Like most of you, I’m continuing to watch the events unfold in Iran via Twitter and YouTube. Not surprisingly, given the escalating violence, doctors and nurses are caught in the crossfire. This video was posted on YouTube on June 16th. One woman who I’m guessing is a nurse is showing a sign that says that 8 people were martyred. Toward the end of the clip the young man (whose voice breaks down many times) is saying that he witnessed the brutal beating of women and children. He speculates that the attackers were Lebanese Hezbollah. Hat tip to Andrew Sullivan, The Daily Dish.
This story really upset me because I work with medical students at UGH (Undisclosed Government Hospital), and because I have children who are the same age as these victims. The eye witnesses reports come from medical students who hid when Iranian militia and police raided a Tehran University dormitory in the middle of the night. Hat tip to Nico Pitney of the Huffington Post. As we witness history, we will continue to witness the murder of innocent people.
“At the same time, Iran’s Interior Ministry ordered a probe into an attack late Sunday night on Tehran University students in a dormitory reported to have left several students dead and many more injured or arrested. Students say it was carried out by Islamic militia and police. Iran’s English-language Press TV said the ministry urged Tehran’s governor’s office to identify those involved. Iran’s influential speaker of parliament, Ali Larijani, condemned the attack.
Students’ Web sites reported mass resignations by Tehran University professors outraged over the incident. One medical student said he and his roommate blocked their door with furniture and hid in the closet when they heard the militia’s motorcycles approaching. He heard the militia breaking down doors, and then screams of anguish as students were dragged from their beds and beaten violently.
When he came out after the militia had left, friends and classmates lay unconscious in dorm rooms and hallways, many with chest wounds from being stabbed or bloody faces from blows to their heads, he said. The staff of the hospital where the wounded students were taken, Hazrat Rasoul Hospital, was so shocked that they went on strike for two hours, standing silently outside the gate in their white medical uniforms.”
Network technology giant Cisco Systems, Inc. invited nurses to offer focus group feedback on a recent study that showed that 92% of nurses believe that communications lapses adversely affect patient safety. I joined five nurses in a cozy break out room at the HIMSS convention center and asked about their real-life experience with communications lapses in the hospital. Here are the highlights:
1. Technology Isn’t Perfect – although some hospitals have instituted bar code scanners and wireless computers to help to reduce errors, these devices often drop their connections. One nurse said that the devices actually slow down the process of distributing medications, and bypassing the system simply results in a loss of automated medication cross-checking. The devices don’t perform well in the case of an electrical surge, and nurses often waste time finding computers on wheels (affectionately known as “COWs”) that have a full battery.
2. Where’s The Patient? – the group of nurses all agreed that poor coordination of care inside the hospital can harm patients. Some nurses expressed frustration at having proceduralists and radiology teams remove the patients from their rooms without scheduling it with the nurses. They explained that nurses give out medications at specific times, and when the patients are taken to another part of the hospital without their knowledge, then they can’t plan to give them their medications appropriately. Missed doses or missed meals (for patients with diabetes for example) can result in dangerous hypoglycemic episodes, syncope, and various other harms.
3. Where’s The Pharmacist? – easy access to hospital pharmacists is critical for all clinical staff. One nurse relayed the shocking story of a med tech who was unable to get in touch with a hospital pharmacist to confirm I.V. zinc dosing in the NICU, and gave such an overdose that one of the premature babies died.
4. Where’s The Doctor? -during an audience poll at the Cisco booth, most nurses rated physicians as the hardest staff to get a hold of in the hospital setting. There is regular confusion about who’s on call, and there is often no direct line to call the physicians.
5. Where Are The Nurses Aides? – when it comes time to transfer patients (who are often very heavy) or move them in bed, nurses often have no way of finding peers to help them lift the patients safely. This results in wasted time searching for staff to assist, or even worse, can result in low back injury to the staff or patient falls.
6. Language Barriers – when patients are transitioned home from the hospital, they are often given complex instructions for self-care. These instructions are particularly hard to follow for patients whose native tongue is not English. Nurses see many re-admissions based on language-based miscommunications.
7. Decision Support Systems – one of the nurses suggested that a recent study showed that the number one source of clinical information for nurses was their peers. That means that nurses turn to other nurses for educational needs more often than they turn to a textbook or peer-reviewed source of information. Nurses would like to have better access to point-of-care decision support tools for their own educational benefit and the safety of patients.
8. Change of Shift – nurses identified shift changes as a primary source of communication errors. Technology that enables medication reconciliation is critical to safe continuation of inpatient treatment. One nurses said: “shift changes is when all the codes happen.”
And so I asked the nurses what their ideal technology would do for them to help address some of the communications problems that they’re currently having. This is what they’d like their technology to do:
1. All-In-One – nurses don’t want more devices to carry around. They want one simple device that can do everything.
2. Call a code – with one press of the button, the nurses would like the device to contact all staff who should participate in resusscitating a crashing patient.
3. Lab Values – nurses would like the device to alert them of all critical lab values on the patients under their care.
4. Clinical Prompts – nurses would like reminders of clinical tasks remaining for individual patients (e.g. check blood pressure on patient in bed 3)
5. Call and Locate Colleagues – the device should function as a full service cell phone with pre-programmed staff names/numbers and team paging lists
6. Locate Equipment -nurses would like to be able to track and locate wheelchairs, electronic blood pressure cuffs, and other equipment throughout the hospital.
