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What did we learn from Alex Wubbels?

September 4th, 2017 No comments

If you are a nurse and you are paying attention, you have seen the video of Alex Wubbels RN, super nurse hero, getting assaulted and handcuffed by a bully cop.  Now I don’t hate cops.  In fact I have loved a number of them in my lifetime.  I had a favorite uncle who was a cop.  I had cops help me when I worked as an ER nurse.  Cops have stopped at traffic accidents that I have stopped at and helped tremendously.  Cops do dangerous and difficult work on a daily basis, but it does not put them on a pedestal.   They are not allowed to make up the law as they go along and they cannot harass and assault innocent citizens “just because”.  The cop in this video was a bully and a jerk.   If he had half the professionalism that Alex Wubbels had, this would not have happened.

What have we learned from what happened to Alex?

1. Nurses MUST know their hospital policy about patient’s rights to safety and privacy.  Without that, you don’t have a leg to stand on.  You can’t just say NO because something doesn’t feel right.   Patients, when you are alert and able, you should also know your rights.

2. If you are being assaulted by ANYONE, yell and scream and object loudly.   Not that this did Alex any good at all. I think her coworkers and the hospital security in this video were dumbfounded and maybe did not dare to step in.  I’m giving them a lot of credit here, because I think they should have stood around their coworker while someone called administration AND the police chief.  Of course I wasn’t’ there, and I am just a distant observer.   I have to ask…would that cop have done this to a man?  (makes the cop even more of a jerk in my eyes)

3. Keep saying  “I have done nothing wrong”.  She did this and she was right.

4. Make sure your administration has your back.  NEVER EVER face off with a cop especially one that is like the one in the video, on  your own.  Have your administrative back up right there, not on a speaker phone.  Just as when facing a violent patient, a cop can turn.  This cop turned.

5. Allow the aftermath process to take it’s course.  Alex is doing that. She is incredibly wise and patient.  She has accepted the apologies of the Salt Lake City mayor and police chief.  There is an internal and a criminal investigation now.  She will not say she wants that cop fired (like I have said repeatedly to anyone who will listen to me).   She is waiting until the process is finished, and in the meantime she has left all of her personal options on the table, like legal action.  She is a very smart and generous person.  I want her for my nurse if I am ever sick in SLC.

6. She is using her personal and traumatic experience to help teach other nurses and police about the rights of patients and and about the hospitals policies regarding that.  Alex has a lot to teach them.

7. Nurses are like protective mothers in the wild guarding their young…don’t threaten a vulnerable, and in this case unconscious patient on their watch, because they can and will take you down (unless all the proper paperwork and policies are in order of course).

8. Nurses stick together and they will fight as a pack against injustices and bullies.  Nurses will generally come out on top, because they know what they are doing and they are by in large very responsible and respectable people.  Alex has every staff nurse in the country (who has seen this video) on her side.   My bet is that this exact issue will be reviewed in every hospital in the country.

9. Stay calm in the face of craziness….Alex did this. She never raised her voice (until she was assaulted).  She was respectful and organized.  She presented the necessary policies verbally and in writing. to the cop in writing.  She got her supervisor on the phone (although he should have been there beside her). She did not disrespect anyone.  She rightfully protected her unknowing, unconscious patient by being his voice and advocate.   She didn’t expect anything from anyone other than mutual respect.

10. Alex taught us what herosim is.  She is an excellent example of nurse strength and courage.

Nurses encounter crazy business every day they go to work.It can come out of the blue, just like this cop did.  It can come from a patient, a visitor, a doctor, a boss, or another coworker.  Nobody expects it to come from a public servant, like a cop.

Appreciate your nurses because they will always have your back.  As patients, we should all be so lucky as to have a nurse like Alex Wubbels.

 

 

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Ode to Louie

August 1st, 2017 No comments

louie

 

 

 

 

 

Louie in wagon

 

 

 

 

 

 

 

 

Our Louie is almost 15 years old. He is truly a geriatric dog.  He still has a puppy face, and many people are shocked to learn his age.  But look closer.  He has arthritic joints, a sway back, rheumy eyes, a small growth on his left lower eyelid and a lipoma on his chest. He is also very deaf.  His front legs have been badly bowed since he was very young.  It was a birth defect that we didn’t notice when he was just 12 weeks old, when we got him.   He looked perfect to us, and he was.  Those crazy front legs served him very well all this time.  Now when he walks, especially after lying down for a long time, he staggers, and sometimes one back arthritic leg, or the other just slips out from under him.   But, he recovers quickly and keeps on walking.  Sometimes his puppy persona takes over and he is downright frisky, jumping and running about.  That burst of puppiness doesn’t last long these days.

Seeing signs of aging in our beautiful pup is so hard.  We all remember his crazy wild puppy play.  He would run in circles or chase a ball forever. If nobody was paying attention he would nudge his ball into our pool and stand at the edge and bark until he engaged someone in his game.  He would get so worked up he would ram into furniture, bounce off and keep going.  He could jump 3 feet off the floor for the right treat.  He had a high pitched bark or yip, and he used it often. He jumped up on furniture to watch out the window and guard our house.  He was a ‘never fail’ alarm for incoming guests.  And, oh, did he love to travel.  We have taken him on countless camping trips.  He is a real camping trooper, except that he is scared to death of campfires.  And, he is petrified of fireworks and thunder, except for now, because he is deaf.

A few months ago, I watched my patient son and husband separate and rescue entangled squirrels. I knew about Mike’s tenderness toward animanls.   Every day I watch my husband go off with Louie, for a short walk, and now he pulls a red foldable wagon.   Louie doesn’t/can’t walk all the way around our block anymore.  He goes far enough to do his business, and Mike pulls him in his wagon the rest of the way.  He loves it.  Louie that is.  Mike was a little self conscious when he first started using the wagon for his crippled buddy, but not anymore.  I believe they have become well known in the neighborhood.  It is such a heart warming sight to see my boys coming up the street, Mike pulling the wagon, and Louie riding in it.

