An Open Letter to Detective Jeff Payne – from a Nurse

An Open Letter to Detective Jeff Payne – from a Nurse

Dear Detective Jeff Payne,

When I was scrolling through my Instagram feed after a day of moving to our new home, the last thing I expected to see was a nurse being chased and handcuffed.  The last thing I expected to hear was a nurse sobbing and screaming as she was pinned against a wall with her hands behind her back. It was pretty upsetting.

After I saw the video, I read multiple news articles about it.  I read the American Nurses Association’s official statement and the statements from Mayor Jackie Biskupski and Police Chief Mike Brown. I tried to understand this as best I could after I saw that body cam footage. I appreciated their responses in how they are dealing with this in multiple internal and external investigations, policy changes, and communications.

Despite this, I just couldn’t get my mind around why this happened in the first place.

Why was handling this situation in that manner even an option to you?  It honestly seemed pretty routine to you. That is what was scary to me about this.  

The way you conducted yourself was pretty alarming, despite the fact that your mayor stated she’s been working with the police department on de-escalation techniques.  You seemed to be the one who escalated, rather than being the one who would facilitate de-escalation.  

Like Alex, I am also a nurse. I tell people no all the time. I don’t do that just to make things harder for someone else, I do it because it’s expected of me in many circumstances.  I promise, it’s not a power trip… it’s just necessary sometimes.  Just because someone wants something… or thinks they have a right to something doesn’t mean they actually do. And many times, it falls to the nurse to not only come to that conclusion, but communicate it, and deal with whatever negative response that comes with it in an appropriate and professional manner.  

It’s important for me to explain to you the mindset behind a nurse caring for any patient, but particularly an unconscious trauma patient who was the victim of a crime.

As a nurse, sometimes I feel like a gatekeeper or a bodyguard for my patient.  If someone wants something from my patient… if physical therapy wants to work with them, if the lab wants to get some blood, if a visitor wants to see them… they’ve got to go through me first. By utilizing my nursing judgement, I determine if it’s safe, appropriate, necessary, and in this case, legal.

I feel like their protector.  And I love it.  I love being able to stand up and care for someone when they can’t do it for themselves. I know their rights as a patient and I am grateful to be in a position in which I can protect those rights.  It gives me honor to do this.  

What makes this situation so upsetting is that I never thought myself or a fellow nurse colleague could be in danger of being arrested while doing what gives me so much honor and joy. I can deal with upset family members, angry patients, and irritated visitors. 

What’s terrifying is when someone who is in a position of power, like a detective, tries to use their authority to scare someone into complying with their request… even if they don’t have the right to ascertain this request. How can one enforce the law if they don’t know the updated policy?

Calmly handcuffing someone and putting them in a squad car is one thing. Chasing after someone and pinning them against a wall while they’re sobbing is another. This wasn’t some irate, belligerent person resisting arrest. This was a professional nurse with their supervisor on the line, surrounded by support staff, in their place of work, calmly talking to you.

If this is an acceptable level of force to use in a situation like this to you, I cringe at the thought of the person who doesn’t have support around them, who is alone, who has done nothing wrong, with whom you are upset, yet has the right to refuse a request you’ve made…

Like law officers, policy is something which also guides a nurse’s practice.  We are all too familiar with the world of policies. Policies are updated for a reason.  It is your duty as a prudent officer of the law to know them.  

As I am sure you are aware, police officers are held to a higher standard. In moments of frustration, anger, disrespect, and so forth, you are expected to possess your soul. It is a minimal expectation for you, of all people, to be in control of your emotions. While being a nurse and a police officer are not one in the same, there is some common ground as trusted civil servants held to a higher standard, especially in the midst of incredibly intense moments. This was no exception. Regardless of how frustrated you may have been, the fact that you went there demonstrated a lack of your ability to maintain your composure, which is highly concerning.

I’d like to believe that this incident wasn’t just as simple as you’re a jerk and went on a power trip.  While that very well may be the case, there’s also the possibility that isn’t the entire story.  When I saw it I had to stop myself from jumping to conclusions. I’ve never met you. I don’t know you, your personality, your faults, your strengths, your tendencies.  However, once seeing that video, I saw a part of you.  And now, I have so many questions. While none of the below would justify what resulted, it would help me better understand your mindset and what led up to this incident. I believe knowing these answers is essential to preventing this from happening again with yourself or colleagues when in similar circumstances. 

  • Were you already having a rough day before you got the call about the accident you had to investigate?
  • Was your supervisor pressuring you for the blood, and get it quickly?
  • Were you frustrated with how long it was taking you to get the blood?
  • Did you have any hesitancy or desire to explore why you were receiving such resistance from the nurse and facility? Did you care why?
  • Do you think they hospital wanted to comply with the law?
  • Practically speaking, how are you informed about policy changes?
  • Have you ever had to obtain blood from an unconscious patient who cannot give consent?
  • How do you, as an officer of the law, mentally and emotionally process frustrating situations in which you must maintain your composure?
  • When you made the decision to arrest, why did you immediately put your hands on the nurse rather than asking her to turn around and place her hands behind her back?
  • Is this how you were trained to deal with situations like this?
  • Have you ever escalated like this before?
  • If so, have you ever been reprimanded for it?

I just want to make sure you know also why this is so scary to the public and the nursing community. It’s not just a mistake at work, a misread policy, a lack of understanding that you can just move past and get back to work.  

