Nurses Week Takeaways from DC Part II: Spoken Words

Happy Nurses' Week. Here are some takeaways from my speech in order of appearance. Some of you might not like what I have to say, but I'm speaking my mind.

"I want you to go back to where you came from and convince at least one of your colleagues to get off their butt and do something about safe staffing- grow a pair, say something, step out of their comfort zone and take a risk."

I don't know about you, but one of things I find absolutely maddening and frustrating is the deferential nature of so many nurses when it comes to speaking up to management. For people who can be fierce advocates for their patients, and some of whom are willing to stick a knife in their own colleagues' backs, when it comes to speaking out about things in the workplace, they run and hide under a table and pee on the rug.

And then they sit behind the nurses station when the manager disappears and bitch about it among themselves in whispers. Pathetic.

"Then…I challenge each of you to have three conversations this year, out of your comfort zone. I want you to talk with that nurse colleague, and a physician, and with someone in administration, preferably an executive. I want you to find common ground with them as a human being and have a conversation. Break the ice by asking them, what is the most difficult part of your job… Let them know you’re interested in what they have to say. And then… creatively propose a way to start solving the problem of safe staffing. Together. Follow through. Commit."

We need to start talking with people, to get out of our everyday routine and realize that unless we start to take steps to change our situation, we won't ever make things better. Don't expect things to happen overnight. The point is, all of us, taking little steps as individuals, can create a powerful force. If you're too scared to have these conversations alone, find a teammate to go with you and back you up.

Don't be intimidated by executives. Just because they wear suits and make lots of money does not mean they have some kind of magic powers. Remember that inside that suit is a human being who could just as easily put on a pair of scrubs. Not that they would have a clue what to do next, but the point is, they are people. If you can relate to them as another human being and not some unapproachable authority figure, you'll have a much more relaxed conversation.

Sometimes physicians can be rushed, abrasive or unapproachable. They are always short on time because they are just as swamped with their patient load as we are. But by refusing to take time to interact within the greater community of healthcare, they are missing out too. They isolate themselves and this is not a good thing. I talk extensively about this in my book, Navigating the C. Physicians need to make themselves available and approachable by taking steps to take control of their own working conditions.

"When we have those conversations, there are a few points I want you to take away, remember, and use."

1. "There is a difference between safe staffing to avoid sentinel events and staffing that is adequate to improve a patient’s health after being hospitalized or being treated in a healthcare facility."

When you look at healthcare like any other business, the whole idea is to make money. But we're not just providing gadgets made on an assembly line. People and illnesses are unpredictable, they don't act in a linear, measured way. You can't set safety standards to cover all possible scenarios. There has to be some human judgement involved. It's not a factory setting.

Maybe with one nurse to 6 patients nobody dies on a given shift, but did every one of those 6 patients get their medicine on time? IV tubing changed? Dressings changed? Blood glucose checked on time? Call lights answered? Education completed with time to ask questions including on the day of discharge? Linens changed? Ambulation (walking) around the unit? Baths? Trips to the bathroom if an escort was needed? Did the nurse get all of the charting done and check all the orders within the limits of that 12 hour shift? Report given to oncoming shift without any omissions?

2. "Today’s nursing jobs are not the equivalent of a regular desk job. They shouldn’t be compensated like a desk job. Hour for hour, we put in a lot more work and have a lot more responsibility than your average paper pusher. It beats us up, physically, emotionally, spiritually. 36 ≠ 40! Think about that."

I know a lot of nurses (and laypeople too) think that working three 12 hour shifts a week is great because you get four days off, but you pay a price for that. How do you feel that first day off? Are you just as perky and productive, ready to jump out of bed and take on the day with full energy? Maybe if you're 23 and just out of school, but the longer you work and the older you get, the less resilient your body is going to be. It takes a day or two to recover your energy after working those back to back long shifts.

