nursing

Author Beware: HIPAA– It’s No April Fools

/ Jordyn Redwood / Leave a comment

Image by Gerd Altmann from Pixabay

One of the biggest errors authors make in regards to writing about something medical is that their character violates HIPAA. HIPAA is a law that outlines a patient’s rights regarding their protected health information (PHI). I’ve blogged extensively on this topic and you can find these posts by following these links:

Author Beware: The Law: HIPAA  Part 1/3
Author Beware: The Law: HIPAA Part 2/3
Author Beware: The Law: HIPAA Part 3/3

HIPAA and Law Enforcement
Author Beware: Proof’s Problem with HIPAA
Disasters and HIPAA
Modern Family: S10/E7 Disclosing Pregnancy Results

The simplest way to explain a HIPAA violation is that someone accesses a patient’s information when they are not directly caring for that patient and/or discloses protected health information about a patient publicly.

Two recent stories have highlighted each of these scenarios.

The first involves actor Jussie Smollett and several dozens of hospital employees accused of viewing his medical information at Northwestern Memorial Hospital in Chicago, Illinois. They were all fired, reportedly some didn’t even open the chart, but just “scrolled by” it. The point is, with today’s technology and electronic medical records, it is very easy to determine who has accessed someone’s health information. It’s basically tracked electronically. Unless you are directly involved in caring for a patient, it is illegal for you to look at their information. I can’t even access my own children’s medical charts at the hospital where I work unless I go through the proper channels, which is signing a release for them through medical records.

The second, and perhaps more frightening case, is of the nurse who disclosed a toddler was positive for measles in the pediatric ICU where she worked and then posted about it to an anti-vaxxer group she belonged to on social media.

She didn’t give the patient’s name, sex, or exact age so she should be okay, right? Many times, people think this is a way to get around HIPAA and sometimes they can be right— it depends on the volume of such a diagnosis. For instance, if my ER sees 5,000 patients a day (which is insane– I don’t know any ER that can even possibly do this) and I say we saw a patient with a rash (and that’s it) then that doesn’t necessarily signify the one I might be talking about because there were probably dozens of patients seen with a rash that day with that volume of patients. However, I will also say this could still be considered a HIPAA violation, but let me further illustrate my point.

The more unique and rare a medical diagnosis is, the more easily it would be to identify a patient even without disclosing name, sex, or age and that is this nurse’s first problem. There was probably only one patient in the PICU that had a medical diagnosis of measles. It had likely been in the news that there were measles cases in Texas (this is frequently disclosed for the public good to encourage vaccinations), but the nurse’s information narrows down the hospital, the general age group, and just how sick he was. Then neighbors can start thinking, “Hey, we live close to Texas Children’s and I haven’t seen Billy (totally made up name) in a while and he’s a toddler—” and then phone calls go out to Billy’s mom asking if he has measles. See?

The frightening aspect of the scenario, from a purely pediatric standpoint is, that even after seeing how sick this child was, she remained an anti-vaxxer and even mused about taking a swab from the ill child’s mouth and attempting to give wild measles to her own child! For one, I consider this child abuse. I truly cannot fathom in my mind how this nurse believes giving her child the real thing is preferred over a vaccine that can prevent the entire illness.

**The safest thing for ANY healthcare worker is to not discuss their patients at home or on social media no matter how vague they try to make the scenario.**

It is also the safest thing for authors who are writing these scenarios. As I’ve always said, you can have a character that violates HIPAA in your novel, but they must face repercussions for it. The positive side of this is that it increases the conflict in your story automatically. It also shows the reader that you’ve done your research.

The Face Behind the Mask: Part 3/5

/ Jordyn Redwood / Leave a comment

We’re continuing our five part series with certified nurse anesthetist Kimberly Zweygardt.

Welcome back, Kim.

So far, we’ve met the characters in the OR and discussed the setting. Today, let’s talk about things that could go wrong including anesthesia complications.

We’ve all read about wrong patient or wrong operation or surgeons operating on the opposite leg, hip, etc. Safegaurds, like the time out, are designed to prevent this, but what if it increases plot tension?