You terrified that nurse. You terrified the public.

This is the opposite of what should happen with law enforcement. We’re supposed to trust you to do the right thing, to de-escalate, to maintain composure. This shattered that trust for many… and many who already have distrust in law enforcement just saw a detective terrify a nurse at work who was doing the right thing.

I think people assume officers of the law never respond to a frustrating situation with anger. Again, as someone who also deals with frustrating situations out of my control, I can get how things can go downhill quickly. I’m not naive enough to assume police never lose their cool. But the response shouldn’t be silence, it should be professional accountability. This is how change happens – when someone messes up, they make themselves an example of how mistakes should be handled. If you lost your cool and know you messed up, own it and apologize. This is how culture change occurs. I think what frustrates people is when someone in law enforcement does mess up, there is never a sincere apology or standing up to take accountability. It’s an official statement, administrative leave, and that’s that.  A genuine, sincere apology in which it is painfully clear that you accept the responsibility for your actions and are disappointed with yourself in how you handled this, coming from your voice alone, would speak volumes.

Maybe you’re not sorry. Maybe this isn’t a big deal to you.  I just need you to know that this is a big deal. This is a big deal to the public – and this is a big deal to the nursing community. There should be a collegiality between law enforcement and nurses and it feels like you grossly violated that.  Just as you would trust us to care for a fellow officer injured on the job, we trust you to know and protect our rights and the rights of our patients. Gaining that back after seeing this footage feels like an uphill battle. 

I’m hoping that whatever inside of you that caused you to respond in this manner is explored if you begin working again.  I’m hoping that this incident will cause the police department to evaluate if others act similarly and work to change the culture from the inside out.  I’m hoping this isn’t just a pause in work for you for an investigation to occur that you don’t believe is necessary, but a time for deep reflection, self-evaluation, sincerity, and humility.  

There is a real opportunity here for law enforcement and nursing to come together and demonstrate the respect we should have for one another and the value we place on our duty to serve the public. Please do not miss it.

Sincerely,

Kati Kleber, RN

 

 

 

If you want more background about the situation discuss above, this article from The Washington Post has a thorough summary.

To learn more about Kati, please visit KatiKleber.com.

Saving Sight – the Toyota Effect

Saving Sight – the Toyota Effect

This post was created in partnership with Toyota. All opinions expressed in the post are my own and not those of Toyota.

I recently was able to take part in reviewing a film created by Oscar-nominated director Kief Davidson.  It documented the experience at a busy eye clinic at Harbor-UCLA hospital.  Inefficiencies in their processes were leaving their patients waiting for months for appointments, and subsequently going blind in the process.

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Basically, Toyota stepped in and reviewed their processes.  Why Toyota, of all companies?  Why would a car company step into a hospital and shake things up?

I personally didn’t realize this, but Toyota has something called the Toyota Production System (TPS).  It was first developed in the 1940’s and is an integrated social-technical system that utilizes small, continuous improvements to facilitate high quality work.  They have been sharing this system with other industries, manufacturers, community organizations, and non-profits because they believe that when good ideas are shared, great things can happen.

Basically, they found something that works and they want people of all industries that can reap the benefits to do so.

So,  TPS + a busy eye clinic at Harbor-UCLA hospital = the elimination of a backlog of hundreds, HUNDREDS, of patients.  That’s pretty incredible if you ask me.

Check out this video that demonstrates their success.

http://toyota.us/1VHrTqI

UnknownDoesn’t that make you pumped?  I immediately was trying to think of things that could be improved on in my unit and came up with a bunch of practical questions.

Here are my questions and the answers from Susan Black (Chief Improvement Officer) and Dr. Pradeep Prasad (Chief of Ophthalmology) at The UCLA Medical Center about this process.

  1.  Did you see any push back from physicians, patients, or any other member of the health care team before, during, or after the process change?  

Change is always difficult especially for physicians and nurses who have grown accustomed to a certain operational flow for years (and sometimes decades).  The operational changes we made with Toyota are predicated on identifying high yield solutions, testing the results of those solutions and adjusting based on the test data.  As a result, initially, every member of our patient-care team experienced significant changes in their work-flow.  Some changes worked, others did not and, initially, the constant change was overwhelming and frustrating for some.  We have now reached a more steady-state in our operations and minor changes continue to be made but not on the same scale as the initial interventions.  Education was key to keep morale up and everyone dedicated to our end goal: to provide better care for our patients.  Toyota did a great job of educating all members of our clinic team (clerks, nurses, physicians, administrators, etc) regarding the TPS philosophy and how it could help us achieve our goals.  This big-picture approach helped us move forward when we felt like we were getting stuck in the weeds of operational changes.

2. Were there any changes that you would have liked to implement but were unable to do so?  (Due to cost, professional disagreements, etc.)

Overall we were able to implement most of our desired changes since they had more to do with work-flow than capital investment.  Part of the challenge, especially in a county-based safety-net hospital setting, is the limitation in terms of financial resources.  Could we be even more efficient with a re-designed workspace? Yes.  Could IT improvements help with our efficiency? Yes.  However these changes take time and money.  They are part of our long-term plan and the hospital administration has expressed a commitment to help us realize these goals in the long-term.  With that said, it’s been remarkable how much we were able to achieve with almost no capital investment.

3.  Was staff of any/all levels involved in the identification of inefficiencies, or did Toyota come in and observe and report their findings?

