No days off

Have you ever encountered this particular situation,

Them: “Hey, when are you off again?

You: “Well I am off tomorrow but I…”

Them: “Oh good because I need you to…”

Or my other personal favorite,

Them:How are you doing?”

You: “Whew, I am worn out! It’s been a long week!”

Them: “How are you always tired, you only work three days a week!!!” 

Seriously? SERIOUSLY?!?!?!?!

Let’s start with the fact that nurses work with people every day we are at work. PEOPLE. Like, human beings… HAVE YOU SEEN OUR SPECIES??? We deal with emotional outbursts, insults, violence, unrealistic expectations, death, etc. ON A DAILY BASIS! It’s not just 3 days, or 4 days, or 5 days, or whatever schedule that we work. It’s the emotional baggage we deal with on days off. It’s wondering if you could have saved that patient if you had done one thing differently. It’s trying to figure out why this one nurse hates you. It’s sitting at home thinking about the child abuse victim that you know will be given back to their parents. It’s thinking about the insults the doctor hurled at you because you weren’t moving fast enough. It’s class assignments due at midnight. It’s the kids having soccer, baseball, and basketball practice the couple of days you have off. It’s 3 weeks of laundry that still needs to be done. It’s a house that desperately needs cleaning because you haven’t had time. It’s never having an inkling of downtime.

It’s constantly feeling like you are walking on a razor-thin edge between success and insanity.

It’s stressful.

The last thing we need is to be made to feel guilty because we are too tired to hang out or because we don’t have time to be someone’s personal errand-runner.

Your days off belong to you. Every single one of them. You deserve to power down. You deserve to do NOTHING if that is what you want to do. You aren’t being “lazy”. You are trying to maintain your sanity. You are not wrong for turning down a night out on the town. You are not wrong for telling someone “no” when they start to come up with your schedule for your day(s) off for you. You are not wrong for shutting out the world temporarily if you need to. You take care of so many people, you deserve to take care of yourself. Nurse yourself back to health. Take your days off and do whatever the hell you want with them.

A nurse that doesn’t take care of themselves can’t effectively take care of others.

 

 

July…

It’s July. For some of you that’s no big deal. However, if you work in a teaching hospital July means something deeper… Darker…

The “brand new” residents begin their rotations…

Chaos ensues.

If you have had the pleasure of avoiding the July rush, you’re lucky. For the rest of us, there’s a sense of impending doom.

So many orders. Most make no sense.

-pediatric doses ordered for adults.

-level one head CT for “AMS” on your 98 year old patient with known dementia.

-12.5 mcg of fentanyl q3hrs for your chronic pain patient.

-one unit of blood for an hgb of 5.

-MRI of the ankle to look for osteomyolitis of the toe.

Many, many more orders from an alternate reality…

In this moment, it is your time to shine! You are the only barrier between your patient and a doctor that is still getting their bearings. You’re going to have to speak up, a lot. You’re going to have to advocate. You may even have to knock a new doc off their self-appointed pedestal (when they tell you you’re “just a nurse” please refrain from punching them in the throat).

You can do this. Take a deep breath and remember: you’ve made it through many July’s and you’ll make it through many more…

Unnecessary

I almost lost my temper.

One of the anesthesiologist does NOT know how to talk to people.

It feels like she is being condescending at all times. I get it, you’re a doctor. I respect that. However, it’s totally unnecessary to speak to people in that manner. I am a nurse. If you talk to me instead of at me you would know I have plenty of nursing experience. I know quite a bit more than you give me credit for. I am fully capable of the tasks that are required of me during this anesthesia case. I can do whatever you need if you just ask. Contrary to popular belief, nurses don’t read minds.

I’ll say this, she has one more time to speak in her condescending tone. One more. While I am going to be professional and respectful, I’m going to put her in her place. I’ve had to do it with plenty of residents and a few attendings. This isn’t new for me, I know how to get my point across. She needs to be knocked off the pedestal she placed herself on… I’m just the one to do it.

A la carte

I work with different doctors almost every day. What I’m doing depends on the doctor I’m working with or which doctor I’m on the phone with at the time. It can be super frustrating.

Doctor A wants things done this way when they are in the department. Doctor B wants to do it a totally different way. Doctor C doesn’t care how its done as long as it’s done. None of the docs actually communicate their wants with the nurse until the nurse does it the way they don’t like. Oh, and Doctor D on the phone wants the test done with contrast but Doctor E ordered it without. As the nurse, I’m just supposed to make it work. It’s as if I should be able to read minds.

Sometimes it feels like doctors order from a menu when they give orders to nurses. A little of this, some of that, a few of those… I just wish we could all get on the same page. Let’s pick a method and stick with it. Why is this so hard?

Resident-splaining

One thing that absolutely drives me nuts is having a new resident come to the trauma unit, that I have worked on for almost three years, and “resident-splain” something obvious to me!

What is resident-splaining? It’s when a resident condescendingly “explains” something to you that they assume you know nothing about because you’re just a nurse…

I’ve had a resident (not a very good one at that) start to “explain” calcium in the blood to me. Why? Well, we had given quite a lot of blood products and I asked about giving some calcium as the ABG showed the ionized calcium was low. This is common. Massive infusions almost always drop the serum calcium due to the citrate used in the unit of blood (if this is new to you, here is an article that explains it rather well). Like I said, I know this. Trauma nurses are typically very aware of this because, you know, we give a lot of blood. Trauma… Bleeding… But hey, I’m just a nurse.

