nurse

COVID19 and Nurses’ Concerns

/ Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 1 Comment

Nurses are the backbone of all of the health care professions: we care for people and communities in difficult situations. We are compassionate and ethical. We put ourselves at risk daily for everything from violence from patients and families to contacting contagious diseases to post-traumatic stress from what we witness.

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Here is some of what I have read about on the social media COVID19 for nurses and healthcare providers pages that are popping up faster than dandelions.

  1. There is poor planning by, and a lack of communication from, most hospital systems, likely in part impacted by the lack of leadership at the state level. A national survey of nurses by National Nurses United found “high percentages of hospitals do not have plans, isolation procedures, and policies in place for COVID-19; that communication to staff by employers is poor or nonexistent; that hospitals are lacking sufficient stocks of personal protective equipment (PPE) or are not making current stocks available to staff; and have not provided training and practice to staff on how to use PPE properly”. https://www.nationalnursesunited.org/press/survey-nations-frontline-registered-nurses-shows-hospitals-unprepared-covid-19
  2. Personal Protective Equipment is now rationed. In inpatient settings, some nurses are asked to use just one mask/ day. An article in the New YorkTimes details how nurses are begging for PPE: https://www.nytimes.com/2020/03/05/us/coronavirus-nurses.html 
  • In the home care settings, nurses are asked or told to use one mask and one gown/ day. Obviously, this means they can’t maintain or implement proper precautions when traveling from house to house, the gown itself potentially becomes a contaminant.
  • In the home care setting, patients are canceling appointments because they view the nurses as vectors. In the long run, this could have huge implications for greater levels of care needed by these patients if they decline without proper care and guidance.

2. Most facilities do not have plans in place for the forthcoming surge in COVID19 patients.

3. The Centers for Disease Control rolled back the N-95 mask requirement and has stated that a simple surgical mask is sufficient in caring for COVID19 suspected or confirmed patients, and that may be used for extended periods while caring for multiple patients. They also have decided that reusable gowns are fine to use. https://www.fda.gov/medical-devices/letters-health-care-providers/surgical-mask-and-gown-conservation-strategies-letter-healthcare-providers

4.  Fears of getting sick themselves are rampant amongst nurses and other providers. Pregnant nurses have no idea if a COVID19 infection might affect their pregnancy. Those nurses with existing health conditions who are at risk are not sure if they should come into work, or reveal their health conditions to the workplace, or risk losing their jobs. Additionally, nurses who come home to care for elderly relatives, children, etc. are petrified of making them sick.

5. Nurses are not offered COVID19 testing, and if they have symptoms, they are often being told to use vacation, paid time off, or leave without pay, and to self-quarantine and contact the workplace in 14 days.  Those who are at risk are not identified quickly. https://www.theverge.com/2020/3/5/21166088/coronavirus-covid-19-protection-doctors-nurses-health-workers-risk

6.  Nurses may be mandated to work overtime, which can wreak havoc on stress levels and immune responses. https://www.fda.gov/medical-devices/letters-health-care-providers/surgical-mask-and-gown-conservation-strategies-letter-healthcare-providers

The CDC and NIOSH recognized years ago that working 12-hour shifts alone may be dangerous, with deteriorating performance on psychophysiological tests and an increase in risk for injuries. Poor outcomes and personal capabilities worsen with 12-hour shifts worked particularly in combination with working more than 40 hours. Working overtime obviously leads to physical fatigue, and it also increases risks for alcohol use and cigarette smoking. And there is still a lot we don’t know, such as how does working longer impact women or older workers? What about those with pre-existing or chronic conditions? What is the influence of occupational exposure?

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What can we do, and what are nurses doing?

Now is the time: we are going to have to advocate for ourselves. We also need to demand proper access to PPE, PPE training, proper testing approaches, and call for OSHA standards related to the risks we face.

We can all act as advocates locally to call for safe working conditions, and we can join forces with our national nursing organizations to continue to call for support, funding, and access to proper PPE.

Feel free to share your ideas here.

