Nurses and the Bigger Picture

Yesterday, as I was finishing prepping my patient for surgery, he looked at me and asked, “Have you ever had those days when something set you off early in the morning and it threw you off for the day”. I smiled, snickered and replied, “All the time”.  He told me that a night shift staff member had come into his room in the wee hours of the morning to do a quick procedure, one that he does for himself at home. He said the staff member really hurt him and that when he told her so and tried to explain to her how he does it at home so it doesn’t hurt but she was insensitive about it and didn’t want to listen to him. He went on to tell me that when he was filling out his menu order for yesterday, he ordered blueberry pancakes for yesterday’s breakfast. He knew he wouldn’t be able to eat breakfast because he was going in for surgery but said he’d look forward to warming up the blueberry pancakes when he returned to his room after surgery. He said while he was in the bathroom, a member of the kitchen staff came and took his tray, uneaten without waiting for him to come out of the bathroom to ask if he wanted to save the tray for later. He expressed to me how disappointed he was that he wasn’t going to get those blueberry pancakes. He also described to me on another occasion, during a treatment, he had to repeatedly remind a member of his health care team multiple times to be careful with a tube that was in his body.

This patient was an admitted inpatient that had come to my unit to be prepped for surgery. I’d taken care of him several times recently as he had developed a problem that required multiple surgical procedures. He always opened up to me about different aspects of his life. I liked him and I knew he’d been through a lot recently. Today, I could see it in his eyes. He was down in the dump and my heart ached for him.

Many things went through my mind as I listened to this man. First, my heart was filled with gratitude that he chose me to vent his frustrations to. To me it meant we had made a connection somewhere in the care I provided for him. From that point, I was determined to help him as best I could in this situation.

I thought about my own experience as an inpatient in the hospital and similar things that bothered me about that hospital stay. My son was born six weeks prematurely via emergency c-section because I was critically ill. Things happened quickly to deliver my son and it saved our lives. I remembered that my husband told me he could hear me screaming “Ouch you mother fuckers” from where he was standing in the hallway outside the operating room when they rammed the epidural needle in my back without numbing my skin or giving me any warning. I remembered throwing a terrible terrible phlebotomist out of my room in the middle of the night because his skills sucked and he was too rough with me. The morning after my son was born, residents coming into my room and ripping my bandage off my c-section incision, and then rolling me over, ripped the epidural bandage off and removed the epidural.

On that same day, my sickest day, I had a nurse that was a bitch from hell. There were many instances that day where she clearly lacked compassion when I needed it the most. I was sick and afraid. I was on a stretcher for 36 hours in a holding area outside of the operating room in case they had to wheel me back in to do an emergency hysterectomy. I couldn’t figure out what was more uncomfortable, my c-section incision or my neck and back from that stretcher. I tried so hard to keep my mind focused because the medication they were giving me made me feel so foggy. I can still see the look of disgust on the night nurse’s face when she relieved bitch from hell nurse and saw that I was still on the stretcher coming up on 36 hours postpartum. She put me on an egg crate mattress and in a bed and I slept six hours. It was the best sleep I’d had in days and that egg crate mattress act of kindness that will never be forgotten.

I was an RN for four years when my son was born so I understood everything that they were doing but that doesn’t matter when you are 28 with a premature newborn and both of your lives had been in danger. I had such a textbook case of Pre-Eclampsia and HELLP Syndrome, that every resident and student nurse wanted to get their hands on me. I felt like a slab of meat in a butcher shop. I knew exactly where my patient was coming from. That egg crate mattress for me was like the blueberry pancakes he was looking forward to.

I told my patient briefly about my experience with my son’s birth but more about a lecture we had in nursing school that I never forgot. My instructor was trying to teach us about giving patients a little bit of control of their care while in the hospital and making sure we remember to do the little things that are so appreciated. She expressed the importance as a psychological aspect of care and always advised us to look at “the bigger picture” when providing patient care. She shared with us that once she had a spider bite, developed cellulitis and had to be admitted to the hospital. She said the moment she put the hospital gown on, she flipped out because she knew she was relinquishing control of her body to the health care providers at the hospital and that was difficult for her.

I never forgot that lecture and after I returned from maternity leave I made sure that my care reflected remembering to give them some form of control over their care and to do the little things for my patients that made them human. Every patient deserves that. As for my patient yesterday, I gave him some suggestions as to how he can verbalize his needs for his care. After he was taken into surgery I called the nurse that was taking care of him on the floor. I filled her in on some of his frustrations, a little background information on him, enlightened her on his “bigger picture”  and encouraged her to give him a little more TLC. I hope she listened.

The moral to this story is, don’t forget to look at the bigger picture. We get so tied up with completing tasks because we are busy and many times in a time crunch, we overlook the simplest things that would put a smile on someone’s face, make their day just a little better and their situation just a little more tolerable.

