Men in Whites: Where are you?

Why aren’t there more men in nursing?

There are several reasons, according to Chad E. O'Lynn, PhD, RN, and Russell E. Tranbarger, EdD, RN, FAAN. They list them in “Men in Nursing: History, Challenges and Opportunities” (Springer Publishing Co., soft cover; $40).

For one, they say, we can blame Florence.

Ms. Nightingale, according to the nurse/authors, looked around Crimea and noticed how awful the conditions were in the field and in the military hospitals. At that time – the mid-19th century – all the nurses were men. The “Lady with the Lamp” not only held the men responsible for the deplorable state of care, but concluded they really couldn’t change or be taught, so she began recruiting women into the profession.

Nightingale also was a feminist and believed women should be allowed to work outside the home, so maybe she used this as an excuse to promote the profession as “women-only” work.

By the way, the authors note that male nurses were around long before the war in Crimea. All the nurses in ancient Egypt were men, and monks in Europe served as nurses for male visitors who came to their monasteries. (Nuns cared for the women.)

So just how many men have RN after their name?

After some research, I found that no one really knows, but various estimates have it at between 7 and 12 percent. The last time I actually saw a statistic, it was just less than 5 percent. Whatever the number, it isn’t high.

So we’re back to the original question: Why aren’t there more male nurses?

Nurses’ salaries have risen to a respectable level in the past decade, so men can’t complain about that. And today’s nurses are not only caregivers, but must be very tech-savvy – something that you’d think would appeal to the male gender. Also, there are plenty of areas like the emergency room where men can get their adrenalin rush.

So why do you think there is a dearth of men in nursing?

How do you think the profession can attract more men?

Tell us what you think.

Technology: Devil or Angel?

I have a love/hate relationship with technology.

Take my computer and e-mail … the computer is a queen until she doesn’t behave. She has the ability to make my day or ruin my life. When she’s good, she’s very, very good, but when she’s bad—well, don’t get me started.

And e-mail is mostly a blessing, occasionally a curse.

With a large family, I absolutely love having the ability to write an e-mail once, press the send button and have the missive shoot through cyberspace simultaneously to four dozen people. The downside is that my e-mail inbox fills with hundreds of messages every day, and although I’ve gotten pretty adept at trashing them quickly, it still takes time that I don’t have. And when I return from a week’s absence, taking out the trash takes some major minutes.

I have a friend who believes that this whole home mortgage mess can be blamed on computers. If there were no computers, he reasons, there would have been no way all the unscrupulous lenders could have processed all those bad loans and so quickly.

It seems to me that computers, cell phones, faxes and other amazing machines have put our lives—both professional and personal—on high speed. Everyone expects you to produce whatever it is now and to be always available. On the other hand, we have unfathomable amounts of information at our fingertips. That’s usually good news for patients and patient care, but sometimes bad news when patients don’t know how to discern valid information from the invalid, the incorrect and the quackery.

I’ve talked with some nurses who curse the COWs (computers on wheels) that they push through hospital corridors because the machines often don’t work well. These nurses complain that they spend more time dealing with the errant machines than they do giving patient care. But those same nurses couldn’t do without their BlackBerrys, iPhones and MapQuest.

I couldn’t begin to list all the technological advances in diagnostics and imaging. For the most part, they allow us care for patients in more precise and less invasive ways, but they can present dilemmas that were once non-existent.

So I ask: Has technology made your life—personal and/or professional—better or worse?

What’s your favorite techie invention?

What technology do you wish never saw the light of day?

Has technology cranked up your pace to an unacceptable level?

Tell us what you think.

Wealthy Does Not Make Us Wise

I was astounded, but then again, not so surprised by a headline I saw this past week: “Life Expectancy Is Declining in Some Pockets of the Country.”

What?

Haven’t we Americans been living longer and longer?

Yes, we have—up until now.

According to the National Center for Health Statistics, life expectancy for nearly all Americans has steadily increased since the early 1960s. The number of smokers has gone down (it’s now less than one in five), and the rate of heart disease has decreased. But something happened in the mid-1980s. We began putting on weight and developing all those problems that come with obesity—many of them related to type 2 diabetes: heart and vessel disease, stroke, kidney failure and other life-threatening illnesses.

Experts at Harvard sum it up this way: There are places in the wealthiest country in the world, which spends more on health care than anyone else in the world, where health is getting worse.

Not surprisingly, the places where life span is decreasing are some of the poorer counties in the country; they are in Appalachia, the Southeast, Texas, the southern Midwest and along the Mississippi River. (Life expectancy continues to increase in the Northeast and on the Pacific Coast.)

There also are more African Americans in counties with decreasing life spans.

And one last stat: The differences in life spans between the counties with the lowest life spans and the highest are 11 years in men and 7.5 years in women.

So whose fault is it anyway?

Is the problem the lack of personal responsibility, education and/or access?

Is it the high cost of health care, the unequal distribution of resources, or all of the above or something else altogether?

Tell us what you think.

McCain's Plan for Health Insurance: Out of Touch?

Dare we talk politics?

Oh, what the heck.

I was astonished this morning to hear Republican presidential nominee John McCain’s proposals for dealing with this country’s health care morass.
He says the problem with health care in this country is that it costs too much (well, yeah) and he wants to bring those costs under control. [For the details, visit http://www.johnmccain.com/Informing/Issues/19ba2f1c-c03f-4ac2-8cd5-5cf2edb527cf.htm.]

