A Junior High Sign……and it is PERFECT for hospitals!

By | Education, Nursing, Workplace Violence | 2 Comments

Today, my youngest was sick at school and I had to pick him up midway through the day. I was able to actually look around the school office for a moment, and found this sign.

think2Perhaps you just totally rolled your eyes at me, and I am ok with that.  It bounced off of my brain and made me think about how much easier life would be at work if we followed these suggestions.


A Scenario:

Your coworker is late, it is the third time in as many weeks.  She has a sick mom, and has been taking care of her. Her routine is not settling down as fast as she would like.  She has two children to take to school, her husband isn’t home to take the kids to school because he works nights, and her mother needs medications in the morning.  Because she has new onset dementia and a recently replaced hip, your coworker is concerned about her compliance with her medications and nutrition, as well as her ADL’s.

Your coworker arrives, 20 minutes late.  You have things to do this morning, and she has put you way behind.  You are back at work for 12 hours tonight, and you didn’t get all the sleep you wanted yesterday either.

How do you respond?

“You are always late now! Aren’t you going to get a home health aide or something?”

  • Is it TRUE that your coworker is always late? No. She has been late three times in three weeks after a life-changing event. 
  • Is it HELPFUL to say this, at this moment in time? No.  Your coworker is stressed out because of her recent life changes, and is probably very embarrassed about being late all of a sudden. It will likely make her defensive, and then she has to go deal with an entire nursing assignment all day, knowing you are angry.
  • Is it INSPIRING to say this? No.  Telling someone that they are not meeting your expectations is never inspiring for them.  Suggesting a solution can be.
  • Is it NECESSARY to say this? No, your coworker knows she is late.  She knows that she is inconveniencing you.  And if you would like to address it, now is not the time anyway.  Not when you are upset.
  • Is this a KIND thing to say? Obviously not.  It may make you feel better initially because you were able to vent, but it will make you feel worse after you have time to think about it.

How about this?

“Janie, I know you are having a hard time. I hope your mom is ok. I don’t want you to get in trouble for tardy arrivals.  Maybe you should think about hiring a home health aide to give you a hand.  You have to be tired.”

Same message, peppered with kindness.kind

  • It is true, she is having a hard time.
  • It was helpful to suggest a home health aide.
  • It is inspiring for her to know that there is help available, and that her work family has her back.
  • It is necessary to address at some point, because you are being totally inconvenienced.
  • It was said kindly, and may really help your coworker realize that she has a really full plate and needs help.


Maybe we can work toward this.  We are so kind to our patients.  Maybe we need to THINK before we react in these situations.







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A Nursing Story – with ZdoggMD props (not a fangirl post, Dogg)

By | Advocacy, Education, end of life | 2 Comments

When I was a fairly new nurse, I had the patient who would change nursing for me forever.

Most of us can say that….but read on.

I was working in SICU, and I was caring for a very elderly lady (upper 90’s) after abdominal surgery. She was one of those super healthy 90+ folks.  She still drove.  Sharp as a tack, and a sweetheart!

Even as a new nurse, that last part chilled me.  The sweet ones always had the worst luck.

The surgery was routine, but she became hypotensive on the floor.  The transfer was initially appropriate.  She had a DNR in place, but we all know that does not mean ‘do not treat’.  She was septic, of course. We did all of the ‘ICU Magic’ and she soon had a central line, pressors, and our (rudimentary at that time) sepsis protocol in place.  She could still consent to these things, but cautioned us that she didn’t want to be on a ventilator for any reason.  

Her husband died without ever coming off the vent 15 years earlier.

Her children visited; all seven who were still alive.  She outlived two of them.  Her oldest daughter was her medical power of attorney.  During the family conference, she held her mother’s hand and agreed with her when she indicated she did not want to be put on a ventilator for any reason.  2011-02-18-047_DyingProhibited

She was placed on BiPap, her organs were shutting down, and was no longer able to consent when a well-meaning first-year doc suggested intubation as a temporary measure.  Alarm bells chimed in my cranium.  I gently suggested to both the physician and the daughter (separately) that intubation was rarely a short-term fix for a woman this ill and this old. I also reminded both of them that this lady was absolutely against this, and had stated it repeatedly.  

I had three days off.

When I returned, Granny was on a vent and pressors, had a rectal tube, NG, art line, and foley catheter.  We couldn’t really sedate her because she was so hypotensive, and she would fight the restraints, pull out the tubes, and roll around in her own feces. Granny, remember her? The lady who didn’t want all of this? She had ICU psychosis, multi-organ failure, and I wanted to stick a 14 gauge IV catheter into my own eyes to kill the pain I felt just looking at her. Her daughter decided she “Wasn’t giving up on her, because she is a fighter” She made her a full code. futile

Eventually, a doc decided enough was enough and told the family that simply nothing else could be done.  When they pulled that ETT, the family stood around absolutely bewildered, and angry that no one told them that granny wouldn’t get better before ‘All of this started’. 

She gasped like a fish until she died.

And nursing changed for me, forever.  

Granny, I am sorry I didn’t advocate harder for you with your daughter.  I will feel the pain I caused you by my inaction forever.

Thanks to ZDoggMD for helping us talk about futile care and why we should make AD’s ironclad with his song  Ain’t the Way to Die.  <—click




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Why Nursing Students are so Important to Me – To SMYS – And to the Future of Nursing

By | Advocacy, Education | One Comment

Nursing students are coming to your floor! How exciting!

Don’t make that face.  We all precept.  We do this because someone precepted us. This is nursing tradition.   You are responsible for molding the future of nursing.  It is actually a pretty damn weighty responsibility.  Some of my nursing school and new grad preceptors are actually still in my life.  Some are on SMYS.  At least one of them would love to tell you a story about me injecting air into a carpuject vial to draw it into a syringe and showering her with morphine. 

But that is another story.  

Nursing students really are our future coworkers, and in this moment we really DO have the chance to shape their thinking when it comes to advocating for the profession, themselves, and their patients.  Is there anything more important than that? They will learn to start an IV after they miss five or six.  They will learn time management after they have time to manage.  However, they are not taught to advocate for themselves.  How many of us heard “Do not take an unsafe assignment or you will put your license in jeopardy” in school with absolutely no suggestion how to not get bullied or fired for refusing one?


You can be that nurse, you know.  The nurse who teaches that student what it means to stand up for all that is good and right.  To do what is right for her patients and not what is right for a multi-billion dollar healthcare company.  You can be the nurse who encourages students to get involved with nursing professional organizations like….SMYS.  Or whoever.  You can encourage them to check out a website or organize their peers to join a Rally on May 12, 2016 in Washington DC or in their state capital.

You may be setting his feet on a path of lifelong advocacy for his profession.  He may become a nurse leader you will read about and fondly remember.  You will know who lit that spark in him. He will spend his career making nursing better, and you will be at least partially responsible.

Or you can be the nurse who rolls her eyes, gives the student little direction, and makes teacherthem do the dirty jobs for six hours. Because being a nursing student is all about cleaning behinds for nurses who are really sick of doing it, right?

Teach.  They are sponges.  Let them soak up the knowledge you have gained in your career.  Your clinical smarts are extremely valuable, and your healthcare policy and safe staffing knowledge will make them a real member of nursing.

It is your choice.  Please make it a good one



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