A 12 hour shift is never just 12 hours. Most nurses don't get paid breaks so they are scheduled for 12.5 hours- usually something like 7 am to 7:30 pm, or 7 pm to 7:30 am. Whether they took that break or not, and it's usually not. Add any time it takes to drive to and from work, find a place to park, walk into the building, get ready for report. For most nurses it's a good 14+ hour day. That leaves little time between shifts for basic self-care- like enough sleep, time to prepare and cook a healthy meal, spend time with your family, take care of pets, doing chores around the house that can't be put off, and so on.

Nurses might be considered full time at 36 hours a week, but they don't get paid any more for the hazards they endure, they don't always get ample vacation time, almost never get sick leave that isn't coming out of their vacation time, they never get compensated for missing lunch, they get in trouble for working unapproved overtime even though they can't finish all the documentation of their day within that 12 hour time frame because they were busy taking care of everything that came up around their patients' needs all day. Some nurses who are represented by unions might get some of these perks, but in most states, especially those deep red, "right-to-work" states, they don't get any extras.

During those long shifts nurses get progressively more tired, they get hungry, they aren't quite as focused and sharp at the end of a shift as they were at the beginning, or at the end of a run of 3 long days. They have to be on the lookout for physical hazards to patients, signs of a patient's conditioning worsening or deteriorating, making sure medication doses they give are correct, checking over the doctor's list of orders to make sure those are correct, tracking down physicians and ancillary staff, taking phone calls, interacting with family members, and things that happen without regard for a nurse's physical needs for food, bathroom, having a moment to clear their mind and think, or even getting off their feet to sit down for a moment.

And did I mention, responsible for the patient's life?

I think nurses should get paid a full-time, fully benefitted comfortable living wage for doing something on the order of three 8-10 hour shifts per week, so they have time to rest and recharge without burning out, so they can come to work able to fully focus on their patients' care. Yes I know this is a utopian dream, but I'm saying it because I mean it. Seriously.

3. "Nurses need to be able to do our jobs without sacrificing our physical or mental well-being. We need to see that we’re not stuck forever with only lateral options for career moves. We need to know that by advancing ourselves, we don’t have to sacrifice our integrity."

Nurses are subject to all of the emotions that any human being has. And we are working around some of the most vulnerable people in the population, as well as the stresses they bring in with them, that likely landed them in the hospital in the first place. Along with their family members and any other dysfunctional behaviors that they harbor in their everyday lives. And we often are on the emotional receiving end of those dysfunctions, when they are paired with fear and misunderstandings in regard to the patient's condition. We are subject to verbal and physical violence from stressed out patients and family members, as well as the internal, lateral and vertical workplace dysfunctional behaviors like bullying.

Nursing is a profession with a wide range of options for work, but within big healthcare organizations, the pyramidal nature of the hierarchy means there are few options for advancement. And more often than not, those with aggressive and less cooperative tendencies tend to move up the ladder, regardless of their leadership and people skills. Once they leave the bedside, managers are bound to serving the aims of the administration and no longer can prioritize their staff's needs.

Management is bound to keep administrative secrets and respond to staff concerns with carefully scripted messages dictated by the highest ranking administrators. Honesty is not always possible if a manager wants to keep the trust of the higher-ups.

4. "Keep your intellectual curiosity alive- don’t rely on dumbed-down, pharmaceutical and hospital industry-funded continuing education for all your career needs. They won’t help you go above and beyond. Strive to grow personally, strive to grow beyond the scripted, measured, limited status quo that keeps us stuck."

Attend any professional nursing conference and you'll see the vendor booths stocked with glossy, full color literature and trinkets from pharmaceutical companies, attractive marketing materials from healthcare organizations looking to recruit employees, and sponsorship logos and banners from industry leaders on every visible surface, screen, and object.

Continuing education is offered as part of the deal for listening to pharmaceutical companies tout their latest drug, so nurses only hear the industry side of things. They might get a nice dinner and a glass of wine too. They tell nurses the message they want them to hear, without any opposing viewpoints, critical questioning, or an explanation of the results of randomized trials that might lead one to question whether the thing they're selling is really as good as the profits they'll make.