 

The Light and The Dark of Nursing: Our Shadow, Part I

/ Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 2 Comments

I love nursing and I love being a nurse. That is what makes this post so challenging to write, admitting that the profession where my heart sings, where I have grown and evolved over the last twenty years, has a dark side. But if we take the advice of Jung, we come to realize, perhaps, that the shadow, the dark parts that we may try to hide or deny, needs to be acknowledged and integrated. We can learn to be loving and kind toward that which was previously denied or rejected. By shining a light on the dark places, we can invite those hidden areas to come out fully, to open up to our secrets and our darkness. While we usually think of shadow work as an individual challenge, the profession of nursing could grow and evolve from examining our shadow, from shining a light upon our darker sides.

The Shadow: Nursing in the Media

I recently read the book “The Good Nurse”by Charles Graeber. I remember listening to NPR and hearing about the book when it was released and being very upset that a book about a nurse serial killer was given such a title. To listen to what I heard on the radio in April 2013, visit this link:

The Good Nurse, NPR

It took me a year to work up to the challenge of reading the book, as I was so upset about the title alone, let alone the interview. Who was this outside journalist who came to investigate these horrendous acts, surely he did not understand nursing if he named the book in this manner. My own anger at the title of the book and the horrific situation should have been clue to me right there that I had something to face here, at least according to shadow theory. Still, I thought a book called the Good Nurse should be all about the good nursing does, not about this outlier who murdered perhaps dozens of patients. Why not call this book, “The Worst Nurse EVER”? or “The Abhorrent Nurse?”

What I didn’t realize at the time was that this book has an important message to deliver, an important message not just about Charlie Cullen, the RN who killed many, many patients, but about the whole healthcare system, about the dark side of medicine for money and the need to protect hospitals’ revenue stream dominating over the need for patient safety.  I finally purchased the book and settled into reading it over spring break 2014. About half way through reading the book, I contacted the author, Charles Graeber through email and began a dialogue about the book and his choice of the title. And I was surprised to find that Graeber was beyond generous in his responses to me, helping me to shine the light, expanding it further into this dark tale.

The story is about flaws in our reporting systems, about flaws in how nurses respond, report, react to concerns for patient safety, and about flaws in quality assurance. The book is about a call for justice, for action to be taken against the healthcare systems and the specific individuals who perpetuated Cullen’s killing spree by failing to act. There is no statute of limitations with murder charges, and healthcare administrators who knowingly supported the continuing practice of a murdering nurse may perhaps be found liable on some level for the many murders that occurred after knowledge of, or even suspicions of. multiple murders were not adequately addressed. You can read my full review of the book here:

http://www.amazon.com/review/R38G2SH63CBCVG/ref=cm_cr_pr_perm?ie=UTF8&ASIN=B004QX078C

Although we can clearly see Cullen carried a deep shadow with him into nursing, that he suffered from some sort of mental illness to have had these deep killing compulsions, that he was a manipulator or sorts who could put up a front as a hard working hero nurse, we have the obligation to also see what worked in the system, and identify the shadows that need to be addressed.

What worked, where was the light? The hero-nurse who helped to indict Cullen, the investigators who did not give up or turn a blind eye, and the penal system were the lights in this issue.This book itself also becomes a beacon to shed some light on the issue.

What did the light reveal about this looming shadow in nursing, what can we learn from this media portrayal of a nurse carrying a gigantic shadow? Perhaps we can consider if academia may have some issues with screening students; that some nurses may consider a nurse who works a lot/takes the hard patients/ and makes the coffee to be a “good” nurse; that QA/QI/surveillance issues around safety as related to nursing practice and competence is apparent; that nurses may have not been empowered to take action when their suspicions arose; and that systems failed in protecting patients through monitoring and reporting.

By increasing our awareness of shadow, dark side incidents such as this obvious one, we can begin to create change and perhaps prevent future devastation. While this is an extreme example of a shadow in our beloved profession, the next entry or Part II will examine some less extreme shadow issues and Part III will focus on actions we can all take to shine the light into darkness and further support our autonomy and evolution as a caring- healing profession.