Also, the OR is its own little world—only staff and patients allowed, but there was a case where someone impersonated a doctor. What did the nurse say when she found out he wasn’t a real surgeon? “I couldn’t tell. He was wearing a mask!” In a large teaching hospital there are students of all types and the OR gets much more crowded. It would be possible for someone to sneak in with mayhem on their mind, although safegaurds like doors to the dressing rooms with keypad entries have become common.

The OR is a very busy place and patient care comes first. As the case ends and the patient wakes up, there is lots of hub bub.My concern is if my patient is pain free and breathing before taking them to the PACU (Post Anesthesia Care Unit), not about the drugs which locked up unless being used. While I’m gone, the room is “turned over” (cleaned and readied for the next case). Nurses, scrub technicians and housekeeping are in and out. In some OR’s an anesthesia tech cleans and restocks the anesthesia supplies, changing the mask and breathing circuit on the anesthesia machine so that when I return, all I have to do is draw up drugs for the next patient.

Due to the nature of the OR, the anesthesia cart is unlocked so that the tech can restock drugs and supplies. What would happen if someone had murder on their mind?

Drug companies sometimes use the same labels for different drugs. For example, Drug A is in a 2cc vial and slows down the heart. The label is maroon and the vial has a maroon cap. It is clearly labeled as Drug A. Drug B also is a 2 cc vial with a maroon label and has a maroon cap but Drug B increases the blood pressure. What happens if the pharmacist sends the wrong drug because he recognized the colored label and grabbed it? Or if both drugs are in the anesthesia cart, but one vial gets put in the wrong drawer along with vials that look identical? Or the patients blood pressure is dangerously low and in my hurry, I grab the wrong drug and slow down the heart causing the blood pressure to plummet even lower? What if it wasn’t an accident?

For your comfort, practitioners are know about “look alike” drug vials and take special precautions to prevent errors. Don’t be afraid if having surgery, but what fun would that be for our characters? Remember this blog post is about getting the medical details right, not making our characters happy!

***Content originally posted January 28, 2011.***

*********************************************************************************
Kimberly Zweygardt is a Christ follower, wife, mother, writer, blogger, dramatist, worship leader, Certified Registered Nurse Anesthetist, a fused glass artist and a taker of naps. Her writings have been featured in Rural Roads Magazine, The Rocking Chair Reader, and Chicken Soup for the Soul Healthy Living Series on Heart Disease. She is the author of Stories From the Well and Ashes to Beauty, The Real Cinderella Story and was featured in Stories of Remarkable Women of Faith. She lives in Northwest Kansas with her husband where their nest is empty but their lives are full. For more information: www.kimzweygardt.com

The Face Behind the Mask: Part 2/5

/ Jordyn Redwood / 2 Comments

We’re continuing our five part series with certified nurse anesthetist Kimberly Zweygardt.

Welcome back, Kim.

Last post we discussed who is in the OR. Today let’s talk about the OR setting then discuss the anesthetic.

The OR is a cold, sterile, hard surface, brightly lit environment that is all about the task instead of comfort. Cabinets hold supplies, the operating room bed is called a table, Mayo stands hold instruments for immediate use during the operation and stainless steel wheeled tables hold extra instruments and supplies. IV poles,  wheeled chairs/stools and the anesthesia machine and anesthesia cart complete the setting.

When a patient comes in, the staff does a “time out.” The circulating nurse, the surgeon and anesthetist all say aloud that it is the correct patient and procedure. It sounds like this, “This is Mrs. Harriet Smith and she’s having cataract surgery on her left eye.”  Once done, the staff swings into action, the circulator “prepping” the surgical site (washing it off with a solution to kill the germs) while the scrub nurse prepares the instruments after “gowning and gloving” (putting on sterile gown and gloves). Meanwhile, the surgeon “scrubs” meaning washing his hands at the sink outside the room. When he is done, he’ll enter the room to get gowned and gloved. Before all this is happens, I’ve started my care of the patient.

I meet the patient before this to fill out a health history specific to anesthesia. Are they NPO (Have they had anything to eat or drink after midnight)? Do they have allergies? Have they ever had an anesthetic and if so, any complications? Has anyone in their family ever had complications with anesthesia? Then I ask about medications and other health problems  so I can choose the best anesthetic. But an even bigger job is reassuring them that I am there to take care of them.

