The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital (59 page)

Doctors’ substance abuse . . .
Ibid.

the nurses’ familiarity . . . the general population.
See, for example, A. M. Trinkoff et al.

tend to get sicker . . .
See, for example, Blythe Bernhard.

take patients’ doses . . . gave only one.
See, for example, Brandi Watters, “Prescription Pill Abuse Surpasses Street Drugs,”
Herald Bulletin
(Anderson, IN), January 26, 2010; Debra Dunn.

might sign out drugs
See, for example, Anne Geggis, “2 Lose Nursing Licenses Over Missing Drugs,”
News-Journal
(Daytona Beach, FL), April 1, 2006; Debra Dunn,

can steal prescription pads . . . didn’t actually give
See, for example, Blythe Bernhard.

or otherwise falsify hospital records
See, for example, “Seattle Nurse Pleads Guilty to Unlawful Theft, Diversion of Controlled Substances,”
US Fed News
, May 19, 2009.

take advantage when coworkers . . .
Interviews; See, for example, David C. Shampine, “Nurse Charged with Supporting Her Vicodin Addiction with Forged Electronic Prescriptions,”
Watertown Daily Times
(NY), June 8, 2012.

ate the gel . . . placebos
Robin Stein, “Did Nurse Take Patients’ Painkillers?”
St. Petersburg Times
(FL) South Pinellas Edition, December 3, 2005.

“Often, it’s our best people”
. . . “What to Do When Confronting . . .”

don’t necessarily act immediately
See, for example, Jason Blevins, “Addicts in Health Professions Flock to Get Peers’ Help,”
Denver Post
, July 23, 2009.

“should incorporate prevention . . .”
Interview with AACN spokesman.

AACN doesn’t monitor whether schools comply.
Interview with AACN spokesman, who said there is too much variability between nursing programs to comment further.

“enables an abusing nurse . . . there was a problem.”
Debra Dunn.

license suspension . . . penalties are possible.
See, for example, S. Trossman, “Nurses’ Addictions: Finding Alternatives to Discipline,”
American Journal of Nursing
103 (September 2003).

again work in healthcare
See, for example, “Nurse Gets 3 Years for Drug Tampering.”

Nursing boards are . . . out of the field.
Debra Dunn.

“The good news is . . . problem it becomes.”
Interview, Al Rundio.

Los Angeles Times
and Pro Publica investigation . . . “impose discipline.”
Tracy Weber, Charles Ornstein, and Maloy Moore, “Loose Reins on Nurses in Drug Abuse Program,” ProPublica and
Los Angeles Times
, July 25, 2009.

California eventually imposed stricter rules
Tracy Weber, Charles Ornstein, and Maloy Moore, “California Adopts Stricter Rules for Drug Abusers in the Health Industry,” ProPublica, November 20, 2009.

ended an anonymous . . . surgeries.
See, for example, Blythe Bernhard.

forty-one have non-disciplinary . . .
“Discipline/Continued Competency/Assistive Personnel Practice,” National Council of State Boards of Nursing.

fewer resources than doctors . . . severe professional sanctions.
See, for example, M. F. Shaw et al., “Physicians and Nurses with Substance Use Disorders,”
Journal of Advanced Nursing
47, no. 5 (2004). Despite the discrepancies between services for nurses and physicians, by focusing on treating a healthcare professional and getting her back to work, these programs at least encourage more people to seek help, rather than to continue to cover up their abuse and put patients at risk by working while under the influence.

“The rate at which nurses . . . representation.”
Ibid.

fewer than 1.5 percent of nurses
See Cynthia Clark.

140,000 nurses . . . what they’re doing.
Interview with Douglas McLellan by Eaves.

compassionately mentioning the topic
See, for example, “What to Do When Confronting . . .”

“The best recommendation is . . .”
Interview with Julie Rice by Eaves.

“It is every nurse’s responsibility . . .”
“ANA Unveils Bill of Rights for RNs,” American Nurses Association, cited in Debra Dunn.

legally responsible to turn in . . .
See, for example, Jane Hedrick and Stephanie Luck.

