Off the Charts

After the Angels: In Search of A ‘Knowledge-Based’ Professional Identity

If you’re looking for angels, you’ve come to the wrong place. So says GuitarGirlRN in her latest blog post.

One stereotype of nursing (and it’s perpetuated by nurses as well as by those not in the medical or nursing fields) that bothers me is that of nurses as “angels of mercy.”

We’re expected to smile while up to our elbows in bloody shit and vomit, be pleasant to rude and sometimes violent people, put up with crap from doctors, managers, patients, their families, nurse techs, and janitors yet keep our cool, never cry, never sweat, never lose our tempers with each other, always be prepared and be right there when we are needed.

Her point is that nurses are human; they do the best they can with scant resources, but they aren’t superhuman. They aren’t saints, they have lives of their own, and they can’t always be all things to all people. Back in 2005, noted author Suzanne Gordon wrote, with Sioban Nelson, an article for us called “An End to Angels.” In it, they presented the idea that nursing is a profession with a serious image problem, one that undercuts recruitment efforts and ill prepares new nurses for the reality of their work. The arguments in the article are subtle and thought provoking, and impossible to summarize. Here, anyway, is the introduction:

Nurses often disagree on the causes of and possible solutions to the current nursing shortage. Mandatory staffing ratios versus Magnet hospitals? Sign-on bonuses […]

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Jacob Molyneux, senior editor/blog editor2016-11-21T13:15:44-05:00September 14th, 2010|career, nursing perspective|4 Comments

Maybe Palliative Care SHOULD Go to the Dogs

By Shawn Kennedy, MA, RN, AJN interim editor-in-chief

Last week, we took Sam, our ailing 14-year-old Labrador Retriever, on what became his last trip to the vet. Sam had been diagnosed with bone cancer in February after we noticed the right half of his head enlarging. Because of where the tumor was, it was inoperable. We felt that at his age chemotherapy wasn’t a realistic option, and we didn’t want the last few months of his life to be bad ones.

His veterinarian, who’d treated Sam since his puppy days, supported the decision, saying she would make the same choice for her dog. And so we spent the last few months adjusting doses of steroids and pain meds to enable him to live as normally as possible. For Sam, “normal” was being able to greet all comers to our door, to be the leader on his walks, to be smack in the middle of where his family was. (If people were in the basement and on the second floor, he would lie equidistant from where everyone in the house was. If we were in the same room, he sat, front legs crossed in his “elegant dog” pose, where he could see us all.)

So last month, when we saw that he would no longer get up to greet visitors or his family; was reluctant to go on walks (he did, but with a great sigh and lots of panting after even the shortest […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:15:45-05:00September 13th, 2010|Nursing|6 Comments

Tubes Don’t Kill Patients, Errors Do

By Peggy McDaniel, BSN, RN. Peggy is an infusion practice manager and an occasional contributor to this blog.

by Lars Plougmann/via Flickr

The headline for a recent article in the New York Times caught my attention: U.S. Inaction Lets Look-Alike Tubes Kill Patients. For me, this conjured up pictures of giant tubes with teeth, wrapping around weak patients in their hospital beds and squeezing them. Although I knew exactly what the article was going to discuss, it bothered me that the tubes were given the reputation of being “killers.” Can tubes kill? I think not. Can they contribute to errors? Certainly.

The article explains that numerous patients have been harmed and some have died because clinicians have connected tubing that should not have been connected. These errors run the gamut from enteral feedings being given intravenously and blood pressure inflation devices being attached to IV lines, to administration of intravenous medications into epidural lines.

However, it remains the clinician’s responsibility to provide safe care. […]

Guest Author2018-03-13T10:51:09-04:00September 10th, 2010|nursing perspective|4 Comments

With Inadequate Staffing, ‘Nonessential’ Care Goes First–Then Patient Safety

A coworker of mine made a medication error a few weeks ago. It was a multifactorial error—the medication had been ordered wrong, labeled wrong, and administered wrong—and was investigated accordingly. That particular nurse was also “tripled,” with two ICU trauma patients and one critically ill medical resident patient. The nurse’s workload wasn’t factored into the documentation or investigation of the error, though, since the nurse manager didn’t consider it relevant. I heard her say, “An extra patient shouldn’t make any difference in the standard procedure for passing medications.”

Guest Author2016-11-21T13:15:51-05:00September 8th, 2010|Ethics, nursing perspective, nursing research, safe staffing|7 Comments

An Evidence-Based Look at the ‘Unvoiced Symptom’: Fecal Incontinence

First, a confession: initially the subject of this month’s CE, fecal incontinence, seemed so daunting that we considered lighter titles (“Don’t Pooh-Pooh Fecal Incontinence,” for one). But we decided against going that route, because we didn’t want to minimize the condition’s importance or its life-altering effects. Indeed, fecal incontinence has been called the “unvoiced symptom,” one so embarrassing that sufferers often fail to tell their health care providers about it—and one that many providers never ask about.

Fecal incontinence has been defined as the “involuntary loss of liquid or solid stool that is a social or hygienic problem.” As authors Donna Zimmaro Bliss and Christine Norton report, possible causes include cognitive or physical disability, impaired sensory or motor function, poor coordination of defecation processes, and loose stool consistency; in some cases the cause may be multifactorial or idiopathic. Although studies of nursing home residents have found prevalence rates of more than 40%, the condition is by no means limited to elderly or disabled people.

Quality-of-life issues. Bliss and Norton provide an overview of fecal incontinence and describe what the research thus far has revealed about its impact on patients’ quality of life. […]

Guest Author2016-11-21T13:15:53-05:00September 7th, 2010|Nursing|0 Comments