[RxForSanityeNews]
Afraid I would be the appetizer. But excited to be invited to the party.
On November 8th, the American Organization of Nurse Executives called for a day of dialogue at their national headquarters in Washington DC. The topic? Nurse – Physician relations. A powder keg of health care.
We didn’t know what to expect Monday as we convened. We represented all facets of health care: four physicians including practicing internists and surgeons, and eight nurses including staff and charge nurses; six of the twelve represented facets of hospital administration as well. We came from as far away as Washington State for this one day think-tank. Our goal: A working plan that your health care facility can implement to enhance collegiality between nurses and doctors.
A tall order. Agilely facilitated by Pamela Thompson, the chief executive officer of AONE, we rolled up our metaphorical sleeves. First we dreamed. Without the aid of illicit pharmaceutical substances, we imagined the perfection of our profession. That triad of nurse, doctor, and patient communicating, healing, and being joyful in our pursuit of health. Then we detailed medicine as it is: harried, beset by financial concerns, and too often a rude profession.
Not dwelling on that picture, as disconcerting as a high school senior portrait featuring a large zit, we moved on to the business of how to transition from where we are to where we dream of being. We discussed successes at our facilities across the country. Then we established principles of healthcare collegiality.
You won’t get the whole scoop here. I have twenty one pages of scribbles. After everything is distilled, you’ll be able to find the full report on the AONE web site (hopefully in early 2005). I’ll publish the link as soon as it comes out, so you can peruse it, print it, and forward it to hospital administration. However I will share the main principles, heavily paraphrased.
Patient focused care and enhanced patient outcomes is the organizing force behind creating the collaborative environment in health care. First we need the support of your senior hospital administration, including their courageous transparency in acknowledging the issue of impaired relations, and agreement that the issue of collegiality requires a sustained treatment and not a one shot fix. We will promote interdisciplinary collaborative relationships at all levels of health care, and teach the skills of collaboration to practicing HCPs as well as to those still in training. Hiring decisions will include behavioral analysis, and not just verification of expertise. We recommended systems for reward, recognition, and celebration, as well as a no-tolerance policy for disruptive behavior. These may sound like mere pretty words, but we solidified these principles with explicit steps, plans, suggestions, and successes.
It’s not a dream. The AONE report will have teeth and specifics. There are now no excuses. We will have the health care profession of our imagination.
*Want to print excerpts from this article for your hospital or department newsletter?* Need self-care filler material but don't have the time to write it yourself? Check out the free articles and chapters from Dr. Raymond at www.DontJettisonMedicine.com.
*Pick That Up and Eat It!*
Do you dust off your fallen Oreos? Brush off your Ho-Ho when it topples? We now have scientific evidence supporting the 'five second' rule in all but the most contaminated (ie hospital?) settings from a winner of the prestigious 2004 Ig Nobel prize.
According to Jillian Clarke, a senior at the Chicago High School for Agricultural Sciences, the 5-second rule dates back to the time of Genghis Khan, who first determined how long it was safe for food to remain on a floor when dropped there. Khan had slightly lower standards, however; he specified 12 hours, more or less.
Among Clarke's findings:
Seventy percent of women and 56 percent of men are familiar with the 5-second rule, and most use it to make decisions about tasty treats that slip through their fingers.
University floors are remarkably clean from a microbial standpoint.
Women are more likely than men to eat food that's been on the floor.
Cookies and candy are much more likely to be picked up and eaten than cauliflower or broccoli.
And, if you drop your food on a floor that does contain microorganisms, like your hospital floor, the food can be contaminated in 5 seconds or less.
A participant in the College of Agricultural, Consumer and Environmental Sciences' summer Research Apprentice Program, Clarke began by swabbing 1-inch squares of floors in a variety of locations on her college campus, including floors in high-traffic areas. They found no countable bacterial or spore forming organisms.
Clarke then purchased smooth and rough 2-inch tiles from the hardware store so she could experiment with different surfaces and a good supply of gummy bears and fudge-striped cookies from the grocery store. Clarke's survey showed that people were more likely to retrieve cookies or candy because they value them more highly. Cookies and candy also have low levels of naturally occurring microflora, unlike fresh vegetables, meat, or cheese.
The next step was sterilizing the tiles and inoculating them with E. coli, then placing 25 grams of cookies or gummies on the tiles for 5 seconds. In all cases, E. coli was transferred from the tile to the food, demonstrating that microorganisms can be transferred from ceramic tile to food in 5 seconds or less. More E. coli were transferred to gummy bears from smooth tiles than from rough tiles.
So, pick it up and eat it at a mall or at home, but don't try this at your healthcare setting. So now you know.
You can read about the other winners, including gems like "The Effect of Country Music on Suicide" at:
http://www.improb.com/ig/ig-pastwinners.html
*Last month's blurb on the recent study by the American College of Physician Executives (ACPE) really tweaked some nerves. This is what you had to say.*
"This is interesting...however, the same holds true with how hospitals deal with other disruptive staff members. How many times has the rationale for poor retention of nursing staff been the result of charge nurses..or even CNA's, who simply have some political clout, making it difficult for new staff to endure the hostile working conditions they encounter. I have seen new staff nurses called obscene names by "seasoned" charge nurses. And, I've seen administrators do absolutely nothing about it. The rationale? We have a working group already (as in clique) and it would be too much trouble to disrupt what already works. As nurses, we are told that we should have the people skills to deal with this type of situation when it arises. But, lets' be honest. If you have worked hard to obtain the professional knowledge you have, do you really want to take insults and attacks to your self-esteem when you encounter it?..or would you prefer to simply go find another job?"
~ Pamela
"Age has its advantages. I find that since I am in my 40's, I get more respect from doctors than young nurses...or maybe I should say they are more hesitant about yelling at me." ~ Tammi
"I work in a CVICU and we have had CT surgeons that have been abusive. This has happened in front of a patient during procedures, too. I am lucky--my hospital is very nurse-oriented and will address this behavior with the physicians involved. This behavior is usually not repeated. At times, I have seen a stressed physician get inappropriately angry, but mostly they manage to choose their words carefully and don't really end up saying anything inappropriate and I see it as simply blowing off steam. My biggest frustration is trying to communicate something I feel is clinically important to the physician or relevant to the patient's situation, and being cut off by the physician before I could complete my sentence or completely ignored. That is, to me, much more disrespectful and dangerous." ~ Renee
"I refuse to let anyone treat me in that way, no matter what their title. No one has ever kept it up, and they always immediately calm themselves. If you let the behavior continue and not make someone accountable for it, it will continue." ~ Sandy
"Good grief! If those are the figures for hospital EXECUTIVES then I'd love to see the figures for those of us on the floor!! I can recall to mind some docs who are a little short of maniacal when they are 'stressed'. Personally, if you can't take the stress why are you in the job? Thanks for that, Pat...how interesting (and I particularly liked their 'bad puppies' analogy!)" ~ Michelle
Good grief indeed. Doctors who are reading, what say you in response? Do you see this behavior amongst your colleagues? Do you speak up (in the words of someone really smart, "If not now, when? If not me, who?). Read the report for yourself at
http://www.acpenet.org/MembersOnly/pejournal/2004/SeptemberOctober/
articles/WeberDavid.pdf.
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