7. Translate Verbal Orders To Written Orders – verbal orders are more prone to errors than written ones. An ideal device would have a voice recognition system in it that would translate physician orders to text.
Is there such a device on the market today? There are many different devices that have the capability to do some of above, but to my knowledge there is no device that can do it all yet. Companies like Cisco are working hard to provide integrated solutions for nurses – and the Nurse Connect phone is an important first step. What technologies would you recommend to nurses?
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More information about the phone (from press release):
Cisco Nurse Connect is a newly introduced solution that integrates nurse call applications, including Rauland-Borg’s Responder product lines, with Cisco Unified Wireless IP 7925G Phones to deliver nurse call alerts to mobile caregivers.
The Cisco 7925G Phone was specifically designed with the features necessary to support the unique safety and biohazard requirements of hospitals, including a battery that supports up to 13 hours of talk-time, ruggedized and hermetically sealed, and Bluetooth support for hands-free use.
The Nurse Connect Solution offers many benefits. For example, by reaching nurses on their mobile devices, the need to continually walk back to nursing stations or patient rooms is greatly reduced. Nurses can also have two-way communications with patients and send immediate requests to different levels of personnel after talking with the patient.
I was following an interesting conversation on Twitter between several nurses. They were expressing concern about how nursing stereotypes were damaging to their profession. I invited them to discuss the subject with me via podcast.I have summarized some key points below.
1. Nursing Instructor Shortage – nursing instructors make about 25% of the salary of nurses who do clinical work. Therefore, there are long wait times to enter nursing school due to instructor shortages. Many students can’t afford to wait, and choose other careers.
2. Inequality of Respect – some nurses feel that they have to continually prove themselves despite their training and qualifications. Patients often express disappointment or annoyance when they see a nurse practitioner (rather than a physician) in a group practice. Some doctors still expect nurses to give up their chairs when they enter the room.
3. Nursing Stereotypes – the “naughty nurse” and “nurse Ratched” images are still very much in the forefront of peoples minds when they think of nursing as a specialty. Some people believe that nurses simply pass out pills and make coffee, when in reality they are active in complex technical procedures and saving lives. These stereotypes and misconceptions denigrate the education and technical expertise of nurses.
4. Primary Care Doesn’t Pay: nurse practitioners incur higher debt and have lower salaries than specialist nurses. Just as in the medical profession, there are no incentives for nurses to choose careers in primary care.
Strengths of Nursing:
1. Nurses Are Better And Brighter Than Ever – since getting into nursing school is so competitive, the quality of individuals who are entering nursing school has never been higher.
2. Job Flexibility – nurses can easily transition to part time work for maternity purposes. Nursing careers offer a wide variety of work experiences – from nursing home work, to cardiothoracic surgery. One license offers hundreds of various opportunities.
3. Job Satisfaction – saving lives and serving patients contribute to a sense of job satisfaction.
What can be done to improve and advance the US nursing profession?
1. Establish an Office of the National Nurse. The National Nursing Network organization is promoting this initiative. The National Nurse would act as a government spokesperson for nurses- promoting preventive medicine, increasing awareness of nursing, and securing financial support for nurse education. He or she would be the chief nurse officer of the US public health service.
2. Do not be afraid to speak up. Nurses should feel comfortable defending their professional ideals, and discouraging stereotypes.
3. Blog to raise awareness of nursing challenges and successes.
In a bleary eyed state I misread a blog post by PandaBearMD. He was on one of his well- written, sarcastic tears, and (jokingly) blamed nursing salaries for the rise in healthcare costs. I didn’t get the humor of that, and proceeded to defend my nursing colleagues. Of course, I took some hits for being unable to recognize sarcasm, but this event got me thinking about nurses…
I have always been grateful for the wonderful work that nurses do – and as I think back at all the amazing feats they’ve accomplished in front of my very own eyes, I thought I’d start a list:
NICU: can place an I.V. in a 1 lb preterm baby with veins the diameter of hair (but docs: don’t TOUCH the baby!)
ER: can put an I.V. in a 400 pound, anasarcic patient with no palpable pulses.
Psychiatric ED: can convince a fulminantly psychotic, violent patient to sit quietly and play with a teddy bear while waiting for the doctor to see him
Medical Floors: can clean up a fecal mess so foul that even the anosmic wouldn’t have the courage to enter the room – and do it in such a way that the patient feels no personal embarrassment
OR Nurse: will anticipate the instruments needed for an unforseen surgical complication and have them ready for use before the doctor gets a chance to ask for them
Pediatric ED: can distract a small child with stuffed animals, toys, and picture books so successfully that they don’t notice sutures being placed in their hand.
Obstetrical Nurse: can withstand the force of a 200 pound leg pressing against her for hours on end as mom bears down to push the baby out of the birth canal
Rehab Nurse: can get any patient out of bed, single handedly, and with little obvious effort (while the rest of us call for the Hoyer Lift, and 3 resident physicians)
This is just the beginning of a long list of magical things that nurses can do… please share some of your favorites!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
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