You need a sense of humour

Everyone in health care knows you need a sense of humour in order to stay in the game. It's sometimes dark, outsiders would be shocked to know what we find funny. But, it isn't because we don't care. The reason I went into nursing (besides the high pay, great hours, and interesting smells) is because I actually do enjoy caring for people. But, you need a defence mechanism when things don't go right. We also reserve the worst for each other. Pranks are common place and legendary, there are plenty of websites devoted to that.

The Ishihara Color Blindness Test is a commonly used test to see if someone is colour blind. Most people are familiar with them, it's a common test done at eye doctors and at the DMV.

If you look at the image above you will see the number, "35" - as long as you have no colour differentiation issues. If you only see a, "3", "5", or no number at all then you are colour blind to some extent. A fun website Fake Science published a nifty image to share with a special colleague.

This lovely image was presented to a particularly blond nurse who stared intently at it before pronouncing, "I can't see any number." All of us get a a good giggle at this. The team are about to go looking for the next victim when the nurse proves her blond hair is natural.

"But, I'm not wearing my glasses."

The hardest thing I ever had to eat

Being a freestanding psych hospital, my unit is not required to follow AB394 - California's law requiring a certain ratio of licensed nurses per patient. Most of my peers work under the law and are used to assuming primary care for five patients. This means they are responsible for the direct care, the medications, everything. While I have 11 patients, I am fortunate to have a Licensed Vocational Nurse (LVN) to pass my medications and two Certified Nursing Assistants (CNA) who spend the most amount of time with the clients. And I appreciate my staff tremendously, especially my CNAs.

One CNA was nick-named, "Bok-Bok" because she sounded like a chicken when excited. She was a fantastic CNA and a kind soul at heart. Loud and friendly, she also spoke in a sing-song voice at times. Bok-Bok arrives one day and announces, "Oh, Tom! I have a present for you!"

Allow me to describe the "delicacy" from the Philippine Islands that is called balut. You start by going over to the Philippines and look for a duck. Ensure it is a female duck and that it is sitting on a nest of fertile eggs. Just before they are about to hatch, snatch one away from her and then bury it. Forget about it for a while. When the urge hits you collect them up and send them in an unrefrigerated cargo ship across the world to America. Have them leisurely delivered to an Asian market in San Diego, all the while still unrefrigerated, and put them up for sale where a CNA can snicker while buying it and giggle all the way to work so she can hand this rotting egg to her charge nurse and watch him eat it.

In fact quite a crowd gathers. Everyone wants to see Tom eat the egg. "Ok. First you crack the egg," begins Bok-Bok, "Then you drink the soup."

I listen to her sing-song voice and wonder if I am at the butt of some practical joke. A CNA whispers to another in Tagalog. I don't understand it but assume it's something like, "There is no way that white boy is going to eat that." I crack the egg and see this purulent, yellow-tinged liquid inside. Deep breath and suck it down. It does taste reminiscent of chicken soup.

"Now you eat the inside."

I look back in the egg and my stomach drops. There's a face looking up at me. A feathered face with a beak open and frozen in time. It is connected to a body. With wings. More feathers.

"Oh, you need to use a little salt."

She hands me a packet of salt. I feel as frozen in time as the baby duckling staring up at me. A hushed silence in the crowd watching me. My hands, feeling like lead, sprinkle the salt into the egg. The spoon pries out the embryo and it somehow enters my mouth where I begin to chew. Tastes just like hard-boiled egg. Except the image in my mind is still on the feathered face that is now being crushed by my molars.

Cheers erupt from the Philippinas watching. Retching noises begin from the others who were watching - along with moans, "I can not believe you just did that."

Thank-you, Bok-Bok.

The American educational system is as good as Lithuania

I have always been astounded by some of my non-nursing peers and the salaries they draw. Social workers are a good example; I have worked with many graduate-prepared social workers (that's about six years of post-secondary education) who earned about two-thirds to half of what I did. Some were envious of the salary but not the educational requirements, "Too much science and math."

The current issue of Newsweek has done a great job in detailing the misery that is the American educational system of today. Here are some lowlights:

• Over a third of teachers come from the lowest 5% of SAT scores.
• Students with two strong teachers in a row (successive grades) will eventually excel no matter what their background while students with two weak teachers will not recover academically.
• In most states teachers are given lifetime tenure after two or three years teaching. This means they can not be fired, even for cause.

