor care versus quality care. In their mind, I did my job, and that did not merit recognition. They are right.

I appreciate the effort hospital administrators make each year during Nurses Week to thank nurses. Recognition for a job well done is one way of saying, “Thank you.” However, a lack of recognition, because the person served is unaware of the effort made on their behalf, is a form of reward too. The best recognition of a job well done comes from within.

Nurses and Pharmacists: For Valentine’s Day All We Want Is Respect

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I’ve written before that I am happily married to a pharmacist. Sometimes when we come home from work, we commiserate together in shorthand about our hospital shifts. When we are grumpy, we play “I work harder than you do,” in which we childishly throw out episodes from our day to prove who had a harder shift and should buy dinner. Usually I win, because as a nurse, I am the one working hands-on with patients. However, I concede that being responsible for every medication calculation, preparation, and drug interaction (and more) is a tough and stressful job. Safe medication administration is a foundation of patient care. I also acknowledge that nurses are occasionally a little difficult to work with (I  was actually once present for a code blue when a stool softener was ordered STAT).

Anyway, for David and all my pharmacist friends, this one’s for you. Special thanks to the friend who brought this video to my attention.

Late Entry: I did have the Pharmacy Respect video here earlier, but I have removed it. Unfortunately, I cannot unlink it from the YouTube playlist that I do not want to post to this site. So, watch the Pharmacy Respect video, click the link or go to YouTube and type Pharmacy Respect into the search bar. It will come right up. Sorry for the inconvenience, but it is a cute video.

Let Me Tell You One More Thing You Already Know

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Intubated (Baby with a Breathing Machine) mixed media on vellum by JParadisi

Maybe it happened because I was tired after working a string of long, busy shifts.

Maybe Mercury, the communication planet, went retrograde last week.

Last week I wasn’t as good of a communicator as I would like to be.

I am one of those nurses who learned something in the Therapeutic Communication module of nursing school. Before you judge me as the nerd I kinda am, I do not go around repeating, “What I hear you saying is…” Such phrases are not what someone wants regurgitated back at them. The phrase is a tool, not a mantra. Instead, I learned to carefully listen to the words a patient uses and watch for any mismatch of those words in their body language. Then I speak to the body language. As a visual artist I first think in images, then put the ideas represented by the images into words, like a songwriter fitting lyrics to a melody. For me, the pictures come first, then the words.

Here’s what happened:

A colleague introduced me to a nursing student whose next clinical rotation is pediatrics. She told her I was once a pediatric intensive care nurse, and the student asked if I had any pearls of wisdom to share. While I am not so vain to believe my words possess a cure for the deep wounds of a human soul, I am vain enough to believe I occasionally have something insightful to say. So I offered this advice:

  • Always consider the parent-child unit as your patient
  • Even if a parent doesn’t know pathophysiology, they know their child better than you do.
  • The smaller the patient, the more important it is that you get it right the first time.
  • If you are unsure of what you are doing, find a nurse who does know. Stick close to your preceptor.

I finished and saw the glazed look on the student’s face. Her shoulders already turned away from me. She didn’t really want my advice; she was only being polite. David tells me when he sees this look in the eyes of the pharmacy students he precepts, he adds, “Let me tell you one more thing you already know.” She was not my student, however, so I shrugged it off.

A few days later, I was starting an IV in a patient. I had started IV’s in this patient before, and this particular day, while I did so, she told me about a bad experience she had as a child when a nurse started her IV. As before, her body language was the picture of calm while she talked. I inserted the IV easily. As soon as the patient saw the blood flash, confirming the IV was in the vein, she passed out, just like that. I yelled for help, but by the time my coworkers arrived, she was already coming to. With the innocent expression of a child she looked up into my face, and said, “Oh, it’s you.”

I disappointed myself. Her words had not matched her body language, and I missed it. I didn’t know how much courage it took for her to come in for treatment. I gave her some juice, and a little time to herself. When it was clear that her inner child had safely returned to her soul’s play room, I told her I was sorry. She apologized for not telling me how she really felt. She didn’t want to be a difficult patient. We talked about her fear of needles, and came up with a plan. She decided to finish her IV treatment, and I learned one more thing I already knew.

Humanity, Health, and the Care of Souls

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There is an excellent post by psychiatrist Michael W. Kahn  in the New York Times Well Blog that every health care provider should read When Battlefield Humor Backfires. Follow it with today’s post by registered nurse Marcy Phipps for AJN’s blog Off the Charts, and you’ll have lots to think about.

Color Coded for Easy Identification

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The White that Binds (Pinning Ceremony) jparadisi 2010

On my other blog, Die Krankenschwester, I explore issues of gender, role, and identity through nursing imagery.  J Doe at Those Emergency Blues wrote an excellent post this morning about titles and power.  Her post runs corollary to the idea of color used as a label of identity in my series of paintings From Cradle to Grave: The Color White. In The Color White series, I question the links between the color white, femininity, purity, and nursing.