He believes employers shouldn’t have to pay for employees’ health insurance and that everyone should buy their own. McCain offers a few things that are supposed to help us do that like tax credits and purchasing insurance across state lines (which presumably would bring competition and lower prices).

The candidate says that we should provide universal access to health insurance, but does he realize that many people can’t afford insurance at any price?

McCain also suggests that people like Bill Gates and Warren Buffet, who can afford to pay for their prescriptions, should not receive subsidies like drug plans to do so. But just how many billionaires does he thinks live in this country? I think it’s safe to say that there are very few people who can afford to bear the total cost of all their medications.

Nothing in McCain’s plan says anything about mandating insurance companies to cover everyone. If the senator were forced to give up his health care plan and buy medical insurance on his own, as he suggests everyone should, he’d be unable to find coverage. Health care insurance companies run like crazy from cancer survivors.

It’s just my opinion but I don’t think there are many who will support this so-called “health system reform” except maybe the CEOs of the health insurance companies who make millions by canceling people’s coverage.

What do you think?

Patients Bearing Gifts: Should You Accept?

Over lunch the other day, a friend of mine and I had a discussion about the ethics of nurses accepting gifts from patients.


Roxanne, a former NICU nurse, told me about the time she accepted a gift from a Mexican woman who had been visiting family in Los Angeles and ended up in a local hospital. The woman went into early labor and delivered a baby that had problems. Roxanne cared for her child in the NICU. The woman didn’t speak English, so Roxanne, with her limited Spanish language skills, did what she could to explain to the new mother what was happening with her baby. Roxanne also found an interpreter to help.


When the woman was ready to leave the hospital, she gave Roxanne a blouse to show her gratitude for what Roxanne had done during the hospitalization.


“I had to accept the gift,” Roxanne said. “I think she would have been insulted or hurt if I didn’t.”


I had a similar experience.


I cared for a Mexican physician while he was hospitalized for weeks with histoplasmosis. We became friends and I helped him with some non-medical problems that were created by his unexpected and extensive hospital stay. When he was finally discharged, he gave me a huge handmade blanket which hung on our wall at home for years. He had made a special effort to get the blanket and seemed so pleased to give it to me.

I believe he would’ve been very hurt had I refused to take it.


If I were ever offered bags of money (!) or other lavish gifts, I’d feel pretty uncomfortable about accepting these and would probably refuse. Or maybe I’d donate all that money to a charity. But I think accepting small gifts from patients who feel that need to say thank you should be permissible. I think they want us to remember them and will feel hurt if we refuse to take gifts to which they’ve given a lot of thought.

Do you think it is unethical to accept gifts from patients?

Have you ever done so?


What would you do if a former patient willed you a lot of money many months after their hospitalization?

Let me know what you think.

Has Mr. Clean Gotten Out of Control?

I have a real issue with commercials and ads that promote the idea that germs lurk everywhere and we’re at real risk if we don’t buy a certain soap, cleaner or spray that eradicates these dangerous pathogens.

These commercials illustrate their point with special effects showing tiny, creepy-crawly things on doorknobs, shopping cart handles, telephones and toilet handles. They are enough to send anyone with obsessive-compulsive tendencies over the edge. It’s true; germs are everywhere, but if they were all that dangerous, wouldn’t people by the thousands be dropping like flies?

Germophobia (the closest Latin term I could find is “mysophobia,” the pathological fear of contact with dirt because of contamination and germs) is a growing problem, according to a therapist with whom I spoke several months ago. He specializes in treating people with obsessive-compulsive disorder (OCD) and says that it’s an uphill battle against this Madison Avenue assault. The goal of these ad men and women is to sell a product with little regard to the harm that’s being done, and their commercials only confirm the legitimacy of germophobia.

I know people who won’t go to the bathroom anywhere except home (this certainly limits life experiences) and others who won’t allow their children to play anywhere they may be exposed to dirt or other people who might be sick. These obsessive-compulsives put themselves into a prison (at the extreme, think Howard Hughes) and make life miserable for their families.

Equally important is what these products may be doing to everyone’s health.

A researcher who studies public health and infection-control issues told me that using all these anti-bacterial/anti-viral products is lowering the general population’s resistance to infection and helping to create the so-called superbugs.

Obviously working in a hospital demands a protocol that discourages infection, but what about in the outside world?

How do you handle contamination issues when at home or in social settings?

Do you think Madison Avenue has sold us on the existence of non-existent dangers?

Tell us what you think.

Medication Mix-ups: Is it the Nurse or the System?

The April issue of the journal Pediatrics contains an attention-grabbing article.

Researchers of a study designed by the National Initiative for Children’s Healthcare Quality found that for every 100 children hospitalized, there were 11 drug-related errors. This means that some children were victims of error more than once.

Apparently statistics from an earlier study put that number at two errors, but researchers used a different method to calculate the mistakes this time. Even though the errors may not have been recorded in the chart, the investigators looked for “triggers” in the medical records that pointed to medication errors. Some of these were the use of antidotes, suspicious side effects like dyspnea and low blood pressure, and the results of certain lab tests.

I’ve been following the issue of medication error and have noticed that the trend seems to be to blame the system rather than an individual for errors. The thought behind this is that looking closely at the systems rather than punishing the nurses who made the mistakes encourages the nurses to report the mistakes. However, the researchers for this most recent study believe that self-reporting really isn’t happening the way it was supposed to.

What happens at your workplace when a medication mistake happens?

Do you think the procedure for handling these mix-ups is adequate?

Should nurses take some or all of the blame for the errors?

Does your institution have policies and procedures that could be improved or revised to cut down on errors?

Tell us what you think.