When University of Louisville nursing student Nina Yoder blogged about her experience watching a patient give birth in a post entitled “How I Witnessed the Miracle of Life,” she may have thought she was just blowing off some steam. Well her school saw things very differently.

When school officials read Yoder’s post, which included a description of the baby as a “creep” and “a wrinkly, bluish creature, all Picasso-like and weird, ugly as hell, covered in god knows what, screeching and waving its tentacles in the air,” they moved to expel her from school by calling her into an office, searching her for weapons (apparently because Yoder had separately blogged about her support for the Second Amendment), and informing her she was no longer enrolled at the school.

That’s right. No hearing, no notice. Expelled from nursing school for blogging.

Not surprisingly, Yoder sued the nursing school in federal court for reinstatement–and won. U.S. District Court Judge Charles R. Simpson III ordered that Louisville reinstate Yoder because her blog didn’t violate the school’s honor code, confidentiality provisions, or principles of professionalism; the judge concluded that although the post was “crass and uncouth” and that Yoder’s attempts at humor were an “abject failure,” it wasn’t written in a professional capacity or from the view of a representative of the nursing school.

The school had argued that Yoder broke confidentiality principles and the school’s honor code by disclosing “the following identifying information about the birth mother: the number of her children; the date that she was in labor; her behaviors; the treatment that she underwent (an epidural); her reaction to labor (vomiting); and the reactions of her family.”

The court rejected that argument, though, finding that such information was non-identifying; types that would be considered identifying, according to the judge, include “the birth mother’s name, address, social security number, or the like….age, race, or ethnicity….‘financial’ or ‘employment related information’ [and] where she was in labor.”

Yoder maintains that her blog post (and others, such as those in which she mocks a suicide patient and calls alcohol abuse “a choice”) “is a mixture of fiction and satire, aimed to be an emotional relief from daily stress.”

Well Yoder won this round in court, but what do you think? What should students in RN programs be allowed to blog about? Did Yoder cross the line?

Guest post by Michelle Fabio, About.com Guide to Law School and frequent contributor at LegalZoom.com.

My particular take on this is that she crossed the line.  I’m not sure that she crossed it enough to be expelled without due process, though.  She was technically within the lines of HIPAA and thus did not break any laws.  But there are more appropriate ways of letting off steam.  Others will probably disagree with me, which is fine.  I personally found her comments very unprofessional.  -ed.

Nicole writes:

Doctors in general are type casted to fit a certain mold of the friendly family-man who helped you when you were a child.  You typically grow up with this mental image of your first pediatrician and the way he gave you lollipops when you behaved yourself during traumatic incidents like shots.  Doctors have typically been painted in the light of a saint, because for many people around the world, they have served to offer them a bit of humanity when the rest of the world turned their back.  The doctors who have helped treat patients in Haiti, African nations, or even war and poverty-stricken area are some of the most outstanding individuals that modern society can produce.

One of the first books I read in college was entitled The Rape of Nanking, which chronicles the destruction that the Japanese army caused on the Chinese city of Nanking.  Some of the main stories that stood out to me at the time (other than the fact that this huge massacre goes largely unnoticed in history books) was the account of the many Western doctors who offered their services to the residents, risking death in order to stay with their patients.  Once the war fully broke out, most foreigners fled the city, although around 25 remained in order to provide some protection for the citizens, establishing the Nanking Safety Zone.  The Zone itself was centered around the U.S. Embassy and was run by Nazi Party member John Rabe who was responsibility for saving nearly 200,000 Chinese citizens from death.  While this is an example of an old historical event, it is still a telling sign of the dedication to many of these aid workers; the Westerners who remained in this zone were true humanitarians who risked death every day in order to provide their services to Chinese refugees.

