Tv after words tv program. She discuss the book the shift in which she discuss health care. Host im going to start by maybe reading a few sentences out of your first chapter. Guest that sounds great. Host my fellow rns combination of snark, humor, Technical Skills and clinical smarts were like me to put our shoulders to the rock that is modern health care and every day push it up the hill. Guest yes. Host talk a little bit about what our Current Health system, how challenging it is to be a nurse in the system today . Guest that image came to me because i really feel like that at work that theres this giant rock, we come in every day and we have to move the rock to the top of the hill and the next ship you come back and same rock, same job because health care is so complicated now and not really focused very well on coordination that it can often take a tremendous amount of time and energy for this very basic ordinary things to happen. For example, one of the patients in the book is misdiagnosed, classic thing that happens, patient comes in the emergency room, goes to a medical floor, it turns out, she actually has a very serious surgical problem. On my behalf, i felt so angry. He said, theresa, it happens all of the time. Host yeah, i dont think i dont think the public can really appreciate how complicated it can be which does cause on us to even try to work harder to coordination. Guest yeah, i dont want to scare people and make them think the hospital is chaotic and a mess. Thats not a mess. Host that is a lot of what motivated me to write this book. The average person doesnt know how qualities are to patient care and if you do well in the hospital, its likely that some of that, at least is going to have to do with your nursing care. Guest absolutely. Yeah. Host when i was in direct practicia practice i practiced in pedestrian pediatrics. Talk a little bit about use of humor to cope. Guest i dont think it comes out as being uncaring. The example i give in the book is i had a patient die and i hadnt known him very long and i felt his death quite profoundly. After he died he had a lot of narcotic left over. Patient die sd not one of the reasons. So together we decided on patient refuse, which struck us as hilarious. But it helped with my grief to do that. Host yeah, great example. You talk about how it is to work within a Healthcare System that sometimes forget that its working with human beings and sometimes were caught up in the bureaucracy and focus on healthcare as a business, to say more about the impatty empathy thats needed and the mental toughness to be a nurse, talk a little bit about that. Guest yes, its so important to totally be there and its difficult because we are pulled away, someone needs you, somebody needs something from you. Sometimes a patient just needs you to be there for them either because theyre in pain, because theyre vomiting, because theyre scared, all kinds of things and being able to come to that patient with your whole heart and at the same time being able to constantly run through your to do list is very difficult and the nurses have to be really good at that. Turning on a dime. Host yeah, i think it is a challenge. We certainly hear sometimes from patients and former patients who feel that their nurses seem so busy, they dont want to ask them for things but things that are important to them, even if its just spending a few minutes to them to explain one of their medications or one of their treatments. Guest yeah, thats tough. I still have time to do all the little things. Yeah, thats right, those are the things that really make you feel that you contributed. Host yeah, really. So lets shift a little bit to the issue of staffing in the hospital. You talk about that at various points in the book and we know that research on staffing has really made it pretty clear that the more patients a nurse has above a certain number, and, of course, thats very dependent on how sick the patients are and the skill level from the nursing staff on the unit that day, we know that that number may contribute to an increase likelihood about the patients outcome, about patients that could die. So staffing issues are really an ongoing concern at the American Nurses association, its been a lot of our work in the last few years, in fact, we have worked with congress to rereintroduce the nursing staffing act. So talk about staffing impacts nurses and their patients . Guest this is such a great question and important issue and i apply the Nia Association for this. But i start with three in the book to show people, at least, with four im hoping all of the time and i really want people to understand that because i think initially said four patients, whats that. That sounds like nothing. Host right. Guest they read the book, wow, i really get it. And the scary thing to me is and have been doing from a bunch of interviews, four patients, ive never had fewer than eight patients. But its very distressing to me that eight patients might be relying on one nurse. How can one person possibly meet all those needs. It is possible, yet with the constraint and funding for healthcare funding these days, we have to find the right balance to get right level of nursing care for the patients because we know that unfortunately it can contribute to bad outcomes. Additional work is needed for sure. Do you think patients what have you had patients say to you in that regard and how can we engage patients even or individual who is are involved with the Healthcare System to better advocate in this area in. Guest thats a great question. I had patients say youre busy, dont worry about this, ive had other patients say, dont give me about change of shift or youve got something else. I need this right now. So neither case is really great for the patient to be so frustrated that their needs arent met or they feel like they cant ask for something because im too busy. So what i would like is if people read my book or learn more about nursing see how important we are and then if theyre going to write to legislators or make a point about how to improve hospital care that they talk about the nursing care. We are focused on Patient Satisfaction now which theres value in talking about that but also having enough nurses leave to