"Nurse Jackie" Disappoints and Demeans

So, I just finished watching the first episode of "Nurse Jackie", the new Showtime television show about a nurse on the front lines.

What is so disappointing about "Nurse Jackie" is that, in the first five minutes of the premier, this insipid "dramedy" depicts the lead character snorting narcotics while on the clock, forging a dead patient's signature on an organ donor card, lying to said patient's family about the organ donor status of their loved one, and engaging in illicit sex with a coworker while her husband's at home caring for her two young children. Meanwhile, a 1st year nursing student pegs our heroine (or anti-heroine, if you will) as a saint, a designation that Jackie appears to aspire to, "but just not yet".

Now, I'm not so naive as to think that there aren't nurses out there who divert medications, have affairs with coworkers, and engage in all manner of improper behavior. But I take issue with the fact that even though nurses are the most trusted professionals in the United States on survey after survey, the media continues to portray nurses in derogatory ways that undermine our credibility and image in the eyes of the public.

While Florence Nightingale may indeed be the most famous nurse in history, Nurse Ratched of "One Flew Over the Cuckoo's Nest" is probably a close second. Sadly, the premier of "Nurse Jackie" does nothing to advance the cause of nursing in the eyes of the television audience, relying instead on gallows humor, sexual intrigue and drug diversion to add spice to a lackluster premier that demeans nurses and diverts the public's attention from the real story of nursing that is ultimately more compelling than any faux "dramedy" could ever be.

H1N1 Creeps Along

The H1N1 virus, otherwise known as Swine Flu, is creeping along at a slow but steady pace, and my work as a public health nurse amidst the outbreak of a novel influenza virus has certainly ebbed----for now.

As predicted by many, the virus is currently no more virulent than your average seasonal influenza, and while more cases and deaths are indeed expected, the rate of the spread of H1N1 is slow and steady rather than rapid and diffuse.

Still, there is a great deal of uncertainty as to what will happen when H1N1 goes somewhat underground over the summer, only to resurface in the Autumn, mutated and ready for the seasonal flu season. Epidemiologists are concerned due to the fact that the 1918 influenza pandemic began with a novel virus emerging in the Spring, spreading slowly but steadily, diminishing in the summer and reemerging in the Autumn, hundreds of times more virulent. Only time will tell.

Another novel aspect of this virus is that, unlike seasonal influenza---which predominately impacts older adults and those with chronic illnesses---the majority of H1N1 cases are those between the ages of 5 and 20, with the vast preponderance being between the ages of 11 and 15. The assumption is that those generations of children have never been exposed to this virus before, whereas the rest of us were alive in the 1970s during the last H1N1 outbreak. And whereas most children and young adults are healthy enough to fight off the infection, there are concerns about children with weakened immune systems and chronic illnesses. When children die from otherwise benign infections, people take notice, and this is an eventuality we all want to avoid.

Be that as it may, the H1N1 scenario is relatively calm for now, and those of us working in public health and other sectors of the health care industry watch, wait, listen, and hope that nothing more comes of this outbreak of a novel virus making its inexorable way around the world.

Bob the Nurse in California

For those of you who have not been following my other blog, The Adventures of Bob the Nurse, Bob is currently in California for a break from life in New England. His journey and adventures are being documented by his hostess, Gina of Code Blog, and we are now seeking other places for him to visit and enjoy.

If you would like to host Bob and send digital photos documenting his visit for posting on Bob's blog, you will be credited for each photo with a link to your website or blog, if you have one. Please contact me if you're interested in being a host for Bob, and pay his blog a visit, where a new photo is posted every day!

Thanks for coming along for the ride!

Change of Shift and Bob the Nurse

The newest edition of Change of Shift, that nursing blog carnival we all love, is currently viewable at Emergiblog.

I'm happy to report that our hero, Bob the Nurse, is prominently featured on Change of Shift once again, as is Digital Doorway.

By the way, Bob is about to take a trip to California, where he will vacation with the kind and hospitable author of CodeBlog. We have no doubt that photos will start pouring in as he gallavants in the land of milk and honey.

The Top 50 Nursing Blogs

I am honored that Digital Doorway has been included in a new list of the top 50 nursing blogs on the internet. The website named Online Nursing Degree Guide has compiled the list and published it today on their website, and I am very grateful for, and humbled by, their recognition.

Grand Rounds: The Diversity Edition

The latest edition of Grand Rounds---the most respected and widely known medical blog carnival on the internet---is now up at Health Blogs Observatory, with a general theme of diversity. I am honored to have my post entitled "Swine Flu and the Working Poor" included in such a fine edition of Grand Rounds.

Of note, Health Blogs Observatory is an "online research lab" which examines the health blogosphere, and I highly recommend spending some time perusing this interesting resource.

Mothers Day

Many wishes for a very happy Mothers Day to everyone who has ever been a mother, had a mother, or provided mothering to another person or animal.

While Mothers Day does indeed conjure expected and quintessential visions of motherhood, there are many forms of mothering and many kinds of mothers, and I want to offer a friendly and appreciative nod to anyone who sees themselves as a mother of any kind.

