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nursetwain

Criticals, Cultures, and Codes

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Today was a tough day from the beginning. At 0800, I got a discharge before I even completed the assessment or given any medications, then at 0900 I got a direct admission coming to an empty room, putting me at six patients. Throughout the rest of my med pass I got 3 critical labs, one unhappy family, beeping IVs, calls for pain medications, a positive blood culture, and telemetry notifications of abnormal rhythms. I finally got finished charting assessments, discharging my one patient, and admitting my new patient by 1430, which meant lunch time. Immediately upon my return, I got a second admission. Then, my extern ran to me and was concerned about our patient who was all of a sudden slow to respond to commands… that led to a rapid response call. Luckily, everything turned out to be fine with her and she slowly started to return to her baseline. By now I was at least an hour late on all of my medications, and got a call with a low blood sugar. Quickly, it was shift change at 1845 and I had yet to give 1700 medications.

Long story short, this was one of the worst days I have ever had as a nurse. It was a day where I barely had time to complete my checklist, could not build rapport, or read any progress notes. My motto of the day was “just keep swimming” and I was just treading water.

Until next shift,

Shania

Nurse-physician communication

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The first time I ever got yelled at by a physician was my first month off of nursing orientation. The patient’s chart was “r/o stroke”. One of the core measures for stroke patients was to provide a handbook and educate them on stroke diagnosis, prevention, and treatment. Apparently, no one had told this patient that we were ruling out a stroke, and as I began my teaching, she got very upset. The physician walked into the room and was flooded with questions from the patient and family about her stroke. The patient was found not to have a stroke, but was not told of any of this. The physician found me in the hallway and immediately starting yelling at me and told me to not tell someone that they have had a stroke. I pointed out on the chart that it clearly stated that they were ruling out a stroke and to provide education. The physician was not even aware of this. I walked back into the patient room and they were appalled by how this doctor had treated me. They ended up leaving AMA because they didn’t want to be in a facility where the doctors treated their nurses like that..

The Chief Medical Officer found me later in the day and told me that the physician actually felt bad for yelling at me because he was having a hard day.

Communication is extremely important in healthcare, however patient surveys often rank this category as in need of improvement. Communicating with doctors can seem intimidating, especially as a new nurse or one who is new to the unit. The best doctors are those who are not only knowledgeable, but personable, make efforts to communicate with nursing staff, allow time for questions, and those who are patient. Unfortunately, many doctors do not act this way. Below are some tips to utilize when contacting the physician.

  1. If you have even a slight feeling that something is wrong, contact the physician. You see them for 12 hours/day. They are only in the room for 20 minutes.
  2. Use SBAR– provide the situation (why are you contacting?), background (labs, dx, hx), assessment (lungs, bowels, VS, etc.), recommendations (what does the patient need?).
  3. Be confident in yourself.
  4. Remember that you do not work for the physician. You work for the hospital.
  5. You are the patient advocate.

Until next shift,

Shania

Why nursing?

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On difficult days at the hospital, it is easy to question if nursing is the right career. Doubt creeps in as I start to remember all of the things I could have done, should have done, or should have known. There are days when nothing may seem to go right and the whole unit is an organized chaos. On both the good days and the bad days, it is important to remember the answer to “Why nursing?” Here is my story.

I never really had a single event or day that I decided to be a nurse- nursing chose me. Growing up in LA, I dreamed of acting in films. I loved (and still love) the stage. I love communicating, speaking, and working with people of all backgrounds. I realized that becoming an actress realistically needed a plan B and so I began volunteering at a local hospital.

Many of the aspects that I love in acting were actually present in nursing. Long story short, my decision to choose nursing was solidified when I was placed in a recovery center my Junior year of High School. I was sick myself, however I was told how I made such an impact on the other patients in the facility. I decided to use this gift and make it a career.

Now, going on two years from becoming a registered nurse, I remind myself “why nursing?”

