In addressing a bill that would mandate uninterrupted breaks and mealtimes for nurses at critical access hospitals in Washington state, this is what State Senator Maureen Walsh had to say,
“I understand helping with employees and making sure that we have rest breaks and things like that. But I also understand that we need to care for patients first and foremost. And by putting these types of mandates on a critical access hospital that literally serves a handful of hospitals. I would submit to you that those (small hospital) nurses probably do get breaks. They probably play cards for a considerable amount of the day.”
It was hard to imagine that a public official went on record with that comment, but there it was.
I’m not a nurse, yet I personally felt offended by what she had to say. I felt further disgusted because the policy on the table is an effort to guarantee the humane treatment of our nurses. I’d like to know why this was even an issue to begin with, and why a bill was necessary in order to ensure that nurses could have appropriate breaks. Of course, there will be those who will argue and fight not to grant nurses what should never even have to be asked for. But what made the Senator’s comments entirely unacceptable was the insinuation that nurses sit around doing not much of anything.
For all of the nurses with whom I’ve worked, and those whom I haven’t… for the nurses who helped to train me as a resident… for those who helped to mold me as an attending physician… for those who nurtured me as I worked alongside them… and even for those who opposed me, I wrote this with all of you in mind…
As penance for her rather irresponsible remarks, Senator Walsh is supposed to shadow a nurse for 12 hours, perhaps in an effort to make amends for her comment. Or perhaps, it is an effort to stem the tide of criticism (and playing cards) that have been coming her way.
I hope that they assign the Senator to the busiest unit of the busiest hospital that can be found. And I hope that on that day, one nurse from that unit calls out.
As soon as the Senator arrives, she should be handed a bedpan for a patient that needs assistance, and an adult diaper for herself. She should be told to put on that diaper because there may not be time to have a bathroom break… in between patient care and card playing.
But, no worries. On that 12-hour shift, she won’t have much of a chance to drink anything, so she needn’t worry about losing control of her bladder. They’ll just need to explain to her that by the end of the 12 hours, her bladder will be full; but she’ll also be dehydrated from not drinking, so there won’t be much chance of incontinence.
The upside is that, if she gets a considerable urge to void, she’ll strengthen her pelvic floor muscles from the occasional Kegel maneuver that she’ll have to perform since bathroom breaks can be rare… in between patient care and card playing.
If the diaper idea really turns her off, they should let her know that there is the self-catheterization option. Hopefully, they’ll tell her that she’ll only have about 2 minutes to insert her own catheter in between putting her belongings in her locker and morning sign out.
Not to fret, though. There will be many people around who can pop that Foley catheter in for her lickety-split. They’ll waste no time at all, because after morning sign out, everyone will want to get to those card games.
In the absence of that, things will get real, and I imagine that the Senator’s day will go something like this:
After sign out, checking and charting vitals, administering meds, ordering meds from the pharmacy, helping patients to get to the restroom and get washed up, answering various questions and demands from doctors on rounds and setting patients up to leave the floor for imaging studies or surgeries, Senator, can you believe that there’s no time left to play cards?
How disappointing! If we’d just finished all of that stuff earlier, not only could cards have been played, but the doctors could have joined in on a game or two before dashing off to their offices!
Let’s see what’s happening now?
Oh, there are 3 patients who were admitted from the ER and have been awaiting beds for several hours. Well, ok. We have no available beds right now, but we do have 5 patients up here awaiting discharge. No problem.
As soon as we get these patients out and the rooms turned over, we’ll start that Poker match. By the way, did the doctors write those discharge orders? Can you call them first and ask them to do that? Once they, do, you can help us to review their discharge paperwork with them, make sure that they have their prescriptions and follow up instructions. Then we’ll help them to get their belongings together and help them down to their vehicles.
Yes. We’ll need to do that for all five. And, don’t forget, that we need 3 of those beds for our admits. So, let’s be expeditious.
Did you call those doctors yet? You did? And they haven’t yet responded. Yes, that happens. Well, we can’t do much without their orders. Not to worry. There is always other work to be done.
In the meantime, as we wait for their calls, Senator Walsh, take that bedpan over to Mrs. Jones in Room 207. She’s been waiting for a while now, since you had to get your diaper on and all. She’s kind of upset.
And after helping her, why don’t you run down to the pharmacy and get those meds that we ordered? They’re taking a while to come up and Mr. Smith in Room 202 is 1 hour late in receiving his Zosyn.
Wait! Wait! Mrs. Wilson in 215 just vomited. Please run in there and start getting her cleaned up.
Senator, you have to put that deck of cards down for that. Trust me.