Ever since I left the hospital setting, I've had much more energy and curiosity because I'm not so fried, and I read journals and medical and nursing newsletters, the latest research findings, I can seek out good continuing education on my own instead of having it fed to me passively. I've encountered a brick wall with my local chapter of my professional organization- I've offered on multiple occasions to talk with them about the work I've been doing, cancer survivorship topics, social media usage by nurses, and other ideas, and have been either ignored or told we can't afford to do that. Why? Because I'm not a pharmaceutical company with a budget to pay for a catered dinner and wine for a couple of dozen nurses.

Fuurthermore, speaking of professional organizations, nurse entrepreneurs with small businesses simply cannot afford to have vendor booths at these big conferences. The price per vendor booth is something like $3000. A small business cannot recoup that.

"We hear a lot about VALUE-based care these days, it’s one of those favorite buzzwords that the scripted bots of the healthcare industry love to hear rolling off their tongues. But healthcare won’t be successful unless those who deliver the care have human qualities to care. And exhausted, burned out, chronically understaffed nurses can’t care. Let’s start using value and care as verbs instead of nouns. How about if we VALUE nurses so we can CARE?"

I think this is self-explanatory.

"But most important of all- let's get back to value- each of us should think about what we value. We’re here for patient safety. We can’t live our values if we’re not authentic. When we know who we are, what we value, and why, we are grounded, and are less likely to be swept away by the strongest gust."

Hopefully this, above and below, is self-explanatory, too.

"If you take nothing else away from this rally, resolve to define your values around your work. Why did you become a nurse in the first place? What’s your number one priority as a nurse? Live and work in accordance with those values. Encourage your fellow nurses to do the same. Moral distress is not good for your health, or your patients’!"

"Patients and nurses alike, each of us only gets one life for sure. Let’s make sure each of us can live it fully."

Take it away, nurses...

Nurses Take DC 2018

photo credit: David Miller

Last week, I attended and spoke at the Nurses Take DC rally for Nurse:Patient Ratios Now in Washington DC April 25-26. The purpose of the event is to bring nurses together to support federal legislation: Senate Bill 1063 and House Bill 2392: The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2017.

Why do I post about nursing and healthcare on my running blog? Because it is an integral part of my life. Running is what keeps me going, it provides my energy and recharges me for the daily work I do, especially as a solo community figure working directly with people who are going through the trials of the healthcare system.

All of my readers, no matter how fit and healthy, are equally vulnerable to an encounter with the healthcare system, whether through illness, injury, accident, or a family member's experience.

Every person is a potential patient, and it's important to understand what nurses do, the importance of nurses, and why nurses are taking to grassroots advocacy to further our agenda through the legislative process.

For too long, nurses have been deferential to a healthcare system that has treated them as second class and given us less respect when we can not be replaced- the healthcare system would collapse if we were not here. But those in power talk out of both sides of their mouth, while they talk about a nursing shortage, they have not shown the moral or political will to do anything about it.

Nurses' top priority, above all, everything we do, number one on the list, always and forever, is patient safety. You can give all the medicine in the world and use all the technology you want, but nurses are there to ensure that the patient is not harmed in the process of administering that medicine and coming through the healthcare facility where they are treated without harm coming to them.

No matter how sophisticated and cutting-edge the interventions are, no matter how advanced the medications are, there is always, always, always risk involved-potential for adverse effects, mistakes in the form of human, mechanical, or technological error, and someone has to look out for the patient, providing checks on the system from admission to discharge from the facility.

About six months ago I was contacted by one of the organizers, someone I knew only through social media. I was surprised and honored to be asked, as most of my advocacy work has been in the form of writing about nurse working conditions and their impact on the patient experience. I discussed it extensively in my book, Navigating the C, as it applies to cancer care, but the premise is applicable to all of healthcare.

