Lost

Why is it that nurses forget that the patients they care for usually do not understand the environment in which they find themselves or at the very least have an outdated or incomplete picture of the health care world they find themselves to be a part of?

To a nurse in the ED/ER they see another patient with the sniffles who decided to be a pantywaist and go to the hospital and end up causing unnecessary delays for those who actually require attention as well as occasionally being an ungrateful ass all the while. They see...well, I'll be damned if I can rationalise a trip to the hospital for a cold...I guess the best I can say is that people go to the hospital based on THEIR understanding of the care they require and not ours.

Does this piss us off?

Yep. But who are the professional in this situation?

That would be us, and we should act like it.

Bottom line, situations like the one mentioned (a very tame example) usually end up needing some level of education and, instead of complaining to those around us about how predictable and frustrating our job is (don't get me wrong, this is completely warranted in the right circumstances) we need to see situations like these with a higher level of respect and understanding and conduct ourselves in a wholly professional manner.

Easier said than done.

We're not really wired that way. We will bitch about ANY job we have, paid or not but you can always tell which ones are commiserating a truth and which ones are raging about something they could probably change if they cared to.

Reminds me of a story...

I used to work in construction and a large portion of my work involved placing concrete in really hard to reach places (called duplex basements) and doing so in extreme heat or extreme cold with precious few of these basements being large open spaces ready to be poured on warm, pleasant afternoons.

I was a crew foreman, which meant I could tell people to do stuff; and during one particularly inhospitable winter, I had a young man (teenager) named Jonas working for me (changed his name...not sure why).  Now, Jonas was not from Canada, he was from Europe and his parents had sent him to Canada to stay with relatives so that he could "get some life under his belt" which, in this case, was code for "get him the hell out of our hair so that we can go on an extended vacation".  So, in turn, Jonas' relatives had talked to my boss and gotten him a job being a labourer with our company because what teenager wouldn't learn some life skills from being chained to a wheelbarrow six days a week and being forced to move large amounts of concrete while angry old Italian men (who were usually in various stages of inebriation by 0900 hrs) shouted unintelligible orders at you?

Clearly the relatives' plan was foolproof.

Now, I was not a cruel taskmaster, I rarely shouted, led by example whenever possible, and was never drunk (at work).  I rather enjoyed Jonas as he was a bit of fresh air from all the aforementioned crusty buggers with whom I was accustomed to working.  But one day, Jonas just couldn't be helped.

It was a very cold day and our boss had given the option of working to the respective foremen at the morning huddle (seriously a huddle in a half-finished house where there was one working heater).  I elected to have my crew stay for a while and finish up some things as Christmas was fast approaching and money can get tight at that time when you work construction.  I gave Jonas one simple job:  drill some small holes in the basement walls, blow the dust out of them, then you can go home.  That's it.  barely an hour's work.  I was about to leave to go outside when I heard Jonas griping about his work and my decision to stay loudly to his buddy filtering up from the basement.

Maybe it was his youth, maybe inexperience with labour intensive jobs, maybe his upbringing in general, I don't know.

 But he had no clue how easy he had it.

I had a ton of work I could have forced him to do, but didn't; but he didn't know that.

I can guarantee my naivete to the nursing world but I bet it isn't that different in the bitching department.  I know things suck and we feel we can't change them but the difference is that we are professionals and like it or not this demands that we respond more appropriately.

This includes nursing students.  Take a step back and realize what an amazing profession you find yourself to be a part of and strive to do better.

Better than forming exclusive cliques.

Better than doing the minimum.

Better than seeing your patient load as a "to-do" list.

Better than seeing your managers as enemies.

Better than making shit up for your continuing competence requirements.

Better than you used to be.

Murses Are Ninja Forklifts

So I recently wrote a paper for a class this summer and initially I chose my topic based on what I thought would be easy pickings for smacking out a paper that would be long enough to get me a B+....or a B, whatever.  So, after researching and doing a large literature review (srsly, I did), I ended up with a lot of material from the last 7 years that was fairly eye-opening.  I'm a fairly unassuming guy and I'm not prone to letting others suggest to me when I have and haven't been 'wronged' but the body of research I read gave me a definition for the nagging uneasiness and situations of perplexity I have felt and experienced ever since I started my nursing training:

Gender bias.

