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The Best Nurses Day Gift: Enough Time With Patients

May 22, 2013
What's Left Behind, oil, graphite, and mixed media on wood panel. 18" by 18." Copyright J. Paradisi.

What’s Left Behind, oil, graphite, and mixed media on wood panel. 18″ by 18.” Copyright J. Paradisi.

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.

I can’t remember which handle on Twitter asked nurses last week for their stories about the best or worst Nurses Day gifts from their employers, so I will tell mine here. It began badly, but became the best.

Nurses Day in May is a cute little rhyme. In Oregon, where I live, May also brings hay fever allergy, which is neither cute nor rhymes, but like Nurses Day, is an annual event.

I woke up on the morning of Nurses Day with a headache and my voice hoarse from allergy. Previously, I had traded shifts to work this day in place of another nurse with an acutely hospitalized family member. If she and I were playing Rock, Paper, Scissors, her need was scissors to my paper.

Calling in sick was not an option. It’s part of the unwritten Nurse’s Code, which is really more of a guideline, but don’t test it. Calling in sick after agreeing to work for a coworker will not garner sympathy from your unit.

When I arrived for work, another nurse remarked that my hoarse voice sounded sexy, like actress Kathleen Turner’s. Despite my crankiness from inadequate respiratory gas exchange, that cheered me up, a little.

Then The Miracle occurred:

The hospital’s phone system, including our outpatient unit’s, went down. No phone calls came in or out, not even between departments. Overhead via the PA system, the hospital operator announced over and over instructions for summoning the rapid response or code teams, if needed. Non-emergent communications were sent by e-mail, or pneumatic tube system.

It took a little while to understand that, for our outpatient clinic, what felt like calamity was in fact a surprising gift: our scheduled appointments were all that we had that shift. Offices could not call to schedule new appointments that morning. The phones at the nurse’s desk were silent.

This created a leisurely pace for our shift, which I put to work at my patients’ bedside. My allergy symptoms reminded me how it feels to be sick, replacing crankiness with compassion. For each patient I pulled up the rolly stool and sat down, listening to their stories and concerns without time pressure or ringing phones. I had time to look up information, print handouts, and answer their questions the way I was taught to do in nursing school. In short, because the phones were down, I spent Nurses Day, well, nursing. I felt fully engaged in the work, and remembered why I chose this noble profession.

By noon, the phones were back up. My headache and hoarse voice were gone. I realized I was having a great day.

Later, while I was fetching a cup of water from the water cooler for a patient to swallow pre-meds, our manger stopped by. “Hey you, how’s your Nurses Day?” he asked, affably.

“Great!” I replied. “The phones were down the first half of the shift.”

Not missing a beat with his quick wit, he winked and said, “Oh yeah. I arranged that as a gift. Have a Happy Nurses Day.”

And I did.

Disclaimer:  No patients were harmed in the making of this post.

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Dispatch #2 from Melbourne: Dues, Election Results, Nursing at the WHO

May 21, 2013

By Shawn Kennedy, AJN editor-in-chief

Melbourne, Australia

Melbourne, Australia

There’s lots happening at the International Council of Nurses (ICN) meeting and I’ve logged more walking miles here in Melbourne in the last two days than I do in a week at home.

Judith Shamian

Judith Shamian

On Monday, the Council of National Representatives (CNR), the ICN’s governing body, announced election results. Judith Shamian, a well-known Canadian nursing leader, was elected the 27th president of the ICN. (For more information about Judith and other election results, read this press release.)

The CNR also agreed to address issues related to membership models and will move forward with a plan designed to support inclusiveness and membership growth in national associations. The plan also includes a tiered voting model that takes membership and percentage of membership into account. (The final vote will take place at the 2015 Congress).

Bryant

Rosemary Bryant

New dues scheme: will RCN return? The CNR approved a new scheme for dues that should address the issue that led the Royal College of Nursing (RCN) to withhold dues, resulting in its suspension from the ICN and its recent vote to withdraw from the ICN. According to ICN president Rosemary Bryant, Norway and Japan, who were also unhappy with their dues payments, were pleased with the new model. She is hopeful that the RCN will be as well. (A podcast interview with Bryant is forthcoming.)

