That slippery slope (pt 1)

[Carlybug]

The Slippery Slope of Perception

The definition of perception is that which is detected by the five senses; not necessarily understood (imagine looking through fog, trying to understand if you see a small dog or a cat); also that which is detected within consciousness as a thought, intuition, deduction, etc.

The definition of opinion is a thought that a person has formed about a topic or issue.

As a recent transplant to east Texas I have found myself often bewildered and perturbed by these two words. As a nurse who has been recently transplanted to east Texas I have found myself offended and outraged at times by these two words. Not the words themselves mind you but rather in how the people around me twist and corrupt them. That’s right I said twist and corrupt them.

I must confess that, not being a native, I realize that when in Rome you do as the Romans do. I’m doing my level best to adapt but it hasn’t been easy. Let me give you a little more information about the situation so that you can adequately perceive what I’m struggling with.

I’m a nurse. I love being a nurse. In order for you to comprehend the depth of what I feel let me try shed a little light on the subject.

As a nurse I am witness to some of the more horrific sides of life. I see death often. I see pain daily. I see some of the most disgusting aspects of humanity hourly. I’m the person who is elbow deep in feces or other human excrement and never bats an eye. I’m that person that wipes your hinny when you can’t do it for yourself. I’m the person who empties your urine from a bag because your body has momentarily failed you. I’m the person who wipes your brow because you’re drenched in sweat from excruciating pain. I’m that person on the phone with your doctor attempting to get you an increase in your pain medication because I can see that it isn’t adequately relieving you. I’m that person that is forced to walk the fine line between compassion and advocacy when your brother, mother, father, sister, daughter, son doesn’t understand why you’re suffering and inadvertently causes your blood pressure to spike to a dangerous level because they can’t contain their own anxiety level. I’m that person that brushes your tongue and sucks out saliva and mucous from your mouth so that you don’t choke or get a hairy tongue because you can’t swallow anymore. I’m that person that puts an arm around your spouse when I have to tell her that there just isn’t anything else we can do for you. I’m that person who cares about you. You aren’t just a room number or a disease to me. I’m that person that makes sure that no matter what is going on around me you retain your dignity. I see You as my mother, father, sister, brother, daughter, son and I take care of you. I am a nurse.

[Carlybug]

part 2

Now that I’ve explained what I am let me share another insight. Let me tell you how a nurse comes to be. You aren’t made a nurse. You’re born one. Sounds trite but it is the absolute truth. No average human being could withstand the heartbreak and stress that comes hand in hand with nursing. To be a good nurse you have to love what you do. To love what you do you have to love humanity. There is no other option. Tell me, honestly, could you come in day after day for 12 or more hours a pop and take care of a person you know to the depths of your soul won’t live through this experience? Could you put your heart on the line time and time again? Because not getting attached to a person you’re sharing an intimate experience with isn’t an option. You cannot be a good nurse and not come to care about the person you’re experiencing life and death with. And death is the least of it mind you. More often than not death is a blessing for most of the people I care for. The 19 year old that wakes up to see your face above him or her only to realize that they can’t feel their legs or arms. Yes, that’s you standing there with tears in your eyes as you see them realizing their lives have been altered irrevocably forever. And you can’t fix it. You can’t make it better. You can only be there as they learn to decipher this new life. You bridge the gap between the child and the mother who doesn’t know if she can cope with what’s happened to her son or daughter. To lost in her own heartache to put the needs of that child first. That’s you gently reminding her that this is still her child, that he or she is still a person, and that life is not over even though it’s changed forever. That it’s now harder and will be harder for a very…very….very long time. And I’m not even going to slide into an explanation about the patients you care for who have been abused. You get the picture, I hope.

The picture is that nurses don’t nurse for the money people. There isn’t enough money in the world to take on what we chose to take on every day. And quite frankly the base starting rate for a nurse in east Texas is $22.00 an hour. Really now, do you honestly think $22.00 an hour is worth the tiny pieces of your soul that are shredded away every time you clock in? Of course it’s not. And in conjunction with the rate of pay the benefits are just as poor. No. A nurse doesn’t work for the money.

So here in lies my confusion. I know the economy is pretty rocky right now for everyone. The number of jobless individuals is on the rise and it’s exponential to the lack of health care coverage. More and more people come in through emergency rooms every day that have no way to pay for the care they receive. I’m aware of that fact. I hope that you all are aware that a nurse has no idea who is a paying client and who is not. Everyone receives the same level of care. Are you beginning to become as confused as I am? No? Let me explain a little bit more then.