I asked Mike recently, “will you take such good care of me if I need it”   My younger son immediately said “I doubt it”.   Mike has the patience of a saint with Louie and it is something special to witness that.  I worry about him when Louie has to go over the rainbow.  There will come a day when he won’t be able to stand on his wobbly legs.  Will that be the time?  Or will Mike get Louie a doggie wheelchair?   It could go either way, but if Louie is suffering, I know we will both agree on what is best for him.

We voluntarily bring these sweet animals into our lives.  Then we fall in love, just like when we have our human babies.   They become part of us, our days and our home.  They mark their space in every possible way.  Louie knows he rules the roost. He communicates with Mike and Mike responds.  Sometimes I think Mike understands dog speak better than human speak.  Louie’s yip, whine, sneeze, cough, or cry elicits almost immediate response from Mike, whereas, my yelp, whine, or complaint many times falls on deaf ears.

I love all of my boys…Mike, Louie and my sons, but the special relationship between Louie and Mike is something to behold.  There is a love and codependency like no other.  I wish it would never end.

 

 

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The Day Hearts, 4 baby squirrels and their Mamma

May 25th, 2017 No comments
Andrew Day

Andrew Day

This is a story about two men in my family and a squirrel family.  I have been married to Mike Day, for 45 years this year.  He is a quiet gentle man who  has the patience of a saint.  He has stuck it out with me and that speaks for itself!  My son Andrew Day is my youngest and he is also a special and big hearted man.  None of us expected notoriety for their patience and kindness but then last Sunday a weird thing happened.

Andrew was visiting us at our Pearl Street home in Bangor and he was about to leave when he looked out our front window.  He said, “Uhoh, there is some cat/squirrel action out there”.   At the end of the driveway across the street, there was a big old orange cat, stalking what we thought was a single squirrel on our side of the street.  We thought we were seeing an injured adult squirrel.  He went outside to find FOUR baby squirrels, all joined together at the tail by a weird ball of debris.  Oh no, what to do!!!  They couldn’t walk or run because they would all pull in different directions.  They couldn’t climb a tree because one or two of them would weigh the others down.  Mother squirrel was on the side of a tree across the street and she was frantically screaming and crying for her babies.  The babies all huddled in a crevice at the base of one our maple trees.

Andrew called for the Bangor, ME animal control.  The dispatch told him they weren’t available on a Sunday, so they put in a call for us to the Game Warden service.  We knew these babies were in jeopardy.  The Game warden called back and he couldn’t come right away, because he was at a remote pond.  When we described our predicament, he said he would just use his pocket knife to cut away the debris, and he would need our help to do it.  So, based on that, my men decided they could do this themselves.

They gathered up some rudimentary tools.  We got a large plastic rake, a soil cultivator tool,  3 foot deep box, scissors, long leather gloves (no bites or scratches for them!), some branch trimmers, and a grabber which is used by handicapped people to pick things up or reach things.  Mike got the rake under the squirrels and Andrew used the claw like cultivator to gently help them into the box.  The little buggers had picked up a number of long branches during their excursion, and Mike cut away all of those.  Andrew then spent almost an hour and a half cutting, trimming and picking away at the ball of stuff that cemented the babies together.   At the end of this operation, they used some Dawn detergent to lubricate and condition the remaining small tangles and then they were separated.  Whew!

andrewheadin box

The tails were tattered and skinny for lack of hair, but they were intact.  The little guys were stressed and tired, and they curled up around each other and rested under an old blanket while I called the warden.  We couldn’t see the mother squirrel anywhere and were uncertain about the next step.  He told me that their only chance for life was with their mother, and to let them out of the box.  We did.  They ran off immediately, and separately, for the first time I think!   Two went up the tree where their nest was, and the two others went in different directions.

About an hour later, we saw Mamma squirrel nudging one of the babies up the tree.  We were all happy and relieved that the little family was back together.  Andrew’s friend Peg dropped by to support Andrew and a couple of neighbors stopped to satisfy their curiosity.  We were all pretty triumphant that these little guys would make it.

THEN! Andrew posted his video of the babies, before they were separated, on YouTube.  A friend of a friend who writes for the Bangor Daily News asked to do a story for the newspaper. http://actoutwithaislinn.bangordailynews.com/2017/05/22/recreation/four-baby-squirrels-with-tails-tangled-together-rescued-by-bangor-men/

WLBZ Channel 2 news asked for an interview.  http://www.wlbz2.com/life/a-tale-of-4-squirrels/442317489

Mike’s and Andrew’s big hearted heroism had spread far beyond our family, a friend and a couple of neighbors. In fact, the story went viral and so did the video.  After only 3 days, there are almost 150,000 hits on his video and numerous media reports.

I love this story and telling it, because it just plain warms my heart.  But, both Mike and Andrew are a little embarrassed by all of the attention.  Neither of them think they did something heroic.  I beg to differ!

 

 

Faith restored

May 15th, 2017 No comments

 

poppyhurt

 

May 8, 2017

All last weekend, I was in the company of some of the smartest, most compassionate people I know.  The Lown Annual conference corrals some of the brightest and best activists,  advocates and scholars in healthcare. This year it was in Quincy, MA.  We learned, laughed,  cried, and we networked.  It was absolutely amazing.  I have faith, in all of them, and in our determination that compassionate and excellent healthcare will thrive and improve, even with the existing odds.

Then this……

My team mate, friend, confidante and colleague, Poppy Arford took a nasty tumble while jogging alone early in the morning.  She stepped into a pothole and her left leg was bent at an unnatural angle and she twisted and fell on her left shoulder, and bumped her head.  She was in the middle of the road and couldn’t get up, so a wonderful Uber driver stopped, picked her up from the ground,  and drove her up the hill to our hotel.   At 62, Poppy is in excellent physical condition because she loves exercise and the great outdoors.  She can move like a teen and bend herself into pretzel like forms.   But, she has grown to distrust the healthcare system in general because of things that have happened to her family and her in the past.  She was literally petrified of going to the ER.  She was away from home,without her family, she didn’t know the area providers, and her fear was compounded by all of that.   She couldn’t walk and she was in terrific pain, but she did not want to go to the hospital.  She was in a roomful of doctors and friends, but they couldn’t convince her. Right there in that room with the kindest people in the world is where I found my friend Sunday morning, in a wheelchair, with her arm in a sling, and her leg propped up on very nice hotel pillows.  Ice had been applied and gentle kind people had brought her some scrambled eggs.

