Nursing Voices

Friday, March 30, 2007

The Doctors Are In

This is my favorite Rolling Stone magazine cover. Yes, I enjoy reading Rolling Stone magazine. I may have gray hair and wrinkles, but I’m a hip old broad.

I'm sure that some of you hate Howard Dean, the originator of the “Dean Scream,” and the current chairman of the Democratic National Committee, but before you start throwing tomatoes at me, let me tell you why I’m so fond of this cover. Ready? There’s a DOCTOR on the cover of this magazine! Now that’s newsworthy. Go Howard!

Did you know that there are doctors and nurses serving in Congress? My favorite doctor currently serving in the House of Representatives is Jim McDermott, a psychiatrist from Washington. I think we need more psychiatrists working on the Hill, but I digress. Representative McDermott re-introduced a bill last month that would improve access to health care. He said, "Access to affordable health care coverage is the single biggest domestic crisis facing America today. The health care crisis gets worse every day and, because of it, more Americans get hurt every day." He is also a cosponsor of a bill that would create the Office of the National Nurse. Thank you, Dr. McDermott.

Another doctor working on the Hill is Senator Tom Coburn, a family practice doctor from Oklahoma. He just introduced a bill that would also improve access to health care. In a recent press release, Dr. Coburn said, “Americans are tired of out of control medical costs, gatekeepers blocking access to the doctors they want to see, being denied coverage of medically necessary care, and health plans that they don’t understand. This bill addresses all of these problems and does so without creating new government programs or bureaucracies. In fact, this bill removes government and insurance bureaucrats from the doctor’s office by providing patients with federal tax rebates that will ensure that every American can purchase the health care coverage that best meets their medical needs.”

Dr. McDermott is a Democrat and Dr. Coburn is a Republican. Doctors from both parties are promoting health care legislation on Capitol Hill. We need more doctors and nurses in Congress.

We also need more doctors on magazine covers.

Wednesday, March 28, 2007

Go Ask Mother

Welcome to another edition of Go Ask Mother. I'm receiving a lot of interesting questions from my readers, and I plan to make Go Ask Mother a regular part of Nurse Ratched's Place.

Last week, AZRN from researchgrrl wrote:

MJ, in your professional opinion, are there treatments for PTSD that work well? I don't know that much about psych nursing (it was a looong time ago :D)

Thanks for bringing up this important subject. I think we are going to see more PTSD as more soldiers return from Iraq.

I don’t know all the answers to this question, however, I will tell you how I help patients suffering from PTSD. Several years ago I had the privilege of meeting a psychiatric nurse practitioner who was helping Pentagon staff members deal with the aftermath of 9/11. I met with her at the Pentagon for lunch, and we talked about the techniques she was using to help staff members deal with PTSD. She said that her goal was to teach patients that they are having a normal reaction to an abnormal event, and that she used cognitive therapy techniques to achieve her goal. She said, “We are what we think,” and by changing our perceptions of the things happening around us, we can alter how we feel and, most importantly, how we act. She assisted her patients in devising strategies for dealing with their symptoms, such as insomnia and poor concentration, and she stressed that people suffering from PTSD mustn’t be allowed to fall into the sick role, or else they will not move forward with their lives.

When I work with patients suffering with PTSD, I’m careful not to demean or embarrass my patients by challenging their feelings. I tell them that they are not going "crazy," but that they are reacting to a crazy event that happened in their life. I taught one patient who could feel himself slipping into a state of panic to repeat the phrase, “here and now.” He said the phrase kept him in the present, and helped him to refocus when painful memories started invading his thoughts.

If you have a question for Go Ask Mother, please send them to

Monday, March 26, 2007

Drug Maker Wants to Make Less Money, and Other Fairy Tales From the World of Mental Health

It’s another Monday morning, and I’m currently camped out in my favorite spot at my local Panera Bread. Just like this young lady, I’m lounging in a soft and comfortable seat while enjoying my day. I’ve parked myself by the all-you-can-drink soda fountain machine, and I'm savoring a wonderful egg-bacon-spinach soufflé. As I surf the web and sip on my second refill of Diet Coke, I'm watching people as they drive off to work. Life is good.

