Misuse of Resources

I was always told I could do anything I dreamed. I tested out as a gifted student at an early age and have generally kept the company of "brainy" students my entire life. Many of my classmates and friends have already moved on to graduate study in their various fields, some even to medical school or law school. I am somewhat behind them, and will be completing my undergraduate degree after 11 semesters of study instead of the typical 8. (This is due to a combination nontransferable credits and some initial meandering through majors). Yet I am anticipating my graduation next August with great enthusiasm. I feel like becoming a nurse will be a real accomplishment. Though I'm still somewhat surprised to realize it, it is one of my dreams.

I often speak passionately to others about my calling. But this weekend, while I was visiting extended family and friends, I was somewhat deflated by their questions about my career. "Why aren't you going to medical school?" they'd ask.

I made a bunch of standard arguments, mostly centered around the saying "Doctors cure but nurses care". I explained that my desire is to work with people holistically and individually. I want to be present. And I am far more interested in the human elements of health care than the scientific ones. While doctors can do those things, nursing just feels like the best fit.

But none of these arguments seemed to phase them. They couldn't grasp why I'd become a nurse instead of a doctor when I was obviously bright enough to be the latter. They cited a myriad of reasons it would be better for me--most of which boiled down to a supposedly "superior lifestyle". But the one thing that really stuck with me was the phrase "Just wait, you will always be subject to people who are less than you."

I can't help but be upset by the entire perspective. It feels wrong on so many levels.

For one, I don't think a "smart person" going into nursing should be seen as a waste! If I succeed--and I plan to--it will only do credit to the profession, not discredit me. For another, I don't think money is a good reason to choose any career. And perhaps I am naive, but I haven't exactly found nurses to be totally subject to doctors. Nurses seek to be collaborators in patient care; this is the meaning of professionalism. True, some physicians still try to walk all over supportive staff. But people who work in hospitals know it's far less challenging to work with doctors than it is to work with patients! "Subject to those less than you"? Obviously! (Just not how you'd think!)

It's very discouraging to be told that you are, in essence, misapplying your potential. But the thing I think others are overlooking is the fact that my gifts aren't limited to the deduction logical puzzles or the intuitive grasp of certain subjects. So what if I took a test when I was a child that indicated I had some above-average abilities? I have developed others as an adult that are far more important to a meaningful life. They're the more immeasurable qualities of the heart... they compel me to extend my hand to strangers and to listen with compassion. I may not always succeed, but I am a person who is not only able, but willing!

Surely that means more than the money I could have made or the power I could have held. It's not a lack of ambition that set me on this path. It's because I feel like if I place more value on relationships than the other factors, I can't really go wrong. I will have enough money and responsibility. But I will have an abundance of friendship and respect.

Again, it is totally possible for doctors to be and do all the things I describe in addition to their regular jobs. But for nurses, that thing is their job. I watch them while I work. I see what each professional does. And I don't regret my choice, not even a little. Because I know who and what I am.

Resarch Study and Commentary by Dana Rutledge, Phd, RN, Nursing Research Facilitator

RESEARCH STUDY AND COMMENTARY

Schulman-Green, D. et al. (2005). Unlicensed staff members’ experiences with patients’ pain on an inpatient oncology unit. Implications for redesigning the care delivery system. Cancer Nursing, 28, 340-347. Staff at SJO/CHOC can access the full text of this article through the library's web site.

Authors’ Abstract

Although unlicensed staff have routine contact with patients in pain, little research relates to their role with these patients. The purpose of this study was to describe the experiences of unlicensed inpatient hospital staff caring for cancer patients in pain. We sought to understand pain identification and communication practices, describe common practice sitaut9on, and identify training needs. We conducted 4 focus groups with unit secretaries, nurses’ aides, and housekeepers (n = 24) on 2 inpatient oncology units at an urban, northeastern teaching hospital. Group processes were tape-recorded, transcribed, and analyzed using Atlas/ti software and content analysis. Analysis generated 5 issues related to pain in the daily practice of unlicensed staff: perceived function with pain, building relationship with patients, interpreting patients’ pain, system issues, and job challenges and coping strategies. Unlicensed staff reported performing important functions related to pain, including alerting nursing staff to patients’ pain, and providing psychosocial support. Participants shared difficulties of working with patients in pain an expressed interest in education on pain identification and course of illness. Findings provide insight into the role of unlicensed staff, and have implications for the educational preparation of this group as well as the nature of their participation in the care delivery system.

Commentary by Dana Rutledge, PhD, RN, Nursing Research Facilitator

In this qualitative study, researchers described results of focus groups of unlicensed hospital staff who were asked about experiences with patient and pain. Nurses might be surprised at some of the important ways these staff perceive that they impact pain and its management. Patient care assistants (14, the largest group of staff) noted that they were assessing pain using the 0 – 10 score at the time they did vital signs. They reported having difficulty identifying the nature of pain when patients found the 0-10 scale confusing or difficult to respond to. Is this a problem that could occur at St. Joseph?