“the nurse becomes [the] nursed.”
See Patricia Welch Dittman.

“Nurses are frequently put”
The American Nurses Association’s
Code of Ethics For Nurses.

“Somewhere along the line”
Interview.

“So many things are just simply . . .”
Interview.

“on day one new interns . . .”
Robert S. Huckman and Jason R. Barro, “Cohort Turnover and Productivity: The July Phenomenon in Teaching Hospitals.” NBER Working Paper Series 11182, National Bureau of Economic Research.

“The July Effect” . . . in August.
See, for example, John Q. Young et al., “‘July Effect’: Impact of the Academic Year-End Changeover on Patient Outcomes: A Systematic Review,”
Annals of Internal Medicine
, September 6, 2011.

harms patient care . . . hospital stay.
Ibid.; See also Robert S. Huckman.

U.S. death rates . . . 2,750 deaths.
Robert S. Huckman.

“spike by 10 percent in July”
David P. Phillips and Gwendolyn E. C. Barker, “A July Spike in Fatal Medication Errors: A Possible Effect of New Medical Residents,”
Journal of General Internal Medicine
(August 2010).

August mortality rates
See, for example, Simon Rogers, “Will Patients Really Die This Week Because of New NHS Hospital Doctors?”
The Guardian
(London), August 1, 2012.

“beyond their capabilities.”
Rebecca Smith, “Thousands of Juniors Start Jobs in NHS ‘Killing Season,’”
Telegraph
(London), August 1, 2012.

in English hospitals . . . previous Wednesday.
M. H. Jen et al., “Early In-Hospital Mortality Following Trainee Doctors’ First Day at Work,”
PlosOne.org
, September 23, 2009.

“Nurses are correcting . . .”
Interview.

not the problem here
Interviews.

“I have had doctors . . .”
Interviews.

25 percent of the hospitals
Author correspondence with American Hospital Association spokesperson.

checking the “About Us” page
Author correspondence with Association of American Medical Colleges spokesperson.

“My reflex was as if . . .”
Interview.

“box shape . . .”
Interview.

“tell you the truth.”
Interview.

“Sometimes physicians practice . . . but staff knew.”
Interviews.

. . . wagered on patients . . . arriving via ambulance.
Interviews.

“games of chance . . .”
See, for example, R. T. Penson et al.

Different “codes” mean . . .
Interviews.

Some hospitals further . . .
Interviews.

Mr. Firestone . . . unresponsive patient
Interviews.

Ohio’s Cleveland Clinic . . . take it easy.
Interview, Rev. Amy Greene. See also, for example, Carolyn Gregoire, “The Amazing Way This Hospital Is Fighting Physician Burnout,”
Huffington Post
, December 2, 2013; Katie Sullivan, “Hospitals Try Holistic Approach to Treat Docs’ Stress, Burnout,”
FierceHealthcare.com
, December 3, 2013.

Cleveland Clinic’s healing . . . in times past.
Ibid.

Code Brown . . . a break to eat.
Interviews.

“Parents call to ask . . .”
Interview.

several props . . . down hospital hallways.
Interviews.

Plenty of nurses admit . . . “something with poop.”
Interviews.

occasionally use larger needles . . .
Interviews.

If breaking a rule . . .
Interviews.

“. . . few rings is a mistake.”
Interview.

personal interaction is against policy
Interview.

“We are working fourteen to sixteen hours”
Lois Berry.

without a strong support system.
Interview.

Even if I haven’t.
See Michelle Crouch, “50 Secrets Your Nurse Won’t Tell You,”
Reader’s Digest
, November 2011.

“We usually know the results . . .”
Interview.

toilet humor . . .
Interviews.

“Nurses are gross.”
Interview.

“happens all the time.”
Interviews.

The most common . . . plan of care.
Interviews.

“. . . lose-lose scenario.”
Interview.

“and not really. . . . counts the same.”
Interview with Arthur Caplan.

If there is time . . . choose differently.
Interviews.

slow codes
Interviews.

“There are lots of unsavory . . .”
Interview.

“Code 55”
Interview.

Some physicians will unofficially call . . .
Interviews.

