From a hospital nurse: We need to treat the community like a hospital right now

woman in black coat and face standing on street
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I don’t work in a Covid unit. I don’t have to wear an N-95 mask all day. But I do work in a hospital full of very sick people with rapidly increasing numbers of people with Covid 19.

This month a friend, and church member died from Covid 19.

At the hospital my nurse friends cry, take deep breaths, pray and go to work in a building full of men and women sick enough to be hospitalized with this virus. They perform high-risk treatments and provide personal care, putting themselves and their families at risk.

Nurses know how to minimize transmission of contagious disease. Preventing the spread of disease is a key pillar of our profession. We know that we don’t have to know exactly how coronavirus spreads and how long the incubation period is to enact practices for preventing the spread of this disease or any virus. Hospital nurses work in a world with contagious disease everywhere. And this hospital nurse has a message: Right now we all need to treat the world like a hospital.

In the hospital there are very sick people with Covid as well as people with strokes, heart attacks, injuries from trauma and more. Nurses, aides, housekeepers, doctors, respiratory therapists, imaging techs and all the above sick and injured people are in the same building. In the hospital we’re caring for patients, having meetings, making schedules, eating lunch, going to to the bathroom, etc. Life and death and the effort to push back death in the hospital carries on. How does it carry on?

We wash our hands, wear masks, distance ourselves, and then wash our hands again and again and again.

We do what we have to do to keep each other and our patients from getting sick with something we don’t see or feel but could be passing to someone else.

We were doing this before COVID and we’ll be doing it after.

This is how we must behave in the world right now. This is why we need to wear masks, and wash our hands frequently and keep our distance from others. When we go to Walmart or to church services. When we fill our cars with gas or visit a friend. This is how we must go about our business. This is how we must live in our communities with Covid 19.

It’s not easy, fun or fair. But it’s the best way we know to push back death and disease and care for one another.

An argument for the costly care of the least of these

grayscale photography of patient and relative holding hands
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If
wrinkled Boomers
with diabetes and heart disease
amputations and hemiparesis
are random collisions of worn out atoms
draining our society of valuable resources…

If
the cost of rehabilitating the Grey Tsunami,
aphasic from stroke,
requiring a hoyer lift
to move their paralyzed frames
from bed to a rolling shower chair
so nurses’ aides can wash silver strands
and run, warm soapy water under breasts
and cleanse away the urine and waste they cannot control
is debilitating our healthcare system…

Why
nurse them with care and aide?
Why not kiss them on the cheek
and hand them over to death
and use the thirty or more pieces of silver to give to the poor
and make our lives a little easier?
Because…

Imago Dei
In every crooked grin
In every slobbered chin
On the face of every one of us
Who sin
And live
And don’t quite die
But slowly break down
In a body of death
Still coursing with blood
And disease

We’re holy
Bone and flesh
Breasts and chest
Bowel and bladder
Tongue and breath

Jesus
in the least of these
who have yet to peak beyond the womb,
whose contracted legs
curl up in an aged, fetal form

We
tremble and shudder
We’re traumatized
We give dignity
and pour expensive resources
on the broken body
because…

Imago Dei

Bedside nurse

bedside nurse
(Image Credit)

It’s a small army I see
two or three days a week.

While it’s dark and cold
we march in uniform,
feet shod with shoes ready
to keep a steady
clip for the next thirteen hours.

The building we raid looms tall and overwhelming,
pregnant with arrhythmias
calls for help to the bathroom
bowel and bladder accidents
vomitting
fevers
complaints
pain
hope
joy
fears
laughter
tears.

But in we march
giving away our days to
the drug addict
the laboring woman
the feverish child
the suicidal man
the fractured old lady
the hemiparetic senior
the wounded, retired warrior.

A PSA from a short-of-breath nurse: Don’t go to the hospital to get pampered.

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(Image credit here)

Amidst the cacauphony of I.V. alarms, bed alarms, chair alarms, call bells, overhead pages for code blue, code purple, stroke alert, ringing phones and the chatter of nurses, nurse’s aids, doctors, therapists and social workers, a nephrologist walks up behind me at the nurse’s station where I’m trying to get a handle on my patients’ (all 6 of them) history, medications, lab results and scheduled tests for the day as well as doing my required log-on charting. (Deep breath… that was a long sentence and that’s usually how I feel about 5 minutes into my shift at work. Deep breath Sheila, deep breath).

The nephrologist asks a question aimed into the general vacinity of the nurse cluster.

“Who’s the nurse for room 22?”

Her question is nearly drowned out by the noise, but since I’m inches from her I stop what I’m doing, look at the nurse assignment in my hand, look up at the doctor and tell her the name of the nurse.  No one knows where 22’s nurse is, so I call her on vocera.  She answers. She’s in a patient’s room doing a dressing change, can I take a message, she asks. I turn to the nephrologist, who heard the radio conversation, and she says, “That’s fine, just tell her I started her patient on lasix and ordered some labs for the morning. Her blood pressure is ok, but she is very edematous. Please be sure to get an accurate weight on the chart.”  And then she grabs her bag, and swiftly walks away, white coat flapping at her pace.

This little vignette, which took me a few minutes to write occurs non-stop for 12 hours on most hospital units.  The fast-paced, noisy, environment that presents demands from signs, alarms, questions, comments, phone calls and call bells are all aimed at one person: the nurse.

I always say nurses are the filter for everything that reaches the patient in the hospital. And whatever the patient wants to reach in the hosptial, has to also go through the nurse. The fact that nurse’s are interrupted every 55 seconds by issues that require their attention, even if only for the time it takes to delegate that interruption to someone else, is nevertheless problematic where nurses are pushed to fetch high patient satisfaction scores.