When they come to the OR, I attach monitors—EKG heart monitor, blood pressure cuff, and pulse oximetry (a small monitor that fits on the finger to measure the oxygen levels in the blood). Once the monitors are on, I give medicines for the  “induction” of anesthesia. As the patient goes to sleep, they are breathing oxygen through a face mask. Drugs include the induction agent (most likely Propofol), narcotics (Fentanyl most common), an amnestic (Versed which provides amnesia), plus a muscle relaxant (Anectine)that paralyzes the muscles.  When asleep, the breathing tube is placed using a laryngoscope that allows me to visualize the vocal chords. Then the anesthetic gas is turned on.

I am with the patient through the whole operation, watching monitors, giving medications and making adjustments.  At the end, I reverse the muscle relaxants, turn off the anesthetic gas, and begin the “emergence” process waking the patient up.

Now, that’s the norm but we’re writers where normal is boring! Next post I’ll let you in on all the things that can go wrong!

***Content originally posted January 21, 2011.***

*********************************************************************************
Kimberly Zweygardt is a Christ follower, wife, mother, writer, blogger, dramatist, worship leader, Certified Registered Nurse Anesthetist, a fused glass artist and a taker of naps. Her writings have been featured in Rural Roads Magazine, The Rocking Chair Reader, and Chicken Soup for the Soul Healthy Living Series on Heart Disease. She is the author of Stories From the Well and Ashes to Beauty, The Real Cinderella Story and was featured in Stories of Remarkable Women of Faith. She lives in Northwest Kansas with her husband where their nest is empty but their lives are full. For more information: www.kimzweygardt.com

The Face Behind the Mask: Part 1/5

/ Jordyn Redwood / Leave a comment

I’m happy to host my good friend, author, and dramatist Kimberly Zweygardt over the next five posts and she shares about being a CRNA— Certified Registered Nurse Anesthetist. You can find out more about Kim by visiting her website here.

Welcome, Kim!

If you have a profession besides writing, doesn’t it bug you when someone doesn’t get it right? It may be something small, but you wonder, “Why didn’t they do some research?”  With the Internet, it is easier than ever to find information, but if it is a hidden profession like my own, there might not be much info for you to glean. Today I want to share with you, The Face Behind the Mask or The Life and Times of a Certified Registered Nurse Anesthetist (CRNA). The operating room is my world, so let’s begin there.

A CRNA is an advanced practice nurse that specializes in anesthesia. CRNA’s were the first anesthesia specialists beginning in the late 1800’s. Anesthesiologists are MDs that specialize in anesthesia (it became a medical specialty after WWII), unless of course you are in great Britain where everyone is an Anaesthetist (Ah-neest’-the-tist’). Confusing, yes? Just remember, the work is the same, but the title is different. For some reason, the term  Anesthesiologist is more widely known (because it is easier to pronounce?), but since CRNAs give over 60% of the anesthesia in the US, if you write a surgery scene, you might want to consider using a CRNA as the caregiver, especially if it is a rural setting. Over 90% of the anesthesia in rural America is provided by a CRNA.

The OR is its own world. Someone has to do the operation, so there are general surgeons, trauma surgeons, orthopedic surgeons (bone), neurosurgeons (brain and nerves), cardiovascular surgeons (heart and major vessels), as well as OB/Gyn (women’s health), ENT (ear, nose and throat) and ophthalmologists (eye surgeon). If it is a large teaching hospital, there might be a medical student or surgery resident assisting the surgeon.

A scrub nurse or surgical technician is there who hands the instruments to the doctor as well as a circulating nurse—a RN who records what happens during the operation as well as obtains any supplies needed in the room. For example, if the doctor needs more suture, the circulating nurse would open it so it remains sterile and hand it to the scrub nurse who is also sterile.

Two of man’s greatest fears are being out of control and the fear of the unknown. The OR setting speaks to both. What great plot scenarios and drama we can create by going through the double doors that lead to surgery!  Next time we’ll talk about interesting scenarios and complications concerning surgery and anesthesia. Happy plotting!

