On Being the “Old School Nurse” in Modern Times

 

Being the Old School….

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I have had so many nurses tell me that I should have been a nurse in a whole other era. As a child I dreamt of wearing the white dress and the white tights and the white shoes and the shiny nursing pin on the lapel of my dress. I dreamt of the things I would teach people, the changes I would have the chance to help people make in their lives, and the opportunities I would have to be a part of the best and worst moments of people’s lives. As far as I was concerned, Nursing was it for me. For Life. And I worked for it. The first day I wore the white dress, tights, and shoes I looked at myself in the mirror with such hope for the future. I vowed to myself I was going to use every bit of what I learned at Northern Arizona University. I was going to apply the theory, evaluate my own outcomes, look for new trends and maybe develop new theories and studies…..I wanted to do it all. To me, Nursing was an endless horizon of possibilities and light…and even on the traumatic days of losing a patient there was still some light to be found as a reminder of why I was there, in this profession, doing what I was doing. I was made fun of by my peers for doing 30 minute one to one teachings about heart failure or heart failure medications instead of just leaving the packet or showing the patient the movie. I was teased about my thing for “drawing my teaching material” on a big tablet of paper to help patients to understand their disease and why their medications were important and where they were working at. I was always told “why cant you just do it the way everyone else does.”

Meaningless Master’s…Meaningless Dreams

The real weirdness all started when I began my Master’s program. If I had to go back and do it all over again I probably wouldn’t have done it. Why? Because I truly believe I would still be an RN at the bedside today. You see, as you advance your education within the nursing profession your view gets BIGGER….WIDER. Your beliefs change a little. You want to make changes for your peers, for your patients. You start seeing things you hadn’t noticed before. Problems to be anticipated, processes that need to be fixed to optimize better and safer patient outcomes, nurse recruitment, retention, and resource utilization. You see a larger view than the nurse next to you because you are learning about a different side of nursing and the healthcare system that calls on you EVEN MORE to RELY ON YOUR SENSE OF MORALS, VALUES, AND ETHICS.   If I could go back, I’d want to go back and just be like everyone else. No Masters, no Post Grad work. Just a BSN.

I know it sounds counterproductive or maybe even disheartening, but in the corporate environment there is little to no room for a nurse who is educated above a Bachelor’s Degree level to do much of anything. Whatever corporation you work for has already defined what nursing is and what it is not within their walls. They have already decided how you will function no matter what your education level. An RN is an RN as far as their definition of nursing goes. I will say that my former stomping grounds at the Mayo Clinic were absolutely heaven to work in because nurses were revered by all the providers. We had autonomy. There was a strong sense of trust between the disciplines and the nurse’s hunch, or plan of care, or sense of what was going on with the patient MEANT EVERYTHING to those doctors. We truly were their right hand, and they relied upon our knowledge base and our knowledge of the patient in a critical manner. We were partners. And it was wonderful. There are times I wish I could go back and cut out the part when I got Cushing’s and it all went downhill…….moments I wish I could go back and re live it all again because it was—for lack of a better way of saying it—the time of my life. All my nursing dreams come true.

Career Defining Moments: We All Have Them….and They Forever Change Us

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It wasn’t “just” the Cushing’s though, that forever altered my journey at the Mayo….stuff changed when I got the MSN. Things were never the same. Cushing’s or not, I knew things would never feel or look like they used to. One of the defining moments of my career was when my nurse manager at the Mayo Clinic took a project I had worked SO HARD on to HELP HER implement a work process initiative that wasn’t being readily accepted by the staff— EASIER. I spent hours researching, utilizing my knowledge of the unit, statistics on nurse satisfaction, recruitment, and retention….patient safety data….my knowledge of the organization’s mission and values until I had crafted a multi-pronged project that would help get this project back on track again and get it moving faster. Her facial expression was stoic, her voice monotone, her energy thick with frustration. My manager’s response to me was that my PowerPoint and my white paper “looked like a random stream of consciousness and plagiarized even.” My heart broke that day. My nursing spirit was shattered that day. The light of hope and enthusiasm had dimmed in my heart that day for any prospect Id have for using my education to help on the cardiothoracic surgery stepdown unit. To add insult to injury, my nurse manager told me not to email her ideas any more, that she didn’t want them. There are few days I remember crystal clear from my nursing career as a cardiac surgery/heart transplant nurse—it was the day my manager told me “I was nothing” (she didn’t say it but that’s what I heard) and standing at the head of an OR table to see my first heart transplant. They were the worst and the best moments of my career. To be honest, my spirit as a nurse remained broken after that day.