The facility that I work for has presented some very unusual standpoints to me. Or at least this is my perception of the situation. I am often reminded daily that this (the hospital) is a business. That money is becoming the bottom dollar. That my job depends on this facility making money. Well…okay. If you say so. That’s usually the first thought that crosses my mind as I honestly try to wrap my brain around what I’m hearing. Honest to pete people I swear to you I don’t remember one single finance class as a prerequisite for my nursing degree. Call me crazy but I don’t believe I took economics. Hey I’m being honest here. I’m a nurse. Not a financial consultant. I couldn’t care less who is paying

[Carlybug]

part 3

and who isn’t. I want to take care of my patient. I want them clean and dry and comfortable on fresh linens. I want them as pain free as medicine can allow. I want them fed and feeling safe in the knowledge that I will see to their every need. I don’t want to look in the supply closet and ****er over whether I should use this bandage or that bandage because one costs more than the other. Are you beginning to feel my frustration? I’m an orange trying to be presented as an apple. It just doesn’t fit.

Look, I completely understand that cost is a factor. I completely understand that in order for the facility to exist there has to be some profit in hand because it’s a necessity. I get that. But it’s not my main concern. I’m the nurse. Not the accountant. You want to switch the supplies to whatever is more economically sound I can work with that. Just don’t expect me to make that my priority. You order what you want and I’ll use it. I’m agreeable. But I can’t help but wonder if these financial officers and accountants are aware that the staff around here often brings in supplies like soap, shampoo, lotion, deodorant, tooth paste, cornstarch for rashes and other little niceties for our patients. That we’re buying these items with our own money so that our patients can feel…cared for. That none of our patients are aware that the hospital isn’t providing these items. We are. Oh don’t get me wrong they give us soap. But there isn’t always toothpaste available. Or deodorant. Or a toothbrush for that matter. I’m sure there down in central supply somewhere but they’re not on always on the floor available to us. Don’t even get me started on oral sponges. We’re nurses. We just want our people taken care of.

Is your brain starting to bobble? Let me toss another ringer at you. Recently I was asked by someone in upper management why I thought our Press Gainey Scores were so low. What’s a Press Gainey Score you ask? Oh by all means let me explain it to you (as I understand it). Press Gainey is a company that mails out a survey to a patient after they’ve been discharged from a facility to get their input on how they thought there stay with us went. It’s basically a score card. And here lately it’s how the staff is being judged. Fair enough we’d like to know what our patients think and feel in all honesty. But there’s a slight problem with this system. It’s not working so well. Why is that? Well let’s see…keeping in mind that at a guess I’d say at least 40% of our patients are from nursing homes and are incapable of responding to the survey due to many reasons (do they even get it? Are they able to answer or were they an Alzheimer’s patient who has lost the ability to read and write?). Then let’s estimate on the side of caution and say another 20% answer but forget to mail it back, another 20% throw them directly in the garbage can because they’re to busy to answer or don’t care (hey I toss my junk mail too), and then there’s the 20% who do answer. Let me say to that last 20% that respond thank you. Sincerely. Unfortunately it’s usually the 20% who didn’t have all that great an experience. You were in that group that we were rather short staffed for. That day or night that we were just trying to keep everybody alive and well and yes, we probably did forget to fill your water pitcher even though you asked. Look I’m being honest here. In addition to all the other aspects of nursing we deal constantly with being improperly staffed. That’s the truth. Our facility staffs by numbers and not by acuity. What’s that you ask? Oh boy.

[Carlybug]

part 4

Numbers means the number of people actually admitted to the hospital. Acuity means how sick/how much time a patient on an individual basis requires. In other words a patient who is a quadriplegic and can’t even scratch their own noses would obviously require more help than the patient who can get themselves to and from the bathroom with no assistance. The best way to staff is by Acuity. The least expensive way to staff is by numbers. See I am learning a little bit of accounting. So in staffing by numbers you get a poor nurse who has 7 patients to her one self (with or without an aide). Out of those 7 patients she might have 3 who are total care patients (people that require constant hands on care) and 4 who are sick and in need of help but can turn themselves over in the bed and pick up their own water cup but still need medicating frequently for pain, dressing changes, assistance to the bathroom, etc. And all 7 need a bath and fresh linens, their regular medications, vital signs taken frequently, breakfast, lunch, and dinner (you have to feed your total care patients by hand) and general assistance. And you have to do it in 12 hours. Still think that $22.00 an hour is enough? Still think we’re in it for the money?

