A Nurse is A Nurse is A Nurse....

Do you believe that?  I don't.

For most of my nursing career I have been a staunch supporter of my nursing union.  Since the late 90's the union has worked hard at improving the working conditions for RN's. They have worked tirelessly on addressing workload issues and the impact it has on patient care.  They negotiated the largest wage increase nurses have seen in decades.  I was proud to call myself a memember of the British Columbia Nurses Union(BCNU).  Today, I question the direction they have taken.

Over the past few years BCNU has been attempting to bring Licened Practical Nurses(LPN) into our union.  The union says LPN's wanted to join our union.  There has been a lot of controversy over how the LPN's were approached about joining BCNU, so much so that the Labour Board got involved and legal battles insued.
HEU believes that BCNU "raided" their union.  Raiding is the practice whereby a union tries to organize workers who are already represented by another union.  In union terms that is an absolute NO NO and does nothing for union solidarity.  As a result of  BCNU actions they have been shunned by The Canadian Labour Congress and the Canadian Federation of Nurses frowned heavily on BCNU's actions.

I started my post out saying that I used to be a staunch BCNU supporter.  What I think I should have said is that I am a strong unionist.  In union terms what BCNU did in my opinion is fundementally wrong .  I  recently read on the HEU website a review of BCNU position on LPN's.   Since 1996 BCNU took a strong stance against LPN's. The folowing is taken from the HEU website:

Back in 1996 BCNU president was quoted as saying "“There’s no room in the health care system for LPNs anymore. Existing LPNs should be re-training as RNs”

2000: BCNU lobbies Health Professions Council to stop LPNs from calling themselves nurses. “The BCNU disagrees with the HPC’s recommendation that the title ‘nurse’ be granted to licensed practical nurses and thus shared with registered nurses and registered psychiatric nurses.”


2004: “We’ve been told they (LPNs) do 70% of our work. That may be true. The 30% that they don’t do, however, is the intellectual work which makes all the difference between a registered nurse and a practical nurse.” BCNU president’s remarks to BCNU convention.

2006: “In most industries, what is happening in health care today would be seen as a dumbing down of the workforce. However, somehow for health care, having overlapping scopes of practice, quote unquote, is seen to be acceptable. As one person put it, when we were out of surgeons, they didn’t call for butchers.” BCNU president’s address to a public meeting on health care reform. (watch the video)

2007: BCNU makes a deal with the Vancouver Jail to replace LPNs with RNs, as positions become vacant.

2009: BCNU successfully fights Fraser Health’s decision to utilize LPNs trained to help carry out immunizations in the community, leading to LPN layoffs.

2010: BCNU publicly blasts Fraser Health’s plan to increase direct hours of care to long-term care residents by utilizing more LPNs. (The Province, September 30, 2010/Abbotsford Times, October 1, 2010 and HEU's response as published in Surrey Now)

And now only 2 years later BCNU is singing  a different  tune and welcoming LPN's to our union.  What changed?   Why is BCNU welcoming LPN's with open arms?

You know that saying " If it looks like a skunk, smells like a skunk, and acts like a skunk, chances are it's a skunk"  Well I smell a skunk.  BCNU's  position is that LPN's wanted to join, and state  that the LPN's felt they would get better representation at the BC Nurses' Union.  On the BCNU website you will find the following statement "At BCNU another nurse will always be at your side to represent you."  Note the generic use of the word "nurse"

So what changed from 2000 when BCNU was lobbying the Health Professions Council to stop LPN's from calling themselves nurses?  BCNU was of the opinion that the designation of "Nurse" should only apply to RN's and RPN's.  I can remember specifically our union campaigning to have all RN's wear buttons identifying themselves as RN's and to always introduce themselves to the patient as  RN.  I recall thinking how silly that was, surely my patient knows I am an RN.  This unfortunately is not the case. I personally have observed LPN's identifying themselves as nurse in the generic ...rather than I'm your LPN.   I can see now how patients get confused about who is providing their care.

I am of the opion that the reason BCNU wanted LPN's in our union was to have them closer at hand.  BCNU is of the opinion that if employers are going to be using LPN's to fill the shortage of RN's then BCNU want to have more control as to how that happens.  I think it's a money grab from our union.  Increased membership = increased dollars to the union.  Increased memembership= increased bargaining strength.

