Forever alone

Sometimes I feel “forever alone” when I am around non-nursing people. As a nurse I get to be a part of something amazing. I’ll always be proud I am a nurse. I don’t feel like my profession makes me better than anyone else. I do feel like my profession changed me.

I have seen death first hand.

I have had to hold back tears while a family kisses their 16 year old goodbye. I have watched a person suffer in the ICU because the family guilted them into remainding a full code, and endure multiple surgeries that ultimately wouldn’t fix anything, until they finally passed away in that bed. I have watched families lose hope as the transplanted organ fails. I have had to comfort patients after a devastating diagnosis.

I have had my ass handed to me at work.

I have worked 12 straight hours without being able to eat or even stop to pee. I have dealt with physical and emotional abuse at the hands of patients and their loved ones. I have been talked down to by medical professionals that feel they are above me thanks to a difference in degrees.

I hold it all in when I’m with family and non nursing friends. When people say my job is “easy” since I work nights and everyone is asleep, I just laugh. When people are certain I’m “paid” because nurses make “so much money”, I just stare blankly. I listen to people complain about their jobs intently while they dismiss my complaints because I knew nursing was hard.

It can make you feel alone.

It’s not all family members and not all non-nursing friends but enough to make me not talk about my job unless I am talking to a select few. It’s why the nursing community is so INVALUABLE to me. We can swap stories about the worst of the worst. We can laugh about some seriously dark sh*t with no judgment! We understand each other. The nursing community keeps me from feeling “forever alone”. Sometimes we are all we’ve got šŸ˜!

Advertisements

Good morning to you too šŸ˜’

Hi management, how are you? It’s nice to see you all bright eyed and bushy tailed. You’re coming off of a full nights sleep. You have quite a bit of energy huh? Sure you do. 

I don’t.

I just finished 12 hours of getting my ass handed to me. I’ve done two CT trips tonight. I got a sh*t show from the OR. I got yelled at by a doc for labs not sent from the previous shift. I finally ate this morning at 5 am and that was at the desk. 

You would know this if you came in and asked me how the night was instead of complaining about the cup at the desk without a lid. No, I haven’t read the email you sent because I haven’t had the time. Yes, the EKG machine is sitting outside a room. You know what else is outside that room? The code cart. It’s been that kind of night… But you wouldn’t know that because instead of inquiring about your staff you came in with complaints.

Maybe, just maybe you could say “good morning” first. Maybe you could take 10 extra seconds to get a feel for the unit and how the night was. Maybe you can look at what we accomplished instead of what we missed. Maybe you could manage to come in with a little positivity… Maybe….

Alarm fatigueĀ 

I am legitimately over it. We have new GE monitors and they beep for EVERYTHING! Apnea is a triple beep but an arrhythmia isn’t. It doesn’t read the respiratory leads well so everyone is either tachypneic or breathing 6 breaths a minute.   There is something beeping every minute it seems. It’s getting to the point that we are starting to ignore the alarms because there are so many of them. 

This is what they mean when they refer to “alarm fatigue”

Story time no. 8

I decided to actually check my work mail box. Amongst the numerous papers that I’ve totally ignored I found lots of little shout outs and even a few gift cards from patients and coworkers.

I don’t think people realize just how much little things like this mean. It makes us feel appreciated. It makes me feel appreciated. It shows me that I’m doing something right…

Dear medical student…

Dear med student,

Hi. I’m the nurse that had been taking care of this patient for the last 12 hours. I am the nurse that charted every med given or not given over this shift. I’m the nurse that verified all those vital signs. I’m the nurse that put in that progress note last night. I drew the labs this morning. Yes, I know my patient.

You do not. That’s ok.

While I do not mind you asking me about my assessment, I will not do your assessment for you. You need to check the pupils. You need to check a neuro status. You need to check the lab results. You need to look over the vital signs. You need to look at the meds. You need to know this patient so that you can give your information during rounds.

Walk in. Introduce yourself to the patient and I, the nurse. Put on your gloves and get hands on. Ask questions, we don’t mind. We nurses understand that you are still trying to get your footing. We were there at one time as well.

Understand that ultimately, you still have to assess your patient yourself. Take these moments to build your communication and assessment skills. Each moment of patient contact is a potential moment for learning. Get all up in there!

DNR vs Comfort Care

I have heard DNR and comfort care used interchangeably, especially by doctors.Ā One is not the other!

DNR: Do not resuscitate. It is exactly what it says, you do not try life-saving measures in the event of a code situation. This doesĀ not imply that you stop caring for a patient. DNR does not mean “do not treat”! You will continue to provide patient care. You will hang medications for their blood pressure if it is dangerously low. You will more than likely continue to draw labs as well. You will still treat this patient pretty much like any other unless the patient, or theirĀ medical POA (power of attorney), tells you otherwise. One thing you must be aware of is whether or not the patient has exceptions to their DNR. Some may say that in the event of a code they want code medications but no chest compressions or intubation. Some people may say meds and intubation are fine but no chest compressions. I have even seen meds and compressions but no intubation (which leaves you wondering but hey, it’s what they want.)

Comfort Care: This is what most people think a DNR is. Just keep them comfortable until they pass on their own. At this point, you are no longer going to escalate care. In fact, you will more than likely begin to scale back dramatically the amount of care you provide. Typically the only medications you will give will be pain medications like morphine and maybe a few breathing treatments to help ease their work of breathing. For the most part, you are there as support for the family if needed, and to assure that your patientĀ diesĀ with dignity.

Please, for the sake of your patient, understand the difference. If you need to clarify with the patient or POA then do so. You don’t want to wait until the patient is near death to try and figure out what the patient actually wants.

Story time no. 7

Had my follow up appointment for my back today. The MRI shows I definitely herniated a disc between the lumbar/sacral region. No nerve involvement so no surgery. Yet. However, if the disc continues to degrade then surgery is where we are headed.

So now this puts me in a weird mental space. Do I continue being a bedside nurse, knowing that I’m going to potentially hurt my back more, or is it time for that cushy office job where I’m not pulling patients? I love direct patient care. I love being at the bedside. My back, however, is not in agreement. I’m a trauma nurse, I’m going to be pulling and tugging. It’s inevitable. My coworkers have been AMAZING at trying to help me out when they see my back is causing me pain. They opt to take the “pulling side” when we turn so I don’t have to strain myself. They put me at the head of the bed holding c-spine so I’m not having to do a whole lot. They have really “had my back” so to speak.

But it’s not fair to them. They shouldn’t have to potentially hurt themselves so I don’t hurt my self any further. I’m starting to feel like a burden. I don’t like that.

So now it’s time to make some big decisions…

Your safety matters

It's happening more and more. Medical professionals are being hurt, attacked, even killed while providing care. We go wherever medicine takes us. Caring for others is a part of who we are.

Let's learn to care about ourselves and our safety more. You are not obligated to go into any situation that you feel is unsafe for you. You do not have to deal with the aggressive visitor that has threatened you more than once. You do not have to deal with sexual harassment from your patient. You are not at work to be subjected to physical abuse from your patients. Your safety concerns are valid. You have every right to demand a safe work environment.

If you need to utilize security then do so. If the nursing staff has to be changed because the patient only harasses a particular nurse, then make that change happen. Report threats and take threats that are reported seriously.

Furthermore, be aware of your surroundings. Know where you are in your room in relation to the door. If the situation calls for it, take a second nurse in with you as your "back up". In some hospitals, security can be used to sit with the patient, if the patient is deemed a danger to the staff (the hospital I am at currently does this).

You are important. Know that your safety is important too.