So finally after this brief explanation I’m going to address my original topic. Perception and Opinion. Not only do you have to be a nurse and an accountant you have to be a good customer service rep. You no longer get the option of just being a great nurse for your patient. Nope. You also have to make sure that every member of your patient’s family is completely satisfied. I bet you’re thinking that’s fair aren’t you. Let me give you a nurse’s perspective on the matter. Sometimes, just sometimes mind you, being a good patient advocate and being a good customer service representative do not coincide. What? You’re confused? Okay, I’ll give you a “hypothetical situation”. Sometimes, while well meaning, families interfere with what’s best for a patient. Like the family who insists on picking up the endotrachial tube that’s in their mother’s mouth and wiggling it (while it’s attached to the ventilator) and complaining that it’s “loose” not realizing that what they’re doing is moving the inflated balloon that’s lodged down next to the airway. The inflated balloon that holds the only thing that’s giving their mother life breathing air in place. Like the family who proceeds to get into a loud and vicious argument at your patients bedside. Like the family who sneaks your patient water when he or she is scheduled for surgery in the morning and doesn’t understand why that mean nurse won’t let mom or dad drink when they’re so thirsty! Like the family that insists on bringing small children into a place that’s filled with germs and exposing this poor child to contagious diseases because that child misses her grandmother. I could go on and on. See as a nurse you don’t expect your family members to understand why they shouldn’t touch that tube in their mother’s throat, why mom or dad can’t have any water, why they shouldn’t bring in a child, why they can’t conduct business as usual in mom’s room. You know that as a nurse, as a patient advocate, it’s your job to instruct them in how these are not appropriate behaviors.

The problem with having to tell a family member that “You need to stop what you’re doing because…” is that they often don’t hear the because portion. They get stuck on the stop. And then they run to management and complain about that mean nurse. You’re okay with that. Truly. You don’t like it, but you’re okay with it. See you know as a nurse your first duty is to your patient. It’s your duty to see that your patient is well taken care of. It’s your job to do what’s necessary to ensure that he or she recovers to the best of his

[Carlybug]

part 5

or her ability. But because those family members “perceived” you as being mean, rude, curt, bossy, etc you get the proverbial lowering of the boom by management. Yup. You get instructed by a manager (who was instructed by a director, who was instructed ultimately by a financial officer) that you need to be more aware of how people perceive you and be more accommodating to family members because “repeat business is often by word of mouth”.

As a nurse I have a big problem with that. It totally infuriates me. Why you ask? To put it succulently I’m not your mother, father, brother, sister, son or daughter’s nurse. I’m your nurse. You’re my priority. And while as a human being you have compassion for the anxiety that your patient’s kin feel because he or she is sick ultimately you (the patient) are my first priority. And sometimes a nurse has to step up and say stop.

You tell me how in the world a nurse can wear so many hats and still be a good nurse? Please we’re dying for an explanation. Truly.

You're an accountant, a customer service rep, a valet, a maid, a masseuse, a cook, a sounding board, a mediator, a bridge, and….a nurse.

What you is, is tired and bewildered. Where is the support? Where is the manager who explains to that family why they had to stop? Where is the director who looks at the situation as a whole and says “Hey, that nurse was taking care of his or her patient?”

You wonder if people in general have any idea how insulting it is to hear “The patient had nothing but wonderful things to say about the care they received with you. The patient had no complaints at all about your nursing skills and we can all see how attentive you are to your patients, how you pamper and spoil them. But the patient’s daughter felt that you were unkind to her because you wouldn’t let her spend the night in ICU with her mother (who is on a ventilator and a full code).” Hmmm…let’s see…ventilator, unstable, full code…is it possible you might have to defibrillate this woman to keep her alive? Well yes of course. You guess you could just leap frog over the daughter while she’s panicking and shaking mom because we can all see and hear the alarms and the bells and whistles sounding off because mom’s heart just stopped beating. Because, hey, good as you are, you just can’t do chest compressions from outside the door. Simply. Mind boggling. Hello. ICU. Glass walls. Other patients. No privacy. Truly Sick people.

You try. Honest to God you try to understand. What you hear is that you’re a good nurse by all rights. Your patients loved you and felt truly taken care of…But!! But the patient’s daughter didn’t like you having to tell her no. And your manager reprimands you for enforcing a valid rule for the department and tacks on that “You need to be more compassionate to family members.” Lord love a duck.

Perception is a slippery slope people. It’s an awful lot like opinion. But we’re learning. Let me share with you and maybe you can learn too and avoid the awful bout with frustration that I’ve endured.

