Tells: Artists, Nurses, 7-Inch Stilettos and What to Wear to Work

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. My neighbor stood as lithe as a bamboo reed.

 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.

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 pea coat, my clogs were the tell announcing I 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.

Update on Vicki Galle & Anne Mitchell Whistle-Blowing Case

    

(study) JParadisi 2010

    I recently posted Texas Nurses Accused of Harassment in Whistle Blower Case  about Vicki Galle and Anne Mitchell, two nurses accused of intent to do harm by reporting a doctor for unsafe medical practice. Charges against Vicki Galle were dismissed, however, 52 year-old Anne Mitchell, if convicted, faces up to 10 years in prison, according to an article written by Kevin Sack, published February 6 in The New York Times.   

     Mitchell is a registered nurse and Compliance Officer for the hospital that fired both her and Galle in June, 2009. The Texas Nurses Association supports Anne Mitchell, and publishes updates about the case on their website. You can also donate to the legal defense fund of Anne Mitchell on the TNA website.

Who’s Flying the Plane?

We've Gotten Off Track photo: JParadisi 2009

       Perhaps a change of nomenclature is needed in health care.  Physicians should be called Pilots, and nurses renamed First Officers, like in the airline industry, which the health care industry often compares itself to. The term doctor’s orders would change to instructions. Instead of a nurse requesting orders from a doctor, the First Officer would ask for further instructions from The Pilot. The name changes promote the team approach that more accurately describes patient care. 

     Gallup Poll: Power Elite Believes Nurses Should Have More Say in Policy, Management  posted by Shawn Kennedy on the American Journal of Nursing blog, Off The Charts  quotes that “69% of ‘people who run things in this country’ see nurses as having little influence on health reform.”  The poll ranks nurses at the very bottom of the list of groups influencing health reform, under patients, who lag behind physicians. Listed as the most influential  are  government, insurance and pharmaceutical executives. In other words, the people flying the plane do not control the plane. Decisions about health care policy are made by people who are not on the plane. Sometimes the decision makers aren’t even at the airport. 

         That’s not to say that physicians and nurses should dictate health care policy without thought or consideration of cost for treatment or alternative options. In the short story Voyagers, I write about recognizing the need for administrators, whose jobs keep hospitals solvent and regulated. However, demoting nurses, doctors, and the patients themselves to the bottom of the list of influential voices in health care policy, while allowing corporate administrators to have the most influence, seems a crippling case of the tail wagging the dog.

A Metaphor: Health Care Reform on Life Support

oil on wood (2008) artist: JParadisi

     The idea that the Health Care Reform bill is on life support is disappointing, but not surprising. It was admitted in a weakened state of health. It appears suspiciously a victim of domestic violence by special interest groups. The bruises on its body resemble the outline of handprints of the insurance companies it was created to protect our citizens from. Already, my patients are complaining of rising health insurance deductibles this year. It is estimated that 14 million people will still be uninsured if the Health Care Reform bill rallies and passes. It is a complex piece of legislation that confuses even those of us who strongly advocate for health care reform. I think that’s where the undecided get lost and fall to the wayside; afraid to support what they do not understand.

     In my grief over Health Care reform, I console myself  by remembering that at least it’s a step in the right direction. At least an estimated 34 million currently uninsured citizens will be insured, and people who are currently insured won’t lose their insurance if they change jobs or become ill. These are progressive and necessary improvements to the present situation. I tell myself that if we lose this moment in history, it won’t come again anytime soon. Something is better than nothing. Fight for the life of the Health Care Reform bill, don’t let it slip away.

     But I know, even if successfully resuscitated, it will not be the strong, idealistic super hero it once was. It is anemic. The bill has been bled by special interests groups and insurance companies. It’s vital organs have been damaged by poor perfusion (lack of blood supply). It is now being threatened with further leeching in order to get even a shadow of its former self passed into legislation.

     Health Care is a human rights issue. Human rights issues are intimately linked to economics. Historically, in most countries, including the United States, it is this link that causes resistance. It is the cause of resistance to Health Care Reform now. Until Health Care is recognized as a fundamental human right, and not a for- profit industry, our citizens will continue to suffer.

