The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital (57 page)

prone to make mistakes.
See, for example, Brittany Hoover, “Compassion Fatigue May Cripple Health Workers, Expert Says,”
Lubbock Avalanche-Journal
, March 30, 2012.

fatigue alone can cause . . . ISMP Medication Safety Alert
, “Nurse Advise–ERR,” December 2005.

nurse burnout is linked to . . . $69 million a year
. Jeannie P. Cimiotti et al., “Nurse Staffing, Burnout, and Healthcare Associated Infection.”
American Journal of Infection Control
(September 2012).

Michigan Health and Hospital Association implemented . . .
See, for example, Tina Rosenberg, “Speaking Up for Patient Safety, and Survival,”
The New York Times
, Opinionator, April 28, 2011.

for every 10 percent . . .
“Study: Nurse Safety, Patient Safety Linked,” United Press International, November 8, 2011.

a national emergency.
See, for example, Meredith Mealer, “The prevalence and impact . . .”

99.9 percent of the nurses surveyed
. . . R. Erickson and W. Grove.

“I work where kids die”
Interview.

As Georgia nurse Brittney Wilson . . .
Wilson gave the author permission to attribute the quote. Wilson posted this comment at: Kevin Pho, “Should nurses be fired for fatal medication errors?”
KevinMD.com
, May 2, 2011.

all but three circumstances . . .
See, for example, R. T. Penson, “Laughter: The Best Medicine?”
The Oncologist
(September 2005). Globally, the use of humor in hospitals varies by the culture. In Taiwan, for example, nursing school professors teach therapeutic humor more than U.S. faculty, but use that humor less often in clinical settings because of a reverence for illness. See Lenny Chiang-Hanisko, Kathleen Adamle, and Ling-Chun Chiang, “Cultural Differences in Therapeutic Humor in Nursing Education,”
Journal of Nursing Research
17, no. 1 (2009).

humor can help patients . . . their treatments.
Ibid.

nurses use humor with patients . . .
See, for example, Howard J. Bennett, “Humor in Medicine,”
Southern Medical Journal
(December 2003); R. T. Penson et al.

staging pranks . . . bejeezus out of her.
Interviews.

hidden under a sheet . . . shrieking down the hallway.
Jim deMaine, “Gallows Humor is Only a Temporary Release from a Traumatic Situation,”
KevinMD.com
, November 13, 2011.

A California nurse has sprayed . . .
Interview.

Nurses have awakened night shift . . .
Interview.

“I am not the only nurse . . .”
Interviews.

When a young Southern nurse asked . . .
Interview.

“I’d been punk’d.”
Interview.

“It tastes infected . . .”
Interview.

urologists tend to have a lewd . . .
Interviews.

“We get very naughty . . . like you mean it.”
Interview.

A Texas nurse remembered . . .
Interview.

“gallows humor. . .” tragedy or death.
See, for example, Howard J. Bennett; J. Sayre, “The Use of Aberrant Medical Humor by Psychiatric Unit Staff,”
Issues in Mental Health Nursing
22 (2001); Karyn Buxman.

when a doctor calls out . . . die in one night.
http://themountainsarecalling.blogspot.com/2010/06/thoughts-on-death.html
. Used with the nurse blogger’s permission.

“circling the drain” . . .“Eternal Care Unit.”
Karyn Buxman.

“donor-cycles.”
Ibid.

“the departure lounge.”
“Gallows Humour in Hospitals Can Help Doctors and Patients Feel Better,”
Daily Mail,
September 27, 2011.

Gunshot wound . . . Celestial transfer.
“Tragedy, Black Humor, and Coping,”
Health Beat
, November 1, 2012.

In the middle of the night . . . they ate the pizza.”
Katie Watson, “Gallows Humor in Medicine,”
The Hastings Center Report,
September–October 2011.

nearly 90 percent used it . . . exercising (30 percent).
Anne Villeneuve, “Why Paramedics Go for the Punch(line),”
Dartmouth Medicine
, Spring 2005.

