Self-Scheduling

One indication of how far nursing has come is the idea of self-scheduling.  Not long ago, nurses had their whole lives on hold, waiting for the next schedule to be posted.  They weren't sure month to month if they would be able to host a birthday party for their child on a certain day.  

Self-scheduling has its problems.  Like concerns that the skill mix will not be adequate or that the weekends will be skeleton crews. 

But somehow, the empire has staggered on.

Statistics

Statistics help us get a grip on our fear and uncertainty.  Consider these true but unpopular facts: 

Peanut butter kills more people every year than terrorists.

You are more likely to be shot by your dog than to use your gun legally on an intruder.

  

Statistics are easily manipulated.  They can "prove" that something causes something NOT to happen.  Like elephant repellent:

Here's another questionable correlation/causation case:  statistics clearly show that when ice cream sales start to rise, drowning deaths also rise.  Does ice cream cause drowning?

There are things we SHOULD fear:

And things we should not:

 

Compassion Fatigue

Nurses are vulnerable to compassion fatigue.  Our capacity to care can be severely challenged by patient's behavior. 

For example:

Patients who unplug their IV's and sneak outside to smoke

Obese patients on insulin drips who call patient relations because their nurse won't get them another bag of candy

Patients who leave AMA, go to the bar across the street, stagger back and pass out drunk in front of the hospital

And patients who smoke meth in their hospital bathroom, causing their monitored heart rate to double  

Nurse's break rooms should have a special vending machine for compassion rejuvenation!

Swan Dive

Doctors are as vulnerable to fashion trends as any other herd of people. The Swan-Ganz catheter is an excellent example.

When I first became an ICU nurse, swans were wildly popular.  Most ICU patients--regardless of their diagnosis--were swanned.  Swans generate a flood of esoteric numbers, so they MUST be beneficial, right?  ICU's had so many swans back then, they resembled aviaries!

The nurses spent a lot of time leveling, wedging and bolusing.  And charting all those numbers.  It was all paper charting back then--there was no such thing as downloading values from monitor to chart with a simple keystroke.  We faithfully charted EDVI, SVI, SV, CO, CI, PAS, PAD, PAM, PAWP, PVR, SVR, SVRI, MAP, RAP and CVP into tiny cramped flowsheet boxes while call lights went off and patients called out for help.  But, since this was IMPORTANT, we prioritized and charted on!

The result?  Did the attending physician call at two in the morning to check on the pulmonary artery diastolic and add dobutamine?  Did the cardiologist stop by, see the cardiac output and tweak the fluids?  What was the impact of all this writing, flushing, leveling and wedging? 

Not much.

I felt like someone who makes seven course dinner for guests who never show up.  Why were we doing this?  Is anybody there?  Does anybody care?

Then studies started coming out demonstrating clearly that swans do not improve patient outcomes.  In fact, with the combined risks of infection, overwedging, valvular damage, thrombus and pulmonary artery rupture, swans actually result in worse patient outcomes.

Younger physicians, current on the data, left the swans to fly in the wild (the cath lab and operating room).  To evaluate sepsis and cardiogenic shock, they used less intrusive means. 

When a swan is sighted now, it's almost always partnered with an old doctor too deaf to recognize the swan song.