Oh Sweet Jesus, Please Make Them Shut Up

I came into work today with the intention of working on a project that I’ve been trying to get done for some time. Once I got here, I was immediately reminded of why it’s been taking so long. I work with some of the noisiest people in the world. My opinion, of course, but I think anyone would agree. We are one of the few departments who still have actual offices yet the people over in the IT department with their skimpy little cubicles have more peace and quiet than I do.  As I type this, I am simultaneously grinding my teeth and biting my tongue to keep from screaming out the words; SHUT UP. It all started this morning when one coworker decided to pop in to tell me about her son’s expensive Christmas list. The child does have expensive taste but I learned long ago not to offer my opinion on my coworker’s buying habits at Christmas. I do not have children, therefore I cannot know. Then the environmental service person (the woman who cleans our office) launches into a diatribe against her boss. She had good points. We work in an old, old office. There is no way to adequately clean the toilets. Her boss should understand that and move on. I agree one hundred percent.  Then it was another coworker who had to blast into the office with her usual mind-numbing rattling off of everything she has to do for her daughter’s wedding. Thankfully a friend stopped by to see her and she went behind closed doors to elaborate the details of said daughter’s wedding. Then a former coworker dropped by. She’s going through a divorce and had to describe and be counseled right outside my office. I do feel bad for her because she is a nice person but I’m not that close to her and I feel a bit uncomfortable with her describing some of the details RIGHT OUTSIDE MY OFFICE. I did get up and close the door at that point. Most people would take that as an invitation to move away from my door but not these three. They continued to talk at my door. After about an hour they went away but that only brought the environmental service lady back. She’s holding forth on a few other opinions now. Combine this with the wedding woman walking back and forth to the kitchen to check on the coffee (that she doesn’t know how to make). The environmental services lady helped her with the coffee, thank goodness. She knows I don’t drink it and don’t make it but she keeps looking at me like I might be holding out some savant coffee skill. Now the other coworker is back complaining about her back. She’ll be in soon to show me pictures of some obscure rat she’s found online. They’re cute and I enjoy looking at them but seriously, I was going to get work done today.

It’s lunch time. They’re gathering around the conference table. I guess I may as well give it up. I’m not going to get any work done today. I should just go out there and join in the conversation. It sure would be nice to duct tape their flappin’ lips closed before I sat down with my lunch. Would duct tape be considered assault or doing the world a favor?

Oh dear god, the wedding woman is back. Is there no end to this caterwauling? I may be exaggerating about the caterwauling but my brain is so tired it can’t tell anymore.

Is Perception Everything When Caregivers Lack Clinical Skills?

Not long ago, there was a patient at the hospital who was admitted for pneumonia. During the course of hospitalization this patient attempted to get to the bathroom without assistance. She fell. The fall resulted in a hip fracture. She was taken to surgery two days later for the repair. The surgery was successful and the patient was returned to the original floor. Everything seemed to be going well when suddenly she became unresponsive. She coded and was resuscitated but it was unsuccessful. The patient died. A root cause analysis was done over this incident pointing to the fall as the problem and the decision was made to mandate the hourly patient round. Nurses or patient care technicians (PCTs) are to enter the patient room, go over a scripted checklist with the patient that includes pain, elimination needs, and position changes, indicate when they will return, document the round and leave the room. The hourly round is supposed to reduce patient falls, prevent skin breakdown, and cut down on the patient calls between rounds. Most nurses are very busy during their day. They do not have adequate time to round on all their patients and get the rest of their jobs done. This results in skipping hourly rounding while documenting creatively at the end of the day. Managers, in an effort to make sure that all patients are seen, then mandated that PCTs round hourly instead of alternating hours between nurse and PCT as was originally intended. According to our Studer coaches, patients will believe because of the hourly round that we are giving them excellent care if we appear in the room every hour and go over this checklist with them. Do they really?

