Nurse Sean (dot) com

Well, as expected, my first shift back after being off for a week (most of it sick) was absolutely horrible. Isn’t that always the way? You feel rested, relaxed, recharged, energized and newly excited about your profession. Then you walk in and within ten minutes you are reminded of exactly why you keep getting burnt out. 

Some of you are thinking, “what? You haven’t even been out of school a year and you’re using the ‘B’ word?” However, for me, burnout isn’t an end of the road situation for me. Instead, I find that it is a cycle that ebbs and flows over time. 

Last night I had fresh post-op patients, new ICU admits, a psychotic patient, a total care patient, a patient that needed excessive toileting (ARG! I hate walking little old ladies/men to the bathroom several times a night when they are sloooooow!), two others that kept me busy by frequently asking for menial tasks. Yes, there’s nothing like that desperate call from a patient because they need their perfectly fine leg moved two inches to the left! We had one of these conversations:

“Nurse Sean, can you move my leg two inches to the left?”

“Why don’t you try adjusting it yourself?”

“Oh! OK, is that allowed?”

I had two patients on tubefeeds, almost all the patients were on q6h sliding scale insulin, one had a heparin drip that needed to be titrated, three were having low blood pressure issues, two others had low urine outputs, one needed discharge paperwork started, another needed to be prepped for a CT scan. On top of all this, administration insisted that we start lining our halls with new patients even though we were short staffed.

I think if I could choose one factor that contributes most to my burnout, it would be a complete lack of control over my environment at work. I have no say in my patient assignment (I can request a change, but it isn’t likely), so if I feel I have too many patients and feel unsafe I have no recourse. If five nurses call in sick but they still insist on filling up our unit far past capacity, we don’t have the ability to stop admissions because we just can’t handle more. I can’t tell doctors that certain procedures will have to wait until morning because I have too much on my plate. In situations like these, I am simply told, “too bad, deal with it.” And usually very rudely.

So, last night my mind was filled with the question of how can nurses  regain control of their own work environment. The only resolution I could come up with was regarding our union contract. I firmly made the decision that I will never say yes to a contract unless it includes some way for nurses to refuse dangerous workloads. Until nurses have the ability to say “no,” I will not be agreeing to anything.

Sure, this may mean that I never vote yes on a contract again, but I believe nurses have massive pools of power that they never use! Instead, they sit around the break room and complain about their jobs without taking action. Imagine if every nurse decided they would never sign a contract or work in a job unless it gave the nurse more power over the safety of their environment! 

Come on nurses, use your power! If you don’t like something, find a way to fight it! Even if the only recourse is to withdraw your yes vote. 

I need to get this off my chest. I am very interested in the debate in the US between private health care and public health care. I am a Canadian and have lived under a socialized system for my entire life. I am tired of reading blogs and forum posts that continue to perpetuate complete myths about socialized health care. These are the main ones I hear that I would like to dispel: 

1. You will no longer have any choice over your doctor or what hospital you can go to. The government assigns doctors to you! 

Ok, I honestly don’t know where this comes from! Doctors are never assigned to people in this country!

Here’s how you get a doctor in my city: first, you go onto the website for my city and click on the link entitled, “Doctors that are accepting patients,” secondly, you choose the area of the city you live or work in…or whatever part of the city you want to travel to to see a doctor. Thirdly, you look at the list of doctors and choose one. In order to help you choose the doctor you can look at comments provided by patients of these doctors on how they rate their services. This process of choice is the same whether you are homeless or a millionaire.

As for choosing a hospital, well, they are all run by the same executives and follow the same policies. Choosing different hospitals won’t get you better care. In fact, each hospital strives to give equally great care. Choice is based on location and availability of beds. 

2. The government controls what the doctor can and cannot do!

Please! The government wishes they were this powerful!

Plain and simply, doctors do not work for the government. They are self employed. The only difference is that they send the bill for their services (as do the hospitals) to the government as opposed to the patient or their insurance company.

Doctors answer only to their licensing body, as do nurses and all health care professionals.

In fact, I think there’s much more freedom for doctors. They don’t need approval from insurance companies for procedures. The doctor is in control of what is necessary and it is more likely to be based on the patient’s needs than profit margins. 

3. You have to wait months to get into the hospital or go for procedures!  

Sometimes this is true! But only for minor surgeries that are being done for comfort reasons. For example, if someone needs a knee or hip replacement because it’s painful to walk they may have to wait a little while (but not the exaggerated amounts of time that you hear).

And no, patients don’t walk around with broken hips. If you are in trouble and you need help right away, you get it right away! I’m tired of hearing ridiculous stories of patients who have to wait months for emergency bypass surgery, or years to get their ruptured appendix dealt with. 