These types of scenarios are still occurring around the world, with more and more doctors opting to work in non profit sectors, thereby bringing aid to disease ridden nations.  Zimbabwe is one of the African nations which contains a multitude of illnesses with no funds to combat them; Doctors Without Borders “is an international medical humanitarian organization” which helps assist citizens who live in areas like Zimbabwe where diseases run rampant without government interference.  This non-profit organization was created in 1971 in order to help people around the world who are plagued by epidemics and violence; many third-world countries are unable to sustain their own populations and are in desperate need of such aid.  Zimbabwe itself is currently amidst the deadliest cholera outbreak in two decades because of the lack of proper sanitation and water supplies.  Many doctors around the world have flown to such places, leaving the comfort of their Western way of life, in order to make a difference in the lives of these people who have been driven to the brink of survival.

While these specific descriptions of doctors are no longer what many people around the U.S. imagine when they bring up doctors, it still holds firm to my own beliefs.  In a country where there are more lawsuits against doctors than praises for them, we need to remember that the entire purpose of a doctor is to save lives; this may not always be the case because of drastic circumstances, but they are true saviors in a time where many countries need them the most.

This post was contributed by Nicole White, who writes about ultrasound tech schools. She welcomes your feedback at Nicole.White222 at gmail.com

I don’t really read poetry… but this is the first poem to be submitted as a story to codeblog and I actually kind of liked it.  Richard Greenall writes:

Mine is not a story as such but a poem about a woman I cared for on m general ITU who had suffered lung trauma after smoke inhalation.

Weariness, like a wave,
Cascading through my head.
Causing thoughts, too deep to voice,
To be thrown up deep inside.

Awake! A cold rush of air to the lungs,
Feels good to breathe,
In… and out. In…. and out.
So easy, calm… effortless.

Beside me she lies there still,
Looks calm – thoughts racing inside.
What has life come to?
A monitor and peering eyes.

If she could talk, what would she say?
Will I get through this day?
The power of life, the call of success
Would make my answer, a sure yes.

Copyright Richard Greenall 2007

Lindi writes:

I’m a young nurse who works in a Pediatric Cardiac ICU.  I live in a house with three other roommates who all work hard but I don’t think they have any idea what my days are like.  It is refreshing to see 20-somethings act like 20-somethings, burdened only by the chain linked fence that will replace our rustic wooden fence in the back yard… And not by the child that just died today.

I return home from what should have been an easy day at work with a patient who remained in the ICU for some HFNC. . . . Enter an 18 year old mom.  This mother has been in the hospital for 5 months with her first born.  She is proud of what she has learned and is very comfortable with the equipment on her daughter.  She makes comments like “don’t you think I should be a nurse?”  I encourage her but in my mind I think about how much she needs to learn about her own daughter first.

She calls me at 1130 am for an update on her daughter.  She confesses that she just woke up.  I politely laugh and give her an update.  Her daughter finally gets to sleep when she arrives with the baby’s father.  I tell her she just fell asleep but she goes in and tries to wake her.  Talking loudly.  Lifting the baby’s arms up.  Turning the lights up.  Putting a cellphone up to the baby’s ear. “Your daddy is here! Wake up, you haven’t seen him in a while!”

Sure enough the baby wakes up, crying.   “Nurse she is awake and I think she needs her diaper changed.”  Frustration hidden with a smile I change the diaper.  I explain that in an ICU infants need their rest.  It is important to their recovery and growth. (Shouldn’t she know this after 5 months?  I think to myself)  With nothing but attitude she asks why her daughter is naked and not wearing her onesie.  I explain about her getting warm with a low grade temp.   While on my lunch break she has another nurse help her dress her little princess.  Sure enough her daughter overheats, spikes a temp, and now has to be pan cultured.  For 2 hours we stick needles into her without any success.  Mom stands there telling us we need to stick her in the forehead because that was where they got blood from her before.