I saw a TED talk the other evening about perception. “Perception is everything” was the theme. In my field, health care, we apparently agree. Perception is very important. A patient’s perception can mean the difference between getting well and going home or dying in the hospital. According to research done by someone, patients who perceive they are getting excellent care, regardless of the actual quality of the care, are more likely to have a positive outcome than patients who perceive their care is bad (again, despite the actual quality of the care). Do you believe this? I have trouble with it. I have known some nurses who spent hours in the room with the patient, talking, counseling, bathing and documenting but when it came to recognizing clinical deterioration, they were completely clueless. I remember when I first started in this business, nurses could be absolute holy terrors and nothing would ever be said because they were excellent clinicians. They might have the bedside personality of pit vipers but they brought their patients back from the jaws of death and the patients were grateful for it. Usually these were the ICU or ER nurses. The hard core battle axes that stared death in the face and you just knew that death itself was a little intimidated. Was perception as important then as it is now? Or perhaps patients perceived that care would be above par when the nurse was no nonsense and a bit brusk. I don’t think so, however. I believe that at some point in the past 20 years things have changed drastically.

Now don’t get me wrong. I think that it’s important to offer quality and service to patients. Their caregivers should be empathetic and friendly. We see patients on the worst days of their lives. They don’t deserve to be treated like widgets moved through an assembly line. They don’t deserve harsh words or rough hands. They deserve to be taken care of, pampered a little, reassured and comforted when they are frightened. From what I gather, talking to people who’ve been in the patient position over the past sixty to eighty years, nurses were caring. They might have been no nonsense but you could tell that they cared through their actions. That does not seem to be the case anymore, according to these interviewees.

My point is that perception has not always been the be-all, end-all of reality. At least, I didn’t think so. I’ve always believed that intention was a valid element on which to base judgment. We have probably all seen the quote “the smallest act of kindness is worth more than the grandest intention” (Oscar Wilde).  However, I think that action without intention is careless. There is no act of kindness without the intention of kindness behind it. We hawk perception as the cure but is it really? Is it not much more likely that the real problem is that we are lacking caregivers with the clinical skills necessary to offer excellent patient care? This includes the softer clinical skills of empathy, compassion, communication, and the hard won character traits of accountability, integrity and contribution. So rather than focusing on perception as the way to fix a problem with clinical skill, why not address the intention behind the actions. If a nurse does not intend to give excellent care, then she shouldn’t be in the field. No amount of pretense is going to make her give excellent care. It may fool the patients but probably not for long. Someone who is pretending to care won’t be able to keep up the pretense in the face of patient demands where someone who actually cares will rise to the challenge. Conversely, the nurse who truly cares about the patient needs the opportunity to learn and grow in her craft.

I’m the first to admit, it’s not an easy fix. This demands a look into the way nursing is taught. Nursing is not a good job for everyone. It is tough. Not only is there a lot to learn about body systems and disease processes but there are ways of thinking about problems that are absolutely vital for the nurse. Critical thinking is the ability to use the body of knowledge we possess as nurses, along with the most current research, to approach a problem and develop a solution without becoming emotional or panicking. For the new nurse, it takes almost five years to begin to think critically about patient situations. Up until that time, the new nurse is just learning to take care of the tasks that consume her day. It takes that long for her to become comfortable enough with the everyday tasks that she can learn to see the bigger picture. Perhaps by incorporating more clinical time into the nursing program, new nurses would begin a faster transition to critical thinking proficiency.

I believe that instructors need to weed out nurses who do not have the necessary attitude or character. While this might take some specific parameters and attention to detail, I believe it is possible to do. In Medical School, students compete against each other, not only with grades but with procedures. Med schools weed out the students who do not have the grades or the resilience for the program. Nursing programs should do the same. If the student nurse is not at the top of her class she will not be offered a good internship program. If hospitals commit to recruiting only the best and offering nursing internships that would give the new graduate clinical practice and mentoring we might end up with a better quality nursing student and graduate nurse. Instructors could make nursing students compete for procedures. My experience with students on the floor is that they will do everything in their power to avoid work. If they have to be checked off on a number of procedures it stands to reason that they would know how to do some of these procedures when they graduate. If they don’t get the procedures then they don’t graduate and the school weeds outs yet another student who did not want it badly enough. We got away from the diploma schools but maybe that was a bad idea. Could we not combine the book work of the BSN program with the clinical labs of the diploma school? The hospitals that participated would have the added bonus of free student labor and a skilled labor pool from which to choose the best and brightest. It might be worth considering.