In 2014, a Virginia patient . . . up a rectum.
See, for example, Evan Bleier, “Colonoscopy Patient Sues Doctors for Making Fun of Him While He Was Unconscious,”
Upi.com
, April 22, 2014.

more than $5 million in damages
Elizabeth Waibel, “Patient Says Bethesda Practitioners Mocked Him During Colonoscopy,”
Gazette.net
, May 13, 2014.

derogatory humor, in which . . .
Delese Wear et al., “Derogatory and Cynical Humour Directed Towards Patients: Views of Residents and Attending Doctors,”
Medical Education
, January 2009.

make fun of patients’ names . . . locker.
Interviews.

“Status Dramaticus” . . .“into the Hilton.”
Interview.

hummed the Jaws theme.
Interview.

“only one joke per patient.”
J. Sayre.

targeted more than others . . . were removing.
R. H. Coombs, S. Chopra, D. R. Schenk, and E. Yutan, “Medical Slang and Its Functions,”
Social Science and Medicine
(April 1993).

trade anecdotes . . . hospital urban legends.”
Ibid.

“whose illnesses and health problems . . .”
Delese Wear et al., “Making Fun of Patients: Medical Students’ Perceptions and Use of Derogatory and Cynical Humor in Clinical Settings.”

“difficult” patients . . . “us all look good.”
See R. H. Coombs et al.

they usually intend . . . A lot.
Interviews.

“There’s nothing potentially funny . . .”
Ibid.

some ERs keep an orifice box . . .
Interviews.

glass perfume bottles . . . an entire apple
Interviews.

After Indiana nurses pulled a . . .
Interview.

he had swallowed “something . . .”
Interview.

required surgery to remove.
Interview.

phone pictures of amusing X-rays.
Interviews.

in meetings
See, for example, Delese Wear et al. “Derogatory . . .”

“difference between whistling”
Ibid.

humor helps medical professionals
Ibid.

“Sometimes when something happens”
Interview.

“find the bright side . . .”
Interview.

shown to improve doctors’ . . .
See, for example, Howard J. Bennett.

It allows them to express
See, for example, R. T. Penson et al.

“having a common sense . . .”
R. H. Coombs.

“How does it feel to be . . .”
R. T. Penson et al.

“stray bullet effect”. . . type of patient.
See, for example, Delese Wear et al. “Derogatory . . .”

“Critics of backstage gallows . . .”
See Katie Watson.

medical students use derogatory . . .
See, for example, R. H. Coombs.

“a safety valve for ‘letting off steam.’”
These arguments are more persuasive than the idea that people who need to fill long stretches of silence in the Operating Room resort to gossip and jokes. (One medical student reasoned, “What else are you going to do? Oh yeah, that’s a nice tibia . . . ? You have to say something.” See Delese Wear et al. “Making Fun of Patients . . .”).

“It’s almost more depressing . . .”
Interview.

“scandalous”
. . . Interview.

can empower healthcare workers . . . locate joy or playfulness
See, for example, Linda Caputi. “Humor in the Healthcare Workplace: A Cure for Stress.” Presented at the Healthcare Educators’ Conference, June 22, 2012; Karyn Buxman.

“Nurses need to blow off . . .”
Interview.

nursing school educators who used humor . . . to combat burnout
. See, for example, M. McCreaddie and S. Wiggins, “The Purpose and Function of Humour in Health, Heath Care, and Nursing: A Narrative Review,”
Journal of Advanced Nursing
61, no. 6 (2007).

“Start a collection . . .”
Karyn Buxman.

“When is behind-the-scenes . . . death won.”
Katie Watson.

“The nurse promotes . . .”
The American Nurses Association’s
Code of Ethics For Nurses
:
http://nursingworld.org
.

“Hospitals tend to focus . . .”
Interview.

base 30 percent of hospitals’ Medicare
HCAHPS Fact Sheet (CAHPS Hospital Survey), May 2012.

“Delivery of high-quality . . .”
Department of Health and Human Services.
Federal Register
, Vol. 76, No. 160, August 18, 2011.

Beginning in October 2012 . . .
See, for example, Jordan Rau, “Patients to Affect Hospital Bonuses,”
Kaiser Health News
, in partnership with the
Washington Post
, April 28, 2011.

percentage will double in 2017
See, for example, Laura Landro, “The Informed Patient: A Financial Incentive for Better Bedside Manner,”
The Wall Street Journal
, November 8, 2011.