Now, she’s not giving me the calcium I need. She starts explaining calcium in the blood and why I should go by the ionized calcium instead of the calcium level on his BMP. Remember, I told her the ionized calcium on the ABG was low… Ionized. Calcium. The level she is currently explaining to me. That level. That’s not enough, she’s not even looking at me while she is talking and it’s in a very condescending tone.

Bruh.

I finally stop her with this statement: “I’m well aware of the purpose of an ionized calcium which is why I told you what it was on the ABG that I just ran (can you hear the attitude in my voice?). I don’t need an explanation, I need calcium. Can you order that or did you need me to throw that order in real quick?” Her:

*blank stare* “Oh, yeah I can put that in for you…” *quickly and quietly begins ordering what I need*

I had no more issues with her for the duration of her rotation on our unit.

It’s irritating. So so irritating. I’m far too outspoken to have someone resident-splain things to me. Don’t try me buddy…

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.

Speak up when it doesn’t feel right

You are your patient’s last line of defense.  Whether it’s meds, bedside procedures, trips off the unit, or just care in general, you are the person that can potentially save a patient.

I know, medical shows would have you believe that doctors are the saviors. Doctors are the last hope. Doctors save the world! Yeah, most of the doctors I know can’t start an IV sooo…

You are the one at the bedside for 12 hours. You are the one that has had them for three shifts straight and don’t even need report anymore. You are the one that knows that patient. You are the one that may notice something wrong.

Perhaps you come in for your shift and notice that Mr. B, who is typically trying to crawl out of the low bed and get back to his “bus”, it far too chill. His vitals have been great all day. The team doesn’t order labs for him daily anymore but the ones from two days ago look fine. In your gut you know something isn’t right. You talk to the doc, who isn’t impressed. You give it all you got and at least convince the doc to order a set of labs for now. You get those labs and anxiously wait to see if they can help you figure out why Mr. B hasn’t tried to kick you in the face tonight.

And then the lab results come back AND THEY ARE A SHIT SHOW! His WBC’s are almost 30. His H&H has dropped by 3. His BUN and creatinine are climbing. All of his electrolytes are out of wack. But once again, his vitals have been good all day.

You just saved your patient. You knew something wasn’t right, even if you couldn’t pinpoint it. By being a patient advocate you may be the reason he’s alive.

Maybe it’s less dramatic than that. Maybe they have ordered a medication for your patient that seems like it just might be contraindicated at this point. His platelets are low. His INR is going up, not down. One of the teams wants you to give heparin. You aren’t comfortable with that, especially since the primary team (or doc) purposefully stopped it because of his labs. You try and talk to the ordering provider and rather than listen he yells “just do it!“.  Do NOT just do it. Healthcare was not designed by Nike and that rarely works out. You can take another step. You can talk to the primary team or doc about a consulting team or doc restarting what they’ve stopped. So you do just that. Primary agrees with your hesitation and they talk to the consult to let them know heparin has been discontinued and why. Turns out, consult didn’t actually look at any labs before ordering it.

Looks at you walking around saving the day, like you have an “S” on your chest! You know what you are doing. You know when something isn’t quite right. You know your patient. Trust yourself and speak up when you feel like it is necessary.

Resting bitch face

I have resting bitch face, also known as RBF, and it’s terminal.

I have been told in my annual evals that I need to work on my “non-verbal communication”. Translation: “fix your damn face woman!” I blame nursing for my RBF. You probably have it too.

I am not only responsible for collaborating with the family of my patients, but also with the interdisciplinary team. Have you ever had to deal with a family member that insists that you know that their “cousin/sister/brother/daughter” works in health care, as if it is going to change how you care for their family?  It happens faaaaaaarrrrrr too often in the ICU. Typically my reaction is this:

waka ok

I am glad that your cousin is a CNA in a nursing home. Really, I am. However, this is an ICU and things are a tad bit different here. My other favorite is when I have to talk to one of the residents about something I need ordered, and instead they want to peacock around and tell me why they don’t think it’s necessary DESPITE the fact that the attending has already agreed that what I want for my patient would be beneficial. Once again my facial expressions look something like this while they are over-explaining things:

nene eye roll

Look, bruh, I know what hydralazine does. I know how it works. I am asking for it because I need to control his BP but his heart rate is like, 58, and maybe metoprolol isn’t the best idea. AND I ALREADY ASKED THE ATTENDING ABOUT IT WHEN HE WALKED THROUGH THE UNIT DOING HIS ROUNDS, just give me the damn meds!

Yeah. I have yet to figure out the whole “poker face” thing. Seven years of nursing and I will still look at you like you’re stupid.

So, to my new nurses, just know that if you don’t have RBF, you will. It won’t be on purpose. One day someone will say or do something so dumb that you just can’t hide your feelings. It is normal. Just about every nurse I know either admits to having RBF or has had a coworker with RBF. It just sort of happens. Don’t beat yourself up over it.