Friday, September 24, 2010
Thursday, September 23, 2010
I ain't no Dr's handmaiden; or, Why Grey's Anatomy is lame
For the past few years I've had to work or have class on Thursday nights so I haven't watched Grey's in years. Having watched my first episode I have to laugh at the total absence of nurses...yet they don't hesitate to pull all the patient related drama into the Dr's storylines. It's incredibly misleading because what Grey's is REALLY portraying is a bunch of scenarios NURSES would be dealing with, not Drs. A guy woke up freaking out and in pain on tonight's episode and Drs. were there to calm him down. I actually LOLed. I have never once seen a Dr. talk someone down from an emotional ledge, but I've seen many nurses do it..hell, I've even done it myself. And, in Dr's defense, they usually have an inordinate number of patients to write orders on and follow medically, so it's not necessarily the fault of a real life Dr. that they are not present for such things. After all, they can't possibly know every little thing about every patient and be there all the time... that's why they rely on nurses to be their eyes and ears. And that's also why if someone is FREAKING OUT about something, it is HIGHLY unlikely that a Dr. will be there to talk them down, contrary to Grey's Anatomy fame.
There was a big billboard up on Rte 22 about a well known medical school opening up a class for med students in my hospital. My husband saw it and said "so did you ever think about medical school?" I just shook my head and smiled and said, "Why on EARTH would I EVER want to do that? I'd lose the only thing that makes working in health care tolerable, actually taking care of people." Doctors are not caregivers. They write orders, they examine, they assess, they question. They are brilliant in their own right and I of course respect them, but the best Doctor in the world can't have good patient outcomes without talented nurses to provide care to their patients and carry out their orders as well as question those orders and bring our own pt. concerns to the attention of the physician...as well as provide emotional support. But I guess that doesn't make for good TV, so keep on with your bad selves you surgeons. I will be right over here showing patients how it's REALLY done.
There was a big billboard up on Rte 22 about a well known medical school opening up a class for med students in my hospital. My husband saw it and said "so did you ever think about medical school?" I just shook my head and smiled and said, "Why on EARTH would I EVER want to do that? I'd lose the only thing that makes working in health care tolerable, actually taking care of people." Doctors are not caregivers. They write orders, they examine, they assess, they question. They are brilliant in their own right and I of course respect them, but the best Doctor in the world can't have good patient outcomes without talented nurses to provide care to their patients and carry out their orders as well as question those orders and bring our own pt. concerns to the attention of the physician...as well as provide emotional support. But I guess that doesn't make for good TV, so keep on with your bad selves you surgeons. I will be right over here showing patients how it's REALLY done.
Wednesday, September 22, 2010
Ma Teresa's joined the mob and is happy with her full time job
http://www.youtube.com/watch?v=_6nEsOE_YKk
Tuesday, September 21, 2010
Wanted: thicker skin and a backbone
Over the weekend I had a pt. who came in with atrial flutter and heart rate in the 160s and on a cardizem drip from a long term care facility. Obese, 2 colostomy bags, cerebral palsy in legs, slightly MR, very needy and impatient. But, I have kids, I know how to talk calmly and sweetly enough so he doesn't get too upset. Often, all he wants is his nasal cannula adjusted or a pillow under his ankle anyway. Maybe some toast and a sip of water. So basically, when he's my patient, I'm the only one who goes in there when he calls because the aides just have no clue how to handle him. Fine, whatever.
When I got him back yesterday, found out his heart rate plummeted into the 30s that afternoon and they d/cd the cardizem drip and started him on a dobutamine drip. I recall during my ICU rotation a few of my pts running dobutamine, but I couldn't remember anything at all about the drug (honestly I didn't think we were allowed to run dobutamine on our floor). All I knew was if his heart rate went over 100 I was to shut it off. (no titrating, just turn it off) Alrighty then. So I'm doing my assessment and thinking, you know, if anything happens to that site, I'm fucked. I better try to get another peripheral site into him. I tried and I couldn't get him. Called the charge nurse, he couldn't get him. Grabbed a Dr. and told him we need a PICC line placed in him by the PICC team. Dr. put in for the PICC team consult and they will be in to place the line tomorrow am. Perfect! Now all I had to do was protect that site with some extra gauze and cross my fingers nothing happens to it.
