There are a lot of misconceptions about the largest group of healthcare professionals and the most popular misconception—that R.N.s are more promiscuous than the general public—was debunked in a large European study a decade ago. Now you know the truth, your nurse is no more sexualized than your accountant. At least Polish nurses are no more promiscuous. Although the same study did find that nurses tend to be more unfaithful to partners and more likely to participate in kinky sex, the profession must nonetheless be doing something right because nursing has been voted the most trusted major occupation by the American public for decades, outpacing physicians for example.
Another view of nursing that is accurate but little known is that there’s a beehive mentality in which a consensus forms of what constitutes good behavior or good practice, while physicians for example are more independent and offer a more mixed bag of views. In nursing there are also queen bees—this has been studied and confirmed—some of whom are nurturing and some who eat their young. We won’t get into that here except to say that the voice of the hive, the collective within the collective that makes the decisions, at least in the Lone Star State, is the Board of Nursing.
Every so often the Board issues a list of nurses who have been disciplined, for a variety of reasons, and the list is always of great interest to other R.N.s who can’t help but look for the names of former classmates or colleagues. Confirmed rule-breaking or bad practice is not confidential and serves kind of the way crucifixions did in the Roman Empire, with the body placed high and in full view in order to discourage others. Or the way public hangings did in the Old West, with whole families making a picnic of the spectacle and the condemned offering a few last words about the wages of sin, before the trap drops. A lot of nursing discipline these days regards drug diversion (an ICU nurse in a hospital in Austin, for example, went missing from his work station a few years ago and was found dead in a bathroom after consuming patient narcotics.)
Another popular complaint that can cost a nurse his or her license is “failure to notify,” that is failing to detect a change in the condition of a patient and therefore not informing the physician accordingly. The Board, it’s important to note, does not exist as a professional association—like a union—but as a protection for the public. Surprisingly, because of the hive mentality, what is appropriate practice and what is not is mostly agreed upon by most nurses. Most but not all. There have also been some slips in the discipline administered.
Every two years the Texas Legislature does a review of a certain number of state agencies and/or departments of government and a decade or so ago it was the turn of the Board of Nursing. In the past, legislators have described the Board as the archetypically well-run state agency but as with nursing discipline, even very good performers may run afoul of the rules. The Sunset Review as it is called found that the Board’s discipline was not always related to actions that had anything to do with a nurse’s work performance. There was also some disquiet on the part of the state reviewers, prompted by a case of discipline involving a male nurse, that some punishment decisions are arbitrary—that the catchall “unprofessional conduct” was subjective, and in one case even involved an expired inspection sticker on a R.N.’s private vehicle. This kind of complaint has been echoed in practice, actually, by men and by minorities who believe they bear the brunt of the wrist-slapping and license-revocations.
We won’t get into that, either, because the case to be examined here involves a white woman, a demographic that has long represented the archetypical American nurse. This is said absolutely without irony or ill will but that the nurse who was disciplined in the Board’s current most controversial case is a Caucasian female is a good sign, whether she is guilty as charged or not. Minority nurses and male R.N.s want to see the Board go after everyone, or no one at all. And, btw, the issue of males in the profession seems to be resolving itself naturally, through time, actually.
While medical schools in the U.S. now admit more women than men, the opposite trend has taken hold in nursing—a lot of guys entering the profession, many who may have served previously as military providers, for example, and a lot of minorities like African-born or Asian-born nurses who have come to nursing to make a good living (and it is good) and to help with the caregiver shortage in this country. To set the scene.
For over a quarter of a century, from the time of Governor Bush until a couple of years ago, the long-serving executive director of the Board was the ethereally-beautiful Kathy Thomas, an ex-Army nurse and pediatric nurse practitioner. Surprisingly, among women—jealousy aside—hot women often seem to rise in nursing, because beauty among women as judged by other women can be considered more than skin-deep and may be a cause for admiration in itself. Or because of girl crushes? We won’t get into that either but suffice it to say that everything you want to know about women is on display at a hospital nurses station.
In any case the BON executive director is now a woman named Kristin Benton and both of these women, Thomas and Benton, despite leading the ultimate caring profession, have ovaries of steel. Which is what the public wants, at least subliminally. Patients and patient families have expectations, one being that the R.N. will have the patient’s back against the healthcare facility and even, if need be, against the M.D., and that the nurse, well, cares. During what for most people is a very very difficult time, being sick and maybe afraid of the juggernaut that is American health care. Failure to uphold these traditions of patient support can lead to unwanted interest by the Board of Nursing.
The “board of directors” of the Board of Nursing, btw, appointed by Governor Abbott, includes lay members but is headed by a nurse, usually the same nurse for years on end—a queen bee because queens live a long time—previously a nursing professor from the University of Texas Medical Branch in Galveston (my alma mater, btw) and now by another professor from a university in West Texas. More ovaries of steel, no doubt. These women are all, in fact, queen bees, and they have recently made a very controversial discipline decision.
