When Chicken Soup Isn't Enough

Stories of Nurses Standing Up for Themselves, Their Patients, and Their Profession

Suzanne Gordon

• Publisher: ILR Press
• Year: 2011
• eBook ISBN: 9780801457401
• Topic: Medicine
• Subtopic: Nursing

The reassuring bromides of "chicken soup for the soul" provide little solace for nurses—and the people they serve—in real-life hospitals, nursing homes, schools of nursing, and other settings. In the minefield of modern health care, there are myriad obstacles to quality patient care—including work overload, inadequate funds for nursing education and research, and poor communication between and within the professions, to name only a few. The seventy RNs whose stories are collected here by the award-winning journalist Suzanne Gordon know that effective advocacy isn't easy. It takes nurses willing to stand up for themselves, their coworkers, their patients, and the public.

When Chicken Soup Isn't Enough brings together compelling personal narratives from a wide range of nurses from across the globe. The assembled profiles in professional courage provide new insight into the daily challenges that RNs face in North America and abroad—and how they overcome them with skill, ingenuity, persistence, and individual and collective advocacy at work and in the community. In this collection, we meet RNs working at the bedside, providing home care, managing hospital departments, teaching and doing research, lobbying for quality patient care, and campaigning for health care reform.

Their stories are funny, sad, deeply moving, inspiring, and always revealing of the different ways that nurses make their voices heard in the service of their profession. The risks and rewards, joys and sorrows, of nursing have rarely been captured in such vivid first-person accounts. Gordon and the authors of the essays contained in this book have much to say about the strengths and shortcomings of health care today—and the role that nurses play as irreplaceable agents of change.

Part 1

SET UP TO LOSE, BUT PLAYING TO WIN

For more than two de cades, I’ve had a front-row seat on nurses’ socialization in self-denial. Whether in nursing school or on the job, nurses are taught how to care for and be concerned about patients. They are constantly enjoined to advocate for patients. What they are not encouraged to do is to advocate for, or even acknowledge, their own needs either as human beings or as professionals. Sometimes I think nurses are taught that altruism means they have no needs at all.

I watched this play out in the early 1990s when I was writing about nursing at the Beth Israel Hospital in Boston for my book Life Support: Three Nurses on the Front Lines. I spent several years following nurses at the Hematology-Oncology Outpatient Clinic. They were amazing and delivered exquisite patient care. What they had trouble with was sticking up for themselves. The nurses worked with patients whose outcomes were grim. Over 50 percent died. The work took an emotional toll. The institution recognized this, and every few weeks, it offered what were called psych rounds. A psychiatric nurse came to facilitate a discussion about their work. Ostensibly they could freely air their concerns, frustration, sadness, even their despair.

Problem was, they didn’t feel the psychiatric nurse was helpful. Even more inhibiting, their manager insisted on being present during these meetings. They wanted a new facilitator (they had a person who was willing to do the job), and they didn’t want their manager present. After each meeting they would complain among themselves about the facilitator and about the fact that their manager’s presence inhibited their ability to comfortably express their concerns.

For two years, these nurses vented their frustration after each session and vowed to do something to change things the next. They never did. They simply didn’t know how to prepare their case, work together for themselves, and make their argument.

Of course, no matter where we work, we all face the choice of do I speak up or remain silent? And, if I take a stand, what should the issue be? But these nurses seemed to be fighting with their hands tied behind their backs. They weren’t supposed to have needs, or if they had them, they were supposed to sacrifice them for the good of the patient or their institution or their profession. They had not learned what I had learned in the women’s movement and from the struggles of other oppressed groups—that is, how to network, strategize, and organize to get what you have long deserved. I wanted to intervene, to advise, to suggest ideas, but I was there as a journalistic observer not as a workplace adviser. Because I kept quiet when I knew I could have helped, it made me feel almost as frustrated as they did.

That’s why I begin with the stories in this first section. Here, we have nurses from every corner of the profession as well as from around the globe who have advocated for what they need and won. They questioned physician decisions that jeopardized patient care and challenged the reorganization schemes of hospital consultants who know far less about nursing than veteran RNs and nurse managers. They refused to accept workplace behavior that was improper and sometimes even illegal. As individuals and collectively, they challenged conventional wisdom that stood in the way of much-needed change for themselves, their patients, and coworkers. And, for them, winning felt really good!

