I don’t have to like you

I don’t have to like you.

You got drunk, got behind the wheel of a car, killed someone.

You lived. You made the mistake and you lived.

I don’t have to like you. I don’t have to be nice to you. I have to treat you.

Remember that.

Sincerely,

Your nurse.

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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. 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 does 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 their 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 patient dies 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…

Racism doesn’t stop because they are sick.

I am a nurse. I am a proud nurse. I am a proud BLACK nurse. I have never refused to treat someone because of the color of their skin. I have had patients refuse me as their nurse because of the color of my skin.

Racism doesn’t stop because someone is sick. 

I have been called a “black bitch”, “nigger”, reduced to “that colored girl”. I have had patients assume I am “the help” and ask for me to send in their “real nurse”. I have had patients assume I can’t be the one in charge because I am black and “black people can’t be in charge”. I still gave them the best care because I am a nurse, a damn good one at that.

When I decided to enter this field I knew that it would not be all hand-holding and smiles, regardless of what the NCLEX would have me believe. I knew there would be struggles. I knew there would be moments when I question whether I am strong enough. I knew I would question whether I am smart enough. I understood how intense nursing would be. I did not think I would be held to a different standard because of the color of my skin. I did not think that even at their sickest moment a racist would still be a racist. Call me naive. I assumed that if someone was dying they wouldn’t care who saved them. I was wrong. Racism runs deep. Hatred is ingrained into their souls. It is who they are. That level of ignorance is all they know.

I cannot take their stupidity to heart. My skin is not a cloak of shame but a badge of honor. I carry the strength of ancestors that have endured and survived hell, I am proud of that.  My skin does not have anything to do with my nursing abilities. My skin does not make me more or less of a person or nurse than anyone else. I am a good nurse because I make the effort to be. I continue to learn and grow because nursing never stops changing. Racism cannot stop me. Racism will not stop me. Racism will make me bring the pain meds a lot slower though…

Nursing convos with non-nursing friends

Guys, I apologize.

I bombard you with all these stories about my hot mess shifts. I rattle off all kinds of medical terminology. I tell you things that probably gross you out because I think it’s cool.

You listen anyway and try to make sense of this shit. You try to keep your questions about the 12 medical abbreviations I just used to a minimum. You participate in the conversation. You are actively listening despite not having a clue what the hell I am talking about.

tenor

I’m sorry.

My life is spent around nurses and doctors. We probably use more medical abbreviations that actual words. I have clearly forgotten how to communicate outside of nursing. I throw terms at you, expecting you to catch them the way my colleagues do. Bless you all, you stick with me for a long as possible.

I am going to try and differentiate between friends and coworkers from now on. I will try to speak in layman’s terms. I am going to work on breaking out of the habit of using medical abbreviations. I am going to continue grossing you out though. I’m a nurse, my entire shift is gross. You’re just going to have to suffer through that part with me.

SBAR it!

I used to run EMS. I did it for eight years. We would call report on the radio to the hospital that we were in route to. There is a lot going on in the back of an ambulance so we didn’t have time for “long and elaborate”. We opted for the “short and sweet”. At one of the hospitals I worked at, you had to page the doctor on call for anything you needed. Unlike at level one centers, the doctors have to be available but not actually in house. So imagine having to page at 2:15 in the morning… The doctors where usually tired, angry you paged, and over it before you even picked up the phone to answer their return call. In that moment the docs probably had a two minute attention span so I had better be quick about it. EMS prepared me for the “short and sweet”, the “just the facts ma’am” answer. The doctors seemed to appreciate that.

So what exactly is the SBAR format? How is it beneficial when talking to the doctor in response to a patient?

Situation- What wrong right now? What happened to make you send the page?

Background- What’s been going on with the patient leading up to the event that makes this a change? A little relevant history of the patient is probably good to add too.

Assessment- What have you noticed about the patient in relation to the change you are paging for?

Recommendation- If appropriate, what do you recommend?

I will put SBAR into use so it makes sense, okay?

It is two in the morning in the ICU. My patient starts to ring on the monitor with a heart rate bouncing around from the 120’s to 140’s. It looks super irregular, kind of like A-fib with RVR. I grab the EKG machine and run an EKG on my patient and sure enough, it is. This is new. Time to page the cardiologist… at two something in the morning… and the doc on call is the one with the worst attitude… Great…

He’s on the phone, let’s do this:

Situation- “I’m calling about Ms. S in room 212. She has suddenly flipped into A-fib with RVR from sinus rhythm.

Background- “She is the patient here for sepsis from infected knee hardware who coded in the OR. She converted to A-fib on the monitor about 10 minutes ago and her blood pressure has dropped with it. I looked back and she doesn’t have a past medical history of A-Fib and she’s been in sinus rhythm and sinus tach since admission and she has been here a week.”

Assessment- “I did an EKG and it is showing Afib with RVR. She is still able to follow commands on the vent even though her pressures have dropped from 130’s over 70’s to 90’s over 50’s.”

Recommendation- “Did you want to start her on the amiodarone bolus and then the amiodarone drip? Also, could I go ahead and get an order for a pressor? She hasn’t dropped super low yet but I would rather have the order just in case she does so I don’t have to page you again.”

That’s it. I have had almost this exact conversation with a cardiologist in the middle of the night. It probably took less than three minutes to get all of that out. It was short enough that instead of attitude, I got the orders I wanted. I recommend giving it a shot the next time you have to send a page to the doctor with the attention span of a two year old and the attitude to match!

(of note, please don’t actually say “Situation” and then start talking. You will sound really weird!)

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.

 

Story time no.6

Sitting at the front nursing station when the door rings.

"Delivery for STICU!"

Delivery? It's one in the morning, what the hell is being delivered at one in the…

Oh.

Ohhhhhh…

THE LEECHES!

He's delivering the God forsaken leeches!

I am thoroughly grossed out. I hate leeches. I hate them with every fiber of my being. I can't touch them. I don't even want to look at them… but I need to open the box so we can put the squirmy bastards in their refrigerated tanks.

I managed to open the box. As you can see, I even managed to pick up one of the bags.

That's as far as I got.

Dude was far too squirmy and I was far too grossed out to do anything else with them. God bless our tech for being able to grab the box and take them away from me so she can put them away.

I'm a horrible charge nurse. I'll take that. I'm not touching those bastards though…