***Content originally posted January 14, 2011.***

*********************************************************************************
Kimberly Zweygardt is a Christ follower, wife, mother, writer, blogger, dramatist, worship leader, Certified Registered Nurse Anesthetist, a fused glass artist and a taker of naps. Her writings have been featured in Rural Roads Magazine, The Rocking Chair Reader, and Chicken Soup for the Soul Healthy Living Series on Heart Disease. She is the author of Stories From the Well and Ashes to Beauty, The Real Cinderella Story and was featured in Stories of Remarkable Women of Faith. She lives in Northwest Kansas with her husband where their nest is empty but their lives are full. For more information: www.kimzweygardt.com

Civil War Medicine: Part 1/4

/ Jordyn Redwood / 1 Comment

I’m pleased to host Erin Rainwater as she shares her expertise concerning Civil War Medicine.

Welcome, Erin!

Pre-war medical system.

This year marks the Sesquicentennial (150-year anniversary) of the beginning of the Civil War. If you’ve never studied it much, I recommend you use these four commemorative years as an incentive to expand your knowledge of it.

That war was a watershed time in our nation’s history like no other event before or since, in war or peacetime. It even changed the way citizens referred to their nation. From the time of the Revolution until then the country was thought of as a collection of independent states. Shelby Foote, the Civil War historian who made you feel like you were there, said that prior to the war people would say, “The United States are…” As a result of the war, it was grammatically spoken as “The United States is…” That’s what that war accomplished, Foote said. It made us an is.

There are many interesting facets regarding the standards of medical care and how it was delivered back when we were still an are. Some of what we read about seems barbaric to us now, yet American surgeons were up to international standards of medical science of the time. Furthermore, as often happens in time of war, this conflict quickly propelled physicians into the role of leaders in medical and surgical breakthroughs.

Prior to the war, cleanliness was regarded as insignificant except in respect to gross contamination by foreign matter. Surgeons operated in street clothes or donned a surgical apron. They might wipe bloody and pus-laden instruments on their aprons or a rag, but washing them wasn’t routine. Clean linens and washed hands were statistically proven to be of value but rejected as non-scientific.

Medical school in the 1860s was normally two years long. Microscopy was taught, as was the cell theory of tissue structure. Tissue samples were stained and analyzed, urinalyses and stool studies were performed.

The primary anesthetics available were ether and chloroform, each having its pros and cons. Chloroform was non-flammable, which made it preferable during the war when gunpowder was lying about and bullets flying about. It was also faster acting. On the down side, it was easier to overdose a patient with chloroform, and anesthesia-related fatalities were higher. Surgeons and attendants, however, were more easily overcome by the vapors of ether while performing surgery.

At the outbreak of hostilities, there were few military physicians, fewer military hospitals, and lack of a hospital corps. Nursing and other duties were performed by soldiers temporarily assigned to hospital detail, and who were not necessarily qualified nor of upstanding character. After the fighting began, civilian doctors flooded into the military system. Others chose not to join up but worked as contract physicians. Doctors not only were required to be skilled but were expected to organize, equip, supply and administrate their hospitals. The enlisting, training and disciplining of subordinates was also in their job description.

Female nurses were rarely tolerated. They were believed to lack the physical strength to help wounded men, and especially in the South they were considered too delicate and refined to assist a rough soldier in bathing and tending to personal hygiene. It was generally conceded, however, that women were more attuned to the emotional needs of the sick and more skilled at “sanitary domestic economy.”

As word of Florence Nightingale’s notable work in the Crimean War spread, women’s abilities in the field of nursing became more widely acknowledged. Some American physicians who had gone to the Crimea to assist the British came home reporting that the female nurses were undeniably competent and able to care for soldiers with war-related wounds and illnesses. It was finally becoming more seemly for females to care for male patients. Their pay, however, was half of what civilian male nurses received to care for military patients. In my novel, True Colors, Cassie Golden receives the standard pay for civilian female nurses working in a government hospital—twelve dollars a month plus meals. That is for twelve-hour shifts, usually five days per week but often more. And she was glad to have it.