Meanwhile, the child is naked again, fever gone.  Her temp was most likely environmental since her WBC were trending downward and she had no central lines… chest was closed and healed. We are torturing her child and she continues to tell us what labs we need to draw, how to draw them, what lights are to be dimmed, what the signs of infection are.  It is exhausting dealing with this woman.  I understand that parents feel helpless and having any sense of control over their child’s care makes them feel better.  But this woman needed to be a mom and not a nurse.  I am kind to her, although I really just want to call her at 5am when I wake up, put a cell phone to her ear, cover her in blankets and stick 10 needles in her forehead and  see how she felt about all of it.

At home my roommates laugh in front of the tv.  Talking about things that amuse them.  I enter a little high strung wondering about a crock pot that had been cooking since the night before.  I am asking questions trying to figure out if it had ever been cooled.  I realize their food poisoning was not that big of a deal.  Let them laugh about co-workers, eat spoiled food, and be 26 years old.  It might rub off on me and relax me.

Cat writes:

First, I’m not a nurse. But I wonder what you think of this (and this is NOT a criticism of anyone–just an open question.) My Mom is on a Telemetry floor after passing through the ER and ICU. She went unconscious during the night. Her BP fell and she was found to have double pneumonia. She has had congestive heart failure and spinal stenosis for several years. She has very limited mobility (sits and sleeps in a recliner, can still use a bedside commode with assistance.)

Okay, so I’ve been wondering why she’s in so much pain. I’ve asked every nurse that has come on shift (not in a pushy or rude way, either). I have carefully explained that I have never seen my Mom in this much pain, and she is not a complainer–but she’s complaining non-stop. She whimpers, cries, pleads and begs for help. Well, this has been going on for over 10 days. Today, they noticed her leg was rotated out and took an X-ray of her hip. Yup, she has had a broken hip for probably the entire time she’s been in the hospital. How did this happen?? (Or rather, why have my questions been ignored?)

I even had one nurse sit with me for 45 minutes and, I have to say, very patronizingly “explain” to me that Mom’s pain, while real, was exacerbated by her anxiety and lack of trust. (Hmmm….wonder how trusting I would be of people who were torturing me–or so it probably seems to my poor, confused Mom.) Let me just say here, I don’t blame any of the nurses. In fact, I believe they are some of the best I’ve ever seen. So my question to you is, how does something like this happen? This is a state-of-the-art hospital which has received national recognition as one of the top hospitals in the country. Yes, I know that “things happen” and sometimes, that’s just the way it is. I guess I am frustrated and wonder what your opinion is (you, the nursing community)? Do you believe nurses don’t listen to family members? (The condescending nurse assured me that she could “see” that Mom was not in “that much pain.”)

I hope I don’t sound like I’m blaming the nurses. Is there anything I could do so that this doesn’t happen to someone else? I can’t imagine having an untreated broken hip and being shifted around continually, being given physical therapy, etc.? (Mom was on decent pain meds, but still…) Do you think elderly patients fall through the cracks?
Okay, I’m done. Thank you for any feedback. I genuinely want to know what you think, and I hope I haven’t offended anyone. Incidentally, my Mom was a Registered Nurse for many years. I feel sick at seeing her treated (even though unwittingly) like this.

————————————————-

I’m very sorry that you and your mom have been going through this.  It has not been my personal experience that a broken hip would go undiagnosed for 10 days.  I find it astonishing that absolutely no one noticed that your mom’s leg was rotated.

Of course we as nurses encounter family members who want to advocate for their loved ones.  Sometimes they can be overbearing with concerns that are fairly unfounded.  But when I hear stuff like, “She isn’t a complainer, I’ve never seen her in so much pain before,” it sets off warning bells in my mind that something is really wrong.

I do think that elderly patients fall through the cracks on minor issues, but I’m surprised about your particular issue.  Can you imagine if she’d had no one advocating for her?  No family around?

Thanks for the submission.  I hope other nurses who read this will chime in with their thoughts.

“Zookeeper, RN” writes:

I am an RN at a very large public safety-net/regional trauma center/teaching hospital. It is a very interesting place to work as a nurse as there is always some kind of drama going on. I work on a medical floor where we see lots of infectious disease (HIV, MRSA, VRE, TB, c. diff, you name it), complications of IV drug use and booze, diabetes, renal failure, and many psych co-morbidities. As we are a public safety-net hospital, we see a lot of the same people over and over again because, well, no one else in town will take them.