Drug Monkey from Your Pharmacist May Hate You has posted his thoughts about this story from the New York Times. It looks like a pharmaceutical company is offering us a "helping hand" while helping themselves into our pockets. Of course the company is claiming that they only have our best interest at heart. I’m sorry, but do we have stupid written across our forehead? Mental health care consumers are the targets of this new program. I encourage you to read Drug Monkey's entertaining thoughts on this subject.

Friday, March 23, 2007

Lady Doctors

Doctors were considered gods the year I entered nursing school. Make no mistake about it, they ruled the hospital. Nurses made coffee for for them, carried their charts as the made their rounds, and surrendered their seat in the nurses station whenever they entered the room. Oh yes, and did I mention that all the doctors were men? Of course there was the occasional lady doctor like the one on this book cover. Lady doctors were an oddity, and the good-old-boy medical establishment hated them. I remember hearing doctors at the nurses station blaspheming women who wanted to be doctors. They were angry that a woman might take a spot away from a man who wanted to enter medical school. “After all,” they said, “they are just going to quit medicine when they get married."

I noticed that attitudes about lady doctors started changing as the years went by. Younger men were entering medicine, and they brought with them more progressive attitudes about women in the workplace. Change came slowly. Many male doctors still felt that female medical staff, like Nora Meade, M.D., should only work as a pediatrician. The attitude was, “Women are meant to have children, and if they wanted to work, they should only work with kids.” The first lady doctor I worked with treated the nurses as her colleagues. She never demanded that we wait on her, and she treated us with respect. She even said that we could call her by her first name! I know this sounds odd by today’s standards, but back then, treating a nurse as an equal was considered revolutionary. She also encouraged many of my nursing colleagues to continue their education, and to advance the profession of nursing. The women entering medicine back then were progressive, and they were fighters. They rocked the boat and bucked an archaistic medical establishment in order to get what they wanted.

I’m really happy that things are changing, and that women continue to make strides in the field of medicine. Lady doctors, you rock. Keep rocking the boat.

Thursday, March 22, 2007

The Orwellian Pill

I saw a news story today that gave me chills. Scientists are doing research to see if Propranolol is an effective treatment for post-traumatic stress disorder. This sounds great until you look at the deeper ethical issues. Who will be put in charge of deciding what is a traumatic event? Will we have "brain police" deciding who can be given Propranolol for the treatment of post-traumatic stress disorder? In his satirical novel, 1984, George Orwell depicts a futuristic totalitarian state in which the government uses mind control to subjugate its citizens. The whole idea of erasing someone’s memory with a pill is a bit too Orwellian for me. Decide for yourself after reading this ABC news story.

Wednesday, March 21, 2007

Whatcha Thinking About?

This is a very unusual meme, and I am honored. Kim at Emergiblog has tagged Nurse Ratched’s Place and now I must tag 5 other blogs within the medical blogosphere that make me think. This is going to be tough because everyone has interesting things to say.

The recipient of this award must follow these rules:

Acknowledge the origin of the meme/award

If you are tagged, write a post with links to 5 blogs that make you think.

Optional: Display the “Thinking Blogger Award” with a link to the post that you wrote using either the gold or silver versions of the award.

Here are the next five recipients of the “Thinking blogger Award.”

Digital Doorway
Scalpel or Sword
Doctor Anonymous
Your Pharmacist May Hate You
The Angry Medic

Thank you, Kim, for listing Nurse Ratched's Place.

Another Day in the Life of a Princess Nurse

This Princess and I have a lot in common. We both like lounging around while other people wait on us. Yes, we’re spoiled Princesses. She has slaves, and if you ask me, they aren’t doing their job very well. She has to wait while they bring her a Diet Coke. They should have anticipated her every need. I don’t have servants or slaves, but I have a Prince who treats me very well, but unfortunately he’s at school today, so I have to wait on myself before I go into work. I love taking care of my patients, but since I work for Mr. Grinch, I'm sure that I'll feel like a slave by the end of the day. What is a Princess Nurse to do?