*********************************************************************************************

Erin Rainwater is a Pennsylvania native whose trip to Gettysburg when she was twelve enhanced her already deep interest in the Civil War. She attended Duquesne University in Pittsburgh, and entered the Army Nurse Corps upon graduation.  Serving during the Vietnam War era, she cared for the bodies and spirits of soldiers and veterans, including repatriated POWs and MIAs. Now living in Colorado, she is a member of a Disaster Medical Assistance Team, and has been deployed to disaster areas around the country. True Colors is partly based on her military and nursing experiences as well as extensive research. She also authored The Arrow That Flieth By Day, a historical love story set in 1860s Colorado, and Refining Fires, a uniquely written love story that was released in July, 2010. Erin invites you to visit her “virtual fireside”.

***Contest reposted from January 10th, 2011.***

 

Author Beware: This Is Us

/ Jordyn Redwood / Leave a comment

Dear This Is Us— please portray nursing accurately. 

Few can argue with the success of the new NBC drama This Is Us. I’m an avid watcher of the show myself. If you like your heartstrings being tugged at every conceivable corner and you’re not watching then you’re missing out on a great opportunity for a good cry. Well, really, several good cries per episode.

nbc-this-is-us-midseason-aboutimage-1920x1080-koThat being said, I was mildly disappointed in a medical scene portrayed in Season 1, Episode 11. If you haven’t seen it, I don’t think I’ll be spoiling much unless you don’t the the fate of Toby post his Christmas collapse. If that statement is true then you should stop reading here.

In episode 11, Toby is getting prepped for heart surgery. He is anxious, but not overly so. It’s a cute and funny scene. There is a flurry of activity as the nursing staff gets ready to take him to pre-op. The conversation goes something like this:

“Name.”

“Toby Damon.”

“Place of birth.”

“Hope Springs.”

At this point, a nurse comes in with a very large needle and makes it noticeable to the patient.

“What is that?” Toby asks. “Holy Cow. Look at the size of that thing! I’m a big guy but geez.”

The nurse then inserts the needle into the IV port and delivers the medication. Another staff member says, “Look this way, we’re getting ready to take you to prep.”

Toby— after the medication takes effect. “What’s in that?”

Nurse replies, “You’re fine. Don’t worry about it.”

Toby asks again. “What was in that needle?”

Nurse responds. “Just medicine.”

Ugh. I mean, really? Let’s take a look at the medical problems with this scene from mild to annoying.

Problem #1: Place of birth is never asked. Although, I do like that they use what is called two patient identifiers— it’s never place of birth. Usually, it’s your birthday. Also, if he’s going to surgery, there should be some communication with the patient about his understanding of the procedure he’s going to have. “Sir, my name’s Jordyn. I’m one of the OR nurses here to take you to the pre-op area. What procedure are you going to have done today?”

Problem #2: It’s called Pre-op. Not prep.

Problem #3: This is getting more egregious. We don’t insert needles into IVs anymore. They are all needleless system. I get that it looks more dramatic to come in wielding a big needle, but it isn’t medically accurate. I haven’t seen an IV system you had to access with a needle in over fifteen years. In fact, in most tubing systems you can’t even insert a needle anymore.

Problem #4: If you are using a needle and the patient is anxious— don’t show them the needle. Obviously, this is one way to increase the patient’s anxiety which is not the direction we want them to go.

Problem #5: The patient asks the nurse twice what he’s being injected with and she doesn’t disclose it. Honestly, this goes against the very fiber of the nursing code. Nursing is about telling your patient the truth and educating them about what’s happening to them medically. Now, in an anxious patient, the explanation doesn’t need to be long. She could have simply stated, “Sir, it’s very common to be anxious before surgery. This medication is called Versed and will help you relax a little bit.”

Just so the staff writers of This Is Us are aware, I am available for medical consultation. Don’t make me hate a show I love by portraying medical people like they don’t care about a patient’s very direct questions. Little is seen in this scene of the medical staff using other methods to calm and relax this patient other than shoving a medicine in his IV and not even educating him about what it is.

That’s not how we take care of patients.

Sarah Sundin: WWII Nursing Part 3/3

/ Jordyn Redwood / Leave a comment

This is Sarah’s final installment concerning her research into WWII nursing. I want to thank Sarah for all the great information she provided. I know I learned a lot. What was one interesting thing you learned?

