Learning Curves, Leadership and Empathy

Mac Attack photo: jparadisi 2010

I finally did it.  Readers who are artists and graphic designers prepare for a collective groan at my old, ass backwards ways: JParadisi RN has converted from PC to Mac. The feeling is similar to the moment you find true love after looking for it in all the wrong places. The same as finally enrolling in art school, and marrying the right guy. I wonder what took me so long? This is my first post using the new computer.

Delaying the conversion had a lot to do with the unavoidable learning curve that comes along with new software and programs, I mean apps. It’s difficult to find answers when you have to learn new terminology to ask questions. Imagine what a patient or family member in crisis feels, trying to talk to nurses and doctors about unfamiliar treatments or end of life issues when they don’t know what questions to ask or the terminology, often with little or no time to prepare. This is the obvious metaphor and an easy post to write. This is not the post I am writing.

This is the post I am writing: I am gaining empathy for my coworkers. A series of unanticipated events has hit our department infrastructure with the force of a tsunami, resulting in several colleagues stepping into leadership roles with little preparation.  Meanwhile, changes continue coming at us like a set of ocean waves pounding the shore.  When these nurse leaders come in for their shifts they find new expectations added on to their day, and I admire their commitment. You can argue that they volunteered for the extra responsibility, and that is true, but someone has to oversee the daily continuity or the unit is crippled. Unit leaders have to make immediate decisions in the midst of the controlled chaos that is patient care. There’s a learning curve for them too, especially for those developing new skills in a constantly changing environment.

Empathy for residents and new nurses is necessary too. There is always a learning curve when you begin something new. First do no harm is a guiding personal ethic for all interactions, not only those involving patients. Not all forms of inflicted pain leave a visible mark.

Just now, after twenty minutes of work, I lost a paragraph while trying to cut and paste it into a future post—Frick! Learning how to use Mac and keep up with JParadisi RN’s Blog“s production schedule is simultaneously frustrating and exciting. I am lucky to learn in privacy, away from the critical eyes of coworkers or patients. My colleagues stepping up to the plate in a time of transition do not have the same luxury.

Wall Street Corporations Don’t Have to Stand in Line for H1N1 Vaccine

     Three weeks ago, I walked into an elevator and stood next to a middle-aged woman. I didn’t notice the younger woman squatting in the corner next to her until the doors closed, or else I’d have waited for the next car. Dressed in flannel pajamas and a messy ponytail, she held a large ceramic mixing bowl up to her greenish and pale face. Then I realized she was pregnant. She had the flu, and her mother was taking her the hospital. I hoped this young mother and her unborn baby would be okay. The H1N1 vaccine was not readily available in Portland.  The virus had gotten her before she could do anything to prevent it. It seemed so unfair.

     There was a discussion on the news yesterday about what’s fair. Several large Wall Street corporations have received 200 doses each, of the H1N1 vaccine for their employees. It’s the same amount of doses given to Lenox Hill Hospital in New York. The vaccine was acquired legally. Since H1N1 flu has been declared a national emergency, and many high risk patients are standing in long lines to receive the vaccine, the question  has to be asked: is it fair for large corporations to receive the vaccine for their employees first?

     Watch this NBC news video,  and see what you think.


Mandatory Flu shots for Healthcare Workers Criticized in New York

     Today’s New York Times has an article supporting the right of that city’s health care workers to refuse both the seasonal  and H1N1 vaccinations. It brings up some very good points, like the question, why is it ethical to violate one group of peoples’ rights over another’s, and do states have the right to enact it?

     Presenting mandatory vaccination of nurses (and other health care workers) as an ethical responsibility, is a tactic  utilizing the media’s representation of nurse- as-angel: ever- willing to sacrifice his or her own feelings of safety to save the world. I don’t worry about the Nurse Jackies, or Hawthornes, but when media-produced stereotypes  extend to manipulate a group of people into believing that self-sacrifice, without justification, is necessary, they are harmful. Nurses are just people, like everyone else. We have rights over our own bodies, and the choices we make about them.