I believe there is an urgent need to fix these issues before it’s too late. When the last of my generation is retired, the only ones who will be left are the nurses who are graduating now. The nurses who don’t have the first clue about critical thinking will be in charge of the ICU. The nurses who consider Facebook a good place to complain about their patients will be taking care of you and me. The nurse who thought herself above giving her patient the bedpan, causing a little old lady to climb out of bed over the rails and fall, fracturing a hip, will possibly be a manager or director. In my opinion, that would be a damn shame.

Enough of the Whining, Already!

Wow! I woke up on the wrong side of the bed this morning. I don’t know if it had anything to do with Wookie the cat scratching the dickens out of me last night or the constant barking from the neighbors dog around 2 am or the fact that I was shopping for craft supplies (with money I don’t have) until midnight last night. Whatever the reason, I wanted to murder someone this morning. In fact, as the dogs welcomed the morning with yet another volley of barking, I though how convenient it would be for someone to break into my house at that moment so that I could safely expel my overwhelming rage on a deserving target. No one broke in though so I yelled at the cats instead.

As I got ready for work, I muttered the usual curses. I don’t mind curses. I see them as a action, albeit an ignorant one, taken towards an event or a situation. Early morning before the brain is engaged, curses seem almost appropriate somehow. Especially when attempting to put my shoes on before the cat can grab the laces with his razor sharp little claws of death. What I don’t like is whining. Whining is stupid and ineffective. It doesn’t accomplish anything and usually ends up making others angry. What I heard come out of my mouth, after the curses, was whining. “Oh me.” I said as I stood up. “I’m so sleepy”, I added. “Oh god, I don’t want to go to work today.” Yes, I was whining. I was apparently comfortable with the words, presumably having said them many times before. It was evident that I have developed the habit of whining. I’m not sure when this happened. I have always seen myself as a person who, when faced with an unpleasant task, will take a deep breath and plunge right in. I decided to discuss my revelation with a coworker. “I’ve been unusually whiny lately.” I began with real shame clouding my voice. “Oh, no more than usual.” She quickly responded.

No more than usual? So the whininess has been going on for a while now? So long that this coworker, who has known me for years doesn’t see anything unusual about it? Well, yea (heavy on the sarcasm)! So how does one stop whining? Seriously, because now I’m hearing it with every word I speak. I even hear it in my thoughts. So I’ve been sitting at my desk googling how to stop whining and praying that no one comes in to talk with me until I get some answers. One article I found ( yes, there are articles about adults whining ) stated that “whining to an inappropriate audience is basically saying ‘please feel sorry for me because I’m a victim with no power to influence my circumstances’ “(http://www.beinkandescent.com/articles/1252/stop+whining). The author suggests using a simple question to stop whining in its tracks. Just ask “what are you going to do about it?”

So, what am I going to do about it? For one thing, I’m going to be more conscious of what I say. When difficult circumstances arise, instead of thinking “poor me” or “why me”, I’m going to try to think “what can I do about this” and “how can this help me to be better”. I made a start today. Instead of joining in the round of “I’m so fat and I can’t lose weight” that was going around the table at lunch, I challenged everyone. What are you going to do about it? We started talking diets and exercise and before the end of lunch, we’d all committed to helping each other with eating in a more healthful manner. We promised to start tomorrow with a group lunch. Perhaps it’s not world peace but it’s a positive step toward a beneficial goal and there wasn’t a bit of whine about it.

Bullying

What is it about the blank page that inspires such fear? How will I fill it? What will this story be about? Will it be any good? Truth be told, I have no idea what I want to write about. I’m promised myself that I would make a greater effort to write every day so I just open a word document and ramble. Not a very promising beginning is it?!