After catching the shuttle to the Denver airport at 2:30 am on Wednesday, I arrived in Washington late in the afternoon, the day before the rally. It was raining. My hotel was the headquarters for the event. That evening I an education offering, called “Ascend to Political Nurse Advocacy”, presented by Pamela Robbins, MSN, RN.

Pam has long been active in political advocacy for nurses and quickly drew the audience in with her explanation of the similarities between the nursing process and the political process, to make it relatable to all of us. It was a useful toolkit all packed into less than two hours. I met many people I've only talked with o social media, including my friend Andrew Lopez, who has been instrumental in encouraging my progress from hospital staff nurse to nurse entrepreneur and advocate.

The first night I was exhausted from traveling and went to bed early. I was still catching up on my sleep from the Palmer Lake 24 Hour, and three hours of sleep before traveling added to my sleep debt. I knew I would see everyone at the rally the next day.

Thursday was a beautiful clear day, perfect for the rally. I shared an Uber with three other nurses to the rally. We were dropped off right smack in front of the Rayburn House Office building- where the House of Representatives offices are. Yes, where the power, money, and influence happens. There was a long line that stretched all the way down the street of mostly white men in suits, with name tags indicating the entity they represented, obviously industry lobbyists waiting to exert influence.

My immediate gut reaction was resentment- I wanted to tell every one of those suits how their money-backed influence was ruining democracy, but I was quickly distracted by my companions who pointed out the capitol building across the street and the fact that we were there on a beautiful spring day that you couldn’t have asked to beat.

I quickly forgot about the lobbyists as we crossed over to Capitol Hill. It was breathtaking, seeing the Washington Monument and the reflecting pool, and the white columns and dome of the legislative seat of power of our country.

There were about two dozen speakers, including legislators themselves- Representatives Jan Schakowsky and Luis Gutierrez from Illinois both made appearances and spoke.

Dr. Laura Gasparis Vonfrolio was the keynote speaker, she's been involved in the movement for more than 20 years and reminded us to raise hell. “If you don’t fight for what you want, don’t complain about your situation!”

As the speakers took the podium, their tone ranged from powerful and inspirational to exhausted and shell-shocked. The stories of some of the nurses who had been fired, harassed, and threatened for speaking out were both maddening and heartbreaking. It still strikes me as beyond the pale that administrators should be so fearful of nurses who choose to speak their minds, but it happens all the time. And that is why we’re here, to support each other so no one has to be fearful.

I felt that my speech went well, I included some takeaways for nurses to go back home for effecting change in their own communities. I will discuss those in the next blogpost. If you want to listen to my speech, it is here.

Nurse staffing ratios are critical, but there needs to be regulation of the hospital industry, because without mandates, they will find workarounds, and nurses will continue to find themselves understaffed and compromising patient safety.

I remember 2012, when some well-staffed hospitals, in the middle of merger mania, experienced notable changes in their attitude toward nursing. Where the independent hospital might have had top-notch staffing and support, as well as respect for nurses, nearly overnight, nurses were told the staffing ratios were changing, their benefits would dwindle, and older nurses started disappearing left and right. Nurses were told point-blank, if you don’t like it, you can leave. I left. Why should I work in a place where I’m not respected or valued?

As time went on, it became apparent to nurses that they were making good on their threats, and no longer valued us for what we brought to the workplace. They only wanted us to fill the staffing matrix, keep our mouths shut, smile, and nod as they nickeled and dimed our benefits and job satisfaction away from us.

And we are always told it’s our fault if we can’t multitask, that we can’t be in two places at once, or remember everything because we are doing the work of two nurses.

Nurses are asking for national legislation to hold decision-makers in the industry accountable, so that our patients are not in harm’s way when we care for them in a facility that is supposed to be helping them.

After the rally was over, Pam and I went to lunch at Union Station, which is an amazing building, where the Amtrak trains come through and the architecture is mind-blowing...we headed back to the hotel via the Metro, which I learned was not a good means of transportation for me. All the lurching and stopping left me seriously nauseated!