Our mutual Maine friend  Kim H, met me in the lobby outside the conference room to tell me that Poppy had been injured.  I had no idea.  I asked why she hadn’t gone to the ER. She said that a roomful of doctors couldn’t convince her to go.  I basically said, she is going.   I shifted into my mean and controlling nurse self.  I can do it…I really can, when the situation calls for it and when I know it is for the benefit of my friend.  Warning, watch out when I switch into this mode.

Poppy told me that when I said “We are going to the ER” she was able to move past the fear as she knew, she trusted, that I would be her “right care“ advocate at the hospital. Yet she still refused an ambulance. That was  a very good decision, because they probably would not have taken us to the hospital that was recommended to us. Sometimes by policy, they have to go to the closest facility.  We were advised by Boston doctors at the conference to go to Brigham and Womens Hospital. Dr. Andy L, Poppy’s friend from one of the organization’s councils gently supported and guided Poppy’s painful leg (there was no leg support on her hotel wheelchair) while we slowly and very carefully wheeled her to our volunteer drivers car.  We packed her and fluffed her up in the back seat of the car.   A contingent of conference attendees and friends came to wish her well, and a hotel employee swung into action to help  Kim gather her bags and other things. Some of us exchanged phone numbers and advice and information….all for our friend Poppy.   Dr Marlene H drove us to the hospital in Boston.  Because I have found humor to be a great salve for stress, we had some pretty silly conversations on the way into the hospital…I hope we didn’t scare our new friend Marlene.

Just before we left, the Right Care Alliance introduced,  from the stage of the conference,  the names of the members of their new steering committee.  Poppy is honored to be on that committee and she spoke into her microphone and told the whole room who she was, and that she had hurt herself badly that morning.  Her voice was shaky and she admitted her crippling fear of being harmed when she went to the ER. She said it shouldn’t be that way.  She is a very wise woman.  I promised I wouldn’t let anyone hurt her.

On arrival at the hospital, I asked the security guard for help.  They gently helped us get Poppy into a wheelchair.  Then a very patient admissions clerk took her information.  We wheeled right into nurse Triage after that and then she was immediately taken to an exam room.  There were no waits and Poppy got compassionate care from the door to her exam bed.  We were assigned a sweet nurse named Christina, and an ER tech named Justin.  She was gently examined by 2 medical residents, the ER attending and an orthopedic resident.  These young doctors treated her with the greatest patience, respect and compassion.  They gave her every bit of information she needed and eased her fears. They fluffed her pillows up and comforted her,  gave her necessary information and  helped her with her needs. We laughed together  and we all learned about each other.  But most importantly they eased her fears and pain,  and they cared for my friend.  She had great care in that ER and both of us were so incredibly relieved.

After she had x rays, we found out that Poppy broke  her rt collarbone and her left lower leg (tibial plateau).  She was given a painful  injection of Lidocaine below her knee so the resident could do a thorough exam of her fracture, and determine if it was stable or not.  He felt that it was stable. When I left her yesterday, she was planning to go home.  The attending orthopedist had a different opinion.  He recognized the importance of Poppys active lifestyle.  He told her that if she wanted to continue to be this active and not develop arthritis, it would be best to fortify the bone with a plate and screws.  These devices can stay in or she can opt to have them removed down the road.   He said that surgery would be her best option.  Poppy agreed to have the surgery.

I left Poppy yesterday afternoon in the competent hands of the B&W ER staff and her beautiful daughter Libby. Husband Loren was on his way.  When he arrived in Boston in the B & W ER, and learned the plan, he drove back to Maine to prepare a downstairs bed for Poppy. Later when he learned that she will spend some weeks in a wheelchair, he and a couple of friends built her a ramp.   When I spoke with her this morning, she told me she has very little pain, and she was very pleased with her night nurse.  She is awaiting the surgical stabilization of her fracture.  She is confident, comfortable and she has a great attitude.  My friend is very courageous.

Late this afternoon, I got a message from Loren that Poppy was out of surgery and all went well.  What wonderful relief. She has a struggle ahead, but I am very confident that she will work hard and have a full recovery.  The human body is an amazing vessel and Poppy has taken excellent care of hers.

Poppy and I have teamed up on a number of presentations and campaigns.  Our friends at the Right Care alliance have affectionately named us the Lucy and Ethel of the RCA.  What an adventure L and R had yesterday.   And, next year at the Lown, what a story we will have to tell, to teach others how to be safe and engaged patients.   I have bold printed the people who helped Poppy just in one day, and there are many more now.  It’s amazing how a large group of  mostly unacquainted caring people pulled together to help my  friend Poppy.  We can never underestimate the goodness of people in times of need.

My opinion is that we found some of the finest in healthcare at the B & W ER  and a great example for the work we are doing.  However, we both went to the weekend conference expecting to help reform the heathcare system, not to experience it!

Addendum.  Poppy never stops working, and when we were in the ER she and I may have even managed to recruit the ER attending and the ER RN to the Right Care Alliance.  I left my card.

To be continued…….

May 10, 2017

Poppy was discharged from Brigham Women’s this afternoon in a wheel chair. Once her clavicle has healed sufficiently, she will begin using crutches to walk with no weight bearing on her injured leg for ten weeks. This will be a struggle, but if anybody can beat this, it is Poppy.  She is grateful to everyone along the way who helped and cared about her.

Poppywheelchair

 

 

 

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Health Care calling and the subsequent beatings

February 21st, 2017 3 comments

nursecap1967Oxford Living Dictionary  Definition of CARE

Noun:

The provision of what is necessary for the health, welfare, maintenance, and protection of someone or something.

Serious attention or consideration applied to doing something correctly or to avoid damage or risk

Verb:

Feel concern or interest; attach importance to something.

Look after and provide for the needs of.

