Thursday, November 1, 2012

To Call a Nurse a Nurse...

To my nurse friends and colleagues:

As you probably already have heard or read, I am appalled at the way the title of nurse is used in inaccurate and disrespectful ways, especially by Medical Office Assistants and the physicians that employ them.  It is very common for both the office staff and the MOA him/herself to refer to anyone in that position as 'nurse'.  The MOA program has no requirements for entry except for a high school diploma or GED, and is usually complete in a year.  It includes subjects such as medical office billing and filing, and includes one term of human body systems (info from LCC).

Compare that to the minimum prerequisites, usually up to two years, the core course of study and clinicals, and often further completion of a BSN, that registered nurses must successfully complete with high grades, and the practice should deeply offend us.  I does me.  It is illegal in most states to identify oneself as a doctor, police officer, lawyer or judge, or any 'officer of the court', in fact. It is interesting to note that police officers often have little training before hiring, although that is changing.  Law enforcement professionals are quick to point out their exact title if it is used improperly, such as Officer, Detective, Sargent, etc.  As are doctors.

I think it is time that we, as nurses, begin to get vocal about the false, misleading and disrespectful use of the title 'nurse'.  It is just another step in claiming our role as medical professionals.  In addition, to insist that only nurses be called nurse is a great benefit to our patients, who often cannot tell a CNA from a housekeeper from a MOA from a receptionist, with all of them wearing scrubs.  Our role as a professional, well educated medical provider is evolving, and this is a natural step in the process, that of claiming and guarding our hard earned credentials.

I have contacted the state Board of Nursing and the state Nurses Association regarding putting some teeth behind prohibiting the practice, but neither have any control or governance over MOAs and both welcome the idea of a grassroots movement.  MOAs are not licensed and in many states not even certified nor regulated, such as Certified Nursing Assistants are in most states.  MOAs are extensions of the doctor's bidding and training, able to perform any procedure the doctor is willing to train them to do.  It is most certainly a monetary issue.  But, if they are training properly and the MOA is performing procedures properly, why is it then necessary to falsely label the MOA as a nurse?  It can only be to mislead the patient into allowing a non-nurse to treat them, as was the case with my medically fragile ninety-three year old mother-in-law.  

I was assured by the staff at the Urology Institute that the instillation of chemotherapeutic chemicals in my mother-in-law's cancerous bladder would be performed by a nurse.  After three successive UTIs caused by three different and unusual bacteria, I demanded to know the credentials of the nurse.  Turns out it was a MOA every time.  My mother-in-law reacted like most medically fragile frail elderly, spending weeks confused, incontinent, unable to walk and in pain from these successive UTIs.  Her chemotherapy had to be halted before the full course because of the UTIs and her deteriorating condition.  

Research shows that all adverse incidences, including infections, complications, even deaths, are reduced when registered nurses care for the patient.  Over and over, studies prove that the deeper training and fuller education create a professional who is able to recognize and address signs of downward trends before they develop into a crisis.  Yet, our very partners in patient care are stealing our title and duping the consumer, and indeed playing with lives and health.

To that end, I am asking of you:  please be vocal at your own doctor's office, where you are the patient/consumer, about how offensive and misleading it is to call anyone but a nurse 'nurse'.  Describe how difficult it is to even earn a coveted seat in nursing school, let alone to finish and to test for the right to be called nurse.  Also, please speak to any other healthcare workers you know to encourage the same. Write to the State Board of Nursing, the state Nurses Association, the state Medical Association, the American Medical Association, your colleagues, your state representative, whoever you think might listen.  Let's make this an important consumer issue.

I intend to write articles to nursing sites and journals, to speak to my legislator and to ask to speak to the house committee on medical issues with the hope of making it illegal to identify non-nurses as nurse.  I think there should be a social media site similar to Angie's List where people can list the name of the doctor in whose office or clinic MOAs and others are falsely called nurse.  Maybe if it becomes obvious that the doctors must be complicit in this deception in order for it to continue, some might be embarrassed enough to cease the practice. (Maybe, the next time we are in our own doctor's office, we should refer to everyone as doctor...)