One such gentleman we see quite often, we’ll call him Sammy, was assigned to me recently. Sammy is what happens when you drink too much for waaaay too long. His liver is shot and all those toxins that a healthy liver would filter out have permanently damaged his brain, so he’s confused, but pleasantly so. He’s yellow as a banana, and he has a history of leaving AMA (against medical advice) – he often will just get up and walk out. Which is another reason why we see him over and over. But I digress.

So Sammy is my patient. He wanders a lot, around and around the unit, talking to people and going into other patients’ rooms thinking it is his . On this particular admission Sammy has been wearing a flowery silk kimono over his hospital PJs. It’s kind of dirty but he refuses to give it up and I have 9 zillion other things to do besides argue with Sammy about his wardrobe. During my shift, one of my other patients codes, so I am tied up for a good hour or so. When I am done, I go check my other patients. Can’t find Sammy. I check all his favorite hang out spots – no Sammy. I have him paged throughout the whole gigantic hospital – he does not come back. I call Security and they look for him (”Oh yeah! We know Sammy” they say) – no dice. I am starting to think he has left AMA again. The ER is screaming at us because they have 50 people in the hallway down there that need Sammy’s bed.

We are about to give the room away when our unit secretary answers the phone. She starts laughing. She’s laughing so hard her mascara is running down her face. She looks at me and says “It’s for you.” I pick up the phone to hear “This is Officer So-and-So from Central Booking. Are you missing a man in a kimono?” As a matter of fact, I am, I say.

Turns out, Sammy did indeed decide to blow that popsicle stand and walked out of the hospital. He wandered up the street to the nearest drug store, where he was promptly arrested for shoplifting. Now, keep in mind he kinda stands out – his skin is day-glo yellow and of course, there’s the splashy kimono. (Side commentary: WHY do we bother arresting this guy? He can’t tie his own shoes let alone summon enough brain power to plot a crime. Total waste of taxpayer money). Anyway, down to Central Booking he goes where someone at last notices the hospital PJs and his ID band and give us a call.

An hour or so later, Sammy returns to my unit wearing a new outfit: a bright orange jumpsuit and carrying his kimono in a little plastic bag (very sad!) I ask him if he is all right. He looks bemusedly at me and says “Well sure hon, why wouldn’t I be?” I explain he left the hospital and was arrested. “I was?” he says. “What did I take?”

At this point I am thinking Sammy has suffered no injury from his adventure. And then he asks me for a sandwich.

Anne writes:

A friend once said that if you throw enough putty at the wall, something’s bound to stick!  Well, here’s some unedited putty.

I’d been practicing nursing for 20+ years when I was diagnosed with lupus and fibromyalgia and there was a nasty bout with previously well-controlled epilepsy. I needed to stop working, stop practicing my chosen profession of nursing.

I began freelance writing to occupy my time and found instant success and satisfaction; hey, I had my own byline and received pay, (albeit poor), for articles! This was life affirming, and at the same time invalidated feelings of low self-esteem because I was no longer able to work in nursing.

Several years later, a new clinical editor was unable to increase my compensation for a column that I was editing, so she called to offer me a place on the magazine’s masthead instead. However, before doing that, she needed to do a routine background check and call me back.

I’ll never forget that telephone call. “Were you aware that your license is no longer active?” I hemmed and hawed a bit, then then realized the unpleasant truth. I had moved from one state to another and planned to apply for reciprocity in my new state – but forgot.

I felt naked and numb all at the same time. This license was part of my identity!  As a result of my forgetfulness to renew my license, I was stripped of a title (RN) although no one could take away my degree (BSN).