There are birth mothers, stepmothers, adopted mothers, those who mother injured animals, and men who mother their children. It's almost impossible to list all of those connected with mothering, but suffice it to say that this day recognizes the essence of motherhood and mothering, and I give thanks for my mother, my stepmother, my mother-in-law, my deceased grandmothers, my wife, and all of those who have mothered me in so many ways over the years.

Happy Mothers Day to all.

Swine Flu and the Working Poor

Several times today, the issue came up regarding what a conundrum the working poor face when forced to keep a child with flu-like symptoms out of school for a week.

With the CDC recommending seven days of home isolation for any child exhibiting a flu-like illness, we discussed in staff meeting what a difficult scenario this must be for parents who work in low-wage occupations that offer no sick time or personal time to care for their sick children.

As Barbara Ehrenreich so deftly illustrated in her seminal book, "Nickel and Dimed: On (Not) Getting By in America", the working poor are employed in occupations where not being able to come to work is almost ubiquitously grounds for instant termination.

So, when a single mother of three who cleans offices for a non-unionized cleaning company, she lives in fear of a child falling ill and missing school. Since her other family members also work in jobs they must protect by never missing a day of work, this "nickeled and dimed" wage earner is between a rock and a hard place when the school sends her feverish child home and demands that he or she not return for seven calendar days.

I am in no way stating that the CDC is erroneous in its recommendations for protecting the public from sick individuals potentially infected with the H1N1 virus, but we must not overlook the plight of the poor and the working poor when mandating sick days for children whose parents are at such risk of losing the little employment they have.

Now, government cannot solve every problem for every citizen at all times, but when we are mandating such a strict policy of isolation from school during a time when every person with a job desperately needs to retain that job in order to survive, there is a missing piece to the economic puzzle that must be examined, if not addressed.

Many workers are woefully unprotected from being laid off or fired when they miss a day of work for reasons well beyond their control, and the H1N1 virus may very well prove to be a problem for many workers on the edge of the wayward economy.

Calling in Sick on Nurses Day

This morning, I am feeling unwell, so I decided to call in sick to work. Having no idea that it was indeed Nurses Day, the administrative assistant at our office expressed her dismay that I was not coming in, leading me to believe that a celebration of some sort had been planned, arrangements that were now foiled by my decision to remain in bed.

That said, my wife remarked that calling in sick on Nurses Day is in many ways quite perfect. Nurses work hard---often too hard---and I am no exception. And like many relatively new employees on probation, I still have no sick time or vacation until I reach my six-month performance review at the end of May. But no matter---self-care is paramount, and this is the perfect day to eschew the vicissitudes of work and the ongoing swine flu extravaganza.

For many, Nurses Day translates as greeting cards, flowers, a pat on the back, and a moment of recognition amidst the frenzied work of health care. For me, Nurses Day conjures images of rest, respite from the work of nursing, and a moment to reflect and remember why I became a nurse, why I'm still a nurse, and how I can take care of myself as a nurse.

After thirteen years in nursing, I have experienced fulfillment, burnout, fatigue, overwhelming stress, camaraderie, boredom, confusion, frustration, excitement, and a mixture of too many other emotions and states of mind to describe here. It has been an interesting ride, and while I'm not sure that nursing will always be some aspect of my working life, I do know for certain that my "nursing mind" will always be an active part of the lens through which I view the world.

For today, I lay my nursing cap by the side of the bed (except when I check my work voicemail and email, of course), and I allow myself a day to play hookey and rest my weary nursing bones. With the birds singing outside the window and our Japanese Maple Tree in full crimson bloom, I sink down next to Tina the Dog and breathe a well-deserved sigh of relief.

Bob the Nurse Gets a Plug from Code Blog

My blogger friend Gina over at CodeBlog has posted about my new blog, "The Adventures of Bob the Nurse". I recently submitted a photo of Bob to an edition of the nursing blog carnival, Change of Shift, and Gina has been kind enough to champion Bob's cause! Additionally, Bob has been invited out West for a vacation where he could experience a needed change of scenery....

So, please visit Bob's world, and also pay a visit to Gina's post about our friend Bob. He truly gets around, and we hope to send him on a lovely vacation some day soon!

Twitter, Social Media and Emergency Preparedness!

Today, I spent an hour or so introducing a group of Medical Reserve Corps leaders to the world of Twitter. I have personally been using Twitter for a number of months. In fact, this blog feeds to my Twitter account automatically.

Now, for those who are working in the fields of emergency preparedness and public health, Twitter has a great deal to offer in terms of the aggregation of vast amounts of information on specific topics of interest. Swine flu has been an excellent example of Twitter's utility for keeping track of trends vis-a-vis the development of the disease, especially when such players as the Centers for Disease Control, the Department of Health and Human Services, FEMA, and the FDA chime in on their Twitter feeds multiple times per day.

Someone in our training stated that it's remarkable that the CDC and other large organizations actually pay someone to aggregate their material and post it on Twitter, Facebook and other social networking sites. However, I would beg to differ. I would actually find it remarkable if these organizations chose to not utilize social networking as a means of getting their message out there. There are segments of the population who rely on social networking for news, friendship, professional networking and entertainment, and savvy organizations with something to communicate are intelligently jumping on this bandwagon.

