Look at me when I’m talking to you!

I am going to vent for a moment so bare with me okay?

I ABSOLUTELY HATE WHEN MY PATIENT DOES NOT LOOK AT ME EVEN ONCE WHEN I AM SPEAKING TO THEM!

This has nothing to do with eye contact. I know for some people, eye contact is uncomfortable or unusual in their culture. I get that. However, when I call someone into my IV chair and they can’t bother to put their  phone down long enough to raise their head and answer my questions it burns me up! I just feel like it is so disrespectful! Is that how they converse with everyone? No, I highly doubt it. I think *that* is what bothers me the most. I am simply trying to provide care within my environment. I didn’t force them to come to this hospital, nor did I force them to make an appointment for whatever reason they are here. I feel like the least someone can do is acknowledge that a human being is standing in front of them providing care.

There have been times when I am trying to go over information with a patient and they are so engrossed in whatever is happening on their phone that they have a hard time answering my questions. Typically this statement will get me the acknowledgment I prefer: “Let me know when you are done on your phone and then I I’ll continue.” After that I take a step back and wait. Patients will typically put the phone down and pay attention.

In all honesty, I don’t need their undivided attention the entire time they are in my care. Since I am the radiology nurse, I am going to be the one to go over the contrast questionnaire with the patient and then I will obtain vascular access. This isn’t dramatic stuff here. I really only need the patient to pay attention when I am asking them questions, after that I actually prefer they occupy themselves because most often it means they’ll focus on their phone and not on the 20g I am about to stab them with.

I don’t know, maybe I’m just getting old or something but a little acknowledgment wouldn’t hurt.

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Uniform… Acceptance…

The hospital I work for has a uniform policy. As nurses we wear ceil blue and/or white. I hated the idea of uniforms… At first.

Now, I kind of like the fact that each department in our hospital has a uniform.

Yeah, it surprised the hell out of me too!

It helps me know who I’m talking to or who just walked into my patient’s room. I’ve often had patients say, “the doctor said I can have something to eat!”, however I haven’t seen the docs come onto the unit. Now I’m trying to figure out who my patient was actually talking to so I can find out what was actually said. With everyone being in uniform I can ask my patients “what color uniform were they in?” I cannot tell you how many times I’ve asked that question and then find out it was xray technician that came in to do the morning portable chest xray that the patient talked to! For a lot of our patients, anyone in scrubs is a doctor.

The fact that I can identify a department just by their scrubs is a real help and as much as I hate to admit it, uniforms made things a lot easier. I only have one big complaint, THESE COLORS!!!!

I despise the ceil blue/white combo. I would really prefer a darker color. Something like a hunter green or a navy blue would work for me but it is what it is.

So tell me, what policy did you initially hate that you’ve learned to accept and perhaps even like?

Teach back

Get your patients to “teach back” what you have taught them. Get them to repeat what you have taught them. You may be surprised at how little information your patient has absorbed from the education you have given. Using the “teach back” or “repeat back” method can help you gauge just how much information your patient is retaining.

With the “teach back” method, it’s exactly as it sounds. You get your patient to teach you what you taught them. This method is really effective for education that involves hands on training. Things like changing a colostomy bag at home, changing a wound dressing, giving tube feeds, doing peritoneal dialysis, etc all require a lot of teaching. These are thing you want to make sure your patient understands before they return home. When you get them to teach it back to you then you know that they have an understanding of the information they have received. As they are teaching it back, you can correct them if necessary and give them little hints to help them with the process.

“Repeat back” works well with information that may not require as much hands-on work. I found that it works well with my patients that are being sent home with multiple prescriptions, especially different inhalers. I had a patient with COPD and asthma (and yes, she still smoked, how did you know?) that had both Symbicort and an albuterol inhaler. She ended up on our unit from a bad asthma attack. When she started to get wheezy I took her the albuterol inhaler to help open her up and she refused. I couldn’t understand why. She said “that’s not the one I need for my asthma, I need the other one”. Confused, I asked her if she was referring to her Symbicort. She said yes, that’s the one she takes when her asthma flares up. She took her Symbicort whenever she felt tight or wheezy and took her albuterol twice a day. OH, nooooooow I know why you’re in here. I tried explaining to her that the Symbicort is for her COPD, not asthma. She argued with me for a good 10 minutes that I was wrong. I had to not only print out information on Symbicort but also have the doctor talk to her before she accepted that she has been using her meds wrong this whole time and that is why she was in the hospital. Upon discharge I made her repeat the education I had given her and show me which inhaler was her twice daily inhaler for COPD and which inhaler was for her asthma. I felt comfortable that she understood her meds upon discharge.