In spite of the fact that I believe once you’re a nurse you’re always a nurse, I’m no longer registered and I can’t say that I belong to that larger collective of Registered Nurses. I’m not like ‘one of you’ anymore. I never thought that losing a license could make me feel so small and so humble and insignificant.

I don’t usually post this kind of story submission, but it does ring a bit true.  I do know preceptors sometimes have a difficult time providing feedback to their preceptees at the end of the shift, only to spring problems and issues on them later.  Anne, RN writes:

It was toward the end of my orientation as a new grad when I got a message from my day shift preceptor, wanting to know “how orientation was going.”  When I called her back she proceeded to tell me a long list of everything I had done wrong over the weekend with my night preceptor.  I was at home on the phone and she was at work talking to me, so I felt backed into a corner.

Meanwhile, over the weekend, my night preceptor told me I had done a great job as she scrambled onto the elevator to go home. I had given an antibiotic late on Saturday night and I had acknowledged it and the next day made sure I gave it on time. My night preceptor told me when I acknowledged my lateness not to worry about it since nurses that have been working for 20 years forget things sometimes. So I thought nothing more of the situation, that is until I received this phone call.  On her long list of things I had done wrong was that I gave this antibiotic late. Her other criticisms included only giving IV pain meds when the patient had PO ordered, meanwhile my night preceptor had told me that since the patient was NPO i shouldn’t give them because it would make her sick.

Then she proceeded to blame me for another nurse’s needle stick, which she later apologized for. She also said that people were saying that I didn’t care and that I always looked bored, which is completely not true. Most nurses go into nursing because they DO care. After 8 weeks how do other people think they can judge you on something so personal?  I had a lot of respect for my day preceptor until that day when she backed me into a corner, since then I can’t think of her in the same light as I once did.

My night preceptor was awful as I am sure anyone can tell, always giving me positive feedback and going behind my back to tell others that I was awful. On my first night shift with her she was talking about sex half the night, which made me extremely uncomfortable and as a new person I didn’t think I could say anything. Luckily my night preceptor has since left my floor but I still have to see her on occasion and my day preceptor has an important position on my unit.  I wanted to share my story because I think it is a great example of how nursing eats their young.  There were many nights when I went home crying and wanting to quit nursing.  Nursing is harder than I ever thought in nursing school, but I am a tough person and I have since successfully completed 3 weeks on my own!

And since it’s been over a month since I received this submission, hopefully Anne is now off orientation and doing well!

Anon, RN writes:

I’m trained as an ICU nurse but lately I’ve been picking up these shifts in an outpatient pain treatment clinic. It hasn’t been an easy thing to get out of that critical care mindset. In critical care you stick with the ABC’s (airway/breathing/circulation). In clinic nursing the first question after the procedure is, “Does my patient have a ride home?”

So I’m working there the other day. Pretty much twiddling my thumbs all day and bored out of my mind because there’s really not much to do except take vital signs and fill out intake forms. But then one of the clerks grabbed me.

“There’s a patient in the bathroom that needs assistance.”

Indeed there was. I found a patient who needed me to help her out of a little situation, let’s just say. So I got her cleaned up and brought her in to the room where she would have her procedure done. I slapped a pulse ox on. Her oxygen saturation was about 70%. With a very good waveform.

Thankfully my critical care mindset kicked right back in. Step one, get her on some oxygen. Step 2, find out what the hell is going on.

Turns out she’s a COPD’er (Chronic Obstructive Pulmonary Disorder – like emphysema) who uses oxygen at home, normally 3 liters. She told me sometimes she just doesn’t bother with the 02 if she’s making a quick trip somewhere. I asked her what about today? This is a little more than a quick trip. She said she ran out of oxygen, and they should be delivering it while she was out.

I got her down to 3 liters and her oxygen sats kind of waivered between 82-88%, which is fine for someone with COPD.

She was completely stable so the doc did the procedure at the bedside. Which was all for the best because at that point she was really in quite a lot of pain.

I asked the charge nurse what we should do about discharging her. This is where the story gets really crazy.

