The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital

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The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital Page 41

by Alexandra Robbins


  injecting up to 8 milligrams of Dilaudid at a time, an enormous dose, but, for Lara, just enough to keep her alert. Lara’s recollection, interview.

  Medical Drug Intervention program MDI is a pseudonym. To find a rehabilitation program in your state, visit http://webapps.aana.com/Peer/directory.asp. While Peer Advisors are for CRNAs and student nurse anesthetists only, many of the programs are for all nurses.

  At 3.5 million strong in the United States See U.S. Census Bureau, “Men in Nursing Occupations,” February 2013.

  and more than 20 million worldwide Correspondence from World Health Organization spokesperson to author.

  nurses comprise the largest group of healthcare providers See, for example, “Nursing Fact Sheet,” American Association of Colleges of Nursing, http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-fact-sheet.

  women who comprise 90 percent of the workforce Interview, Office of Occupational Statistics and Employment Projections, U.S. Census Bureau. See also “Men in Nursing Occupations.”

  “like a secret club . . . ” Interview.

  “We are not just the bed-making . . . ” Interview.

  They are, for example, frontline reporters. Thank you to nurse Meghan Yowell for inspiring the structure and content of this paragraph.

  “Nursing is not a job.” Interview.

  “Doctors breeze in and out . . .” Email from this nurse to author.

  an “I’m-going-to-eat-my-hair-in-a-corner person.” Sam’s words, interview.

  Chapter 2

  “I will not be ashamed to say ‘I know not’ . . .” From the Modern Version of the Hippocratic Oath. See Peter Tyson, “The Hippocratic Oath Today.” NOVA. March 27, 2001. Accessed at pbs.org.

  “The intimate nature of nursing care . . .” The American Nurses Association’s Code of Ethics For Nurses page at http://nursingworld.org.

  “Lots of hot residents . . .” Interview.

  I-STAT A portable device that can perform diagnostic tests at a patient’s bedside.

  “ . . . shadowy, dark corners of our profession.” Barry Silbaugh, “ACPE Foreword.” In Owen MacDonald, “Disruptive Physician Behavior,” American College of Physician Executives, May 15, 2011.

  bloody handprint on her scrubs. Abigail Zuger, “Nurses Speak Out, About Doctors,” The New York Times, October 28, 2008.

  shoving matches in the operating room Interviews. Also see, for example, Richard Knox, “Doctors Behaving Badly? They Say It Happens All the Time,” NPR, May 25, 2011.

  physicians throwing stethoscopes, pens, or surgical instruments Interviews. See also, for example, Harold Levy, “Heal Behaviour, MDs Urged,” Toronto Star, September 15, 2004.

  scissors See, for example, Liz Kowalczyk, “Hospitals Try to Calm Doctors’ Outbursts; Medical Road Rage Affecting Patient Safety, Group Says,” The Boston Globe, August 10, 2008.

  Physical abuse by physicians is on the rise. “Unresolved Disrespectful Behavior in Healthcare,” ISMP Medication Safety Alert, October 3, 2013.

  “Are you stupid or something?” Interview.

  A Texas doctor threw a metal clipboard . . . Interview.

  A surgeon threw a scalpel at a Virginia nurse . . . Interview.

  “. . . He-Who-Must-Not-Be-Named” Interview.

  The Institute for Safe Medication Practices (ISMP) . . . has reported rampant bullying in healthcare ISMP’s Survey on Workplace Intimidation, 2013; ISMP’s Survey on Workplace Intimidation, 2003.

  87 percent of nurses encountered Ibid.

  “Every single nurse I know . . .” Interview.

  in countries such as Australia . . . “Workplace bullying is a serious health and safety hazard affecting nurses and midwives.” See “Bullying in the Workplace,” policy paper, The Australian Nursing Federation. Reviewed and re-endorsed November 2011. See also Amanda Place, “Dealing with the Bullies in our Midst,” The Age, Melbourne, Australia, June 22, 2002.

  prevalent in South Africa Simone Honikman and Ingrid Meintjes, “Nurses are Stressed, Ill-Treated, Burdened,” Cape Times, September 9, 2011.

  Hong Kong R.P.W. Kwok, “Prevalence of Workplace Violence Against Nurses in Hong Kong,” Hong Kong Medical Journal, February 2006.

  Canada Lucie Lemelin, Jean-Pierre Bonin and Andre Duquette, “Workplace Violence Reported by Canadian Nurses,” Canadian Journal of Nursing Research, September 2009.

  In 2010, a nurse in India committed suicide “Mamata Suicide Case: Nurses Set Deadline to Nab Doc,” The Times of India, February 16, 2010.