I think this teaching our patients about their health is where the medical system is lacking. Often, we are in such a rush to get people out so we can get people in that we just assume the patient understands because they didn’t ask any questions. Often, it’s the opposite. Some are embarrassed to say they don’t understand. Some can tell we are in a rush and don’t want to bother us by asking us to repeat what we have told them. It is up to us to make sure our patients are leaving with a full understanding of their health and their medications.

So you have to send your patient to MRI…

So your patient needs an MRI. Maybe you can just send them down with transport, maybe you have to come down with them. Here are 10 tidbits to help make it easier or yourself and us.

  1. THE MAGNET IS ALWAYS ON. ALWAYS. 
  2. Because of #1, don’t bring anything you don’t need on your person. Majority of what you carry is not MRI compatible and you’re going to have to leave it somewhere away from the MRI room anyway.
  3. Also, don’t leave anything on your patient that they don’t need. The 4 blankets? Yeah, let’s consolidate that. The SCD’s? Leave those in the room. The stickers from their morning EKG? Take those off, they aren’t MRI safe. No, your patient can’t bring his/her phone with them. Your patient will need to be moved off of the hospital bed and onto the MRI safe stretcher, let’s make this easy on everyone.
  4. Coming down with your patient? Understand that you aren’t just going to walk into the MRI room when you get downstairs. You may be in a rush, we aren’t. Safety is our number one priority. We have to make sure you don’t have anything unsafe on you and we have to check the patient for the same reason.
  5. ICU nurses please note: your ECG leads and pulse ox are coming off once you get here so be prepared to replace those. We have our own MRI compatible monitoring equipment, your patient will be monitored using our stuff not yours.
  6. Take a look at what IV fluids you have hanging, are they necessary? Your IV pump is not compatible with the MRI machine. No, seriously, it’s not. You are probably going to have to add like 30 feet of extension tubing to your drips unless your hospital has the MRI safe pumps and there aren’t many hospitals that have them. Do you really need to bring the patient down on normal saline? Really? Can the TPN and lipids be paused for 30 minutes to an hour? Thinking of this while you are still on the unit is going to make the transition much easier. ICU nurses, take note because we are notorious for bringing down drips that could really be paused for this test. I’m not saying be unsafe to make it easier, just use your judgment.
  7. The magnet of the MRI interferes with the ECG monitor, you are NOT going to get a good rhythm while your patient is in the scanner. This, in particular, applies to my ICU nurses. Please understand that there is nothing we can do about that. The monitor is wireless and whenever the magnet begins scanning it disrupts the signal so the rhythm that we see on the monitor is garbage. In between scans you will see a normal rhythm but once the technologist begins the next part of the study you are going to see nothing but artifact. If your patient has been having unstable arrhythmias you may want to speak with your docs about the risk/benefits of coming down for the scan. You may want to wait until you can trust that they aren’t going to jump into some funky heart rhythm during the scan. That MRI of the foot can wait.
  8. Pacemakers no longer exclude a patient from having an MRI. It used to be having a pacemaker was an automatic “no”. That has since changed. There are now MRI conditional pacemakers and we are now scanning patients with MRI non-conditional pacemakers. That being said, let your physician know that an MRI on a patient with a pacemaker is NOT going to happen the day it’s ordered. Many steps have to be taken to assure we do this in the safest manner possible. We need paperwork from whatever company manufactured the pacemaker. We then have to set it up so that a technologist from the company can be there to put the pacemaker in “MRI-safe” mode.
  9. FYI: MRI safe mode does NOT mean we turn the pacemaker off for the scan! This was something I was not aware off until I became a radiology nurse. It’s the exact opposite. The pacemaker mode is actually changed from pacing only when needed to pacing continuously at a set rate determined by the doctors and set by the technologist from the company.
  10. Do not send your patient down if they are claustrophobic, altered, or in pain unless you have a plan. For a successful MRI, the patient MUST lie still for the ENTIRETY of the scan. If they move, that section of the scan must be restarted FROM THE BEGINNING! If you know they are claustrophobic, ask for something to help calm them. If they are altered and can’t hold still, ask for a sedative of some sort or reschedule. If they are in pain, please premedicate them. The MRI table is hard and uncomfortable, your patient won’t be able to tolerate the scan if they are already in pain.