 

 

I need to get something off my chest.   Health Insurance is not Healthcare.  When people ask, “Do you have Healthcare?”, we should not  think insurance.  Insurance is an  expensive profitable commodity, that has been marketed as care, but it is not care.  It is a negotiating service.  Let’s call it Medical Negotiators.   Insurance companies do not “care” for us or about us, even though some of their employees may be very nice and helpful.    Insurance corporations “are people too” but they do not touch us, or render care.  They care about their profits and their stock holders.  They negotiate insurance coverage for us with providers of care, like hospitals, doctors, dialysis centers, etc.  The only people left out of the negotiations are us, the people who pay for it.  We do not get to negotiate our payments to the insurance company or to the provider.  And some people are unable to have any insurance at all, even with all of its  imperfections.

Our families “care” for and love  us.  Healthcare workers and professionals “care” for us and sometimes they love us.  The professionals spend a lot of time and money to learn the proper care and handling of human beings and their health.  Doctors generally spend about a full decade getting educated.  Nurses can become licensed in 2 to 4 years, and some choose to continue on to become nurse practitioners.  There are many levels and kinds of professional caregivers . We can’t leave out the people who do abbreviated training like CNAs, PCAs, and such.  All of them learn to care for real live people. Real Health care is a challenging but noble career calling to answer.

I can only speak from the nursing end of things because that is my experience.  I was a wide eyed naive 18 year old girl when I entered nursing school at St Elizabeths Hospital School of Nursing in Brighton, Massachusetts in 1967..  St E’s was a 3 year Catholic Nurses training program.  I had no idea what I was getting into.  Our first half year and some of the second half we studied all the sciences.  Chemistry, Anatomy, Physiology, Nutrition, …argh!  That first year we also started on the fundamentals of nursing, which is how to give great hands on daily care to our patients.   First we learned about making a bed and how to do tight neat bed corners.  There were no fitted sheets when I was in school.  I was really good at that and I still am.  Next, we learned to give a bedbath and give backrubs and skin care.  This is the first time we really learned how to touch the bodies of strangers, so thank goodness we practiced on dummies.   Our instructors were exemplary professionals, and they taught us to be the same.  It was all very serious stuff for a goofy 18 year old. (Unfortunately now I hear from patients that their sheets were rarely changed and they never had a bath the whole time they were hospitalized. Back rubs and skin care??  Patients have never heard of that! Time isn’t allowed for such frills).     Soon we launched into more serious procedures like giving injections,  catheterizations, IV  insertion, sterile technique and dressing changes.  We learned Pharmacology (that was a tough one) and nursing specialties like maternal and child health, operating room nursing, psych nursing, pediatrics, medical surgical nursing and ICU.  We spent at least 2 months, sometimes 3 months at each specialty.  I had to live in a dirty dorm at Boston State Hospital for 3 months to learn psychiatric nursing.  My brother, who is also an RN spent 3 days at a psychiatric facility for his psych training.

I remember my trepidation when we first went onto the hospital floors.  What the hell was I doing there? I had never even worked as a candy striper, so I knew nothing of hospitals except as a visitor.  This was all of a sudden very serious business and it scared the bejesus out of me.  Between our in hospital time and our classes, there was not much time for anything else.  Off hours were spent studying.  Our weekends were when we let our hair down.

Caring is either in you or not.  I remember a few of my classmates who I doubted really cared about patients.  I can’t really pinpoint why I sensed that, other than the fact that they cheated in class on exams.  If they really cared, they would have taken the learning more seriously.   Someone who skated dishonestly through really difficult classes was not someone I would want caring for me.  Could I trust them to really care?

I didn’t have to learn to care, but I had to learn how to give hands on professional care.  Prescribed steps had to be followed for certain procedures.  If I skipped a step, I could endanger my patients.  Let’s take getting a medication ready.  We followed the 5 rights rule, but there was more.  The 5 rights were  Right Patient, Right medicine, Right dose, Right Route, and Right time.   Then of course there were the steps to keep medicine safe, like appropriate storage, keeping multi dose vials uncontaminated, using sterile needles and syringes and not contaminating them, prepping the skin for an injection the right way, putting pressure on and gentle massage of an injection site.   And after a medicine was given, we had to watch for appropriate effects and possible side effects.  Yes, all of this is part of giving an injection, and most of this is also followed when giving what seems like  a simple pill.  One slip up and there can be serious consequences for the patient.   All of it takes time.

When I was a student, I was under the tutelage of excellent and strict clinical instructors.  We were observed and corrected if we missed a step.  We did things in order, and efficiently.  We only had assignments that we could handle.  It was all very detailed and orchestrated so we could learn to be excellent nurses.  When I graduated, I felt like I had the world by the tail and I could take on anything.

After school I went to work in a small town operating room.  I took my nursing boards exam while I was sick with strep throat, but passed my nursing boards first time around!  My parents were so excited and so was I.  And then…..

I didn’t have my instructors to guide and protect me anymore.  I didn’t have the luxury of time anymore.  Most days, our OR schedule was reasonable, but I remember a visiting surgeon who was demanding and in a hurry to finish.  He put demands on the staff that were impossible to handle.  He wanted his patients lined up at the door of the OR so he could get out of there as soon as possible. Think widgets on an assembly line.  I found myself in charge of the OR one day (not my usual position) when he was there.  The surgical tech on with me and I decided that we were going to take our usual cleaning steps between cases whether the surgeon liked it or not.  It was our job to care about cleanliness and the patients.  He reported me because he was forced to wait between cases.  I stood up for us and our meticulous work, and that was that.  The Director of Nursing stood by me.  It could have gone either way.

Eventually I ended up working in a busy ER in Bangor.  Most days, it was controlled craziness, and then it would become uncontrolled craziness.  patients with very serious problems were forced to wait in the hallways.  If I was on triage, I was responsible for some of  those patients in the hallway. When I asked the ER administrator about short staffing and how we could remedy that, I was told “you just do the best you can with what you have”.  I recommended some kind of call in for especially busy days, so every patient got the attention they needed.  It never happened.