Those interviewed mentioned their roles in assisting in patient comfort by giving emotional and physical care. Some use nonpharmacologic pain management techniques such as distraction or listening. These staff members consider comfort care important to their roles. Most unlicensed staff reported communicating patient pain to nursing staff, and consider this one of their most important roles.

As with nurses, unlicensed staff identified challenges to dealing with patients’ pain. One was their overall heavy workloads, which interfered when they wanted to spend time with patients in pain. They emphasized the importance of teamwork, individualizing care, and empathy in caring for their patients.

In the discussion of their results, Schulman-Green and colleagues suggest that care redesign that enhances PCA-nurse relationships, expands training for unlicensed staff, and debriefing at intervals would improve pain management for patients in pain. What do you think?

BP?

Oh ya, and trying to get an actual accurate reading of a blood pressure on a baby is damn near impossible! (3 of us tried, 2 of "us" being actual RN) and I got it first, after 3 tries! oye...

NPA

OK, cool clinical for me, YAY!
I had a 20 day old baby boy, in for rule out sepsis and possible meningitis. The MD asked for us to do an NPA (naso-pharyngeal aspiration) and my co-assigned RN let me do it! I was with my clinical instructor and 2 classmates and man was I nervous! BUT did not let it show... as both parents were there. It was the first time I was doing this procedure on a live person, let alone a baby!
Managed to do it without incident and we got the sample and sent it to the lab. No idea what the results are though as we had to leave.. hope the little guy is ok.
Can't wait to do more skills like that.



"Nasopharyngeal Aspiration for Respiratory Virus or Bacterial Testing

Requires a suction mechanism (syringe, vacuum pump or wall suction), a specimen trap and catheter.

Insert catheter nasally into posterior nasopharynx.
Apply suction as catheter is slowly withdrawn. Do not leave sample in tubing.
If sample has been aspirated into a syringe seal the end of the aspiration tube and send specimen in syringe
or wash aspirate through tubing or trap with:
• 3mL of virus transport medium if for viral diagnosis only
• 3mL of sterile saline for microbiology culture/sensitivities and or viruses
Place sample in transport medium into sterile transport vial.
Ensure that the top of the vial is screwed on securely.
Label with patient name, date of birth, sample type and date of collection."

who me? ...Uncoordinated?

OK, went to Starbucks and bought a Grande Pepermint Mocha, then proceeded to walk home with it... ended up with some on my pants!
Damn I can't walk and drink coffee at the same time.. wonder if I can still walk and chew gum at the same time!

St. Joseph Hospital PACU Nurses Win Poster Presentation Award

Tracy Dickman, RN, BSN, Clinical Nurse II, Pavilion PACU, Darlene Soriano, BS, MHA, Surgery Support Specialist, Pavilion, OR, and Dana Rutledge, RN, PhD, Nursing Research Facilitator, won first prize among 14 other presentations for a nursing research poster at the recent Joint Southern California STTI Chapters Odyssey 2006 Conference.

This prestigious honor was bestowed along with a plaque at the Ontario conference October 26-27. The poster presentation described an action research project carried out in the Pavilion PACU.

During Fall 2005, Alicia Leal, BSN, RN, CPAN and other PACU staff initially designed the research study that examined patient flow within the Surgery Center. Tracy analyzed the statistical data collected and noticed a potential clinical problem. Tracy then met with Kathy Dureault, RN, MSN, Clinical Educator. Many patients were arriving unprepared to ambulatory surgery (e.g., did not have transportation home or a responsible adult to be with them upon discharge, etc.). Kathy connected Tracy with Dr. Rutledge, who discussed how to evaluate the nature and intensity of the problem using survey methodology.

PACU nurses implemented an action research project. They found that in over 600 patients admitted for surgery, 75% had received the Personal Recovery Plan Pamphlet (PRPP) developed by SJO nurses and disseminated through surgeon’s offices. In all patients who received it, the Plan was perceived as helpful. Of the patients, 78% received a preoperative call from SJO staff. Despite not all patients receiving the pamphlet or call, 99% of patients thought that their preparation for surgery was adequate.

During fall 2006, Darlene called surgeon’s offices, making sure staff understood how the PRP was to be used. She updated and converted them into electronic files available of the English, Vietnamese, and Spanish versions to enable staff to keep copies readily available in offices. The PRP is also now available on the SJO Intranet/website at http://www.sjo.org/ under the Patients and Families link. You can also view the Personal Recovery Plan Pamphlet here. Between Thanksgiving and Christmas, Tracy and PACU nurses will be surveying patients again to determine proportions of patients who have been adequately prepared for their surgeries. They hope to see a change.

Implementing a Sedation Protocol for Ventilated Patients

One of the presentations at St. Joseph Hospital's recent Grand Rounds on Evidence Based Practice and Nursing Research was "Implementing a Sedation Protocol for Ventilated Patients" by Victoria Randazzo, RN, BSN, CCRN, Clinical Nurse IV, Intensive Care.

Victoria discussed the practice change in progress in the Intensive Care Unit. You can review her complete PowerPoint here.