I spoke with David Benton, chief executive officer of the ICN, about the RCN’s two-year suspension. According to Benton, the ICN had no choice. “The RCN made a unilateral decision in 2010 with no attempt to negotiate another resolution,” he said. He added that as a long-time member and a fellow of the RCN, he’s personally saddened by its decision to withdraw from the ICN. He noted that only a small portion of RCN’s dues goes to ICN membership and that other countries with far less resources continue to support the ICN’s work. He, too, is hopeful that the changes recently approved by the CNR will prompt the RCN to reconsider its position.

Meanwhile, two new associations were admitted to the ICN: the Chinese Nurses Association and the Palestinian Nursing and Midwifery Association (read more here).

Invisible nurses at the WHO. Another issue, not new but perhaps one that is coming to a head, is the “eradication of nursing expertise at the WHO.” Nursing positions, especially leadership posts, have been disappearing from the WHO headquarters and regional offices and are now at an all-time low of 0.6% (down from 2.6% in 2000).  (See AJN‘s July 2011 editorial and July 2012 report on this.) According to a document issued Monday, the CNR “calls upon the WHO Director General to urgently reinstate the vacant positions of WHO Chief Nursing Scientist  at WHO headquarters and urges regional directors to retain and strengthen senior nursing advisor positions in their regions.”

I also attended several interesting sessions: Read the rest of this entry »

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Dispatch from Melbourne: A Significant Loss for International Council of Nurses?

May 20, 2013

By Shawn Kennedy, AJN editor-in-chief

Melbourne, Australia

Melbourne, Australia

So this week I’ve traveled halfway across the world to Melbourne, Australia, where the International Council of Nurses (ICN) is holding its 25th quadrennial meeting. Nearly 4,000 nurses from 134 countries are expected to attend. There’s a mind-boggling number of concurrent sessions—there must be about 60 sessions each hour, offering glimpses into various  international  health problems and solutions from nurses.

Chinese Nursing Association at ICN 2013

Chinese Nursing Association at ICN 2013

A river of nurses. Sunday morning was the opening plenary. I left my hotel at 8:30 am to walk to the convention center along the Yarra River, which runs through this very metropolitan city. I began as a fairly solitary walker, but was soon joined by other walkers, mostly women, all carrying the same ICN2013 conference bag, all walking purposefully in the same direction. We were mostly middle-aged and dressed in sensible walking shoes and “business casual” clothes, and must have looked like a well-dressed walking club to those biking and strolling past. I was quickly reminded that, for all our differences in language and customs, we’re all pretty much alike.

Missing this year from the Congress of Nursing Representatives, however, is the Royal College of Nursing (RCN), which represents nurses from the United Kingdom. The RCN was suspended for failing to pay all of its dues and now is expected to withdraw membership from the ICN. In April, over 91% of members attending (539 of 588 present) an “extraordinary general meeting” voted for withdrawal. The precipitating issue for the RCN was the breakdown of negotiations to reduce its annual dues payment, which is currently about 600,000 pounds (about 1.8 pounds per member). Though a number of RCN members forcefully dissented from this decision, this dues payment was, according to the RCN, “unsustainable.” The question that no one is asking is, “Will any other members follow suit?”

More to come . . .

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Where Medicine Leaves Off

May 17, 2013

Long before we see the face, we hear the crying. Mournful, broken, it expresses general discomfort more than acute pain. In it lies the anxiety of all those children brought here against their will, made to submit to the probing of pale strangers who speak an alien tongue.

AftertheScienceIllustrationThat’s the start of the May Reflections essay, “After the Science,” by Charlie Geer, about working as a medical translator on an Episcopal church–sponsored team in the Dominican Republic. Geer, who published a comic novel in 2005, writes with sensitivity about the limits of medicine and the way the “nurses gather round, the compassion that brought them to medicine picking up where medicine leaves off.”—JM, senior editor

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Angelina, Florence, End-of-Life Care, Nursing History, Postpartum Depression: A Web Roundup

May 14, 2013

By Jacob Molyneux, AJN senior editor/blog editor

In the news today we have an op-ed piece in the New York Times by Angelina Jolie about her rationale for getting a double mastectomy. There are sure to be many reactions to this disclosure, with many offering praise for her frankness about her decision. There may also be some who disagree with her decision to take this preventive step because she has the BRCA1 gene, which sharply increases her risk of getting breast cancer. Jolie’s perspective seems to be one of empowerment for women rather than a sense of helplessness or sorrow. Though Jolie’s circumstances are hardly universal in terms of the cushion provided by her great wealth, it’s hard not to admire the strength it takes to see things in such a positive light: “Life comes with many challenges,” she writes. “The ones that should not scare us are the ones we can take on and take control of.”