Now, please understand that I'm not upset.  I'm not mad at anyone, and I'm not holding any one person accountable for what I've learned; but I am determined to fix what I see as broken in any way I can.

I would give you the rundown of my paper here in the post but I feel my paper can stand on its own so I will let you all peruse it at your leisure.  Apologies for the length!

Mursing and the Struggle for Equality

Men entering the nursing field not only encounter the unique challenge of learning, working, and thriving in a profession that is numerically dominated by females, but also face a nursing education system that is geared toward female learners.  In a nursing program, men have the rare distinction of being a visible minority and, as a result, their needs are often overlooked and consciously or unconsciously ignored by faculty members who often represent the white, female majority of the profession (Keogh & O'Lynn, 2007; Taylor, 2010).  Attrition rates of males in nursing programs are high and have been recorded at an estimated 40-50%, which is well above the average faculty attrition rates (Stott, 2006).  Additional qualitative studies have found that isolation, discrimination, and exclusion are common themes expressed by male nursing students (Bell-Scriber, 2008; Stott, 2006; McLaughlin, Muldoon, & Moutray, 2010).  It is of serious concern to the nursing profession that this cycle of negative inputs and outcomes involving male nurses is occurring in an age and society where gender issues are thought to be an issue of the past.  Moreover, these inequities are occurring in the faculties and workplaces of a profession that prides itself on being a leader in health education.

The Large Male Elephant in Pink Scrubs

Recalling personal experience, I have not found that my experiences in nursing have been tainted by any overt gender bias.  However, upon further researching this topic I found that there were a number of issues that I had thought to be normative where, in fact, they were half-truths or omissions.  The most significant of these realizations was the seemingly complete omission of the historical contributions of men in nursing.  The title of this section exemplifies my current feelings toward being a male in the female-dominated profession of nursing.  Specifically, men have been academically accepted into nursing faculties and many have succeeded in completing their programs; but we, as men, have been ‘clothed’ in a feminine-based model of nursing and somehow nobody is even discussing the odd fit. We no longer have the ‘luxury’ in this day and age to identify issues of gender bias simply by their superficial characteristics as was possible in the past. Instead, we have moved into an era where the overt biases have been eliminated but the deeper, more subconscious biases are only beginning to be discovered.

Nursing has never been a more important issue in society than it is in this modern age.  With almost every healthcare model in the world relying on nursing in some capacity to function, the recruitment and retention of skilled nurses has never been a more pressing issue (Bell-Scriber, 2008).  As Canada faces an all-encompassing shortage of nurses, the fact that men make up such a small percentage of the nursing workforce is of particular concern to both society and the nursing community itself (Bell-Scriber, 2008).  The provinces have been proactive in pursuing strategies to mitigate the shortage; with some even attempting to meet the demand in their nurse staffing levels by ‘importing’ trained nurses from other countries. From a bystander’s view, however, it is curious to see the astronomical effort expended in obtaining these out-of-country nurses when the option of tapping into the underrepresented 49% of males in Canada seems to have gone untested (Meadus & Twomey, 2011).  In 2009, males accounted for just 6.2% (16,475) of registered nurses in Canada and had an average provincial representation rate of 6.04% (CNA, 2011).  This rate is below that of the United States (6.6%) (HRSA, 2010) and Australia (9.6%) (AIHW, 2011).  Additionally, the Yukon employed the highest percentage of male RN’s with 10.6% while Prince Edward Island had the lowest at 2.4% (CNA, 2011).  From 2005 to 2009, the proportion of male RN’s in Canada grew by only 0.62% and the average provincial growth rate was 0.15% (CNA, 2011).  These numbers serve to quantify the glacially slow increase of male nurses in all Canadian provinces but do not give light to the mental and emotional state of males in nursing.