Princesses know how to have a good time when they aren’t at work. This Hawaiian Princess is relaxing by a lake while playing her ukulele. She looks happy and stress free. Her servants are preparing a pig roast in her honor as we speak. I also hear that she looks great on her surfboard, and that she really knows how to shoot the curl.

Since I don’t how to surf or play the ukulele, I have found other ways to spend my time at home. Most Princess Nurses that I know love to blog, and I am no exception. You might say that I’m obsessed. All right, I admit it, I am obsessed, but since I don’t have a lake in my backyard to sit by, or a pig roast to go to in my honor, I’ll just keep blogging.

This Indian Princess is modeling an outfit that she picked up at her local thrift store. She loves finding bargains at the Salvation Army Store. Doesn’t she look pretty sitting by the waterfall? This Princess also loves to shop at flea markets, garage sales, and consignment shops. These places make up her happy hunting ground. When my Prince and I have time off together, we drive many miles to find our happy hunting ground in Virginia, just outside of Washington, D.C. I’m always amazed by what I find there. There are a lot of very wealthy people who buy expensive items, and then never wear them. I find designer clothes on the racks that still have their store tags still hanging on them. I am a very happy Princess Nurse when I find these bargains. And as you may know, we are always hunting for books.

I’m not looking forward to what awaits me at work. Maybe one day I can live like these other Princesses. Until then, you’ll have to excuse me because I have to start getting ready for work.

Monday, March 19, 2007

I Want My Dream Job

It’s finally happened. The corporate insanity overtaking my hospital is driving me nuts, and I’m looking for a new job. I sent my resume to these nurse recruiters and they are trying to help me out. I told them I want to work in a place that truly values their nurses, and they understand that I’m not a corporate drone. I won’t sacrifice patient care in order to make someone else rich. I hope these gals can help me find a job like these nurses have. Take a look.

Here’s Nurse Nan delivering bedside patient care. Forget irksome JCAHO regulations, Nurse Nan hates VMAR machines, and she passes medications with the use of an old-fashioned pill tray. She is smiling, and there is a spring to her step. She only has four patients today, and she really loves her job. I love her cap. I rate her cap a 10 based on the
Emergiblog nursing cap scale. Nurse Nan has a collegial relationship with the doctors. They never scream at her or try to belittle her at the nurses station. Doctor James is assessing his patient, and he asked Nurse Nan for her opinion about the patient’s condition. Dr. James understands that nurses are intelligent professionals, and that they are the cornerstone of good patient care. This sounds like a dream job, but on second thought, I’ve been away from medical-surgical nursing for a long time, so I don’t know if I could do this job.

Here’s a job that looks intriguing. I want to work where people notice my special talents. Look what happened to Student Nurse Kitty Walters. She’s not even out of nursing school yet, and some hotshot movie producer wants to make her a star. Every nurse is a star in his or her own right, and fewer nurses would leave the profession if employers appreciated them and treat them with respect. Perhaps I should send my resume to a talent agent. Maybe some movie director is looking for an old burned out psychiatric nurse to play the role of Nurse Mildred Ratched in a remake of One Flew Over the Cuckoos Nest.

I’m ready for my close up Mr. Demille.

Nurse Marcie is a very lucky young woman. She has a dream job complete with her own island and her own yacht. She also has a cute guy waiting on her hand and foot. He is at her beckon call. Nurse Marcie has the luxury of working in a serene environment, surround by nature. She works independently, and her patients treasure her. I’m asking my nurse recruiters to start looking for an island that needs a psychiatric nurse, but I’m not holding out much hope. I doubt that too many people become depressed while living in an island paradise. Drat!

While the recruiters are looking over my resume, I’m going to start looking for my dream job at They have a lot of listings, and you never know what you can find until you start looking.

Friday, March 16, 2007

One Last Thought

Remember this Chinese Proverb at the end of the day:

You cannot prevent the birds of sadness from passing over your head, but you can prevent them from making nests in your hair.

Have a nice weekend.

Thursday, March 15, 2007

Bottom Line Therapy

I went to a staff meeting today, and I left feeling angry. I’m in a sour mood.