Yes, literally everyone working in the clinic was involved in identifying areas of improvement.  This wasn’t a Toyota consultation.  This was a Toyota skills transfer.  They educated us on the TPS strategy, guided regarding its implementation, and have now largely left it up to us to continue to improve.  This is far more valuable to us as an organization than simply prescribing a fix for our problems.

4.  Did your staffing levels change because the efficiency was so drastically changed?

Our clinic volume was already above and beyond our capacity with our old operational flow.  Now our clinical activity better matches our workforce capacity.

5.  Has there been another follow-up since the creation of the video to see if all changes stuck?   If so, how is the unit doing now?  What was their average patient throughput pre-intervention and what is it today?

We continue to find ways to improve.  A major change for our hospital was the implementation of an electronic medical record system about 1 year ago.   This change forced us to rethink some of our workflow and admittedly we took some steps back before moving forward.  However, had we not already gone through the Toyota training, the implementation of the electronic health record might have paralyzed us.  Instead, patient care did not suffer, and in fact, is much better now than it was a year ago.

This made me think. what other areas of the hospital can this be applied to?  What inefficiencies do I see that could be easily corrected and save my time, the health care team’s time, and streamline processes?  Change occurs so quickly in health care that you barely have time to react.  You are barely keeping your head above water as an end-user.

What would Toyota say if they saw your unit?  What changes would they implement?  Would it not only save time, but lives?  What do you think about this?

Coming up this Saturday on the Nurse Eye Roll blog:  a post about the recent ruling in California and a nurse’s viewpoint on assisted suicide.  Stay tuned!

Miss Colorado, Joy Behar, Michelle Collins, ABC’s The View – and a Nation of Nurses

Miss Colorado, Joy Behar, Michelle Collins, ABC’s The View – and a Nation of Nurses

Updated to Sept. 26, 2015

A lot has happened in the nursing social media world and I wanted to bring everyone who was working a 12-hour shift yesterday up to speed and didn’t get a chance to see what occurred.

Like many of you fellow nurses, I saw the beautiful monologue that Kelley Johnson, Miss Colorado, performed as the talent portion of the preliminaries for the 2016 Miss America competition.  She spoke about her experiences as a nurse and one patient in particular who suffered from Alzheimer’s.  It was quite touching and actually made me tear up.

If you didn’t have a chance to see it, here it is:

After the competition, nurses across social media were pretty pumped to see us so positively represented in such a large venue.  It made me pretty proud, honestly.

As they do with many similar nationally televised events, the ladies of the ABC show The View talked about the contestants.  They tried to make fun of the competition and competitors in their typically fashion.  They were trying to make it funny, trying to poke fun, trying to get people to laugh.

What they said

They praised some contestants and poked fun at others.

Michelle Collins, initially commended the contestant who sang opera. She then stated (paraphrasing) that Miss Colorado came on stage in her nurse’s uniform and “basically just read her emails,” (then laughed) and that it was “hilarious.”  Joy Behar’s initial reaction was, “why is she wearing a doctor’s stethoscope?”

Here is the link to the clip.  It is very short:

https://www.youtube.com/watch?v=WNQW9l5_2y4

How people reacted

Well, the nurses of America (and other countries as well) were not amused.  Family and friends were not amused.  Physicians were not amused.  Additionally, (and potentially the most upsetting) loved ones of patients suffering from, or who had succumb to, Alzheimer’s and dementia were not amused.

It didn’t take long for it to catch fire on social media.  Both “Joy Behar” and “NursesUnite” was trending on Facebook by the end of the day.  The video clip from the episode of The View has had over 1 million views in 24 hours.  A Facebook group entitled Show Me Your Stethoscope was created and had over 200,000 members in less than 24 hours (it now has approximately 800,000 members).  The View’s Facebook Fan page had post after post of nurses issuing complaints and explaining their thoughts.  If you follow more than 2 nurses on any social media platform, you’ve probably already seen that Twitter, Instagram, Facebook, and Tumblr are all flooded with pictures nurses, student nurses, CRNA’s, PA’s, NP’s, surgeons, CNA’s, CMA’s, and physicians from tons of different specialties in their stethoscopes.

Big advertisers started pulling their ads, posting on social media about how they respect and honor nurses.  Such companies include Johnson & Johnson, Party City, Eggland’s Best, to name a view.  It was pretty awesome to see such a big response from huge companies.

Dr. Oz did an entire show about nurses and filled the seats in his audience with nurses.  He’s even issued a campaign to find a nurse to add to his panel of experts (#NurseSearch, #NurseNation)!

The Doctors did an episode called The Nurses and featured four different nurses (including my bud, Nurse Mendoza, the YouTube nurse!) and Kelley Johnson herself.  So cool.

Was it really a talent?

The second half of the discussion online was if this monologue about her job was really a “talent” per say.  Many contestants typically perform such talents as dance, vocal and musical performances as well as acting/dramatic readings/monologues.

Michelle Collins, one of the co-hosts, later tweeted (and subsequently deleted) the following:

Screenshot 2015-09-16 10.44.59

From reading these tweets, I believe that Michelle assumes that all “jobs” are created equal and that it’s okay to make fun of people, regardless of how disrespectful it is, for the sake of comedy.

Just to clarify – they are not.  And comedy/poking fun/making light of certain things does not mean you have license to say what you want, and when others are deeply offended you can just tell them to relax.  That’s not how this works.  That’s not how being a considerate and respectful human being works.