Sure, you hear about people going to the states for procedures. However, this is for the extremely wealthy. If someone said to me, “you can pay $20,000 and have your knee replaced tomorrow, or wait a couple months and have it done for free,” well, I’ll wait! Going to the US for procedures is absolutely NOT as common as people think

4. The US has the absolute best health care in the world! People flock from all over the world to have procedures done here.

I hate to break it to everyone, but (brace yourself) all that technology that you have is miraculously available in the rest of the world as well!!!   

*gasp!*

Don’t flatter yourself. All the things you can do in the US can be done everywhere else. In fact, on my particular unit, the doctors specialize in a particular cutting edge procedure. Patients flock here from the US and all over the world to have it done. 

5. If the government runs the health care system, the bureaucracy will run the hospitals into the ground!

Are you kidding? The government is the only place billed. There’s no paperwork to fill out, just a healthcare number to keep on the chart. There’s no billing department to send out itemized bills to patients, insurance companies, etc. The administrative side of public healthcare is incredibly streamlined.

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OK, that’s all I can think of for now. I’m sorry if I offend. I simply am tired of people telling me all about this crappy system I work in when really they are completely misinformed about how this system works. 

I recently renewed my membership to The New Democratic Party of Canada. I am very proud of this fact! If I were an American, I would probably be crucified for being part of such a left-wing party. I’m proud to live in a country that doesn’t put you down for supporting a party that supports socialized health care, gay rights/marriage, strong environmental solutions, equality for women/minorities, and strong social programs to help alleviate poverty.

Here’s a link to their position on public/socialized/universal health care.

I have seen so many blog posts/comments and discussions at allnurses.com that are very much against universal health care. I thought I would start a list of reasons I love Canada’s health care system. This will be added to on a continual basis as I think of new reasons or examples.

1. Currently on my unit there is a homeless woman who found refuge at a homeless shelter. The nurses who assessed her at the shelter were worried about her condition and sent her to the hospital. She was dirty, weak, malnourished, and on death’s door.

There is also a very rich businessman who was sent to our unit after many weeks of traveling Canada and the U.S. for opinions on his condition. Every surgeon told him to go to our unit, to our surgeon. He is considered the best of the best.

Both of these people had the exact same condition; a deadly cancer that was slowly killing them and needed to be removed. Both of them received the same surgery from the same surgeon. Both of them received the same care from nurses, physiotherapists, social workers, residents etc. They lived in identical hospital rooms next to each other and recovered at the same rate.

Both patients walked out of the hospital on their feet. The wealthy business man (back in his suit and tie) went back to his mansion and luxurious life, and the homeless woman went to her new apartment with homecare nurses put in place and adequate government funding for her to survive (away from the streets). The social safety net had successfully caught her.

The treatment they had cost approximately $500,000. If health care were privatized, the homeless woman would never have been able to receive the surgery. She would have died on the streets.

When it comes to health care, we are all treated as equals. Some will go home to mansions, some will go home to crappy apartments. However, we will all be treated with respect and dignity when we are sick.

I strongly believe that health care is a right, not a privilege.

2. Hospitals in a socialized health care system are not-for-profit. This is an extremely important detail for many reasons. However, for number two on my list, I want to focus on the idea that in a not-for-profit hospital, health care professionals (read: nurses) are not forced to become customer service agents.

Our hospitals are functional. They aren’t overly “pretty” or filled with pleasantries to attract “customers.” Hospitals here are there to serve the needs of the community, without having to stoop to gimmicks like having food courts in the lobby so that patients will choose that hospital first!

Our professionals are truly professionals and can focus on executing their skills, rather than focusing on whether or not patients like them. We are not insulted by being presented with satisfaction surveys or “customer” complaints. When I’m putting a tube through your nose, poking you with needles, and shoving Foleys in your bladder, is it really an appropriate time to ask if you are happy with me?

I’m not even directly affected by the American system of treating patients as consumers, but I am continually insulted by it. The idea that well-educated, skilled, brilliant professionals can be lowered to feeling like a fast-food worker, is horrifying*. Does an architect, lawyer, or manager submit themselves to satisfaction surveys? NO! They let their work stand for itself. Nurses should the same.

I have never worked within the American system, but I am in love with the Canadian system. I feel it is a much more mature, humane system that treats its patients and employees with respect. The power is balanced between all individuals, rather than just the patient, because we all pay for and use the same system. I know that if I am ever sick, I will receive the same great treatment that I give every day.

*I don’t think fast-food workers should be made to feel like lesser citizens, but unfortunately (and unfairly), they are. Please, for the love of god, be nice to fast-food workers. You have no idea how tough their job is if you have never been there. They are continually treated as lesser citizens, and that is NOT right! I just wanted to clear that up.