[Carlybug]

the end

Here in east Texas it doesn’t matter if the person who’s complaining has the perception of a rock. It matters more than you being a good nurse.
Here in east Texas you do not put your patient first if it will cause any disagreement with that patient’s family whatsoever. No matter what! Because the bottom line is money. And we can’t make money if you anger that family member and they decide they don’t want to come to us for treatment. If you do your job well at the expense of angering anyone then you need to do your job less well. Because perception is everything here in east Texas. And god forbid you cost us business we’ll put a black mark on your impeccable work record.

Hey that’s a nurse’s perception.

So nurses beware. Think long and hard before you consider taking a job in this area. Research those facility’s thoroughly before you commit yourself. You just might end up in a position of forced compromise. There is, after all, a valid reason for the large amount of turnover in the nursing industry for this area. Perception is everything.

And yet you can’t help but wonder, as a nurse, how these hospitals could possibly run without you. Economically speaking it might be possible…but legally? Could a hospital really exist without its nurses? And do they ever consider that in their bottom line?

[hppygr8ful]

Quite a bit to get off your chest - I know how overwhelming dealing with families ( I was an acute in-patient psych nurse for 4 years) is but as nurses we are taught that the families are also our patients. We need to be sensitive to the needs of families - I know when my father was dying some nurses were just down right mean as they went very competantly about their job. I know only too well how stressed they were (been there done that ) but a smile goes a long way where loved ones are concerned.

Peace and Namaste

Hppy

[Kdog]

Alot of nurses have felt this way.
I would recommenend to look for another JOB if you are overwhelmed and bothered to to THIS POINT...

[Ricu]

Hi Carly,

I really think I know where you are. Actually, every once in awhile, I still find myself there. The room gets kind of crowded sometimes because there are a lot of us out there.

You sound like a empathic person who has had a lot of very intense patient situations. You absorb all of the emotional energy around you; the patient, family, visitors, coworkers and so on. This makes you an excellent nurse but it costs you. The spiritual and emotional drain ebbs and flows, sometimes it's very intense and other times not, but it IS always there. When the fatigue level gets up there, those oddities about behavior and circumstances that surround every patient regardless of geography really start to challenge the ability to care for everyone around you. I'm sure you would have it no other way at the bedside but we know well that nursing is more than bedside care.

With your tank nearly empty, you have to deal with cranky coworkers, indifferent management, supply inventory and charging issues, ever-present memos and notices, financial updates, satisfaction surveys, and so on. I'm sure you knew going in that this was all part of the job but never figured it could get this bad. We start thinking about specific causes and the tendency is to link the problems to the worksite so, we move to a new location, specialty, shift or all of the above. It's good to change things up every once in awhile but eventually we realize that it is the nature of the profession. Okay, but how do we deal with that? We deal with it by doing just what you did. When the furry little pest finally becomes a big hairy monster, go to a safe place and off load. Everyone has a safety valve and healthy people know when their's is ready to blow. It can be a cumulative thing or a single event. Whatever it is that sets you off, deal with it ASAP. Doing so will really keep things running well in not just your professional life but your personal life too.

This website is an excellent safe place that is open 24/7. Try the chatroom for realtime interaction. Develop a close relationship with another healthcare worker- doesn't have to be a nurse, either. This is important because as you indicated, it has to be someone who is able to handle the things you will say. Finally, think about putting together a book. You have a gift for writing.

In closing, I really like your "Slippery Slope" analogy. It truly is the perfect description of what everyone in the healthcare setting is on.

Thanks again, for being a great nurse,

R

BTW, you may find that you really like East Texas.

[Carlybug]

Thank you Ricu. You seem to have gotten my point completely. It isn't that I'm overwhelmed or in need of a new job. I've been a nurse for quite some time. It's that I was aggrivated and needing to blow off steam in an appropriate manner that would not negate my commitment to my nursing licensure.

This being the "Rubber Room - for crying, whining, bickering, shouting, etc".

I am not looking for affirmation, agreement or criticism. As you can see I did not bother to respond to any of the other posts. I did not find them constructive or helpful (as a matter of fact that first reply makes me think said person is in management ). Yours, however, I deemed worthy of a response.

I am a good nurse. An excellent nurse for that matter. With an abundance of compassion and impecable work habits. I do not toot my own horn however and I will not begin to do so here. I was extremely frustrated (an accumulation of six months worth) when I sat down and wrote up that diatribe. And you're right I felt much better by simply getting it off my chest. So I thank ultimate nurse . com for allowing me an avenue of expression that did not interfere with my integrity as a nurse.