6/2/11   Issue LXVII  850-477-1234   850-477-1234   Toll Free 866-CDI-NURSE
Thanks for being a nurse

Douglas Terrell  RN
© Critical Difference Inc. 2011
6/11 to 12/11
Making a Difference
So your new supervisor has been appointed.  She seems nice but has no
experience in your specialty area.  Her supervisor feels perfectly content
with the decision.  She fits the need, a proven manager, and someone
who can staff and keep to the budget.  What is wrong with that?  Plenty,
says Michael Feiner, Professor, Columbia University Graduate  School of
Business.  He points out in his book Feiner Points of Leadership Business
Plus  2005, New York, NY, that a manager has to be able to do
Competency-Based Coaching.  Just as you would not send your child into
the street to practice riding a bike for the first time, even if the drivers on
the street were very careful drivers.   Neither should nursing
administration let someone run a department without being a master of
that specialty. If we are to create a pipeline of staffing, we have to depend
on supervisors who know their area of practice.  Without the ability or the
willingness for the supervisor to coach, the system fails.  It is about the
patient.  The staff that cares for that patient has to be constantly
improving; a once a year conference doesn’t get it.  It is shoulder to
shoulder coaching that moves us forward.  It is by this method the
apprentice becomes the master. Skip putting the master craftsman in the
mix and the system falls apart.   It is a measure of how bad things have
gotten that we are seeing this behavior.  What administrator appoints a
pediatrician as the head of nephrology? The supervisor has to be able to
defend, on the spot, the practice on her floor, and she has to do it at all
levels, from the JACHO inspector confused on a point of practice to an
outraged surgeon.  She has to be able to read a Tropinin T level and be
able to know what that represents to the patient, her nurses, her
department, and the medical staff who will soon be yelling orders.  A
supervisor’s role is to spend roughly 10% of her time on her budget, it’s
planning, implementation and evaluation for next year, 30% of her time on
staffing, schedules, and coverage issues, 30% of her time coaching,
moving her staff forward.
Electric Faucets more contaminated!
Hands-free electronic faucets can save a lot of
water — and because you don’t have to touch
them with your grubby fingers to turn them on,
have widely been assumed to help fight the
spread of germs too.  But a team at the Johns
Hopkins Hospital in Baltimore has discovered that
at their facility, electronic faucets were more likely
to be contaminated with Legionella bacteria than
the old-fashioned manual type.   “Newer is not
necessarily better when it comes to infection
control in hospitals,” said Johns Hopkins infectious
disease expert Dr. Lisa Maragakis.
The remaining  30% of her time spent on
administrative duties, defending nursing in
committees, and working to keep the pipeline
primed so the hospital and most importantly, her
floor has a supply of interested nurses.  The
supervisor who keeps you staffed - good.  The
supervisor who can coach, and create a working
9/2/11   Issue LXVIII  850-477-1234  850-477-1234   Toll Free 866-CDI-NURSE
Prehypertensive …Scary News           Even people
whose blood pressure is slightly higher than normal
(120-139/80-89)  may have a significantly increased risk
of stroke, finds a  review of past research. Hypertension
is known to be a powerful predictor of a person’s risk of
stroke and heart disease. But less has been understood
about the health consequences of prehypertension,
which effects about one-third of American adults. A new
study, published in the journal Neurology, suggests that
prehypertensive people have, on average, a 55%
greater risk of stroke than those with normal blood
pressure. Yikes!
Making a Difference
Dr. Charles Kahn’s words still stay with me from 30 years ago “the
work done by the least paid people in a hospital determines it’s
success”.  Our antibiotics are failing us; new super bugs are
evolving on an ever faster and scary scale.