The Catalyst for Recall…

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You are probably asking why I am bringing these things up now. Well, that’s easy: WE HOLD EACHOTHER BACK. WE LIMIT OUR OWN POTENTIAL. WE ARE THE ONES RESPONSIBLE FOR THE CURRENT STATE OF NURSING BECAUSE OF HOW WE REGARD ONE ANOTHER AND SUPPRESS EACHOTHER’S UNIQUE QUALITIES, TALENTS, AND VOICES.  I recently came across an article that was posted to the American Journal of Nursing’s blog: Off the Charts. As I read the author’s words, I became frustrated with its overall message and tone. The article presented as pretty, shiny, idealistic, and in a nutshell– telling us “all was well and on track” in the nursing world and she was proud to be one of the drivers of that. It’s been quite a few days now since I read Susan Hassmiller’s ODE to Self–the pretty paisley words of encouragement resembled a teacher patting her students on the head letting them know “everything is ok now children you can get back in your seats.” I immediately responded, professionally of course, and I waited to see if the American Journal of Nursing’s Editor in Chief Maureen Shawn Kennedy MA, FAAN would actually “bless me” with a sign of the cross from the Nursing Pulpit and allow the post to be “seen by the masses” within the profession.

I made a plan. If she allowed the post to be seen, read, and responded to Id engage in some good collegial debate with my nursing colleagues and learn a thing or two, ….. If she didn’t allow the post to go through Id BLOG about ALL MY THOUGHTS on what Susan Hassmiller had to say in her “State of the State Address on Nursing” and publish it myself. I’m sure that Editor in Chief Shawn Kennedy was so excited about receiving Susan’s piece she must have nearly peed her pants trying to get it posted before running to the bathroom. After all, Susan Has miller IS the “IT NURSE” the “IT NURSING VIP” you want to be in good favor with. Yours truly, has written Ms. Hassmiller several times over the past few years since my Banner Health Whistleblowing case and I’ve never heard a single response from her—which translates to “YOU aren’t worth MY TIME.” I’m going to be nicer than that, and give HER MY TIME on MY BLOG.

Guess What? I AM The Future of Nursing….Ready or Not

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I could play this in the opposite direction—SHE should be so honored, because whether she likes it or not—I AM CHANGING THE FUTURE OF NURSING. RIGHT NOW. AS WE SPEAK. Just like nursing programs are using her to inspire their students, my blogs are also being utilized in nursing curriculums across the nation. So– Shawn and Susan, you aren’t the ONLY people who GET TO PLAY ON THE “Campaign to Change Nursing” PLAYGROUND. There are OTHERS in the sandbox with you. Can you play a little nicer and pass the pretty red ball around so we can all play too?

The Benefits and Blessings of Blogging

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Blogging has afforded so many of us out here in cyberspace to have our voices, experiences, and perspectives heard, acknowledged, considered, responded to, and maybe even acted upon to improve the profession itself or the future of patient safety. Blogging has given those of us “pesky tell it like it is” professionals the chance to BYPASS the higher echelons of the profession and enter the minds and hearts of multiple generations of nursing. If you think about it, that in and of itself could be considered “Campaigning to change the future of nursing.” I do. And I give thanks to social media every single day that I don’t have to get on hands and knees begging the likes of Shawn Kennedy to bestow upon me the blessing of being published. I can make a change in the future of nursing, I deserve to make a change in the future of nursing, and I deserve to be heard and considered by the masses just like the suits and heels of our profession who probably haven’t worn scrubs and worked a 14-16 hour shift in YEARS.

