Don't Curse the Nurse!

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Perspective

His accent was thick, the number of k’s and v’s in his name made pronunciation difficult, and his reserved nature also made it difficult to read his mood, but I continued.

” In the case of an emergency, could we give your son a blood transfusion?”

“Yes.”

“If the doctor wants to do an x-ray when completing surgery on his shoulder, can he utilize our technician’s services in the room?”

“Yes”

“O.K, thank you. And next…”

He lifted his brow and let his mouth part as if searching for the words to use.

I paused.

“Miss, So many questions.”

I took a breath in. This dad looked tired. An injured teen son. Surely, other sports injuries must make these kinds of events common.

” It’s just, well…”

I waited. I didn’t want him to feel rushed.

“Yes sir?”

“In the Ukraine, they just do what they do. There are no questions.”

I pulled up a chair and sat down next to him.

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HOLLERING

From where I sat putting charts together for the next day I could hear it, a ” Hey, watch it!” and a ” No, don’t!” coming from the recovery room. Following that was a groggy loud ” I’m going!”

I stopped what I was doing and paused. There were always three staff members in the recovery area, and, if a problem, I would have heard anesthesia called overhead.

Then I heard the distinct voice of our lead Anesthesiologist, ” Watch it there! We’re not in the ring.”

He was already in there.

Then the hollering stopped.

Ketamine, that special dissociative anesthetic great for surgeries that don’t require muscle relaxation, but prone to cause hallucinations was strutting its stuff.

Too curious to stay seated, I wandered around the corner in time to hear our lead Doc say ” So glad I ducked in time. God Bless that baby dose of Narcan!”

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Humility’s not a bad thing.

 I thought I had reached that point — become cynical…and it was time to consider getting some distance between myself and hands-on nursing care. When you are feeling hopeless about the changes in healthcare and what a machine it has become, you become more vulnerable to the affliction of cynicism. Despite giving the best care I could, I’d lately been meeting lots of patients that treated me like they were doing me a favor by having surgery.

Then this happened:

Three months ago, a fall resulted in a spinal cord injury to her. She had no feeling from the waist down and little strength in her shoulders. Her left-hand lay limp and her right hand slightly contorted. What followed was two surgeries to stabilize her damaged back in addition to physical and occupational therapy five times a week to gain use her right hand. A complete remodification of her home to accommodate her minivan sized electric wheelchair became a medical necessity. She wore a Depends because the level of her cord injury destroyed all bladder control.  

She’s sixty-one, a time when most are starting to feel the aches and pains of age creeping in, not having almost all capacity taken from them.

I had two days’ notice that her husband would be bringing her in for stoma surgery.

                                                                ***

They together took control of the atmosphere once I met them in the waiting room. Each greeted me with a smile and direct eye contact. Down the hallway to the pre-op area, they exchanged a few comments and joked with me about how much ‘road space’ the electric chair took. There was a calmness about them. They were not stoic. They had their hearts right out there on their sleeves.

In the bay set up for her, a stretcher lined the far wall.

“You both tell me what works best for her. I would like to help, but I also want to respect what is most comfortable for you.” I waited for their response.

Her husband, a good foot taller than me, moved swiftly in front of his wife so he was now facing her said, “We’re good. We got this.”

As he leaned forward, he placed her arms over his shoulders and wrapped his arms around her waist. To a non-medical person, it looked like an affectionate bear hug, and this beautiful couple, that’s how they treated it.

I was standing close enough to get to see it; absolute adoration between them. The wink he gave her. He held and moved her as if he was picking up and transferring the Hope Diamond.

She now sat on the stretcher. Hands on the bed and wrists bent back to promote her balance,

 I clumsily wiggled the steer gear and moved the heavy wheelchair out of the way.

“Are you able to balance yourself sitting without back support?”

She gave me a reassuring look.

 “Susan, just a little support from you and the three of us will get me up higher in bed before you swing me legs around onto the bed.”

I assisted with getting her into a surgical gown then, seeing the Anesthesiologist coming to interview her, stepped back.

His timing was perfect because I was becoming washed with emotion. Stepping into a hallway passthrough, I gulped back a rising urge to cry. At the same moment, our business manager, a woman keen on noticing subtle changes among us slowed as she approached me.

“Susan, what’s wrong?”