Hopefully these 10 tidbits of info make your trip to MRI a tiny bit easier.

Humbled

Since I have become a radiology nurse I have witnessed something that has humbled me; cancer patients and the infallible strength that they have.

My role in radiology is different from my role as a bedside nurse. I am still responsible for patient safety and care but in a more indirect way. I monitor the patients during their MRI’s and I am the one that starts the IV’s before the study begins. I encounter a lot of oncology patients. In fact, I would say almost 90% of my patients some days are getting scanned to assess for metastasis, diagnose new cancer, or stage some form of cancer. These are people from all walks of life. All races, all statuses, all religions, all education levels, all ages, cancer does not discriminate.

What has humbled me is their attitudes. Almost every cancer patient I have come in contact with in my department has had a bright smile and a sunny personality. Most of them come in with the mindset that they have another battle to fight and they are going to win it. I love that! Their smile makes me smile. We end up joking and laughing during our time with each other. These are people that are getting a procedure that could potentially present more bad news and yet they walk around with a smile. I wake up bitching and moaning in the morning about having to get up so early. I complain about my knees being stiff or my back causing me pain. I rarely wake up and just thank God for being alive and being *relatively* healthy. I am going to make a real effort to try and change that. If these oncology patients can still tackle life with such vibrancy then why can’t I? Every day that I am alive is a blessing. Every day that I am blessed to not have to experience the things that these wonderful patients are having to go through on a daily basis is a gift. I am humbled yet inspired by the strength and positivity these patients demonstrate. I’m going to live for them.

Full circle

I started working in a hospital on my birthday in 2007. In this particular hospital, there were two separate transportation teams. One did regular transports and discharges and the other only did transports to and from radiology departments. I started as a transporter in the radiology department. The hospital offered a free EMT-B course, all you had to do was pass. Of course I took up that offer! I transported for over a year and in the process started nursing school. That’s when I decided to become a tech. After graduation, I worked on that unit (med-surg) for two years. I hated it. I am not a med-surg nurse. I got frustrated very quickly with all the frequent flyers. I felt like I wasn’t making a difference. No matter how much teaching I did I knew I would see those patients in a month, maybe two. So I left the hospital to take an ICU position in a smaller hospital. It was hell for me to go from a teaching hospital where I was autonomous and a part of the care team to a community hospital where I was supposed to just do what I was told. Yeah, no. They got two years out of me as well before I took an ICU position in another teaching hospital. I loved it. I learned so much and got to be a part of things I had never experienced before. The only drawback was the commute. An hour and a half one way, and I was working night shift.  I managed to pull this off for three years. I kept telling myself I would move closer to the hospital but I never did. I love the city I live in right now. I love the diversity, something that was lacking in the area that particular hospital was in. So, I started the job search again. Guess what hospital and what department were in need of a nurse? Yep, my first hospital and the opening was in radiology! I jumped at the chance and luckily got the position.

Its been a bit surreal. Being back in the radiology department feels familiar and new at the same time. Most of the radiology techs and nurses were there when I first started. They remember me as a transporter from 11 years ago. Now here I am in their department as a clin 2 nurse! I’ve come full circle.  I am getting used to being the new kid without actually being a new kid. Maybe, just maybe this is where I was supposed to be all along…

 

“It’s ok, we’ve got it”

I don’t trust this phrase whenever it comes to my patient any other medical professional or anyone for that matter.

