Let me clarify a bit-your personal opinion doesn’t matter. You cannot let your belief system influence how your practice nursing, because you will not be a successful nurse. Your nursing practice is not the place to show your bias. You will have to take care of people whose personal choices differ from your own. Get over it; get over yourself. I guarantee those beliefs you hold so dear will change faster than your scrubs after a code brown. Nursing changes your opinions and makes you re-think life, in the most basic and most complicated ways, ways you never imagined.
Moreover, patients can tell when someone is judging them, being insincere or flat out lying. Your biases will show, whether or not you want them to, so you need to learn to let them go. This does not mean you shouldn’t have values and morals; everyone needs them, especially nurses. You need to have ethical and professional morals that guide your practice. What you need to understand is that you can’t change someone’s choices; all you can do is give them the best information possible and help them make an informed decision. There’s nothing you can do about the fact that they made decisions you don’t agree with, or wouldn’t have made. They made the choices they did, and now they’re on your ward, in that bed. And you’re their nurse. Their health care advocate, teacher and interpreter. That is the reason nursing is one of the most trusted professions in the world.
A good nurse washes their patients first thing in the morning, a good nurse does not wash their patients first thing in the morning
A good nurse never makes a med error, a good nurse makes a med error
A good nurse doesn’t cry at work, a good nurse cries at work
A good nurse never takes it home with them, a good nurse take it home with them
A good nurse always goes home on time, a good nurse goes home late
There is a startling trend I am seeing, people saying “well, a GOOD nurse...” You know what a good nurse does? They take c are of their patients to the best of their ability, they hold the hands of the dying, they hug the families, they share the joys and mourn the losses. To say that a good nurse must or must not do something is ridiculous. Some of the best nurses I know have made errors (actually, all nurses will. If a nurse tells you they never have, they are either lying, or they never found it.) So many things make up a good nurse, and nobody is perfect. More than that, each situation is unique, and what a good nurse does is adapt to suit each patient need
Cartoon scrubs drive me crazy. How on earth can you expect someone to take you seriously if you are wearing Minnie mouse? You are their nurse, not their paid entertainment. Would you take your doctor seriously if he was wearing a t-shirt with bugs bunny on it? Or how about a lawyer wearing a tie with the road runner. Using the rationale “well, it lightens the moment, etc” Or “well, What if you work in peads?” does not work for me. Nurses are supposed to inspire confidence, trust and respect. Tinker bell does none of those things.
I disappeared for a while there, sorry folks. Work was crazy, and I needed some reflection time. I've got some blog posts on the go, I'm getting them just right. I promise!
Happy Nurse's Week. I'd like to share something with you written in 1987,by Mary Mallison. that I feel has incredible meaning. If you are not a nurse and reading this, maybe it will help you understand your nurse better.
How Can You Bear to Be a Nurse?
How can you be a nurse? How can you bear the sight of blood?
Wait until you slide a catheter into a tiny vein just before it collapses. The flashback of blood you see will make you sing.
How can you be a nurse? How can you bear the sight, the embarrassment, of urine?
Wait until your new postpartum patient can't void, and her uterus is rising. Your persistent maneuvers finally work, making a catheter unnecessary. Urine then looks glorious.
How can you be a nurse? How can you bear to touch that alcoholic who hasn't had a bath in weeks?
Wait until you've repeatedly given ice lavages to that alcoholic and his esophageal varices have finally stopped bleeding. When he actually recovers enough to amble onto your unit to visit, dirt and all, you'll be happy enough to hug him.
How can you be a nurse? How can you bear to watch someone die?
Wait until you've worked for weeks helping a dying woman repair a decades-old conflict with her children, and at some point along the way you see the guilt fall from their shoulders and peace enter her eyes. Watching such a death can be an exaltation.
How can you be a nurse? How can you bear the sight and smell of feces?
Wait until you've been anxious about the diarrhea that nothing has stopped in an AIDS patient. Finally, your strategies work and you see and smell normal stool. You'll welcome that smell.
How can you be a nurse? How can you bear to watch children suffer?
Wait until you've rocked and soothed a suffering child into peaceful sleep, and you feel the child's relief washing over you like a blessing. Then you won't need to ask.
How can you be a nurse? How can you bear to look at searing trauma, at burned people?
Wait until you see healthy granulation tissue that has been given a chance because your sensitive nose detected an infection before it could take hold. That healing will look beautiful to you.
How can you be a nurse? How can you bear the stream of abusive words heaped on you by psychotic patients?
Wait until you've prodded and pulled a silent, withdrawn catatonic back over the lifeline, and she releases a string of expletives. Could Mozart sound better?
How can you be a nurse? How can you bear the sound of babies crying?
Wait until your combination of vigilance, bulldog advocacy, and gentle handling has given a preemie's lungs the time they needed to develop, and you hear his first lusty cry. You'll laugh out loud!
How can you be a nurse? How can you bear to care for frustrating, confused Alzheimer's patients?
Wait until you've devised a combination of strategies that provide exercise and permit safe wandering and you see a lift, almost a spring, in a patient's shuffling gait. You'll feel the lightness of Baryshnikov in your own step that day.
How can you be a nurse? So many of your patients are so old, so sick, these days. How can you bear the thought that, in the end, your care may make no difference?