In her book Color, author Victoria Finlay (2002 Ballantine Books) discusses the historical association of the color purple with royalty.  If some physicians insist they are the only ones who may use the title Doctor in the medical setting, then perhaps they should be required to wear the color purple in hospitals, which was traditionally only allowed to royalty in ancient times. That way, patients will know at a glance who their doctor is, because name badges and an introduction may not be enough.

I’m just sayin…

Using Influence for the Benefit of Others

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This post is long over due.

Dr. Dean Burke uses simile in his post about influencing patients about their own health care and teaching nurses about personal finances at The Millionaire Nurse. He also shares some good information about using SEO this week. Be sure to check out his blog! Who says nurses and doctors can’t be friends? (anybody remember the musical, “Oklahoma”?).

Popcorn Lung?

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Twice this past week, I arrived at work to the noxious odor of burning popcorn wafting throughout the infusion center. What is it with nurses and microwave popcorn? We save lives daily. We keep critically injured patients from circling the drain into certain doom. We safely medicate patients and do complex procedures, but as a group we are notorious for our inability to pop popcorn in microwaves without burning it. I can’t remember ever smelling burning popcorn in a movie theater. Statistically speaking, you’d think burnt popcorn occurs more often in a movie theater than a hospital, based on the sheer volumes of popcorn popped at movie theaters. That isn’t the case. I wonder why.

You think I exaggerate? Using the search words popcorn microwave hospital fires today resulted in 93,200 results in 0.22 seconds on Google. My favorite is this YouTube Video about a pediatric ER nurse named Stephanie:

Stephanie, you are not alone among your nursing peers. I found an unconfirmed reference online that said Seattle, Washington has made it illegal to pop microwave popcorn in its hospitals because of the fire hazard.

When I signed up for nursing, I expected exposure to many unpleasant odors, including “code browns” (poopy messes), emesis (vomit), and blood. I can handle all of them, but burnt popcorn makes me gag.  Also, fumes of microwave popcorn containing diacetyl, burnt or otherwise, may cause Popcorn Lung, according to this article (dated September 2007). I wonder if this is covered by workman’s comp?

I love microwave popcorn, and it makes a quick, tasty snack that is easy to share with coworkers. Let’s preserve this simple pleasure. If we can save lives, surely we can learn to pop popcorn without burning it.

It Ain’t no Sin to be Glad You’re Alive

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Bathing Sparrow (sorry it's hard to see) photo:JParadisi 2010

After weeks of daily rain, the sun was shining in a brilliant blue sky and the weatherman promised the warm weather would last all weekend.  My coworkers were feeling fine too: in the staff lounge, two of them sang “If I can’t have you, I don’t want nobody baby” and I joined in as the third Bee Gee, before traipsing to blood bank to retrieve a couple of units for a transfusion. On the way, I passed a surgery tech wearing cap and scrubs, who started dancing in the hospital hallway to the tune of his ringing cell phone. We both laughed when he caught me watching. I was still smiling when a woman stepped out of the elevator, looking haggard and sad. She was not hospital staff, and her sorrow reminded me that many people in the hospital were not having a good day at all. I quickly doused the smile and flipped on my professional demeanor switch.

It’s part of the job when you are a nurse. It’s not enough to like people and have excellent skills. Nurses need the ability to separate their personal lives from their jobs. Don’t bring your own drama in, and don’t take the drama of others out. This is a valuable survival technique for longevity in health care. I’m pretty good at it, but occasionally worlds collide.

Like this morning. My oncology patient mentioned she sure missed having a glass of wine once in awhile. We joked about it before I went into the room of my next patient. Filling out the admission record, I asked the required question: “Do you drink alcohol?” I was unprepared for the ferocity of my patient’s reaction, as she explained emphatically that she does not drink alcohol, and it ought to be illegal to drink it. I stopped the admission process, sat down on the rolly stool in the room, and listened to her. When she finished, her glaring eyes dared me to contradict her. I quietly asked, “Have you or someone you love been harmed by someone drinking alcohol?” She had. Or rather, her son was in an automobile accident caused by a drunk driver. Now he is ventilator-dependent and confined to a wheel chair for the rest of his life.

Joking with one patient about an anticipated glass of wine as a reward for going through chemo is supportive. Bringing the topic up with another patient is traumatic. Nursing requires the ability to respond thoughtfully to either patient, sometimes within the span of a few footsteps.

While warming myself in the sunlight on a bench in a neighborhood park after work, I thought about all of this, reminded of how good it is to be alive and healthy. At the end of even difficult shifts, nurses leave the hospital behind while the patients stay there and endure.

Next to the bench, a sparrow bathed itself in a tiny pond. I watched him scatter water droplets that glittered like diamonds in the bright sun, thoroughly enjoying himself on a beautiful day. He wasn’t paying attention to me. He wasn’t thinking about patients, car accidents, cancer, or a glass of wine. He was just enjoying the moment.

“…it ain’t no sin to be glad you’re alive.” (Bruce Springsteen)