Category: Nursing Practice

Nurses Retiring Early: Life Of Retiree Nurses Case Study

Nurses Retiring Early: Life Of Retiree Nurses Case Study

I took a review of retiree nurses in Rivers state and i weep for a beautiful profession that fetches thousands of dollars over sea.

The business of nurturing from birth to grave ought to be given priority attention and dignity it deserves to practitioners especially as it’s difficult to manage people who are well let alone people caring for the sick and interacting with all form of diseases and infection while caring for the sick.
The biggest question i do ask: Who cares for the nurses that cares for all?

Nurses gave up their night rest with their husbands and wives doing a security work of caring, nurturing people from dependent status to independent status only to be called ordinary nurses by the society. They are burden bearers to their respective families.
The question is who is against the nurses?

My careful observation suggest only nurses are against the nurses. For example:
1. Who denigrate student nurses in front of patients?
2. Who refuse nurses promotion to directorate level?
3. Who schedule duties like errand nurse?
4. Who petition nurses every day for little benefit?
5. Who stop nurses from diversifying their economic base after work to be comfortable as their pears in the medical profession?
6. Who refuse to participate in strike action against government that treat nurses with levity?
7. Who accepts salaries of N20, 000.00 in private hospitals?
8. Who trained auxiliary nurses without auxiliary doctor?
9. Who said only BNSC is the requirement for management position irrespective of higher degrees one possess even in management, psychology, public health, health education, medical sociology, law ,nutrition, microbiology which are all health related disciplines?
10. Who said RN, RM recognized all over the world as the prerequisite for nursing practice and a certificate without malpractice is not a qualification?
11. Who sees a community health extension officer promoted as directors and still feels nurses can’t be director under his/her watch?
12. Who post nurses to distant places from their home simply to punish them to have family problem.
13.who traces nurses who have multiple job opportunities but still can offer 128 hrs a month and 8hrs daily to government with a view to ensure they are queried and sacked?
14. Who told the public nurses are not supposed to be comfortable like a professional and should never own a car and good house?
15. Who refuses to sign study leave with pay?
16. Who rejects nurse’s sick leave?
17. Who fail students with scores of 49.9?
18. Who said a man cannot be a director no matter how qualified because its women profession?
19. Who refuses to give accommodation to junior nurses in the hospitals?
20. Who schedule night duty for a nurse on honey moon?
21. Who are the only implementer of civil service rule even in recession?

The answers to these question is nurses have been inhuman to nurses not any other professional in the health sector.

Unfortunately the consequences of punishing a colleague manifest in retirement. Most of our colleagues retire without a home, without a car, poor retirement benefit, untimely retirement, some denied managerial promotions, some regretting being a nurse. Some retiree nurses now sells akara in the market to survive and others rejected by their families.

No nurse is a permanent secretary they say no problem!
No nurse is represented on the hospitals management boards they say no problem!
No nurse is a commissioner nor minister they say no problem!
No nurse is on the board of primary health care they say no problem!
No nurse on disaster committee they say no problem!
No student union government in schools of nursing they say it doesn’t matter
No payment to junior nurses for several months they say it doesn’t matter!
NANNM calls for meetings they don’t attend with all excuses!
Hospitals are empty almost all senior nurses are retiring it doesn’t matter!
Student’s hostels collapsing it doesn’t matter!
No offices for cno’s it doesn’t matter!
No official car for nurses it doesn’t matter!
No emergency or call duty phones no problem!
No medical equipment no problem!
No nurse consultant no problem!

As much as it’s no problem and it doesn’t matter we may be a victim someday. Let’s correct our mistakes now before we become a victim.

I am sincerely sorry if i am denigrating our profession in the public but crying for nurses attention to nurses plight while calling on the attention of nurses in position of authority to please help their colleagues grow in capacity, character, competence and economically .their colleagues could be a source of succor to them at retirement as well promote the public status of the profession.
Paper qualification is good but skilled nurses is better because only a skilled nurse can save a life not paper not certificate. It’s not a sin to be a nurse rather it’s a blessing.

Solutions.

1. I encourage all nurses to further their education for reason of adding knowledge, prestige and evidence base practice to the profession not for discrimination. a true scholar tries to raise the weak and build a viable profession for all not for only the strong.
2. Remove all self-inflicted barriers in nursing.
3. Keep promoting your colleagues provided the decision is within your table.
4. Support nannm with information and advises that can move the profession forward
5. Nannm should rise to the occasion of defending nurses in the labour market.
6. Organise duties to give younger ones the opportunity to go back to school be it for bsc, msc, phd, post basic courses.
7. Love one another.
8. Defend your colleague at work.
9. Correct your colleague with love.
10 Get involve in the health sector politics.
11. Develop your skill of caring through evidenced base practice to give the best to your patients and clients.
12. Reach out to our retirees and form a retired nurses forum to serve as our experience bank.
13. Approve study leaves for your colleagues.
14 Initiate a 1-2years rn to bnsc programme that is hospital based like residency programme for mass movement of nurses to degree level
15. Initiate a nurses national dialogue on what nurses want for their profession.
16. Initiate immediately nurse practice bill to the national assembly.
17. Propose bill to state assemblies for schools of nursing and colleges of nursing.
18. Collaborate with NUC to make colleges of nursing specialized degree awarding institutions only in nursing and midwifery courses, and making various other specialties appealing program of qualifications for growth and development in skills in nursing profession.
19. Initiates an alumni association in all schools of nursing and midwifery.
20. Institute student union government in all schools of nursing, midwifery and colleges of nursing.