I worked in 4 ERs over my career.  2 were small community ERs and 2 were city ERs.  I learned that in order to survive, I had to take short cuts.  Some shifts I felt like an automaton, or a machine.  I had so many patients that it could be confusing, and I never felt like I was doing any of them justice.  I remember asking a patient to take his pants off to have a hemorrhoid checked.    He asked me “why, I’m only here for sore throat!”  He misheard me when I called the patient’s name. This is a good example of how easily mistakes can be made.  Caring for sick and injured people should not be this chaotic, and there should always be enough nurses so that one nurse is not caring for more patients than they can manage safely and efficiently at one time.

My last hospital job was in the hosptial Walk in Care doing 12 hour shifts.  I took this job because the patients were not as acutely ill and required less skilled care.  I was in my 50s and I was ready for this level of care.  I worked with one aide and a registrar.  I was responsible for all of the triage, and other RN duties like assessments, medications, treatments, orders, charting, etc.  I thought…”piece of cake”.   NOT.  After being told  a several times  that I would not have an aide to help me with the workload, and I was facing 12 hours with no relief or breaks, it was not a piece of cake.  After I worked with an LPN who just walked off to take her breaks in the middle of craziness,  without asking if it was a good time to do so, it was not a piece of cake.  After triaging dozens of patients and facing a dozen more in the waiting room staring at me and wanting immediate service, it was not a piece of cake. Eventually, I refused to work alone anymore in Walk in Care.  I would only work the part of the shift that I had help.  On a couple of occasions, my supervisor had to relieve me when the aide was leaving for the day.  This new staffing decision left the department with just an RN for the last 4 hours that WIC was open.  She came to relieve me and as soon as I left, she called for one of the ER aides to come and help her. So, the supervisor could get herself some help, but the other RNs and I were never given that option.

My hospital jobs forced me to learn to take shortcuts in care.  They were not harmful shortcuts, but the steps were there to assure safety of patients.  Lack of support and inadequate staffing forces all nurses to do this.  An example is handwashing.  We all know that handwashing is perhaps the most essential step a nurse can take to prevent infections.  If done appropriately and often enough, patients are safer.  But handwashing compliance is never 100% and often times is as low as 40%.   Nurses are considered whiners if they complain about their work load.  Middle management and upper management nurses are not managing by walking around, they are managing by looking at and calculating numbers on a piece of paper.  Bean counters at the top are budgeting to the bone and telling middle management that there is no more money for safe staffing levels.

In later  years, after struggling with short staffing time and time again, I became a union organizer in a small Maine Hospital.  When nurses cannot reason with their managers and directors, this is what they do.  We won our organizing effort and nurses are represented by the union now.  Great strides in patient safety and nurse staffing have been made because of the union.

I always cared about my patients.  But, I found myself asking.  WHO cares about me?  If we don’t care about the people giving the care to patients, and we don’t listen to them when they have needs, like some help with their workload,  we will beat them down, force them to take shortcuts, and everyone suffers.  Eventually I got beaten down…and the joy of nursing just wasn’t in me anymore.  I retired early.

When I went into nursing in 1967, young women were just starting to assert themselves in careers other than nursing, teaching or secretarial work.  My high school guidance councilor basically steered all of us to those 3 careers.  And it was not uncommon for 18 year olds to get married right out of high school and start families.  It is very different now.  We are facing having our very first female president, or so I hope!  Young women look at that and think there is no limit on what they can do with their lives.  Will young women consider nursing, particularly if it stays the way it is??  What about young men?   It is a tough profession, but if done correctly and by the right caring people, it is an honorable and inspiring profession.  We learn the professional skills and the patients teach us about everything else.    And, if done right, patients love you as much as you love them.

Nursing is an honorable and rewarding profession Nurses are the most trusted professionals and our patients need us.  My hope is that the industry sees the light and stops beating down nurses and other caregivers.  Patients need our care, not the care of insurance companies.

 

 

 

 

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November 9, 2016, the Day After a Sexual Predator Won the Presidential Election

November 13th, 2016 1 comment

At 345am on November 9, 2016, my alarm went off.  I am retired but I volunteer work on Patient Safety and other healthcare issues.  That morning I was headed to New Orleans to a conference on cost and quality.  The night  before, I had watched  all that I could stomach of the presidential votes being counted on TV.

Mike, my husband confirmed it.  Hillary had conceded to T.

Mike and I voted early.  The tension and vitriol during this presidential campaign was causing both of us way too much stress.  I just can’t stomach that much hatred and negativity.   We already knew how we would vote and we thought that we could allay some tension if we took care of our voting business.  NOPE, it didn’t work.  TV coverage and constant horrifying and disgusting stuff surfaced every day.  What was happening to my country?

About 10 years ago, a sexual predator, in the form of an uncle, scared a cousin of my granddaughter. He lured her into going for a ride with him in his shiny new truck.  She had just turned 16 and had a newly printed drivers license.  He directed her onto roads that she was unfamiliar with and then he began a sickening sexually explicit trash talk with her describing what he would like to do to her, and bragging about what he had done to other young girls.  She was such an innocent that she didn’t understand half of what he described.   She was scared, and lost.  She didn’t know how to get back home, so she just kept driving.  She was from a beautiful Christian family and on most occasions she didn’t go with boys unless she was chaperoned. This was her trusted uncle!  One can only imagine her fear.  She didn’t stop the truck and fortunately she eventually found her way home.  He did not touch her and thank God for that.  That uncle was my only grandchild’s other grandfather.  And he lived in the same house as her.  She was just 13 at the time.   On the advice of police, her father (my son) and I worked to get him away from her.  We did it to protect her and her young friends from a sexual predator.  That was the beginning of the end of our relationship with my granddaughter.  Her loyalty was to her “other” side, including the sexual predator grandfather.  We had cared for our sweet girl for many years in our home.   She spent entire summers here and most holidays.  She had her own room and things here.  We love her deeply.  And now she barely speaks to us. We haven’t seen  her for over 7 years.  She is now 24 years old.  We were not invited to any events in her life, like her high school graduation with honors or her college graduation.  She has shared one photo of herself in all those years.  I have books full of them from our time with her.