MarchCoverIt’s come to our attention that, in honor of Nurses Week, the American Antiquarian Society blog, PastIsPresent.org, put together an interesting collection of items related to nursing from its mid-19th century archives, leading their post with a mention of AJN‘s March cover, which featured a vintage illustration, “A Map of the Open Country of  Woman’s Heart.”

A recent post we ran about the fading away of certain nursing blogs gets a mention from PixelRN, who has written a post called “Why I Stopped Blogging.” Short answer, for her: she stopped working in nursing, and “life got difficult.” Understood. As always, we hope new voices will pick up where the early nurse blogging pioneers have left off.

At the INQRI blog, there’s a post about recent nurse-related research, including the finding that nurse home visits decrease postpartum depression. Yes, in a way this is obvious, in that we are well aware that a little attention from nurses could, in many instances, go a long way toward preventing more serious problems down the line. But it’s good to let it be known far and wide in this age of sequestration cuts and lean staffing.

And in the May issue of AJN, Joy Jacobson gives an in-depth look at the important and timely subject of end-of-life care, paying special attention to recent research, whether or not we are improving the quality of the dying experience or still focusing too much on aggressive treatment, and the important role played by nurses at this crucial time when families and patients need a truly understanding presence at the bedside: “Palliative and End-of-Life Care: Where Are We Now?”

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Winding Down Nurses Week 2013

May 10, 2013

By Shawn Kennedy, AJN editor-in-chief

We’d be remiss not to mention Florence Nightingale during Nurses Week, especially since her birthday marks the end of the celebration. (She was born on May 12, 1820.) I often wonder what this visionary would be like if she were a nurse today—my bet is she would be a PhD and FAAN, and conducting multinational outcomes research related to nursing-sensitive indicators with grants from the Royal College of Nursing and the AARP/Robert Wood Johnson Foundation’s Campaign for Nursing!

Nightingale never wrote for AJN, but there are some 200 stories and mentions of her in our archives. We thought we’d mark the close of Nurses Week with a comment from AJN’s founding editor, Sophia Palmer, on the occasion of Nightingale’s death in 1910. Here’s an excerpt, or read the original piece in our archives (free until next week on AJN‘s Web site).

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Telling Patients About Staffing Levels: Transparency or Self-Interest?

May 9, 2013

ethicsscreenshotIt’s a very busy Monday. Because of chronic difficulty in recruiting staff, the unit has only three-fourths of its RN positions filled. In addition, Mary Evans, an experienced nurse who always helps less experienced staff with their patients while carrying a full caseload herself, has called in sick.

Linda Smith is 68 years old and two days post-op from hip replacement surgery. As you enter her room, 45 minutes after she first requested pain medication, you can sense her irritation—but worse than that, you can see from the grimace on her face and her guarded movements that she’s in pain. After several days of good nursing care, you’ve let her down, and you consider telling her about the staff shortage. But you wonder: Is it right to disclose today’s short staffing to Ms. Smith?

The situation above is an ethical conundrum because values are in conflict. On one hand, transparency is good and patients have a right to know about administrative factors affecting their care. On the other hand, care should stay focused on a patient’s problems, not the nurse’s.

As the article excerpt above suggests, nurse staffing is a contentious issue having to do with both patient safety and job satisfaction for nurses. We’ve covered this issue many times in the past, most recently in a blog post that got quite a few comments back in January.

But should a nurse ever tell a patient about inadequate staffing? This is the ethical quandary posed by nurse ethicist Doug Olsen in his latest article, in the May issue of AJN (free until the first week of June). Having posed the situation described above, he goes on to pinpoint the ethical principles that come into play when making such a decision, explore the pros and cons of disclosing certain information to patients in various related situations, and emphasize both the need for awareness of the patient’s perspective and the necessity for nurses of engaging in honest self-examination.

As with many such situations, there’s not always a right answer; every situation is different, and gray areas do exist. What’s your take?—Jacob Molyneux, senior editor

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