45 minutes later he hits the call light and says, "I think my IV site is out"
FUCK.
Go in the room, sure enough the site is out. While I'm assessing the site, a priest walks in to give him communion and I'm thinking to myself "well good thing you're here, we may be needing last rites, too.."
Page the Dr. and tell him the site is out and the pt. is not getting his dobutamine. He tells me to page general surgery and have a central line placed (a little riskier than a PICC insertion but he needs the medicine and it's well known he's a tough stick). Get in touch with general surgery and the Sr. resident says, "Have you exhausted all your other resources? Called ICU units to get a peripheral site put into him? A central line should be a LAST RESORT and it sounds to me like the only reason you are asking for a central line is because you don't have the skill set necessary for this patient's needs. Keep calling other floors and if no one can get a line in the next 2 hours we will come and place the line."*slam*
I stood there stunned for about a minute and ran though about 5 scenarios in my head.. most of which ended up with my patient coding because I wasn't able to get him the help he needed in time... and I cried. I stood there right in front of the printer by the front desk and cried. Charge nurse (G) saw me and said, "WHAT DID HE SAY TO YOU? What's his number? I am calling him now.." I begged G to just help me get a the pt's dobutamine into him and we can talk about the resident's communication techniques later. I was more worried about my patient than my pride. In the midst of my crying, the priest came over and asked me if it's ok if the pt. received communion and I said yes, it's fine. (The priest looked kindly concerned for me and told me he's sorry I'm upset and he will pray for me, that was very sweet of him.) One of the nurses from our floor was able to get a line in him after all and the dobutamine was back up and running. Who knows, if not for the priest maybe things wouldn't have resolved so quickly.
Anyway, the better part of today was spent in tears, partially from exhaustion, partially from stress, partially from sheer loneliness. I hate that I internalize everything and things affect me so deeply. I can feel my healthy life perspective slipping away from me, it's getting more and more difficult for me to process all the complex scenarios (this story one simply one of MANY). All I feel left with is raw emotions and an inability to cope with them. Giving all you have to complete strangers for 12 hours a day 3 days in a row is exhausting emotionally and physically. The odd thing is, while I'm at work, for the most part, I feel invigorated. I kind of view my patients as a gift, I'm so lucky I get paid to do what I do. The downside to that is, allowing my heart into the nursing equation I think will eventually become my greatest mistake. When you give so much of yourself, you risk losing much of yourself. I hope time teaches me how to balance my emotions because if I continue on like this I'm going to suffer tremendous consequences.
When I got him back yesterday, found out his heart rate plummeted into the 30s that afternoon and they d/cd the cardizem drip and started him on a dobutamine drip. I recall during my ICU rotation a few of my pts running dobutamine, but I couldn't remember anything at all about the drug (honestly I didn't think we were allowed to run dobutamine on our floor). All I knew was if his heart rate went over 100 I was to shut it off. (no titrating, just turn it off) Alrighty then. So I'm doing my assessment and thinking, you know, if anything happens to that site, I'm fucked. I better try to get another peripheral site into him. I tried and I couldn't get him. Called the charge nurse, he couldn't get him. Grabbed a Dr. and told him we need a PICC line placed in him by the PICC team. Dr. put in for the PICC team consult and they will be in to place the line tomorrow am. Perfect! Now all I had to do was protect that site with some extra gauze and cross my fingers nothing happens to it.
45 minutes later he hits the call light and says, "I think my IV site is out"
FUCK.
Go in the room, sure enough the site is out. While I'm assessing the site, a priest walks in to give him communion and I'm thinking to myself "well good thing you're here, we may be needing last rites, too.."
