Flu Shot? Yes, Check That Box

This week I got a flu shot, free of charge from the hospital. I bared my deltoid muscle, allowing a nursing student to practice her immunization and injection skills. She did a pretty good job. It barely hurt. Those are penguins on the adhesive strip she covered the tiny bead of blood from the needle prick with, in the photo to the right.

Flu shot? Yes. Check that box

Flu shot? Yes. Check that box

I hardly thought twice about getting a flu shot this year, which hasn’t always been the case. In fact, in the past I opposed mandatory flu shots for nurses; arguing against someone else making rules about my body. While I was never threatened with job termination for refusing flu shots, some hospitals did make nurses refusing them uncomfortable with policies mandating they wear respiratory masks in patient care areas during flu season, or producing notes from their primary care provider explaining the nurse’s choice to avoid it; stuff like that.

What changed my mind about flu shots? I don’t know it has actually changed. What’s changed is my attitude: I don’t feel it’s worth the fuss anymore. It’s not a battle I choose to fight. I don’t know if this is a sign of maturity, or aging, but it’s lost its importance in the greater scheme of my life.

This year, and the last, I got a flu shot, and then I went back to work.

What about you? Are flu shots still a hot topic for nurses like they were in 2009, during the height of the H1N1 virus epidemic?

Do Facebook Likes Help or Scam Patients?

by jparadisi

by jparadisi

I am cautious when initiating online interactions, with good reason.

Sometimes, being cautious feels uncomfortable, however. I’m talking about the Internet phenomenon of patients asking strangers for Likes, or even donations to cover the cost of their medical expenses on Facebook. Despite a high index of suspicion, like most nurses, I have a soft heart. When I see those sweet little faces of bald children asking me to help them get a bazillion Likes on Facebook, I think, “I’m a cancer nurse, how can I not click Like? What can it hurt?” But I don’t click Like, and I feel guilty.

What I want to know is: How does my Like help these children? Are they really out there anxiously waiting for me, a stranger, to Like their Facebook picture? Have their lives as cancer patients come down to this? Where’s Make a Wish? Wouldn’t they rather go to Disney Land, drive a racecar, or meet a teenage popstar? How exactly does my Like benefit them?

Worse yet, what if my Like does harm? It’s easy for anyone to click on a Facebook photograph, and to add it to a file on their computer. Then they can repost it, adding anything to the original post out of context. What if this cute little kid’s picture was used without either his or his parent’s knowledge, and is passing like a virus throughout cyberspace? Worse than that, what if the child is deceased and a family member discovers the picture unexpectedly?

Perhaps I’m reading too much into it. I only wonder, is this a valid use of social media? Then I feel guilty because some little kid with cancer wants my Like, and I won’t give it to him.

A newer version of Internet donations is crowdfunding, and uses social media platforms such as GoFundMe, or GiveForward. As an artist, I’m familiar with crowdfunding. Frequently, artists raise funds for projects through Kickstarter, but patients collecting donations in this manner to pay for medical expenses is a new phenomenon to me.

According to Crowdfunding a Cure, by Alice Park for Time Magazine, December 3, 2012: “Patients and their relatives are raising thousands of dollars to pay for surgeries, cancer treatments, and more.” The article continues to outline the waging of a successful fundraiser through social media contacts via Facebook, Twitter, and email campaigns. This being the case, it’s not unlikely that I’ll soon feel guilty deciding between emails meriting a contribution, and those that do not.

What do you think? Are you with Likes and donations? If this is the future of donations, how will it affect traditional cancer foundations’ collection and distribution of funds?

The Nursing Dilemma of Medical Marijuana

Medical marijuana is legal in Oregon, where I practice. In one sense, this seems to be an enlightened act of legislation for patients who cannot tolerate conventional medications or simply prefer an herbal approach to managing pain and/or nausea. Its use is particularly prevalent in among oncology patients, and those with chronic pain.

