Journal of Nursing Jocularity

I started out like the others.  I entered nursing school with bright eyes and high ideals, naive to the ways of the real world of nursing.  I knew I was going to be different.  I would do all my charting immediately after giving care.  My patients would be turned every two hours, on the dot.  My meds would be given exactly on time.  I would be the perfect nurse.

Well, I’ve been a nurse for over two years, and the honeymoon is over.  In my disenchantment phase, I believed that the perfect nurse existed only in the minds of humorless, dictatorial nursing school instructors.

Of course, that is not true.  Because eveyone has a definition of the “perfect nurse”.  It just means different things to different people.  For example: (more…)

Hob Osterlund is a clinical nurse specialist in Pain and Pallative Care at The Queen’s Medical Center (QMC) in Honolulu. She also writes, performs, and produces comedy that provides therapeutic benefits for both patients and nurses. She and her research team have just completed the COMIC study (COMedy In Chemotherapy) at QMC and are eagerly awaiting the results. Before we get to the details of her study, let me introduce this amazing woman.

Appreciation of Comedy

Hob’s first and most powerful connection to comedy came through her father, who taught her the art of luxurious laughter. In nursing school, her attempt to share humor with her patients was criticized by instructors who cautioned her that humor was inappropriate. This was the 1970’s, and clinical distance was the key. The criticism caused Hob to search her soul. She decided humor was a central value in her life. This decision launched more than 30 years of writing, performing and producing comedy. She continues to produce closed-circuit Chuckle Channel programming for hospitals and to perform her alter-ego comedy character Ivy Push RN
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I don’t think I like this business of changing the name “nosocomial’ to “health-care-associated.” Yes, I get the point: to also include all health care settings, and not just hospitals, under one heading. But see, first of all, this new name is in plain old, you know, English! Health care consumers can even understand the term, which is supposedly the exact opposite goal of medical lingo. And worst of all doesn’t the term say outright, in that plain old understandable English, that basically we health care providers messed up?

You never hear patients, including your Aunt Helen whose gall bladder was removed last January, talking about their ‘nosocomial infections.’ They may know they ‘got an infection in the hospital,’ and maybe even realize it’s sort of related to the hospitalization itself. But that’s it. ‘Nosocomial infection’ is—oops I mean WAS– a term kind of shrouded in mystery. Thank goodness for that.

But now? Good grief! It’s like we’re announcing that it’s our fault!! “Health-care- associated- pneumonia?” We may as well wear t-shirts proclaiming “I am carrying germs right into your lungs.” It’s telling the entire mankind that we, members of the most highly thought of and trusted professions in the world (at least until now), are the cause of these bugs.

I can already see the guy with the stuffy nose in bed 3052– who really only came in with intractable back pain but now has this uncomfortable nasal congestion that we all get every allergy season, now telling all his friends and neighbors and maybe even his lawyer that he has a “health-care-associated pneumonia.”

Boy am I glad I have my own malpractice insurance. I suggest you get your own.

Granted, I may have once or twice been the source of a nosocomial– I mean healthcare associated- infection or two myself. I really never told this to anyone before, but once we’re announcing this health-care- associated pneumonia bit, I may as well be the first to give my confession: I definitely recall only scrubbing my hands vigorously for only 14.2 seconds instead of JCAHO- required 15 in between taking the BP of the guy in E.D. Room 3 (c/o sprained arm r/o fx) and checking on the lady in bed 8 (c/o cephalgia).

Who’s next? Come on, it’s coming out in the open anyway. Let’s all let our hair down. (Although loose and/or long hair breeds germs and should really be kept short or pulled back away from the face.)

And now that the world will be hearing that “health-care-associated” infection bit, you can imagine what will be going on in hospitals health-care-associated sites now. Patients will be suspiciously studying every single health-care-associated staff member. Not just the nurses and MDs and CNA’s but now every housekeeper and mop, every dietary worker bringing trays and clearing them off, maybe even the volunteers bringing their mail. Can’t you see these patients tucking details in their heads as they mentally note, “Thaaaaaat’s what’s causing all this ‘health-care-associated pneumonia’ I hear about. That volunteer just delivered my get-well card–without gloves!!”

Actually, once we’re embarrassing ourselves and being completely honest with this confessional new term, let’s go all the way. That physician who doesn’t wash his hands between one patient and another– and you find it unsurprising that his patients get MRSA more than the rest of the unit….well, we could name the infection “Dr X- acquired MRSA,” but there’s always that libel and defamation of character suit. (Which is probably not covered under your malpractice insurance policy.) How about ‘poor-handwashing-technique-acquired infection?’

How about some other stuff we see– will they be named things like “Poor-suture-technique associated wound dehiscence?”

And what about us? How about ‘insufficient-betadine–pre-Foley-insertion -associated UTI?’ ‘Faulty -IV-technique-associated phlebitis?’ And something a few of my own patients might have suffered during my first six months out of nursing school: ‘Poor- injection -technique-associated ecchymosis?’

Then again, maybe it wasn’t my fault. Some of them- especially those geriatric ones- were really “insufficient -subcutaneous- tissue- associated ecchymosis.” That’s better. See, it’s not always the fault of the health-care- associated-providers, is it?

And waittttttttttttt a minute. Now that I think about it, lots of conditions are not our fault. Why do we have to be honest about our health care flaws, but the patients don’t have to be? Why can’t we ALL be honest here? Patients included?