Texas Nurses Accused of Harrassment in Whistle Blower Case

No one is free when others are repressed.

Don't Tell (study) JParadisi 2009

                                                          attributed to Mahatma Gandhi

     For a couple of years, I worked in Quality Improvement (QI) for a nursing department. My job was to review error and near miss error reports, tease out the cause(s) and develop strategies preventing error recurrence. I learned a lot of things that helped make patients safer in a hospital. I loved that job.

     So, I am concerned about a situation I became aware of last week in a post by Shawn Kennedy, MA, RN, AJN interim editor in chief, on the American Journal of Nursing’s blog Off the Chart. In the last paragraph of her post, she discusses the case of two Registered Nurses in Texas, who are facing prosecution as whistle blowers for reporting a physician of behavior they assert is unsafe for patients. Vicki Galle was in charge of the Hospital’s Quality Improvement and Anne Mitchell was the hospital’s Compliance Officer. For readers not involved in health care, this means it was their jobs to investigate hospital safety issues and report noncompliance ( people who aren’t following the rules). Both nurses were terminated from their jobs in June, 2009.  Although Texas is a state with laws protecting whistle blowers, the laws do not prevent the physician they reported from filing a harassment suit against the pair. Sounds like another “damned if we do, damned if we don’t” scenario that health care providers can

inadvertently find themselves party to. Please read more about this complex case on the Texas Nurses Association website. There is also link to click which allows you to contribute to the legal defense fund of these two nurses, should you wish.

 

Happy Birthday JParadisi RN’s Blog!

Happpy Birthday JParadisi RN's Blog! photo: JParadisi

     Today, January 10, 2010 is the first year anniversary of JParadisi RN’s Blog. I had no idea I would enjoy blogging so much. Or  that the blog would receive recognition from readers, other bloggers, RNCentralOff the Chart, and The American Journal of Nursing. Thank you, each of you.

       Through thoughtful posts about art, nursing, and humanity, JParadisi RN’s Blog aspires to represent nurses as multidimensional people with diverse talents and viewpoints,  demonstrating nursing as a profession which promotes such diversity.  2010 is The Year of the Nurse, and hopefully, we’ll use this opportunity to raise public awareness of what real nurses do. Nurses, don’t wait for the media to do it for us. Wake up Cinderella, there is no Prince Charming! We have to do this for ourselves. 

     Thank you, readers, for opening your hearts to the ideas in the posts. I realize you have a lot of blogs out there to choose from.

 With humble gratitude,

JParadisi RN

Just Because You’re Big Enough to Hold Still (patients, pain & procedures)

    I still experience culture shock, since my transfer from pediatric intensive care to outpatient adult oncology nursing , over the difference in sedation use during procedures for pediatric and adult patients. What allowed me to tolerate 15 years of pediatric intensive care nursing (yes, it is as emotionally challenging as you think it is) was the routine sedation of the child going through procedures. 

   Adult patients know that when their healthcare provider says, “You may experience some discomfort during the procedure”, what we mean is  “This is gonna hurt.” Remember, this is an industry that accepts anal leakage as a reasonable side effect of some medications.  Adult patients are expected to lie still.

   Like during a bone marrow aspiration. My patient cried before the oncologist arrived, but the doctor didn’t see that. She cried during the injection of the local anesthetic too. Her family looked concerned, but no one spoke up.  Nurses, because of our extended contact with patients, are the emotional thermometer in the room. It is my practice to request from the physician a small dose of sublingual lorazepam to offer the patient before such a procedure, just to take the edge off, but it’s rarely ordered, unless the patient demonstrates high anxiety levels in front of the physician, which indicates the patient might not hold still. The procedure lasted only minutes (the oncologist was skilled), but I winced to see my patient hurt. This patient made it through bravely. The physical pain was quick, then over, but the pain of the procedure was potentiated by the fear of a blood cancer diagnosis. Lorazepam does not control pain. It does ease anxiety.  She was big enough to hold still.