Click the links for Part I and Part II.

wwii-nursing-2US Army Nursing in World War II—Part 3

“Lieutenant Holmes is going into anaphylaxis.”

 Harriet’s elfin face blanched. “Oh no. Thank goodness Dr. Sinclair is on the ward.”

“Not yet.” Ruth grabbed a tray and put two sterilized syringes on top.

“So—so why are you already getting the meds?”

“I want to be ready when he comes. I can’t waste any time.” One vial of adrenaline.

“But he hasn’t ordered them yet.”

 Ruth leveled a look at the girl. “I know the treatment for anaphylaxis.”

“That—that’s presumptuous of you. You’ll make the doctor angry.”

Ruth pulled a vial of morphine. “I don’t care about the doctor’s feelings. I care about my patient’s life.”

In my World War II novel, A Memory Between Us, the heroine, Lt. Ruth Doherty, serves as a US Army Nurse in England. The amount of research seemed daunting, but I found fantastic resources, read intriguing real-life accounts, and gathered fascinating facts about nursing in World War II.

On November 24th, I covered requirements to serve in the Army Nurse Corps. On November 26th, I discussed the training the nurses underwent and rank in the Army Nurse Corps. And today I’ll provide some details on uniforms, nursing practices, and a list of my favorite resources.

Uniforms

On the job, nurses wore a white ward dress with the white nurse’s cap. They were also issued a set of “dress blues,” a dark blue service jacket and a medium blue skirt, a white or blue shirt, black tie, black shoes, and a dark blue garrison cap or service cap. This uniform is pictured on the cover of A Memory Between Us. A dark blue cape lined with red and an overcoat were also used for outdoors wear. Starting in July 1943, the blue uniform was replaced with an olive drab service jacket and skirt and cap, khaki shirt and tie, and brown shoes—but implementation was slow and sporadic.

In combat areas, white ward dresses and skirted suits were absurdly impractical, but the Army was slow to provide appropriate clothing for women. In 1942 during the early campaign in North Africa, the women resorted to wearing men’s fatigues and boots—in men’s sizes. In time the nurses were issued WAC (Women’s Army Corps) field uniforms and the popular Parson’s field jacket, as well as easily laundered seersucker ward outfits, both dresses and pantsuits.

Nursing Practice

On the ward, the nurse was assisted by a male medic, an enlisted man. Some men had serious problems taking orders from women, and some didn’t. In stateside hospitals, Red Cross nurses’ aides also served. Physicians entered the Medical Corps with the rank of captain and only male physicians were admitted to the Corps. As was typical in the 1940s, the physicians expected unquestioning, speedy obedience from nurses.

For the writer, it’s important to remember this was long before our disposable, single-use, universal precautions era. Syringes were made of glass and were sterilized in bichloride of mercury before reuse. Gloves were washed and reused—and holes were even patched. Improvisation was the rule, especially in combat areas, and nurses used their creativity and imagination to turn trash into useful items.

Resources

http://history.amedd.army.mil/ANCWebsite/anchome.html (The official website for Army Nurse Corps history.)

Sarnecky, Mary T. “A History of the U.S. Army Nurse Corps.” Philadelphia: University of Pennsylvania Press, 1999. (A comprehensive history with a thick section on WWII).

Tomblin, Barbara Brooks. “G.I. Nightingales: the Army Nurse Corps in World War II.” Lexington: University Press of Kentucky, 1996. (A wonderful history, including all theaters, full of personal stories).

Brayley, Martin. “World War II Allied Nursing Services.” Oxford: Osprey Publishing, 2002. (Detailed information on military nurses’ uniforms).

http://library.uncg.edu/dp/wv/ (The Women Veterans Historical Project—a vast collection of oral histories, letters, photographs, diaries and other treasures).

http://history.amedd.army.mil/books.html (Prepare to get lost…this website contains dozens of on-line historical medical texts, from detailed—800 page!—books describing medical services in each theater, to period textbooks used for neuropsychiatry to infectious disease to orthopedic surgery).