Forget it, forget it. We’ll take care of Mrs. Wilson. We’ll need you to get a wheelchair and help Mr. Dawson downstairs. He’s ready for discharge. And hurry, because we need that bed. And you’ll need to help him get his belongings packed up! Grab that cart and put his flowers and bags on there so that it all can go down at once.
Hurry up, please. Those patients in the ER are angry and are threatening to call administration.
No. Going to play a game of cards with the ER patients will not help.
Did you get those meds from the pharmacy yet?!! Do you have any idea what time it is?
No. It isn’t time to play Canasta. That will have to wait until we get these discharges done and these patients admitted.
Ok. Ok. You seem a little overwhelmed. This is all new for you. Sit here and catch your breath. You have about 5 and a half seconds to do that. Then we need you to call the OR and see when they’ll be coming for Mr. Anders who’s having surgery this morning.
What do you mean, “He’s still eating?” Who fed him?!!
You did?!! Why? Didn’t you see the sign that says “NPO”?!!
No! NPO does not mean “Noon Poker Opponent”! It means that he shouldn’t have anything by mouth! Now his case will have to be cancelled! You can call Dr. Scream-a-lot and let him know that his case is being cancelled because you fed his patient. And call the OR and let them know, too.
Hey, Senator! Did you catch your breath yet? It’s now been 6 seconds and it’s time to jump to it! Chop, chop! How can we ever play cards if we don’t get our work done?!
This is awful. I guess that we’ll just have to postpone that next game of cards, too.
No, you can’t go to the restroom. There’s no time. That’s why, first thing this morning, we gave you the option of the diaper or the Foley. Unfortunately, you still haven’t gotten those meds and Mrs. Jones is frantically ringing her call bell, because you never took her the bedpan that she needed. Please do that!
Hey! Wait a minute! Dr. Scream-a-lot is on the phone for you! You need to go and talk to him. Then we need your help with those three ER patients that just arrived. First make sure that their rooms are ready, then you need to help us with their admissions.
Mid-morning snack? For a patient?
Oh. For you? You’re hungry? There are some Keebler club cracker packs in the pantry. Grab a couple of those and keep it moving.
What just happened? Mrs. Jones fell trying to get herself to the bathroom? Didn’t you take her that bedpan? What do you mean, “You had too much else to do?” Can’t you multi-task?
Senator, you’ll need to do a better job of keeping up.
Let’s get to 207 and check on Mrs. Jones! Hurry up! Run!
What is it now? Oh. The diaper chafes you? I’m sorry. You’ll be ok. Just put some Desitin on it the next time you get a bathroom break. No. I don’t know when that will be. Probably shift change. You’re ok, right?
Sure you are!!!
Ok. Now that Mrs. Jones is back in bed and cleaned up, you need to call her doctor and let her know what happened. She’s complaining of pain in her lower back and we need to know what her doctor wants to do.
You’re nervous to call? Yes. You should be. Her doctor has some anger issues… but you’ll be ok. We’ll be generating this incident report for administration, because, of course, we have to account for her fall. This can take a while, but I’m sure that her doctor will have a great deal to say to you while we’re completing the paperwork.
Man. If this hadn’t happened, we might be playing cards right now.
Senator, you’re bringing us down.
Ok. Great. You called her doctor. What did she say? No. I don’t want to know the names that she called you. Don’t tell me those. What did she say that she wants done? An X-ray? Ok. I’ll work on getting that into the computer and you call radiology.
Did you go with the LVN to check vitals for everyone? You did? Great?
Yes, I know. We do have a lot of patients who need vitals checked. Matter of fact, all of them do. Do you have the results of each patient’s vitals? You don’t? Why not? You didn’t write them down? Seriously?
Come on, Senator Walsh. You had ONE job.
Please go and find the LVN that you were working with and ask if she has a record of them. We need those.
Lunch? Uh, we don’t have much time for that at all. Did you put your lunch in the refrigerator? You did? Ok. Wonderful! That means that your food won’t go bad while you’re working. Chances are you won’t get to sit down and finish it… or even really start it… anytime soon. Not to worry, though. Those crackers that I told you about are good in a pinch.
Awesome! You finally got those meds that we’d been asking for since 7:30. Wonderful. It’s only 1:45 now. But no worries. This is what incident reports are for.
I’m proud of you, though. You haven’t asked about playing cards in quite a while.
Hey. About those vitals?
Ok. Wonderful, they were taken, recorded and entered into the EMR. Great! Someone must have done that for you. How nice of them. I’ll bet that they gave up a quick game of cards to make sure that that got done.