For example, I think it’s time for a NEW classification of MIs. ‘STEMI,’ ‘Non Q,’ ‘Subendo,’ ‘anterior wall,’ blah blah– outdated. Let’s go for it: The guys who sit home for 3 days not believing it’s an MI: Denial-associated MI. The chain-smoker who eats at McDonald’s every day for lunch after breakfast at Burger King– is Unhealthy-lifestyle-acquired MI. And the poor folks who really take care of themselves but have MIs mostly because of family history: “No- fair- it’s- only-DNA-associated MI.” Insurance companies could have a FIELD day with this.

OK well, um,………So maybe this idea is NOT a good thing. Well, then….. how about making up a NEW term that would include all health-care-associated-settings, without publicly humiliating ourselves? Let’s think. Um, well….. maybe some acronym or something? Oh hey, I’ve got it! How about “NOSOCOMIAL?”

Now they’ll all be happy at JCAHO (Just Clean All HOspitals), and HCFA (Hospitals Cause Fevers and Ailments). Oops my mistake– I think the idea was the CDC ‘s(Caregivers Don’t Contaminate). Of course we still get to keep that nice mysterious hard-to-understand-and-even-spell ‘nosocomial’ term, and no one will know what it stands for, except us. You know, the guilty parties. Nurses/Nursing homes, Offices/Outpatient Settings, Other Caregivers Or MDs Infecting ALL.’ See, that’s more all-encompassing.

February is American Heart Month, which means that here at JNJ, we’re going to be taking a look at the connection between what makes us laugh and what keeps us going: humor and the heart.

Our Patients Have Hearts

Despite what we may sometimes believe during initial assessments, the vast majority of our patients do, indeed, have hearts. Those hearts aren’t in particularly great shape: cardiovascular disease is the number one cause of death in our country. According to the American Heart Association, over 80,000,000 individuals in the US have one or more forms of cardiovascular disease. (more…)

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At the point of 
leaving the ivory tower of formal education for 
the discount store of 
the work world, one’s 
real education often be- 
gins. The practice of 
psychiatric nursing is 
no exception. I remember clearly the day that 
mine began. A very 
large, very angry man 
appeared at the glass 
window of the nursing station. He ranted, he raved, he 
threw hi arms about and shouted 
his list of complaints. Remembering my chapters dutifully read in Mereness, I listened until he 
wound down and then acknowledged his feelings by 
stating, “You seem angry.”

Hi response was one I’ll never forget. “What a 
stupid thing to say! I’ve been yelling at you for five 
minutes and you say I seem angry?” He stalked off, no 
doubt feeling very mi understood. So much for empathic communication.
A I continued in the real world of psychiatric 
nursing, I developed a list of common sense rules, some 
original and some borrowed. Here are Vallery’s Common Sense Rules for the Real World.
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As the worldwide nursing shortage makes recruiters more competitive and our remuneration 
more equitable, it’s easy to become misled by the slick advertising some institutions have adopted. 
In order to help you avoid feeling misled, here are the real-life definitions of the most common 
ploys used to attract nurses.

WHAT THE AD SAYS / WHAT IT REALLY MEANS

“Competitive pay” / Pay is as low as we can get away with and still have our body count be reasonable.

“Salary” / Hourly wages based on time clocks or time sheets.

“Challenging 
environment”  /A lot of really sick patients, short-staffed, little support from managers and 
administrators, a high-density of “difficult” physicians and bitchy nurses.

“Excellent benefits” / Minimum legal requirement, one or two low-cost perks and eventually you will get 
to take a vacation …. maybe a couple of days next year.

“Diversity” / You’re required to float to cover units you don’t feel competent to work in, and 
don’t say you’re not comfortable there. “A nurse is a nurse is a nurse.”

“Tuition 
reimbursement” / We have a written policy, but your schedule will be so bizarre that you’ll never 
be able to complete a course so don’t even bother enrolling in one.

“Committed to 
professional development” / You’re expected to serve on many committees and task forces, to participate in 
your manager’s projects but we’re so short-staffed right now you’ll have to do 
them on your off-duty time. And no we really can’t pay you any extra for this work 
you do for us, but since we need all this for our accreditation, if you don’t do it, 
we’ll have to write that in your performance evaluation.

“Free housing” / We had to close some beds since we couldn’t staff them so you can stay right here 
in-house where we will call you anytime of day or night to come to work.

“Clinical ladders” / 12-foot ceilings from which everyone hangs the IV’s, i.e. very old building.

“Research 
opportunities” / We want you to discover how to do 12-hours of work in the 8-hours they pay 
you. Also they want you to figure out how to care for 50% sicker patients with 33% 
fewer staff. No statistical knowledge needed.

“Job security” / If you’re licensed and breathing you can work ’til you die.

“Inter-facility transfer 
opportunities” / We have seasonal peaks and troughs so they’ll float you 2000 miles away.

“Per diem.” / What’s that?

“Free parking”  / Some places still charge you money to come to work.

“Medical coverage 
that includes chronic 
kidney care” / That’s part of a new union contract since staff rarely get a chance to go 
to the bathroom.

“Salary-in-lieu-of- 
benefits”  / Silly goose! Who said you could have both?

“In-house continuing 
education” / We can’t schedule you for 2-3 days off together just because you want to 
attend a workshop. Even though the class is required for your job, we’ll still 
charge you money to attend.
by Anita Bush, RN, CCRN
Volume 1 Number 1, Spring 1991