realnursing

Family Dynamics

Fri, 18 May 2012 23:46:18 -0400

I am the angry family whisperer.

The woman on the other end of the line is angry because we discharged her husband home and he still drinking, and she’s talking over me and won’t let me explain that her husband was medically stabilized and ready to go home and honestly, we can’t keep people from drinking or using drugs or being assholes in general. Just not our job.

When you have someone yelling at you it’s really hard not to get mad back, and as I tried to get this woman to calm down, asked her not to yell at me or talk over me, I realized that this was a person in crisis. She didn’t need me to be confrontational back. She needed me to listen.

Do I really want to listen? No. I’m busy, I have four patients and discharges and our hospital is filled to the brim. Do I take the time anyway. Absolutely.

I start by recognizing that the woman on the other end of the line is in a difficult situation. Her husband has a brain injury, has poor impulse control, is an alcoholic. No one is going to win in this situation and the people who lose the most are families. I tell her that it must be hard living with these challenges, I reflect that she sounds frustrated, I support her in taking care of herself, in addressing her own psych problems.

At the end of the call, she’s no longer angry. She has been listened to. Nothing I say will change anything about her situation. Her husband has further to fall before he’ll get any help, or he’s going to die from his behavior. But his wife has been heard, even if it’s just for five minutes.

Providing compassion under duress. Recognizing that families are in crisis. Giving a shit even when you don’t have the time. That’s real nursing.

you get asked this often, but i am interested in being a nurse. i like your blog, because it's more realistic than what i come across. i have time before i can apply to nursing school (i moved from the States to overseas and am still learning the language, etc) and was wondering as someone with no nursing experience, should i begin to look for jobs that require working with shit, snot, etc, to see if i can do it? i have a genuine interest, and this seems like a good way to see how serious i am.

Fri, 18 May 2012 15:18:44 -0400

sorry I’m behind on answering this question.

If you are destined to be a nurse, if you have the deep vein of compassion and a sense of justice and advocacy, you will deal with the blood, shit, snot, urine, bile and other disgusting fluids that come your way, along with MRSA, VRE, CDiff and other lovely creatures. So yes, you could go get a job working with bodily fluids but that’s not going to tell you if you’ll love being a nurse or not. It’s a hard job, and not because of the bodily fluids. It brings long hours, stressful working conditions, terrible interpersonal work dynamics, but if you are meant to be a nurse, you’ll get through all of that.

I know it’s not a clear answer, but I do believe this is a job people do from their very heart and soul, and if you are destined to be a nurse, you know it already.

Talk to Me About Scripting

Thu, 17 May 2012 21:22:00 -0400

anyone seeing this horrible trend in their workplace?

“I have the time.” This is one of the things I have been instructed to say to my patients.

Here’s reality. My patient down the hall is high on cocaine and throwing things at the staff. I need to figure out how to keep him safe and the staff safe. I have to call security, the doctors, the psych people, my charge RN. And I have three other patients and it’s time for my five o’clock med pass. But you know what, I have the time. Let me get you some coffee while I run down the hallway with restraints in hand. I HAVE THE TIME.

What makes happy patients? Happy nurses. Nurses who have decent patient loads and time to be the truly caring people we are. Nurses who aren’t stressed out and overburdened. Nurses who are respected. Then we can walk into a room and smile. Then we can have the space to be true advocates. Then patients will be truly satisfied.

The trend towards scripting at the bedside is degrading. We are professionals who have gone to school and worked hard to gain assessment skills. We save lives. And patient satisfactions scores do not prove anyone has received quality care. Actually, a recent study shows that the most satisfied patients also have higher mortality rates.

Sometimes to keep a patient safe or to save a life, you have to do something that will leave a patient unsatisfied, but they will also be alive.

That’s real nursing.

efficiency

Wed, 16 May 2012 23:51:54 -0400

they say that the average worker is efficient something like 40% of the work day. Since most people work eight hour days, that means that in 8 hours a person will actually work 3.2 of them.

I would say that a nurse would never be only 40% productive. There are days that I am 100% productive, pounding the floor from the moment I get out of report to the very last minute before I head back in to pass my patients off to the next shift.