“
Responders literally walk”
Interview.

“It’s often for the sake . . .”
Interview.

“not ethically appropriate”
Interview.

“. . . as comfortable as possible.”
Interview.

Respectful patients might get . . .
Interviews.

“I’m always happy . . .”
Interview.

“rest assured that every single . . .”
Interview.

Many hospitals also treat VIPs . . .
Interviews.

John’s Hopkins Marburg Pavilion.
www.hopkinsmedicine.org/the_johns_hopkins_hospital/planning_visit/room/marburg_enhanced_amenities_program.html
.

Nurses described accommodations . . . “because they aren’t famous.”
Interviews.

“The doctor is at your bedside . . .”
Interview.

“Half of the hospital is unavailable . . .”
Interviews.

If a hospital’s technicians . . . “it can be bad.”
Interviews.

Nurses have strong opinions . . .
Interviews.

“Studies show that patients . . .”
Interview.

patient with a history
Interviews

If you say something . . . “getting better service.”
Interviews.

“Sadly, doctors and doctors’ offices . . .”
Interview.

“If I could talk to”
Interview.

nurses do cry . . .“home from work.”
Interviews.

don’t portray hospital . . . “make orders, and leave.”
Interviews.

“make their rounds in the morning.”
Interview.

patients who survive . . . “Even in a hospital.”
Interviews.

“Doctors and nurses”. . . she has insurance.
Interviews.

“After that talk . . .”
Interview.

appreciate the fragility . . . “holy profession.”
Interviews.

California nurse Jared Axen
Interview.

transplant nurse Allison Batson
Alicia Tejada, “Atlanta Nurse Donates Kidney to Hospital Patient,”
ABCNews.com
, January 17, 2012; Helena Oliviero, “Nurse Donates Kidney to Patient,”
Atlanta Journal-Constitution
, January 29, 2012.

Batson saved his life . . . to help people
. Interview with Clay Taber.

“Nursing is a calling”
See, for example.
www.hhsnalumnae.org/TheNightingaleTribute.pdf
.

“Nurses are the glue”
Interview.

At six feet two inches . . . “sisterhood without any issues.”
Interviews with Dean Visk.

330,000 are male
U.S. Census Bureau, “Men in Nursing Occupations: American Community Survey Highlight Report,” February 2013.

41 percent of CRNAs are male
Ibid.

lingering public stereotypes
Interviews. See also Eve Tahmincioglu, “Men Are Much in the Sights of Recruiters in Nursing,”
The New York Times
, April 13, 2003.

“hold a high degree of masculinity.”
Kenny Thompson, L. Lee Glenn, and Daren Vertein, “Comparison of Masculine and Feminine Traits in a National Sample of Male and Female Nursing Students,”
American Journal of Men’s Health
(May 2011).

gay, feminine or “not man enough”
Interview.

stereotypes don’t bother them
Interviews.

“I realized after seeing”
Interview.

“It insults my profession . . . proud to be a nurse.”
Interview.

disproportionately assigned
Interviews.

“glass escalator” . . . across other fields.
“Men in Nursing Occupations.”

“Yes, I’m in a job . . . end of the day.”
Interview.

“It is incredibly fulfilling.”
Interview.

“Nurses can work individually . . .”
American Nurses Association’s
Code of Ethics For Nurses
.

“Our clinical skills are essential . . .”
Interview.

“Hospital finance people . . . expected to retire.”
Interview with Peter McMenamin. The Bureau of Labor Statistics estimates that 555,000 RNs and APRNs will retire over the next several years, but the occupational projections do not specify how many of those nurses are working specifically at hospitals.

“A hospital that now . . . sound long-term strategy.”
Ibid.

patient-to-nurse ratios . . . and patient satisfaction.
See, for example, “Workplace Violence: Assessing Occupational Hazards . . .”; Lois Berry and Paul Curry. For length of stay, infections, upper gastrointestinal bleeding, pneumonia, and failure to rescue rates, see also Jack Needleman et al.,“Nurse-Staffing Levels and the Quality of Care in Hospitals,”
New England Journal of Medicine
346, no. 22, May 30, 2002.