***This blog originally posted 11/29/2010***
********************************************************************************************

sarahsundin2Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

Sarah Sundin: WWII Nursing Part 2/3

/ Jordyn Redwood / Leave a comment

We’re continuing our three part series with historical author Sarah Sundin about her research into WWII nursing. You can find Part I here.

US Army Nursing in World War II—Part 2

wwii-nursingRuth hugged her knees to her chest, her dark blue cape tented around her against the gray chill.

            Where would the money come from? Promotions were meager in the Army Nurse Corps. All the nurses were second lieutenants except the chief nurse, a first lieutenant. At twenty-three, Ruth was too young and inexperienced to become a chief nurse.

            She’d always solved her own problems, but now she longed for advice, and she kept thinking about Major Novak.

In my World War II novel, A Memory Between Us, the heroine, Lt. Ruth Doherty serves as a US Army Nurse in England. The amount of research seemed daunting, but I found fantastic resources, read intriguing real-life accounts, and gathered fascinating facts about nursing in World War II.

On November 24th, I covered requirements to serve in the Army Nurse Corps. Today I’ll discuss the training the nurses underwent and rank in the Army Nurse Corps. And on November 29th, I’ll provide some details on uniforms, nursing practices, and a list of my favorite resources.

Recruitment and Training

The American Red Cross served as the traditional reserve for the Army Nurse Corps. On October 9, 1940, the ANC called the reserves to active duty, to volunteer for a one-year commitment. At first there was no formal military training for nurses. On July 19, 1943, the first basic training center for nurses opened. Training centers were located at Fort Devens, MA; Halloran General Hospital, Staten Island, NY; Camp McCoy, WI; and Brooke General Hospital in San Antonio, TX. The nurses trained for four weeks, learning military courtesy and practices, sanitation, ward management, camouflage, the use of gas masks, and map reading. They also drilled and underwent physical training.

To train the increased number of nurses needed during the war, Congress authorized the Cadet Nurse Corps on July 1, 1943. The government paid for women to attend civilian nursing programs in exchange for service in the Army Nurse Corps upon graduation. The women in this accelerated program (two and a half years instead of three) had their own special cadet uniforms.

Rank

Nurses entered the ANC as second lieutenants, and the vast majority of them stayed at that rank. The chief nurse of a hospital was usually a first lieutenant, but sometimes a second lieutenant or a captain. The highest rank in the ANC was held by the superintendent of the ANC, a colonel.

Even so, nurses held “relative rank.” They held the title, wore the insignia, were admitted to officers’ clubs, and had the privilege of the salute, but they had limited authority in the line of duty and initially received less pay than men of similar rank. On December 22, 1942, Congress authorized military nurses to receive pay equivalent to a man of the same rank without dependents, and on June 22, 1944, Congress authorized temporary commissions with full pay and privileges.

One of the main reasons nurses were granted officer status was to “protect” them from the great crowd of enlisted men, and—it was often thought—for male officers to keep the women for themselves. The Army had rules against fraternization between officers and enlisted personnel.

***This blog originally posted 11/26/2010.***

*********************************************************************************************sarahsundin2Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

Sarah Sundin: WWII Nursing Part 1/3

/ Jordyn Redwood / Leave a comment

Redwood’s Medical Edge is pleased to host historical author Sarah Sundin who has done extensive research regarding nursing during WWII.

US Army Nursing in World War II—Part 1

a-memory-between “I love this smell, don’t you?” May said.

            “Bichloride of mercury?” Ruth laughed and shook water from a pair of gloves. “Only a nurse would like this smell.”

            May rolled syringes in a pan of the blue green disinfectant. “In the orphanage I had no control over my life, but with soapy water and a stiff brush, I could scrub away the smells and pretend I lived in a castle.”

            Ruth draped the brown latex gloves over a clothesline to dry before being sterilized. “Cleanliness may not be next to godliness, but it beats back the demons of poverty.”

In my World War II novel, A Memory Between Us, the heroine, Lt. Ruth Doherty serves as a US Army Nurse in England. The amount of research seemed daunting at first, but I found fantastic resources, read intriguing real-life accounts, and gathered fascinating facts about nursing in World War II.

