How Not To Die In The Hospital

Imagine if this was your family member and the Nurse was responsible for other patients.

Imagine if this was your family member and the Nurse was responsible for other patients.

Imagine a world of safe medical care. A world in which your family and friends not only get adequate care but outstanding care. Medication errors, hospital acquired infections, wrongful deaths occur all too frequently in our current healthcare system. Hospitals are driven by cost containment and Healthcare providers are expected to do more with less. We are busier than ever.

I have had the good fortune of working in hospitals throughout The United States for over twenty-five years in various settings from Med-Surg, PACU, Oncology, Intensive Care and Obstetrics. I have had as many as thirteen patients on a shift and as little as one in the ICU. Working in specialty areas allowed the opportunity of safe patient ratios. Working in the forward thinking state of California has allowed me the opportunity to provider safer care than if I worked in another state.

You see, California saw the value of demanding that hospitals provide the safest care possible to it’s citizens. In 1999 they passed a law requiring hospitals to implement safe staffing ratios by 2004. Human beings will make mistakes, myself included but I am much less likely to make a mistake with safe patient ratios. This is what it would look like:

I probably will finish my Nursing career in California with adequate patient ratios. However, I feel passionate to wake our country up to the urgency of the future of healthcare. I am joining Laura Gasparis Vonfrolio and other dynamic Nurses to petition for National Safe Nursing Ratios throughout the country. If you are a Nurse, NP, PA, MD, you need to sign this petition. If you have ever been a patient or anticipate being a patient in the future, you should sign this petition. If you have friends or family members, you should sign this petition so they get the best possible healthcare.

Click here now and save some lives today.

ICU Nurse, Attorney, Conflict Resolver - Meet Debra Gerardi

How long have you been a nurse and what areas of nursing did you or do you currently work in? I have worked with healthcare organizations 1979 when I started as an ER admitting clerk when I was 19. After graduating from Creighton University in 1987, I worked as a critical care nurse until 2003.

What led you to pursue law and mediation? I became interested in health policy in nursing school and became involved in Bob Kerry's first senate campaign in 1988. My interest in working in the public health arena, particularly health policy as a means of improving patient care delivery led me to law school in 1989. During law school, I learned about a program in Preventive Law, fashioned after the public health model, and began to learn about mediation as a means of resolving disputes rather than litigation. At that time, mediation was not as widely used and it was just touched on in law school. That is not the case now where law students are routinely exposed to mediation and other alternatives to litigation. I moved to Los Angeles after graduation in 1992 and I did 40-hour mediation training through the LA County Bar Ass. in 1994.

Tell me your biggest concerns about nursing. In my work now as a conflict specialist and executive coach, I am most bothered by the difficulty of the work environments that nurses are working within and how depleted nurses are trying to provide care to patients within a compliance and cost driven system. The need for nurses to make intentional choices for their own self-care and to develop reflective practices to maintain their own resilience and stay grounded in the values that underlie the practice of nursing is growing. I love helping nurses develop practices to help them restore their own well-being so that they can better do the work they were called to do.

What throws you off balance and how do you know you are out of balance? What throws me off balance is when I have not paid attention to my own resilience and I find myself taking in too much of other people's energy into my own body. This depletes me and it makes it easier for me to be "hooked" by my own triggers or habits. This imbalance can lead me to move to far into a "rescue" mode and take on work that belongs to others. To rebalance myself I do a number of practices including: Journaling almost daily, working out (my goal is 5 times per week), regular sleep when I am not traveling, being in nature (I need a lot of this), reading poetry and authors who inspire me and give me a larger perspective, good nutrition and hydration (this works like magic!), and spending time with people who bring me joy and love to play! As you can see, rebalancing is a full time job for me!