Please assist and support a nurse to be economically independent because they are leaders by virtue of nursing training, their responsibilities to families are enormous. Help your colleague in whatever capacity you can.
Note: whatever you deny a fellow nurse will never be given or added to you. if we pray for favour we should also be a source of favour to others. Then you force your leadership on a people you end up achieving nothing but when you earn your leadership from the people your achievements becomes uncounatble. Nurses arise to save your profession now!
No matter your qualification once a nurse is a nurse hence be respected
And accorded the dignity of a professional.
God bless nursing profession in Nigeria.

Written by Joy Emuze

Nursing Medication Errors Stories: Confronting Doctors With Wrong Orders

Nursing Medication Errors Stories: Confronting Doctors With Wrong Orders

Confronting doctors can be intimidating, but we are the patient’s final defense against wrong orders. Somebody has to make sure we get it right. (As always, the illustrations are the products of my imagination or names or events used in a fictitious manner. Any resemblance to actual events is purely coincidental.

Confronting Doctors with Wrong Orders
We are standing at the counter of the nurse’s station in the ER when I tell Dr. Hanson that his patient in 18 is asking for pain medication.
“There’s nothing wrong with her,” he retorts. “She’s just full of BS.”
“If there’s nothing wrong with her, and she’s just full of BS, why are doing $8,000 worth of tests?” I ask bluntly. “Maybe we should give her some pain medication just in case.”

When Dr. Hanson slides back into the doc box to order some morphine, another nurse who had overheard the exchange nudges my arm to get my attention. She half whispers, “I like the way that went down.” I hadn’t given the exchange a second thought while it was happening, but, based on her comment, it occurs to me that I’d just done something she would have found hard to do. It may be easier for me to confront doctors because I’m older than a lot of them and worked here longer than most of them. Also, in the ER, we are used to working alongside different classes of providers, interacting on a casual level that might feel uncomfortable to nurses in other departments. Admittedly, I am writing from an ER perspective. But, even if you are relatively young, new, or intimidated for any other reason, there are three times nurses must be assertive enough to speak up.

First, we need to confront providers when their orders don’t make sense or demonstrate a clear mismatch to a patient’s individual situation. In the era of point and click, entire panels of orders are quickly entered. Sometimes the entire set is intended for another patient. Or maybe the doctor fails to remove a fluid bolus from a panel ordered on a potentially septic patient who is also showing signs of acute CHF. Maybe a provider orders an x-ray on the wrong hip, or omits a Digoxin level on a patient with symptoms of toxicity, or orders antibiotics without ordering the usual blood cultures. These simple, potential, or even obvious oversights are easy to confront because we’re “just checking” without questioning judgement. It’s an easy question: “Hey, I just wanted to double check. Do you want any blood cultures before we start the Rocephin?”

The second level is a slightly harder conversation. But when there appears to be clear judgement error, we still need to ask. For example, an 87-year-old with multiple system failures comes in via EMS. He is crashing, and we intubate him on arrival. The workup shows he needs immediate surgery to remove a large intra-abdominal abscess. But, when the family shows up, we learn that the patient has an Advance Directive and doesn’t want any heroic measures. He probably would have refused intubation if he had been alert enough to express himself. The surgeon evaluates the patient and states that he will not survive the surgery. The family decides to have him extubated and go to comfort measures only. The daughter specifically asks, “But you won’t do anything to make him die quicker, will you?” Dr. Stone assures her that we will not.

Dr. Stone and the surgeon spend several more minutes discussing the case with the family while the respiratory therapist removes the ET tube, and the patient starts breathing on his own again. As Dr. Stone walks away, he says, “We can restart Fentanyl drip.” The Fentanyl drip was held along with the Diprivan due to low blood pressure prior to the decision to extubate the patient. It was running at 300 mics/hour. I ask Dr. Stone, “Are you sure you want to restart it? You just told the daughter we wouldn’t do anything proactive to cause his death.” He replies that it will be okay and turns to walk away. I just questioned his judgement, and he confirmed his intention.
Now we hit level three. It gets more challenging when we have already questioned a doctor’s judgement once, but he persists in following a course we cannot condone. Continuing the case above, I follow the doctor toward the doc box. I’m not belligerent, but I can’t let this go. “Dr. Stone, at the very least I’m going to need you to enter a new order, and I’ll have to chart we had this conversation just in case we all end up in court together trying to explain why we ran Fentanyl at a rate that stopped this guy from breathing right after you assured the daughter we wouldn’t do anything to hasten his death.” He stops on a dime, whirls back toward me, slaps himself on the forehead, and says, “I forgot we just extubated him. Good catch.” They can be very good. They are not gods. Sometimes the third level is essential.

If we get to level three, a second or third opinion may help bolster courage before going back for the decisive confrontation. For example, there is an order for a bolus of Integrilin which is well over the standard protocol dose. I question the doctor, and he confirms the dose. But he is looking at an x-ray, and I have a feeling I don’t have his full attention. I double check the order in the computer, pull the medication from the Pyxis, and turn to another seasoned RN in the med room. I hold up the bottles and show her that the order for the bolus alone grossly exceeds the volume in the large bottle for the total infusion. We look at each other and say in unison, “No way.” Emboldened by her confirmation, I go back to the doctor with both bottles in my hands. I get his complete attention and show him the bottles, explaining the usual dose compared to his current order. He checks again and finds that he is off by two decimal places, accidentally ordering 100 times his intended dose. Oops.

A friend gave me a t-shirt years ago. It is threadbare now, and the slogan is hardly readable. But it has generated some interesting comments and stories through the years: “Be kind to nurses. We keep doctors from accidentally killing you.” It’s true. We are it. We are the patient’s final defense in the delivery of most healthcare, and we must have the courage to confront other providers on whatever level is necessary to make sure we all get it right.

by RobbiRN, RN Pro