Why?

Because I’ve seen it come back to bite people.

The patient needs to go to the bathroom, you go in to help. The family says “it’s ok, we’ve got it”… Annnnnnnnd your patient is on the floor.

They want to place a central line at the bedside so you go in to assist. The fellow tells you “I’ve got my med students so it’s ok we’ve got it” annnnnnnnd then they proceed to place a femoral central line in the right subclavian because the student didn’t know the difference between the kits (this is a true story).

X-ray comes in for the morning film and needs to reposition the patient, you offer to help. They tell you “it’s ok I’ve got it” annnnnnnnd now your IV is ripped out and on the floor.

As far as I’m concerned, you don’t “got it”. Don’t you touch my patient without me being there. I’m going to help whether you like it or not. I do NOT have time to fill out safety events. I’m probably not even done with my regular charting.

It’s ok, I’ve got it.

Log off

Log off of your computer, nurse!

I know you’re just going to go into the room of your patient for a few minutes. I understand that you just need to go to the pyxis and grab one more med. Log off.

You have very personal information about your patient visible for anyone to see. EVS, the random med student, the family member/friend in the room (for those of you with bedside computers), they can all see this very personal information.

How would you feel if one of your friends found out that you tested positive for opioids on admission because your nurse left your labs open on the computer in your room? You’re sedated and intubated so you can’t remind the nurse to protect your personal information.

Doesn’t sound fun does it?

Your patient and their information deserve that same respect.

Even more importantly, it’s law. You have been given the responsibility to maintain patient privacy and you should take it very seriously. You’ve heard of HIPAA. You know just how important it is. Understand just how serious it is to your medical facility. Nurses have been written up, suspended, even fired over HIPAA violations.

Don’t be that nurse.

Get into the habit of logging of when you walk away from your workstation. It may seem tedious but it is your duty to protect that information.

That’s so gross

You would think the grossest thing that I have seen as a nurse would involve the patient.

Oddly enough, no.

I can say for sure the grossest thing I have seen is the patient’s family member(s) sleeping on the floor of the room.

DO YOU KNOW WHAT HAS BEEN ON THAT FLOOR?!?!?

I have walked into the room and nearly tripped over a family member sleeping peacefully on the floor. I was immediately freaked out. Like, what makes someone think sleeping on a hospital floor is safe or sanitary?

Oh, you have to get up off that floor honey.

There have been soiled linens, blood, body fluids that I can’t describe, EVERYTHING on that floor. Glare all you want but I’m not leaving you down there.

People think hospitals are far cleaner than they actually are…

Consent and ethics

Nursing is fully aware of consent. We know that we need to have documentation that the patient accepts this treatment. It’s a no brainer. But, what if the patient doesn’t want treatment and the power of attorney does?

Prime example, you have an elderly patient that is obviously letting the family talk them into surgery. To no one’s surprise, it doesn’t go well. They end up sick. They have to remain intubated. They need an art line, central line, pressors, the works. Even on the ventilator they are adamantly shaking their head no to all the things you’re trying to do. They are fighting. They keep trying to pull away. They don’t want this.

Their family does.

The POA is who the doctors decide to ask for consent to treat. They completely bypass the patient. They’re intubated, they can’t answer for themselves right? If course the family wants everything done… So, everything is done. Is that fair to the patient?

Shouldn’t the patient be allowed to say no without having someone else choose otherwise? What is the fine line that decides when a patient no longer has the capacity to make their own decisions? Does intubation automatically take away that right? Does having a POA take away that right? If a patient is clearly communicating, even in the vent, shouldn’t we respect their wishes?

The nurse in me says yes. The nurse in me says to respect my patient’s dignity.

The nurse that’s been at the bedside for almost 8 years knows that that is normally not the case.

I have seen advanced directives ignored because the patient is unconscious and the family isn’t ready to let go. I’ve seen cases like the one mentioned above. I’ve seen doctors watch as the family is almost forcing a patient to go along with treatment and the doc just goes along with it as well. I’ve had to be a part of “moral distress” meetings because nurses were stressed over the ethical dilemmas involved in certain cases. When do we stop?