When nurses need to give a “straight” answer

How long am I going to be here? How long does the surgery take? How long do I have to take this medication? How long do I have to wear this thing?

I often get these type of questions asked quite a bit from patients and their families. I get questions asking for ‘time frame’ specifics regarding any and everything about their care. Unfortunately, there really is no recipe for success in health care is there?

If I can, I always answer these questions with a bit of humor. A quick witted, “whenever the doctor says so”, seems to bring a smile to most faces. Yes, it may very well be a sarcastic smile, but a smile nonetheless.

(Oh, c’mon you know you’ve used that one before)

Isn’t it ironic that we constantly require our patients to adhere to a time schedule, yet we never can give them a straight answer about ‘how long’.

After my quick rebuttal to most of these questions, I give the long drawn out speech about how there is no recipe for success in healthcare. A + B does not always equal C. While we always have the best intentions, time is not something we can ‘predict’. Not even in the most ideal conditions.

The ‘real’ answers:

A perfectly performed surgery without any complications can still have scheduling delays. There are always emergent cases that take priority in the echelon of care. You can’t preventing the unforeseen.

Being in the hospital can be as short as 1 day and as long as 3 months (or more). There are a myriad of factors that determine whether or not the issues that brought you into the hospital can be resolved. Most of which we have no control over.

Some medication can be a lifelong venture, some can be taken for a specific time frame, while others are taken until your supply runs out.

What you are required to ‘wear’ is serving a purpose to help aid in the healing process or to probably prevent further damage. So it will be worn until it is no longer needed.

Oh, and don’t think for one second that just because you have a friend or family member that was treated for the same thing means that you’ll get the same treatment in the same frame of time. Uh-uh. No-siree-bob.

I wish I could make up a recipe book, I really do. It might make our jobs a lil easier, and I’ll bet the patients would love it!

Am I the only nurse that does this??

When nurses need to give a “straight” answer | Scrubs – The Leading Lifestyle Nursing Magazine Featuring Inspirational and Informational Nursing Articles

The BEST way to train nurses

What do you think is the best way to train nurses to be the very best caregiver? Have them be the patient.

I learned a very valuable lesson this week. Everyone that works in health care doesn’t know jack about being a patient, until they are one. If we did, we’d take better care of everyone. We really would.

I was on the other side of the ‘bedside’ this week. It was nothing emergent or life-threatening. But yet it still was important to me and my family.

We nurses (I only use nurses since that’s what I am) tend to trivialize and even minimize what the patient and their families are experiencing, regardless of what that may be at any given time. I think we do this subconsciously or subliminally or maybe even reflexively because it’s something we ‘deal’ with every day we (as nurses) come to work. Dare I say aspects of our job become repetitive in nature (to a varying degree)?

Being on the receiving end of that clockwork care sprung my eyes wide open. I realized how much I have failed my patients in recent months.

Something that seems so trivial and minimal for me can a be very big deal and could quite possibly be a life-altering event for someone else (our patients).

Yes, I’m being vague. It’s intentional.

Take for instance something as ‘repetitive’ as dressing changes. For us, we almost go on autopilot about all the varying aspects of a proper dressing change. Everything from the type of tape, type of gauze or drainage pad, the integrity of the skin, the healing process of the skin, the condition inside the wound, around the wound and outside the wound. The important aspects of wet versus dry. Proper cleaning techniques. Knowing when to dab, knowing when to wipe. What looks good? What looks bad? (the list is quite possibly endless). When we do a dressing change we sometimes fail to properly educate the patient and their family members. We sometimes fail to put ourselves in their shoes. The insurmountable amount of questions they may have. Their fear. Their intentions, etc., etc.

I guess being the patient reminded me of how delicately balanced our responsibilities are, and I’m glad I was reminded in a cooperative and kind way. Because the fact of the matter is, we deal in life and death every hour of our working day. I don’t want any part of my care becoming trivial.

The BEST way to train nurses | Scrubs Magazine

I believe I will. I only say ‘will’ since I haven’t actually been admitted to a hospital in a number of years. In fact since I’ve been a nurse I have not been admitted at all. I haven’t even made a trip to the emergency room (yet). And now that I say that, you know Murphy’s Law is going to kick in (help!).

I for one think that nurses can and do make the worst patients. I think as a general rule, anyone in the medical field can be a handful simply because of their knowledge and experience.

Physicians of course lead the pack with their vast knowledge and skill, then you have the Physician Assistants’ on par with the Nurse Practitioners. I’m not discrediting or discounting the other areas of medicine (Paramedics, EMT’s, etc.), I just think by the sheer nature of our jobs nurses and doctors can be a PIA when we are on the other side of the ‘bedside’.

Nurses top my list because the bedside is where we ‘live’ (and yes, of course there are exceptions – not all nurses work at the bedside. Just go with it here). Our day is ruled by the minute-by-minute roller-coastering of what can and does happen throughout a patients stay.