     Read the article:


Superman’s Song: Lyrics by Crash Test Dummies

Tarzan wasn’t a ladies’ man
He’d just come along and scoop ’em up under his arm
Like that, quick as a cat in the jungle
But Clark Kent, now there was a real gent
He would not be caught sittin’ around in no
Junglescape, dumb as an ape doing nothing

Superman never made any money
For saving the world from Solomon Grundy
And sometimes I despair the world will never see
Another man like him

Hey Bob, Supe had a straight job
Even though he could have smashed through any bank
In the United States, he had the strength, but he would not
Folks said his family were all dead
Their planet crumbled but Superman, he forced himself
To carry on, forget Krypton, and keep going

Superman never made any money
For saving the world from Solomon Grundy
And sometimes I despair the world will never see
Another man like him

Tarzan was king of the jungle and Lord over all the apes
But he could hardly string together four words: “I Tarzan, You Jane.”

Sometimes when Supe was stopping crimes
I’ll bet that he was tempted to just quit and turn his back
On man, join Tarzan in the forest
But he stayed in the city, and kept on changing clothes
In dirty old phonebooths till his work was through
And nothing to do but go on home

Superman never made any money
For saving the world from Solomon Grundy
And sometimes I despair the world will never see
Another man like him

A Personal Response to Moral Distress in Health Care

oil on wood 2008 J.Paradisi

oil on wood 2008 J.Paradisi

This morning I visited Pauline Chen MD’s Well blog at the NY Times on-line to read comments posted to her Moral Distress article. There were many, mostly from MDs, a few by nurses, and one from a patient, who’s life was saved when an ICU nurse challenged the doctors treating him.  The strong emotions reveal the virulence of the topic.

The article resonated for me. I read it after returning home from a particularly busy shift. In the clinic, I saw a patient and knew something had changed since our last encounter. The tension of his muscles indicated pain, but he didn’t ask for medication for it. He knew better. Let’s just say that his track record of lifestyle choices make him a less than stellar patient. The package of cigarettes in his shirt pocket is his least dangerous vice and negates the purpose of the medication his doctor prescribes for his asthma. Still, something was clearly wrong with the man, and my job is to be his advocate, not his judge.

So, I looked closer, to see if I could spot the problem causing the change. I found it: his calves were swollen to twice their normal size above his ankles; his soiled socks acted as  compression wraps, so his ankles were deceptively normal. Taking a stethoscope to his chest, I heard the anticipated expiratory wheezes, but otherwise muffled breath sounds. CHF, congestive heart failure. We were treating him for another condition, unrelated to his heart, but CHF added itself to his problem list anyway. He needed treatment.

I paged the doctor who ordered his care. The doctor called me back from the  ICU, where he was treating a seriously ill patient, hopefully a compliant one. He patiently explained to me he was no longer treating my patient. He had only been brought in as a consult to begin with, and my patient was not following instructions, and missed appointments. He had sick patients who were trying to get well needing his care. He doesn’t have the time or resources to continue treating a patient who thwarts all efforts to improve his condition. I heard what he was saying, and I understood.

Choices have to be made. Still, I was the one looking at a human being and watching him struggle to breathe.  I called another health care provider familiar with this patient, and he was sympathetic, but my patient wasn’t under his care either. I would guess this provider has fifty to one hundred patients just like this one whom he is committed to caring for; I cannot accuse him of a lack of compassion.

The patient in front of me was now wheezing audibly. Never particularly conversant,  now he  only responded to my questions in monosyllables.

I had to make a decision. I seated him in a wheel chair, and walked him to the emergency department. It was a particularly busy day there, but the triage RN was very kind, and efficient. We both knew this noncompliant, substance abusing, uninsured, suffering, frightened patient was very ill and would be admitted to an expensive, and hard to come by hospital bed. But what was our choice? In the face of economic crisis, outpatient resources are cut by the minute, leaving emergency departments and inpatient care the only avenues available for the uninsured.

And lately,the faces of the uninsured are morphing in front of me. They aren’t always dressed in dirty socks and flannel shirts. Now I see unfunded patients with expensive college degrees who used to have jobs, and they are parents of a child or two, as lay- offs create a new kind of uninsured patient.  Will I be asked to choose which kind of unfunded patient gets care, as hospital funding dries up, and administrators have to decide where to make more cuts in order to keep the hospital solvent?  This is the moral monster underneath the bed I fear, and even with the lights turned on,  it’s not my imagination.

Moral Distress in Healthcare


Detail from Goldsmith Artists collaborative project. Graphite/charcoal on wall. 2008

     There is a thoughful article in the NY Times on line regarding moral distress in nursing and medicine.  Go to

http://www.nytimes.com/2009/02/06/health/05chen.html?_r=1&partner=rss&emc=rss    to read the article.