BCNU has just negotiated a tentative agreement with our employer.  It's a 2 year contract where  nurses will find themselves with  a 3% increase in the Spring of 2013, workload language, and an increase in the number of nurses  by March 31st, 2016.    I'm not quite sure where our union or employer believe we are going to find another 2100 nurses by 2016 especially when a lot of the baby boomers will be retiring within the next few years.  Although BCNU states that it will be RN/RPN positions that will be increased, I am not sure what stop gaps will be in place to prevent LPN's from filling the need.  I fear there might be a little conflict of interest on BCNU's part.

Now I see that BCNU has opened nominations for LPNs to elect LPN Bargaining Committee/Council Representatives. So what does that mean to me?  Well,  next time we are voting for a president for our union it might be an LPN voted in.  Not sure how I feel about that.  I'm still not sure how LPN's feel that by joining BCNU they will be better represented.  The LPN's only had a 69% provincial YES vote, to join BCNU personally I don't think that is a very high percentage.
Please don't get me wrong there is a place for LPN's, but under no circumstances do I believe that LPN's should be replacing RN's.  I certainly think it is imperative that RN's start identifying themselves as such to their patients.

I am still not sure if BCNU is the right union for LPN's.  It will be interesting to see if  LPN's feel same way in a few years and if  they truly believe their voice is better heard.

I have never believed a nurse is a nurse is a nurse.  Isn't that why there are so many avenues for RN's to practise? I have met some amazing and well educated medical nurses but they are not trained to do what I do.  Although my nursing career has been varied I am not trained to be a neonatal nurse, or maternity nurse, or an OR nurse or to do outpost nursing just to name a few.  So no, I would say  a nurse is not a nurse.  An RN is an RN, LPN is an LPN and we should use our titles accordingly and proudly.

SkyWatch Friday

These photos were taken at the same day.  This lake is very popular in summer and gets very busy.  It was strange to see it so deserted, but nice at the same time to have this beautiful place all to ourselves.  If you would like to join in on the fun please check out Sky Watch Friday You can see a large version of the photo by just clicking on the photo.
Happy Friday all!

Did you know....

I just received my February edition of Canadian Nurse.  One of the sections I love to read is the "Feedback".  In this section there were to comments from RN's about our Canadian RN entry-to-practice exam.  This is the exam all nurses must write in order to become a Registered Nurse in Canada.

The two RN's who wrote in talking about these exams and how 10 of Canada's RN regulators selected the U.S. based National Council of State Boards of Nursing(NCSBN) to develop a new computer-based RN entry exam for Canada.  The NCSBN would bring the existing American exam to Canada for the purpose of licensing new Canadian nurses.  Is it me or doesn't this seem a little odd to you.  Why would we want another country to write and control our entry-to-practice exam?

What I find sad is that I didn't know anything about this until I read it in the Canadian Nurse magazine.  So I started to do my own research to find out what this is all about, and what I have found is that the Canadian Nurses Association have come up with a Declaration ensuring a Canadian solution for the RN entry exam.
This declaration only came out in December 2011. 

The CNA believe that by choosing the U.S. based organization which delivers the American exam NCLEX, raises question as to the exam being applicable to Canadian nursing and our health-care system.  I couldn't agree more.  I for one don't understand how an American based company can write an exam which is applicable for our Canadian health care.  This sends my antenna's rising.  I can't help but wonder if our health care leaders have an agenda which they want to keep from the Canadian public.

The CNA have come up with seven principles they feel are essential to any negotiations
(I have copied these from the CNA declaration)
1. The decision must not have a negative impact on Canada’s RN recruitment and retention strategies.
2. Canadian exam data and personal information must not be subject to the USA Patriot Act and must be housed and protected in Canada according to Canada’s Personal Information Protection and Electronic Documents Act.
3. The new computer‐based RN entry exam must promote, maintain and align with the curriculum of Canadian schools of nursing.
4. The new computer‐based RN entry exam must reflect the unique character, qualities and values of the Canadian publicly funded, not‐for‐profit health system, including:

•  a focus on primary health care, health promotion and injury/disease prevention;

•  Canadian legislation that affects nursing practice, such as the requirement to report child abuse;

•  respect for Canada’s cultural diversity and societal values, such as the inclusion of the health needs of Canada’s Aboriginal Peoples, social justice and a focus on the determinants of health; and

•  the Canadian Code of Ethics for Registered Nurses.

5. The new computer‐based RN entry exam must reflect 100 per cent Canadian content.
6. RNs from across the country representing all domains of nursing must continue to
participate in the development of the new computer‐based RN entry exam.
7. Canadian francophone RNs must continue to develop 25 per cent of the new
computer‐based RN entry exam questions in French, and must continue to
Please check out the Canadian Nurses Association
.
In the current edition of the Canadian Nurses magazine there is a card that you can sign if you disagree with our Canadian exam being sourced to the NCSBN.