Page the Dr. and tell him the site is out and the pt. is not getting his dobutamine. He tells me to page general surgery and have a central line placed (a little riskier than a PICC insertion but he needs the medicine and it's well known he's a tough stick). Get in touch with general surgery and the Sr. resident says, "Have you exhausted all your other resources? Called ICU units to get a peripheral site put into him? A central line should be a LAST RESORT and it sounds to me like the only reason you are asking for a central line is because you don't have the skill set necessary for this patient's needs. Keep calling other floors and if no one can get a line in the next 2 hours we will come and place the line."*slam*
I stood there stunned for about a minute and ran though about 5 scenarios in my head.. most of which ended up with my patient coding because I wasn't able to get him the help he needed in time... and I cried. I stood there right in front of the printer by the front desk and cried. Charge nurse (G) saw me and said, "WHAT DID HE SAY TO YOU? What's his number? I am calling him now.." I begged G to just help me get a the pt's dobutamine into him and we can talk about the resident's communication techniques later. I was more worried about my patient than my pride. In the midst of my crying, the priest came over and asked me if it's ok if the pt. received communion and I said yes, it's fine. (The priest looked kindly concerned for me and told me he's sorry I'm upset and he will pray for me, that was very sweet of him.) One of the nurses from our floor was able to get a line in him after all and the dobutamine was back up and running. Who knows, if not for the priest maybe things wouldn't have resolved so quickly.
Anyway, the better part of today was spent in tears, partially from exhaustion, partially from stress, partially from sheer loneliness. I hate that I internalize everything and things affect me so deeply. I can feel my healthy life perspective slipping away from me, it's getting more and more difficult for me to process all the complex scenarios (this story one simply one of MANY). All I feel left with is raw emotions and an inability to cope with them. Giving all you have to complete strangers for 12 hours a day 3 days in a row is exhausting emotionally and physically. The odd thing is, while I'm at work, for the most part, I feel invigorated. I kind of view my patients as a gift, I'm so lucky I get paid to do what I do. The downside to that is, allowing my heart into the nursing equation I think will eventually become my greatest mistake. When you give so much of yourself, you risk losing much of yourself. I hope time teaches me how to balance my emotions because if I continue on like this I'm going to suffer tremendous consequences.
Tuesday, September 14, 2010
GET THEM THE DAMN SODA
There's a new trend in hospitals across the nation. The trend is a goal of meeting and exceeding patient (and family's) expectations. (There are other trends regarding payment/reimbursement issues and hospitals not getting paid for hospital acquired infections/pressure ulcers/etc.- but I'm not discussing that today) The problem lies within the perception of what that mentality means to some nurses. There are many nurses who resent this pendulum swing into more "customer focused" type of care.. nurses who feel that they are above taking dinner trays away or getting a cup of ice water because "I didn't go to school for X amount of years so I can wait on people hand and foot." Nurses who are hell bent on being the one in charge and telling the patient to do things because they are In Charge and You Will do What I Say.
Nurses are highly trained professionals with an enormous amount of skills and who need to be able to think critically, have a solid knowledge base, be able to delegate as well as coordinate care from many different disciplines. It takes time to master all of that and it's something to be proud of for sure, but once you start thinking all those things make you "better than" having to do little things for your patient too, I have one thing to say: Get over yourself.
Your patients are scared. Maybe from lack of knowledge, maybe because they saw family members die in the hospital, maybe because of a fear of the unknown-- there's a million things that can scare them. Your patients are frustrated. 10 Drs tell them 10 different things and they don't understand 50% of what the Drs are saying because the patient is so intimidated. Their health is in jeopardy, they are facing their own mortality in a lot of cases... and some nurses will get upset because they asked for a diet soda. REALLY? Well, let me tell you what I do. I get them their damn soda and I ask their family members if I can get them something while I am in there. It's the least I can do. Look at the big picture. You are healthy, perfectly capable, and compared to the patients you are caring for, you are in a pretty good place... GET THEM THE DAMN SODA.
If you have a diabetic looking for laffy taffy, yes, you can say no and explain to them why you can't give them candy because it will affect their health badly, but if they want, you can get them sugar free yogurt, ice cream, etc. But I will tell you something else.. if I have a 96 year old man on a cardiac diet who hasn't been eating because he doesn't like the food and his son brought him in a doughnut? You bet your ass I'm going to let him have the doughnut. He's 96, for christ's sake, let the man have his damn doughnut! I believe that there's a lot to be said for life's little pleasures boosting a patient's morale and give them something worth living for.
