This blog has since long been visited by persons from every continent on the planet. I like that. I like that people can be connected with one another, that we can discuss important matters, share knowledge and information that makes it possible for us to create a better world for ourselves and our children.
Not all are though
on that page. Many are on their own page striving through reality to survive,
to make up for mistreatment and failure from family or society not having them in mind when creating roles and regulations set to diminish not to make a
child rise up and shine in its own way.
The more of those misfits
– not meant in a bad way - society creates the bigger the problem it must
solve. And the more they use different common structures to create a platform
for themselves the more dangerous a society for us.
It didn't take
long for me to realize health care is seriously dangerous, a mess and a mix of
uncountable unstable persons many on their own personal path - like animals on
hunt at the worst - working side by side with almost angel-like, naive
co-workers being easy targets for those who crave power.
I came from
economy, from being a bank clerk with responsibility of millions of crowns - everything
missing in the end of the day was to be paid by me. I had to be responsible or
it would cost me. I came to the health care organization where it is the patients
who have to pay for the mistakes of others. I've never gotten used to it
although 30 years has passed.
I do really hate
bad organizations unable to solve internal problems, blaming others, looking
the other way and getting more involved for every tragic misstep.
In the end even
the angel's glory has faded away and they drop out suffering from all kinds of
psychosomatic diseases.
It will address the fact there are few more difficult co-workers than doctors and there are few work areas more filled with opportunities to hurt one another and to create threats against those who work for changes, than health care.
My aim is to address the ongoing threat to the development of nursing science and to the growth of high level nursing education.
Three leading nurses in Sweden have recently warned of German doctors making claims in the EU to lower the level of our education.
I’ve seen that aim working in full power in the capital of Sweden, in Karolinska Institute, for soon to be 20 years
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Their dream doesn't seem to be to work together with strong and independent Swedish neonatal nurses but with young and sweet and depending girls not even on their way to understand they are about to harm the children they've come to protect - because their choise will be between caring for the doctors or for the children.
I think I've seen almost 150 nurses leave the NICU at Karolinska in Solna during my 13 years in the unit.
I've never heard of one who didn't want to stay.
- - - - - - - -
Add the next day - 20-01-2013
I don't like the article written by
the three Swedish nurses, although I liked that they brought up the question of
German doctor's are attacking the professional growth of the nursing
profession.
The Swedish nurses
write about areas where nurses and doctors compete, areas where both groups can
work and will do a fairly good job no matter who is responsible - it's a matter
of education and training.
What I see
necessary is to lift the areas where nurses cannot be replaced by doctors. I
see an urging need to lift what is the difference between nurses and physicians
- when is it that a nurse knows best and the physician should step back?
Of course, in the
end, it’s a matter of level of education.
I don't know a lot
about education in different countries. I know what I see and what I've learned
from my own education and experience - which includes studies including medical
care, surgical care, psychiatric care, obstetric care and pediatrics to get a
CGFNS certificate in the early 90'ies.
To be able to work
as a nurse in the US you need to complete an examination called "the
CGFNS" - the opportunity is given to nurses all over the world.
I went to Gothenburg in spring 1991 and spent one whole day with US authorities. I liked the procedure. Everyone was placed well away from one another. The placements given were registered so that it should be possible to trace people cheating together.
In Sweden i
sometime wonder if teacher find them to be smart, who can cheat their way
through an education. Especially is that the case with some men looking for
personal opportunity to make a career in the health care sector. I've seen it
more than once.
The test was made
in three different parts, first one medical test, then a language test -
although we had taken the Melab exam to be accepted to write for the CGFNS -
and finally - in the afternoon, one more medical test.
I was impressed by
the questions. I learnt a lot that day by the short, informative and well
thought through questions.
I'm still very
proud to say I didn't fail the test and that I have my certificate even though
my former husband and I never made it to the US to work - but that is another
story...
So what is it that nurses know that doctors don't? I will try to explain.
As a nurse you receive massive knowledge from physicians if your education is well built and if your workplace has high quality as a leading star.