I do have something that’s been weighing on my mind. This current epidemic of bullying that is plaguing our young people. I don’t have children so I don’t see it first-hand. I do, however, hear about it and it worries me. Have children always been this cruel? I don’t think they have. I remember being teased as a teenager. I guess you could call it bullying. While it bothered me, the person who did it was not a part of my social circle and therefore not really a concern. I saw her briefly on the bus. She couldn’t hurt me. The most she could do was make a few cutting remarks. To be honest, I could out-snark her easily. I don’t remember it hurting my feelings overly much. I started driving halfway through the year and stopped riding the bus, not because of her but because, well, I could drive. I knew girls who had a hard time all the way through school. I remember friends of mine encouraging me to make fun of a girl in junior high school. I did once or twice but I could always hear my mom’s voice saying “how would you feel if Jesus suddenly were standing beside you?” She was a Sunday school teacher and that was one of her favorite ways to instill guilt. I was sure Jesus would be very sad about me making fun of this girl. By the same token, I was also sure that Jesus didn’t mind if I hit my brother or called him names. Jesus is cool like that! I told my friends I wasn’t going to make fun of Sarah. My friends decided I wasn’t much fun to hang out with after that. Oh well, I had other friends who were considerably better behaved. Sarah became a good friend. She had a wicked sense of humor and the most amazing artistic ability.

Back to the present day, teens now use social media to bully. How do they get social media? Seems like they should have to be a certain age before they can sign up for an account. I guess not. A coworker told me about an eleven year old girl who killed herself (with a gun) because she was being bullied. I don’t know the whole story. I wondered if her parents had known she was being tormented. Surely if they had, they could have intervened. But what do you say to a child who can’t get away from bullying because it invades her email and texts and Facebook page? If her parents were at all like me, they may not have understood how pervasive and cruel bullying can be. I also wonder if there’s anything you can do to prepare your child? My folks allowed me and my brother to slam each other at will. Mike was six years older so he would have had an advantage. I was quick, though, and maybe a bit smarter than him. Mom and Dad seemed to enjoy it when their little girl could put her big brother in his place with a well-spoken quip. That was probably wrong of them but as it taught me how to think on my feet and not let the odd verbal barb hurt my feelings; I can’t fault them too much. So is that the way to arm your child, teach them to hurl insults and ignore taunts? As I said, I don’t have kids but if I did, I’d want them to be kind, not mean. It took me until my thirties to realize that some of the things I said to people were hurtful. Maybe the reason I wasn’t bullied was because I was the bully? God, I hope not. I was a sarcastic little bitch at times but I don’t think I ever said anything to anyone that would make her want to kill herself.

Maybe the answer is to teach kids to be kind but also teach them to defend themselves, verbally and physically. It wasn’t long ago when child snatching wasn’t a part of our world. After all, when my brother and I were kids, we walked to school. It was about two miles away and we cut through neighborhoods to get there. That was before the Lyon’s sisters went missing in 1975. Wheaton Plaza, the mall the girls had been at that day, was close to where I grew up. After that, I was told to park my 12 year old self at the bus stop with the other kids and not to walk anywhere. It was a terrifying time for our parents but we kids quickly adapted to a life that no longer allowed free ranging through our suburban neighborhood. We learned to run away from strange cars and strange people. I’ve heard friends with children say that they routinely teach their children about strangers, improper touching, drugs, and peer pressure. So now it’s time to add bullying to the list. By prepping our kids, we can give them tools to use with bullies. Physical tools like martial arts and mental tools like de-escalation and negotiation techniques. I do think it’s time that parents take back some of the responsibility for curriculum from the schools. I also think it’s time that authorities be encouraged to confront the parents of bullies. Some sort of trauma causes this behavior. By shining a light on the home life of bullies we could be saving children other than our own.

Digital Download vs Handwritten Copy

This started as a simple rant about the irritating relationship I have with my electronic aids and their frequent failure to get me where I need to be. It has become a warning about allowing electronic devices to think for us. If you don’t hear from me again, you will know that they became aware of my attempted rebellion and squashed it!

