McCleary MRSA Prevention

Oxford 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.