I would appreciate you input and support.  Although, support for me in this is support for us all.

Good health to you and yours.

Wednesday, October 31, 2012

An Open Letter to My Adult Children


Today, I mailed our family member's ballots. All of them. I am so very proud of your commitment to the process of determining the future of this great country. I must be difficult to imagine what the world will be like when we finally hand it over to you. I'm sorry for the idiocy, the waste and the debt the previous generations are leaving for you to sort out. And to try to live a fulfilling quality life while doing so.

One time, when you three were small, a friend asked what I wished for you when you grew up. I said the usual: fulfilled, happy, healthy, and then: I hope they become responsible taxpayers who add to our country and our way of life.

And, you have. You are intelligent, involved, and responsible. You are givers, not takers. You are inventors and innovators and do-ers. In a country of takers and stoppers and complainers.

As I placed the ballots in the mailbox, I realized that I didn't care how you voted, because I knew that you voted with your hearts and your minds and as if your very life depended on it. I trust you to do what's right, as I always have.

I am proud to be... 



Your humble mom

Sunday, August 5, 2012

A Repost For My Mom, who would be 91 today...


THURSDAY, AUGUST 6, 2009


Happy birthday, Jennie May


Happy birthday, Mom. This is the day I will celebrate your birth, eighty seven years ago today. You got to see your sixty-third birthday, and three days more. You got to see your children grown, and some of their children grown. You got to see what a big beautiful family you had created. You expressed pride and contentment at the family reunion in your honor that last birthday weekend.

In the chaos that was our family life, you taught me love. To love a child or a handicapped person or an old person or an animal. To love a man who is flawed. To 'have a little talk with God' when things crashed in around me.

I miss you, Mom. You are always in my heart, and often on my mind. Your voice is the voice I hear when I need strength and guidance at a patient's bedside. Your hands guide mine as I soothe the sick and vulnerable. Your dedication and uncompromising standards of patient care helped set my own standards. You are never forgotten and always with me.

I only wish you could have been here to see my kids. They are awesome. I know you are with us, I know you can see and feel them from where you are now. I have tried to bring you to life for them through stories and favorite objects of yours. But, I just wish you were here, for them, for us, for me.

Thank you for being my mom, my friend, my example. 

Happy birthday, Mama.

The Language of My Soul

I was given a writing assignment in nursing school; to write something that reflects 'the language of my soul'.  Hmmm... could be open to many interpretations.  But, there are fundamental truths about me, the woman I am, the nurse I was becoming, and the people who made me whole.  Irrevocable truths.  Relationships come and go, but three things remain...


First, I am an outdoors woman.  Before husband, before children, before escaping the birth home, I found solace and meaning in the out of doors.  It is the breath of the wind, the hush of the forest and the scent of pine and moss and water that soothed the soul of a hurt child.  I think the Earth saved my sanity, and thus, my life.


Second, I am a mother.  I have wanted to be a mother for as long as I could remember.  Except for a few short terms in college when, deeply involved in the women's movement, I questioned my desire and probed its source and motivation.  Was I merely acquiescing to a paternal structure designed to exploit women?  Was I giving in to hormones before I was mature enough to analyze their trickery?  Nope, I decided.  I wanted to be a mother, a good one, at the right time, with the right person.


Motherhood is irreversible, thus becoming a fundamental part of a woman's life.  Once a mother, always and forever, a mother.


A third important component to my soul is the long term relationship I have had with my husband; a ten year courtship full of passion and pain and resistance to change and eagerness to change and laughter and anger that commenced at age eighteen for me, twenty eight for him.  Then, a marriage that has lasted thirty years.  I have been married to him as long as I was not.  I have borne his name longer than I did my father's.  I cannot imagine life without him.  


These three things, then, comprise the language of my soul:  the out of doors and my place in it, motherhood and my children, and my love for my husband.