They may have made a good decision, in fact, but they may also have set themselves up for a bad one that will alter the public’s historically approving view of the profession of nursing, somewhere down the road.
Camp Mystic.
All you have to do is say the name and people have the same thoughts. Kids. Flooding. Drownings. Poor official/governmental response. Kind of like the Uvalde bloodbath but swollen river waters instead of gunfire.
The Camp Mystic floods last year along the Guadalupe River in the Hill Country bring to mind much of the same horror that one associates with the Uvalde school shootings four years ago, except that Mystic was an Act of God while the Uvalde shootings were oh-so man-made. And Mystic was more deadly. 25 drowned kids, 2 counselors and the camp owner, named Eastland, who was also father-in-law of the camp nurse suspended recently by the Board. Both Uvalde and Camp Mystic featured alleged official misconduct, literally, which so far has led to lawsuits and the retirement of a county emergency official but no one really taking responsibility—the Texas Rangers are still investigating—except the camp nurse. Which has caused some R.N.s to believe she is a scapegoat while the more culpable have gotten a pass.
In Texas government it seems there is always a demand for accountability but the one held responsible may just be a fall guy/girl, the person going to the gallows is strung up more as a deterrent than as an actual perp. Time will tell in this case. Briefly, what Nurse Eastland has been accused of are three charges. It’s critical not to pre-judge her, because a full hearing will in all likelihood be held during which the facts will be explored. A lawyer whose practice is defending nurses in administrative appeals, at the Capitol in Austin, notes that the temporary Board orders suspending a nurse, as in this case, are often made without the nurse or his/her lawyer being heard. And the Legislature, in its wisdom, has historically required the Board to follow appropriate administrative procedures in deciding discipline but has left up to the Board of Nursing itself to define what good practice is. That said, the early charges against Nurse Eastland include:
Use of medications or procedures that must be ordered by a provider, like a doctor or advanced-practice nurse, even though it was an emergency situation, in this case a flood. This is slightly reminiscent of the sequelae of the Hurricane Katrina flooding in New Orleans, when a doctor and two nurses were indicted for, in effect, euthanasia of patients in a hospital where flood waters were rising. Those criminal charges were eventually dropped. Secondly, Nurse Eastland was health director of Camp Mystic yet is accused of failing to identify an escape route for kids in a camp on a river prone to flooding. The question is whether the so-called “prudent nurse” should have thought of potential evacuation.
The third charge is the most interesting and inflammatory. During the torrential rain storm and flooding, Nurse Eastland is alleged to have gathered up her own kids and escaped, even as the other children in the camp were at risk and, in fact, drowning.
During most hospital orientations for new employees, nurses are advised on routes of escape in case of fire and how to evacuate patients. There is an expectation of giving assistance, obviously, and the same standard presumably applies to the case of flooding. Because health care occurs in so many diverse arenas like schools, hospitals, clinics, military bases, prisons, and in the home—the idea of evacuation may not be the first thing that occurs to a R.N. at a new job site. Identifying an escape route, nonetheless, and how to assist patients in case of an emergency, in other words critical thinking, or lack thereof, may be considered fair game for discipline by the Board. But that opens the Board and nursing to a probable backlash from the public in a different emergency circumstance that is not a fire or a flood.
During the new-nurse orientation in Texas hospitals—and probably in every other American state as well—in which flooding or fire might be discussed, the new healthcare workers are advised about another danger as well, the active shooter. And whoever is giving the in-service, whether it’s a police officer or the head of hospital security makes clear the different reality of a nurse’s duty in case of a disaster that is anything but natural. The nurse is free to run and abandon his or her patients to a killer. But not to a fire. Or flood.
The only potential weapon for self-defense at most nurses stations is a scalpel and you may actually have to go to the supply room to find it, and it’s probably not much use against a killer with a firearm. But appearances are everything to the trust that nurses hold in the community. The first time a nurse abandons patients, whether under gunfire or not, trust can break down. If for example you leave to her fate the 84-year-old Ms. Smith who can’t get out of bed or, God forbid, a nursery or NICU full of sick kids, the public will eventually hear about it and may revise its good opinion of the noble nurse. You may say, oh well, that’s not going top happen. Really?