Nursing is a talent

I argue that nursing is a talent.  Nursing takes talent.  Furthermore, getting up on a stage in front of thousands of people and articulating a moving and profound experience in an eloquent manner takes talent.  A talent in which I do not posses.  You don’t think nursing takes talent and it’s just someone talking about their job?  Is your job the most trusted profession in the country, “with top marks for honesty and ethics”?

If you’re not a nurse, you can’t say that it is.

Nurses care for patients that are dying, being born, slowly losing their mind, children that are suffering from cancer.. Nurses pronounce children and adults deceased and comfort the family.  Nurses clean up patients that have lost all control of their bladder and bowels with respect and dignity.  Nurses feed their patients before they feed themselves.  Nurses take their patients to the bathroom when they themselves have not taken a bathroom break in 9 hours.  Nurses drive to the homes of the dying to hold their hand and make sure they are comfortable.  Nurses are in the military, caring for wounded soldiers right this very second.

Not just anyone can be a nurse.  Just because you want to become a nurse does not mean you will become one.  Getting into school is very competitive.  It is a strenuous process followed by a really tough exam.  If you land a job after graduation, it the followed by a very grueling on-the-job training process.  Not everyone can handle it.  Not everyone is cut out to be a nurse.

In short, nursing is not just a job.  Nursing isn’t even a career.  It is a calling.  It is a lifestyle.  It is who we are.

Stock brokers manage finances and talk to clients about what shares to buy and sell.  I mean no disrespect to stock brokers, but a monologue about buying and selling stocks versus about connecting with a man who is slowly sinking into Alzheimer’s and proving care for him are two very, very different things.

What I believe should happen

After the episode on Sept. 15, Joy was pretty quiet about everything.  However, Michelle hopped on Twitter and made some additional statements that were also insulting, and when you watch the clip you can see she spear-headed the disrespectful commentary.

A response (not an apology) was issued on The View but it was pretty disappointing/nonexistent.  Apparently they felt we were not listening and are overly sensitive.  The words “sorry,” or “we apologize,” etc. were never uttered.  All 2.7 million of us that heard this apparently were “not listening,” as Whoopi Goldberg said it.  The problem was that we were listening, intently.

I don’t know about you, but I felt like Whoopi Goldberg was scolding our entire profession.

There was even more backlash after this response on their show because it was so insincere.  The next day, they had nurses come on stage and accept another attempt at an apology.  Again, it wasn’t that awesome.

I believe The View should send those the hosts who commented (Michelle, Joy, Raven, and Whoopi) to a pediatric oncology unit and have them interview the parents about their nurses.  Or send them to a surgical-trauma intensive care unit and see what the patients and families have to say.  They should film their conversation and reactions. They should then follow a nurse in a busy nursing unit for a full 12-hours.

Katie Duke, do you need a few people to shadow you for one of your overnight shifts in NYC?  Or how about Nurse Mendoza in his cardiovascular intensive care unit?

Here is a link to the first response to the social media backlash.

https://www.youtube.com/watch?v=XC5Up1paKdc

At least Michelle isn’t on Twitter telling 2.7 million nurses to relax anymore.  Honestly, I’m a little more offended at this apology than the original comments.  But, what can you expect?  Making fun of people is how these women make a living.

Michelle, I did want to say something specifically to you in response to that tweet yesterday about nurses having hidden anger.

Nurses do not have hidden anger.  We are passionate.  We care deeply about our patients and become fiercely defensive when they and their experiences have been disrespected.  This passion “is not a little funny” – it is necessary to appropriately advocate for our patients when they are being disrespected by individuals such as yourself.  I pray that if you are in the hospital and need a nurse to advocate for you to a physician or a family member that they will be as fierce and unrelenting as the response has been on social media.  Because you, as the patient, and your needs/well being are of utmost importance to us, regardless of what you may think of us.

Alas, the damage has been done.  The way they feel about our profession and lack of understanding of the depth of what we really do was clearly not impressed upon them.  I would be very interested to see what happens to their ratings after this issue.

The one amazingly beautiful thing to take away from this is that NURSES ARE UNITED.  Mess with one and before you know it, 2.7 million are backing them.  I was blown away at how amazing the nurses of the world are.  I mean I knew we were awesome, but this was amazing.

I personally believe we should use this momentum to make necessary changes to our field.  I believe that nurse to patient ratios should be legally mandated.  I believe we have the power to facilitate this change.  If you agree, please sign this petition to provide the collective power and support, that we provided Kelley, to our entire profession:  https://petitions.whitehouse.gov/petition/provide-federal-legislation-nurse-patient-ratios

Go nurses!  We can do this!

People doing it right in the media

Just in case this has left you with a bad taste in your mouth, I want to share two videos from celebrities that have a deep and profound respect for nurses.

Here is Lawrence O’Donnell on MSNBC talking about his recent experience with nurses:

And here is Tracy Morgan, talking about his experiences in the intensive care unit with his nurse when he was hallucinating and scared.  He starts talking about his nurse specifically at about the 4:30 mark.  Also, it’s impossible not to cry during this.  I’ve watched it 10 times and cry every single time.

You’re awesome to me

In conclusion, I just want the 2.7 million nurses in America (and all of you international nurses as well!) to know that you are amazing.  And I appreciate you and the care you provide your patients, even if a group of women making jokes doesn’t.  And Kelley Johnson AKA Miss Colorado, thanks for your outstanding monologue.  You make me proud to be a nurse.