I still can’t even imagine what it’s going to be like when I finally do get sick enough to be in the hospital. I’m going to micro analyze everything while at the same time keeping my mouth shut since I know better than anyone that bedside nursing care does not happen in a vacuum.

Maybe it wont’ be so bad? Maybe I won’t be ‘that’ patient that all the nursing staff avoids? Hopefully I won’t be ‘that’ patient that makes it a point to remind every person that walks into my room that I’m a nurse? I’ll try my best not to speak in a condescending manner anytime someone is doing their job to help me. Or be ‘that’ patient that questions every action the staff makes while in my room, or near me or my room.

If you haven’t noticed, I think all of us have had to take care of ‘that’ patient before.

I promise to try not to be ‘that’ patient.

Really, I promise I’ll try.

……….

This is what not to do. (Shout Out to ER Stories)

Keep it professional people.

Keep it professional.

Heard through the halls of the hospital by a patient the other day:

“Man, my mouth is as dry as a popcorn fart”

Who said health care wasn’t funny.

Carpe Diem

For those of you who have visited my blog today, or are anywhere near my chatter on the internet you know that I had a wisdom tooth extracted earlier this morning.

I’ve been comical about the whole ordeal, and honestly for having a tooth yanked out of my mouth, I don’t think it could have gone better.

Well things just got even more shockingly better.

I just received a phone call from none-other than my oral surgeon. He called to check in on me and my recovery.

HOW ABOUT THAT!?

The surgeon called me personally at home to check in on me.

I don’t know what’s more shocking. The fact that HE called ME at HOME, or the fact that I was shocked by the mere action. Since in this day and age it’s unheard of.

Take care of those who take care of you my friends. Good ole’ fashion genuine sense of ‘I give a shit’ makes all the difference in the world.

Carpe Diem

A 77 yr old patient (former nurse) was having knee arthroscopy. She had a history of extreme nausea and vomiting with previous surgeries when receiving general anesthesia, so she chose to have spinal anesthesia with the hopes of deterring her nausea.

I first of all found it unique to have a patient choose spinal anesthesia for such a moderate-minor procedure. Most patients I take care of who receive spinal anesthesia are getting major surgery (joint replacements, or intricate lower extremity osteotomy procedures)

Her recovery was progressing well, she was in great spirits and her anesthesia was wearing off in a quick manner. When all of a sudden she stopped speaking mid-sentence, gave me this pale-faced look of fear and calmly said, "I’m going to be sick".

When most patients tell you that, it’s usually too late. They uncontrollably vomit, or basically succumb to the body’s need for removal.

Not this patient.

She fought back her nausea like a champ. She grunted and groaned. She sat up in her cart, she leaned forward. She deep breathed. She did everything imaginable to prevent the event from happening.

In the mean time my co-worker and I were scurrying to get her some anti-emetics.

Unfortunately we didn’t deliver the med fast enough. By the time we began to push the IV med, she did have a very small emesis.

I told the patient, that is a level of courage and strength I have rarely seen. She was a trooper. She was bound and determined NOT to vomit. And just to see her tough it out was rather stoic.

I also had the pleasure of taking care of a 32 yr old patient who had a total knee arthroplasty. Yes, you read that right. 32 yr’s old having her knee replaced.

She unfortunately had advanced Rheumatoid Arthritis. And the disease basically gnawed her knee joints down to where she couldn’t walk properly, nor without extreme excruciating pain. So she was to have both knee’s replaced. One then the other.

You could see that the disease had beaten up most of her joints, Her hands had the typical swollen deformed look.

What impacted me was her demeanor and her attitude. After listening to her tell her story about her challenges and difficulties. How she was told she wouldn’t be able to do certain things and would be limited in most areas of life. How she was diagnosed with this disease as a teenager, and now in her early 30′s she’s battling her disease head on with these surgeries to enhance her quality of life.

I was in awe of her no-holds barred genuine personality. She was so appreciative of everything. She too had chosen the spinal anesthesia. And for the first time in her life, her legs didn’t hurt.

It was a very humbling experience. I didn’t want to discharge her out of the PACU. I wanted to keep talking with her. I wanted to give her as many pointers as possible to make sure she had the best recovery as possible.

I sometimes forget how lucky I am, how precious life really is, and how strong we all have to be to survive this rollercoaster we call life.

Carpe Diem

All nurses can tell the difference between a patient with ‘real’ reported pain and a patient seeking narcotic abuse. We are all required (by law and ethical duty) to say we do not have any knowledge of ‘drug seekers’, and that we treat all patients with pain the same, regardless of OUR perception.

This is the difference between textbook nursing and the ‘real world’ of nursing.

Ask any nurse who has some experience under their belt. We can spot a ‘seeker’ just as fast as we can recognize a patient having a breathing emergency.