  In Korea, a 2013 survey . . . “Half the Nurses Suffer from Sexual Harassment.” Korea Times, February 26, 2013.

  the more abuse that nurses experience . . . Laurie Scudder, “Physician Abuse as Reported by Early Career Nurses,” Viewpoints, Medscape Nurses, September 20, 2013.

  a link between doctors’ intimidation and poor nurse satisfaction See The Joint Commission. “Behaviors that Undermine a Culture of Safety,” Sentinel Event Alert 40, July 9, 2008.

  most nurses don’t speak out See, for example, David Maxfield et al. “The Silent Treatment: Why Safety Tools and Checklist Aren’t Enough to Save Lives.” VitalSmarts, AORN, and AACN.

  Nurses are afraid to report doctors . . . “Workplace Violence: Assessing Occupational Hazards and Identifying Strategies for Prevention, Part 1,” a CE Home Study Course by National Nurse, January-February 2012.

  a male travel nurse . . . saw cardiologist Abdul Shadani . . . Reed Abelson and Julie Creswell, “Hospital Chain Inquiry Cited Unnecessary Cardiac Work,” The New York Times, August 6, 2012.

  “Sir, what are we going to fix?” . . . inserted the stent. Ibid.

  Soon after Tomlinson reported . . . including several other unnecessary procedures. Ibid.

  Shadani still works at Lawnwood. Author’s 2014 phone call to Lawnwood Regional Medical Center and Heart Institute.

  In 2009, two Texas nurses filed . . . that risked patient health See, for example, “New State Law Bans Anonymous Complaints Against Physicians,” FierceHealthcare, September 20, 2011.

  taking hospital supplies to perform at-home procedures See, for example, Betsy Blaney, “APNewsBreak: Ex-County Lawyer’s License Suspended,” February 2, 2012.

  pushing patients to purchase herbal supplements that he conveniently sold on the side. See, for example, “Editorial,” The New York Times, February 10, 2010.

  sewing a rubber scissor tip to a patient’s thumb See “Justice Doesn’t Always Have Happy Ending,” Austin American-Statesman, October 7, 2011.

  using an unapproved olive oil solution on a patient . . . failing to diagnose a case of appendicitis See, for example, Kevin Sack, “Doctor Arrested in Whistle-Blowing Case,” The New York Times, December 23, 2010.

  performing a skin graft without surgical privileges Ibid.

  When the board informed Arafiles . . . his supplement business. “Medical Justice, West Texas–Style,” The New York Times, February 10, 2010.

  Arafiles tracked down contact information for the patients listed in the complaint See, for example, “Former Winkler County Memorial Hospital Physician Sentenced for Scheme to Fire Nurses in 2009.” States News Service, November 7, 2011.

  and gave it to the sheriff, who got hold of them Kevin Sack, “Sheriff Charged in Texas Whistle-Blowing Case,” The New York Times, January 15, 2011.

  to determine the nurses’ identities . . . found the letter. Ibid.

  A hospital administrator fired both nurses Ibid.

  who had not signed their letter because they feared . . . retaliation. Rick Casey, “Justice, Injustice are Served,” Houston Chronicle, August 13, 2010.

  after months of unsuccessful attempts . . . Betsy Blaney, “Nurse Testifies Talks on Doc’s Cases Delayed Often,” the Associated Press State and Local Wire, June 8, 2011.

  charging them with “misuse of official information
” . . . Editorial, The New York Times, February 10, 2010.

  Charges against one of the nurses See, for example, Betsy Blaney, “Ex-County Lawyer’s License Suspended,” APNewsBreak, February 2, 2012.

  filed a federal lawsuit . . . won a $750,000 settlement Ibid.

  the sheriff, who lost his license . . . one-hundred days in jail Ibid.

  county attorney, who was sentenced to ten years’ probation “Retaliation case merits stiff sanction,” San Antonio Express-News, February 10, 2012.

  Arafiles pleaded guilty . . . five years’ probation See, for example, Betsy Blaney, “Texas Doctor Pleads Guilty in Retaliation Case,” The Associated Press, November 7, 2011.

  As part of his plea agreement, he surrendered his medical license Texas Medical Board. Public Verification/Physician Profile; Ibid.

  charging him with several additional violations of improperly treating patients and intimidating the nurses . . . monitored by another doctor Mary Ann Roser, “New Texas Law Bans Anonymous Complaints about Docs.” The Associated Press State and Local Wire, September 20, 2011.

  Texas Legislature passed a bill . . . “Justice Doesn’t Always Have Happy Ending.”

  and protecting those nurses from criminal liability. Betsy Blaney, February 2, 2012.