Advertisements

A Day in the life of a Nurse

On Friday, if anyone were to ask me if I’d recommend nursing as a profession or if I’d be happy if my children told me they wanted to become nurses, I would have said no. My shift started out smoothly. I had a good assignment and I was able to get my two 0730 patients into the OR safely and without delay. As I was reading over my third patient’s chart, one of my coworkers asked me to look for IV access on one of her patients.

Prior to entering the room, I learned that variables that classified this patient as what we call a “hard stick”. I entered the room and introduced myself with a smile and told the patient I’d give her IV a try. I felt confident. I’m good with hard sticks. I take my time and I’ve been complimented by multiple patients that my technique is gentle. This patient was tricky but I felt a few small veins in her hand and I decided to use a smaller gauge needle. IV needles have a bevel at the end and the technique requires us to puncture the skin with the bevel up. Upon entry of the needle, we wait until we get a blood return before we advance the needle into it’s final position. After that, we click a button and the needle retracts into the handle and the jelco is left in the patient’s vein. I prepped the patients skin and held her hand with my left hand, pulling the skin down to secure the vein under the skin. As I punctured the skin, bevel up with not even a big enough portion of the needle in her skin to even maneuver the needle, she let out a blood curdling scream at the top of her lungs and in my face. My body jerked and stiffened immediately and I froze for a second. My initial reaction was shock and I tried to quickly regroup and continue with the task of this difficult IV stick. I was too distracted and shocked though and decided I couldn’t proceed. I covered the needle with gauze and removed it. I applied a piece of tape and pressure to the site, looked her in the eyes and said, “I am sorry if I hurt you. You really startled me”. She really didn’t give me a chance. Shortly afterwards, the shock turned into anger. I washed my hands and quickly exited the room. I managed to escape without the patient realizing that I was angry. Three of my coworkers were standing outside of the room with their mouths hanging open. Someone else told me the screaming could be heard on the other side of our unit, forty yards away. I was thankful that this patient was not assigned to me because I although would have taken good care of her, I would not have been able to feel empathy for her. It took me several hours to shake off the screaming, the shock and anger.

Later on, I received my sixth patient of the day from an inpatient unit. She had five family members with her. As a rule of thumb, most nurses do not allow that many family members in the room when there is care to be provided with time constraints. I personally find it disruptive to my care to have that many people at once in the room so I politely asked them to choose one person to be in the room with the patient during my care and promised the rest of them can return afterwards. They agreed and chose the patient’s son. Everything was fine until the son became argumentative during parts of my interview. He didn’t like the way I described the Advance Directive question that we are required to ask. He interrupted me when I was doing the pain scale assessment and insisted that his mother didn’t understand. I matter of factly explained that I wasn’t finished with the pain assessment yet and hadn’t determined if the patient understood it or not because he interrupted me. I proceeded to question the patient on her pain tolerance and as it turned out, the patient did understand and answered the question appropriately. I completed the pre-op interview and called the rest of the family into the room until it was time for the patient to go into surgery.

The two scenarios that I just described occur more often that nurses wish to to reveal to people outside of the health care industry simply because most people just don’t understand. It happens to all of us, in some form every day. In addition to the many things we see in our work that we don’t tell you, we endure working long hours, evenings, nights, weekends, holidays, short staffed, underpaid and very often with empty stomachs, full bladders and achy feet or backs. What I experienced on Friday, takes its toll on nurses over time and makes us question why we chose this profession. It is a huge contributor to burn out and job dissatisfaction. Why would I want one or both of my children to experience this throughout what will be a career that will span over forty years? Why am I putting up with this? Where is it written that just because we are care givers that we should have to tolerate physical and verbal abuse just because people are sick? But somehow, for some reason we continue. We try to shake it off as best we can. Sometimes we have a drink when we get home. We vacation. We pray, We exercise. We meditate. We engage in activities that we enjoy. We spend time with family and friends. We thank God everyday that we are healthy and do not have the diseases that we treat.

To my patients I say: I am your caregiver and your advocate. You are safe on my watch. I am a registered nurse. I hold a nursing license, a bachelor’s degree and a nationally recognized certification. You’ll never know the blood, sweat and tears I shed during college and throughout my career to become the skilled, knowledgeable and caring nurse that stands before you. The fact that you don’t know me as a person or as a nurse, doesn’t give you the right to tell me I don’t know what I’m doing. If you’d give me a chance before your judge me, you’ll see that I do know what I’m doing. Being sick and afraid doesn’t give you the right to verbally and physically abuse me. I know you are sick and afraid and I promise to give you my very best. Please treat me with the same kindness, you wish for in return. Please remember, like yourselves, I am a human being too.