I’ve been a nurse for almost 18 years and over the years the increasing demand to bring in these high patient satisfaction scores has largely been directed, you guessed it, at nurses.  The reason is because the nurse is the filter.  And there’s nothing wrong with being the filter. Nor is there anything wrong with wanting a patient to be satisfied with their experience at a hospital.  But I take issue with the goal being patient satisfaction and not patient safety.

When nurse’s are pressured to be sure they deliver thorough assessments of their patients, detailed, accurate charting, and be the filter through which all things in the hosptial go to reach a patient, with the goal being a “happy costumer” and not a well-informed, well-cared for, safe patient, nursing becomes a juggling act with a fake clown smile.  And it shouldn’t be.

Without fail, every shift I work I hear complaints from my patients, not about the poor assessment or education their nurse gave them.  Not about the lack of kindness.  But about the missing mayo on their lunch tray.  That it’s noon and no one pulled the shades up. That they pushed their button 3 minutes ago and no one came to pick up their dinner tray.  There’s an attitude of entitlement amongst many of the patients I work with and in part I think it’s due to a lack of understanding about what nurse’s do and what the hosptial and healthcare system is for.  I think there’s a misconception perpetuated by hosptial advertisements that make people think when they go to the hospital they’re going to a 5 star resort. But it’s a hosptial, where people are really, really sick!  And people, not robots, are taking care all those sick people.

Deep breath Sheila, deep breath.

I am a Christian.  I believe deeply that loving my neighbor well, including my patients at work, is evidence that Christ is real and lives in me.  I believe serving others opens the door for testimony of the good news of Christ. I’m all about loving people well.  But catering to people’s desire to be pampered should in no way be part of what people expect when they seek healthcare or go to a hospital.  There’s a distinct difference between love and pampering.

There’s a healthcare crisis in America.  We are getting older, we are obese, have diabetes and are chronically ill.  According to the CDC 1 in 4 adults in the U.S. has two or more chronic diseases. Heart disease, cancer, stroke, diabetes, chronic lung disease, alzhiemers, and chronic kidney disease are what many of us in the hospital have two or more of.  And many of these are preventable.  But there’s an attitude I’ve been sensing over the past couple years among my patients that concerns me.  There’s an expectation to be pampered by the healthcare system and a lack of ownership for our choices.  There’s a lack of willingness to learn or change.  And there’s a lot of pressure on nurses to make us happy.

As a mom, I feel like this is antithetical to what it means to care for another person in love. Love does not rejoice in evil.  It does not coddle. It does not pamper.  It does not tell you what you want to hear when you have diabetes, heart disease, an infection and want the nurse to make you happy by bringing you extra ice cream.

I am not saying we should be rude nurse crachets to our patients.  I’m saying we need to enter the healthcare system as patients being our own best advocates.  We need to want to make changes in our lives so that we can be healthier.  We need to want to know what medications we’re taking and ask questions.  We need to learn about our diseases and how best to control them.

So in summary, as a PSA, from a nurse who very much wants you to be happy, in the long run, and healthy as you can be, please take ownership of your health.  And if you enter the hospital, please go there to get better and get home.  Don’t go there to get pampered.

*P.S. This post is not talking to people who can’t even access healthcare.  That’s a whole other PSA aimed at Christian doctors and nurses and people in positions of power and it goes something like this: Taking basic care of our neighbor’s human body is the right and dignified thing to do. Stay tuned…

Nurses, you’re doing God’s work!

india1.1.jpgThe idea of serving others in Christianity is unique in that it’s not the lowly who are called to serve because of their low position.  The call to serve is for those who would be the greatest.

When Jesus was describing the unique way his people would lead, he said:

“You know that the rulers of the Gentiles lord it over them, and their great ones exercise authority over them. It shall not be so among you. But whoever would be great among you must be your servant, and whoever would be first among you must be your slave, even as the Son of Man came not to be served but to serve, and to give his life as a ransom for many.” ‘ Matthew 20:25-28

Christ, the King of kings, said he did not come to be served but to serve, and to give his life as a ransom.

Nurses in pre-structured nursing history were seen as the dregs of society.  They were prostitutes and “ignorant [women] who [were] not fit for anything else.” (Draper, 1893/1949, p.51).  The idea behind the nurse was that they would have to do what no one of upstanding or honorable report would want to do.  No one would want to clean up vomit, or bath a rotting body, or clean an infected would, or wash feces from an elderly persons perineum. The world saw nurses as “low” people fit to do “low” things.

But Jesus said that it’s the great people who do the “low” things.  He himself did what the society around him considered menial and too low for a man, much less a rabbi and surely not for the Son of God. He washed the feet of his disciples, including his betrayer. He touched social outcasts with leprosy and applied healing treatments to the eyes of the blind.  He spoke to a woman who’s “issue of blood” had separated her from society, called her daughter and healed her.

God’s work, as manifest in his Son, is to go low to lift others up.  God doesn’t go low because he’s ignorant or unfit for anything else.  He goes to the poor, the outcast, the broken, the ill, the foul-smelling, bleeding, blind, diseased and dying and he reaches into their need to lift them out of despair and hopelessness.

Nurses do God’s work.  And they are not ignorant men and women unfit to do anything else.  They are honorable, knowledgeable, skilled, professional and educated and from their high position they do a work that is like the work of the Servant-King who laid down his life that others might be healed.