"You Is Smart, You Is Kind, You Is Important"

I was watching "The Help" a couple of days ago with my daughter.  The movie has so many strong depictions of love and acceptance in a complex world that has a lot of barriers.  There were racial, sex, age, class and socioeconomic barriers depicted throughout the movie, most of which my daughter at the age of ten just couldn't understand.  At first I really didn't think about the relationship the movie could have to the field of nursing, but then it dawned on me that there are still many barriers in nursing today that do apply.

I started to think about the way Hilly and her friends treated the other characters, Celia, Skeeter, Minny, Aibileen, Mae Mobley and even Missus Walters.  The harshness of their comments and their deliberate actions all while looking the poised part.  This is how some new nurses are treated when they enter the profession, there is that same bitterness and the "eating of their young" that is unfortunately exhibited.  That ugly way the characters treated "the help" was handed down generationally, it was ignorance then and it continues to be today.

The help, like new nurses were not empowered, they were pushed down, talked down to, treated as second class citizens, talked about and threatened.

For me one of the most emotion and important scenes of the movie occurs when Abilieen and May Mobley are alone in the nursery when May Mobley repeats back the valuable words her "real momma", Abilieen, tells her, "You is smart, you is kind, you is important".

I believe that new nurses need that same reinforcement, guidance, reassurance and love.

While there are many change agents in the story, the collaboration between Skeeter and the help, standing up together brining light to the treatment these women endured is encouraging.  With so many nurses entering and leaving the workforce there is a changing tide and attitude.  Now is the time to remind our peers that: "You is smart, you is kind, you is important".

Striving for Five-- Buying Into Hourly Rounding

Customer Service!  Striving for five!  That's what its all about!

I don't know about you but I cringe just about every time we get to that part of the staff meeting and my departments' Press Ganey scores come to light.  It's even more fun when you look at the hospitals' websites and see the stats, those darn rehab nurses always beat us.  But I'm in the ER, and it's not easy to please people who are laying on stretchers, sometimes with no privacy in hallways, waiting for hours and having limited food choices- stale turkey or stale cheese sandwich.  

I've had some extra time to read a few books and professional journals lately.  I see pictures of smiling nurses and their happy patients, with happy captions, but does this reflect what is happening in the hospitals? There's has nursing research articles about how hourly rounding reduces call bell usage and reduces falls.  In theory this is a wonderful thing, but it's not a sure fire way to bump Press Ganey, is it?  

A recent article that appeared in the Journal of Emergency Nursing's January 2013 issue, written by two ER nurse managers supports hourly rounding.  Their article showed a statistical analysis of how their facility's Press Ganey scores dramatically increased.  It was reassuring.  In addition to hourly rounding the Emergency Room employees also had to buy into the concept that  they would meet specific goals that were directly related to the Press Ganey patient survey.  

The approach the authors reported is not unlike other emergency rooms.  AIDET was a key focus in addition to hourly rounds that included: "the 4 P's- personal issues, pain, position, and problems". 

So how did they get folks to buy in?  I know we have the same standards at the hospitals I work at, but it just doesn't seem to be uniform.  Rounding is generally left to the nurses, and when those nurses are busy and staffing is, well, short, hourly rounding sometimes takes a back seat. 

So how much of an increase did this particular hospital have?  The Press Ganey scores were at 57% prior to hourly rounding and increased sharply.  The authors also reported increased job satisfaction.  

The hospital was able to get the buy in from its staff and more importantly maintain it.  One of the ways they did that was through reward systems.  They utilized movie tickets, gift cards and employee recognition to keep their teams motivated.  In addition to the buy in from the employees side, the patient discharge paperwork also included a signed thank you note from the staff that cared for him.  According to Sharron Kelly, coauthor of the article, she stated that her department had not increased staffing levels, during that time.  She further clarified that the hourly rounding was a joint effort by physicians, techs and nurses.  

For more information please refer to the article "Improving the ED Experience with Service Excellence Focused on Team work and Accountability" by Sharon Kelly and Lou Faraone which was featured in the January 2013 issue of the Journal of Emergency Nursing.  

Little Hearts Big Love-- CCHD and CHD

February is a busy month of celebrations for matters of the heart.  Over the past few years heart health and wearing red has been in vogue for supporting the cause.  But who are we bringing awareness to exactly?

When you see CHD you might think coronary heart disease, but there is another CHD out there.  Congenital Heart Deformity  and Critical Congenital Heart Deformity which affects approximately 1 out of 120 infants. While some infants are diagnosed prenatally others may not show signs or symptoms until they are discharged home.

New Jersey has taken the lead in helping identify CHD by mandating a simple procedure that is non invasive and part of routine vital signs.  While most nurses wouldn't consider a pulse ox as being so groundbreaking, considering that we seem to use almost without thought.

Is that enough to diagnose CCHD and CHD?   No, it's not, but it is a start!

While some CHD can be suspected related to lowered pulse ox values, it is not the case for all forms of CHD.

Commonly associated CHD linked to low pulse ox include:

• Hypoplastic left heart syndrome

• Pulmonary atresia

• Tetralogy of Fallot

• Total anomalous pulmonary venous return

• Transposition of the great arteries

• Tricuspid atresia

• Truncus arteriosus

It is recommended that the pulse ox be done 24 hours or later, because newborns bodies will often show signs and symptoms several hours or days after birth. For optimal results it is important that the infant now be crying or moving during the reading.  The probe should be placed on the right hand or either of the feet.  
A positive screening includes one of the following

1. SaO2 measurement <90 percent
2. SaO2 measurement <95 percent in both upper and lower extremities on three measurements, each separated by one hour
3. SaO2 difference >3 percent between the upper and lower extremities

http://www.uptodate.com/contents/congenital-heart-disease-chd-in-the-newborn-presentation-and-screening-for-critical-chd#H270523895

While nursing is about medicine it is also about the families of these infants and children who are born with these serious and life threatening conditions.  Below is a link to some amazing stories that truly touch the heart.  http://www.chop.edu/service/cardiac-center/patient-stories/

Insurance and Addiction- Not What the Doctor Ordered

Having worked in the Emergency Room in a few facilities over the years I have seen the heartbreak in the eyes of the family or loved ones of addicts when they come to the ER in hopes of detox or rehab.  Unfortunately addiction recovery is not something that ERs do, and less and less hospitals have specialized units for this kind of medicine.  

http://www.nj.com/news/index.ssf/2013/02/new_jersey_heroin_insurance_tr.html#incart_river_default

Sadly when a person is triaged and they say that they want to "kick", stop using, whatever addictive substance they have been abusing and dependent on we can't always offer them help.  Sometimes the patient has been down this road before and they know that the only way they are going to get away from the substance is to say.."I'm suicidal". But what happens when the ER they go to doesn't have an addictive treatment center or unit?  

Unfortunately the person is generally medically cleared, they are seen by a mental health screener (social worker from a crisis unit) and then a psych doc and if that patient doesn't have a plan for hurting themselves, they are often given a list of treatment facilities and discharged.  If the person is truly an addict and they walked into a facility seeking treatment, then that was a major step.  Perhaps they really wanted to change their lives.  But then there is the discharge and the piece of paper.  There is no hand holding or someone to help them navigate the insurance red tape.  They are on their own.  If the person is lucky maybe they hit rock bottom and still have a family or support system intact, but there are the others who have nobody.  No support.  They have that piece of paper.  Perhaps no cell phone, no home, no address.  They might be withdrawing and this isn't what they expected recovery would look like.  Maybe it was easier just using. 

Addiction and mental illness are not luxuries like Botox and boob jobs!  It's time that we start treating the whole patient, addictions included.