  In 2011, another Texas law . . . “New State Law Bans Anonymous Complaints Against Physicians,” FierceHealthcare, September 20, 2011.

  An examination of policies and calls Calls to every state nursing board. Arizona would be a forty-second state, but its policy is hazy. A spokesperson said, “The Arizona Board of Nursing does accept anonymous complaints, but the contact info of the complainant needs to be given to the assigned investigator. The complaint remains anonymous to the nurse.”

  a nonpartisan Texas citizen advocacy organization http://www.texaswatch.org/about.

  “It is shameful that nurses . . .” Interview with Alex Winslow by Eaves.

  “intimidating and disruptive behaviors” The Joint Commission, “Behaviors That Undermine a Culture of Safety.”

  afraid the doctor will yell at them See, for example, Alan H. Rosenstein and Michelle O’Daniel, “A Survey of the Impact of Disruptive Behaviors and Communication Defects on Patient Safety,” The Joint Commission Journal on Quality and Patient Safety 34, no. 8, August 2008; Interviews.

  Nurses have reported . . . confrontation with a physician Alan Rosenstein and Michelle O’Daniel, “Impact and Implications of Disruptive Behavior in the Perioperative Arena.”

  Approximately half of surveyed respondents . . .“intimidation clearly played a role.” “Unresolved disrespectful behavior in healthcare.” ISMP Medication Safety Alert. October 3, 2013; ISMP Medication Safety Alert: Intimidation: Practitioners Speak Up About this Unresolved Problem (Part I).” March 11, 2004.

  many OR nurses are too intimidated See David Maxfield et al.

  Despite mandatory safety protocols like checklists . . . See, for example, Julia Edwards, “Nurses Afraid to Speak Up When Doctors Slip Up,” The National Journal, March 23, 2011.

  more than 80 percent of nurses . . . “and disrespect” at their hospitals. “New research shows communication breakdowns in hospitals undercut the effectiveness of safety tools and negatively impact patient outcomes,” AORN/Vital Smarts press release, March 22, 2011.

  Of the nurses who admitted . . . 83 percent did not report the violation See David Maxfield et al.

  Rhode Island Hospital in 2007. . . which side was correct Michelle R. Smith, “Brain Surgery Errors Rack Up at Prestigious R.I. Hospital.” The Virginian-Pilot, December 15, 2007.

  most likely to jeopardize patient safety Carla Johnson, “Group Calls for Zero Tolerance of Doctor Bullies.” Associated Press Online, July 9, 2008. For more information on these issues, see Shellie Simons, Roland B. Stark, and Rosanna F. DeMarco, “A New, Four-Item Instrument to Measure Workplace Bullying.” Research in Nursing and Health 34 (2011). See also Arminee Kazanjian, Carolyn Green, Jennifer Wong, and Robert Reid, “Effect of the Hospital Nursing Environment on Patient Mortality: A Systematic Review,” Journal of Health Services Research and Policy 10, no. 2 (April 2005).

  Botched communications See, for example, Alan H. Rosenstein and Michelle O’Daniel, “Impact and Implications . . .”

  More than two-thirds . . . or patient deaths See, for example, Alan H. Rosenstein and Michelle O’Daniel, “A Survey of the Impact . . .”

  63 percent of cases . . . communications failure The Joint Commission, “Sentinel Event Data Root Causes by Event Type 2004–2013,” April 15, 2014.

  “the most significant factor . . . communication” Arminee Kazanjian et al.

  patients die unnecessarily Ibid.

  the mother of a toddler . . . to follow up with him. Lisa Rosetta, “Abuse Protection Sought for Healthcare Workers,” Salt Lake Tribune, October 21, 2009.

  “We tried to stop the doctor . . . an advocate for the patient.” David Maxfield et al.

  “Failure of MD to listen . . . outcome in newborn.” Alan Rosenstein and Michelle O’Daniel, “Impact and Implications . . .”

  “When a nurse reported . . . safety and well-being.” L. L. Veltman, “Disruptive Behavior in Obstetrics: A Hidden Threat to Patient Safety,” American Journal of Obstetrics and Gynecology 196 (2007).

  attending surgeons are . . . disruptive behavior. Alan Rosenstein and Michelle O’Daniel, “Impact and Implications . . .”

  Doctors and nurses . . . neurologists. Ibid.

  The hospital departments most likely Ibid.

  three-quarters of doctors . . . affects patient care. Owen MacDonald, “Disruptive Physician Behavior,” American College of Physician Executives.

  “despite the best efforts of many . . .” Barry Silbaugh.

  “I could teach a monkey . . .” Interview.

  Up until the mid-twentieth century . . . wait on him.” Leonard Stein, “The Doctor-Nurse Game,” Archives of General Psychiatry 16 (June 1967).