having more satisfied patient and the not enough good nurses to be able to do the job and patients doing well needs to be more established and then the public needs to say, this is what we want. Host well, i think there are everincreasing opportunities to educate the public around what kind of questions they should be asking before they have to go into the hospital or maybe one of their family members has to, whether they have a magnet designated hospital in their area or even a simple yes about what is the average staffing, what is the average Nurse Staffing for a unit. So theres a great deal of work that i think were all engaged in right now about what are those measures, particularly related to nursing care that we would like to see publicly reported that patients can go to or individuals can go to and look online, people are really getting pretty savvy about accessing information online. Guest yes. [laughter] host what would they want to know specially when they have the ability to compare different hospitals, different Healthcare Providers and different facilities . Guest right, that kind of transparency would make a difference. They can see that the hospital across town has more nurses in general than we we do on the floor. You know, we cant tell people how much an mri will cost for complicated reasons, but surely we can find a way to tell them how good the nursing care is. Host right, absolutely. Im going to shift a little bit to the image of nurses. You give an example about Nurse Practitioners so individuals can see who is caring for whom, who is assigned to whom and how those individuals as well as nurses are often listed by first name. Right. So we use physicians, resident often are listed by their last name. So they more about the relationship among individuals and what kind of issues do we have in our setting that keep this challenge as we work on, nursephysician relationship, respect among the team and understanding about what Healthcare Team members do . Guest right, theres a clear hierarchy, theres a legal hierarchy in one sense. Doctors have Certain Authority that nurses do not have, but theres a bigger problem with hierarchy in that nurses find themselves in situations where we feel that our contribution is not looked at being significant, and so the doctors always being dr. Brown and the nurse always being theresa reinforces the sense that the doctor is the expert and the authority and the nurse is something between a way tress and a best friend. I dont mind patients call me theresa. I would like the formality that doctors work within even if you talk to a physician, they will talk about another physician and they will say doctor. Dr. Scott, dr. Brown, dr. Miller, you have no idea what theyre talking about. On a very basic level reinforcing of the hierarchy of titles can get in the way about care about who is the doctor and how do i call that person. Host right, right. Another example you used in the book is how nurses can be or certainly trusted to administer a drug that could be very damaging to an individual particularly in an oncology unit. Youre administering medication through the vein and then you encounter that example that youre not quite sure to use google without filters. Its like we have a dynamic of fut competence and trust and yet we have barriers that seem to impact the respect that we would have for a professional. Guest yes, thats a great contrast. On the one hand, we are very skilled technicians. I attended very extensive classes that my job provided to be able to give patients equipment chemical chemother. It seem today come and go, that authority and then another nurse said you can pull out a ekg, somebody found that out and cut that out. [laughter] guest the idea that we are intelligent people and we might need to look up something. The point is from getting us on facebook, i guess. And i just didnt see that happening a lot. Host a little too busy to be using facebook. Guest yes. Host besides this issue of first name, last name, respect and access to the internet resources that may be needed for patient care, are there any other areas that you could think of, anything else youve had in your experience in which nurses need to be focused about more respect for their positions and who they are as a key member of the Healthcare Team . Guest nurses are notorious for the phrase nurses eat their young. I have experienced that. It is really horrible, but we could change that. I think that it happens out of a sense of frustration, not being listened to, not being taken seriously and that anger has to go somewhere and nurses take it out on each other. It could be younger nurses against older nurses, new nurses, any combination you can think of is possible, and its just bullying but we could stop it if we really looked at it as a management problem and a Work Environment problem. Why are these nurses so frustrated . Host right. I would agree with you absolutely. Talk a little bit you do a great job in the book talking about your relationship with these patients and even some other patients you allude to that you cared for before or have been on your unit previously. You know, our relationship with patients particularly in your setting patients who sometimes would come in and out of the hospital so you get to know them more than a single episode, they are kind of complexleading relationships with the patients and talk more about that, particularly when we have the challenges and health care about Patient Satisfaction scores and the dynamics of you know them for that period of time and then you send them off and of course, as you say in the book on a cancer ward you hope to never see them again. Guest yes and we say that to people. I hope i never see you again and then theyll say, maybe i can see you at the mall. I dont want to see you here. [laughter] host dont want to be back on that one. Guest yeah. Anyone who goes into nursing and maybe specially oncology nursing, this has the impulse to connect hearttoheart to other people. I remember as a pretty new nurse talking and when she said, if you stop caring, thats when you need to get another job. Sometimes its going to be really painful and attached to people, they are going to die and that hurts, but its part of the job