So, this is what I turned in to the instructor, 'The language of my soul...'


'The language of my soul is spoken in babies' sighs and nuzzles against my breast; in a thousand inaudible words of love seen in the eyes of my graying husband.  It sings in the wind on my face as I stand on a rimrock filling my lungs.  It whispers quietly by on the bow of my boat and between my trailing wet fingers.  It hollers its robust pride as I watch my son orchestrate daring complexities on the field with his wondrous young body.  It swirls and twirls gracefully around the long strong limbs of my dancing daughter.  It whispers in awed hushed wonder at my eldest navigating a vast technological world, a world I can neither comprehend or visit.  It soothes me as I soothe others; my children, my husband, my friends, my patients.  As I help them, I help myself.  And I feel whole.'

Friday, June 29, 2012

A Lovely Career...

                                                                               the above is from an Internet Nursing site...

And, an absent gag reflex, the ability to stand up for a patient in the face of a doctor who wants to pass the problem on, families who are confused and looking to vent on the nearest person, the ability to ignore unnecessary alarms and tune into the critical ones, willingness to accept all levels of nut-so-ness, psychosis, religious extremism, and superstition, disapproval and judgement by coworkers and doctors, and resistance to medical advice. Just to name a few...

Trucks Aren't Welcome...

I swear its getting harder and harder to park anywhere close to the store entrance. Handicapped spots, absolutely, compacts (hmm, big families and small farmers/entrepreneurs suffer), low emission (now, I'm getting cranky; we all can't afford a new rig), but now: electrical outlet spaces? Where're the free gas spaces? Someone is paying for that electricity. Someday, I am gonna pull up in my 3/4 ton Chev (USA made) 4x4, run an orange electrical cord under the hood up to one of those plug in pumps and go shop...

Sunday, June 3, 2012

Don't Tell Me It's 'Normal'...

Empty Nest Syndrome refers to feelings of depression, sadness, and/or grief experienced by parents and caregivers after children come of age and leave their childhood homes. This may occur when children go to college or get married. Women are more likely than men to be affected; often, when the nest is emptying, mothers are going through other significant life events as well, such as menopause or caring for elderly parents.


Feelings of sadness are normal at this time. It is also normal to spend time in the absent child's bedroom to feel closer to him or her.



Recent research suggests that the quality of the parent-child relationship may have important consequences for both at this time. Parents gain the greatest psychological benefit from the transition to an empty nest when they have developed and maintain good relations with their children. Extreme hostility, conflict, or detachment in parent-child relations may reduce intergenerational support when it is most needed by youth during early adulthood and by parents facing the disabilities of old age. (APA)


The experts thus describe the Empty Nest (EN).  Worse for women than men.  Other life events worsen it. It's okay; it's 'normal'.  Normal to sit crying in an empty room.  


Well, it may be normal, but it sucks.  I am a mom who did everything possible to prepare for the EN, including returning to school to launch an exciting new career as a critical care nurse.  And, yet, I still sat holding baby clothes to to my face as they soaked up my tears.  To know what's normal and to be comforted by those words are two different things.   



Saturday, June 2, 2012

Empty Nest, Part One: The Birth of a Mother

Motherhood is many things, partly interpreted through the media, partly through the expectations and history of one's family, partly through the stimulus/response randomness of daily life.  It is an amalgam of all of these, and more.  It is also comprised of the dreams of the mother, the past longings, the long ago decisions of 'when I'm a mother, I will/won't...', and the great responsibilities and fears that the actual experience engenders.


Many of us try very hard to be good mothers, to be the best we can be.  We are never quite as good as we might want to be, or have dreamed of being, but still we aspire to do better, be better, make our child's upbringing as valuable and special as possible.  


