Articles

Hold High the Lantern: Illuminating Culture, Perception and Power

Holistic Nurses are the hologram for a new brand of nurses who embrace their role, responsibility and privilege in healing

When I graduated from nursing school at 39 years old, I sobbed through the entire ceremony. They weren't tears of joy, but rather tears of relief that the hardest thing I had ever done in all my life was finally over. As the single mother of five children, I was exhausted from the long commute, managing work and school, life in a small trailer, and the challenges of re-wiring my brain to comprehend anything mathematical.

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Risk Management in Canadian Health Care

Only six months into my tenure as nurse manager, a sentinel event occurred that directly linked bullying behaviours to medical errors.

On morning rounds, I was informed that a patient had been found with an oxygen saturation of 52 per cent and taken to the ICU. An MRI showed anoxic changes of the brain that were so significant the physician was concerned his patient would not return to baseline. Even on a full re-breather mask, the patient could not converse normally. I took the Patient Controlled Analgesic ("PCA") machine into my office and opened it up to find that the machine had been mistakenly programmed for Morphine instead of Dilaudid, the patient's decreased saturation was a direct result of receiving more than ten times the normal dose of narcotics.

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Cultural Chains

Human beings rarely, if ever, succeed at accurately perceiving their own culture.

So deeply entrenched is culture that no one talks about it: the unspoken rules and behaviors (called norms) are never written down, and yet everyone knows them. We learn these norms the hard way through the process of assimilation into a culture. For example, when Shelli was a new scrub nurse with only six months experience, she failed to anticipate that the surgeon would need a particular scalpel. Immediately, her experienced preceptor deftly handed the correct blade to the impatient surgeon with a glare in Shelli's direction. At that moment, Shelli learned that if she was not on top of the surgeon's needs, she would end up feeling embarrassed and looking incompetent. Shelli did not find this information in her orientation manual.

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Hostility OR Connection

THE JOINT COMMISSION SAYS HEALTHCARE FACILITIES, labs and other related organizations must establish a code of conduct that defines and sets out a process for handling unacceptable behavior by health care workers, such as rude language, temper tantrums and bullying. The Commission said such behavior can impact patient care by causing breakdowns in provider communication and teamwork

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Silent Treatment

Recently, a highly accomplished orthopedic surgeon was scheduled to work on three consecutive cases with his OR team. The operating rooms were state of the art within the medical center’s newly constructed orthopedic hospital, which had not yet celebrated its first birthday. A system of time outs including use of the World Health Organization (WHO) surgical checklist had been in place at the medical center for almost three years now, with multiple checklists for patient identification, pre-op procedures and instrumentation.

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Stress The Heart of the Matter

The most critical action you can take to decrease your personal level of stress in the workplace is to raise your own awareness of the emotional work of nursing, and to honor your own feelings at all times.

As the mother of five children under the age of 12 living in a 500-square foot trailer in the south, I thought I knew stress. I had struggled with adapting to single-parent life while attending nursing school full time, working at the university, dealing with financial concerns and spending tremendous amounts of psychic energy to nurture my young family. But I was wrong. The kind of stress I was familiar with was tangible and expected—acknowledged and validated by friends and family. The stress that I experienced in the transition from nursing school to staff nursing was like nothing I had ever experienced before because it was intangible and unnamed.

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Conflict

Significant research exists to confirm the damage caused by relationship conflict in healthcare; particularly aggression, verbal abuse, and horizontal hostility among nurses. Relationship conflict affects morale, satisfaction and quality of care. Nurses who report the highest degree of conflict also experience the highest degree of burnout (Hillhouse). This data is no surprise to managers who spend 30-40% of their workday dealing with some form of workplace conflict (Thomas). Because resolving the quarrels that result from poor relationships can be exhausting and time consuming, many managers tend to ignore nurse-to-nurse conflict, or act like a third party and negotiate compromise in order to end an energy-draining situation quickly. But neither of these strategies is effective. What is the best way to manage nurse-to-nurse and nurse-to-physician conflict in the ICU?

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RN-MD Relationships

The Patient Always Loses

Research shows us that good RN-MD relationships are ego boosting for both nurses and physicians; and that the safest environment for the patient is one where staff can openly communicate - where even the meekest member feels comfortable speaking up.  But that is not the current culture everywhere.  It's the patient who loses when we fail to create collegial interactive teams. How do we get there and why has it taken so long? What is SBAR and how do you use this RN-MD communication tool?

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Community in the Workplace

Nurse leaders struggle to prioitize the many recruitment and retention strategies proposed in the literature, at conferences and workshops. And with the first wave of baby-boomers reaching retirement age, attaining and maintaining a vital and viable workforce is becoming a priority healthcare issue. Creating a sense of connection among workers in the organization is a proven retention strategy....

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Lateral Violence

A nurse hides a surgeon's favorite instrument when a substitute fills in as the scrub. Acirculator does not tell a new nurse who is scrubbed that she knows the shunt the surgeon selected has fallen on the floor. Anewly hired RN who was previously a scrub tech is shunned by both camps. Is this just life in the OR? Is it part of a nurse's rite of passage? Or is it something more insidious -- bullying...

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©2010-2017 Katheleen Bartholomew