Thereafter you are in a much better position than the physician - you are closer to the patient. You are standing bedside for hours if you work in neonatal intensive care. You see your suffering patient repeatedly in surgical care, in psychiatric care and so on. You have the unique opportunity that no other healthcare personal has of being allowed to disturb a physician with questions about a patient’s condition at any time - it is really good, and it's a source for solid education.
Myself I've been really lucky. As working as a night nurse in the county hospital Ryhov in Jönköping Sweden I was not depending on physicians under education in caring for the babies in intensive care or for the smallest of the premature babies.
I was to talk to a so called "neonatal back up doctor" about those babies. To never have to discuss those children with physicians under education - as I'd had to do my first years as a lonely night nurse working with only nursing staff - was perfect, wonderful, secure and really satisfying - my knowledge grow constantly.
This very week the hospital Ryhov has been chosen by the magazine Dagens Medicin to be the best big county hospital in Sweden. In 2009 the Childrens clinic in the hospital received a special award – “Swedish quality”. I understand that choice.
What takes place in time is a professional development inside a registered nurse. This has been described by Patricia Benner in her books “From Novice to Expert: Excellence and Power in Clinical Nursing Practice” and Expertise in Nursing Practice, Second Edition: Caring, Clinical Judgment, and Ethics”.
The nurse embodies the sum of what she had been given from the medical expertise with what she, herself, is observing in the patients. The more patients the nurse cares for, with the same disease or problem, the more she learns. While the physician is far from the patients, rushing from them after short visits the nurse is staying close to the problems connected to a certain illness. In time, as her/his experience grows the nurse start to experiment with different ways to handle different problems. That raises the knowledge even more. By trying different way to solve the same problem nurses, in time, knows better than the physician how to solve many problems – and that's when the problem starts.
Many doctors are unable to see that anyone can know anything about how to care for patients, than a physician. When I, a nurse with 28 years experience in neonatal intensive care, tell some doctors they need not to withdraw oxygen so rapidly in care for a premature baby some physicians act as if they’ve been stung by a bee.
If I don’t immediately back of, curtsy and say “yes doctor” I could sometimes worry of the risk of the doctor getting a heart attack. If you lower the oxygen level rapidly in WLBV and ELBV children their ductus arteriosus will open up. These babies need to be handled with care, they need small steps in almost every aspect of their care. The physicians in Jönköping knew that - because they understood the importance of listening to the observations of the nurse and to work together as a team. Many doctor’s in University clinics understand as well, but some don’t and they are dangerous as the children are smaller and more fragile and the power of the physician not seldom brings the thoughts to some kind of godlike creatures.
As a nurse you know a lot that many physicians cannot even process as "there are no scientific proves".
The best example of collision between nursing experience and physicians one-eyed screaming for scientific evidence - showing the blinding of a whole profession - is the attitude towards children and pain.
As late as in the 80’ies Swedish doctor’s held their own “knowledge” high in the issue. As me being a nurse student in Emergency unit a physician wanted to “educate” me. He said some nurse students and fragile nurses delude themselves to believe that children feel pain. He, himself knew better. There was no evidence, what so ever, for children being able to fell pain. Therefore he should sew a wound in the face of a 2-3 year old without painkilling the area first.
I came from high responsibility in banking and had been taught to think free and to be observant of security. I told the doctor he must be wrong. I said I had three younger siblings and a child of my own and I didn’t need scientific proves - I had an own ability to judge in this matter. I was sent out of the room while the doctor sewed and the child screamed.
When I started working in pediatrics I saw powerless nurses shaking their shoulders, saying there was nothing to do about it – if the doctor’s say there is no need for painkilling for children no nurse can do anything to change that …
Today
some of this has changed in Sweden. Physicians are well aware of children’s
ability to feel pain but they still have not realized the useful knowledge
among nurses working by their side daily.
From
the day doctors discovered the pain issue they promptly took control over the
problem. They formed instruments to measure pain that are as rigid it isn't
working. Many different problems cause similar symptoms in the children. Before
Swedish children’s nurses gave reports including every aspect of the child’s
condition to help the doctor to find out if the child was in pain, had an
upcoming infection, needed less or more food, needed to get a catheter in the
urinary tract due to already ongoing treatment with painkillers, and so on.