  In 1967 . . . penis envy. Ibid.

  “Nurses have spent . . . hate each other?” Rahul Parikh, “Do Doctors and Nurses Hate Each Other?” Salon, May 30, 2011.

  “A couple of the nurses . . . got the point.” Interview.

  “Female doctors” Interview.

  Nurses have continued to battle . . . instructors are nurses. See, for example, Rahul Parikh, Salon.

  “Nursing school . . . to be a physician.” Ibid.

  Kevin Pho . . . carry that attitude into the workplace.” Kevin Pho, “Theresa Brown Unfairly Blames Doctors for Hospital Bullying,” KevinMD.com (blog), May 7, 2011.

  doctor bullies blamed a heavy workload . . .” ACPE survey; see also “Reader Consult: Does the Culture of Medicine Enable Bad Behavior?” WSJ Health (blog), May 25, 2011.

  “Surgeons have learned . . . behavior by observation.” Alan H. Rosenstein and Michelle O’Daniel, “Impact and Implications . . .”

  “culture of disrespect among healthcare providers” “Intimidation: Practitioners Speak up About this Unresolved Problem (Part I),” ISMP Medication Safety Alert, March 11, 2004.

  In October 2014 . . . Ebola from a patient See, for example, Alice Par, “Nurses ‘Infuriated’ by Suggestion of Dallas Ebola Protocol Breach,” Time.com, October 14, 2014.

  “Dr. Thomas Frieden . . . breach in protocol.” Rebecca Kaplan, “CDC Chief on Second Ebola Case: There Was a Breach in Protocol,” Face the Nation, cbsnews.com, October 12, 2014.

  National Nurses United . . . to an isolation unit See, for example, “Dallas Nurses Accuse Hospital of Sloppy Ebola Protocols,” abcnews.com, October 15, 2014.

  protective gear left their necks exposed See, for example, Saeed Ahmed, “Ebola Outbreak: Get Up to Speed with the Latest Developments,” CNN Breaking News, October 14, 2014.

  Frieden later said . . . misconstrued. See, for example, “CDC: Nurse not to blame for breach o
f protocols in Ebola infection.” Nurse.com, Oct. 16, 2014.

  “There’s a lot of outrage . . . blame the nurse again.” Nancy Shute, “Nurses Want to Know How Safe Is Safe Enough with Ebola,” npr.org, October 14, 2014.

  At Vanderbilt Medical Center in 2013 Kimberly Curth, “Vanderbilt Medical Center to Have Nurses Cleaning Up.” WSMV TV, Nashville, Tennessee, September 6, 2013.

  half-and-half “Will Work for Half-and-Half,” Emergiblog (blog), July 14, 2012.

  Nearly 40 percent of doctors ACPE study. The Joint Commission’s Sentinel Event Alert, July 9, 2008.

  As of 2015 . . . to earn a doctorate. See, for example, Gardiner Harris, “Calling More Nurses ‘Doctor,’ A Title Physicians Begrudge,” The New York Times, October 2, 2011.

  Nurse leaders say . . . respect in the medical field. Ibid.

  physicians have turned the debate . . . endangers patients. See, for example, Cindy Borgmeyer, “AMA Delegates Oppose DNPs as Medical Team Leaders,” AAFP News Now, June 25, 2008; Amy Lynn Sorrel, “AMA Meeting: Physician Supervision of Nurses Sought in all Practice Agreements,” June 29, 2009.

  They argue that . . . confuse patients See, for example, “American College of Physicians Response to the Institute of Medicine’s Report,” Journal of the American College of Physicians, November 1, 2010; Jeremy Olson, “U Program Turns out ‘Doctor Nurses’ but the Name Ruffles Some Doctors,” St. Paul Pioneer Press, June 21, 2008.

  an attempt to equate . . . medical training. See, for example, Cindy Borgmeyer, “AMA Delegates Oppose DNPs as Medical Team Leaders,” AAFP News Now, June 25, 2008.

  loudly protested the DNP . . . dentists, and podiatrists. “ANA Letter to AMA on HOD Resolution 303 (A-08) Protection of Titles ‘Doctor,’ ‘Resident,’ and ‘Residency.’” Targeted News Service, June 11, 2008. Interview with AMA spokesperson. See also Resolution 232, AMA Resolutions, June 2008.

  Eventually . . . physician Interview with AMA spokesperson. See also Resolution 232, AMA Resolutions, June 2008.

  Nurse practitioners say . . . the field. See, for example, Mary Anne Dumas, president, National Organization of Nurse Practitioner Faculties, “Letter to the Editor,” American Medical News, August 18, 2008.

 

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