Back at the hotel, we had an after party with nurse humorist Terry Foster, who is hilarious. It was a chance to talk further with some of the organizers and discuss future action, as well as relaxing and getting to know a few people better.

Friday it rained again, and I had some time in the morning before I had to catch my flight, so I went to get Starbucks and then walked along the Mt. Vernon bike trail along the Potomac.

I posted a couple of videos on social media about my thoughts and experiences, and said goodbye to the people who were still around in the lobby of the hotel.

I headed back to the airport to fly home with a sense of empowerment, a tool kit, some great advice, and feeling much less alone. For me, the best part of attending the rally was the new friends I made- colleagues who share my passion for making change, ready to work hard and not give up, willing to go back home and spread the word, bring more nurses along next year, and help others lose their fear.

I learned about turning your concerns into political action and how nurses can effect change in our profession. Despite what you might think about political divisions, apathy and fear are truly our biggest enemies. Here is a link to the House Bill 2392 sponsored by Rep. Schakowsky.

We can use technology to our advantage when talking to legislators, because there is new app called Flo's Whistle that helps report unsafe staffing conditions by legislative district. Nurses can show their representatives in Congress what is going on in their districts and they'll have data to back it up.

My next post will be about Takeaways from my speech to the DC rally, to keep nurses motivated and focused forward all year. For more information about the Nurses Take DC movement, visit http://nursestakedc.com

Base: A Curse And A Blessing

Last Friday I had the brilliant idea of going up to do three Rock Repeats. Two weeks ago I had run two, so three seems like a reasonable progression.

I got to the trailhead on a cool foggy day and started up the first time. Feeling good, I ran the bottom switchback up the road before I settled into a powerwalk as the pitch got steeper. I ran the flatter stretches on the way up the Southridge Trail, and as I neared the top, approaching Audra Culver trail, I turned and saw this guy in a light blue top running up behind me. I’d seen him at one point closer to the bottom. He appeared to be going just slightly faster than me.

Deciding not to push myself, I decided to ignore his pace rather than challenge myself to stay ahead. I don't have to take every opportunity to chick somebody. Save it, I thought. He passed me near the junction of the Horsetooth Rock trail and Southridge, and he took off on the trail as I continued up the steep, loose, rocky pitch before the last saddle at my turnaround below the Rock.

I reached the top of my route, despite only 8 minutes of running, in 35 minutes, not my fastest, but not too bad of a bad time for me. I turned around and headed down, reaching my car in well under an hour. Without stopping, I turned around and headed back up for repeat number two. On my way down repeat number two, which was over 40 minutes up, I already could feel my quads from the fast descent on number one.

I wavered between calling it quits at the bottom and doing a third, knowing I would pay for it. I decided it’s now or never, I want to be ready for the Grand Canyon in October, and I’ve slacked off in every possible way I can get away with. Now I have to at least inoculate my quads with a good bashing.

I stopped at the car and refilled my bottle, grabbed a jacket in case it rained, and headed back up for number three. I completed that one faster than number two, with a less painful descent. I don’t know why it hurt so much coming down the second time and not the third, but I did it and felt good, my best workout in a few weeks.

Saturday I was reasonably sore but not too bad. I only walked the girls, I didn’t go out for a workout of my own. Sunday I walked nearly 10 miles and by the end my hips were screaming, and I could feel every step down and descent on the mostly flat bike path. By Sunday night I was in quite a bit of discomfort, and by Monday it wasn’t feeling much better. I jumped in the hot tub and soaked for a while, and by Tuesday morning the soreness was mostly gone except for a few little pings occasionally.

It’s weird how you can run three times up and down Horsetooth Rock after being pretty much of a slacker for seven months, because of your base, but then it comes back to bite you in the butt. You do pay for the privilege of having a base. Your body thinks it can do anything, and it can. You do pay, but if you stick to it, the pain passes and you get strong again, quickly. In the long run, literally, it pays huge dividends.