Still, it’s a nursing conundrum. The issue is that marijuana remains illegal at the federal level. Because of this, many hospitals are reluctant to allow prescription marijuana on their campuses. Although a 2009 Justice Department memo recommends that drug enforcement agents focus their investigations away from “clear and unambiguous” use of prescription marijuana, it also says users claiming legal use but not adhering to regulations may be prosecuted.

In light of this, hospitals take the conservative approach: Attending licensed medical practitioners are prevented from prescribing medical marijuana for hospitalized patients, and create policies prohibiting the use of medical marijuana on their campuses.

For pharmacists and nurses the problem is this:

  • Pharmacists can only dispense medications prescribed by licensed medical practitioners. The federal government classifies marijuana as a Schedule I drug, which means licensed medical practitioners cannot prescribe it.
  • Nurses administer medications only with an order obtained from licensed medical practitioners.

Nurses may have run-ins with patients and caregivers unfamiliar with this policy, and a patient’s home medication routine may be disrupted.

Though it does not happen often, I had the experience of treating a chemotherapy patient expecting to smoke marijuana between infusions to control nausea and vomiting. Initially caught off guard, I struggled to find a way to manage the situation.

The campus did not permit smoking, tobacco or otherwise. When I reviewed the hospital policy, it confirmed that the medical marijuana was not an exception. I explained this to the patient, who was understanding, but skeptical.

Reviewing the premedication orders, the oncologist had done a good job of covering nausea and vomiting with conventional medications. I asked the patient to give it a try. Always having a plan B, I promised that if the medications didn’t work, I’d call the oncologist and, if necessary, the department manager.

Fortunately, the conventional medications worked. The patient enjoyed a hearty lunch and held it down. For the future, I recommended the patient smoke marijuana at home before appointments, and afterwards if indicated.

Several states have enacted medical marijuana laws. Do you work in one of them? How does this affect your nursing practice?

 

Nursing The Unexpected Job Change

Besides reimbursement changes, The Affordable Care Act (ACA) calls for the formation of Accountable Care Organizations (ACOs): joint ventures coordinated by hospitals and providers in communities in which they stop competing and create coordinated services for patients, thereby reducing the cost of care.

I said NEO, not Nemo by jparadisi

I said NEO, not Nemo by jparadisi

In this vein, the hospital I worked for has undertaken collaboration with another hospital to provide outpatient oncology care for patients. As a result, after working for the same healthcare system for nearly 20 years, I have become an employee of the other hospital. Though my job is basically the same, I unexpectedly find myself working for a new healthcare system.

In many ways this change is actually beneficial. However, it has also created turmoil for my coworkers and me.

For instance, there is the expectation that we occasionally float to locations other than our home unit, involving commutes for some. Vacation plans beyond the new hire date are uncertain; we’ve been asked not to request vacations until after the end of the year (2013). New benefits packages require reading, new retirement options must be considered, and there is a different pay scale than what we were accustomed to. I want to reiterate, none of this is a bad thing, but when a job change is unexpected it creates disruption. Here are some coping skills I learned, in case it happens to you:

  • Get your vacation plans approved by your manager as soon as you are aware of the job change. Merging two staffs means some people won’t get the time slots they desire.
  • Polish your resumé. Find the addresses of the schools you attended, remember the names of past managers, and assemble reference contacts. Even if you are automatically offered a job with the new employer, you will have to fill out a job application.
  • Anticipate drug testing as part of the hiring process. This was my first time ever!
  • Make dental, vision, and medical appointments, and renew your prescriptions before the new hire date, in case your new insurance coverage makes it necessary to seek new providers.
  • If you can’t rollover your sick leave or vacation time, consider using as much of it as you can before the job change. It might be taxed at a lower rate that way.
  • Remain calm, and avoid the rumor mill. Find out who is authorized to answer your questions, and get as many answers in writing as possible.
  • Be patient. ACOs are new for everyone. Administrators and human resources personnel are also learning facts as the project develops. They are not necessarily purposely vague. They really may not know the answers to your questions yet.