In my limited experience there are ‘red flags’ that raise my awareness of a possible ‘seeker’. It’s nothing written in a textbook, but within the closed circles of certain healthcare professionals we can all agree on these ‘red flags’:

Red Flags:

A patient will request a specific narcotic medication before they are even asked if they are in pain

A patient will deny any other forms of analgesia except for the ‘strong-armed’ narcotic medications

A patient will request pain medication even though they are having a difficult time maintaining mental alertness (they can’t stay awake)

A patient’s pain will never be relieved. (even if you give enough narcotics to kill a horse)

A patient will know exactly what you are going to ask them and how you are going to ask them to rate their pain.

After you waken the patient from a sonorous sleep, and ask the patient to rate their pain. They state their pain is at it’s maximum, it’s intolerable, unbearable and makes them sick. (except when they fall back asleep)

A patient will become overly dramatic about the most minimal of things. ( the pulse oximeter on their index finger is causing severe numbing pain to their finger)

I cannot help my reaction some times. I DO try my best NOT to jump to conclusions and be the bigoted jerk that we all can be. I pride myself on my fair, ethical and genuine caring attitude towards my patient. I constantly remind myself what it’s like to BE the patient.

But when a patient arrives to the PACU. They are still in their fog of anesthesia. Their mouth still bone dry from the airway equipment used during the surgical case. They can only open one eye. And before you can finish your interview assessment the patient, in their foggy-slurred intoxicated-like speech, asks for a specific narcotic. Not only asks for a specific narcotic but then proceeds to name 3 other narcotics that will NOT relieve her pain.

I tried. I really did.

The patient continued to recover from her anesthesia in the ‘expected’ or dare I say ‘normal’ manner. Her pain was attended to. Medication was administered. Position changes were made frequently. Adjunct analgesic therapies were initiated (ice, compression, elevation). Each time medication was administered, the patient would drift off to sleep. As part of my responsibility, I would have to actually wake the patient up to re-assess and ask about their pain.

“Oh, it’s still 10/10″

I tried. I really tried.

I won’t give the details, but in the end the patient got everything they asked for.

A patient’s pain, is sometimes a Patient Pain.

Carpe Diem

OK I take that back.

Being a nurse is hard ALL the time. LOL

But being a nurse provides you with information and knowledge that most other individuals are not privy to. By individuals I mean John Q. Public, or any non-healthcare professional. Basically anyone outside of the medicine world.

Is it just me, and I may be spit-balling here.

Is it just me, or are your personal healthcare decisions directed and curtailed by the knowledge you may have about a certain physician, doctor, surgeon, etc.

Where do you go, whom do you entrust your care to, and who do you think will treat you the way you hope and want to be treated?

Do you NOT go to a certain provider because of what you have seen professionally? Because of what your patients have had to endure? Because of what another colleague may have or have not told you?

And when a fellow colleague , friend or loved-one asks for advice? When they ask where should they go? Who do you think they should trust?

What do you tell them?

Is your advice biased? (And if it’s not, you’re lying to yourself)

Here is where the slap in the face comes in.

I am guilty of this, and I’m willing to bet a great majority of us are. We are highly guilty of NOT practicing what we preach.

Do we not educate and encourage our patients to not judge or measure their healthcare decisions by what someone else has experienced?

How many time has a patient said this to you:

“Well if I have surgery, that anesthesia stuff will kill me. It killed my mother, don’t you know?”

“Why you checkin’ my sugar? I don’t have sugar problems. Wait, this is like my sister’s friend who came to the hospital for the flu and got that Diabetes. Do I got it now? Is that why your checkin’ my sugar?”

“Why you need those things on my legs that pump up? I don’t have any blood clots? Those things caused my grandfather to have a stroke and go to the ICU. And you know what happens when you go the ICU? They kill you. That’s what happened to my grandfather.”

Every patient will react, recover and rehabilitate in their own unique way, regardless of who they know, and what happened to them. Regardless of how that person is related to them, whether kin or not.

Even with an identical procedure or illness. No two patients will have the same experience.

So why do WE think that?

Carpe Diem

I have spent some time in the peri-operative world as a first assist to an orthopedic surgeon. And I have had and now currently work in the post-operative world, the Recovery Room. Or what it is collectively called the PACU.

We do everything within our power to ensure the patient’s safety. From following the ominous and forthright JCAHO patient identification standards, to double and triple checking each other’s work.

Here’s where my confusion sets in.

Why is it that all areas and environments of the surgical services are sub-zero temperatures? Everything from the waiting rooms, the holding areas, and of course the auspicious Operating Room itself! All areas are cold enough sometimes that if you looked long and hard enough you’d probably find some frost or icicles on a the surface or ledge of a counter!

And what do we do to the patient…

WE HAVE THEM DRESSED IN A PAPER THIN GOWN??!!

Uhm.. Does anyone wonder why the patients temperature upon arrival to the PACU is hypothermic??

Heh heh.

Carpe Diem