The meeting started off fine. We ate cookies, and talked about a few problems that popped up during the week. Most of us hate the new VMAR machines. JCAHO mandated that we use these things when we pass medications. We were told that the new system would make passing medications less cumbersome and improve patient safety. Someone told us a big fat lie. We are now spending less time with our patients and more time trying to figure out the machine. VMAR is a piece of crap. Thanks, JCAHO.

Then we moved on to the hospital’s new pet project. We are now going to run our adult day treatment program during the weekends as a way of generating more revenue for the hospital. Our boss gave us some written information about the expanded program. You would think it would mention how this is going to benefit our patients, but it didn’t. The first item on the sheet revealed how much more money the hospital would glean off of each patient per month. Yes, I understand about needing to meet payroll and paying for other expenses like Mr. Grinch’s expensive new office furniture, but can we still please pretend, just a little bit, that the patients are still the focus of the program? And of course, we were told that we will be doing this extra work with less staff. The hospital can't make extra money if they have to pay for additional staff.

Here’s what I see: More patients - additional nursing staff to help run the program = burnout. Here’s what the hospital sees: More patients + more billable hours = more money. I call this bottom line therapy. And people wonder why nurses are leaving the profession.

Tuesday, March 13, 2007

Rich Chicks

Here is Nurse Kay Landon in her sporty red convertible talking to Doctor Peter Hayes. He is the dreamiest doctor at Lakefront Hospital. Kay was born with a silver spoon in her mouth, and she is burning out after working at a public hospital. She is wondering how she’s going to last another day at work. It seems like her biggest challenge, however, is going to be keeping her nurses cap on her head once she hits the accelerator on her speedy little sports car. It’s quitting time, and she really wants to go home. Who can blame her, especially after a hellish shift?

Dr. Hayes and Kay have a “history.” He insulted her, and told her that she was “spoiled, a snob—in short, the sort of girl who is not much use in the world.” She was offended, and to show him how wrong he was, she enrolled in nursing school:

“Kay Landon had enrolled for nurses’ training and turned her back on her easy luxurious life. Her family and friends were horrified, but she was braced for their disapproval. Now she must tell her fiancé, wealthy Nicky Fairchild.

“But you can’t, Kay.” Nicky’s firm jaw was stubborn. “I won’t let you do it!” What on earth made you ever consider such a thing? You’re lovely and fun. This crazy mixed-up world needs girls like you.”

It sounds like Nicky adores spoiled, rich party girls. He thinks the world needs more rich chicks like Paris Hilton. Maybe he’s right. Imagine how things might change if Paris Hilton, like Kay, wanted to become a nurse. I can see it now. Paris attends Celebrity University and graduates top in her nursing class, and after a long night of clubbing, she goes home and gets ready to go to work. She slips on her Gucci scrubs and Jimmy Choo nursing shoes, grabs her Louis Vuitton handbag, hops into her limo, and goes into work with her posse in tow. The Paparazzi snap pictures of her as she enters Hilton Hospital. Young girls yearn to be a nurse just like their role model, Paris.

During morning report, a makeup artist reapplies Paris’ lipstick. Paris goes to assess her patients after report, but she quickly becomes overwhelmed with work. Seeing that Paris is about to throw a temper tantrum, her personal secretary starts taking off orders that are piling up at the nurses station while Paris’ personal trainer turns her bedridden patients every two hours. Paris is popular with her coworkers because she hires everyone their own personal staff. She’s a team player. Other celebrities soon follow in Paris’ footsteps and enter into the nursing profession. One day Brittany Spears, Nicole Richie, and Lindsay Lohan will be working as nurses. Of course someone will have to tell Brittany that she can’t go “commando” at work.

If you are a hot young doctor like Dr. Hayes, please, step up to the plate and help solve the nursing shortage. Insult a rich chick, or rich dude, and convince them that they, too, want to become a nurse.