When a family gets behind a sexual predator and dives into denial, it is impossible to penetrate that.  The disgusting perpetrator  we knew 10 years ago has a “devout Catholic” wife who immediately took him to her priest.  He lied to the priest, after telling the police the truth.  The small minded wife stuck by him and defended him.  She told her daughters and son and their families “we will never speak of this again”.  Her doe eyed denial saved  face, but destroyed very close and loving relationships all through her very large extended family, and it separated my family from our beloved girl.

There is great impenetrable strength in denial and undeserved loyalty.

This example of my painful separation from my sweet granddaughter is a microcosm of the vast harm a disgusting small man with those sickening tendencies can bring to those around him.  When they get away with their appalling behavior repeatedly, over many years,  it empowers them to be even more disgusting.   I have never written about this part of my life before.  It is very painful and something that I have not shared with a lot of people, but it is true, it is my reality and it is time for me to share it.

Almost 50% of American voters got behind a sexual predator for president and now he is going to live in the White House. That is a huge portion of our citizens that turned a blind eye to his predatory behavior, that was confirmed by his own words,  a number of women,and even by prior wives.   I can only imagine what kind of harm he can do to all of us, when a single creepy sexual predator uncle/grandfather could wreak such havoc in his own family and as a result, in mine.  Even before his election, T has left a path of destroyed lives and emotionally battered women.

I am horrified over this election and I will grieve it until T is finished.

God help us all.

 

 

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Right Care Action Week and Recompence Shore Campground

October 21st, 2016 1 comment

Last Monday October 17, my husband Mike and I packed up our camper and went to Freeport, ME.  The weather was predicted to be unseasonably warm and dry.  Also, it is the peak foliage season.  This couldn’t get any better, could it?

The reason for our trip was twofold.  We are early senior citizens (67 and 68) we feel the need to do what we can while we can still do it.  Camping has been a big part of our lives and we would love keep it up.  It is a great way to travel, and to do it cheaply and mostly in comfort.  Our traveling nest offers this.  And we get to take Louie.

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We settled that afternoon on the edge of a field at Recompence Shores Campground.  Then we found a vacant ocean front camping lot and stared at the gorgeous views and foliage.   It’s pretty simple stuff, but stuff that we love.

On Tuesday morning, I drove some hilly beautiful roads to Brunswick Maine to meet up with Poppy Arford, my colleague in Healthcare transformation.  We would host a listening booth table as part of Right Care Action Week at the Brunswick Senior Expo, in the Cooks Corner Mall.   Poppy had information sheets and beautiful posters printed up for our display, and we each carried clip boards to write on.  We introduced ourselves to about 100 seniors and other exhibitors, and asked the question “What worries you most about healthcare?”  and if they had no worries, “What do you like about your healthcare?”  http://rightcarealliance.org/right-care-action-week/

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I have always loved working with seniors.  They/we are generally sharp, engaged and straight forward in their responses.  This was exactly the case on Tuesday.

Let me tell you about a few of the people I met that morning.

1. A tiny white haired 80ish lady with a walker approached.  When I spoke to her, she said it was hard to see me because of the bright light behind my head, and could we switch positions.  So we did.  She told me she is legally blind.  She uses the walker because if she bumps into something, the walker takes the hit instead of her.  Her greatest worry was getting alzheimers.  She said she doesn’t have it, but if she got it, she has no one to help her.  She has no family or support people.  Her worry touched me personally because of my own mother and her dementia.  This lady also expressed her exasperation with the Maine DHHS and how they lack coordination, efficiency and effectiveness.  She struggles with poverty and when they mess up her EBT card, she is in trouble.  She said she never gets the same case worker twice, and that they take care of complaint forms in bunches instead of as they come in.  The services are slow and uncoordinated and it affects her a great deal.

2. A sweet couple, married 59 years shared that they have a 45 year old ‘girl’ and a 54 year old ‘boy’.  The girl is a nurse and she told her Dad to take his hands out of his pockets because if he falls, he would not be able to break the fall.  I told them they have  a wise daughter.  They were generally happy with their healthcare.  They were patients at Martins Point in Brunswick and their Medicare Advantage plan is through them as well.

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3. A man, estimated to be 80 or so, talked about his late wife’s costs for medicine.  He said that with insurance, a 90 day supply of 2 liquid nebulizer medicines was $900, and without insurance it would have been $9000 for 90 day supply.  He talked about his beloved wife and her struggles at the end of life, and also about the expenses for her medicines.  He felt that he was healthy and liked the care that he received at the VA.

4. A younger senior, maybe a little younger than me, was running a display table on Reiki, an alternative treatment for many health issues.  She was enthusiastic and bright and when I told her about the Right Care Alliance, she got very excited.  I invited her to join our movement.  When I told her about the Lown Institute annual conference, she said she could envision herself there, offering Reiki to the attendees in a central lobby!  WOW, what a great idea. He concern is that too much medicine is prescribed to mask symptoms of illness.  (yeah, my kind of gal!)  She said the goal should be to eliminate the symptoms, not mask them or drive them deeper.  I hope she joins our group.

It was a very busy and productive day.  I loved meeting, and talking to these awesome seniors about their healthcare.  We will take their comments and concerns to the Right Care Alliance staff and they will create a data base.  My guess is that costs issues will rise to the top, so I wonder if the question should have been a little different.  People associate the term “healthcare” with insurance and that can muddy the waters and center the conversation around coverage/cost.  I think perhaps I should have asked more about their actual hands on provider and perhaps hospital care.

Mike and I stayed one extra day at the campground, and it was a beauty.  On October 19, the temperature was 77 degrees at Old Orchard Beach, Maine.  Imagine that.  We had a great seafood lunch outside at a picnic table and then we went to the beach and watched the high waves crashing on the almost empty beach.  After we got back to our camper, we got a can of cold beer and took our chairs to the waterfront again and stared at the beauty of the place we were at.  Amazing.  Life is good.

oobseafoodwaterfoliage

 

 

 

 

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Perfectly Imperfect Human Beings and Love

September 23rd, 2016 3 comments

bert and ernie

 

 

 

 

Every single one of us comes bawling and squirming into the world all bloody and gooey.  There is nothing gentle or neat and clean about delivery, and certainly the same can be said about death.  We are all equals at the beginning and the end of life.   It is what happens in between that changes us.  That is when some  begin to believe that equality ends and they have risen above the rest of humanity.