My woman cave office and living room in the house have turned into a video production studio. The student I’ve been working with is graduating and we’ve been trying to get a lot of video footage shot before she finishes next week. I spend every spare moment on producing the materials for my services I plan to launch later this year.

I’ve made some good contacts lately on social media and I’m enthusiastic about the prospects for getting the word out once I launch things. And tomorrow is the start of Nurses’ Week.

Ha! You probably think I’m going to launch into a rant, but I already ranted on Fighting Dinosaurs. You can check that out if you like.

I went out to a party last weekend for one of my former coworkers who became a nurse practitioner and is leaving our old workplace. It was great to see my old coworkers. One of my other former coworkers is retiring in June so I will get to see them again soon when we celebrate that event.

I do miss a lot of the other nurses I worked with at the hospital. But I keep going forward, keep running, keep moving in the direction I’m going. I talk myself down from the occasional panic moments and anxiety about the unknown. I keep meeting interesting people and learning so much, it’s amazing how much there is to be learned that nurses don’t know about the patients they care for in the hospital setting. I’ve learned so much more from the real people going through all of these experiences with cancer than I could ever learn from reading journals and taking classes and working in traditional healthcare.

There is much work to be done, and I feel so fortunate to have an opportunity to be doing it.

So this Nurses’ Week, far from the misery of my last “job”, I am truly celebrating what it means to be an #empowerednurse, hashtag and all.

Funny how it all parallels with my running.

I have a strong base, that nursing knowledge along with my past experiences and education, and I paid for it with the rigors of a healthcare job, pushing through the discomfort of short-sighted people who are running the show but don't know how to put one foot in front of the other, but I passed them, and now it’s paying off in ways I never dreamed. Relentless forward motion.

Happy Nurses' Week!

My Life Lately...

This week was a busy one. I started out trying to cheer myself up by getting some Peeps, now that they are out in the stores. I set them up for the girls and of course Iris the peep snatcher got almost all of them. Isabelle wasn't all that interested. I think she knew something was up.

We scheduled Isabelle's surgery on the 10th, to have a huge lipoma removed from her right hind leg. The 10th also happened to be my birthday, number 51, and I knew we'd be busy taking care of Isabelle, so on the evening of the 9th, we decided to go out to the Rio and get some margaritas. It was a last minute decision after dinner. I had one regular margarita which is normally more than enough to do me in, but they had blood orange margaritas as a special and I had to try that. So I did.

It was sweet, didn't taste all that good. But by the time I went to bed that night my was head spinning, knowing I had to get up in the morning to take Isabelle to the vet.

Isabelle's surgery went well. She's been comfortable. Dennis and I have taken turns sleeping on the futon, which we dragged into the living room, so we could be with Isabelle all night. She can't do stairs for a couple of weeks.

That has resulted in sleep deprivation for both of us. My brain has been gone. I went to the store yesterday, forgot the most important thing on my list, and realized I had my shirt on backwards.

Running has taken a back seat to everything, once again. I guess it's just not time to start coming back yet. When things settle down and I can think again, then I'll be able to enjoy running. I take Iris for walks and that's about it.

Isabelle got used to the collar, she only needs it when I can't watch her. She hasn't tried licking yet, but she's still pretty doped up from the pain meds. I will start weaning her off those later today, it's been two days now.

As far as running goes, I am just looking forward to the 12 hour run next weekend. No matter what, it will be good for me to get out and stretch my legs, cover some distance, listen to music, and lose myself. I need it for therapy so bad!

The exciting thing this week is that the Empowered Nurses book, in which I wrote a chapter, is due to be released on March 16th. there is also a telesummit that shows the interviews with me and the other 10 authors. I am going to write a separate post about that and the book soon. Check it out. There's a link to purchase the book in the right-hand column of this blog.

The premise behind the book is to show how nurses can rise above the problems in the profession and find a more fulfilling path in nursing.