Gender bias has been defined as “behaviour that results from the underlying belief in sex-role stereotypes” (Cudé & Winfrey, 2007).  This volatile issue is particularly contentious to female nurses in general as their history, since the inception of modern nursing, has been forged in its flame.  The effects of nursing’s history are visible even in the current state of the profession; in a recent newsletter from the Manitoba Nurses Union (2012) a smiling, middle-aged white female is pictured in a report as a ‘profile’ of a typical Manitoban nurse.  While picturing a middle-aged female was likely a conscious decision on the part of the editor(s), there is no indication that the race of the model is intentional.  This small window into the collective mind of a nurse union shows us that the lack of representation of society’s makeup in the nursing ranks is in plain sight but gives no indication that it is being remedied or that it is even viewed as a problem (Taylor, 2010).

This has a personal effect as it shows to me that unions, staff nurses, managers, nursing faculty, and other students can plainly see the issue of misrepresentation before them but nobody in the schools (where I have the bulk of my nursing experience) seems to have acknowledged it as an issue.  To say nothing of other visible minorities in nursing, this realization has stripped away some of the rose colouring from my view of nursing as a profession and given me a small taste of being a minority.  This has ultimately been a positive experience as it has given me a new sense of purpose within this profession.  My original purpose was to complete nursing school and work hard as a nurse for as many years as I was able; now, however, I have added the desire to further this profession by making the road to nursing a little more navigable for men entering nursing after me.

Historical Analysis

Nursing is a profession with roots in antiquity; the first nursing school in recorded history was located in India in approximately 250 BC (Cudé & Winfrey, 2007).  The earliest nursing structure resembling modern nursing models staffed wards of the hospitals of the Byzantine Empire around 330 AD (Bullough, 1994). The majority of the nurses in both instances were male (all-male in India), and it was not until the 19^th century that this tradition would take a historic gender-based shift at the hands of one Florence Nightingale (Cudé & Winfrey, 2007).  The effects of her contributions to nursing can be seen in almost every textbook dealing with nursing history, but the most telling of her contributions may lie with the pieces of history not included in the texts (McLaughlin, Muldoon, & Moutray, 2010; Meadus & Twomey, 2011).

Nightingale: The Destroyer

According to Cudé and Winfrey (2007), Nightingale was the first to declare nursing as “women’s work” and actively opposed the involvement of men in the practice as, “their ‘horny hands’ were detrimental to caring.”  Nightingale’s statement has had an indelible effect on the nursing profession in the time since she first gave voice to this view because, by wholeheartedly embracing the ideals Nightingale embodied and advocated for, nursing was transformed into “a profession for single women of impeccable moral standards” (Cudé & Winfrey, 2007). Furthermore, Nightingale’s proclamation that nursing was a natural fit for women due to their ‘inborn’ caring and mothering characteristics was, itself, a stereotype that did a disservice both to men who wanted to nurse and to women who did not (Cudé & Winfrey, 2007).  From this point in time forward (arguably, even today), it was nearly impossible to distinguish the image of a ‘good nurse’ from that of a ‘good woman’ or a ‘good mother’ (Keogh & O'Lynn, 2007). These views, in addition to the advent of structured nursing training, were eventually successful in ostracizing males from nursing (Keogh & O'Lynn, 2007).  Unfortunately, the feminine conquerors (women of the period who were shedding Victorian ideals of female subservience) were also successful in another form as the history of men and their contributions to nursing were ultimately forgotten (Cudé & Winfrey, 2007).

While Nightingale certainly represented a new standard in women’s liberation of that era, the ingraining of an anti-male ideal among generations of nurses has created a modern problem that was likely impossible to foresee and difficult to imagine. Perhaps, then, it is not so difficult to see why the current nursing environment is so unwelcoming towards men as the touted “mother of modern nursing” was also its most vocal chauvinist. 

Socio-Cultural Analysis

The culture within nursing has been depicted by current literature to represent a treacherous pathway sown with hostility, contempt, selfishness, and even violence (MNU, 2012; Keogh & O'Lynn, 2007).  This environment has led to difficulties in recruiting and retaining nurses in general and has likely had a hand in the premature end of many nursing careers (McLaughlin, Muldoon, & Moutray, 2010).  To fully grasp the gravity and breadth of the causes behind the low numbers of males in nursing, this negative culture must be explored with a gendered lens. 