I was personally offended at both the original comments and the subsequent “apology” – I did not watch The View at all before and will continue to avoid that show and the women that have chosen to host.

My name is Kati Kleber and I am a bachelor’s prepared, nationally certified critical care nurse and nursing is my talent.

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Another Open Letter to Nurse Nina

Another Open Letter to Nurse Nina

Today I read this article in the Dallas Morning News entitled Free of Ebola but not fear, Nurse Nina Pham to file lawsuit agains Presby paren, worries about continued health woes by Jennifer Emily (thank you Katie Duke, for sharing).  Nurses and nursing students, please read it.  

Hey Nurse Nina,

My name is Kati and I’m a fellow critical care nurse. I wrote a letter to you on my nursing blog back when all of the Ebola stuff was happening in the news. Today I’m reminded that when someone goes through something traumatic and painful, not only do they need support and encouragement in the midst of it, but also after the dust settles.

I read the interview you did with the Dallas Morning News. I read and reflected. I put myself in your nursing shoes (Danskos, right?) and tried to think about how I would feel. I, too, have cared for someone shift after shift, only to watch them die before my eyes. The images of patients in their final moments struggling to breathe, their hearts stopping, and their skin turning ghostly pale, will be burned in my mind for the rest of my life. Being a nurse comes with a heavy, heavy burden.

I can only imagine how difficult it was to watch Mr. Duncan die.   I know you formed a bond with him, cared for him, and were there for his most intimate and vulnerable moments. I’m sure he talked to you about death. I’m sure he cried. I’m sure you held his and hand reassured him. I’m sure your heart was ripped in half, left to lie on that dirty isolation room hospital floor.

Every day as a nurse, I try to disconnect the dots so I can be more emotionally available for my patients. I pretend that it’s not a possibility for me to contract or experience whatever it was that got my patient into intensive care. Being slightly detached from reality while I’m trying to critically think about all the things I need to do during a shift…making sure my medications are all appropriate, vital signs are stable and treating them appropriately as they become unstable, calling the physician when something is wrong, emotionally supporting the patient, coordinating care with an entire health care team, and basically making sure every single need of that patient is met…is a survival tactic used by many nurses. Doing so with Mr. Duncan was probably a challenge, however I cannot imagine how difficult it was to watch the patient you bonded with die before your eyes, only to find out that you were infected with the disease that killed him.

That’s absolutely terrifying. I watched the situation unfold like the rest of the world did; through the eyes of the news. From my perspective, you handled the entire situation with bravery and grace. I was, and still am, proud to share your profession.

I’m upset for you

However, when I read in your article that you specifically requested multiple times to remain anonymous, yet Gary Weinstein MD, your treating physician, filmed you without your consent and the hospital published the video, I got hypertensive. The second you went from nurse to patient – things should have changed completely. If your name was to be private, that should have been respected. Your role as employee and nurse ended, and at that moment you had become a patient of that hospital.

Sadly, at that point you were not a patient to them. You were an opportunity to make them just not look so bad. I wish they had used that opportunity to support and protect you, not exploit you, after you risked your life to care for Mr. Duncan.

I cringe – in anger and frustration. I am furious that this organization, together with your physician, created an instance to obtain a video of you despite your repeatedly expressed desire to remain private, as well as lied to you and used it to make themselves look better.

That seemingly private moment of you in your hospital gown in tears was obtained and mass distributed illegally. Every nurse and nursing student in this world understands how unethical and illegal that is.

You trusted that physician with your life and he exploited you to make the hospital look better. He should be fired. The group of hospital employees that facilitated the making and distribution of that video should face an investigation and they should all lose their jobs.

They kept identifying you as a nurse, but at that point, you were a patient. With a right to privacy. And that was horribly violated.

We live in a society in which a nurse can get fired in the middle of a shift for re-posting a picture that a physician posted online, but a physician can lie to a patient and film them without their consent, and mass distribute it to all major news networks, and still have a job.

I am appalled at Gary Weinstein’s lack of professional judgment and violation of the Hippocratic oath.

I am horrified at the complete disrespect of you and the violation of your privacy.

I am also upset that you were put in that situation – not being adequately prepared to safely care for Mr. Duncan. I respect and understand the duty you felt to do your job as a nurse and continue to care for him.  I would have done the same thing.

I want to publically say thank you for caring for Mr. Duncan. Reading that article about how emotionally difficult it was to care for him, how physically and mentally exhausting it was dealing with the isolation process and waste…I could see and understand it in a way that probably all of the nurses in the country could. We understand what all that entails and how difficult it must have been.

I want to encourage you

I also want to encourage you. There is a nation of nurses out here, standing with you. We support you. We are thankful for you. We are happy that you have physically recovered, and are praying for mental and emotional healing. I know court proceedings are a tough process, and I pray that it will go as smoothly and as quickly as possible.

I know your life may not feel like your own at this point. You worked your butt off in nursing school, became a nurse, and suddenly you have this traumatic experience and you’re left to figure out what’s next.

There is an amazing and supportive community of nurses on social media. Twitter, Facebook, Tumblr, and blogs all contain so many amazing nurses that understand what you went through. I want to encourage you to get involved and see this world of supportive nurses online. We want to stand with you against this injustice because you are one of our own. And you did not deserve to be exploited so a hospital could attempt to save face.