We are given the gift of, and responsibility for, precious, helpless beings that possess our hearts from the moment we are aware of them sharing our body.  Our body changes as does our sense of self, our view of the future, our dreams and goals.  We are forever changed, forever a mother. And if we are fortunate enough to bring the child safely into the world, a permanent shift in paradigm occurs in the heart and mind of the mother, and the world is never, ever the same again.  One mother, Elizabeth Stone, says:


“Making the decision to have a child is momentous. It is to decide forever to have your heart go walking around outside your body.”


Yes, it is.  

For the first time, the mother is no longer able to be self contained and to know all is well as long as she takes care of herself.  Her happiness, her future, her 'heart' is off on it's own, making independent decisions and drawing the attention of Fate.  She is out of control.

Children change quickly and wholeheartedly.  Once content with a Happy Meal and cartoons for a big adventure, once able to fill an afternoon with a shovel and pile of sand, a child suddenly needs money and i.d. and transportation and time away.  Mom lags behind, shuffling forward into an unknown future while looking back at the sweet memories.  And, is often vilified for the delay.  'C'mon, Mom, get with it!', 'Mom, I don't like that anymore', 'No body does that anymore, Mom' replaces 'Play with me, Mommy', 'Read me a story', and 'Up, Mama'.

And, then, all too soon, they are gone.  Off to college, off to their own apartment, off to travel the world.  At each subsequent milestone, a hero party celebrates the child's accomplishments, a loving tribute to hard work and growing up.  Congratulations, cards, gifts, money, flowers, balloons, all for the growing child.

And, there, back there in the shadows, is the mom of the past, smiling through her tears.  Hating the passage of time.  Wishing to scoop up a muddy little one and, laughing, head to the bathtub. 

She has become obsolete. She has been forceably retired from the greatest, most important and all consuming job she has ever known.  A career that has defined and redefined and meant the world to her. No party, no cake, no cards, no gold watch.  She is expected to simply deal with the loss, the emptiness of heart and home and driveway and washer.  It is seen as a natural part of life.  Then, why does it feel so unnatural and painful?



Friday, June 1, 2012

Simple truth...









Of all the truths in life, this I know with certainty: 


a manicure would be wasted on me..

Saturday, March 24, 2012

Thursday, March 22, 2012

Pioneer Up!


My friend Anna, a young mother of a toddler, lives in an area of large fir trees. During a recent snow storm, one of the trees gave up its earthly hold and fell through the roof of Anna's house. A bathroom was damaged, the ceiling light hanging loose, water and snow pouring in. She immediately went on Facebook, describing the occurrence and asking 'what do I do? I have no idea!'

The answers, from her female friends, were appallingly pathetic, weak, unhelpful, and ineffectual. I am so disappointed. I expected more from this group of bright, educated, worldly young women.

-I will pray for you...
-Turn the bathroom light off. Call Andy! (the husband)
-Turn out all lights and wait until Andy gets there. Don't go into that room. Praying! Hugs!

Oh, for god's sake! There are some pioneer women struggling to get out of their graves to kick some ass. I thought we had taught our young women better.

I wrote:

-Turn off the breakers to the bathroom and any other room effected.
-If you can safely put buckets under the leaks, do it.
-Call your insurance company for a referral to a tree removal service and to get an adjustor out.
-Notify the nonemergency number for the police/fire dispatch for an information only notice.
-Call the utilities; electricity, gas, sewer, cable.
-If you can't get help, call me. I know folks who can secure your home by nightfall.

Now, THAT'S advice, ladies. Hugs and prayers won't keep the rain off your prized possessions or make sure there isn't a gas leak. Make us older women feel like you can handle things. Or, we'll take back the world...

Monday, February 27, 2012

The Code of the West


Although the Code of the West was unwritten, every cowboy knew what it was. The Ten Principles are Jim Owen's distillation of the timeless, universal cowboy values that are still relevant to our lives today. They are at the heart of cowboy ethics and of Jim's book, Cowboy Ethics: What Wall Street Can Learn from the Code of the West.