Blue Cross Blue Shield
See, for example, Liz Kowalczyk, “Nurses Balk at Bid to Guide Dealings with Patients,”
The Boston Globe
, March 21, 2012.

Hospital Value-Based Purchasing Program
“Administration Implements New Health Reform Provision to Improve Care Quality, Lower Costs,”
Healthcare.gov
, April 29, 2011.

thirty-two-question survey . . . improved the patient’s medical issue.
See HCAHPS Survey:
http://www.hcahpsonline.org
, March 2014.

“my roommate was dying”
See “Scrubs Contributor,”
Scrubsmag.com
, July 4, 2012.

“This somehow became the fault . . .”
Interview.

“Many patients have unrealistic . . .”
Interview.

Medicare calculates scores . . . Not an average rating. “Always.”
Confirmed with a CMS spokesman; See also, for example, Cheryl Clark, “Top 12 Healthcare Quality Concerns in 2011,”
HealthLeaders Media
, January 4, 2012.

Medicare awards bonuses . . .
See, for example, “Administration Implements New Health Reform Provision to Improve Care Quality, Lower Costs,”
Healthcare.gov
, April 29, 2011: “Hospitals will be scored based on their performance on each measure relative to other hospitals.”

Washington, DC, and New York patients . . . lower ratings.
See, for example, Jordan Rau, “Patients to Affect Hospital Bonuses.”

either call or mail . . .
See, for example, Jordan Rau, “Test for Hospital Budgets: Are the Patients Pleased?”
The New York Times
, November 7, 2011.

a patient asked Molly . . .
Interview.

patients who reported being most . . .
J. Fenton, A. Jerant, K. Bertakis, and P. Franks, “The Cost of Satisfaction: A National Study of Patient Satisfaction, Healthcare Utilization, Expenditures, and Mortality.”
Archives of Internal Medicine,
March 2012.

results could reflect that doctors . . .
Ibid.; see also “Patient Satisfaction Linked to Higher Healthcare Expenses and Mortality,” UC Davis Health System Press Release, February 13, 2012. In an email to the author, Fenton clarified, “Most of our work on satisfaction pertains to outpatients, although some have generalized it to hospital care.”

“Focusing on what patients want . . .”
Theresa Brown, “Hospitals Aren’t Hotels,”
The New York Times
, March 14, 2012.

hospitals that perform worse . . . “definitely recommend the hospital.”
This is a conservative tally. I did not include hospitals that scored better than the national average on any one category, even if they had multiple categories in which they scored worse than average, because of the low but still possible likelihood that patients responding to the surveys fell into the “better” categories. I also excluded hospitals that did not have enough data in any one category for Medicare to rank them, in case highly satisfied patients filling out the surveys could have fallen into those categories.

“Patients can be very . . .”
Interview.

In 2012, when a white father . . .
JoNel Aleccia, “Hospital Granted Dad’s Request: No Black Nurses, Lawsuit Says,”
NBCNews.com
, February 23, 2013.

Hurley settled. . . $41,250 apiece.
Gary Ridley, “Hurley Paid Nearly $200,000 to Settle No-Black-Nurses Lawsuit, Records Show,”
MichiganLive.com
, March 20, 2013.

more than 61 percent of patients . . . in the bottom half.
See Saket Girotra, Peter Cram, and Ioana Popescu, “Patient Satisfaction at America’s Lowest Performing Hospitals,”
Circulation: Cardiovascular Quality and Outcomes
(May 2012). Some caveats: The 61 percent who would recommend low-performing hospitals is compared to 66 percent of patients at hospitals with high scores, Girotra noted in correspondence with the author. He added, “Although the difference between low and high performing HF hospitals was statistically significant, it was small. . . . Lastly, it is important to remember that the patient satisfaction ratings were provided by a sample of all patients discharged from the hospital and not just heart failure patients.” In addition, Girotra said that on average, patients treated at consistently low-performing heart failure hospitals were less likely to give high marks to those hospitals compared to patients treated at high-performing hospitals.

“is part of an ongoing national effort”
Sample Initial Cover Letter for the HCAHPS Survey, March 2013.

valet parking
See, for example, Nina Bernstein, “Hospitals Aren’t Waiting for Verdict on Healthcare Law,”
The New York Times
, June 10, 2012.