Society has taken cues from the history with which the nursing profession has aligned itself and widely holds many beliefs about nursing, such as nursing as a feminine profession and that men who pursue this career are gay or ‘unmanly’ (Meadus & Twomey, 2011; Bartfay, Bartfay, Clow, & Wu, 2010; McLaughlin, Muldoon, & Moutray, 2010; Dyck, Oliffe, Phinney, & Garrett, 2009).  These beliefs lie at the core of the issues that see many males leaving nursing training and many more deterred from entering nursing school at all.

I Care, Therefore I am Female Male

Another issue that has been realized recently with the re-integration of men into nursing is the long history of caring being marketed as a distinctly feminine trait (Grady, Stewardson, & Hall, 2008). The concept of caring is core to the profession of nursing and, as such, is imparted at every level of nursing training as a common denominator to each action and role of the nurse (Grady, Stewardson, & Hall, 2008).  The claim that caring is a feminine trait that is always better exemplified by females is a view that has created role strain and anxiety among male nursing students and has been identified as a factor that directly contributes to attrition among this same population (Bartfay, Bartfay, Clow, & Wu, 2010).  

Continually passing off caring as a feminine trait in nursing curriculum has placed a barrier in the path of males in nursing faculties (Meadus & Twomey, 2011).  Faculty members may be unconsciously contributing to this problem as the majority of these members are middle-aged, white women who were taught and socialized in an era where the feminine qualities of nursing were highly valued (Cudé & Winfrey, 2007).  Nurse educators, as is the same with all educators, have the unique opportunity to teach and influence a large number of impressionable soon-to-be colleagues.  If an educator is teaching a discriminatory message to their students (even unconsciously), it serves as a veritable oil spill of discrimination whose source continues to sully until plugged, the cleanup is tedious and never quite fully successful*.  However, blame is not so simple to lay in this case as nursing professors are often precluded (through no fault of their own) from offering bias-free teaching as they are operating within systems and curricula that were designed to educate women (Grady, Stewardson, & Hall, 2008).  Surveys have identified that one of the most significant hurdles faced by males in nursing school is being viewed as “uncaring” and that men’s caring behaviours have been associated with fear, inappropriateness, and sexuality (Grady, Stewardson, & Hall, 2008; Meadus & Twomey, 2011).

Men are Ninja Forklifts

Another aspect of society’s effect on men in nursing is the view that men are always to be called upon when physical strength is required.  In a number of qualitative studies, male participants identified experiences where they felt they were the focus of discriminatory actions when they were conscripted to move patients or control potentially violent situations (Meadus & Twomey, 2011).  These actions could definitely be viewed as discriminatory as they only take the nurse’s gender in account while ignoring the individual and their strengths and weaknesses.  In one situation, a male student nurse was pushed into a room with an agitated patient and, after the fact found that it was upsetting as he felt he was singled out simply based on gender and no consideration was made for his comfort with being asked to control the patient (Meadus & Twomey, 2011).  Students have also experienced unfair treatment from instructors where their patient assignments were decided using patient size and level of dependency to decide which patients the male student would be caring for (Keogh & O'Lynn, 2007).  Additionally, other students related that they were called to assist with patient moves in areas where they were not assigned and where no regard for their current workload was given (Keogh & O'Lynn, 2007). 

The opposite side of this issue could also be argued that men are typically physically stronger than women and, as such, should be expected to assist colleagues in tasks that require a greater level of physical strength.  However, this issue could likely be mitigated if nurses took the time to consider the individual they are asking for help, male or female, instead of assuming compliance and making demands of that individual.  Nurses, as a profession, are called to a higher standard of consideration in their interactions with both their patients and their colleagues; there is simply no room for nurses to treat gender with flippancy.  This sort of conduct leads into the legal-ethical considerations that will be discussed in the next section.