You will overcome this. You will do, and have done, great things. “He who is faithful with little will be faithful with much,” and you were faithful and diligent with Mr. Duncan and his care.

Do not despise the day of small beginnings, because through this you will rebuild and do even greater things. Rejoice in life, health, and Bentley.   You are so awesome and brave to me.   I don’t know you personally, but I am proud of you. Proud of the example you have provided as a nurse. You’ve handled everything with dignity and grace.

I know you publically mentioned relying on God to get you through this. I read a verse today that I thought might encourage you.

“.. we know that suffering produces perseverance; perseverance, character; and character, hope. And hope does not disappoint us, because God has poured out his love into our hearts by the Holy Spirit, whom he has given us.” Romans 5:3-5

If you’re ever in Charlotte, come hang out with me! I’ll take you to get some delicious Charlotte food and my dogs would love to snuggle you.

We support you

And now I want to address the rest of the nurses in the nation. I want us all to stand with Nina…throughout the trial she will face, as she recovers from this trauma, and as she fights this horrible injustice. We are constantly told how essential HIPAA is, that our patient’s privacy is of the utmost priority, that we will lose our jobs for exposing our patient’s private information – and this hospital and her physician, leaders of the institution, severely violated her basic right. I know you are as disgusted as I am. I want nurses all over the country, and world, to write notes of encouragement to Nina. I want our voice heard as a nation and world of nurses both in support of her hard work as a nurse, and as a patient who deserved her right to privacy. Just because she was a nurse employed at that facility didn’t make her any less of a patient. I want us to fight for her like she is our coworker and our patient.

I also want to acknowledge and support Amber, who also contracted Ebola. I can only imagine she is having a similar experience since the Ebola dust has settled in the United States. Know that we uplift and support you as well.

All the best,

Nurse Kati

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Nurses on the Front Lines: How Do You Handle Patients Addicted to Prescription Pain Killers?

Nurses on the Front Lines: How Do You Handle Patients Addicted to Prescription Pain Killers?

Have you seen this video posted on KevinMD this month about drug seekers in the emergency department (ED)?  Take a look at this 4:31 video made by an ED physician.  Spoiler alert! If you love Taylor Swift, you will totes love this.

 Disclaimer:  If you are someone who does not manipulate physicians and nurses to obtain narcotics, then this video does not apply to you.  This video is referring to people that are not in physical pain; they are addicted and will do anything to obtain these substances.

This satirical video discusses the epidemic in America of prescription drug abuse.  As a bedside nurse, many have attempted to manipulate me into receiving copious amount of pain medication.  Conversely, I have also advocated many times for appropriate pain relief.  There are definitely two sides of this issue.  Regardless of the situation, opioid pain medication abuse is truly an epidemic in America and we, as nurses, are on the front lines.

After reading the comments on the video, I realized that people in society don’t see what we, as health care providers, see every single shift.  Most people don’t see or realize how many people really are addicted to these medications.  However, those of us that work in a hospital and administer medications see it all the time.  The scenario discussed in the video (the man back in the same ED again, saying he lost his pills even though he was prescribed many recently or that they only lasted a day, requesting medications by their street name) happens many times in the emergency department every single day.  It happens in the clinics.  It happens on nursing units.  It happens everywhere, all the time.

Every day 46 people die from an overdose of prescription pain killers in the United States

The Center for Disease Control discusses this issue in depth here.  Take a look at this graphic.. for every single person that dies from an overdose, there are 825 people that use narcotics who are not using them for their intended purpose, and 130 people that are abusing the substances/are dependent.  WHOA.  That is an insane number.

photo credit: Center for Disease Control, http://www.cdc.gov/homeandrecreationalsafety/rxbrief/

photo credit: Center for Disease Control, http://www.cdc.gov/homeandrecreationalsafety/rxbrief/

So, as health care providers we’re stuck between a rock and a hard place.  You cannot believe every single person – otherwise the death tolls from overdoses would skyrocket (even more so).  But you also can’t NOT believe everyone either, because many people are truly suffering and need pain relief.  Desperately.

It’s hard because as the nurse you feel like you can’t win.  You either believe everyone or you believe no one – it’s so hard to discern who truly needs it and who is lying to your face.

Just give ’em what they want

I know what some of you may be thinking, “why can’t you just give them pain meds when they want it?  Is it that big of a deal?”  Yes.  It is a huge deal, guys.  The type and amount that people request by name is astonishing.

Patients know which medications and which doses to request specifically.  Some will claim they are allergic to all pain medications except the heavy hitters and claim they need high doses to feel any relief at all.  Some will say oral pain medication won’t do and demand IV pain medication until the physician says they can go home and suddenly Norco will do just fine.  People know what to say and how to say it so that you’re left with no other option but the most potent pain medication in the highest allowable dose.

Additionally, these medications are no joke.  They are chemically very similar to highly addictive street drugs.  For example, we give a medication called Fentanyl frequently in intensive care.  It provides great pain relief for those in severe acute pain (think multiple broken bones after a car accident with a breathing tube), during bedside tracheostomy placements, for managing chronic severe cancer-related pain, or with hospice patients, but not appropriate for many other scenarios.  The Institute for Drug Abuse noted that, “Like heroin, morphine, and other opioid drugs, fentanyl works by binding to the body’s opiate receptors, highly concentrated in areas of the brain that control pain and emotions. When opiate drugs bind to these receptors, they can drive up dopamine levels in the brain’s reward areas, producing a state of euphoria and relaxation” (2012).  It causes people to relax so much that causes respiratory depression.  Your respiratory drive can be so suppressed that you just stop breathing.  And you die.