I cried and laughed at the same time. “Nothing’s wrong, everything’s okay. I’m gonna be okay.”

She cocked her head and looked at me quizzically.

“I’m just so humbled by the patient I just met.”

I went on to explain this: I have and will always believe that if you no longer have an emotional reaction to the remarkable people you will meet, it’s time to leave.

The exchange with that patient, it was a gift.

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Say Hello !

Nikki from Fort McMurray Canada is a nurse who’s started a blog and I recently started following her after reading a post she did on Intention.

Her sincerity is appreciated in a time when lots of nurses are using various platforms to only vent frustration.

Go check it out! Meet her family. Show some WordPress love !

https://mymommylife.family.blog/

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I broke one of my rules, but it turned out okay.

” Could I get you a warm blanket? Our pre-op area is kind of cold.”

I had her husband ready to go, Discharge teaching initiated and prophylactic antibiotic started, there was nothing left to do but chart the medication.

“Sure, that’d be nice.”

When I returned with the blanket, I noticed, as I have before, this was one of those couples that struggled when required to sit together in a place such as pre-op where there is no T.V, computer, or gaggle of children to fill the space. The wife with her shoulders stiff, moved her eyes everywhere but toward her husband. He stared straight ahead.

“Did you two have far to drive this morning?”

“No,” he said, “We live close.”

“Good, you’ll get home fast and you’ll both catch up on whatever sleep you didn’t get last night.”

I had just put my head down to make sure the consents were flagged for the surgeon when the patient asked me a question.

“How long have you been a nurse?”

“Thirty-six years.” Sometimes I can’t believe it’s been that long.

“Our daughter’s in a Nursing program.”

Thirty-six years gives you a lot of opportunity to meet family members of someone in Nursing school, but this was different. My patient’s wife, her mouth turned down the second he shared that fact.

Before I could stop myself, I did it. I broke one of my rules. I made the conversation about me.

“I’m working on the first draft of a book for young nurses, kind of a Self-Help book.”

The wife cocked her head thoughtfully.

“Oh, what kind of advise would you give?”

What I said came from a place deep down in the center of my soul.

“It’s important to remember, your patients, they’re the ones in pain, not you. They’re the ones grieving — it’s not yours to carry. Forgetting that is self centered and also brings imbalance to your life outside of work.”

I don’t know if the wife’s dour look triggered my response. I held my breath when she started to speak.

“That’s really good advise.”

She turned to her husband and continued.

” We should tell her that.”

I need to finish the draft.

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COVID – The Sorting Hat for Nurses

Because I arrived a day late to the National Association of Perianesthesia Nurses conference last week, I missed the Keynote Speaker Mr. John Perricone.

The title of his lecture: Developing a Philosophical Identity

                        Subtitled: Professional Development for Nurses

I was only twenty-one when I started nursing. My philosophical identity was not as layered as it is now. The career choice itself, over this last thirty-six years has driven the development of my philosophical identity. Cherished mentors and my faith sculpted it futher.

This is from his web site:

Mission Statement

“We often witness, in times of crisis, the best of our humanity rising to the surface (complete strangers shielding or coming to the rescue of others, etc.) It is my fundamental belief that every human being has an inherent desire to live their life at the best expression of who they are, but this deeper self (or their “true self” if you will) is often buried under layers of what might have been a toxic upbringing, addiction, familial or societal expectations, etc. The goal of my work is to attempt to use my voice to bring this “best self” to the surface — where it can hopefully become the predominant expression of a person’s being, rather than the exception.”

                                                                        ***

Before even looking up his name to reach his web site, I had said to a family member, “COVID seems to me, to have been the Sorting Hat for nurses; some took advantage of the rise in pay for travel jobs and left places they’d worked for years, some retired early, some buckled in and have held on.”

I’d like to think my sorting experience was similar to that of Harry Potter’s ( Books by J.K. Rowling).

The Hat struggled when placed on Harry, whispering Slytherin, and Harry, mentally pleaded Gryffindor, please, Gryffindor.

I still wanted to help people prepare and safely complete their surgeries with all the education they need when home recovering.

I just needed to be in a different ‘house’

Changing to a setting where I could do that and also be more available for my family and address my health needs — a perfect sort for me.

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What Does This Mean for Nurses?