Legal-Ethical Analysis

Ethics, more than legalities, apply to the issue of gender bias in nursing, as it is a self-regulating profession that sets its own standards of practice to address such an issue. There are very few legal cases in Canadian nursing involving men alleging discrimination on the basis of gender; the reason for this is likely that most issues are handled at the provincial regulatory level.  The various provincial nursing colleges, including the College of Registered Nurses of Manitoba, are mandated to regulate the nurses who hold licensure with their organization (CRNM, 2009).  As license holders with the CRNM, nurses are bound by the Standards of Practice for Registered Nurses (2009).  This document specifically references the Canadian Nurses Association (CNA) Code of Ethics for Registered Nurses (2008) as the main standard against which the behaviour of Manitoban nurses is to be weighed.  The Code of Ethics (2008) contains short but clear guidelines when issues of discrimination are involved.  The treatment of men in nursing will be contrasted with the regulations set out in the Code of Ethics in this section.

Speak Softly

Men in nursing often receive treatment different from that of their female counterparts and this is also evident in nursing schools.  In one case mentioned by a qualitative study, a male student was singled out of a group being taught electrocardiography (ECG) in a nursing skills lab and instructed to remove his shirt so that the group could practice the application of the ECG leads (Stott, 2006).  This student described feelings of shame as they felt that it was assumed he had no qualms about removing his shirt simply because he was male (Stott, 2006). This instance is very similar to the aforementioned violent patient situation where the student felt they were singled out for no other reason than that they were male.  In another situation, male students were instructed to provide urine samples during a skills lab demonstration while their female colleagues received no such instructions (Stott, 2006). These situations bring to light the tendency of educators to treat male students differently, particularly in the clinical scenario (Stott, 2006). 

In response to this type of treatment, I find a sense of commonality with the male students in these scenarios where, in the moment, neither the male student involved nor other students contradict or question the actions of the instructor, leading to the reinforcement of the behaviour.  I recall a nursing health assessment class involving cardiopulmonary assessment and auscultation where we, as males were told to remove our shirts so that others could hear the heart and breath sounds more clearly but the females were not instructed to do the same.  At that time, it occurred to me that it would likely be frowned upon to even suggest that female students be asked to do the same, even if it was only for other females to assess them.  There is no doubt that vulnerability exists more readily in the mind of a female being assessed by a male than vice versa but again, in a professional setting, it cannot be assumed that men all feel the same way simply because they are male.

A number of male students involved in nursing studies expressed concern over providing intimate care to females, fearing they would be accused of sexual inappropriateness or even sexual assault (Keogh & O'Lynn, 2007; Meadus & Twomey, 2011). This very real concern has lead to current practices such as the use of chaperones when doctors are examining a patient of the opposite sex (Cudé & Winfrey, 2007). Oddly enough, this practice appears to stem more from the doctors’ fear of allegations of misconduct as surveys have found patient attitudes toward these chaperones show the majority have no preference regardless of patient age or gender of the physician (Cudé & Winfrey, 2007).  These findings seem to support the notion that healthcare practitioners are creating a larger issue than that which actually exists and unnecessary action is being taken as a result.

Carry a Big Stick

The scope of the aforementioned issue is undoubtedly smaller than that of other gender issues discussed.  However, the origin of these thought processes is likely the lingering social norms possessed in the minds of faculty and students alike. The Code of Ethics for the Canadian Nurses Association (2008) contains a broad statement regarding its view on discrimination in nursing practice:

When providing care, nurses do not discriminate on the basis of race, ethnicity, culture, political and spiritual beliefs, social or marital status, gender, sexual orientation, age, health status, place of origin, lifestyle, mental or physical disability or socio-economic status or any other attribute. (Emphasis added) (p. 17)

This statement clearly shows that the nursing profession is serious about creating an atmosphere where professionalism abounds and its detriments are spurned. However, the exception to this intention lies within the labour and delivery wards of hospitals all over North America (Cudé & Winfrey, 2007).  In one survey, only 3 hospitals out of 30 surveyed had male nurses employed in labour and delivery (Cudé & Winfrey, 2007). Even though the unit managers were large proponents of these men in regards to qualification and performance, many more managers surveyed were skeptical of men’s ability to nurse in this area (Cudé & Winfrey, 2007).  Male students are often escorted in interactions with patients in labour and delivery wards and, contrary to the instructor’s belief that they are being helpful to students and protective of the patients, they may actually be insinuating that there is something wrong with having a male nurse care for these women (Cudé & Winfrey, 2007).  Once again, if nursing is truly a quality, independently governed profession that prides itself on utilizing evidence-based standards of care, then why is the focus in this area of nursing set so firmly on the gender of its care providers when there is currently no research indicating its importance?