I’m wondering if anyone else has this problem? I can type a meeting into my calendar or enter it into my phone but it doesn’t help me keep the appointment. Even setting an alarm doesn’t help me remember the meeting in time to actually prepare or arrive on time. The act of manually writing the meeting in a paper calendar; however, keeps it at the forefront of my mind and I not only remember to prepare for it but arrive early. As a result I am calm and remain relaxed throughout. Why is this? It seems like the method of entry wouldn’t matter. It should be the act of entering the information itself that keeps the appointment fresh.

I look at my calendar multiple times a day, everyday at work. I carry my phone with me at all times. It isn’t that this information is not readily accessible. In fact my leather planner, while accompanying me to meetings, just sits out on my desk. It doesn’t beep or flash but somehow I remember what’s in there and forget the appointment that just popped up on my screen saying I had 15 minutes to get over to the main hospital building.

I have a theory about this. During my formative years, I had to rely on paper planners. That’s all there were. I could write things down but I had to have a process of remembering to look everyday and then remembering what was on that day’s schedule. I think that the computer calendar and the phone apps have allowed our brains to become lazy. How many people can’t remember phone numbers anymore? As a teenager, before the advent of the cell phone, I had an entire list of phone numbers in my head. In fact, I still remember my old phone number. I don’t know my current office number. It’s on my business card but I rarely look at that information and I don’t call myself. I don’t remember a fraction of the numbers on my contact list. They are in my phone. If my phone dies, I might know who to call but I won’t remember his number.

I have taken to entering information into a paper planner, not only as a backup, but to help retrain my brain to process and retrieve information. I thing the computer and the phone are wonderful tools if we use them correctly. I fear, though, that too many are turning off important mental processes and relying on electronic aids to do the busy work. I don’t believe that computers will eventually become our masters here on Earth (well, except in the sense that I must have the newest model) but I wonder if we are doing our future selves a disservice in terms of preventing neurological disorders. Could it be that memory work could help delay Alzheimer’s? For me, I think I’m going to start working a bit harder on my memory. I hate to think that I didn’t do everything possible to avoid the ultimate brain dump.

Well-Meaning People

I went to a friend’s exercise studio last week. To do Zumba. I knew it was a bad idea. I have a torn meniscus in one knee and am prone to severe knee inflammation and pain. My orthopedist has told me “NO HIGH IMPACT ACTIVITY”. While I listened, I just wanted to do something fun and high energy. I’ve been very sedentary with this injury and I’ve gained weight and I don’t like it. I need to get moving and lose the weight. I kept up with the group for about five minutes and then started doing modified steps because the pain had started and was steadily growing in intensity. After about 25 minutes, I’d had enough. I was ready to climb in my truck and drive home but my friend insisted that I get on the recumbent bike and pedal to keep my muscles from stiffening up. It was good advice but I expect that from her. She’s a nurse and like me has been in the business for 20 years.

One of the ladies in the class, decided to make me feel welcome and introduced herself. She gave me some helpful tips about the dance steps. Concentrate on the footwork she said. Don’t worry so much about the arms yet. It was also good advice. After I got on the bike she stopped by to see how I was doing. I didn’t share my injury with her. I don’t really know her. Not only that but most people aren’t really interested in how I injured my knee. So I just said I’d gotten tired and was now riding the bike, keeping lose, stretching muscles.

This week, I chose not to come to the studio. I’ve had enough pain for the month of July and think I will at least wait until August before intentionally trying to aggravate the injury. Besides, I had just adopted a new kitten and was spending quality time with her in the isolation room (she had a bad case of fleas and needed to be treated and kept separated from the rest of the feline population). When my phone rang and I saw my friend’s name pop up I eagerly answered as, in addition to being the exercise and health  guru, she is also the cat whisperer. Before I could tell her my news she told me that she had someone who wanted to speak to me and this woman from the studio came on the line. She proceeded to tell me that she really wanted to see me at the studio the next week and that we would just start with the arm part of the Zumba steps while I stood in one spot. I wanted her off the phone. I wanted to get back to my kitten. I wanted to talk to my friend about my kitten. I did not want to talk to this nosy woman. So I said, sure, I’ll try that. See you next week. Then I proceeded to put it out of my mind.