Monday, March 12, 2007

Don’t Mess with Karma

In Buddhist teaching, the law of karma says only this: `for every event that occurs, there will follow another event whose existence was caused by the first.' The Karma Gods are very angry, and they are kicking butt at our hospital. The hospital administrator, Mr. Grinch, is telling the staff that the hospital is having financial difficulties related to the hospital’s expansion, yet, his office is now decked about in opulent office furniture. I found this out from a housekeeper who couldn’t believe her eyes one morning when she went into Mr. Grinch’s office to empty his trash. She reported the sudden appearance of butter-soft leather furniture and a large flat-screen plasma television in Mr. Grinch’s lair. She also said that his new private office came with other amenities, including a private bathroom that came complete with granite counter tops and a seven-foot window that allows Mr. Grinch to peer at staff and visitors coming and going from the hospital as he sits on the crapper. It’s good to be King!

A couple of weeks ago, the Karma Gods took revenge on Mr. Grinch. They obviously have a wicked sense of humor. Somehow a drainage pipe somewhere in the hospital’s plumbing system backed up and spewed raw sewage that ended up in front of Mr. Grinch’s office door. According to one of my friends who witnessed the eruption, it stank to high heaven, and Grinch ran out of his office like his pants were on fire. Of course he left it to the underlings to clean up the mess.

I wonder what the Karma Gods are planning next. Stay tuned.

Thursday, March 08, 2007

Crazy Genes

American Humorist and Author, Sam Levenson once said, “Insanity is hereditary; you get it from you children.” It seems as though that Dr. Davenport would agree because his daughter, Elizabeth, is stressing him out and he feels like he is losing his mind. Elizabeth has decided that the frivolous life of a “deb” is not for her, and she has made up her mind to embark on a nursing career. For some reason, Dr. Davenport doesn't want Elizabeth to become a nurse. Maybe he knows that being a nurse is hard work. It looks like Elizabeth is very frustrated about her father's attitude. She thinks that her dad is an idiot. After all, doesn’t he realize that not every girl wants to sit around all day eating chocolate bonbons while waiting for Prince Charming to come sweep her off her feet? I bet Elizabeth wins this argument. She looks like she has spunk, and her friends are backing her up.

Although we know that some mental illnesses, such as schizophrenia and bipolar disorder, may have genetic components, medical science once believed that all mental illnesses were caused by primitive drives related to heredity. In other words, mankind comes from a bad seed. According to the book, Modern Home Medical Adviser: Your Health and How to Preserve It, published in 1935, mothers could avoid raising someone who would become mentally ill by using sound mental hygiene techniques. These techniques included hitting and shaming a child into submission, and telling them that they were going to hell if they are bad. The author said that the child would grow up to be mentally ill if the mother did not use these techniques to suppress her child’s “evil primitive impulses.” According to the author, these impulses were genetically based, and to keep a child from becoming mentally ill as an adult, it was the mother’s duty to turn her child into a quivering psychological mess. I know it doesn't make sense, but I didn't write the book.

Dr. J. H Kellogg, the inventor of cornflakes and the Chief Medical Director of the Battle Creek Sanitarium believed that “bad breeding” played a big part in the development of mental illnesses. In his book, A Thousand Questions Answered, published in 1917, Dr. Kellogg writes, “Mental defectives have increased within the last fifty years at the rate of 900 percent in a century. That is, at the present rate of increase, in one hundred years from the present time, 9 percent of the total population will be insane, idiotic, or imbeciles. Mental defectives now constitute 1 percent of the population. The recognition of a new class of mental defectives, the moron, gives us the key to a large number of social problems and explains the rapid increase of a certain type of criminal of the growing army of ne’er-do-wells. Of all classes of mental defectives this class is by far the most dangerous because they are not easily recognized except by experts, and so left to reproduce and increase without restriction.”

In order to save the human race from mental illness and other social ills, Dr. Kellogg advocated the use of eugenics and euthenics, and he also advocated the use of a eugenics registry in order to keep the “races pure.” Thanks to Dr. Kellogg and his followers, many states tried to pass legislation mandating the sterilization of mentally ill patients and other “undesirables.” That’s code for people of color. The idea was to keep the insanity gene from polluting the general gene pool. After reading his book, I’ll never be able to look at cornflakes the same way again. I'm sticking with Quaker Oatmeal for breakfast.

So much for the good old days of medicine when you could blame someone else for all of your problems. It really isn't your mother's fault.