   Perhaps I’m sensitized to this issue because I have been a patient needing a biopsy for a cancer diagnosis too. I remember the white noise of anxiety drowning out my ability to hear all of the information presented to me during the early weeks that my treatment plan unfolded.  The surgeon, who was very good, wanted to do a biopsy of my lump in his office. It’s done all the time. I wanted the lump removed, under conscious sedation. That required an OR, and an anesthesiologist, the surgeon informed me. “That’s what I have insurance for,”  was my reply. I know too much about procedures.  I trusted my surgeon, and I wanted to be out while he did what he needed to do.  A member of  his office staff chided me about the request: “You’re a baby, I’ve had several lumps removed in this office myself, and went back to work afterwards.” I complained to the surgeon about the inappropriate comment.

   Like a frightened child, I didn’t want to lie still.

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:

http://www.nytimes.com/2009/10/14/health/policy/14vaccine.html?_r=1&partner=rss&emc=rss

Aftermath of the Eric Cropp Sentence: Will the Criminalization of Medication Errors Make Patients Safer in Ohio?

     Although medication errors are not the focus of this blog, I feel it’s important that health care professionals know what is occurring in the state of Ohio, in the aftermath of the Eric Cropp sentencing referenced in this blog’s post Not a Wonderful Life: No George Bailey for Pharmacist Eric Cropp  or his Patient (September 5, 2009).

     According to the September 10, 2009 issue of  The Institute for Safe Medication Practices, Legislation has been introduced in Ohio that would establish criminal penalties for pharmacists, pharmacy interns, and qualified pharmacy technicians who fail to report suspected dispensing errors with a “dangerous drug” to the Board of Pharmacy(legislature.state.oh.us%2fbills.cfm%3fID%3d128SB+119)  Criminal penalties would include fines of up to $250 and 30 days imprisonment. Three or more convictions within 6 months would result in increased fines and up to 180 days imprisonment. The Board of Pharmacy would also be required to investigate all errors and pursue disciplinary action if warranted”

The article goes on to say

ISMP adamantly encourages reporting of medication hazards to promote learning. But you can’t punish people for not reporting errors and then subject them to punishment if they do report errors…Ohio pharmacy staff are ” damned if they do” and “damned if they don’t” report errors; in either circumstance, they face the very real threat of imprisonment, fines and a criminal record.”

     Will this type of legislation create a safer environment for patients? Will other states follow suit? Will legislation such as this be applied to health care providers who administer medications, such as nursing instructors training students in clinical rounds, or nurse preceptors? (remember, pharmacist Eric Cropp did not mix the hypertonic chemo, a pharmacy technician did)  Will it drive people away from careers in health care professions? 

Read the full article at http://www.ismp.org/newsletters/acutecare/currentissue.asp 

    

 

Color Theory: Anemia

     This week, it seemed all of our patients required blood transfusions. They came in with similar symptoms: fatigue, shortness of breath on exertion (SOB or dyspnea), headaches, and low hemoglobins, however, the causes of anemia vary. Anemia is a common side effect of chemotherapy, but renal disease, and nutritional malabsorption can cause anemia too. Then, there is  the anemia caused by a leakage of blood from the capillaries in the gastrointestinal tract. Insidious and slow, it takes awhile before the patient is aware of the onset of fatigue, shortness of breath on exertion, and headaches.

     I thought  of this slow- leaking anemia the other day when a colleague mentioned that last week she had “hit the wall” and could not add one more request to her list of commitments. It’s a metaphor describing the creative depletion artists, nurses, and most people feel when we lose control of our protective boundaries; when we forget to say “not today” to the ” just one more simple request” from someone needing our talents, our skill, our time; taking us away from our studios, our breaks, and the activities which nourish and renew our souls.

      I am learning I don’t have to catch every ball that’s thrown to me. I know it’s about choices. But I hate to turn away new experiences and opportunities, so instead of “no” I’ve learned to say, “not today.”

     I like to keep the door open….

Disclaimer: This post is not intended to dispense medical advice. If you suspect that you or someone you know has anemia, consult with a Licensed Medical Practitioner (LMP) for diagnosis and treatment.