Listen, Mrs. Pierre is on the way back from surgery. Please check that her room is in order and that her bed is made so that she can be transferred as soon as she arrives.
No. No. There’s really no time to eat, go to the bathroom or play cards. We still need to finish the admission on Mr. Navarez. He’s in a bed, but we have to make sure that his next set of labs gets done, that his CT is ordered, that his Neurology consult is placed and that he’s getting his meds. As a matter of fact, we’ll probably need you to run down to the pharmacy and get his meds so that they can be started.
And, by the way… when you get there, you need to grab the package that they have for you and come right back. Don’t ask about cards. They don’t have time for that there, either.
Wow. Thanks for coming back so promptly. It only took you 40 minutes to make that trip.
Me? Sarcastic? Never. But you do realize, Senator, that EVERYTHING that we do here is time sensitive, right? You got lost? I understand. It’s a big place. You’d think that there were card games going on all over the place, right?
Your ankles are swollen? Yes. We empathize. It’s being on your feet continuously that will do that to you. What do you mean, “You haven’t sat down all day?” Of course you did! You sat down to call the doctors. That was at least twice. And I believe that you sat down for a chance to catch your breath. You know… that 5 and a half seconds. Do you need more than that?!
Ok. Well, keep up the hard work. It’s almost dinner time, and then you only have a couple more hours. But, we can’t stop to rest on our laurels! We need to make sure that Mrs. Cassidy in Room 201 gets to her physical therapy session. Please call and check that transport is on the way for her, and then we’ll get her prepared together.
You feel faint from not having eaten? Well didn’t you have those crackers? My word. Go grab a couple more, then meet me in Room 201!
Great teamwork, Senator! It only took 15 minutes to get Mrs. Cassidy turned and onto the transport bed.
And, yes. Now, I’m being sarcastic.
It took longer than it should have, but at least she was safely transferred. It was a little hairy for a while, though. Wouldn’t you say? I take it you’ve never had to turn an adult patient who has limited mobility. It requires strength, agility, expertise and compassion… especially when a patient is nervous or afraid, which Mrs. Cassidy was. Card playing doesn’t help us to attain those skills and characteristics… in case you were wondering.
Ok. Time for dinner!
No, Senator. Not for us! For our patients. We need to make sure that everyone’s meal has arrived and that they all received the proper menu items and diets. But, if you’re very hungry, there are those crackers. And if you need some variety, I’m pretty sure that there are some graham crackers in the pantry, as well. Yum! Wholesome and hearty! Grab a few and let’s keep it moving!
Alright! We are in the home stretch. I have a ton of charting to do, but you can be helpful by making sure that our patients are comfortable, that no one needs help getting to the restroom or transferring to a chair, and that they otherwise have what they need. Some of them will already have finished dinner and we need to remove their trays. Also, let’s make sure that their rooms are stocked with items like Chux pads or other personal products that they may need.
When you’re finished, let me know. We are getting close to sign out with the night shift.
Thank you for doing all of that, Senator. That will go a long way towards helping the night shift with their work on behalf of our patients.
How long does sign out take? It takes as long as it takes. Yes. We are officially off at 7:00, but if our duties are not complete, meaning our primary patient care duties, charting and communicating with the night shift about what has gone on and what needs to be done, then we don’t leave. We stay until it’s ALL done.
It’s then that we go to the restroom or grab a quick snack on the way home. Home is where we finally sit down and put our legs up to relieve the swelling that’s accumulated throughout the day. It’s there that we rest and recover so that we can return and be of service to our patients. Rest is essential so that so that we can effectively serve patients and family members who are frightened, hurting, angry, disappointed and, often uncertain. We do our best to keep our patients safe and cared for, nurtured, free of pain, and helped in a manner that preserves their dignity.
Senator, we don’t play cards, or any other games, at work. We often power through the day without meals; without breaks (even though our contracts mandate those); without sitting for longer than it takes to enter data into a patient’s record. (And now, tablet technology has made it possible for us to stand while we chart! Winning, aren’t we?)
Our personal needs and even bodily functions are placed on hold as we run to the OR for an emergency case, respond to a patient who’s become unresponsive or attend to the delivery of an infant. Medical problems, complications and emergencies are never scheduled, nor are they convenient. Our jobs require that we start and complete the job regardless of who has reported for work or who hasn’t. Our jobs require that we respond, NO. MATTER. WHAT.
We ask that as policy is crafted around the practice of nursing and medicine, that our health and needs are taken into account so that we may show up at work, as our best and healthiest selves; and so that we can continue to serve our patients with diligence, vigilance and energy.