Monday, March 05, 2007

The Stepford Nurses

Two of my nursing colleagues were sitting at the nurses station the other day while having a conversation about things going on at the hospital. The first nurse said that she was frustrated about how new hospital rules are making it harder for nurses to give quality patient care. She said that she had been thinking about things, and that she’s unhappy because the new policies don’t make any sense. The second nurse quipped, “You would be a lot happier if you just stopped thinking.”

Perhaps unhappy nurses should take a lesson from the Stepford wives. Imagine a hospital filled with mindless, Stepford type nurses, blindly following hospital policies. Everyone would be happy. Nurses would gladly work double shifts, every weekend and holidays, and never request a day off. No one would use their critical thinking skills, and nurses would never protest about poor working conditions or about how patients are being shortchanged by the health care system. The creation of such a nurse would be a hospital administrator’s dream.

Maybe I should keep my mouth shut. I don’t want to give someone any ideas.

Friday, March 02, 2007

A Night with Patch Adams

Back in February of 1999, I attended a fundraiser benefiting a local community counseling center located in Virginia. I went with another psychiatric nurse, and we were very excited about our night out on the town because we were going to meet a famous doctor. Little did I know that I would be getting into a war of words with a clown.

The event was held shortly after the release of the movie, Patch Adams, and Dr. Hunter Adams was speaking at the gathering. There was a small turnout at the event, and this allowed us to meet Dr. Adams in a small, intimate group. He chatted with each person, and then he approached my friend and me. He was very happy to meet nurses. He said he loves nurse, who doesn’t, right? Then he asked us about our work. When we told him that we worked in a psychiatric unit, he glared at us. I saw rage in his eyes. He snarled, “Psych nurses! So, have you drugged up anyone today?” Then he turned and walked away. We were shocked, and my friend burst into tears. This guy wasn’t like the character that Robin Williams played in the movie, and his comment was a slap in the face. I walked up to Dr. Adams, tapped him on the shoulder, and demanded to know what his problem was, but before he could answer, I asked him if he had been treated badly on a psychiatric unit in the past. He gave me his speech about how love can cure mental illnesses, and then he called me a pill Nazi because I give people Haldol. I stopped and stared at him, and then I started laughing. I told him that he wasn’t the first doctor to call me a name, but he was the first one who had the balls to say something so ridiculous while wearing a clown suit.

In his book, House Calls: How We Can All Heal the World One Visit at a Time, Dr. Adams talks about caring for the mentally ill. This picture is an illustration from the book. Dr. Adams writes:

“ So much of what is called “mental illness” is really a consequence of our troubled society—one that promotes loneliness and conformity in a world whose gods are money and power.”

Dr. Adams goes on to write that mental illness is curable if patients are provided with a loving, creative, and communal environment. I don’t know about you, but I thought much of what we call mental illness had something to do with neurotransmitters. Maybe Dr. Adams would have a greater appreciation of psychotropic medications if he had to care for extremely ill patients on a daily basis.

On the way home from the fundraiser, my friend told me that she thinks that Patch Adams is bipolar because he was loud, verbose, and labile. She also pointed out that not too many grown men run around wearing a clown suit. Whatever he is, I just wish he would stop telling patients that they don’t need to take their medications.

The pill Nazi has spoken.

Thursday, March 01, 2007

More From Walter Reed

This poster is from World War I, and it shows a wounded veteran who needs help. Back then our government made a pledge to care for our wounded men and women in uniform. Now the military is pledging to punish anyone who talks to the press.

It looks like my friend that I talked about in this post got out of Walter Reed just in time. She never would have survived in this environment. According to an article published in the Army Times , the patients at the Walter Reed Army Hospital are paying the consequences for talking to the Washington Post about living conditions in the infamous building 18. They are being watched very closely by the government, and have been ordered not to talk to the media. As a nurse, and as an American, I think this policy is despicable. How can we as a nation address problems if we don’t know about them. The doctors and nurses at Walter Reed are doing a phenomenal job in caring for our troops. It’s too bad that our government can’t do the same for those who have given so much for our country.

So much for keeping my blog a political free zone. Silence is bad medicine.