and i look at it as a sort of then idea of i go in, i do my best for these people, i try to make their lives better, i try to make their care good and then ive done my good and i leave. In training that gets reinforce, you all show up on the floor and leave together, theres no call to go see, how is mr. Jones doing. Everybody who is bit as good as you are is going to take over from you. Host right, exactly. Well you also talk about some other things that impact patient care, paperwork is one of those things and you used this great example that i want to talk about and read from about your time with sheila, the patient you just mentioned a minute ago. And you say, theresa, you just cant stop bothering dr. Coyle, can you. This is the moment that i try her refusiveness and i feel upset. Im not add hearing to the expected relationship and its not the first time as an opinionated or pushing a nurse. Why is that . Shouldnt i feel assertive instead . So talk a little bit about, you know, the physiciannurse relationships, paperwork that impacts, those things that get in the way of doing the care that we know our patients need, the time that you want today spend with sheila and her family and yet this balance of and needing to feel pushy. Guest youre not being pushy, thats your job. Hes there as a great corrective. Why dont i just be myself as assertive, again, i think its a way that nurses can be hard on ourselves and the environment doesnt always reward the outspoken nurse. I was going to say opinionated and then i thought, no, dont say that because that also sounds negative. Paperwork a more complicated issue, as i show in the book its a constant demand and you never get away from it and it hangs over for the entire shift. I still have to do one of my full assessments and youre at the end of a 12hour shift and charting the stuff that happened at 9 00 in the morning because you didnt have time to do it before. A lot of nurses feel like more and more charting is what we call, paperwork requirements are being placed on us and none ever drop off the other end and so we are spending more and more time at the computer, and i know physicians feel this way, physical therapists feel this way so we are not alone in this, but again as a society we need to be thinking about all the paperwork requirements and thinking about how we could streamline them and make them for efficient, what is it that we really want to know and need to know and say that paperwork is never going to be more important than actually being with your patient. Host right. Guest thats what matters. Host i sometimes think we need to ask the question is how are we going to use this information, you know, with the Electronic Health records, we are really looking a lot at how do we can we extract information from the information, not a single patient but across the board and seeing are there certain things that we are doing or not doing that may contribute to good patient care or negative falls with patients and those kinds of things, but theres a lot of documentation that is not useful and that we dont think about how are we going to use this information. So i certainly think looking for opportunities to really streamline that because you talk about spending time with sheila and her family and and how that was one of the most important things for you to do that day and yet, it wasnt on your to do list. It wasnt on your dropdown menu. [laughter] host unfortunately it was not one of those things whereas starting an iv or giving medication and all these. We understand from a legal perspective certain things need to be documented, but its that balance of how do we balance documentation direct care because we know that patients value that time of comfort, thats what they look for, often thats what they talk about when they leave. Guest thats right. Thats exactly right. That is very important for the patient and their family members, and its what nurses are so good at for, trained to do. Its what where we are there for along with a bunch of other things, but to feel like its not in paperwork that we keep and when you hang an iv and take an iv down and on and on. [laughter] host exactly. You also talk about how in this day and age, of course, i finished Nursing School and did my earliest, you know, kind of work in the direct care in the hospital setting in 1980s, so its been a little while, but i think even in nurses educated completely separated from physicians, i think to a large extent that is still the case although we are finding. In some schools of nursing, schools of medicine they are doing some classes together better understanding roles and those kinds of things, but i think for the most part and you even talk about this in the book that mds have little idea what nurses actually do when we check chemo orders or activity that is we do and that they dont necessarily understand that nurses are performing independent functions, independent verifications, checking the order, making sure the right drug gets to the right patient and thats why thats so important and making sure the patient is ready for the medication and you use the phrase that our work is invisible to each other. We talked about respect earlier, but talk a little bit about the actual need to understand each others role and work well together to optimize the care that we are giving both in different roles to the patient. Guest its so important and strikes me strange that nurses dont learn in Nursing School how to work with doctors and doctors dont learn in school how to work with nurses. So im not sure why anyone thinks this is a really good way to achieve the best results possible. So as you said, there are programs that are now starting to focus on interprofessional education and that is a great start. I think for each of us to have empathy for the other makes a huge difference. I read books by doctors partly to know what theyre thinking, what theyre doing and i would love it if doctors would look at writing by nurses, try to find out what is it that were actually doing all day, get a sense of how we are trained, what we were able to accomplish, im thinking of a story where we had a patient who was doing very badly and did not want to go to the icu but we didnt have a do not resuscitate