Every one of us, whether we are men, women, smart, average, rich, poor, well or sick, are basically the same organism.  We all cry, hurt, get zits, bleed, defecate, laugh, cough, and breath.  This is a short list of what we do as human organisms.  The things that make us different from each other is how we think and learn and what we choose to do with the lives that our mothers gave us,  and how we treat other human beings.

No matter what we choose to do with our lives, we all have to struggle, learn, make friends, work, and best of all, love.  As imperfectly perfect as human beings are, we are nothing without love.

This is what is missing in healthcare.  I am not talking about the marrying kind of love…the kind that often ends up producing new lives.  I am talking about the kind of love that is for mankind in general.  Compassion, understanding, caring, listening, patience, touch….that kind of love belongs in healthcare relationships between patients and professional caregivers.   That is the “calling” that I had as a nurse and that so many of my colleagues had as well.  We went into nursing to care for people and help them to get healthy and when that was impossible to gently guide them to death.   We didn’t go into nursing to become bitchy cynical old crabs.  Sadly, too many nurses and other providers  end up that way.   The system beats the love out of them and doesn’t allow time for it.  There is no check box on the EMR for touching, or hand holding or spending time with a grieving family.  Therefore it is not a billable moment.

I want to share a few personal healthcare love stories.

In 1969 when I was about 19 years old, I did my maternity and nursery nurses training.  3 weeks before  I started nursing school in 1967, my baby brother Jamie was born.  I never felt very maternal before that.  I did a lot of babysitting as a teen, but I had no urge to have my own babies.  Jamie changed that.  I missed him terribly and he was growing so quickly between my visits home.  So, when I met Molly (I am making this name up) I fell in love.  She was perfectly perfect, but she only weighed 4lbs and came a little too early.  She was the first African American baby or patient I ever cared for. I came from an all white community in Northern Maine, my only exposure to diversity was at intramural basketball games.  I held Molly as much as I could.    I loved Molly and I cried both happy and sad tears when her Mom and Dad took her home.  This was my first awakening that humanity and love is  color blind.

A year or so later, I was doing Medical Surgical training.  I was assigned to 2 older gentlemen.  I was 20, so men in their 60s like I am now, seemed wicked old.  One was a sweet Italian man with an accent, who was what we use to call compliant, and polite, and who did everything I asked him to without complaint.   I’ll call him Ernie. I don’t remember Ernie’s medical problem so let’s say he had an ulcer…if he didn’t he would get one with his roommate.   The second man (I’ll call him Bert)  was a prominent Boston attorney, and he was  boisterous, bossy,  loud, nasty and even belligerent at times.  He was an alcoholic and a diabetic.  He would refuse to do what he was asked to do…even with a lot of explaining cajoling and nudging.  He sneaked chocolates from Ernie and laughed about it.  He was basically impossible!!!  So, I approached Ernie with caution, but also with professionalism.  I repeatedly told him that it was his choice, he could continue to do what he was doing and probably die prematurely, or he could take care of himself and I was there to help him. He figured out that even though I was green and young, that I wouldn’t cowtow to him and guess what….. He loved me!  In fact he demanded that I come to his room and draw his blood rather than the lab phlebotomist doing it.  I assured him that she was much more skilled at that than I was.  Both men turned their health around during that stay.  In a very short time, I fell in love with both of them and loved their teasing and joking around.  After they were discharged, Ernie’s wife brought  a large dish of  genuine Italian homemade lasagne to my dorm! This was a token of appreciation and love from Ernie.  Then the best of all…both Ernie and Bert came to my graduation.  It was a surprise.  Bert had lost weight and told me he was sober! He had been since he was discharged.  Both of them gave me huge hugs and a nice gift.  Their presence at my graduation was the best gift of all!   I felt like I had actually made a difference as a nurse, and I will never forget Ernie and Bert.

I have cared for thousands of patients over my career.  As an ER nurse, I gained skills at making a human connection with patients very quickly, and I could tell hundreds of stories.  At the end of my career, I felt the humanity slipping away…   I still loved my patients, but the lack of support and bureaucracy was a weight that I was ready to shed.  Arriving at  work and finding out that I would be understaffed, yet again was a killer.  12 hour shifts with no meal breaks broke me.   In the end, hospital nursing sucked the joy of nursing out of me, I am sad to say.

These are very old stories, but they are important ones. They are about genuine loving connections with human beings, not medical conditions.

I am now starting to be on the receiving end of healthcare. I have been a patient more than I like this past few years. I had anesthesia 3 times last year for needed surgeries.  I woke up all 3 times, crying.  My caregivers asked me if I was in pain.  “No, I said  “I am just relieved”.  I was also extremely grateful for their skilled and loving attention and for keeping me safe.   I have felt that patient/provider connection several times during my experiences.  Very special people work in our hospitals and doctors offices.  Let’s make the changes we need to so those special people are not broken, like so many of us have been.

Love, like water, is an essential part of our perfectly imperfect human lives and we need to bring it back to healthcare.

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Rightcare Starts with ME

September 10th, 2016 2 comments
Poppy Arford, Kathy Day, Stephanie Aines

Poppy Arford, Kathy Day, Stephanie Aines

Right Care Alliance

On September 8, 2016, my colleague Poppy Arford and I co-presented at the Maine Patient Safety Academy.   Poppy first introduced the Lown Institute, the origins and their incredible leadership. Then we encouraged our group to join our Healthcare Revolution with the Lown Right Care Alliance, and suggested ways to engage with us and our work.    Our theme for this particular exercise/presentation was “What Worries You Most”.  So, I shared my most pressing worries about Patient Safety, and then shared a story about my mother who is in assisted living. I worry about her health, safety and finances.  I know her money will not last and that eventually she will have to move again.  Change is extremely difficult for people with dementia.  Wouldn’t it be grand if insurances helped to pay for what really matters for people.  Dementia support and services are not covered by Medicare, but they would pay for an unending list of extremely expensive diagnostic tests, treatments and medications that would not make much difference for her at the age of 90.