Wait until you've used your hands and eyes and voice to dispel terror, to show a helpless person that his life is respected, that he has dignity. Your caring helps him care about himself. His helplessness forces you to think about the brevity of your own life. Then and there, you decide yet again to reject the pallid pastel life. No tepid sail across a protected cove for you. No easy answers. So you keep choosing to be a nurse. You have days of frustration, nights of despair, terrible angers. Your highs and lows are peaks and chasms, not hills and valleys. The defeats come more than often enough to keep you humble: the problems you can't untangle, the
lives that seep away too fast, the meanings that elude your understanding. But you keep working at it, learning from it, knowing the next peak lies ahead. And gradually you realize your palette is filling up with colors. You see more shades of meaning. You laugh more. You realize you are well on your way to creating a work of art, maybe even a masterpiece.So that's why you've remained a nurse. To your surprise, your greatest work of art is turning out to be your own life.
I’d like to speak a bit on confidentiality. Confidentiality is incredibly important in my profession. Being sick is not something people like to be. Nobody is in their best frame of mind when they’re sick, and they often say or do things they regret. This includes doctors. Every doctor has their strengths and weaknesses and some of them cannot handle crashing patients. It’s not something that nurses talk about to make the patients or doctors embarrassed. We talk about it because we have to. Call it venting, de-briefing, decompressing or just bitching.
Walk through a hospital and listen closely, and you’ll hear patients being discussed everywhere. Elevators, cafeterias, hallways, even coffee shops close to the hospital. Nobody means to break confidentiality, and yet that is considered a breach. Do you talk about your patients in the break room? Breach of confidentiality. Do you post a facebook status or twitter about your bad day because of a patient? That could be considered a break in confidentiality.
People have approached me about this blog, as they feel they know the situation I was describing, or they felt I was breaking confidence. In the situations where they felt they knew the patient/doctor/hospital I was speaking out, they did not. I change almost everything about the situation. I read and re-read the posts before I publish them, making sure that there are no identifying characteristics.
But, if you have a concern, e-mail me or contact me and I’ll be happy to discuss it with you.
Every nurse has it. The sixth sense; that gut feeling. The thing that tells them to check on their patient “just one last time” The ability to judge what is an emergency and what isn’t, even though the two situations seem pretty much the same. It’s the thing we can’t really explain to other people. In school it’s called critical thinking; the ability to look at all facets of a problem and come up with a solution. In reality, it’s instinct. It’s the years of experience you have, plus the experience of other nurses you’ve worked with. Hearing about other people’s stories gives you the ability to recognize the same situation. Plus that little voice that tells you “just check one more time”
I was working nights, about to go for my break. I gave report to the covering nurse, and was about to head down to the cafeteria to meet a friend. I decided at the last minute to check the vitals on a patient that hadn’t been doing that great. They had been having some problems protecting their airway. The situation appeared to have been resolved. The MD was aware of the situation, the RT was aware; the patient had been doing okay. When I checked, the O2 sats were 75% on room air. They were totally obstructing their airway, and ended up being intubated and going to ICU.
A fellow RN decided to do early rounds one night, and found a patient attacking another patient in a ward room.
Call it what you may, but nurse’s instinct has saved more patients that anything else I’ve seen.
I have spoken a lot about the violence and abuse nurses are put through. As a nurse, that’s not what I carry with me. That’s not what gets me through the bad days. That’s not what I live for. There are a few moments that have gotten me through the worst days, the worst situations. There are moments that make every bruise, every curse, every obscenity and every long day worth it. These include:
-a grandson bringing me a cup of tea after I cared for his grandmother when she died
-being told “you are a wonderful, caring person and are definitely in the right job, this is your calling”
-being introduced as “the nurse that knows everything” (and NOT in a sarcastic way!)
-getting an e-mail from a colleague that said I was the calm eye of the storm, and she was grateful I was there.
-Being told by a nurse that “I’ve never felt so supported, I’m so glad you were there for me”
and a million other little moments that I call on when I’m having a bad day.
So, night shift at MediumHospital was always an event. You never really knew what was going to happen. Part of night shift duties was cleaning and stocking the med cart. I’m in front of the nursing station one night, stocking away and my co-worker LPN is having a little cat nap at the desk. The phone rings, my co-worker sits bolt upright and answers....the stapler. That’s right, she grabbed the stapler, put it to her face and said “hello” . She didn’t realize she’d make a mistake until the phone rang again. She then looked around to make sure nobody saw her, and found me with tears running down my face as I tried to laugh silently. Best. Night. Ever.
I was working nights, the ward was over capacity, so I had 6 patients. Two were fresh post-ops and one patient getting blood, with one empty bed. I get word that I am getting a patient from the step down unit. I take report over the phone and the patient comes up. Immediately I have concerns, they look scared, their resp rate is high and their lungs sound bad. I went out to ask the charge nurse to call the RT, I go back in and they looks even worse; their sats are dropping. I go back out to tell the charge nurse to call the MET (medical emergency team), when I go back in the room, they are in full blown respiratory arrest, face is blue, foam coming out of their nostrils. I yell for help, and two PACU nurses come running in, they had just dropped off a different post-op. They start bagging her and call the code. It seemed like I blinked and all of a sudden there were a million people in there with me. I felt frozen; everyone seemed to know what to do except me. Standing beside me was a very senior nurse who pushed the clipboard in my hand and helped me start recording. I started answering questions the best I could, considering how little I knew about her. Eventually they got her intubated and into the ICU. I will never forget how scared I felt, or how the code team made me feel better, relaxed even. I remember the roommate saying that she was saying a prayer for them. I remember feeling like every drug, every breath, and every action was a prayer.
That was my first code.