 Currently, no proponents of anti-male or solely pro-female viewpoints have been discovered (beyond labour and delivery wards) among published nursing literature so it is unlikely that males will ever face an organized resistance to their presence in nursing.  However, the official standpoint of the nursing profession as evidenced by the CNA Code of Ethics (2008) is clear in its expectations for the behaviour of all nursing practitioners. Nevertheless, males in nursing must be equally respectful and caring in their handling of sensitive situations in order to avoid repeating the mistakes of their nursing predecessors (Cudé & Winfrey, 2007).

Barriers to Resolution

“She’s embarrassed because she’s dating a nurse and I can’t see why.”

- Nurse Paul Flowers

“Well, that’s because you’re doing a woman’s job, son.”

- Dr. Kelso

Scrubs  - “His Story” (2003)

One of the main barriers to men wishing to become nurses is rooted in the societal belief that nursing is “women’s work” and the fact that this belief seems to be so entrenched in the psyche of nurses and laypeople alike (Bartfay, Bartfay, Clow, & Wu, 2010). Mass media (television, movies, print materials, etc.) and the entertainment industry have not been judicious or particularly considerate in their portrayal of men in nursing and the negative effect this has on males who may otherwise prefer to become a nurse cannot be discounted (Bartfay et al., 2010).  Many nurses still deny the existence of a gender bias in nursing simply because no overt discrimination exists in the incarnation that such nurses are accustomed to experiencing it (perhaps, even personally) (Bell-Scriber, 2008).

A sentiment I have heard echoed by numerous practitioners and laypeople alike is that patients (particularly in labour and delivery wards) won’t stand to have a male nurse and will ask that their male care provider be substituted for a female. While there is still a relatively small pool of qualitative research into the experiences of male nursing students, current research shows that these students have indicated that nursing instructors and staff nurses are much more likely to view their presence in nursing negatively than are the patients (Keogh & O'Lynn, 2007).

Strategies for Resolution

Perhaps the most important aspect in regards to effecting lasting change is the need for nursing educators to take the lead in teaching and exemplifying behaviours of acceptance and confidence to their students (Stott, 2006).  Recognizing discriminatory treatment and messaging can be difficult if attempted solely through self-reflection so it may be helpful for teaching staff to invite outsiders or colleagues to their teaching sessions in order to obtain feedback (Bell-Scriber, 2008). Including support for men in nursing by teaching that caring can be accomplished without a rigid adherence to the feminine model of caring could also assist male learners in identifying with their newly chosen vocation (Grady, Stewardson, & Hall, 2008).  Overall, I believe the nursing profession would benefit if this approach were extended to all minority learners in its ranks.

Another strategy that has been echoed in the literature is the need for male role models within nursing programs and in the workplace (Bell-Scriber, 2008). Male role models (as well as role models for other minorities) must be sought out to give students individuals within nursing with which they may more readily identify (Stott, 2006). This strategy should also include plans to set up formal mentorship programs within the faculty where any student could be connected with an appropriate faculty member, volunteer staff nurse, or senior nursing student (Bell-Scriber, 2008). This strategy would give newer students greater support and greater incentive to stay the course in their chosen profession by giving them an example of success (Keogh & O'Lynn, 2007).

Reflection/Personal Views

My personal views have been greatly challenged throughout the course of this assignment and I cannot recall the last instance where I felt such a close connection to an issue I was dealing with.  My opinions have also been changed as a result of the research I have conducted; where I once viewed these issues with a mental shrug of my shoulders, I now see a real opportunity to effect change that could have a significant impact on other men who are deciding their career path.  I believe that the nursing profession is in a position where it is ripe for change and I feel that I have a lot to contribute to this change.  This issue extends far beyond gender and I know that nurses can continue to be leaders in all aspects of the healthcare field if we afford ourselves the opportunity to change.