I am tired tonight. I’m switching from days to nights by staying up all night, and my body is NOT happy about it. Normally it’s not a big deal, but three days ago I was asking my body to switch from nights to days. Seriously, how cruel is it to give me a schedule that involves working night shifts for two weeks, then two day shifts, and then back to nights for two weeks. Yes, I shall be dead before I’m forty!

Charlie had his splint off today. I dropped him off at the vet early in the morning and took off to run errands while the vet took an x-ray and examined his leg. When I picked Charlie up, he had a cone on his head and he looked miserable! The leg is just fine; however, he would not stop licking his foot/leg. So, until he stops, he will have to wear the cone (all that licking could cause an infection). He spent the afternoon under the coffee table looking completely unimpressed with the entire day.

The poor guy is having trouble walking. You can tell by looking at the leg that it is much weaker than his healthy leg. Weeks of not using the muscles of caused them to become imperfect. On top of that, he seems confused by the lack of splint–he had become so used to it! Four weeks is a lot of time in the life of a fifteen-week-old puppy. So, he needs to strengthen his leg and learn to use it again. I wonder if there’s a doggy physiotherapist around here.

I enjoyed the day off with a vehicle (Richard got a ride to work so I could use the van to take Charlie to the vet). I bought a couple books at Chapters, sipped tea at Starbucks, bought Richard some pants, and wondered around the mall. I forgot how much better it is to have a vehicle of my own. I was reminded of the freedom a vehicle allowed, and it pleasantly intoxicated me! I may just decided to buy that new Honda Civic after all.

Patience! That’s what I need! I need to pay off a couple debts, then try to get approved for a mortgage…and when that fails, I can get my fancy new Honda Civic.

Work is driving me to the point of insanity. There are just too many patients and too little time. I am so disheartened by all the “solutions” that are being introduced in order to help speed up admissions to the hospital, and thereby reduce ER wait times.

For the record, I am absolutely tired of the news reporting that the long waits are due to a massive bed shortage. To whomever is listening THE REPORTS OF THERE BEING A BED SHORTAGE ARE FOR THE MOST PART A MYTH!!!!! That felt good…

The news keeps stating over and over again that there is a critical bed shortage and that we need to hurry up and build new hospitals, and add on to current ones in order to ease the crunch. The news reports that because of this shortage of beds, patients in the ER have to wait thirteen hours or so to be admitted.

The problem with that is that there are dozens of beds in my hospital that lay empty at every moment of the day. On my unit there are usually four and sometimes eight beds that lay empty all the time. So, why aren’t patients being admitted to these empty beds? BECAUSE THERE ARE NO NURSES TO TAKE CARE OF THEM.

Sorry for the capitals, but seriously, why does this fact seem to escape the media, the health region, and the Government? Why do all of these institutions insist that building more beds will solve the problem? They are building a big hospital down south, but if there’s not enough nurses to run the hospitals we have, then who will run the new hospital?

So, the “solutions” to the ER wait times? They have implemented what they call “Triggers.” For example, if someone has been in the ER for four hours (the four hour limit being the trigger), they will be sent to a unit whether there’s a bed available or not. If someone has been in the post anesthetic recovery room for a certain amount of time, they will be sent to a unit whether there’s room or not.

They expect us to admit these patients post-op and from the ER and care for them in the hallways. This is about as unsafe as it gets! Not only does it overwhelm the nursing staff (I didn’t think we could be more overwhelmed…I guess this will prove me wrong), but putting patients in hallways means that we don’t have emergency equipment available at the bedside.

What we need is MORE NURSES. We need to find innovative ways to attract AND KEEP nurses to the city. This could include great signing bonuses, competitive wages (not to nurses in other provinces, but to other, similarly educated people in this city), excellent benefits (seriously, shouldn’t nurses have good health benefits?), and more than anything…a positive work environment.

What we don’t need (which we are experiencing) is difficulty getting a pay increase that even comes close to matching cost of living increase. The government wants to give us a couple percent raise over the next few years. They are also attempting to roll back many of our benefits. Is this really a time to take a step backward?!?!?!?!

This in a city, where on a full time nursing wage, you can’t even get approved for a mortgage for a 500 square condo. If you doubled a nurse’s wage, he/she would be able to just barely get approved for that bachelor suite (assuming they don’t own a car or have an ounce of debt). On a nurse’s wage, even renting a one bedroom apartment can potentially take up half of your paycheck.

Ok, I’m going to stop there. Rant over. I could type for hours about this issue, but I need to stop somewhere.