In terms of my friends and colleagues in the emergency preparedness world, one of my warnings was that, while Twitter and other sites can be fun and informative, it is best to keep a tight rein on who one chooses to follow and how much time one devotes to such an endeavor. Social media can be an enormous time waster, and even the most diligent of us can be unwittingly sucked in, even when the clock is ticking and there is work to be done.

That said, if one is interested in knowing the latest information on swine flu, public health threats, fires, product recalls and disease outbreaks, there is a veritable river of useful information flowing on Twitter that can keep one up to speed on a daily basis.

Social networking has certainly found a variety of audiences, and it remains to be seen how these applications will change and grow as they become more popular and their creators decide how to monetize them. Twitter is still a free service that's 100% free of ads, but I'm fairly certain that we will eventually see some form of ads on Twitter, just as we have seen ads develop as Facebook found its place in the online universe.

For emergency preparedness folks, tracking the trends and keeping in touch with colleagues on the front lines is a very useful way to apply Twitter to the work that we do. When emergency response teams on the ground can post brief and informative up-to-the-minute tweets about their current status vis-a-vis an ongoing emergency, everyone wins. And when we can easily track the progress of a new disease or other emerging threat with an application that's easy to use and free, there truly seems to be nothing to lose.

I'm happy to be opening my colleague's eyes to the uses of blogging and social for public health and emergency preparedness and response, and if these processes and applications actually serve to improve lives or otherwise positively impact our good work in the world, then I am a happy nurse indeed.

Swine Flu Fatigue?

Dear Readers, I apologize for not posting since Monday. My work life has been consumed with swine flu and its effects here on the local level, and Digital Doorway has suffered from a lack of attention. This situation will now be remedied.

So, a lot of people are already complaining of Swine Flu Fatigue. Of course, the media has latched onto this breaking news, disseminating information---and misinformation---throughout the 24-hour news cycle that is part and parcel of our 21st century lives. Still, a novel virus making its way around the world is certainly cause for concern and conversation, and the public health infrastructure is certainly responding as it should in such a circumstance.

On Twitter, on grocery lines, and in workplaces, various individuals claim that the government is overreacting, that public health officials are making a mountain out of molehill, and that the media is fanning the flames for the benefit of increased revenue in dark economic times. But I must beg to differ.

As a (relatively novice) public health official, I am impressed and heartened by the rapid, comprehensive and thoughtful reaction by the global public health community to this new viral threat. I have taken part in numerous conference calls with the CDC, with our state Department of Public Health, FEMA, and other players, and I can see that officials are acting responsibly and appropriately to a credible threat.

When Hurricane Katrina was bearing down on New Orleans and our government was essentially asleep at the wheel, FEMA and other emergency management agencies fell down on the job, and their negligence and slow response certainly resulted in increased suffering, loss and death in the ensuing days during and after the storm. In retrospect, the public and media called for answers, recognizing clearly that preemption of calamity is an essential aspect of managing such situations before they mushroom out of control. The initial Katrina response was essentially a failure, and lessons learned at that time are still being analyzed and digested.

With swine flu, we have another opportunity for the machines of government, public health, surveillance and emergency preparedness to swing into action before all-out calamity strikes. While the current measures and attention being paid to the situation may appear to some to be somewhat overblown, one must only imagine what we might all say at some future date if the government's reaction to the early stages of the outbreak were less robust.

If this indeed becomes a global pandemic of massive scale in the months to come, it will be certain that we will be thankful that the assets and resources made available by the government and associated agencies were activated so early in the development of this viral process.

With antiviral medications at the ready and vast amounts of information being made available to the general public, the media, and the medical community on an up-to-the-minute basis, we can rest assured that the situation is being monitored vigorously by those in positions to make clear and intelligent decisions.

Here on the public health front lines, we local boards of health rely on the federal and state governments to guide us as we answer the public's questions, assuage their fears, and prepare our own local assets for appropriate and timely response. We are very appreciative of the responsiveness of the CDC and our other response partners, and without their guidance, this process would be infinitely more challenging.

In a few weeks or months, if the pandemic proves to be short-lived, we will all breathe a sigh of relief, knowing that we were properly prepared for a feasible and credible threat to public health. While some would potentially point fingers and make light of our credibility vis-a-vis such threats, we will still maintain our thankfulness that we reacted so swiftly and comprehensively based on the information available at the time the outbreak began.

If the outbreak does indeed develop into a larger-scale pandemic, then our reactions will also have been proven to be prudent and correct, and we will be well prepared to face the mounting threat.

Whatever the outcome, I see the national and global response to swine flu as an excellent example of how the public health infrastructure can mount a credible and rapid response on the local, regional, national and global levels when needed. This is a test---no matter the outcome---and in my view, the reaction to swine flu has been an excellent example of prudence, intelligence, and collective preemptive action at a time when such qualities are sorely needed and duly delivered.