The article is filled with examples of teachers who are not just weak but malicious - yet still teach. A quick search on the Internet finds many more examples of why really bad teachers can keep teaching. Santa Barbara High School teacher Matef Harmachis has threatened, sworn at, and made lewd comments to students but keeps on going. The school spent a million dollars trying to fire him without luck. A million that could have been spent of bonus pay to teachers who demonstrate success. Los Angeles has it even worse. They currently pay ten million dollars a year to teachers to do nothing, literally nothing. Some 160 teachers who have been accused, among other things, of sexual contact with students and other staff, harassment, theft or drug possession. The union rules prohibit them from doing any useful work such as grading papers, filing, or even stuffing envelopes. They simply sit.

Teachers rarely have student's test scores as a measure of their proficiency. In New York it is even illegal to tie student's scores to their teacher's evaluations. Powerful unions ensure that the system is set up so that teachers are not accountable for their student's failings. What other measure could be used to evaluate a teacher?

Nurses earn more money than doctors?

I recently saw an article on Yahoo with the headline of nurses being paid more than doctors. The title is misleading, the actual article goes on to explain that Certified Registered Nurse Anesthetists (CRNA) make more money than family medicine doctors. It's a poor comparison, CRNAs have an extensive (and expensive) education and do not represent the earning potential of regular nurses. Family medicine physicians are the lowest paid doctors and do a year less residency than other MDs. Let's see a better comparison:

Salary data for Surgeon, Family Medicine, and RN come from the US Bureau of Labor Statistics (BLS), the CRNA Yahoo article quoted above. I note that the BLS reported a lower figure for family medicine than the article. I also note that physicians are paid during their residency while the CRNA is free labour during their MSN.

I am, in no way, denigrating the family medicine physicians. They are in short supply, not because of the lack of demand but the lack of interest by many medical students to enter the field. Prestige and additional money await specialists and bright students are encouraged to actively avoid the role of primary care medicine. High office overhead with an ever-increasing bureaucratic maze created by private insurance companies makes primary care less attractive as well.

I also suspect gender has a lot to do with this issue. Women now outnumber men in medical schools while men are entering nursing in larger numbers. Any field that is dominated by women has traditionally been poorly compensated. Doctors in Soviet Russia had little prestige and were very poorly paid. In all specialities except surgery. It is no surprise that the ranks of physicians were mostly filled with women except for surgery - almost entirely male. I see more and more of a slide in the salaries of Western doctors in the future. I also see continued improvement in the remuneration of nurses as more and more men enter the field.

Hiring new employees

Some time ago I was sitting in with my hospital's Director of Nursing for my daily chat and ventilation (a funny word we use in psychiatry to mean, "blow off steam") I noticed quite a large pile of applications for employment. Almost absentmindedly I started flipping through them when the DON said he was in a rush to go to a meeting and would I look through them and give them a rating from one to three. The "ones" would get interviews, the "twos" re-evaluated at a later time, and the "threes" would get round-filed (a funny term we use in business to mean toss into the great wastebasket of no return).

In my previous incarnation as a Clinical Nurse Manager I have seen a lot of job applications. I was still surprised by the quite hefty pile he had though, until I remembered that when I was hiring there was 1.4 unemployed persons for every open job in the US. The most recent stat is 6.7. There are a lot of people looking for solid work with benefits, hospitals offer that. If you ever wondered why some applications get to the front of the pile while others are dismissed outright - read on.

Always use a cover letter.

This shouldn't be more than two paragraphs or so but should clearly show exactly what kind of work you are looking for as well as your qualifications. I won't immediately toss an application without a cover letter but I hate rifling through an application to see what position you are applying from and whether or not you have any previous employment or education to back it up. If you are not applying for a specific job you will not be considered for any job. Always check to see what is available; the position doesn't necessarily have to be open (we rarely "save" CVs but often there are opportunities in organizations that are available but not posted for some internal reason) but make sure it at least exists.

Nothing beats a clear, typed resumé or CV

If you show up to an organization they will often ask you to fill out an application. By all means obey but attach your printed CV to it. No fancy colors, no bizarre graphics. It's probably going to be photocopied anyway so ensure it looks good in black and white. Your contact information should be clear and "normal" - if your email address is "sexygrrlll69@hotmail.com" I will giggle briefly before tossing it. Lie about anything and I will find out during the background check. It's an instant blacklist then toss. Use a diploma mill (I look up every institution I do not know) and you will get my derision then blacklist then toss.

