It's a wonderful life

This time of year we all gather together and re-watch the classic holiday movies. We all have our favorites, be they in black and white or Chevy Chase and Home Alone.  One of my all time favorites is It's a Wonderful Life from 1946.
The film stars James Stewart as George Bailey, a man whose imminent suicide on Christmas Eve brings about the intervention of his guardian angel Clarence. Clarence shows George all the lives he has touched and the contributions he has made to his community.
George's dream has been to see the world. However, he repeatedly sacrifices his ambition for others. He spends his life running the Bailey Building and Loan Association, that his father started and vital to the people of Bedford Falls because without it they would be at the mercy of  Henry Potter, a heartless slumlord and majority shareholder in the Building and Loan, who also owns the bank and most of the rest of the town.  Without George, the people of Bedford Falls would have little hope of ever owning a home or improving their lives.
George forgets this and Clarence is sent from heaven to help him remember.  If Clarence succeeds, he will earn his wings. 
There are many great scenes, let me share one of my favorites.
On Harry's (George's younger brother) graduation night in 1928, George discusses his future with Mary Hatch (Donna Reed), who has had a crush on him since she was a little girl. Later that evening, George's absent-minded Uncle Billy and Harry break the news to George his father has had a stroke, which proves fatal. A few months later, Mr. Potter tries to persuade the board of directors to stop providing home loans for the working poor. George talks them into rejecting Potter's proposal, but they agree only on the condition that George himself run the Building and Loan. He gives his college money to his brother with the understanding that when Harry returns from college, he will take over the Building and Loan, which of course, doesn't happen.
This scene shows George's passionate speech before the board on why the Building and Loan must continue.  It speaks to the idea that love is more important than greed, an idea George forgets for a time until Clarence helps him remember and realize that though he may not have the most money he is indeed "the richest man in the world"!

GRINCH OF THE YEAR

On Saturday, the following wonderful letter from John Hayes of Pomfret, appeared in the Norwich Bulletin letters to the editor section: Appparently, Scrooge has moved to Norwich in the form of the CEO of The William W. Backus Hospital. While the current CEO laughs all the way to the bank to the tune of $600,000 per year, he’s withholding annual holiday bonuses from the nursing staff. He isn’t alone in his merriment. Backus also pays the former CEO, yes, former, as in no longer working there, $700,000 per year. These figures are public through the tax records. The nurses, from Norwich and surrounding communities, are representative of the people to whom they provide care. They may be raising young children, struggling on single incomes or caring for aging parents. They care for people at the best and worst of times. Through birth, illness and even death, nurses are often the ones holding the patient’s hand. The holiday bonus was a small recognition of the contribution the staff makes to Backus’ success in caring for the community. The nurses look forward to this recognition as a way of helping with financial needs. With its coffers overflowing with more than $24 million, and the CEO and former CEO more than amply rewarded, Backus Hospital should acknowledge the work of the nurses and give the bonuses. Thank you Mr Hayes, and well said. His letter got us thinking. Tonight a delegation from the Backus Federation of Nurses attended the Southeastern Connecticut Central Labor Council meeting, a gathering of labor leaders from all the different southeastern Connecticut unions of the AFL-CIO. We approached the council for support. I am happy to tell you that our brothers and sisters of labor unions across southeastern Connecticut stand in solidarity with us! They have nominated Backus CEO David Whitehead as GRINCH OF THE YEAR! The labor unions of of the area, the state and the nation stand with us. Millions of people like John Hayes, people who care.

A call for laborers

A man named Matthew wrote, "At the site of the crowds, his heart was moved with pity. They were lying prostate from exhaustion, like sheep without a shepherd. He said to his disciples : "the harvest is good but the laborers are scarce. Beg the harvest master to send out laborers to gather his harvest. " We are the laborers. There is much to do. Many in this world suffer; from poverty, sickness, depression, addiction, spiritual emptiness. There is no shortage of work for the laborers. We all have a calling, it may take some time to find it, but if we continue to search, we will find it. It is our way of leaving the world better than we found it. When we find our calling, we know. The urge to follow it is overwhelming. It is a "calling" because the harvest master calls out to us. Whatever it is, we are to perform it with love and respect for each other. There is dignity in all labor performed in this way. The harvest master is known by many names, by all religions and all spiritual paths. He does not belong to any one and yet he belongs to all. He is love at it's purest. And the best part? He desires closeness to us - His laborers!