Also, did you note that they compared it to heroin?  Heroin, guys.  Heroin.

We would be negligent health care providers if we pretended this wasn’t a problem and just continued to give a script to everyone claiming they needed one.  People are literally dying because of this.

Here’s another phenomenal article written by a physician that explains this epidemic in a really black and white, evidence-based sorta way.

Why does this happen?

A few years ago, a nurse from the United Kingdom was shadowing on our unit.  I was curious about her thoughts on socialized medicine and our health care system in America, so I asked what she thought about working as a nurse in both systems.  Her response surprised me, as we weren’t talking about pain medication at all.  She said, “when I got to America and started working, I was absolutely astounded at how much IV pain medication is given.  In the UK, patients never get IV pain medication, everything is oral and rarely are narcotics prescribed.  I just couldn’t believe it.”

Needless to say, that’s not what I expected her to say.  I just assumed that everyone, everywhere, administered pain medication this way.  I had no idea people handled pain differently outside of America.

So, why does this happen?  Why America? Why us?

An interesting thing to consider is the influence of the Press Ganey Patient Satisfaction survery.  These are surveys given to patients after their visit to a medical facility.  In most facilities, an aspect of reimbursement from the government is based on patient satisfaction.  So, if your patients are happy, you get reimbursed for the care you provided (this applies to physicians and nurse practitioners/physician assistants, and hospitals as a whole, not nurses individually).  Keep in mind, this is just an aspect of reimbursement.

So the scenario is that a patient comes to a medical facility with their mind made up on what they need.  They think they need an antibiotic for the minor viral illness from which they’re suffering.  Or they decide they need 2 mg IV morphine for their sprained ankle and a Percocet script for the road.  And if they don’t get what they’ve decided they wanted, even though it is not medically appropriate, they will fill out a negative Press Ganey survey after their visit.  The hospital is then not fully reimbursed for this visit, and therefore suffers financially.  Physicians are encouraged to increase their Press Ganey scores.. but how does one go about doing that exactly?

Now, I’m not saying that these surveys are the direct cause of this epidemic in America, but it is definitely something to consider.

Here’s an article entitled I’m Addicted to Prescribing Pain Medications, written by a physician experiencing this stressor.  And here’s another article written by a physician called Why Patient Satisfaction Surveys are Riddled With Problems, which explains surveys a little more in depth.  And according to a 2014 article in Medical Economics, two US Senators are urging the Centers for Medicare and Medicaid (CMS) to investigate if Medicare’s patient satisfaction surveys are contributing to the abuse of prescription opioid pain relievers.

This is a very real and very serious issue that has not only resulted in deaths of epidemic proportion, but it also negatively affects the physicians being pressured into prescribing and the nurses manipulated into administering these medications.

What about the nurses that are actually giving the medications?

In nursing school, you’re taught to believe everyone when they tell you they’re in pain.  And let me tell you, it’s not as easy and straight forward as it sounds.

It is truly stressful when you’re caring for an unstable patient and their  family, and your other patient hits the call bell every 2 hours, on the dot, to remind you to bring in their 2 mg dilaudid, 50 of benadryl, and 25 of phenergan, and to push it fast … all while their vital signs are stable, and they’re talking and laughing on the phone.  And this was after a standard procedure that typically has minimal pain and they have no medical history.  You ask them to rate their pain on a scale of 1-10, 10 being the worst pain in the world and they rate it a 12, as they yawn and send a few Snapchats.  You defer to the doctor, who then discontinues the medications.. and then it’s your job to tell the patient.. who is not happy and says the oral medications you give never work and they must have IV medication.  And they demand you call the doctor back.

You feel manipulated.  You feel tired.  And your other patient needs you.  You just don’t know what to do.

Let me tell you – nursing school did not prepare me to handle patients addicting to prescription pain medications.

How do you handle this?

So.. what do you do?  Have you ever been in a similar situation? What did you do?  What worked, what didn’t work?  And have you ever thought that you were being taken advantage of but you misjudged the situation and the patient actually was in pain?

How many of you actually gave the patient the ordered pain medications, only to get yelled at by the physician for over-medicating them?  Been there.  That was so defeating.  What a terrible bind to be in.

And to those of you that are not nurses in America – how do you handle pain management in your country?  Do you administer IV pain medications frequently or is that unheard of?

Again – I realize so many people are in real pain and I don’t want to take that away from anyone.  I want to use this post for nurses to talk about how they manage pain within this specific patient population and how they professionally and respectfully handle patients that repeatedly request/demand/pressure them into administering alarming amounts of pain medication.  

I am a nurse.  I want to care for the sick.  I want to alleviate suffering.  I want to emotionally support patients and their loved ones.  For those that are addicted, I want them to receive the specialized rehabilitation they so desperately need in the appropriate setting.  Not in the emergency room.  I don’t want to spend time arguing with someone demanding an unsafe amount of pain medication, when I could be hugging the crying daughter whose mother is dying in the next room.

Note:  all sources that were cited contain links to the original article

Addendum:  Beth over at nursecode.com posted about this topic as well!  Here’s her article, which I think you may find helpful!

