You’ve Come a Long Way Baby. Maybe.

Untitled. photo: jparadisi 2011

A friend of mine talks about aspects of one’s life occurring between bookends.  People use the cliché “things come around full circle” to mean the same thing, but I like my friend’s reference to bookends better. Coming full circle suggests ending back where one started, but the bookends metaphor implies a linear journey that includes revisiting one’s past, which is unavoidable if you live long enough. Personally, I prefer the bookends metaphor to the circle one, because I think moving forward is an important attribute of  happiness.

Today was my second shift using the new electronic medical record. Yesterday I practiced order entry, updating the home medication list, and documenting blood transfusions. Today, I focused on medication administration. The way the EMR works in our hospital, patients wear a bar code wristband and the medications are bar coded too. When giving a medication, the nurse deploys a laser scanner the size and shape of a pistol to scan both the patient and medications, verifying that the right patient receives the right medication, an important upgrade in patient safety. Scanning the bar codes exactly right so they register in the EMR is tricky. Most of the time I had to repeat the scan more than once before I got it right. I’m thinking it’s not very different from learning to start IVs: eventually my small motor coördination will develop muscle memory, and I will have a “feel” for getting it right the first time. It just takes practice.

Sometime during the course of the shift, however, I told a coworker that if my scanning ability doesn’t improve, my plans for a career at Whole Foods are doomed. We laughed. Then I remembered something from my nursing school days:

When I entered nursing school there was a nursing glut. Nursing shortages hadn’t occurred since before Salk invented the polio vaccine, and tuberculosis ran rampant. Around the same time, grocery store chains were investing in a new technology using lasers to scan bar codes on grocery items for prices at check out. After attaining my Registered Nurse license, I could look forward to eventually earning the same hourly wage as grocery clerks then. All through nursing school, both instructors and students joked about “scanning cans” for a living, if our careers in nursing didn’t pan out.

My very first nursing job paid an hourly wage of thirteen dollars and some change. Six months after graduation, the first wave of a nursing shortage hit where I lived, and my hourly rate nearly doubled in a single pay raise; a windfall. I never thought about scanning cans again, until today when I aimed a laser scanner at a patient’s wristband and medications, and I realized I have traveled a straight line punctuated by a bookend.

Who’s a Jethro? Thoughts on an Aging Nurse Population

Study Detail/artist: JParadisi (2009)

     My patient was watching The Beverly Hillbillies on TV while I set up the supplies needed to start her IV. I stopped what I was doing when she said, “What is this show? Is it a movie? What’s the name of this show?”  

     “How young are you?”, I asked, gesturing towards the TV.  “That’s The Beverly Hillbillies. You know how people say, What a Jethro? Well, that’s Jethro. He’s always coming up with good ideas that don’t actually work.”  

     I’m not all that old myself. The Beverly Hillbillies was already in syndicated reruns when I was in elementary school. However, I meet the over 40 criteria which the Age Discrimination and Employment Act uses to identify “older” employees.  

      I read an article on Medscape,  Retaining an Aging Nurse Workforce: Perception of Human Resources Practices, written by Mary Val Palumbo, Barbara McIntosh, Betty Rambur, and Shelly Naud. The paper explains that a majority of employed nurses are over 45, and Human Resources departments worldwide are looking for ways to increase retention of nurses into their 60’s.  

     According to studies, nurses want three things from the organizations they work for:  

  • Recognition and Respect
  • Having a Voice
  • Receiving Feedback

     Really? That’s what nurses in studies say they want? Really?  

      Listening to my colleagues discuss what they want, increased healthcare benefits, increased reimbursement for educational conferences, pay increases for career related achievements such as advanced degrees and certifications, are examples of what nurses want. I think this falls under Recognition.   

     Nurses universally complain about missing scheduled breaks because of too heavy patient assignments, and uninterrupted lunch breaks are considered a luxury by most of us.  Some department managers even post important notices such as changes in policy on the staff bathroom walls, to read during our “bathroom breaks”. Fortunately, the walls of the staff bathroom where I work are free of required reading. This probably falls under the Respect category.  

     Coincidentally, I attended a Human Resources customer service presentation. A Power Point slide projected a scripted phrase to ask the patient (customer): Is there is anything else I can do for you? I have the time.”  The HR representative emphasized that studies show the phrase “I have the time” is a crucial part of the customer service interaction, and we were urged to say it.  I raised my hand: “I’m playing devil’s advocate here: if the phrase is of such importance, then shouldn’t staff be provided with the necessary resources ( i.e. time = staffing)  to say it truthfully?”  

  • Recognition and Respect
  • Having a Voice
  • Receiving Feedback

will never be achieved unless nurses of all ages find the voice to clearly define what these terms mean to us.