Glad you made it to this point!  Be kind enough to leave me your thoughts!

Also, references are available on request, ahahaha!

Americuh!

So I've been partaking of a friend's generosity in the form of a shared Netflix account and so far I've been plundering the documentary listings with regularity that would make any senior's bowels go green with envy.

How's that for an opening? I should just quit now.

A couple of these documentaries have depicted the American healthcare system in varying capacities: as the focus of the story, a minor subplot, even a plot device. Now, I really try not to take many solid cues from the media as it just never feels quite right to accept something that has been influenced by many forces before the finished product (and all its missing pieces) gets presented to me. It (media) actually has begun to offend my sensibilities and now I get disgruntled because I can't check source references or know that the story was published objectively by a peer-reviewed entity.  So much communication contains, relies upon, and is sustained by misinformation that it is very difficult to differentiate and I know I'm just beginning to learn.

I digress...

Suffice it to say that, personally, I know the American system and its inner-workings VERY loosely and have no first-hand experience with how it functions; so, if we could keep that disclaimer at the back of our minds, I'll continue.

It breaks my heart.

I wanted to insert profanity here for emphasis but I'll let my yes be yes.

Now the explanation.

I don't understand a lot of things about the US system.  For instance, I don't understand how people have to make a choice between seeing a doctor and paying their rent.  I also don't understand how a family with a paranoid schizophrenic child suffering an acute episode has to first call a customer service wonk from their insurance to see which hospital they're allowed to go to and for how long their child can stay before they will no longer be covered.  I don't get how nurses are (forced?) told to discharge patients who have no coverage or means to pay for treatment.  I don't get how a serious illness or serious trauma can result in the remortgaging of your house or the seizure of your house because you had to use it as collateral for your ballooning hospital bills and now you can't pay because you're sick.  I don't understand how being sick precludes you from receiving coverage that would help you to stop being sick.

I guess overall I don't get how the issue of money runs even with the state of health of the individual.

I come from a far away land where we have different way of doing things and dammit if we don't have our own injustices and problems to work out.  Please don't mistake this for an argument whereby I'm just asking why the US doesn't just do what we do; I mean, they should, but that's rather trite.

I am on my way to becoming a registered nurse in this country and I'm getting somewhat excited to get done with school and get back out working again. My excitement is buoyed by the healthcare system that I will be representing because I know that the number one priority is to be the patient and the health of the people as a whole. However, as I get more and more glimpses into the US system, I have realized that there exists a situation where I would walk away from my profession because I couldn't reconcile my actions with my thoughts.

You get paid as a nurse...

 

...and this is great; but what happens when you don't believe in/agree with the system you represent?  What would you do?

This is what keeps bothering me.  Obviously people raised in the the US will be acclimatized to their healthcare system and some will end up working there as nurses.  No big deal.  But then I keep hearing (constantly) about how Canadian nurses are flocking to the US and the reasons vary slightly but they ALWAYS contain more money. Chalk it up to personality differences but I'd rather sodomize myself daily with a roll of newspaper articles bemoaning Canadian ED wait times than have to look a patient (NOT a client, customer, or guest) in the eye and tell them I could no longer treat them because their coverage had run out and accounts recievable hospital policy says they have to leave.

That's what it comes down to for me.  If being a nurse means prioritizing money ahead of the patient's needs then I'm done....I'm out.

I will be the first to admit that I am naive about a great many things and this goes doubly for nursing.  What I always want and need is a little perspective, a little learnin'.  No better way to do that than asking questions and listening with your mouth closed.  Come at me!

From Hell...

So, the stars finally aligned and I have come across the legendary "clinical instructor from hell".  The one that doesn't listen, is always right, thinks positivity is simply an electrical charge, threatens you with learning contracts and failure on a daily basis but only when he/she isn't berating you in front of your patients, their family, or other nurses.

We've all had one, right?  You've at least had a friend who had one, surely.  No?  Maybe it's you!