Finally, remember this: Regardless of the changes, patient care and safety are pretty much the same everywhere. Your employer may change, but you still know how to be a nurse.

Nurse is Not Gender Specific

Nursing has a media identity problem, and it extends to men in nursing. For every sexy nurse Halloween costume, there is a patient refusing care from a nurse who is also a man. For every nurse-bitch portrayal, there is a gay male nurse joke.

Don't Call Me Murse by jparadisi

Don’t Call Me Murse by jparadisi

Occasionally, I read comments saying something like, “It’s about time men are exposed to what women have to endure in the workplace: less respect, lower pay, fewer promotions.” Women experience these inequities, but punishing another group instead is not the way to promote equality in the workplace.

According to a report published by the WSJ, the number of men in nursing has tripled since 1970 to nearly 10 percent. Men choose nursing for the same reasons women do: job stability, flexible hours, skill variety, and opportunity for promotion. Interestingly, according to the same report, men in nursing earn more money than women in nursing. This is not attributed to gender bias, but instead to choices: Men are less likely to enter nursing as LPNs, more likely to enter nursing at the BSN level or higher, and more likely to become “nurse anesthetists (41 percent), who earn nearly $148,000 on average, but only 8 percent of licensed practical nurses, who make just $35,000.” Men are also more likely to work full time than their female counterparts.

Still, men in nursing report problems of gender bias within our profession. A few common complaints are:

  • The persistent myth that men are less caring than women. The statement is rather a paradox considering the volume of information about bullying among nurses.
  • Many men complain that they endure more scrutiny and criticism of their nursing skills than their female counterparts.
  • The existence of tenacious stereotypes, which belittle all nurses.
  • Don’t call me a “male nurse” or “murse.” Like firefighter, soldier, pilot, and physician, the title nurse is only gender specific from a gender-biased perspective.

Why wouldn’t a person of any gender not want to work in a profession combing the education, technical skills, and personal interaction found in nursing? Add in nursing’s flexible hours, stable employment, and its identity as the most trusted profession? It is a disservice to discourage anyone with what it takes from entering our ranks.

So the next time your child’s elementary school teacher invites you to Career Day, if you are a woman, bring along one of your male colleagues, and begin changing the image of nurses for the children we are raising.

And a word to the guys: If you’re the new nurse in a unit of women, please leave the seat down in the staff restroom. This can make or break your relationship with colleagues.

Will we ever reach a point in the nursing profession where stereotyping no longer exists? What experiences or suggestions would you share?

It’s That Time of the Month Again: JParadisiRN’s Post for Off the Charts

Yes, it’s that time of the month again. Before you go thinking JParadisiRN is giving out Too Much Information, let me say that I’m referring to my latest monthly post Who Will Watch the Watchers? Consider Nurses for Off the Charts, the blog of the American Journal of Nursing.

In this latest post I contrast nurses’ accountability to protect the privacy of our patients while maintaining their privacy under the oversight of HIPAA, against the current debate over personal privacy versus national security, and who should have oversight of the NSA and the information they collect.

Read the post at Off the Charts and leave a comment. We’d love to know your opinion!

JParadisiRN Illustrates Texas Tech Health Sciences Center Article About Alumni Winkler County Nurses

Any alumni of Texas Tech University Health Sciences Center out there? That’s my painting on page 28 of their alumni magazine, Pulse. I’m not an alumni, but this image accompanied one of the posts I wrote in support of The Winkler County Whistle Blower Nurses, Vickilyn Galle, and Anne Mitchell, who are, for JParadisiRN.com. The editor contacted me for permission to use the image. I am proud to be connected in a tiny way to these two courageous nurses, who put their careers in jeopardy for the protection of patients.