Unless you are applying for an academic or executive level job, two pages is the maximum.

Handwriting counts

Anything that you can type should be typed. Perfectly, no spelling or grammatical errors. That which you must write should be neat and similarly free of errors. While many health care organizations are switching to electronic records there are many more that rely on paper and pen for communication. If your application looks like crap I know your work will be even worse. If it asks for a criminal history then again, be honest. It will turn up in the background check and even the smallest employers use online services that cost nearly nothing but find everything. I read today someone wrote under criminal history, "I have a misdemeanor, I don't remember when." Seriously, do you really think I believe you forgot the time you were arrested, tried, and convicted of a crime? Please.

So, what happened to the pile of applications? Out of the twenty-odd applications, four received "ones". Five failed one or more of the above and received "threes". The balance went into a pile to be looked at another day...

Violence towards nurses

While national nursing organizations, nursing unions, and most employers tell you that violence against nurses is not tolerated in the workplace - the truth is that we get attacked. A lot. According to the federal Bureau of Labor Statistics, nurses have 12 times the rate of days off because of assaults in the workplace. That's double the rate for police officers.

I work in mental health, specifically psycho-geriatrics. Many people, especially fellow nurses, roll their eyes and say, "Well, of course you're going to get hit." It's part of the nursing culture to accept abuse. A booklet published by the Occupational Safety and Health Administration (OSHA) in 2004 noted that violence in health facilities was, “...likely to be underreported, perhaps due in part to the persistent perception within the health care industry that assaults are part of the job.”

Today I received a good scratching and a blow to the ribs from a patient. It reminded me that we spend very little time discussing this subject in nursing school and often it is not at all addressed in specialties outside psychiatry. We are not alone though. In a 2006 survey by the national Emergency Nurses Association, almost 90% of respondents said they had experienced violence in the previous three years, and 20% said they encountered it frequently.

Fewer and fewer students are entering the nursing profession. The U.S. Department of Health and Human Services report that the average age of RNs climbed to 46.8 years, the highest average age since the first comparable report was published in 1980. They go on to say that just over 41 percent of RNs were 50 years of age or older (33 percent in 2000 and 25 percent in 1980). As for the young blood in nursing, only 8 percent of RNs were under the age of 30, compared with 25 percent in 1980.

There are many reasons young people are not choosing to go into nursing. The public understands the unpleasant shift hours, the stress of an ever increasing technological environment coupled with more and more limits to resources, and the difficult science requirements to get into nursing. What the public doesn't know is that we also work in a culture where violence against us is both ignored and accepted.

The great American lie - you have health insurance.

The biggest barrier to universal health coverage for the United States is the commonly held belief that their own health care will suffer if a public option is available. This is like saying that your drive to work will be impaired if there is public transportation. That's silly. In fact, your drive to work is safer with public transportation. Public transportation means less cars on the road and if you loose your car you can still get to work. In this analogy there may be occasion where the public transportation is even better or more cost-effective than driving your own car. But, you have a choice. Without the option of public transport you have no choice. And that is what health care is like now.

If you are fortunate enough to be over 65 and have Medicare you have one of the best insurances there is. You know this because your congressional representative is using it right now. There are options to opt-out into a private system. There are plenty of insurance companies who are very eager to take that Medicare money and give you their plan - it's called a "carve-out". The problem is their plan sucks. I know, I deal with those individuals who would normally have very attractive insurance (Medicare) for us health care providers. But, when they need services, the carve-outs provide very little service or deny service completely. They promise you that they are more efficient and cost less than Medicare (co-pays and such) but they take out a profit from that piece of Medicare pie and are constantly looking for ways to squeeze more out of you. "No, sir. That medication your doctor prescribed is not covered. Neither is that hospital. You will have to pay the whole costs out of pocket." If you take away nothing else from this, please know that Medicare is gold as insurance. Never sign over your Medicare insurance to a private company, never let loved ones do it either.

Until you get Medicare, you do not have insurance. What you have is health care that is held over you by the whim of your employer. The percentage of the population covered by employer-based health insurance has fallen every year since 2000, from 64.2% to 59.3% (US Census Bureau statistic). Your company could decide tomorrow to stop offering it, put the entire cost in your lap (which you may or may not be able to afford), or shut its doors. What about you leaving the company? Many people are tied to jobs they hate for health care reasons. Do you get benefits via your spouse? What about a divorce? Too many variables, too much uncertainty. This doesn't sound like insurance to me.