From One Nurse to Another: An Open Letter to Nurse Nina

From One Nurse to Another: An Open Letter to Nurse Nina

Hey Nurse Nina,

My name is Kati and I’m a critical care nurse in Charlotte, NC. I hope you’re able to read this in your isolation room. I hope some thoughtful soul gave you a computer so that you can do something to pass the time. Let me know if you need some Netflix recommendations, as I am well versed.

My city is preparing like many others, getting isolation units ready and training staff. I can’t help but have your nursey heart on the forefront of my mind as we prepare.

I wanted to let you know that this nation of nurses stands behind you. We commend you for going to work, putting on your protective equipment, and putting your life at risk to stand at the bedside of a deathly ill and contagious patient for twelve hours at a time.

Thank you.

We know how tedious and difficult it is to put and take off on full protective gear over and over again. We know how hot, sweaty and unbearable it gets. We know what it’s like taking care of critically ill patients with constantly changing needs. We know what it’s like standing beside someone for hours at a time, knowing that life is slowly leaving his or her body. We know how much that hurts mentally, physically, and emotionally. We know all of the painful little details of what it’s like to be a critical care nurse. But, because we are nurses we are expected to deal with it with a smile on our face and carry on.

I hope you’re doing the best you possibly can be, kicking Ebola’s butt. I hope your nursey vitals are stable, your labs are improving, and that you’re playing pranks on all of the nurses caring for you. Try to resist the urge to interpret your own telemetry strip.

I’m sure those sequential compression devices are getting annoying and you’re super tired of that hospital bed. We are all praying for a quick and complete recovery.

Also, how awesome is that doctor that donated plasma to you? Major nursey respect, doc. Nurses everywhere love you.

I know that having one of our own nurses fighting this battle hits us all close to home. We all know and accept the risk of caring for people when they are ill. It saddens us when one of our own has been afflicted.

Thank you for caring Mr. Duncan. Thank you for putting your life on the line to provide care for another. I know it’s just part of our job, but it’s a job not everyone is willing to fill.

I also want to thank the nurses caring for you right now as well. You’re all on the same team, #TeamNina – and we’re all praying for the safety and health of the nurses at your bedside and as well as your complete and nursey recovery.

We salute you. We stand with you. We are praying for you all. And we are rallying behind you all.

And hey, #TeamNina – you’re so awesome to us.

From a nurse and her pup to another nurse and her pup, hang in there!  (I promise he’s enthusiastic – he’s just being a grump right now)

Stay nursey. Stay strong.

Signed,

a nation of nurses and their pups

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FreshRN Weighs in on MTV’s Scrubbing In

FreshRN Weighs in on MTV’s Scrubbing In

FreshRN Weighs in on MTV's Scrubbing In

After I saw all the buzz on Twitter about a new reality show, MTV’s Scrubbing In, I thought I should check it out.

I didn’t have high expectations, given that it’s MTV.

I guess I went wrong when I assumed it was a reality show about nursing when it’s actually a reality show about people who all happen to be nurses.

MTV’s Scrubbing In

It’s essentially a group of attractive 20-something nurses all on the same travel assignment that lives in the same apartment complex.  It shows some shots of them at work and in scrubs, but it’s mainly about what their life is like outside of the hospital.  It’s no surprise that these 20-somethings like to go out and party and that it is a priority.  And it’s also no surprise MTV does what it does best and plays that up, along with interpersonal drama, to make it seem more than it really is.

When you watch the show, you can tell how they’ve edited and planned certain things to create drama.  A girl got mad and said some mean things to a guy and then later apologized to him.  (I don’t think that’s a big deal in life, but that was a huge part of the episode.)  They did a segment on girls shopping for skimpy clothes.  They had another segment on a guy cheating on his boyfriend.  They had a spray tan party where they all got naked.

Ok, MTV, you’re getting really obvious about your whole “sex + drama = great ratings” thing.

Yes, we as nurses are people that need to blow off steam and vent because we work in a really tough field.  We see people in pain, code, die, or find out they’re dying, and that’s just a regular Tuesday.  And that is tough.

However, we as health care professionals, need to be careful how we blow off steam.. especially when the whole nation is watching.  And someone is editing.

Otherwise, we compromise our credibility as safe and competent caregivers.  And this doesn’t just reflect on the individual, but the profession itself.

So, MTV.. you didn’t surprise me.  I figured it would be more about sex, drama, and ratings, than good nurses caring for their patients.  I was just really, really hoping you were better than that.

Because of this show, I now feel that I have to work harder to maintain my credibility as a competent nurse with patients and families that have seen the show.  That shouldn’t happen to a profession in which peoples lives are in your hands every day.

If you want to see a reality show about hospital life and nursing in the most accurate, respectful,  and amazing way possible, then you need to watch NY Med.  (It’s on Hulu!)

They’re getting puked on by a guy with HIV + Hep C, deathly ill and sassy ladies are yelling at them, they’re doing chest compressions on someone they know, they’re putting spit-masks on people, they’re getting orders for scrotal elevation on combative patients, getting hit on by silver foxes, and crying when they meet the patient whose life they saved just 48 hours ago.

And, more importantly, they’re nurses that I would trust with my loved ones.

That show makes you trust and respect our profession more.

Sigh.

How beautiful is that?

Nursing is real.  It’s hard.  It’s terrifying.  It’s difficult.  It’s rewarding.  It’s hilarious.  It’s fun.  It’s exciting.  It’s sad.  And it’s serious.

Anything that portrays it as less is a disservice to our patients, their families, and ultimately us.

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