Painting by jparadisi on pg 28 of TTUSC alumni magazine, Pulse winter 2013 issue

Painting by jparadisi on pg 28 of TTUSC alumni magazine, Pulse winter 2013 issue

Changing Nurse Stereotypes Through Creative Control

At a restaurant, I demurely settled onto a chair pulled out by my escort. Glancing at the menu,  I wonder out loud what the night’s special might be. In a gesture meant to display his bravado, my date raises his finger to signal the server, shouting, “Nurse!”

Another relationship bites the dust.

If Kafka Wrote About a Nurse by jparadisi

If Kafka Wrote About a Nurse by jparadisi

The public’s image of nurses hasn’t changed for decades. Every Halloween, sexy nurse costumes appear out of nowhere, as if summoned by call lights. On TV shows, doctors do hands-on patient care while nurses find the necessary supplies STAT! from wherever TV hospitals store their supplies.

The media represents nurses as one of five basic archetypes. Oncology nurses, in particular, tend to get lumped into the nurse saint group, perhaps because of the longstanding relationships we tend to develop with our patients. It’s a difficult persona to uphold during long, short-staffed shifts.

Additional images are created from combinations of the basic five, which are:

  • Nurse bitch
  • Nurse saint
  • Smart-ass nurse
  • Nurse/mother substitute
  • Sexy nurse

Why do derivative portrayals persist?

Because screenplay writers do not write from a nurse’s perspective.They write about nurses from their own point of view, limiting the possible creation of new characters. These portrayals of nurses are weak because depth of knowledge, intuition, internal dialogue, and a range of personalities cannot be grasped through observation without familiarity. Writing workshop instructors will tell you: Authenticity only occurs when a writer has a clear understanding of her topic.

For instance, in his deeply moving novel, Cutting for Stone, Abraham Verghese creates a complex tapestry of personality for his character, the surgeon Thomas Stone. However, in his portrayal of Sister Mary Joseph Praise, the mother of Stone’s twin sons, Verghese resorts to a clichéd saintly-sexy-mother nurse composite who dies early in the story, saving him from further character development.

I’m going to go out on a limb and suggest Verghese is more familiar with the personality traits of surgeons (he’s an MD) than of nurses. He writes a stronger character when he’s familiar with his character’s point of view.

With this in mind, I believe nurses will not be authentically represented in the media until we raise book writers, novelists, and screenplay writers, or TV and filmmakers, from within our ranks. The media’s portrayal of nurses will change when nurses take creative control of it.

What might occur if grants were available to nurses desiring to make film documentaries, write books, or create paintings from our point of view? What if hospitals allowed, and encouraged, creative sabbaticals for nurses to pursue such projects, as do many other industries? Would the public perception of nursing change? Would nurses’ perception of themselves change? Would patient care and delivery of service also benefit from nurse empowerment through creative control?

Nurses, They’re Making Their Lists. Does Honesty Exclude Influence?

The List by jparadisi 2012

The List by jparadisi 2012

As 2012 draws to a close, editors compile their annual lists for publication: The Top 10 Worse Movies of the Year, The Twenty Most Twittered Tweets, The Single Most Googled Christmas Gift, and so on. I enjoy lists, even making up a few of my own: Things to Do Today, lists of Goals For The Week, Month and Year.

December is a list-lover’s dream: Christmas gift lists, grocery lists of items necessary for making the best holiday meal ever, and of course, the requisite list of who’s been naughty or nice, which I will point out, are not necessarily mutually exclusive characteristics.

Unfortunately, some characteristics do appear mutually exclusive, keeping a group of people on one list, but off of another. I’m talking about The 2012 Gallup Poll results, which list nurses as the most honest and ethical of professionals for yet another year.

I don’t need Gallup to inform me of the public’s trust in nurses. Once, a retailer refused to require my driver’s license as proof of identity when I wrote him a check. “You’re a nurse,” was his explanation. “Nurses never write bad checks.”