I chose nursing because:

  • I can literally change someone’s life in 12 hours
  • I learn something new every day
  • I get to talk with people from all different backgrounds
  • I see all aspects of health care- doctors, PT, nutrition, case management, social work
  • I am a teacher
  • I am always on the move
  • It encourages me to stay healthy and to inspire others for the same
  • Small acts of kindness go a long way
  • I see what really matters at the end of life
  • I witness God’s miracles
  • I get to see the goodness of humanity
  • I can experience genuine emotion
  • I can change positions when I want
  • I have a flexible schedule

Why nursing?

A nurse may be the only voice a person has.

Until next shift,

Shania

The patient with the brain tumor

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It was a 25 y/o male with osteosarcoma of the hip. He was receiving outpatient chemotherapy, but presented to the hospital for uncontrolled pain. After having found to be constipated, he was placed on a bowel regimen. He refused all PO medications due to nausea and vomiting, and also did not want a suppository. It took me nearly 12 hours to get this young man to take the suppository to prevent an impaction. Finally, he took the medication.

When I came back to the hospital two days later, I had found out that this patient had been transferred to critical care after finding a brain tumor. He passed away shortly after. Words cannot express how sad this patient and my interaction with him had affected me. I started to wonder if I had communicated clearly enough? Did I ensure that his wishes and needs were fulfilled? Was I too focused on the simple nursing tasks at hand and disregarding the human being?

Questions like this are what keep me up at night. Tragedies like this refocus my mind to focus on the human, not an order. I hope I did not come off as too hard for this man.

Tomorrow is not guaranteed. Count your blessings.

Until next shift,

Shania

A personal care plan: how to refuel after a shift

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Nurses create care plans for patients to guide nursing interventions toward favorable outcomes. We also need to create our own care plans for ourselves in order to continue to care for others. I have created a list of healthy interventions to ensure that I am full, so that I can pour out to others.

  • EXERCISE 3x/week- running, hiking, walking, lifting weights
  • Eat a variety of healthy foods and colors- meal prep for the week to save money and prevent yourself from choosing unhealthy choices
  • Socialize- LIMIT social media. Engage in community events and groups.
  • Go outside- it’s amazing what fresh air can do.
  • Read- fiction, nonfiction, articles, online journals
  • Sleep- Try to take the hour before bed to really wind down from the day.. Stay off the phone and any social media. Read a book or take a nice warm bath.
  • Take a long shower
  • Binge-watch netflix
  • Watch a movie
  • Paint/Color
  • Journal
  • Pray
  • Get your nails done
  • Prepare for the next shift

Until next shift,

Shania

What makes a good day?

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A good day in the hospital is not like a good day on a day off. It is not a lack of patients, more free time to browse social media, or even a full 30 minute, uninterrupted lunch break (although, that would be nice).

A good day in the hospital is a day when each patient can be cared for individually, rather than quickly checking off the Cerner checklist. It’s a day with a 5 patient load and the chance to focus on the physical and emotional needs and wants of each patient.

It’s a good day when a patient wants to show me their family or a hobby they enjoy and I actual have time to sit down and listen.

It’s a good day when a patient who wants a bath is able to get one when they want it and even get a nice hairdo.

It’s a good day when a doctor appreciates the work that you do and the thought behind any questions.

It’s a good day when even when everything is going wrong, you know you couldn’t have done anything else.

It’s a good day when you have time to read progress notes.

It’s a good day when 0800 charting is done by 1100 when rounding began at 0730.

It’s a good day when there is time to walk a patient in the hallway or go outside in a wheelchair.

Its a good day when you find that one patient of the day that validates why you chose nursing.

It’s a good day when the power of prayer becomes evident.

It’s a good day when cancer has been ruled out.

It’s a good day when nurses work as a team.

What makes a good day?

There is good in every day, you decide how you see it.

Until next shift,

Shania

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615-856-8181
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