1 Live each day with courage

2 Take pride in your work

3 Always finish what you start

4 Do what has to be done

5 Be tough, but fair

6 When you make a promise, keep it

7 Ride for the brand

8 Talk less and say more

9 Remember that some things aren't for sale

10 Know where to draw the line

Saturday, February 18, 2012

Reynaud's Disease, My Cold Weather Companion


Definition

By Mayo Clinic staff
Raynaud's (ray-NOHZ) disease is a condition that causes some areas of your body — such as your fingers, toes, the tip of your nose and your ears — to feel numb and cool in response to cold temperatures or stress. In Raynaud's disease, smaller arteries that supply blood to your skin narrow, limiting blood circulation to affected areas.
Women are more likely to have Raynaud's disease. It's also more common in people who live in colder climates.
Treatment of Raynaud's disease depends on its severity and whether you have any other health conditions.
So, there is the definition and correct pronunciation for the malady. The daily reality is often much more dramatic, more painful and limiting than that short excerpt presents. My own symptoms are worse than that, but not as bad as some sufferers experience. As I age, the symptoms appear more quickly at exposure to cold, become more pronounced, more difficult to reverse. While it has heretofore not been particularly painful, I am becoming more uncomfortable as winters pass.
Raynaud's disease is more than simply having cold hands and cold feet, and it's not the same as frostbite. Signs and symptoms of Raynaud's depend on the frequency, duration and severity of the blood vessel spasms that underlie the disorder. Raynaud's disease symptoms include:
  • Cold fingers and toes
  • Sequence of color changes in your skin in response to cold or stress
  • Numb, prickly feeling or stinging pain upon warming or relief of stress
During an attack of Raynaud's, affected areas of your skin usually turn white at first. Then, the affected areas often turnblue, feel cold and numb, and your sense of touch is dulled. As circulation improves, the affected areas may turn red, throb, tingle or swell. The order of the changes of color isn't the same for all people, and not everyone experiences all three colors.

That's why it is sometimes called the red, white and blue disease. Sounds patriotic, doesn't it? Again, the symptoms can be trivialized and minimized. But, RD can be a precursor or complication to other conditions, such as Lupus Erythematosus not to mention a difficult medical issue to live with. And that numb prickly skin upon rewarming? Rewarming and the reperfusion of blood can be excruciating to experience.

Types of Raynaud's
There are two types of Raynaud's. It can either be:
  • primary: when the condition develops by itself (this is the most common type)
  • secondary: when it develops in association with another health condition
The causes of primary Raynaud’s are unclear. However 1 in 10 people with primary Raynaud’s will go on to develop a condition associated with secondary Raynaud’s such as lupus.
Most cases of secondary Raynaud’s are associated with conditions where the immune system goes wrong and starts attacking healthy tissue, such as:
  • rheumatoid arthritis: when the immune system attacks the joints causing pain and swelling
  • lupus: when the immune system attacks many different parts of the body causing a range of symptoms, such as tiredness, joint pain and skin rashes

Secondary Raynaud’s can cause a more severe restriction of blood supply so it does carry a higher risk of causing complications such as ulcers, scarring and in the most serious of cases of tissue death, which is known as gangrene.

Who gets Raynaud’s?

Raynaud’s disease is a common condition. It may affect as many as one in every nine women and 1 in every 12 men. (It is hard to be entirely sure as rates can differ widely from area to area depending on how cold the temperature is).
Primary Raynaud’s usually begins in your 20s or 30s. Secondary Raynaud’s can develop at any age depending on the underlying condition it is associated with.

I have primary Reynaud's Disease, having several occurrences of it in my 20's and 30's. Now, though, in my 50's, I have an occurrence every day in the winter where I live. Any weather below about 55 causes my hands and feet to turn white. I often have the vasospasms while I am in the house during really cold weather. It is always a blessing to spend time in warmer weather during the winter. I hope to do that every winter from now on. Become a snowbird instead of a white winter dove.



For more information on RD, contact: http://www.raynauds.org/
Content in blue above from The Mayo Clinic site:
http://www.mayoclinic.com/health/raynauds-disease/DS00433