I am a hardworking acute care nurse.

Take today. I did manage to look at labs for about 20 minutes in the morning, but any labs that weren’t up didn’t get looked at because then I was off and running. One of my patients was wanting to talk to the supervisor because he wanted a phone book, then it was morning meds, then two discharges, then placing an NG tube that the patient pulled out ten minutes later at the very moment I was taking report for a new admit, then sending NG tube patient to echo, and while my TBI patient is crawling out of bed, then my admit arrives and she’s breathing 46, so I do her admit, then I finally get time to have my TBI patient transfer from his bed to his wheelchair so I can ensure a safe discharge, which he does, so then I have my third discharge. Then I have to call a rapid response on my admit because she’s still breathing too fast and my NG tube patient in echo is back and I have to drop a second NG tube on him and my TBI patient’s ride has arrived, and I have to pull his IV, and he leaves but when he gets home doesn’t have his keys so they threaten to bring him back so I have to find his wife’s phone number and call her, and my admit is now on 50% oxygen and needs hourly vitals, and my NG tube guy needs a bedpan, and in the midst of this I have to do vitals and pass meds.

I got about 20 minutes for lunch. I had no breaks. I did manage to pee at the end of the day.

That’s real nursing.

Real nursing is...

Thu, 19 Apr 2012 14:21:11 -0400

Knowing that our health care system is far from functional.

With the reduction in services due to the recession there has been a loss of psych beds. The result is that psych patients are boarding on acute care floors in hospitals everywhere because there’s no place for them to go and they can’t go back into the community. It’s a lose-lose situation. The patients don’t get the psych care they need. The acute care units aren’t a safe place for psych patients. The care is costly and usually paid for by the taxpayers. And those beds aren’t available for people who really need them. It’s a terrible abuse of our system.

Real nursing is knowing that we need to work to fix the system.

yes. yes we do. never doubt it.

Thu, 19 Apr 2012 09:33:50 -0400

yes. yes we do. never doubt it.

Real nursing is...

Thu, 19 Apr 2012 04:51:14 -0400

knowing how to whip up a grilled cheese from items in the pantry.

I have not failed today

Wed, 18 Apr 2012 19:08:30 -0400

I have not failed today.

My patient decided to leave AMA today. She’s a drug addict. Most likely she’s going to go out and use again. She’s sick, full of MRSA abcesses, and she isn’t finishing her therapy. She’ll probably be back. But still, I have not failed her.

It is not a simple thing to be a drug addict. A hard core street drug habit costs about $50K a year, not far off what an RN makes. Now imagine coming up with that money without being able to work. And it’s not an easy thing to not use. Addiction is complex and multifaceted, and no one should ever tell an addict to simply stop using. And if you stop, it’s not simple either. Relapse is part of recovery. It is not my job to fix this woman, so if she walks out and still uses and gets sicker, I have not failed.

What is my job is offering compassionate care, and I have done that. I have treated her like a human being and an adult. I have taken her pain seriously. I have empowered her to take charge of her medical care, to take all her antibiotics, to go to her follow-up appointments. I have told her that even if she is a drug addict, she can be someone who makes a decision to take care of herself. And I have told her that if she comes back she will not face judgement, at least not from me. She is one of my people, the ones I work hard for and care for, and I as her nurse, I will not let her down. At least while she’s under my care.

My patient decided to go AMA today, but she did not have an unsafe discharge. Because I respect her right to make her own decisions, even if they aren’t the best decisions, and I’m going to do my best to give her all the tools she needs to succeed.

I have not failed today.

And that is real nursing.

Best part of today...

Wed, 11 Apr 2012 16:06:09 -0400

an intern telling me, “why do we have a problem with this patient whenever you’re on?”

Because my patient is in pain. Because I’m willing to call. Because other people just ignore this patient, and I don’t. And now I just want to cry because everything I’ve worked for to help my patient has been destroyed by one jackass doctor.

Real nursing is paging that doctor again and knowing that being an advocate for a patient is never truly a problem.

Real Nursing is...

Wed, 11 Apr 2012 15:24:00 -0400

a good discharge plan. I’m sending a patient home today into less than ideal circumstances, but I’ve done the education, I’ve empowered the patient, and because I’m willing to do that, he’s going to be okay.