The day after Christmas in 2017, A Tennessee nurse did an override from an electronic medication cabinet and gave an anxious patient (about to have an MRI) Vecuronium, a strong muscular paralytic, instead of Versed, a sedative in the same family as Valium.

The nurse admitted her mistake quickly, but also pointed out she was distracted by a trainee.

She was fired a week later.

The hospital settled with the family within five months post the incident. Not speaking about the event was part of the settlement.

One article I read, reports that the hospital did not report the error to state or government officials despite it being mandated by the Health Data Reporting Act of 2002.

This revelation resulted in threats to suspend funding. 22% of Vanderbilt’s funding is via Medicare reimbursements. The hospital submitted corrective action and that possibility was put to rest.

Eight months post the fatal error, an anonymous tip brought this case to the attention of the district attorney’s office. In December of 2018, penalties and criminal charges were only placed against the nurse. She initially plead innocent to all charges.

Miss Vaught immediately lost her license.

In March of this year, a verdict of gross neglect and negligent homicide means Miss Vaught could spend anywhere from three to six years in prison. The sentencing is on May 13th.

Everything I’ve read has been sympathetic, especially a review from the Institute of safe medicine practices. At one point in the article, this nurse is referred to as the ‘second victim of a fatal error’.

However, see, there’s this thing: The Five rights of medication administration (Right patient, drug, time, dose, and route)

It’s Nursing 101.

If we start using automation and computerization as excuses for errors, we are in big trouble.

Jailtime, No. It is a shame it’s come to this.  I think the Tennessee court, unsure what to do, is overextending on this case. The criminalization of medication errors is scary.

 With that being said, some journalists that are reporting this outcome as a concern to the already ongoing crisis of nurses leaving the profession, eh, that has to stop.

Let’s get serious about the job. Let’s get serious about all Healthcare jobs and focus on quality, not setting goals in terms of productivity and cost cutting.

https://www.ismp.org/resources/tn-board-nursings-unjust-decision-revoke-nurses-license-travesty-top-tragedy

https://www.tennessean.com

https://www.npr.org

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Cheeky, but Somewhat Brilliant Idea

As I walked by two Recovery room nurse that were sitting at the desk and chatting, warm blanket in my hand for my Pre-op patient, I had a thought:

Why don’t we focus on making salaries for Nursing school instructors more competitive? ( I know they’re not because I peered closely down this path a year ago.)

Why don’t we reward people that are willing to take responsibility for teaching future nurses? I’m talking about more than the little extra you get if you can put preceptor on your end of the year work evaluation.

Articles have been out for a while about the diminishing interest / increased difficulty in filling positions in college nursing programs.

The U.S Board of Statistics has an interesting graph that shows the projected departure rate of nurses. It’s divided by RN’s, LPN’s, Practitioners, and Anesthetists.

RN’s are leaving by double the rate of the others.

These are our clinical nurse, the bedside nurses.

How about we go back to the beginning where it starts, in school, and reassess what is being taught and what tools nurses are starting out with.

And I’m not talking about stethoscopes.

https://www.bls.gov/careeroutlook/2020/article/careers-for-nurses-opportunities-and-options.htm

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Patient with a giant personality / Repost

We didn’t see his type often.

He walked in, chin up, thick belly, arms cocked at his side, gave me a smile, a mischievous smile, and I thought , oh well, every now and then, you gotta take care of someone you know is going to be different.

“Hi David, I’m going to be your nurse. We need to get your weight and height right over here.”

He gave me a ‘You must be crazy’ look, but he did comply. I jotted the numbers down and led him along with his female escort to his pre –op bay.

Paperwork completed, I closed the curtain, giving him privacy to change.

A small adult cuff fit his arm, Yay!, the O2 saturation probe picked up fast, and I thought things were going well until the woman with him asked for help.

“Susan, we need to find a channel he likes, like fast!”

I started pushing the channel up button as quick as possible. I didn’t want a meltdown on my hands. He started to scowl. His face turned red. I flipped to high channels then back to low one. Panic was making me inconsistent. Why does the hospital need sixty-eight channels? I just passed a really hard test. I can’t believe how nervous this is making me.

Finally.

Channel 18.

The cartoon channel.

Crisis diverted.

Four year olds are cute, but I’ve changed my mind about being ready for grandparenthood!

 

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Words of Wisdom

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