What is the role of nurses, physicians, nurse managers and administrators in creating a healthy workplace? So often we adapt to the culture because "it's always been that way". Managers or administrators often are swamped with meetings to address what seems to be petty behavior or bullying. The role of all health professionals, and particularly those in leadership positions, in creating a healthy work environment is to first become aware of how they are personally contributing to an unhealthy work environment and to set an intention for how they might shift their own habits that may make things worse or at a minimum maintain unhealthy patterns. For example, interrupting the tendency to talk about someone rather than directly to them or remaining silent when there are behaviors that are compromising care are two habits that most of us have adopted as part of "the way we do things here." Understanding that I have choices in how I respond and intentionally choosing to respond in ways that align with my values and promote connection with others in healthy ways and then trying on better behaviors is the main way that cultures shift over time.  Leaders who do this can have a much larger impact because everyone is watching them to see how they behave in order to know what is acceptable.

Additionally, the emphasis on bullying and unprofessional conduct has taken on in many places a punitive approach or a compliance-based approach rather than a relational approach. By reframing how we engage, we have a broader range of options for responding in ways that are less about discipline and more about confronting individuals and groups with a mirror to help them appreciate the impact their behaviors are having on patient care and colleagues and then providing them with the choice to change their approach or choose another place to do their work. Often people who are behaving unprofessionally are unaware of the impact of their behavior, they are having trouble coping with the stressors in the environment, and they have poorly developed emotional intelligence. Providing support for development of these skills early in training is essential. For the small percentage of folks for whom this approach will not work, the more traditional disciplinary action can be used to further protect the work environment and the quality of patient care. Of course, this particularly applies to those in leadership positions who are doing the bullying or who are having difficulty coping with the stressors of their jobs due to their own diminished resilience.

What advice do you have for healthcare providers that avoid conflict or difficult conversations? Are there ways to start getting comfortable?  We all avoid conflict! No one likes stepping into an unpredictable situation in which there are strong emotions and if we are worried about retaliation, making things worse, or not seeing any benefits from taking the risk, then we are even less likely to take it on. Knowing when and how to engage are core competencies for engaging in conflict. Becoming more comfortable with engaging in hard conversations comes with practice and development of our intrapersonal capacity (knowing myself and my own triggers) and interpersonal capacity (knowing how I interact with others and how they respond to me). This requires self reflection and self awareness so that I can try on things and see what works. Learning how to listen openly, acknowledge what matters to the other person, reframing the situation into something we can work on together, looking for common interests, and using empathy are all tools that nurses have some exposure to and using them intentionally with colleagues and others helps us get better at engaging, just like practicing other nursing skills helps us develop mastery. Another important point is to appreciate that when we are fatigued or under resourced personally, we are less likely to choose to engage and if we do, we may not be our best self when we do.

You worked with JCAHO on sentinel events. What relationship does a healthy workplace have on patient outcomes?  The Joint Commission started tracking sentinel events around 1997. The data consistently points to the importance of teamwork and communication as essential for safe care. This has led to a number of standards and sentinel event alerts that highlight the need for conflict management and team training. What is missing is attention to how the work environments with the excessive attention to productivity and quantification of patient care are contributing to fragmented approaches to care and removing the time and connection necessary for health professionals to form relationships with patients and with colleagues. It is these relationships that are the source of quality care and that provide a feeling of having done meaningful work.

What advice would you give to new grads starting out? Be compassionate with yourself and others. Nursing is noble work and hard work, and it is one of the most sacred spaces you will ever inhabit. Make friends with your colleagues and support one another- no one does this work alone. Become a life long learner- things will change and there is always more to know- about nursing, the health system, your community and about yourself. Have fun! The work is serious and sometimes overwhelming but you have to find ways to have fun and enjoy what you do so that you can keep doing it for as long as it feeds your soul.

Healing Nurses through Painting

How long have you been a nurse and what areas of nursing have you worked in? I graduated from Nursing school in 1978 and was active working with patients until 1997, working in the following specialties: Surgical ICU, Post Anesthesia Care Unit,  UCSF Out-patient Osteoporosis Clinical Research and HIV research at the Blood Center and Epidemiology Department

What did you love most about nursing? On one side, the thing that lit my fire as a young Nurse was the excitement, the emerging science and oh, how I loved the gadgets- ventilators, ECG monitoring, arterial lines, and oximetry. I loved it all except for the alarm sounds. On a more holistic approach, being the patient advocate was the single most important concept I held in my heart. Hospitalized patients are almost always defenseless in some area and need someone standing on their side.