Real nursing is empowering patients around their care.

Great blog! Love your perspective on nursing!

Tue, 10 Apr 2012 22:16:34 -0400

whoot! thanks so much. gotta keep it real, yo, or you end up going crazy. back on shift tomorrow.

I don’t take them. Give me report and send the patient...

Tue, 10 Apr 2012 18:08:16 -0400

I don’t take them. Give me report and send the patient after shift change.

Real Nursing is...

Tue, 10 Apr 2012 18:02:02 -0400

being glad your therapist is back in town.

totally

Tue, 10 Apr 2012 16:04:44 -0400

totally

Real Nursing - Bullying

Tue, 10 Apr 2012 08:05:15 -0400

If you’re a nurse, you’ve been there. You’re in report and all of the sudden you’re being drilled about your patient. You’re not incompetent. You know what you’re doing. You’ve been providing excellent care all day long. Your patient is safe, medicated, skin intact and NOT DEAD. Yet all of the sudden you’re having to defend yourself on what labs you might have asked for or why you didn’t call the doctor about some random thing. You’re nursing judgement is being called into question, by another nurse, and you either squirm and feel humiliated or, if you’ve been a nurse long enough, you think to yourself…

FUCK YOU.

Nurses are bullies. We have too much responsibility and too little power and it’s a hard place to live. We eat our young, we skewer our old, we make ourselves feel better by putting others down, we take power wherever we can get it. We do this to our patients. We do this to the doctors. But worst of all, we do it to each other. If you’re a nurse and tell me you’ve never bullied someone, you are lying.

It’s time to stop.

Start with our new grads. Give them love and support. Allow them to be learning. Trial by fire is not the way anyone becomes a kick-ass RN. Move onto each other. No one does this crap-ass job unless they’re there for the right reasons. Allow your coworkers to be tired and burnt out and frustrated and to have bad days. Allow them to be human. You are a team. No one is the perfect nurse. We all bring different mad skillz to the party. I can tame an asshole narcotic seeking street addict but I’m not so good at sitting and talking with cute old ladies. Give me props and I’ll give you props as well. Then recognize that it’s a twenty four hour job.

We nurses are family, a sisterhood and brotherhood. We have secondary trauma. We do the best we can. Recognize this in everyone you work with. And then be kind.

Bullying does not have to be an accepted part of nursing culture. Stopping bullying is truly real nursing.

Real Nursing is...

Mon, 09 Apr 2012 16:04:56 -0400

being really glad to be home from your shift.

Real Nursing - Superheroes

Mon, 09 Apr 2012 08:04:58 -0400

“With great power comes great responsibility”

- Uncle Ben

You know who are superheroes? Nurses. We work physically demanding jobs, we have to be able to shift gears at a moments notice, to leap to catch a falling patient in a single bound. We battle the bad guys, whether they’re bad decisions from doctors or out of control patients. We tackle problems and find solutions. We save lives. Give us capes and a wind machine as we walk down the hallway with your pain meds in hand because we are awesome.

With such superheroes in our midst, you’d think nurses would garner mass respect. But the last words that Uncle Ben tells Peter Parker, the words that shape the destiny of the best super hero ever, Spider Man, do not ring true for the real superhero nurses out there. We have great responsibility and none of the power. We know our shit but the minute a doctor decides he or she doesn’t really want to hear our what we have to say, it’s like kryptonite and our powers wither away. We have a ton of knowledge and experience and but unless you get lucky and work with a doc who thinks nursing has a place at the table, none of that matters.

Real nursing is finding a way for nursing to be heard. It’s working to increase respect for ourselves as professionals.

Real Nursing is...

Sun, 08 Apr 2012 19:05:27 -0400

starting a fucking awesome IV.

Real Nursing is...

Sun, 08 Apr 2012 17:01:00 -0400

when your enema slips out while you’re giving it. not pretty.

wait, there are nurses on TV shows? Yet, I still watch,...

Sun, 08 Apr 2012 16:05:51 -0400

wait, there are nurses on TV shows? Yet, I still watch, don’t I. Even if I have to yell ‘call a code’ at the television.