An Altered Reality….and the REALITY

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Ms. Hassmiller discusses some of the tenets learned by her mother at Bellevue Hospital’s nursing program and how they have influenced her view of nursing and her own personal practice. Though I give kudos to her for trying to follow in her mother’s footsteps by being the Golden Nurse, I have to ask the question of why I wasn’t treated with the same regard when I tried contacting her via emails, twitter, and Facebook. I don’t call that professional regard for another colleague’s concerns or ideas, compassion for another colleague’s disposition, or her efforts at striving to treat all human life with equality “because all human life deserves to be treated with equal care and attention.” Yes, Ms. Hassmiller, its always “more comfortable to stay with what (and who) you know,” but ignoring me as a colleague or anyone else whose views differ from yours or those you are being “influenced to ignore” hardly constitutes the kind of professional behavior nurses were taught at Bellevue so many years ago. You see, in order for change to happen for nursing and for patient care, a certain degree of discomfort must be experienced. (Remember Lewin’s Theory of Change from school?) Sometimes that discomfort may come in the form of interacting with people you just plain don’t like or even want to hear. Consequently, you yourself could be stunting the professions growth and evolution in the same fashion as Shawn Kennedy when SHE DELETES  my posted responses.

Your piece is a “call to arms” (should be a call to COMPASSION) that carries with it unrealistic expectations that cannot be met right now, Ms. Hassmiller. For example, you discussed workplace diversity. Just a couple of weeks ago I was involved in a heavy debate with other colleagues in a chat  entitled “Is it rude to speak a different language in the nursing station?” The responses were shocking, discriminatory, mean spirited, harassing, and presumptuous—andnot in  in any way culturally sensitive. Please recall a recent court case outcome in California in which Filipino nurses won nearly a million dollars in their suit against a hospital that literally terrorized them—their own nurse coworkers did this to them every shift. The way these nurses were treated, and the way other nurses are being treated TODAY, AT THIS MOMENT simply for being from another country of origin and speaking a second language (God Forbid) in the presence of their colleagues is NOT CULTURALLY COMPETENT BEHAVIOR THAT DISPLAYS EQUALITY AND COMPASSION.

“The $975,000 settlement, announced Monday by lawyers from the Equal Employment Opportunity Commission, is believed to be the largest language discrimination settlement in the U.S. healthcare industry, according to the Asian Pacific American Legal Center.

Officials at Delano Regional Medical Center insisted they did nothing wrong and settled the lawsuit only because it made financial sense. Under the terms of the settlement, however, the hospital must conduct anti-discrimination training and hire a monitor to track workplace conduct.

The case, filed in 2010, involved 69 immigrants who said they suffered “constant harassment and humiliation when they opened their mouths, or talked with family members on the phone,” said Anna Park, a Los Angeles-based attorney for the commission. She said nurses were banned from speaking Tagalog and other dialects in break rooms, hallways and the cafeteria.”

Your mother, she hit the nail on the head when she said “anything less is unethical” behavior for nurses—in these cases terrorizing, bullying, making fun of, isolating, or discriminating nurses in the workplace because they do not resemble “everyone else” or “look like everyone else” or “talk like everyone else” is indeed unprofessional and unethical, not to mention terribly abusive and traumatic. And I’m sorry to say, hardly any nurses “were advocating for a more diverse workforce and equal treatment for all” in the nursing forums discussing this topic. This IS (whether you like it or not) the current reality of the profession you speak of.

Behaviors Unbecoming: Becoming A Trend

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Nurses making fun of patients on the internet, taking inappropriate pictures in their workplaces, prejudging patients on their admission diagnosis, disregarding pain levels, treating prison inmates like they are less than human, nursing magazines writing articles telling “civilians what not to do” in the hospital so they aren’t a “nightmare to the nurses” or calling on nurses to submit the funniest or craziest birthing plans they have ever heard of —and nurses ARE responding— none of these things would probably fall under Bellevue’s standards of nursing conduct…..In fact, how many nurses are conducting themselves on social media every moment of the day probably wouldn’t fall under Bellevue’s standards of nursing conduct.

So What’s The Problem?

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Consider the state of Arizona—We are after all the model state for all that is going wrong in nursing: Nurses failed to report conditions at the MCSO jail and a patient died, Nurses failed to report conditions at the State Mental Hospital and a patient died, Nurse and Doctors failed to report conditions at the Carl T Hayden VA Medical Center and hundreds of veterans died. One in particular case—a vet who presented to the ER reporting that he was going to kill himself was turned away and told to sleep it off in a corner of the ER and then go home. He went home alright, and killed himself.