A Covert Operation

Kathleen Bartholomew

I was a brand new manager with absolutely no experience, but I knew intuitively that to run the fifty-seven bed orthopedic and spine units effectively, I would have to cultivate a relationship with their physicians. The orthopedic physicians met every Friday morning at seven for rounds where two physicians would present their most difficult cases. While the first and second physicians were switching out x-rays, I asked if I could talk to the doctors to establish a definite time and place for weekly communication. Thereafter, every week at “half-time” (i.e., halfway through rounds), I would get five precious minutes to speak to the orthopedic doctors. This time was invaluable. It allowed me to address unit problems, relay critical trends in care, and bring the concerns of nursing to our physician partners.

The spine doctors were a different story. Month after month I would ask them to meet, and no one would show up. I was frustrated. How could I get the neuro and ortho doctors on the same page if I couldn’t even talk to them? This was a new unit, and there was a lot of work to be done. One day, one of the spine physicians stopped by my office, and I asked him point blank why the attendance at my meetings was slim to none.

“Because we already meet once a month at a physician’s house,” he replied. “It’s called ‘Journal Club,’ and we are meeting tomorrow night…. So no one is going to go to your meeting today when we can all see each other tomorrow evening.”

“Whose house are you meeting at?” I replied curiously.

“Why, Doctor Wagner’s,” he replied slowly.

“Great,” I said boldly, “I’ll need directions.” Reluctantly, he gave me the address.

The next evening I drove through one of the most expensive areas in all of Seattle until I pulled up in front of a huge mansion on the water. Nervously, I approached the front door. My heart was beating so loudly that you could have taken my pulse by just looking at me. The giant door-knocker reminded me of the scene from The Wizard of Oz where Dorothy is shaking uncontrollably as the wizard’s voice booms. But as I approached the door, I saw a small note posted there that read, “Just come right on in.”

AGH! It was difficult enough to knock on the door, but to “just walk in?” Nervously I opened the huge solid oak door and followed the trail of voices through the massive entry hall into a dining room clearly intended for a king. The view of the lake was breathtaking. As I came around the corner, I could see three spine physicians eating pizza and drinking beer while waiting for the rest of the group to arrive. The room reeked of testosterone. For just an instant, shock and disbelief flashed across their faces, escaping only briefly before being politely recalled. Suddenly, I felt like a covert operator infiltrating enemy ranks.

Graciously, the physicians offered me a drink and I sat down at the table. When the entire group arrived, one by one, they shared their assignments, which were reviews of the latest journal articles, as I sat silently without ever saying a word. Clearly, this was not the time or place for a discussion on the problems the nurses were having on the unit with the various physician orders. I sat and listened through the evening.

Even though it was a struggle at times to follow some of their complicated jargon, I came the next three months as well. Finally, after the fourth month, a physician said, “Kathleen, why don’t you present next week?”

“I would love to,” I replied. “The nurses have noticed that some physician’s patients are up walking faster than others and we have linked that to the use of Toradol post-op. I would like to present the research on this topic.”

I can think of nothing that elevated the profession of nursing more in the eyes of those physicians than the nursing research I presented at these meetings for a year. At last, we felt like we were at the same table. The nurses joked and said that I belonged at Journal Club because I had “the balls to even go in the first place.” The change was gradual, but over the months my relationships with the spine physicians became more comfortable, and I no longer shook with fear as I approached their houses. Physicians gave me more of their time on the unit where I did bring up the problems with various order sets, and we eventually reviewed these at a Journal Club meeting. I called them by their first names, just as they called me by mine. Finally, despite the differences in education, class, role, and gender, it felt like we were actually partners in patient care—thanks to a successful covert mission.

. . .

KATHLEEN BARTHOLOMEW, RN, RC, MN, is a Practicing Orthopedic Nurse and national nursing speaker, as well as author of Ending Nurse to Nurse Hostility, Speak Your Truth: Strategies to Improve RN/MD Relation- ships, Stressed Out about Communication, and coauthor of Our Image, Our Choice.

Saving Patients from Dr. Death

Toni Hoffman

I first met the surgeon who came to be known as “Dr. Death” when he was hired to work in our small rural hospital, Bundaberg Base Hospital, in Southeast Queensland in 2003, where I was nurse unit manager in the intensive care unit. Dr. Jayant Patel, who’s been implicated in eighty-seven patient deaths and was hired as a general surgeon, came to us from the United States. No one had ever really checked up on him—and no one had ever bothered even to Google him. That would have saved a lot of lives and a lot of anguish.