In Norway whenever anything really bloody or bloodthirsty happens, which is not often, you know what the locals say? “That’s so Texas.” No shit. A violent hospital disaster is going to happen in the Lone Star State, because sooner or later some sick individual will discover that the ultimate pool of vulnerable victims for a shooting is in health care. And it’s particularly likely it will happen here, if history is any guide. In fact let’s do a brief review of bad shit happening in the Lone Star context, God-created or man-made:
First, the largest single loss of life to a natural disaster in American history is the 1900 hurricane in Galveston. Between 6,000 and 12,000 dead. The single largest loss of life due to a man-made accident in American history was a few decades later and also in Galveston County, on the peninsular side, in Texas City, when a French-flagged freighter freshly-loaded with ammonium nitrate (which is used for fertilizer but that terrorists like Timothy McVeigh have also preferred for making bombs) spontaneously exploded and killed almost six hundred people including the entire local volunteer fire department. “One of history’s largest non-nuclear explosions,” or so we’re told. Firefighters are, btw, the profession that may be closest to displacing nurses as the most trusted in America.
In order to quantify the man-made shooting front in Texas—the only question is how much time do you have? Just in living memory there is the “invention” of the modern mass killing in a public space, a university, the UT Tower massacre (15 dead) in 1966. There are also a couple of church-themed Texas slaughters, Sutherland Springs in 2017 (26 dead) and the Waco siege and fire of 1993 (86 dead including four federal agents). And of course the Uvalde school massacre which would be the template for a hospital attack. If armed cops hesitate to go in, as was the case in Uvalde, it may be a little unrealistic to expect the nurses to stay. There is some reason for hope, however.
There are almost 600,000 nurses in Texas, including advanced practitioners—bedside nursing being the second largest profession in the state after teachers. About one in four are now male. And men are more violent and confrontational, as women love to tell us, and presumably there’s a better chance—not to be sexist—that the guys will stand and fight an invader at the nurses station. Did you see the wonderful video of the antisemitic attacks at Bondi Beach in Australia last year in which a fruit-seller confronted a shooter and grabbed the rifle from his hands? That is a possibility, if not much of a probability, in a hospital. The mantra that you hear in hospital security training is that one’s options are “Run, Hide, Fight,” and it will kind of be up to the nurse which to do.
There have already been shootings in hospitals of course, murders, but they have been more targeted, against a physician or even a patient. Indeed violence is already pretty endemic to health care.
This is purely anecdotal but in my own work life last year there was a 300-pound otherwise mild-mannered chef among my patients, going through severe alcohol withdrawal, who had to be held down by four nurses and two cops in order to get him into leather restraints. Shit happens in a hospital, in other words. And my actual first experience of healthcare violence was a quarter-century ago, in a pediatric emergency room in Austin, when a kind of chunky twelve-year-old girl threw a nurse across an examination room and then prepared to take on the police summoned from their post in the adult ER. The little darling—who did not want a shot of antibiotics—was crying the whole time as she asked why everyone was being so mean to her? But that is the difference between isolated violence from patients or family members and someone who is really sick and who has come to a hospital as a hunter, with an AR-15, because he knows there are vulnerable prey to be found.
That’s why what used to be the practice of having an off-duty cop or two on hand in the ER has now morphed into armed officers patrolling hospital hallways. It’s not because something might happen, it’s because something almost certainly will happen.
Suspending Nurse Eastland’s privilege to practice may be all well and good, but the Board may be looking at something a lot worse down the road. Not the least because, after Hurricane Katrina laid waste to southern Louisiana, and its hospitals, the American Nurses Association noted the ethical quandary for R.N.s working along the storm-prone Gulf Coast which includes Texas, where the nurse may have to give his or her life in an emergency. The nurses’ association insisted on reminding regulators that the R.N. has an obligation to his or herself as well as to the patient.
Interestingly, for a healthcare worker outside the workplace there is no obligation to help in case of emergency and there is immunity from civil liability (“Good Samaritan Law”) in most cases, if things go south. Still, those who question why a nurse is the only one to take a fall so far for Camp Mystic are looking thru the wrong lens or looking at the wrong context. The context for judging Nurse Eastland’s actions, as the Board might argue, is not the banks of the Guadalupe River but the nurses station and the hive. Whether others take a fall or not for Camp Mystic, nursing keeps its own accounts. That’s why it’s a trusted profession. In fact one might argue that the Board stepping in to look at Nurse Eastland’s performance, despite others looking the other way, is a good sign.
The Board of Nursing actually has a lot on its plate these days. The spread of nurse practitioners (it’s said that there is so much demand for preceptors, to train new advanced nursing providers, that students in Houston are now being charged $50 an hour to show the students how to do the job) and the sudden prevalence of doctors of nursing practice has helped pull American health care out of a provider hole. These new roles must be regulated and disciplined just like the bedside nurse. The Board is also responsible for nursing education, and that means auditing and certifying nursing programs across the state.
Nursing school, whatever the level, may actually be the best venue for addressing a nurse’s obligations in case of an emergency, including an active shooter, instead of the Board waiting for someone to make a mistake and then making an example of them. Unexpected danger in the healthcare environment is not going away and, in fact, is only likely to increase. This isn’t Norway after all. It’s Texas.
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