Keeping quiet about medical errors and helping to cover them up, not speaking up for patients to protect one’s self also probably wouldn’t fall under Bellevue’s standards of nursing conduct. Perching in front of computers and perusing through dating websites, internet shopping, tweeting, or Facebooking while call lights are going off and patients are falling would probably fall under downright disgraceful behaviors within Bellevue’s white halls of academia. But this is the reality of your profession today. It is falling apart, the foundational fabric unraveling, and the time honored tenets tossed out in favor of “what everyone else is doing.” It has become about speed and productivity. How fast a patient can be moved in and out, the bed cleaned and a new body put in it.

Passivity and a Fractured Profession = A Profession in Peril

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We have, as a profession, allowed corporations to divide our profession and decide what nursing is and what it is not. We have allowed people who have never been to nursing or medical school, who sit in board rooms every day, decide what skills nurses will perform and what nursing skills can be taught to other personnel so nurses don’t get paid as much. Our profession, collectively, has done NOTHING to change the fact that nursing care is lumped in with the hospital room charge. Our profession, collectively, has done nothing to protect each other from work place violence, whistleblowing retaliation, or disruptive physician behavior, not to mention impossible nurse to patient ratios. The icing on the cake is this ever growing mentality that “the nurse knows more than the patient.”

Forgive me if I cannot envision the shiny hopeful future Susan Hassmiller does. Excuse my pointed view of the profession’s reality, but—as Iyanla Vanzant would say: “Let’s call a thing a thing” already. Our profession is in trouble, has been in trouble, and is continuing to deteriorate without aggressive push back from a profession that has been around for decades upon decades. What this means is—patient safety is in trouble and will continue to be in increased jeopardy because the state of nursing is directly tied to the state of patient care. At a loss of around 1,000 patients per day Ms. Hassmiller, I’d say we as a profession have some explaining to do. The loss of life due to medical/nursing errors is now the third cause of death in this nation and it doesn’t have to be. Forgive me, but I cannot agree with your optimism for the future when you yourself probably haven’t taken off the business suits, heels, stepped off of the podium,  donned scrubs and worked on one of our nation’s busiest nursing units for 12-16 hours—shorthanded, without patient care aides, a telemetry pager going off every five seconds, without the critical supplies you need to get your job done and a team of nurses who function nowhere near the definition of a “team.”

Aside from the need to support a more diverse workforce and the equal treatment of all (colleagues and patients) I will agree with you on one specific point Ms. Hasmiller—to act any other way than in the most ethical, professional, compassionate way towards colleagues and patients “would not be in keeping with the privilege of being a nurse.” But I guess your words didn’t and don’t apply to ME.

I acted in all of those ways on the night of April 12, 2011, at Banner Del E Webb Hospital and I was found to be what you would refer to as “not in keeping” or privileged to be a nurse today. My patient passed away, having had their rights stripped from them with no one taking accountability for it.

So try something a little different. Before writing the next article telling all of us good little girls and boys that the world is as it should be and the world of nursing and its future is all shiny and pretty like the DWTS Mirror Ball Trophy—browse through some nursing discussions online, then get back to us on the “real state of our profession” and what you think we should do about it.

Emphasis on the word “WE.”

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Comments

  1. All this talk of diversity makes me wonder, what about the AASN? As a RN with an AASN, having worked in critical care for almost 20 years I find myself being pushed out of nursing completely. Somehow the idea that a BSN qualifies a new grad more than an AASN with 20 years under the belt has taken a very strong hold in the profession. I am no less a professional than my best friend with a BSN, who states quite emphatically that I am and always have been better at my job than she. Interesting that more patients are dying, more errors are occurring since the push for all BSN RNs started. I am constantly pushed out of job candidacy by a computer that picks up on “key words” in my resume. Whatever happened to the “human touch?” My first year as a RN, I won a raffle at my hospital and received a t-shirt that I still have. It had a picture of many hands in many colors and stated “Health care with a Human Touch…” (possible paraphrase) Whatever the case, at that time I worked with diploma nurses, LPNs, AASNs, BSNs and MSNs. None of us were held any higher than the next. We respected each other for our individual contributions. Many of my BSN coworkers asked my opinion on many things, partly because I’d just graduated and had the most updated knowledge. Now? I’m nothing. I can’t even get a job for the last year because a computer kicks my resume out for “not having our preferred qualifications.” I’m sorry, but I’m not seeing the advantage of an all BSN RN staff anywhere considering that everything I’ve seen and read thus far goes directly against all those high priced studies that “prove” otherwise.

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