Only three weeks after his arrival, Dr. Patel was promoted to director of surgery. It didn’t take much longer to recognize that there were problems with his behavior and competence. Almost straightaway, he began to sexually harass staff. For example, while examining a sick patient in the ICU, he asked a female staff member for her phone number and then repeatedly called her at home to ask her out. He also wanted to perform the types of surgery that were way beyond the kind usually performed in our small hospital and had been—before his arrival—routinely transferred to larger hospitals in Brisbane. Although I and other nurses were very concerned about Dr. Patel, he quickly built up a strong rapport with our chief executive. He would say that he could do what ever he wanted because he was earning so much money for the hospital.

I lodged my first complaint about Dr. Patel five weeks after his arrival. His patients were coming to the ICU with serious complications—for example, with wounds—that we had not seen before. Operating theater staff would say, “Oh, Dr. Patel has nicked a liver or spleen,” but these incidents were never documented. Nothing happened when I lodged my complaint, and problems like these went on. I tried to approach other colleagues, but no one would do anything. I put in another complaint in June 2004, after a patient who’d suffered a serious chest injury wasn’t transferred quickly enough to Brisbane and died. Dr. Patel had interfered with the transfer.

I made my complaint, and the administration turned against me. The director of nursing, the district manager (hospital CEO), and the director of medical services claimed that this was a personality conflict and that I had trouble with conflict resolution skills. They also labeled me a racist. The focus had clearly shifted from him to me.

Nonetheless, the nurses in the ICU were trying to stop Dr. Patel from operating on patients. The medical doctors were, by that time, aware of the problems. Behind his back they were calling him “Dr. Death” and saying things like, “If I come in here, don’t let him near me.” Some did complain about him, but when they went to the executive, they were ignored. So we would conspire with the doctors to transfer patients out to Brisbane before Patel could get to them. Toward the end we were actually hiding patients from Patel.

After I put in my big complaint, the executive gave Patel an employee of the month award. That made it crystal clear that our complaints were not and would not be acted on. I spoke with other agencies within Queensland Health. I spoke to the coroner, the police, and the nurses’ union. Toward the end, I decided I had to go outside the organization. So I went to see a member of Parliament, Rob Messenger—who was in the opposition National Liberal Party. (Queensland had a Labour Party government.) I also contacted a journalist named Hedley Thomas.

At first Messenger didn’t believe me either. He rang up a doctor in town who said, “Yes, we know about Dr. Patel, and we hope he will go away quietly.” Dr. Patel’s visa was soon to expire. But finally, Messenger presented my letter of complaint in the Queensland Parliament.

Shortly after, Hedley Thomas came to our hospital to talk to the nurses. Then he did what no one else had ever done. He Googled Patel and discovered that his problematic history dated all the way back to 1981. He had been first disciplined for falsifying records and relinquished his license to practice in 2001 rather than face prosecution. He also had the dubious honor of being the most sued surgeon at Kaiser Permanente in Portland, Oregon. He wasn’t allowed to perform surgery in the United States. Then, of course, all hell broke loose, and the story emerged in public.

Patel fled back to Portland, Oregon, but was extradited in July of 2008. He is out on bail, awaiting trial on three manslaughter charges, several grievous bodily harm charges, and fraud. Because the Labour Party was in government and I went to a National Party member, there were significant political ramifications. The health minister was fired and was just sentenced to seven years in jail on corruption charges. The director general for health lost his job. Not to mention the poor patients who suffered or died. Dr. Patel operated on 1,400 people in the two years he was here and has been involved in at least eighty-seven deaths. But no one really knows how many people he harmed or killed.

For me, standing up for my patients was a difficult experience. Some people supported me and some didn’t. A lot of people can’t forgive me for goi...

Table of contents

• Acknowledgments
• Introduction
• Part 1 SET UP TO LOSE, BUT PLAYING TO WIN
• Part 2 WE DON’T HAVE TO EAT OUR YOUNG
• Part 3 EXCUSE ME, DOCTOR, YOU’RE WRONG
• Part 4 NOT PART OF THE JOB DESCRIPTION
• Part 5 WHEN ONE ADVOCATE CAN MAKE A DIFFERENCE
• Part 6 CHOKING ON SUGAR AND SPICE
• Part 7 APPLIED RESEARCH
• Part 8 STICKING TOGETHER
• Part 9 STILL FIGHTING