realnursing

One thing that drives me absolutely nuts in report is drilling. I’m sure every nurse has been through this experience. You’re going along and the other nurse interrupts you to ask questions that you actually might address later and you get that stellar moment of feeling like an idiot. Here’s an example. Me: Patient had some chest pain... Night Nurse: What were his troponins?  Me: Uhhhhhhhhhh. 

Now, the patient may actually not have been having a cardiac event. Maybe it was epigastric. Maybe it was relieved with movement. Maybe it was intermittent. MAYBE IT WASN’T A CARDIAC EVENT. But you know what, ask me about troponins so I can feel like an utter idiot. Please. 

Still, it’s not like I don’t do it. It’s not like I don’t drill. Because getting and giving report requires your to know your patient, and sometimes it’s pretty clear that you don’t. Sometimes we get so focused that we forget to ask why. Why is an important part of critical thinking, and critical thinking is a huge part of the professionalism of nursing. If we don’t critically think, we don’t serve our patients, we become simple task performers at the bedside and we actually don’t save lives. 

Patient dropped his hematocrit to 17. WHY?

Patient had an IJ placed. WHY? 

Patient started on telemetry. WHY? 

Just giving me the facts about a patient falls short of the job we do. We need to not only medicate and take vitals, as nurses we need to have endless curiosity and be willing to be great detectives about our patients. The better we know them, the better we help them. 

It’s not always easy. Nursing these days is a never-ending crush of endless tasks. We have heavy patient loads and are worked to the bone. Our patients start to blur together. We are tired, overworked, hungry and it sometimes seems that we have more and more added to our jobs on a weekly basis. And there are shifts when I feel like I know NOTHING about the people I’ve taken care of all day because I’ve been running all day. But if our standard of nursing is the lowest common denominator of just the facts and nothing else, if we don’t read charts, talk to patients and research diagnoses, we don’t actually do our jobs. 

So my hospital is pursuing magnet status. What is magnet status? This is what I gleaned from the ANCC (American Nurses Credentially Center) website:

The ANCC Magnet Recognition Program® is viewed around the world as the ultimate seal of quality and confidence. Magnet organizations are recognized for superior nursing processes and quality patient care, which lead to the highest levels of safety, quality, and patient satisfaction.

These are the benefits of Magnet status:

Attract and retain top talent

Improve patient care, safety and satisfaction

Foster a collaborative culture

Advance nursing standards and practice

Grow your business and financial success

To summarize, Magnet status tells you, average consumer of healthcare, that a hospital is a place that nurses like to work. You love nurses. Nurses are AWESOME. They Dare to Care. They Save Lives. If they like working there, it must be a good place. You will now decide to have your elective knee replacement at that hospital.   (And guess what, you can hire ANCC consultants to help that hospital on its quest for Magnet status.) Magnet status focuses on things like whether or not a nurse has their BSN and establishing unit based nurse practice committees. These are good things, I mean, unless you’re an ADN nurse. And who doesn’t want a committee. Committees are fun might have food. But still, these efforts just seem out of touch with what really works for patient care and patient safety. An example of what I mean from the ACNN website:

Today's Magnet recognition process primarily focuses on structure and processes, with an assumption that good outcomes will follow. 

An assumption of good outcomes. Except we actually know what brings both happy nurses and good outcomes. It’s well-studied and documented. It requires no consulting firms, no certifications, and will not only make happy, satisfied patients, but it will also keep them alive. I’m happy to outline them here, and I’ll even put them in bullet points so they’re totally legit. 

Pay us a reasonable wage that reflects the goddamn hard back breaking soul ripping work that we do every day. 

Give us our breaks. 

Staff us so we don’t feel like we’re going crazy. 

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