Combat produces injuries. Injuries require treatment. If you write a novel set during World War II, you may have to write a medical scene—and you’ll want to get the details right about your nurse characters.

During World War II, 57,000 women served in the US Army Nurse Corps (ANC), 11,000 in the Navy Nurse Corps (NNC), and 6500 in the Army Air Forces. More than two hundred nurses died serving their country.

Today I’ll cover requirements to serve in the Army Nurse Corps. On November 26th, I’ll discuss the training the nurses underwent and rank in the Army Nurse Corps. And on November 29th, I’ll provide some details on uniforms, nursing practices, and a list of my favorite resources.

Requirements

To serve in the Army Nurse Corps, women had to be 21-40 years old (raised to 45 later in the war), unmarried (married nurses were accepted starting in late 1942), a high school graduate, a graduate of a 3-year nursing training program, licensed in at least one state, a US citizen or a citizen of an Allied country, 5’0”-6’0,” have a physician’s certificate of health and a letter testifying to moral and professional excellence.

Pregnancy was the main cause of discharge from the Army Nurse Corps, or as the women called it, PWOP (Pregnant WithOut Permission). To discourage pregnancy, the Army had a cumbersome process to gain approval for marriage. Other methods to prevent pregnancy included careful placement of nurses’ quarters, discouraging drinking, and encouraging the women to socialize in groups. The second main reason for discharge was “neuropsychiatric,” what we call combat fatigue nowadays.

Remember that gender and race discrimination was still rampant in the 1940s. Male nurses were not allowed in the ANC during World War II, and only a limited number of African-American nurses. Despite a large number of black registered nurses in the United States, fewer than five hundred were allowed to serve, and then only to care for black patients or for prisoners of war.

***This post originally published 11/24/2010.***

*********************************************************************************************sarahsundin2Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

What Does a Nurse Do? Part 2/3

/ Jordyn Redwood / Leave a comment

Let’s continue our discussion of what a nurse’s role really is and how you can use this to increase conflict in your manuscript.

You can find Part I here.

Last post we looked at the nurse as patient advocate. This post, we’ll look at the nurse german-shepherd-puppyas the patient’s safety net. Which dog would you rather have defending your house? The cute, furry puppy or the grown dog with the watchful eye? A strong nurse is the patient’s watchdog. I look out for my patient’s interests when they may not be able to do so.

I  am often the last line of defense between everything and the patient. Let’s delve into the medication arena. The nurse gives the patient’s medications. It’s my job to ensure that what the physician orders is the correct medication for the illness, for the right patient at the right dose given the right route (by mouth, intravenously, etc…). One of the challenges in pediatrics is there is no standard dose. Every drug dose is based on the patient’s weight. I’m not going to give the same amount of morphine to a 5kg infant vs. an 80kg teen. If the patient is not weighed or their weight is entered incorrectly, this can have disastrous effects when medications are given.

german-shepherd-578929_1920Medication errors do happen. I want to reassure you that there are a lot of safeguards in place to prevent such occurrences. Most departments are going to computer based medication ordering. This is beneficial in many ways. One, the order is typed and therefore easily read eliminating mistakes in reading handwriting. Second, most medication based ordering systems have built in safeguards that will check the prescribed dose against the patient’s weight to make sure the dose is not too high. In pediatrics specifically, all high risk medications are double checked by another nurse and co-signed on the chart. But as a good nurse functions as a safety net, so should the parent question what is being given to their child and why.

Let’s take a real life example. During my years in the pediatric ICU, I worked at a teaching hospital. At this particular institution, residents could rotate through the unit their second year. I had a second year resident order potassium, which is a potent electrolyte, at four times the recommended dose. Now, if too much potassium is given, it will cause the heart to stop beating. That’s how big this error could have been.

I approached the resident and questioned the order. He stated, “But the drug book says to give 4meq/kg/day.”  I explained that the “per/day” was the key term. That the drug should be divided into four doses given every six hours, no more than 1meq/kg at one time. I told him he could order it that way, but the pharmacy wouldn’t fill it and I certainly wouldn’t give it.

Needless to say he changed the order and the drug was given correctly.

Have you ever had a medication error happen to you? How do you think it could have been prevented?