“She only needs to be close to her baseline, in order to be discharged.”

“Yes, but her baseline is that she is on home oxygen, which she didn’t bring today and her 02 sats are in the 70’s without it.”

“It’s okay. We’ve discharged her with 02 sats in the 70’s before.”

!!!

I explained to the charge nurse that it’s not okay to discharge someone with 02 sats in the 70’s. Especially if they “forgot” their oxygen that day. It was at that point that I decided I really had no use for this “charge nurse,” and tried to come up with an answer on my own. First I tried to find out if the patient’s son could go to her house and get one of the tanks that was being dropped off. No dice. He had no money for a cab ride and we couldn’t even confirm really that the oxygen had been delivered. I tried to find out if there were any kind of social worker around that might be able to identify some resources for the patient, maybe give her a loaner tank to take home. Again, no dice. So the only other plan was to take this patient to the ER.

We arranged for a transport person to come, and I went to find a portable oxygen tank for her. The charge nurse asked the transport person if he could return the oxygen tank to the clinic. “No, I can’t,” he said. Then the charge nurse said, “Well you can’t take it, then. If it leaves our floor it will never come back.”

!!!

At this point I decided I would transport her to the ER (it was the next building over) so I could bring the precious oxygen tank back to the clinic. Also, the patient was getting a little somnolent, which is never a good sign when you are worried about hypoxemia/hypercarbia, so I figured it would be best if a nurse accompanied her. So I took her to the ER, and got her safely checked in.

When I got back to the clinic there was some talk about how we can avoid this in the future, blah blah blah, we never should have done the procedure on her, yadda yadda yadda, and the conclusion was that if she turned up at the clinic again with out her oxygen tank, we should just turn her away.

How about some patient teaching?

How about some communication with her PCP to find out why she thinks it’s okay to go anywhere without oxygen?

How about a better EMR system so we could “flag” her and alert her other providers that she needs better education?

If anyone thinks we are even close to fixing healthcare, well. I’ve got some land down in Florida you might be interested in.

Submit your own story!

Here’s a story submission by Michelle G, RN. My thoughts are in italics at the end.

I called first thing this morning to see if they needed me to work extra. Sure enough, a scheduled nurse was not coming in. I show up on my unit which is the medical floor to see that I have been assigned 4 patients. Wonderful! Great not to have 5 right off the bat.

Today I take care of a gentleman who I had taken care of just 4 months ago. He was diagnosed back then with liver failure and was not a candidate for liver transplant. This admission brings him in with End Stage Liver Failure which means he could have a few weeks to under 6 months to live. He is in denial and refuses some of the treatments/medicines/blood draws. Patient’s wife is excited to see that I will be his nurse again with this admission. Patient has been noncompliant and has not been following medical advice. He is on a 1500ml fluid restriction but doesn’t seem to want to adhere to those restricitons nor acknowledge them. I gently remind him about his fluid restrictions during the day which seemed to agitate him. I explained to the patient why the fluid restrictions…there was a reason for this.

Well, now he wants a wheelchair to go outside. I know exactly what he wants to do….smoke. We are a smoke free hospital but I am not security. I explained I am not going to babysit him nor police him. I explained to he and his wife that we can not cure him nor are we going to give him anything that will make him better. If the patient wants the extra juice or cup of ice than who am I to restrict a dying man?! Who are we to deny a dying man’s last pleasures…ice, a smoke, a visit outside on a sunny day?

Much of nursing is not only carrying out doctor’s orders and educating the patient why those orders are there…but looking at the BIGGER PICTURE.

At the end of my shift; patient and family were greatful to have had a nurse that took the time to explain the disease process and plan of care but also most importantly to treat him as a human being with respect and care.

What do you think?

I think Michelle is absolutely right. If the patient is able to get all the information he needs, then it’s up to the patient to make the decision. If there is no cure what what ails – heck, sometimes even when there is – a life lived with restriction after restriction with no pleasure at all is probably not worth it to many people.