After our introduction and  presentation, we asked our group of about 30 women, mostly nurses and other healthcare professionals,  about what worries them most.  This is when our session got really interesting.  First they wrote down their own worries in just a few sentences.  Then we gave them the floor, and they told us their worries.  WOW!  I still have a little lump in my throat.

Maybe nobody ever asked these hard working dedicated professionals this question, especially at a healthcare patient safety conference.  Their words validated my own worries and feelings, and they/we all validated each other.  It was a moving and emotional experience for all of us.  When a group of dedicated healthcare professionals say they are worried about something, everybody should be paying attention.

Our RCA organizer Stepanie Aines has compiled the list of worries from our session, and I am including them in this blog.  I am not shocked about most of these issues because I have worked in Patient Safety advocacy for 8 years now and I have heard most of them.  I was so moved because these people were so enthusiastic and candid about their worries, and everybody in the room understood each other.  We are all in this together, and that is the only way we can reform healthcare, together.  We will find trends and priorities and then go to work for change!

Poppy and I will be doing more listening exercises in listening booths over the next several weeks.  Right Care Action week is October 17 thru 21.  If anyone who reads this is interested in doing one of these activities themselves, in their place of work or some other setting please contact me or the RCA.  Links and contact information are at the end of this blog.  We are also working to form a Right Care Maine chapter and would love to have Mainers who want meaningful healthcare change to join us.

What worries you most about Healthcare?

These are the responses from our group of dedicated professionals.

Government – run healthcare

-Healthcare is a business-focus on profit making

-Pain management at end of life

-That a visit to the doctor will cost more than I can afford

-Not having an advocate when I can’t speak for myself

-Not having my wishes known

-1) Affordable healthcare during catastrophic illnesses. 2) There won’t be enough long term care beds available in the years to come with aging of Baby Boomers. 3) Proper placement of (human beings, real people) individuals relating to level of care, moving unnecessarily

-People I love being zombies – they are on wrong medications with awful scary side effects. Will that happen to me?

-1) Patients on too many medications. 2) Where meds are coming from now. ie clothes and other items must show a country of origin, meds do not, including prescriptions. 3) Healthcare is the only purchase that we make where we do not know the cost until after the fact. 4) The waste in Mainecare when a patient can come to ED at anytime where others with regular insurance have to wait because it is too expensive. 5) Hospital infections v. falls. My mother passed due to Central Line Infection,  Father from fall at a Nursing Home.

-1) Not having all the information to make an informed decision about my care or the care of a loved one. 2) Not being able to take care for a parent who has failing health and children who have their own needs (i.e. college tuition).

-1) Pain management in healthcare. 2) Staffing – staffing ratios increased pay for CNAs 3) lack of medicare support for assisted living

-  Loss of identity and decision making as well as ability to pay for healthcare as I age

-Unaffordable care – esp in negotiating for access to excellent care that is available to those who afford it (meds, tests, office visits, etc)

-Cost of Obama Care for retirees/folks on SSI – $700/month w/ huge co-pays and not all docs in network = substandard continual of care to folks that worked all their lives and paid into the tax system.

-Working too hard to put food on the table and to afford proper things for my kids that I’m too tired to be there emotionally and mentally for them and my husband. I fear working for those expensive, yet necessary things will take away from making a life.

-1) Affordable care. 2) My children won’t have resources and quality healthcare available to them. 3) High deductibles and HSAs are becoming the norm and more people cannot afford quality care. 4) Reimbursement from insurance companies is down – as a result quality practices cannot sustain practices.

-The lack of beds and help for treating patients with mental illness.

-Being stretched too thin. Having more and more tasks and responsibilities added that I cannot do my job safely. I am afraid that all the tasks will distract me from what matters most – patient care and safety.

-Medical errors in healthcare safety.

-Costs

-Available affordable healthcare for all.

Links:

http://lowninstitute.org/

http://rightcarealliance.org/

http://rightcarealliance.org/right-care-action-week/

https://usm.maine.edu/muskie/psa

Contact info:

kathydayrn@aol.com

parford@gmail.com

saines@lowninstitute.org

 

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Sepsis, a race against time

August 25th, 2016 No comments

The day after my 83 year old father was readmitted to the Hospital, where he had contracted MRSA pneumonia, he slipped into Sepsis.  He was extremely weak and feverish on admission, and they had put him through a lot of testing and diagnostics.  My mother and I went into his room after lunch and I immediately saw a change in him.  His skin was ashen, and he was hard to arouse.  His nurse, a freshly minted RN, was typing on the computer on wheels right next to his bed.  I asked her to check his vital signs.  She said, “oh, he is just exhausted because of all the testing”.  This was a reasonable excuse for his exhaustion, but I knew something was off.  I reiterated that his color had changed and he wasn’t responding to us appropriately.

Dad’s nurse checked his blood pressure and it was dropping very rapidly.  He was going into septic shock, part of sepsis.  She called for the crisis team and they brought the code cart with them.  While my mother and I watched, they injected life saving drugs and slowly brought Dad back.  He was transferred into ICU and kept there for several days.   Mum and I called the priest.

That was the most frightening day of my father’s illness.  Neither he nor our family were ready for him to go, and so he fought valiantly to stay alive.  His infection sapped his strength and he had become bedbound, but he lived for a few more months.   Rapid response of the hospital team brought him back from the brink of death.  Septic shock is a very dangerous medical condition.  Dad’s sepsis symptoms were very subtle, and without my intimate knowledge of my father, and my ability to assess his status as a nurse, his sepsis might not have been caught as early as it was.

This week, the CDC has raised the alert about Sepsis and how important it is for everybody, not just medical people, to know the symptoms.

http://www.cdc.gov/vitalsigns/sepsis/index.html

	Graphic: Healthcare providers are key to preventing infections and illnesses that can lead to sepsis.

 

Everyone should learn the signs of sepsis and be able to detect it in themselves or a loved on.  Sepsis progresses rapidly and it can affect major organs and/or cause death.  Rapid response to Sepsis is the only way to stop it.   It is indeed a race against time.