The Good Boss

It was a very busy second shift in the ED.  I was a brand new nurse, certainly less than a year into my practice.  I had worked in the ED for 5 years as a nursing assistant and was given the opportunity to start nursing there after a brief orientation on the Med Surg floor.  It was unusual at the time and I was grateful for the chance, now it is common practice.
On this night we had a trauma and the experienced nurses were handling that, leaving a few of us newer nurses to manage the rest of the floor.  One of my patients was having difficulty breathing, the ED doctor was concerned, I could see it in his face.  He ordered an IV drip of magnesium and I started to prepare it.  Back then we mixed most of our own drips, especially on 2nd and 3rd shift.  As I pulled out the vials of magnesium I felt uncomfortable, there seemed to be too many vials.  I ran it by one of the other new nurses and she thought it was OK.  Now I realize that she was as overwhelmed as I was.  My patient's condition deteriorated after we started the drip because I had overdosed him by a factor of 10.  I alerted the doctor that his condition was worse, we stopped the drip and the patient was intubated.  At this point I had no idea that I had made a mistake.  God was watching us all that night, the patient recovered. 
A little while later, while I was standing at the medication Pixis, a wave came over me.  I realized what I had done. 
I almost fell to the floor. 
By now, the experienced nurse who was precepting me was out of the trauma. I went to her and she said to tell the admitting doctor.  I walked over, sat near the hospitalist who was writing orders, took a deep breath and told her.  She had just written an order for an IV with magnesium in it.  She ran a pen line over the line, initialed it, put the pen down, turned to me and said, "It's going to be alright".

A couple of weeks later I was called to the office and Susan Davis, my boss, asked me if I realized what the mistake had been.  I said yes and we talked about it.  Sue said " I know you'll never make that mistake again".  That was the total of my disciplinary action.

Today, our Pixis machines are in rooms instead of on the open floor, with it's distractions while you are pulling and mixing meds. The confusion over labeling of electrolytes in both milligrams and milliequivalents is minimized.  We mix meds in the med room and are encouraged to  have the pharmacy mix meds whenever possible. 
That is what came of my mistake, because I had a boss who looked out for me and who corrected flaws in the process.  There are still things we need to work on, such as help for less experienced nurses and appropriate staffing ratios that take into account patient severity and nurse experience.
Sue was a good boss, an advocate for her patients and her nurses. She now teaches Nursing in Virgina and works part time in an ED.
She recently sent me an email about a trend toward criminalizing nursing mistakes:

Hey John!
This article made me think about patient-nurse staffing ratios at WWBH. Nurses are now more than ever, at risk for legal actions. I firmly believe that staffing ratios and nurse's complex assignments set us up to fail. Maybe there is some information here for you to blog about. Always thinking about my family at WWBH.
Susan

The Criminalization of Nursing Mistakes

Don't piss off an Irishman

Can I tell you something? I'm pissed. I'm sorry, but I am. We have been meeting with management for 5 months. They arrive late every session and they just don't seem prepared when they do get there. I wonder if they even talk with each other between sessions. It's disrespectful. Our committee has met for countless hours to prepare. Five months ago we gave them a complete contract proposal. They have only responded to about a third of it. I am told it is not unusual, management considers it part of the game, part of the negotiation dance. I don't want to dance and to me it's not a game, this is my life, it is the lives of my coworkers, it is the lives of my patients and it is the financial life of my hospital. We will do what we can to move things along but in the meantime remember that we ARE a union and we have to act like one. We have stepped in and intervened for nurses in discipline/discharge proceedings, protecting their rights, making a bad situation better for them and the hospital. We got an extension on filing for insurance for next year. Management had given ten days and with everyone's busy lives many people, nurses and others, missed the deadline. We got a one week extension. Some nurses are being told that vacations past a certain date can't be approved. We have spoken to Human Resources and they have assured us that this is not the case. If you are told otherwise let us know and we will intervene for you as we already have for others. Management denied nurses the bonus they earned from a year of hard work. We filed charges with the labor board and if needed we will take them to trial. We had wanted to have negotiations at the hospital to make it more convenient for nurses to stop in during dinner breaks or after work and to save both union and hospital money but management refused. That is their right. So we applied for the use of the hospital conference rooms for negotiation update meetings and were tentatively approved and then denied. These rooms are used by all kinds of community groups so to deny us was discriminatory. We filed charges with the labor board and the hospital gave in. Our first meeting was well attended and people wanted to know what they could do to help. Some people can't make negotiations for various reasons, we understand. There are other things you can do to help. Wear your union buttons, tell us if you need more. Call David Whitehead at 860-889-8331 ext 2722. Tell him to listen to the nurses and instruct his team to negotiate in good faith. His secretary will answer the phone, give her the message, or call at night and leave a voice mail. Call often. There seems to be a feeling from management that this is their hospital to do with what they want. They have had complete control and they want to keep it that way. Guess what, if we thought they were being good stewards of our community hospital we wouldn't have gone though all this trouble. It is the community's hospital and we all answer to them. So, I'm angry, but I'm not discouraged. You are my strength. You are the entire committee's strength. We will prevail, we will bring our hospital to where it should be. The only question is this. Will management help or be a hindrance?