 

Some history on the origin of the word “nurse”

/ Jane K. Dickinson / 5 Comments

Thomas Lawrence Long, from the University of Connecticut, has graciously provided a guest blog post on the etymology of “nurse.” I happened to see something Tom posted about Shakespeare and “nurse” and thought this would be an interesting topic to discuss here.

Because historians of health and health care are sometimes preoccupied with the slipperiness of the signifier nurse (see Monica Green’s (2000) caution concerning the term in reference to medieval and early-modern studies), a brief historical lexicography might illuminate the meanings that the word has accrued, absorbed, and may, to some extent, still carry. Here is examined the historical traces of a noun-substantive, from wet-nurse, to caretaker of children, caretaker of the sick, asexual hive bee, and health professional, in which the traces of ideologies of gender identity and gendered work appear to be retained.

The first instance in English of nurse occurred in the early thirteenth century as the Anglo-Norman nurice, derived from the fifth-century post-Classical Latin nutrice, a wet-nurse (hired to provide an infant with breast milk when the infant’s mother would not or could not do so), although by the time it entered the Middle English lexicon, it had already absorbed the figurative sense of any female caretaker of children (Oxford English Dictionary 2010). Etymologically it is related to our modern word nourish, to feed.

Already by the late fourteenth century nurse had also taken on the figurative sense of any thing or any place that nurtures or fosters a quality or condition, and by the early fifteenth century, any person who takes care of, looks after, educates or advises someone.

The earliest attested use of nurse in a strictly medical sense appears in Shakespeare’s Comedy of Errors (ca 1616): “I will attend my husband, be his nurse, Diet his sicknesse, for it is my Office” (V.i.99). The wife as nurse (and the advantage of marriage as engaging a live-in nurse) is also apparent in the Duchess of Newcastle’s Matrimonial Trouble (1662), which contends, “That he might do [sc. marry], if it were for no other reason, but for a Nurse to tend him, if he should chance to be sick.”

Another curious figurative usage is attested to in the early nineteenth century: nurse as an entomological term, explained by the OED as “A sexually imperfect member of a community of bees, ants, etc., which cares for the larvae; a worker,” citing Kirby and Spence’s Introduction to Entomology (2nd edition): “The workers, termed by Huber nourrices, or petites abeilles (nurses), upon whom the principal labours of the hive devolve.” The Huber in question was the Swiss naturalist François Huber (1750-1831) whose Nouvelles Observations sur les Abeilles was published at Geneva in 1792 and translated into English in 1806. Perhaps by association the later zoological term nurse shortly came to characterize any asexual invertebrate, a spineless sexless creature.

The semantic process whereby the word nurse begins by denoting a woman hired to provide surrogate breast milk and comes to denote a sexless worker insect may be related to the religious associations of woman as healer and caretaker of the sick, particularly the ubiquitous presence of European women’s religious orders comprised of celibates (and thus, in the medieval view, sexless) devoted to the wellbeing of others.

Reference

Green, Monica H. (2000). Documenting medieval women’s medical practice. Women’s healthcare in the medieval West. Aldershot, UK: Ashgate Variorum, pp. II, 322-352.

When you think of the word “nurse,” what comes to mind for you?

Welcome, nurses!

/ Jane K. Dickinson / 2 Comments

Hello readers/bloggers!

I wanted to say hi and introduce myself. I’m a nurse and diabetes educator. I wrote a post on our old blog about feeling disconnected from nursing at times. A specialty like diabetes education can do that to you, because it’s a multi-disciplinary specialty (dietitians, social workers, pharmacists, exercise physiologists, PTs, MDs can all be diabetes educators). I am in full support of a multi-disciplinary approach, especially when it comes to diabetes education and management. However, it makes me feel isolated from my nurse colleagues. Not to mention that I’ve been a department of one for the last twelve years! My hope is that this blog will be an opportunity to stay connected to nurses. We can share our thoughts, passions, ideas and more.

Thanks for joining us!