If you do nothing, please at least read about what is being proposed and stay informed.

Sky Watch Friday

Hubby and I had been travelling on the logging roads on Mt. Arrowsmith. The view is looking West towards Port Alberni and the Wild Westcoast of Vancouver Island.

If you would like to join in on the fun check out SkyWatch Friday

Healthy Choices....food for thought

They say life is made of choices. We've all made some good and bad choices.  Some of those choices not only have an impact on us but those around us.  Others are small  but even those small choices can have a ripple effect.

When we think about choices we often think about things like, should I take that job even though it means moving either yourself or your family or moving away from loved one.  Do you buy that house in another province or state?  You really want that car but it's just a tad out of your price range.  Or what about that new suit and those shoes you always wanted should you buy them even though you know it might leave you a bit short on paying your bills this month.  Or you have fallen in love and believe you have met your match yet others oppose the union and you go with it anyways knowing that is could have long term effect on your family relationships.

Yes choices they aren't easy, but we do make them, every day of our lives.

I'd like to talk about those health choices we make.  Most of us I think have a pretty good idea of what a leading a healthy life style means.  I think if we are savvy enough to be able to access the Internet, read blogs, post a blog and the myriad of  other things we do on the Internet we should be able to access information that would help guide us to leading a healthy life style.

Being a nurse I see folks everyday that as a result of their "choices" of life style have brought them to the hospital. The hyper or hypoglycemic diabetic patient, the alcoholic, the drug addict, the over indulgent overweight orthopedic patient, the type "A" personalities and their increased risk for cardiac events.  Some folks fall into all of these categories.  And I bet that every one has a reason or excuse for why they are in the state that they are in, most of them not taking responsibility for the life style choices they make.

We are all human, we innatley make mistakes or bad choices.  I would like to think that we could learn from our mistakes or bad choices and move forward to making positive good choices for ouselves.

We've just come through the overindulgent season of Christmas.  All the parties, the sweets, the snacks and huge dinners, the being pressed for time and not being able to excercise or plan a wholesome meal.  Ah it's easy to slip into the "oh I'll just pick something up at the fast food store", it's quick it's simple and little clean up.  How convenient.  However, there does come a time or should I say I hope there comes a time when we just have to say ENOUGH.  It's time to get back on track.  Why does it take a visit to the hospital to give people a wake up call about taking responsibility for their health issues and the choices they make.

Back in the later part of October I watched a movie it was the opposite of "Super Size Me". It was an Australian fellow who was morbidly obese and realized he had to change his ways.  Long and short of it, he lost his weight by going on a Juice diet.  Along his journey he helped countless others do the same thing.  The wonderful thing about this movie was that he just asked people to try it for a week.  One week, I think most of us can do something for one week.  I was hitched.  The next day I started.  I lost 6lbs in my first week. I was estatic with the results.  I continued and lost 10lbs.  I'm now eating solid foods and I have lost 18lbs. and I feel fantastic.  Now this isn't about me and my weight loss it's about taking control and being responsible for the food choices I make in my life.

I have changed my diet completely and I have seen the increased energy and I thank myself for making positive choices for ME.  Sure I am human, I still like sweets and I do eat them occassionally, but then it's time to get back on track.

Let's acknowledge the choices we make good and bad.  What I'd love to see is more folks taking responsibility for their own health and I'd love to see a lonely quiet ER one day as a result of it.

SkyWatch Friday

This photo was taken last weekend.  Hubby and I decided to travel up some logging roads.  I just loved the clouds.

If you would like to join in the fun please check out SkyWatch Friday

She entered my life....

She entered my life only briefly.  She lay there quietly resting, only speaking when spoken too, yet in those brief moments of interaction her simple words, gentle smile and a quick retort touched me more than she will ever know.

Have you ever been touched by the gentleness of another?  They completely unaware of the impact they  have on your life?

I experienced that yesterday.   I had admitted a patient who had undergone a very large bowel surgery for the removal of cancerous tumour.  This patient had already had her share of cancer and surgeries having undergone mastectomy for breast cancer and esophageal cancer.

It makes me wonder how one person can undergo and withstand so much and still be positive and bring joy and happiness to others with their simple smile.

Her quick wit and soft sweet smile touched me.  She never complained and never asked for a thing, she was just simply appreciative of the care she was receiving.  She spent a good portion of my shift in the recovery room.  There were many things that needed to be done for her before I could send her to the ward.