What were the biggest challenges you faced in Nursing and what led to leaving the workforce? What led me to burnout were periods of extreme turmoil in my personal life, while at the same time there would be a favorite patient dying or I would have a string of patients with the same diagnosis as my dying father.  I could cope until my world was falling apart.

What led you to creating Paintbrush Cafe? Creative projects are like mana (life power) to me.  Whether it was creating batiks, making candles, needlepoint, cooking- these types of activities always soothed me. My first weekend painting experience with Shiloh Sophia McCloud in 2012 was so powerful in transforming a core ‘story’ of mine that I signed up 6 months later for Color of Woman™ Intentional Creativity training.  I knew early on that my work would be with Nurses.  I know Nurses, I know that more practical outlets for self-care are needed and the Intentional Creativity method is genius.

Paper collages from Hospice Nurses

Paper collages from Hospice Nurses

Intentional Creativity is employed when a person creates with a focus, such as dealing with Grief in Hospice, or Painting Your Legend as a Nurse, or turning a thought that ‘runs’ you on its head by turning it into an affirmation.  Color, intuition and writing are the vehicles of transformation and a new personal story is created.  The method addresses heart, body, mind and spirit. A large draw is that it is also fun.  It is less about ‘fine art’ and more about the process or the journey a person is on.  Here are some Legends painted on canvas by Nurses- all beautiful, all different.

Legends painted on canvas by Nurses

Legends painted on canvas by Nurses

What are some of the benefits Nurses report from your workshops?  Relief, shift in story, feelings of support, honor for their story and a remembrance of how much fun you had as a child coloring with crayons, finger-painting, all without an inner critic bossing your actions.

What throws you off balance and how do you know you are out of balance?  Out of Balance vital signs:  Champion breath holding and Olympic shoulder tensing. Their root cause results from being out of the present moment.

What brings you back into balance? Morning Café.  Café is a daily introspective, meditative practice.  It takes place in my art studio space usually before sunrise, starting with lighting a candle, breathing and uses several intuitive writing and sketching methods. Sipping coffee and warm water also plays a part. It can last from 15 to 45 minutes.  This practice sets the tone for my day. Walking every day is a must.

What advice would you give to new grads starting out? Nursing is a fantastic profession; it can take you anywhere you want to go. Remember to always put the oxygen mask on yourself first, before assisting others. That is, if you can make it a habit to honor yourself by taking care of yourself, Nursing can provide never-ending scientific wonders, a good income and rich experiences. 

To learn more about Eileen Nash and her work, click here to her website

Can We Turn Our Nurse Role Off?

Chatting with a friend while driving my beat up Honda in stop and go traffic on the freeway, I saw something alarming. An elderly gentleman was nodding asleep at the wheel in the middle lane! My non-Nurse passenger described me as going in Steven Seagull action mode to save his life and potentially the life of others. As if in CPR class, I pointed at her to call 911, where we were met with a message that we were on hold.

I pulled my car to the shoulder, walked to this man’s car and woke him by knocking on his passenger window. He very politely told me that he was fine and there was no problem here. When I told him I saw him nodding at the wheel, he repeated that he was fine. He did agree to put his hazards on but he was unwilling to pull off the road. I noticed he had a wedding band on and I asked him if he could call his wife. That was met with a dismissing smirk.

I returned to my car just in time for 911 to take our information. The man continued to drive in stop and go rush hour traffic nearly scraping the divider on a slow turn. He came to a complete stop and this time was willing to pull over to the shoulder.

When I walked to his window, I could hear his wife on speaker and was hopeful that this familiar voice would help reason with him. I told his wife that he was sleepy and too impaired to drive. She told me that he had an illness and really shouldn’t be driving. From my short encounter with this stubborn, independent man, I could only imagine how challenging this conversation might be at home for them.

At the end of the day, his boss picked him up and drove him home and they arranged to get the car the next day. Hopefully he was counseled by the police officer or his physician about future driving. As Nurses, we see and respond to emergencies all day at work that it becomes second nature.