Monday 13 October 2014

Do you know why you are a nurse? When was the last time you acknowledged the choice you made to make a difference in the world? Being a nurse is usually by choice and not by chance. Take the time to connect with your reasons you chose nursing and make this a part of your mission statement to make a difference in the world of your patients and your institution. Nursing is at the center of the patient experience even when the world shines the spotlight elsewhere. This article touches on the competition within healthcare and nursing's role in keeping the focus on the patient experience.

This question came up recently when my mother went in for open heart surgery, "Why not be a doctor? Are you happy just being a nurse?" In the course of my mother's surgery, we approached the doctors and nurses on the team with questions, alternatives and options. During this dialogue one of the nurses asked the question I have heard many times during my career as a nurse, "why not become a doctor?"

Competition in Healthcare: Just a Nurse

Last year the Association of American Medical Colleges announced that US medical schools were on track to increase enrollment by 30% between the years 2009 and 2017. Medical school notoriously super competitive would now be opening up more seats increasing the odds of getting in.

For me, nursing was not a second choice to medical school; fear of not getting accepted or of doing the work did not keep me out of medical school. I chose nursing school and for 40 years, I continue to choose nursing as my profession despite having other options.

This question allowed me to reflect again on my decision to be a nurse and the advantages of this decision. It also had me think about this competition within healthcare. Are we not all on the same team?

It is true that physicians get the spotlight in any organization and in any breaking story about healthcare. Even in the current ebola crisis, it was physicians and the work they do that was highlighted, until a nurse became the first person to contract the disease in the US. And then the first response by physicians was to blame the nurse for a "breach in protocol" that exposed her to the deadly virus. This is a scenario that most nurses have experienced at some point in their career.

I remember working in an ICU and losing a patient after he bled out from his stomach, and as the doctor walked the family out of the unit, I overheard him say, "the nurse was not able to get the blood in fast enough..." I felt weak in the knees. I had been a nurse for about 3 years and loved my job and the challenges of blending the art and science of caring in an ICU. I, along with the team of healthcare professionals worked furiously to save this man. I had a blood bath to prove it and when the attending physician blamed nurses, I felt betrayed and confused. Weren't we all fighting for the same end - excellent patient outcomes? In this case, that meant life. This was my introduction to the blame game that does permeate healthcare. Does it have to be this way? I went to graduate school to better understand what was happening in this misguided competition between nurses and physicians.

Competition in healthcare needs to be between the disease and the healthcare system not within its ranks. What is even more important is to learn from every experience. Part of the problem is that nurses and doctors do not really talk to each other. When was the last time a group of MD's and RN's sat down and talked about what it was like for each in their role within your institution? I know when I was at the bedside, in the ICU, I attempted to organize such a meeting and it was quickly squelched by Administration. The explanation was, "no time." I think it is fear. Fear of losing control? The mere presence of fear means control is already lost.

Nursing by its nature puts the good of the whole in front of the individuals performing the duties. The spotlight for the nurse comes within the intimacy of the family unit when the effort and caring are acknowledged as making a difference in their lives. This is true for me and so many other nurses I have talked with. I love being a part of patient and families support system during difficult times of their life (or death).

Physicians are tuned into the disease process while nurses tune into the patient's experience of the disease. The climate today where medication and pharmacology rules has physicians fighting disease rather than supporting health. I chose to support patients during their disease and or struggle with health along the continuum of life. It is the innate strength of the patient that ultimately supports healing. I like being for the process of healing as opposed to fighting the disease.

And it is in finding balance that nursing excels. This is why I believe it is nurses that hold the key to improvements in the culture of healthcare and the end of competition. It is time to stand up, side by side with physicians as partners in the quest for health. It is time for nursing to shift the focus to health vs disease. Nursing is part of the healthcare team and yet quite capable of leading this transformation.

This question that prompted this post, "Why be just a nurse?," is a question all nurses should reflect on and then proudly claim. What are your reasons for becoming (and staying) a nurse? The passion for making a difference, for being on the team and by the side of patients is a worthy calling and one that has changed the world of millions of patients.

Saturday 29 March 2014

Maintaining Perspective

San Francisco de la Paz is a small town east of Tegucigalpa, Honduras. During the day it masquerades as a quiet community devoted to religion and agriculture. On good nights, the gunfire is but a soundtrack to adventure; far in the distance like corn kernels burning over an open flame. Other nights, the gunfire is so close that it consumes your every thought and move.

Regaining Perspective: My Path to Emergency Nursing

The morning after a fight, expelled bullet shells could be found just outside my window. The drug runners are nocturnal and sleep most of the day. Were it not for the lone day-guard across the street with a machine gun, I may have thought the gunfire was only a bad dream. Talk of the violence was rare at the school. Honduran teachers whispered quietly of murder for fear that I may overhear, feel unsafe and pack my bags and abandon the English program.

On a hot February afternoon I walked aimlessly home from school reflecting on an unusually productive day of teaching. It was as if the students could sense my frustration in their lack of progress. Taking pity on my restless soul they decided to give me one day of focus to make up for a month of lackluster learning.

As I approached the empty lot on my left, I noticed a set of eyes which normally would be fixed on the gringo walking home from school; however that day they remained fixed on the empty lot and a figure under a large piece of scrap cardboard. It wasn't until I was parallel to the figure that I noticed the blood pooling on one end and a mess of hair sticking out just far enough to be recognizable as a man's head.

In a rare event, a man had been murdered just a few meters from his house in broad daylight. They shot him several times and took the liberty of plucking his eyes from his skull, maybe a symbolic gesture to remind the rest of town to forget what they see.

In the morning Lydia and Miguel, brother and sister, were absent from school. It was their father that was murdered and dismembered in front of their house and within eyesight of their mother. That was the second funeral I had ever attended, but for Lydia and Miguel it would no doubt be one of many funerals they would attend in their lifetime.

There was no ambulance that day. The police didn't even show up to file a report for fear that they would be next. Their uncle would be the one to collect the body and ensure that it received a proper burial. Emergency medicine is obsolete in the rural Third World. Even if they could afford to run an ambulance, the nearest hospital is 4 hours away.

I fell in love with emergency medicine in Honduras, but I wouldn't realize it until I received a phone call just months after returning from Honduras. Luis Cardona, a teacher at the school, had been struck while riding his motorcycle. Although alive after impact, Luis was left on the side of the road while cars sped past too afraid to stop. After several hours Luis bled out. When the family finally noticed his absence and got word of the accident they arrived to the scene to find him dead.

I will always remember Luis the day he bought that red motorcycle and the freedom and youth he exuded as he sped away each day after school. He was truly beautiful and free in those moments. Timeless Like a picture or sculpture he remains captured within my memory.

As I learn each day in nursing school about the fragility of the human body I also am reminded of its resilience. I am reminded of all that a well trained professional can accomplish in the field. On especially hard days filled with petty, minute problems I try to regain prospective and be thankful that I am fortunate enough to have modern medicine at my fingertips and have the ability to solve big problems on a daily basis. Life, and the ability to save a life, is precious.



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