When she was ready to go and the porter was wheeling her away  she thanked me.  I wanted to say no Thank you I didn't know how.  I don't think I realized until I got home the impact she had on me.

She of course was not my only patient and as I went back and forth from my patients there was such a contrast in coping skills. I wondered how does someone find that place of acceptance, and control.  Some have better coping mechanism than others.  Maybe she was one of those people.

It was a great day to be a nurse.

Patience

They say that Patience is a Virtue.  Well I suppose it is.  My husband often tells me I am not a very patient person. I tell him I beg to differ.  I tell him spend one day walking in my shoes and  then tell me I am not a patient person.

In nursing school they taught us about compassion, caring, empathy, and therapeutic communication just to name a few.   Yet I don't recall them teaching us about having patience.  Which one would think they would as that is a number one skill you use every day in your nursing career.

Maybe it's one of those skills you innately have.  I don't know.  What I do know is that you won't survive very long in the nursing profession if you don't have it.

There's the times when your unit is running short staffed.  You have a heavy patient assignment and you are trying to juggle getting patients fed, bathed, medications dispensed, orders reviewed and processed, assisting with other health care professionals who are working with your patient, changing dressings, answering questions of family members and if you are lucky holding the hand and spending some time with your dementia patient.

You have to have patience in order to and achieve any of the above with a certain amount of  empathy, caring and compassion.  It's not easy some days.

In the recovery room you have to have patience.  You have to patiently wait and assess patients for the effects of the anesthetic to wear off.  Assessing pain levels and medicating frequently and evaluating outcomes, being on the alter to change the course of action when the desired outcome is not achieved.  Then throw in the juggling of Operating Rooms and sometimes having to put them on hold, lack of beds to move post operative patients to, and of course the unexpected cardiac or respiratory arrest.

Yes you MUST have patience in order to survive your day.

So I started to think about what my husband has said to me, and I think, maybe he's right.  Maybe I don't demonstrate a lot of patience when I am at home.  Maybe that's because I have used it all up at work!

I remember reading on another nursing blog, where the nurse said that before she goes home she almost has to desensitize herself from the work environment and put on her mom/wife hat.  Some days it's easier said than done.  Some days  your family have no idea what your eyes have seen and what you have experienced, nor in some cases do you really want to share that with them.  I think what I need to remember is that I am only human, I can not be everything to all people at all times. I have to start to use some of that therapeutic communication on myself and be a little kinder and gentler to myself and then I think the patience my husband says I lack demonstrating at home just might come out.

I was on Facebook today and I noticed one of my colleagues had posted a video from YouTube titled Being a Nurse. In this video they say being a nurse is 90% and 10% job, I think I would agree with that.  I went and checked out other YouTube videos about nursing and what it is like to be a nurse and the one I linked to below title To Be A Nurse really kinda of spoke to me.
To Be A Nurse

Sky Watch Friday

I love clouds. I love how the take shape, tell a story, predict the weather.  I love how they just seem to magically take me to a happy place.

If you would like to join in on the fun please check out Sky Watch Friday

Happy Friday All!

Did we not explain ourselves?

As a Recovery Room nurse, not only do I recover patients who have had major surgeries, but I also work in our Ambulatory Recovery room.

In the ambulatory recovery I am recovering patients who have had primarily IV sedation for colonoscopies, gastroscopies, bronchoscopies, eye surgeries and general sedation for ECT's.

It's the IV sedation patients that I want to talk about.  Prior to their procedure they are told that they MUST have a responsible adult driver to take them home post procedure or alternate arrangements made for going home, ie taking a taxi.  The driver must report to the recovery to physically escort the patient to the car and ensure that they take the elevator and NOT the stairs.

When these patients come to the admitting area I know the clerk asks the patient who is driving them home.  She also asks for the persons phone number, or will that person be staying or do the nurses have to call for their ride. The clerk also advises them that the person who is providing the ride MUST report back to the unit to come and physically pick the patient up.   The clerk diligently writes this information down in the chart, so I as the recovery room nurse know what arrangements have been made for this individual person to get home.

It never ceases to amaze me how many patients still think that it is ok for them to drive home post procedure, and never follow one thing we tell them NOT to do.

Let me share with you some simple stories.  We had a husband and wife in. Both were from out of town, both were having a procedure that required IV sedation.  When they were coming around we asked about their ride and if there ride has a ways to come so we can give the individual enough time to get to the hospital to pick the patient up.  This particular couple's idea of having arrangements being made were to take a cab to the pub where they were to meet their friends. Hmmmmmmmm.