While I don’t know if it’s true that nurses never write bad checks, one thing they never do is make it on Time magazine’s list of The 100 Most Influential People in The World. A couple of actors made the list. So did the son of Kim Jong Il. Of course, Stephen Colbert made the list; he’s on all the lists, except the Gallup’s list of the most honest and ethical professionals, which we nurses top. That may create a new list: the only list of 2012  excluding Stephen Colbert.

I digress from my point, however, which is this: why are there no nurses on Time’s The 100 Most Influential People in The World list? Not only of 2012, but ever? Florence Nightingale, who founded modern nursing by improving the plight of wounded soldiers, was not included on Time’s somewhat tongue in cheek list, The 100 Most Influential People of History.

I do not cast doubt on the ethics or honesty of those listed as Most Influential. In fact, many on the list, including Stephen Colbert, serve by bringing humanitarian needs to the forefront, and deserve recognition.

Perhaps we nurses should focus on raising leaders, imbued with ethics and honesty, towards influential goals. With health care provision in the limelight of national attention, there has never been a better time for nurses to aspire towards positions on both lists.

Obesity, Stress and The Politics of Eating

photo: jparadisi 2012

Last week I attended a two-day chemotherapy and biotherapy course. I wasn’t worried about sitting through 16 hours of lecture, nor about taking the open book test. Instead, I was preoccupied with wondering what to eat for lunch during the two days. I watch my calories, which means I don’t usually buy lunch on days I am unable to fit in a run to compensate for the extra calories, as was the case on the two days of classes.

I track how many calories I’m eating, just in case overweight nurses are someday prohibited from working. You never know. Precedents are set daily, what with the proposal to outlaw extra large sodas and sugary beverages in New York. This will force the sugar addicted to quench their thirst by buying two large sodas instead of one super-sized one, creating an extra container for the landfill, and they will still be too fat for the skinny nurses allowed to work to wheel around in the super-sized wheelchairs hospitals are now purchasing for transportation to the super-sized MRI machines for images of the damage to overweight bodies.

I pack my lunch on workdays, knowing a refrigerator and a microwave are available. Even as a kid, I have not enjoyed sandwiches like peanut butter and jelly, bologna, turkey, etc. As an adult, I bring frozen meals, leftovers, salads, and yogurt, stuff like that.

Since I didn’t know if a refrigerator and microwave were available at the class, I wandered the aisles of a grocery store the day before, looking for something healthy, and low in calories, which did not require refrigeration or microwaving to bring.

I may as well have been on a snipe hunt, traipsing through a forest of shelves loaded with foods from around the world, none of which met my criteria. With the exception of fruit and vegetables, if it was fresh, it needed refrigeration. Prepackaged salads started upwards from 500 calories or more; I couldn’t believe it.

If it sat on a shelf, it was processed, embalmed in sodium or sugar. Nothing fun to eat was even in the ball park: chips, “fruit snacks,” and cookies earn their title ‘junk food.”

Fortunately, there are other choices, such as investing in a lunch sack that accommodates ice packs or is thermal lined to keep food cold. Salads can be made at home, controlling amounts of fattening ingredients like cheese, and salad dressing. I wonder, however, how do working parents with two or three kids make nutritious lunches five days a week, given the available choices? During childhood, how many thermoses did I break; how many lunch boxes did I lose, before my lunches were carried in a simple brown paper sack, and I had to eat the sandwiches I can’t stand as an adult?

Limiting the size of sugary drinks to 16 ounces is perhaps a good idea, but I suspect, as a method of weight control, it’s akin to spitting in a bucket to fill it. Our society is surrounded with the food of our own demise. Restoring children, patients, and nurses to normal weight takes rethinking the way most Americans live. There is evidence overeating is an addiction of self-medication: children and adults eat to control feelings of discomfort and stress. For instance, understaffed at work, you may fear you will not get a lunch break, so perhaps a super- sized soda and bag of chips seems like a plan that will take you through your shift.

I’m a nurse, not a dietician, but I wonder if outlawing overeating is a form of treating the symptom, not the disease.