However, this morning I started thinking about that conversation. This woman doesn’t know me from Adam’s housecat and yet she has the audacity to offer me advice about my exercise capacity. She offers it like she is a healthcare professional but it’s bad advice. My orthopedic doctor specifically said, bike riding is one of the best activities for a knee injury. It does not put strain on the joint. This woman told me that pedaling was a repetitive motion and was bad for the knee. Patients undergoing knee replacement spend hours in something called a CPM machine (continuous positive motion, repetitive motion!) to keep the joint from seizing up. It also strengthens the muscles that surround the joint. Standing in one spot on a hard surface causes the joint to bear down with the force of body weight. It’s much worse than just walking or shifting from side to side.

I’m sure this woman was just trying to help. She is a well-meaning individual. I appreciate her attempt. However, if I wasn’t a nurse, if I hadn’t already gotten the advice of health professionals, if I didn’t have a strong smattering of common sense, I might have listened to this woman. I could have returned to the studio, standing there while my joints ground together, waving my arms around like a loon. I could have taken handfuls of ibuprofen trying to reduce the swelling that always accompanies foolish behavior. What a great world if well-meaning individuals were required to provide references from peer-reviewed journals for the advice they gave? I’m not saying they shouldn’t offer help or advice. I’m just saying they should put a little effort into it instead of just offering their uneducated opinions.

But that’s just my uneducated opinion!

My Happy Place

When things are at their most hectic, I force myself to remember my happy place. I only experienced it for a few brief minutes but the feeling I had was so transcendent that it has stayed with me throughout the years. It was the summer of 1984 and I was on the campus of the University of Maryland at College Park. I’d just come out of the North Administration building where I had added a much needed class for my senior year.

North Administration Building, University of Maryland, College Park

North Administration

I was relieved and exhilarated at the same time and I sat on the steps of the building to enjoy my victory. Drop/add days at the University of Maryland were always tense and frustrating. On more than one occasion I had ended up with a class that was not only not my first choice but not my second, third, or fourth. On this day, however, I was victorious. I remember looking across the mall at McKelden Library with its Greek columns and noticing how incredibly blue the sky was against the white of the building. On either side were these old growth trees that added that a cool touch of green. In that moment, I was perfectly happy. I stayed there for almost thirty minutes, just taking in that picture and enjoying my contentment.

McKeldin Library from the mall

The view of McKeldin from the fountain

My happy place

Imagine this view without a cloud in the sky.

For some reason, I didn’t take a lot of pictures of my college years. That was before the digital phenomenon, of course. Pictures didn’t do much for us in those days. Most of the time they just sat around in an album or worse, in the development envelope they came in. So, I Googled the campus to see if I could recapture the image of McKeldin against a pristine sky with those magnificent green trees. The campus has changed quite a bit in the nearly 30 years I’ve been away from it. McKeldin’s still there but it looks so different. In fact, it took me awhile to recognize my old haunts (at least on Google images). Perhaps it’s time to update my happy place.

Day Seven: No Caffeine

It’s almost been a full week since I gave up caffeine. The headaches are over (I hope) and I’m starting to feel almost normal. I still miss it! Although food is tasting normal, it just doesn’t have the same draw that food with a diet Coke or diet Pepsi had. My office mate walked in this morning with two diet cokes and I actually started salivating. One note; my father had promised me that if I stopped the caffeine I would stop grinding my teeth. This is false. Don’t believe people when they tell you this. Caffeine does not make you grind your teeth. Or if it does, once the grinding becomes a habit, stopping the caffeine will not stop the grinding. So much for saving on the dental bills.

Day Four; No Caffeine

The headache is diminishing, thank goodness! I have to say that life without caffeine (and aspartame) sucks. I miss my diet sodas. Now that it’s just water, I don’t want to eat. Which is great for my waistline. Maybe I’ll get it back this way. 

Day two: no caffeine

It hurts!

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