Another patient tells us that her husband is at the Pub and to call him there to come get her.  Sure enough we call the pub and the waitress tells us that well she doesn't see him at the moment but his "beer" is still on the table.

Another, a young fellow says he didn't realize he had to have someone drive him, we tell him we can't let him go until someone comes to get him.  He gets on his cell phone to get a hold of a friend, someone eventually shows up, the patient doesn't take the elevator as instructed but rather walks down the stairs, then once out of sight(or so he thought) he jumps into his vehicle and drives off.

Then there are the patients who have arranged a drive and the person who comes to pick them up appears to be in worse condition than the patient.  Sometimes the person arrives being short of breath and on home oxygen, so they are dragging their oxygen tank beside them.  Others have their ride arriving walking very slowly either utilizing a cane or a walker. Many many patients rides think they can just wait in the car, even though they have been told they MUST come to the unit to pick up the patient.  You can't imagine all the stories we get regarding patients rides, I think I could write a book on all the excuses or stories.

My point is that all of these folks are told prior to the procedure that they will need a RESPONSIBLE, capable and able adult to get them home.  We tell the patients that they are legally impaired, we tell them not to drink alcohol and the list goes on.  But I guess human nature being what it is, they will do what they want to do regardless of being advised not to do something.

I don't tell patients these things to ruin their day, on the contrary there are risks involved when you have had IV sedation and I must make ensure they are aware of these risks.  I personally would think that one would want to take those precautions.

Just a few things that just make me shake my head.

Appropriate Care in the Appropriate setting....fact or fiction?

I'm sure you have heard the saying "It's only a matter of time before something happens", and don't you hate to  be the one who says "I told you so".

Two weeks ago an elderly female dementia patient was admitted to a small community hospital.  This woman was placed in a co-ed room. At the time of her admission there were 2 males and another female in the room.  A few days later this changed and a young 43 year old drug addict male was admitted to the room..  This young male sexually assaulted the elderly female dementia patient. You can hear more about it on this news clip.

 http://video.cheknews.ca/services/player/bcpid1011606683001?bckey=AQ~~,AAAA4mHNTzE~,ejlzBnGUUKY1gXVPwEwEepl35Y795rND&bclid=975107450001&bctid=1365974421001 

The hospital administration initially was trying to point fingers at the nurses for not keeping a closer eye on the patients.  With hospitals running at over capacity and working short staffed on a regular basis, it becomes difficult to observe all patients at all times. The nurses union for sometime  has been telling the administration that co-ed rooms are a recipe for disaster. It's unfortunate that it took an incident such at this for the administration to realize that they needed to do something about how they were assigning beds.  My heart goes out to this woman and her family. To me they are a casualty of part of the health care crisis.

I have been a patient in the hospital where I have been placed in a co-ed room.  I can tell you that I do not like co-ed rooms.  My last experience in the hospital and I had to share a room with two men and another woman.  On my second day in the hospital the woman was discharged and another male was admitted to the room.  The only redeeming thing was that my bed was next to the door and I kept my curtains closed most of the time for privacy purposes.  I had no problem with my male room mates but it was more a sense of not having any privacy and I was forever having to lower the toilet seat in our shared bathroom.

As one of the people in the news clip says, hospitals have been running at overcapacity/disaster levels for sometime now and there doesn't seem to be any light at the end of the tunnel.

I was watching the news yesterday and heard about  another hospital on the mainland.  This hospital is one of the major trauma hospitals in BC and is very busy.  Last year this hospital made the news because it was caring for patients in the adjacent Tim Horton's restaurant.  Now we are hearing that nothing has really changed and that once again staff are having to care for patients in corridors and make shift units.

Almost simultaneously I watch a documentary about  patient placement, and  in particular seniors who they identify as "Bed blockers".   This story coincides with my last post about how we have patients in hospital who are in the wrong setting for the care they need.

In the documentary the journalist spoke to the chairperson of the committee who was faced with the  task of looking at  health care and seniors.   This committee came up with many recommendations none of which the  Federal or Provincial governments have initiated.  This documentary focused on a family who's husband/father had dementia and had been in an acute care hospital for 6 months waiting placement.  It was an inappropriate environment for this man, but because there were no resources in the community he had to stay in the hospital until they found him appropriate placement..

The governments have known for a very long time that they need to put resources in the community but they don't.  Why?  I think because they are on a mission to destroy the publicly funded health care system.  destroying the current system would open the doors to private health care.   They can fix this if they really wanted to I'm not convinced they do.