CDC has found that pathogens can be found on surfaces dozens of
feet from where the patient had died, the patient having never left
her bed.  We are about to have to rethink what it takes to clean a
room for the next patient, or we should be. Housekeeping CAHPS
scores are almost always our lowest score, we don’t even meet the
standards of our patient’s expectations of what clean should look
like, let alone CDC’s.  We have to do better.  Our patient’s health,
our hospitals reputation and its funding depend on it.  Florence
Nightingale wrote that the first rule was to provide a clean
environment, clean air and clean water to the patients.  Well, we
have not met her standards either.  To change the paradigm one
has to totally revalue the housekeeping dept. Manned by the least
trained, least educated, lowest paid we are getting the best they
will ever give you.  Training has to be uniform.  A set video program
has to be used so that everyone, despite the environment they live
in, or the reading level they possess, start with the basics.  
Everyone who works at the hospital, be it an IT guru or accounting
manager starts at the hospital in housekeeping. The person
cleaning the bed, or mopping the floor may be your next boss. Want
to change the conversation on what needs to be done? Put an
administrator trained in problem resolution behind a bucket, and
they will clean up.  These folks only get to stay in housekeeping for
a week, but get their regular pay and are debriefed by an
administrator prior to joining their usual dept. to see where
improvements could be achieved.  Everyone starts in housekeeping.  
So if you are looking for a job in the lab and there is nothing open,
you start immediately at the hospital.  You get on the payroll and
become part of the talent pool working, not looking at a competitors
want list.  Housekeeping no longer becomes the most understaffed
dept. working with the least educated and worst paid people in the
hospital.  Everyone starts in housekeeping changes the picture and
gives us a chance to buy some time against the next super infection
destroying our patients and our facility.
IUD’s v. Cervical Cancer    Pregnancy may not be the only
thing intrauterine devices (IUDs) prevent. Women who use
the contraceptive devices are about half as likely to develop
cervical cancer, a new international study showed. That was
true even though the women in the study were no less
likely to be infected with human papilloma virus that causes
cervical cancer. Previous research had shown that use of
IUDs reduce the risk of endometrial cancer, the authors of
the study wrote.   
12/22/11   Issue LXIX  850-477-1234  850-477-1234   Toll Free 866-CDI-NURSE
Fat Cells Came Back !
A study published in the Journal of Obesity, found that fat removed
from the thighs and abdomen came back later, though in a different
location — typically the upper abdomen, but also around the
shoulders and triceps. The change in body fat was checked using
MRI and X-ray at six weeks, six months and a year.  At the end of
the year, about the same amount of fat was back, but it had moved
into new neighborhoods. Hernandez et al. Obesity (Silver Spring).
2011 Apr 7
Tall and Fat?
A new study shows that tall, obese men are more than five times
more likely than short, normal weight men to develop venous
thromboembolism, a potentially lethal condition marked by   deep
vein blood clots (usually in the legs) and blood clotting in the
lungs (pulmonary embolism). Arteriosclerosis, Thrombosis and
Vascular Biology: Journal of the American Heart Association. Apr
Making a Difference
History is filled with people who have survived terrible
reversals, torture, and privation.  When asked how they
had survived, they related why they had to live.  The
search for that why is the meaning of life.  In nursing,
we see people that have hung on to life by a thread
until a loved one arrived, and then slipped the bonds of
life.  These people had a reason to hang on, something
had meaning for them.  Equally, we have seen someone
retire, and very shortly thereafter, die.  Freud felt life
was the pursuit of pleasure, Adler felt it was power,
Frankl argued it was meaning.  He believed the two
deepest sources of meaning were from love and work.   
Looking around, one can find little rhyme or reason for
who people fell in love with (about half end in divorce).  
Let us look at work.  In nursing, we see life’s entire
continuum.  We are there when the infant takes his first
breath and his grandparent takes their last.  We are
there to guide folks through some of the worst
moments of their lives.  Nurses, by their very nature,
are the observers of life.  We know when the heart
rhythm takes a wrong turn or a wound is not healing
right.  We notice when someone is moving further into
depression, or when an infant’s nares start to flare.
These skills are not easily obtained and do make a
There are few professions that mix art and science as
does nursing.  It is as rich a source of meaning as one
can find.  How is it, then, that so many nurses are
suffering in their jobs?  Humans, designed as hunter
gatherers, were able to meet their caloric and shelter
needs in about 4 hours a day.  We have somehow
gotten the notion that 12.5 hours a day is an
acceptable work day.  We have to give it up.  I don’t
mean to say that we go to 4 hour shifts (though the
Greeks did talk about it).  After all, Neanderthals never
had to pay for a new Prius battery pack.

When you hear the grass is greener on the other side
of the fence,
remember, the most common reason is that someone
on that side of the fence is working her fingers to the
bone to make sure it’s watered.  If you find yourself in a
work area that doesn’t sustain your willingness to
serve, it may be time to move on.  All of nursing is not
made the same, and we are not made for all the
profession has to offer.  Before leaving nursing, jump
some fences, see what’s out there.  Finding meaning in
your life is heavily based on finding meaning in your
work.   It’s just too important to ignore.  You are too
important to nursing
Newsletters from 10/1/07, 6/24/07, 3/19/07
Newsletters from 12/19/06, 7/9/06, 3/9/06
Newsletters from 12/9/05, 9/9/05, 6/9/05
Newsletters from 3/9/05, 11/9/04, 7/9/04, 5/29/04
Newsletters from 12/21/07, 4/10/08, 6/1/08
Newsletters from 6/29/09, 3/9/09,12/29/08,
Newsletters from 3/9/10,12/9/09,9/9/09
Newsletters from 10/1/07, 6/24/07, 3/19/07
Newsletters from 12/19/06, 7/9/06, 3/9/06
Newsletters from 12/9/05, 9/9/05, 6/9/05
Newsletters from 3/9/05, 11/9/04, 7/9/04, 5/29/04
Newsletters from 12/21/07, 4/10/08, 6/1/08
Newsletters from 4/2/11,1/2/11,9/25/10
Newsletters from 6-11 to 12-11