Today nurses with all kinds of education, but for children, are reporting a
figure from a scale and doctor's from any country are prescribing painkillers intravenous not yet tested on small children, after getting rid of Swedish doctors to gain
own position and power.
I came, as I’ve told, from economy and high security and thought it was insane that one profession had such a power that no one could question.
I’d already seen it as working as staff in psychiatric care for five years, before becoming a nurse. There’d been teams with a physician – not seldom under education – psychologist, social worker, psychiatric nurse and special trained psychiatric staff discussing the patients. Over and over I’d seen physicians overrule the suggestion of a team with the same opinion to disadvantage for the patients.
Of the team members the person most far from the patient was the doctor who held on to his/her biomedical explanation to psychiatric problems as hard as a python clings to a prey. It was horrific – like a horror movie and it was the reason why I left psychiatric care.
Today doctors have managed to maneuver out psychologists from many units in psychiatric care. It has recently been discussed in Swedish media that children are put on medication for what should be seen as normal behavior or reactions in a crisis as for example the divorce of their parents, the children being forced to leave their home and friends maybe seeing their parent drown emotionally in a new relation and without solid network for the emotionally abandoned children.
In neonatal intensive care the nurse is more important than the doctor.
There is need of a physician if the child cannot breath or if it has an illness but the problem in neonatal care is primarily to create an environment that is no danger to the patient, to use equipment in such a way the child isn't injured, to keep up hygien standards at a level used for patients with suppression of their immune system, to provide food in a way that the immature bowel can endure, to prevent neurological damage by keeping the child in a nest similar to the mother womb, to prevent problems in the future by helping the parents to recognize the childs way of communicating and to build the relationship - and much more.
There is a need in health care of someone balancing the physicians not every day, not in every small issue but sometimes when they lure themselves and one another that children do not feel pain, that the only way to close an open ductus is Pedea, when they don't understand that listening to others is a way to learn and we all need to learn.
To work with doctors has been a true blessing. I've loved to be surrounded by knowledge, to work with someone who has the answer to much that I will never learn, to listen to wise men and women discussing the best way to solve a medical problem.
But I've hated to take care of young nurses who has been crying at work and fainted by the roadside on their way home from work, overloaded by the diminishing treatment from physicians on amphetamin or embodying plain stupidity in their craving for personal power. And it has been plain suffering taking care of parents of children who has been born healty but has had their bodys destroyed by incompetence and ignorance by doctors who refuse to acknowledge the knowledge in the nursing profession.
The change of the nursing education is absolutely necessary. Health care organizations needs nurses who can stand up against doctors claiming that children feels no pain - or, one of todays problems - that they have no taste and you can feed them with anything by mouth without developing feeding problems and millions of other details that seems small but creates huge problems that will be expensive for society in time.
Nurses in Europe need help today to lift our knowledge, to explain why we are needed and what our knowledge is about.
There need to be tests like in the US before a nurse or a physician is accepted in another country.
Since some years doctors in the neonatal units i Stockholm, the capital of Sweden, has imported German nurses from ICU for adults to care for the tiniest babies born in our country. One of those nurses told me they are not even allowed to work with older children back home.
After pushing specialized childrens nurses out of the unit for years, and after driving several head nurses to breakdown, the import of the German nurses begun. Most of the ones I worked with didn't know Swedish as well to understood reports at the beginning. The smallest baby at the time weighed 374 grams - or maybe 347, I'm not sure, I'm way too old to care too much about such things. I care about the organization, the education of personell and the development of cooperation between nurses and doctors.
In the US you need to be tested if you want to move from Nebraska to Colorado to work as a nurse. In Europe there are no such demands.
Todays strategy in health care, at least in Sweden, is as putting up a tent on the back of a grizzly still sleeping when snow has begun melting...
To
end with what I wrote in the beginning.
Health
care is tricky business and there are many ways to gain power.
There
are some really good neonatologists at Karolinska in Stockholm - no one outside
the unit can know who the good guys are and who the bad are.
The good ones
strive under gruesome conditions well aware one who is a friend today can be an
enemy to count on the day after tomorrow.