I can't say I know exactly what causes these nurses to not only sign up to take lower pay and longer hours just so they can emotionally and verbally abuse nursing students but I will say that I have found one common denominator in each of these malcontents' story lines:  it happened to them first.

At some point during their fragile beginnings as a student or grad nurse, some other bigoted meathead decided it was their personal responsibility to break down every shred of confidence that this impressionable rookie had and pounded the remains into an effigy to the power of unhealthy fear.

So now it's their turn.

They've decided that the pain and anger has simmered long enough and it's time it manifested itself in the continuation of a cycle as old as humanity itself.

Why?

I have a theory:  Fear.

If someone is a one-way street  and their M.O. in every situation (good or bad) is to assign blame responsibility for the negative consequences that occurred or could have occurred (these people have no concept of positive outcomes) then you are witnessing a truly pitiful human being.  I mean this in the truest sense of the root word pity.  This person is living in their own hell brought on by who knows what events have befallen them.  The fact that they are perpetuating the cycle is simply them taking the easy road of dealing with their inner angst. The opposite of this is, in my opinion, is love.

I posted this video a while back to my twitter feed (@nurseofdoom) because I believe it touches on a couple fundamental points that I truly agree with; the most eye-opening one for me being that she defines blame as "a way to discharge pain and discomfort".  As I mentioned before, this is simply one of the manifestations of the fear this person is living in.  The video has a lot of other great points regarding how we all live our lives and how we make choices but I'll leave that to you.

So, you've heard this before?

Good.

But please don't just listen.

Change it.

Stop it when you see it because this cycle ends in only two ways: when people start acting out of love and the other way.

I know that my current situation is not dire and I am lucky to be well-equipped enough to deal with these individuals but the actions of bullying are a common enemy we must all share and work to end.

That, and a "used" VRE test may just find it's way into the instructor's lunch bag...

Reflect This...

"This is not a reflection, please redo and resubmit."

This is the verbatim feedback I received on one of my required but not graded 'personal reflection' assignments this past semester.  I found this to be amusing because these assignments are sold as a way that the student has a "written conversation (with their instructor) about clinical nursing practice."

I took this description to mean that just about any topic was fair game as long as it related to my clinical practice and i related how it made me feel.  Nope.

I wrote a one page reflection regarding my feelings towards the reflective process as administered by the University of Manitoba Faculty of Nursing.  Basically, they regard the reflective process as a tool with which the instructor can better evaluate the student's growth.  So far, I don't disagree.  Then the syllabus goes on to say that successful completion of the course is only possible when a minimum of three reflective journals have been completed by the student.  

Hold it right there.  

I don't know if it's obvious to the readers of this blog, but other than venting once or twice a semester, my reflective juices aren't sloshing about in sufficient quantities to slam out three journals in two and a half months.  Also, my personality isn't the type that often has a lot to say about my own practice and I'm sure my ACTUAL reflection wouldn't exactly pass muster with the instructor. For example:

"I really shat the bed when trying to insert an IV into my obese 31 year-old patient.  I should get better at sticking needles into fat, puffy things.  Perhaps voodoo?"

or,

"I didn't give my patient's acetaminophen in the appropriate time because I did not see that someone had changed the administration schedule in the MAR (medication administration record). By golly, I will just do better at looking at the page."

Yeah, not exactly what they are looking for I think. 

So, I had a thought that I would reflect on the reflection process itself as it was the only thing giving me any sort of emotional reaction that I could talk about at length.  So I did.  I poured out my heart (honestly, I did, there were even tear stains on the keyboard!) and I wrote a true reflection of my feelings toward my professional practice.

So, what hope is there for someone in my position?  

None, as it turns out.  

"This is not a reflection." 

So, what did I do?

I resubmitted a regurgitated version of how I really didn't like how the doctor was speaking to my patient about the root cause of her hypertension (starts with a 'Mc' and ends with a 'DELICIOUS!!!') and how I should always stand up for my patient and advocate for their right to clog their own damn arteries and I don't care how many hard-luck fatties the doctor has already seen that day he still better be sweet and loving to my patient!!!  

I get the journal back the next week.

"Very well done."

*facepalm*