I can go on and on with examples but my general rule of thumb is this when a patient asks for something, "Will it really hurt? If so, what's a better alternative to offer? If it will benefit them by making them more comfortable (pillow, blanket, water), just GET it- if at all possible, right away. A patient won't remember if you gave them their lopressor at 2:13pm but they will definitely remember if someone walked by their room and thought they looked cold with just a sheet on and put a blanket on them... that reminds me of one of my favorite things about working overnights. When all my patients are asleep and I am peeking into their rooms I always think to myself that they were someone's baby at some point and how lucky I am to be able to be able to watch over them like someone once did, sometimes almost 100 years ago. Nurses need to remember it's a privilege to be able to care for patients, you are not doing them a favor, you are simply doing your job- and if you are doing it well you are taking care of their body and their emotional well being. THAT is the heart of nursing.
Nurses are highly trained professionals with an enormous amount of skills and who need to be able to think critically, have a solid knowledge base, be able to delegate as well as coordinate care from many different disciplines. It takes time to master all of that and it's something to be proud of for sure, but once you start thinking all those things make you "better than" having to do little things for your patient too, I have one thing to say: Get over yourself.
Your patients are scared. Maybe from lack of knowledge, maybe because they saw family members die in the hospital, maybe because of a fear of the unknown-- there's a million things that can scare them. Your patients are frustrated. 10 Drs tell them 10 different things and they don't understand 50% of what the Drs are saying because the patient is so intimidated. Their health is in jeopardy, they are facing their own mortality in a lot of cases... and some nurses will get upset because they asked for a diet soda. REALLY? Well, let me tell you what I do. I get them their damn soda and I ask their family members if I can get them something while I am in there. It's the least I can do. Look at the big picture. You are healthy, perfectly capable, and compared to the patients you are caring for, you are in a pretty good place... GET THEM THE DAMN SODA.
If you have a diabetic looking for laffy taffy, yes, you can say no and explain to them why you can't give them candy because it will affect their health badly, but if they want, you can get them sugar free yogurt, ice cream, etc. But I will tell you something else.. if I have a 96 year old man on a cardiac diet who hasn't been eating because he doesn't like the food and his son brought him in a doughnut? You bet your ass I'm going to let him have the doughnut. He's 96, for christ's sake, let the man have his damn doughnut! I believe that there's a lot to be said for life's little pleasures boosting a patient's morale and give them something worth living for.
I can go on and on with examples but my general rule of thumb is this when a patient asks for something, "Will it really hurt? If so, what's a better alternative to offer? If it will benefit them by making them more comfortable (pillow, blanket, water), just GET it- if at all possible, right away. A patient won't remember if you gave them their lopressor at 2:13pm but they will definitely remember if someone walked by their room and thought they looked cold with just a sheet on and put a blanket on them... that reminds me of one of my favorite things about working overnights. When all my patients are asleep and I am peeking into their rooms I always think to myself that they were someone's baby at some point and how lucky I am to be able to be able to watch over them like someone once did, sometimes almost 100 years ago. Nurses need to remember it's a privilege to be able to care for patients, you are not doing them a favor, you are simply doing your job- and if you are doing it well you are taking care of their body and their emotional well being. THAT is the heart of nursing.
Sunday, August 29, 2010
Goodnight, sweetheart
I've had a miserable, emotional day and I am beyond exhausted so this entry will be brief.
Three peaches guy passed away last week. One of the nurses heard about it and told me since she knew I had bonded with him. (I wish I had known sooner because I would have gone to his funeral.)
I hope they played the 1950s music at his funeral that he wanted... but on the off chance they didn't....
This one is for you, Stephen. May we meet again someday, my friend.
http://www.youtube.com/watch?v=egX9N8yOgaU
Three peaches guy passed away last week. One of the nurses heard about it and told me since she knew I had bonded with him. (I wish I had known sooner because I would have gone to his funeral.)
I hope they played the 1950s music at his funeral that he wanted... but on the off chance they didn't....
This one is for you, Stephen. May we meet again someday, my friend.
http://www.youtube.com/watch?v=egX9N8yOgaU
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