Letters

Nursing, Apr 2003

Another "do" will do

* I'd like to add another "do" to a recent Clinical Do's fr Don'ts ("Administering Medication through a Gastrostomy Tube," December 2002). Always use an oral syringe when drawing medications that you're administering through an enteral tube. Using a parenteral (LV.) syringe to administer P.O. medications can open the door to a potentially fatal error if someone mistakenly gives the drug through an IN. line that's compatible with the syringe. If you don't have oral syringes available to administer P.O. medications, ask the hospital pharmacy to supply them.

-HEDY COHEN, RN, BSN

Vice-President

The Institute for Safe Medication Practices Huntingdon Valley, Pa.

Is an honest nurse a liable nurse?

* I'm concerned about Penny Simpson Brooke's response to a query about short-staffing ("Patient Safety: Divided Allegiance," Legal Questions, January 2003). Ms. Brooke criticized a nurse for telling her patient that she couldn't answer his call bell sooner because her unit was short-staffed. According to Ms. Brooke, this statement raises concerns about quality of care that could be used against the nurse or the facility

Is Ms. Brooke aware of the nursing shortage? How does she suggest overworked nurses deal with institutions and managers who constantly understaff units and then write up nurses who voice their concerns?

I think her response smacks of the theory-practice gap. Perhaps she should reacquaint herself with the realities of a busy ICU.

-WILLIAM ANDREW, RN, BN

New York, N.Y.

I disagree with Ms. Brooke's response. We must be honest and sometimes apologetic about why we can't always come immediately when patients call us. We should help patients understand that we're doing our best, despite circumstances.

Don't insult my intelligence by telling me to discuss staffing concerns with administration. They're fully aware of the problem. Unfortunately, nothing changes until patients take their business elsewhere, someone files a lawsuit, or a tragedy occurs. In the meantime, we must continue to provide compassionate, nurturing, and honest care.

-LINDA CAPLAN, RN

Columbia, Md.

Penny Simpson Brooke, APRN, MS, JD, responds: I'm very aware of the real-life staffing problems nurses struggle with every day. But because I'm asked to give advice from a legal viewpoint, I can't ignore the basic assumptions of risk management when responding to a readers question. If I did, I'd be doing a great disservice to the next nurse who's fired for insubordination for ignoring facility policy, or who someday hears her words turned against her in court.

I commend any nurse who takes steps to report and remedy unsafe conditions in her facility. If she's exhausted administrative remedies and nothing changes, perhaps she should look for an employer who's more responsive to the needs of nurses and patients. Most employers face these dilemmas, but some are more committed to helping nurses practice safely than others.

Med/surf as a specialty

I agree with Cheryl Mee's support of medical/surgical nursing as a specialty, and an increasingly difficult one at that ("Medical/Surgical Nursing: The Overlooked Specialty," Dear Colleague, January 2003). I spent my first 3 years as a nurse working in a medical/surgical unit, and it was the hardest job of my nursing career. Juggling so many patients with complex problems and choosing what issues to address in a given shift was more than I'm capable of.

How to recognize medical/surgical nursing as a specialty is a complex issue. Every specialty needs ways to measure professional achievement. Career ladder programs, RN recognition, clinical certifications, and career development incentives will not only help acknowledge specialists, but they'll also help nursing as a whole survive. People can stagnate anywhere. We need success stories, role models, and encouragement to grow as a profession.

-KIM DIETIUCH, RN, CEN, BSN

East Fallowfield, Pa.

* I wholeheartedly agree that we should consider medical/surgical nursing a specialty. After graduating with a BSN degree 19 years ago, I started working in an ICU. Whenever I was floated to the medical/ surgical unit (which I didn't like doing), I was impressed with the way that medical/surgical nurses organized their work. I'm still thankful for their kind assistance.

-SUSAN ZEMKE, RN, BSN

Kenosha, Wis.

More about harsh instructors

* The letters you've published in past months regarding harsh nursing instructors brought to mind my experiences when I returned to nursing school a year ago. Three of my nursing instructors made my education a real challenge. They told some of my classmates and me that we'd never amount to anything. One of us was told she was too old to be a nurse.

Luckily, I finally connected with an instructor who offered support and encouragement.

I now work in a long-term subacute care facility, and I love being a nurse. To nursing instructors, I say: Please don't ever belittle a student. Your influence will have lasting effects; make it positive.

-TAMI SCHMISEK, LPN